Log in

No account? Create an account
One step closer... - Nobody wears a white coat any more... — LiveJournal
...a tribute to becoming a doctor.
One step closer...
Submitted my application for scheduling permit for Step III exams today.

Heard a few words from someone I've been worried about - somewhat reassuring.

Have a half-completed journal entry on the main computer that I'm going to finish - I hope - about life and death in the ICU.

There is nothing like leaving the hospital one day filled with delight at the trends of the day, having shared good news and good prognoses with a patient's family - only to return the next morning and see a curtain drawn across the glass doors. You try to justify - maybe they're doing a late bath - but you know it's not true. And when I walked around the corner to hear the renal physician dictating, and heard the words "This is Dr. Kidneydoctor dictating a final discharge-slash-death summary on patient P.B..." I went numb, fingers to toes, my whole body.
Literally, O Best Beloved, I forced myself to turn around and walk back to the room in the ICU, tip aside the curtain, step in to see what had happened. Seeing makes it real. Touching makes it real. The monitor was still on, still displaying that flatline waver that means the heart is no longer even twitching deep inside the chest, just discharging the occasional tiny impulse as a cell leaks out to its threshhold. He was intubated and waxen-pale, eyes closed, bed in Trendelenberg position with the head low for maximum circulation, the detritus of a code strewn around the room: paper strips and caps from medication ampules and syringe covers tossed wherever there was room. Silent.

I came back later, once the hubbub was gone and they'd cleaned up for the family. We always clean up for the families - a made-for-TV code sequence generated for their viewing pleasure, rather than the nightmare chaos that is a real live code. (And I cringe to use that particular turn of phrase, but I haven't another right now) I slipped in after the sister was gone and before the wife came back, spent my five minutes with the body of a person fled, touched his cheek, discovered that I could not weep. It was too sudden, too strange. Not real. Not him.

I have told you about death before, O Best Beloved, and I will tell you again and again and again - and it is because of all the things that I have seen and done and said death is the strangest. It wraps tendrils of wonder and terror about me, and every experience sends me delving into my soul, to discover something new. Often, I find my flaws. I hear the things that people say to each other about their loved ones, in those first grieving moments, hear them coaxing and pleading long after life has fled, and I wonder. I always wonder.

Who will remember me, and how?

Tags: , ,
now feeling:: thoughtful introspective

3 whispers echo . o O ( ... ) O o . whisper a word
turnberryknkn From: turnberryknkn Date: March 31st, 2006 09:39 am (UTC) (etched in stone)
Thank you again for sharing.

I started M3 year on Transplant. Many of our patients were the sickest of the sick, the ones who came to us because only a transplant could save them, or because other hospitals could not manage their rejections or their complications. Many died on our service, many patients I had had the honor of serving. Many knew they were going to die, lucid right up until the encephalopathy took them.

And then there were the organ donors, already brain dead but otherwise looking and feeling just as alive as any other unit patient, up to the moment when we flushed them with cryro solution and stopped their heart, and at the end, while the chief surgeon and chief resident are at the back table prepping the organs for transport, being left with the junior at the table, slowly, carefully looping suture across the incision we made from above the manubrium down to the pubic rim.

Babies on Pediatric Surgery with NEC. Teenagers post-MVA on Neurosurgery. I had had the privelege of serving kids with cancer way at the beginning of my sabbatical, years ago, many of whom were terminal, some of whom I was there when we had to break the news, but I had never been on the floor when that last moment came. That had to wait until I returned to the service. I'm sure that, like you and the rest of us, I will see more; and with where I hope to earn the right to go at the furthest edge of Pediatric Heme/Onc, death will be something that will be ever-present, if never routine.

I guess... I don't know. I don't know if it's a weakness of mine, or a coping mechanism, or what; in all the many deaths I've been a part of, there was always immediately afterwards the press of the needs of the living. Comforting the family, helping make the arrangements, and ultimately, soon enough the demands of the other 15 or 20 or 30 very sick patients who remained, whose needs continued even as our one or two patients needed no more. Or the other twenty kids coming in that morning for clinic who needed help that day even after the child you could help no longer. I don't know if you would call it an escape or a cop-out or what, but ever and always it was the press of the next fight, and the one after, and the one after that, to keep me from dwelling on the one just lost, that by the time we finally had time to think about it, hours and shifts later, the immediacy of the experience was gone. But I always found my team and myself absorbed -- perhaps unconsciously deliberately losing ourselves -- in helping those left behind by the patient who expired, and then the needs of the patients who still remained. Maybe it's a lack of imagination. Maybe it's an unconscious defense mechanism. I don't know.

fyrfitrmedic From: fyrfitrmedic Date: March 31st, 2006 04:04 pm (UTC) (etched in stone)
You may be right about it being a defense mechanism.

I've experienced much the same thing thoughtout my tenure as a street medic, even at the deaths of my father and sister. It's not until considerably later that I ever get the chance to grieve acutely, and by then it's blunted by the passage of time and everything else that's gone on since then.
omarius From: omarius Date: March 31st, 2006 10:15 pm (UTC) (etched in stone)
One of your lurkers here.

I adore how much soul you have. I love the idea of someone as sensitive as you being, if not at, then at least near, that door of death through which we all go not to return. I find hospitals scary and techno-soulless, and if (when?) I need to go to one as a patient I hope I find someone like you there.
3 whispers echo . o O ( ... ) O o . whisper a word