| | Life from the Ashes
I saved a kid's life the other night. Or at least, that's what everyone is saying. If I did, it was pure luck. And if I did, I can't help but regret it. I was on call, the only doctor covering about 60 floor patients. It was one of those absurdly irritating nursing calls, the kind where the nurse, either out of pure ignorance or in a fit of cover-her-assness, pages you to "make you aware" that her patient's hand is cold. Now technically, the word "cold" should raise immediate concerns in your mind of ischemia, lack of blood flow, a threatened limb. But in reality, there isn't a damn thing wrong with the patient's hand. The nurse just wanted the monkey off her back so she can document in her shift note that "MD is aware" (therefore nurse not responsible). At this point in the year, we've all learned to ask a few pointed questions (i.e. does the patient have a pulse), say "fine, thanks" and hang up. For some reason though, some trick of Providence, I told the nurse I'd come to check it out. Maybe a part of me wanted a chance to tell her in person not to bother me with useless pages.
Lo and behold, half an hour later, I was at the patient's bedside holding a warm, normal hand. I went through the motions of a quick physical exam... squeeze my fingers... squeeze my fingers... SQUEEZE MY FINGERS. The kid moved all his fingers alright, but not to any command. Is he always like this? The nurse shrugged, not really. The kid was building a pipe bomb between his legs when it exploded, taking both legs and causing significant brain injury. He now thrashes around in bed at baseline, yelling nonsensical things. But at this particular moment, he was listless, lethargic, unable to follow commands that he was able to a few hours ago. There was nothing wrong with his hand, but his mental status was not right. A quick blood draw later, and it turns out his serum sodium was 117. Cerebal salt wasting, from the traumatic brain injury. He was well on his way to a coma, perhaps death before the medical team rounded in the morning... if it weren't for the irrelevant call.
Every medical TV show and every hopeful pre-med student labors under the giant delusion that being a doctor is about saving lives. I think it'd be more accurate to say we're in the business of delaying death. Few pass from my care in the same state they were in before they met me. They leave with huge surgical scars, incontient of urine and stool, with strange tubes protruding with orifices and man-made holes, in chronic pain, with altogether different personalities from all the brain damage they suffered. Sometimes I look at these unfortunate creatures and wonder hard whether it was worth it to delay their death. Or, as in the case of the pipe bomb kid, I regret not ridding society of such a menace, and not saving his poor, long-suffering mother another long night at his bedside, enduring his curses.
I went to an Ash Wednesday service tonight. As the congregation moved forward to receive ashes, I could hear the pastor repeating "you are of dust, and to dust you shall return" as he painted their foreheads. I guess most people need a reminder of our mortality. Trouble is, an hour before church, I had my hand thrust deep into the neck of a young man who'd been shot in the jaw. The bullet tore through his esophagus and trachea. What is that, a >50% mortality rate? I could still smell his blood and remember the squelch his fat tissues made as I dug around, trying to find his carotid artery. You are of dust, and to dust you shall return. What's hard to believe is that any beauty, any redemption is going to rise from this shitstorm of decay.
February is a difficult month. It's cold, it's dark, and we're all exhausted. 30 years ago, the then-chairman of the surgery department faced a riot of unhappy residents. He solved the problem by booking a bus, loading it with a keg of beer, and sending all the surgical residents skiing for a day. Thus began the annual Ski Trip. We went last week, on a gorgeous, sunny day. It was the first time in weeks many of us had even seen the sun. I was planning to sit in the lodge and drink, but changed my mind when I saw how inviting the mountain was. The ride up the ski lift was exquisite. Snow and blue skies, evergreen trees marching up the slopes, the muffled silence of a world in winter. For a brief moment, I forgot about blood and pus-filled wounds, about nurses and patients, about being a doctor who's expected to fix death. We all did. It was wonderful to feel dwarfed by the majesty of the mountains, to be free to revel in the stunning beauty of Creation.
Life is one long march toward death. But there is still beauty. There is. Hidden in forgotten crevices, shouted unheard from the mountaintops, winking from behind the clouds... undeniable, persistent, hopeful. Dark as it is here in the trenches, praise God that I can still say with confidence that all is not lost. Somewhere in the depths of time, I hear a tomb stands empty. And to the One who was raised, I've attached my lifeline of desperate hope.
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| | Posted 2/26/2009 12:34 AM - 125 Views - 6 eProps - 3 comments
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