Wednesday, August 31, 2016

Mama Said There'll Be Days Like This . . .

It's a lonely job when things don't go well.

I cannot say that my work this week, at least thus far, has been especially uplifting for me personally. It's educational, certainly. Learning experiences abound in this aspect of my training. Cardiac surgery, however,  is not now, nor will it ever be my choice of course of  study or work. 

We all need to be exposed the very basics in every field of medicine to make intelligent choices as to our specialties. Furthermore, somewhere way down the road, I may be in a position where circumstances are so very dire that I'm the most qualified person to assist in a cardiac procedure. God help the patient if such is ever indeed the case. I am in my current rotation for a very good reason. I need to learn everything I possibly can from it and I need to put into it everything that I have to give. That does not mean I have to like it. Fortunately for me, because of a glitch in my scheduling, I'm here for only one week instead of the customary two. It may work out that I will put in an extra week in cardiac surgery next year. On the other hand, it may not work out that way. However it works out, I'll live with it.

Next week I'll have an unusual opportunity. My pseudouncle is visiting the hospital where I'm currently working in order to perform a thoracic procedure as a guest physician. The technique he'll be using is one that has yet to have been performed here in the hospital at which I'm currently assigned. He requested that I be allowed to scrub in for the procedure, and his request has been granted. I won't miss much in the way of my regular duties, as I am assigned to outpatient pediatrics for the next two weeks. The surgical procedure is set to begin at 5:30 a.m. If we're lucky, it will conclude by 10:30 a.m.  I'll then change out of my surgical clothing, scrub out, and rush to the site of my assignment, without, I hope, having missed out on anything too exciting. I do not wish to start off on poor footing with my next supervising physician.

Today was an especially rough day for more reasons than just one. We had a couple of myocardial infarction patients who were operated on as last-ditch efforts. The odds were against the patients, and the odds both times worked out the way odds are supposed to work. I was warned in both cases by the interns that  the surgeries were long shots at best, but it's still hard to see that in real life, things don't have as many happy outcomes as they do on TV and in movies.  I stood far back. There was nothing I could do, and no one needed me in his or her way. I did hug the son of the deceased afterward just because he looked so forlorn and it seemed the natural thing to do. I had a few tears running down my cheeks, but I wasn't blubbering, which would not have been appropriate, as I didn't even know the lady.  The attending physician said that showing compassion toward family members is a good thing, and that minor emotional displays are even OK.

I worked sick today. It was determined that my illness was a manifestation of colitis and not of anything contagious, and so I was told to remain at work.  I knew when I signed on for the program that working sick would occasionally be a part of the experience. I had to leave the surgical suites in the midst of two procedures. My superiors knew this was a possibility, and I was given the green light to exit whenever it was imperative that I do so.  The surgeon allowed me use his private bathroom attached to his personal office. I'd still much rather experience the barfing and other stuff that accompanies colitis in my own bathroom at home, but I was at least not stuck on the floor of a stall in a public restroom with God knows whom walking in and out of the stalls on either side. I borrowed cleaning supplies and gave the surgeon's private space a thorough detoxification after befouling it.

All things considered, if every day turned out the way today did, I would probably quit medical school and become a 900-number psychic, but chances are that not every day will be as depressing as today was.  The sun'll come out tomorrow. You know the rest of the song, so I don't need to spout anymore bullshit for your benefit.


  1. I'm sorry about those two patients. It sounds like you do, at least, have good teachers and understanding people to work with.

    If I weren't so squeamish and better at math and science, maybe I would have gone into healthcare. I find it fascinating. But I can understand how hard the work is on all levels. Hope you're feeling better.

    1. I'm feeling quite a bit better. Unless the attack is bloody, I usually recover quickly enough. I'm typically dragging for the next day or two, but otherwise OK, and this time seems not to be any exception.

      I knew it was only a matter of time before the Grim Reaper would actually do his thing right before my eyes. It was probably just as well that it happened sooner rather than later; I no longer have that hanging over my head, not that it makes it tons better when it happens again just because it's no longer the first time.

      It's not really that this matters because, for one thing, not one of us has a whole lot of say in this matter, but when it's my time to go, I hope it's not a heart attack. I wouldn't have a huge problem with dying on the table in an OR in heart surgery or surgery of any other kind, but I saw staff wheeling both of the deceased in through the ER with paramedics pounding on their chests. that's not that way I would choose for it to end for me, again not that I'll have any choice when the time comes. Once in awhile the chest compressions do actually accomplish something and someone is saved and goes on to live a productive life for awhile longer, but not very often. I don't feel strongly enough to put a DNR out on myself at the ripe old age of 21, but at 70 I might consider it.

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  3. Ah Alexis,
    The great wheel of life. It is a privilege to be with someone on any part of that journey, not just the joyous beginning. I have had wonderful moments with patients at the end of their lives also. The unexpected ends call up different but no greater emotions. Never be afraid of your emotions.

    2 of my best. I ,as a family physician,cared for a young woman,an RN ,through her entire struggle with glioblastoma.One day, at the end of a long morning's consultation and rounds I visited her room. She had by then lost vocalization but was still otherwise alert and semi-mobile. I sensed she was reluctant that I left and soon her lunch tray was delivered.She divided the food on her tray in half and gestured it towards me. We shared a very special,if inarticulate lunch and she died only a few days later.

    Another patient of mine asked if I would be willing to supervise the terminal care of her sister who was moving from a rural area to access support & live with my patient. I did so, & was involved in a wonderful few months of an extended relationship with good people as all my patient's friends formed a loving circle. When the call came that she had passed & I needed to visit to certify the event,my patient told me that this circle of friends would all be there at the time i arrived. Her sister had chosen a special bottle of champagne for us all to share as they joined in the final acts of caring.

    Just think how lucky you are to get the opportunity to share in life's great moments.

    1. OzDoc, you're absolutely right that it is an honor and a privilege to be able to share in the major milestones of others' lives. I just feel as though I'm not quite there yet, and I'm going to have to get there very quickly or fake it extremely well.

  4. You are actually doing quite well using all your human traits while undertaking constantly difficult situations. Good for you! You knew it wouldn't be easy, but I think you are doing quite well. Keep fighting the good fight.

    1. Thanks, Jono. When I'm struggling, it's good to hear an opinion that I'm not failing miserably.