January 27th, 2004

Toledo doorway

open season on interpretations: "balanced scales"

We touch and pass,
     exceeding slow,
  we whisper words
          we used to know
               and leave ourselves
to carry on
       when we are left behind

So cold, so pale,
     false memories
  like ghosts we are
         we all will be
and standing still
      those not yet gone
   still leave themselves behind

A kiss, a tear,
       a finger's brush
     the heat of life
           its faded flush
and here in silence
         cold and still
   we leave ourselves behind

The dead are silent;
      living too
   in silence find
          immortal truth
and all abandon
        whim and will
    when they are left behind
             NsB 27.01.04
  • Current Music
    Code 5 Drill, West Wing...
White Coat

Morning has broken...

Posting poetry, now a bit of a real entry (is this my third today, or my second? I can't recall) before trauma rounds potentially begin at 11.
It's cold here in Indianapolis, cold and snowy. It snowed Sunday, pouring inches upon inches of snow onto my car, and then it frozen-rained yesterday and snowed last night. IPS and Marion County schools are closed. I drove carefully, after spending 15 minutes chipping the ice off Michel-Ange, and took 45 on a 20-minute drive. It's amazing that our pagers have been so quiet.

Yesterday: one trauma, a gentleman who was stabbed the previous day in the chest. His uncle wouldn't take him to the ER at the time, so he took packing tape and a gauze pad and taped it up. Today his wife made him come in, and we got called because "penetrating trauma to the chest" is a criterion for Code77. We shot a chest X-ray, debated the merits of him having a pneumothorax, and finally decided he didn't. So I taped some gauze back over his wound, told him to use real tape and to come back if it got infected, and we went on.
The cool thing was that none of the new interns have trauma pagers, the old interns were over at another hospital, and the chief was in the OR with Scott, so Zach, the midlevel, and I were the only people there. Oh, and staff and the floater. But I felt genuinely useful, as Zach was late due to being in the bathroom.

Other cool things yesterday: very few. As previously stated, rounds were painful. Rounds, I anticipate, will continue to be painful. But there's only a day and a half left.

Cool things this morning: the gentleman who came upstairs to die yesterday afternoon (I'll tell that story eventually, really) is improving, awake, and making urine. He may very well survive, against all odds. Hallelu.
Updating may be sporadic to cryptic this week, as Friday is the big exam and yesterday's score on 50 questions came out a 32%. Surgery is all bloody medicine, but they don't teach us any of it, so I'm stuck outlining again, and outlining takes time. Speaking of which, I'm going to go migrate to the SICU and do a little more studying.
  • Current Music
    Code 5 clear :)
Nescafe rabbit

Miracles do happen, O Best Beloved...

(welcome to staralyn, mydestination,xostrawberryxo, and randi_girl!)

Monday: I'm sitting around with nothing to do when my pager goes off. It's Zach. We medical students take care of each other. "Scott just got out of the triple-A repair," he says. "They lost rhythm as they were closing, been coding him in the OR, he's going to the floor for a bit, they may do some more resuscitating there. If you want a little excitement." I went.
He had an abdominal aortic aneurysm, a 6x6 cm defect about 10 cm long, which fits the criteria for having it repaired. It's a 5% per year chance of rupture at 5cm, with a >50% mortality for rupture. The risk of death in surgery is 2-5%, as high as 10% by some retrospective studies. He elected repair. He had a brief run of V-tach (ventricular tachycardia, when the bottom of the heart controls the beat and makes it too fast) mid-surgery, then it was okay. And then, as Scott was stapling the skin closed, he went into V-tach again. They did CPR, shocked him twice, got him into a weird rhythm and then back to V-tach. Sustained V-tach is a dead man's heart rhythm - it has a tendency to degenerate into VF, which is when the heart just twitches a lot.
Cardiology's verdict: he had a heart attack during surgery.

They brought him up to the ICU, 40 minutes later, after getting him as stable as they could. We were all hanging around to see what would happen. They brought him up to the ICU, O Best Beloved, so his family could say goodbye to him. He was on all the medications known to support blood pressure, intubated, run by machines and drugs. He was grey and pale, and I wanted to touch him to see if he was cold. But when he got here they had him in some kind of rational tachycardia and they slowly started to wean the pressors. They were going to take him off life support last night or today.

This morning he was still there. This morning he was bucking the vent, off half his meds, supporting his own blood pressure. ICU staff said they were going to lessen sedation, take him off the vent.
This afternoon, O Best Beloved, we went in to see him on rounds. He was lying in bed, arguing with the nurses, on just a face mask for oxygen. He has a morphine PCA pump that he's only used once - no pain, really, he says, just where we made the incision. He says. We're taking the NG tube off tomorrow. EH says "He's just going to pick up his IV pole and walk out of here."
We stood outside his room, four medical students with eyes like saucers, and all we could say was "Wow." He was a dead man yesterday.

Miracles happen, O Best Beloved. And sometimes - sometimes, we're lucky enough to see them happen.
Amen.
  • Current Mood
    jubilant jubilant