Came in this morning, and S says to staff "You know that lady we admitted with vomiting and diarrhea? The one I almost sent home?" Staff nods. "She died last night." No reason for her to die, she'd been smiling and reassured it was just an overnight stay. S was worried, very concerned. I would be too, if it were my patient who had just died.
My patients aren't dying, though. My patients are having normal Cardiolite tests and going home happy and suddenly getting better with the addition of a tiny bit of Vioxx (oh, please let the increased creatinine be just because I overshot on the Lasix and not because he's had a 20% nephrectomy and I started an NSAID in consultation with Rheum and Nephrology, because it's working) so that today, the entire transitional unit watched in shock and awe as he walked 40 feet with a walker on his own. My patients are seeing resolution of their nausea and vomiting under only fluid resuscitation, my patients are smiling when they see me too.
Life, O Best Beloved, is fragile.
You watch TV shows - E.R., Scrubs - we watch them too, sometimes, and wonder. When they run a code on E.R. it's a sterile chaos, busy, and it has an 80% success rate, and patients are going home soon after their brush with death. It's not like that.
Going to a code, O Best Beloved, is running down the hallway (only when someone's life hangs on your promptness may you run in a hospital) in scrubs and white coats, leaving the coats behind to squeeze into a room full of twenty people where there is room for five, it is blood and chaos and the bed tilted frantically, futilely into a Trendelenburg position (head down, 45° angle) to maintain cerebral blood flow. It is people calling out numbers and requests and someone scribbling drugs and doses, and someone - you hope it is someone there before you - running the code.
Going to a code as a medical student puts you in the delicate position of observer-student, because you become acutely aware that next year the screaming beep of the code pager may be coming from your hip and that you may be the first doctor on the scene, and do you know what the first thing to do when you arrive at a code is?
Check your own pulse. It means: take a deep breath and think.
Which drugs were first on the ACLS algorithms? Do you have your cards? Do you remember, doses, numbers? All that learning, all that energy, all that effort and memorization and when you are coding a rubber mannequin with big silver splotches where the paddles should go it is not the same. And as a student, as an observer, it is always on my mind that of the handful of codes I have seen, only the mannequins survived.
Life, O Best Beloved, is so very fragile a thing.