My parents and sister visited this past weekend. I was granted the weekend off from my responsibilities at the hospital to spend the time with them. The Cloisters were recommended to me prior to my moving out East, and had remained on my list of places to see since that time. I finally was able to make a triumphant check as the four of us stopped by Saturday morning.
View from the Terrace, GW Bridge half obscured by fog.
The day almost got by me without a single case. I was taking the opportunity to complete some paperwork and research. I even got to eat lunch with my team! But I did say almost, almost got by me. Flight EMS rolled through the trauma bay doors asking where to take the aneurysm. This coincided with the Vascular chief calling me to look out for the same aneurysm and see it immediately. Less than an hour later we had our hands in his belly, one goal on our mind. Control. Get control first. Aneurysm second. I don't think I've ever listened so intently to the beeping monitors at the head of the bed before. The steady beep, signifying the rhythm of life, the heart rate. I listened to that beep the whole case long, wondering just when, if when it would suddenly stop. We kept working, the beep remained steady, and eventually I started to notice the crowd of anesthesia at the head of the bed started to thin down. They started moving slower, and then they started relieving each other for breaks. The beep kept going, and so did we. By the time we finally finished and safely got our patient to the ICU, it was late.
Speaking of rhythms... It's been awhile since I've shared one. Here's a rhythm I've been enjoying the recent past while.
The team I have been assigned to this month has changed its political makeup since the last time I flew its colors, carried its banners, and yelled its war chant. Ha, kidding... but not really. It's almost like three individual houses banded together under a single title with one Chief. Although, in reality, the houses govern themselves, and the chief stands there and smiles. And as for my role?... The word that comes to mind is a PAWN. The least valuable player, I have no say over where I go, or what I do. And at the same time, the most valuable player. Every morning its like I'm auctioned off to whomever claims me first. Oftentimes this auctioning continues throughout the day and my assigned cases are often changed and rearranged. I'm strategically moved wherever and whenever the chiefs desire pending case loads of all teams and which residents are actually available for the day.
There's a part of me that protests at feeling used and abused, but I get over it quick enough, because at the end of the day I'm in the OR.
Another month down, just 45 short months yet to go. I leave this month of pediatric surgery, and am thankful to see a few of my kids get to leave with me. I've mentioned before my strong distaste for perforated appendicitis. We had more than a few come through this past month. It's not fun watching a child suffer. Mom & Dad struggle with it even more. And it doesn't matter how many times you answer their questions, reassure them, explain the situation to them, TIME is not the treatment anyone wants to try. Usually, as the care provider, you find yourself plowing ahead with TIME, albeit with very unwilling occupants on board. Mom & Dad following along begrudgingly. The patient, sometimes dragging their feet, other times planting their feet requiring you to bring them along kicking and screaming.
One such patient came to us early morning, so sick her various organ systems had already started failing, mental status altered to the point of nonresponsiveness. It took days before I even saw her with her eyes open. After that, initially all she could muster was a whimper. But she wouldn't stop whimpering until I had left the room again. As she continued to heal, her strength came back, followed by her voice, and what was once a whimper grew to an all out protest. Of course which would end only by our exit. She didn't speak English, so I couldn't explain what was happening, couldn't tell her I loved her. All she saw was that when I came into her room, someone was going to push on her belly, or mess with her tubes, and not allow her to eat or drink. I'd hate me too! But even after belly felt better, tubes came out, and she could finally eat again; she still loudly protested our presence. So I refrained from patting her messy head of curls, approached her bedside only when necessary standing instead a foot or so back when speaking with mom & dad, and took care to always smile at her. Maybe when she's old enough to remember and understand what happened to her here, she'll finally forgive me.
Protesting is one thing when it's limited to words, but when another's protests resulted in a swing narrowly missing my nose, I called for backup. When a few moments later a med student had come to my aid, I gave him only one instruction. "Don't let her kick me!"
The human body is amazing. Especially in kids, when its still a new and healthy body that's really good at healing itself. It'll do so, despite the protests of its inhabitant, just takes TIME.
Throughout the residency year, education follows a somewhat loose curriculum. There is a nationally produced list of core competencies that must be taught. This is for all residencies, how surgery teaches them versus pediatrics versus radiology, etc, is up to the program itself. Just as long as when the ACGME comes calling, the individual program can show proof that they are being taught. It is also required to provide support and awareness about stress and sleep. Personally, I inwardly groan when it comes time for such a lecture. 1) I won't learn anything new + 2) there's a million other things I could be doing instead = 3) this lecture is a waste of time.
So when I got a phone call from one of my chiefs this past week telling me to go listen to a guy talk about stress, I really wished I hadn't picked up the phone. But I also knew that at least half of the residents were going to successfully be able to come up with a good excuse on the spot and avoid going. Therefore I headed over to listen.
One of his powerpoint slides was somewhat similar to the following... Medical students
Depression rate - 27% (corresponding rate in the general population 4-5%)
Anxiety and burnout rates grater than 50% Residents
Burnout rates - 60-75% and higher Practicing Physicians
Depression and suicide (Physician is the profession with highest suicide rate in the US, has now officially surpassed Dentists)
Burnout - 54%
Would not recommend the field to their kids - 60-90%
Don't quote any of those... I didn't actually catch the guy's source for reporting such rates. But he was just making a point, and trying to reinforce the point by giving examples. Why do 27% of medical students report being depressed when for that same group of individuals only 4-5% (normal rate corresponding with the general population) reported struggling with depression on their medical school admission. What about medicine/medical school/healthcare causes depression rates to increase by roughly 500%?
One can't actually answer that question in a one hour lecture. That's for psychologists, anthropologists and the like with much discussion, much thought, and even more time.
He did though, quote Viktor E. Frankl.
“A man who becomes conscious of the responsibility he bears toward a
human being who affectionately waits for him, or to an unfinished work,
will never be able to throw away his life."
“Those who have a 'why' to live, can bear with almost any 'how'.” I will spare you the details of the HOW, but the WHY, is something that thankfully, I have never struggled with. And if I took anything away from this one hour lecture about stress, was just affirmation that I am incredibly blessed. I traverse along this path with so much unknown, but before I had even taken my first step, back before I knew anything, I knew the WHY. There is still much HOW I must traverse, but my WHY is the same yesterday, today and forever. Much Love.
I was passing through the NICU the other day when one of the Nurse Practitioners stopped me.
"Has anyone asked you about Baby B?" he asked me.
"Yes," I replied, "I need to ask Dr. X if he has availability."
To which the NP responded, "Oh he was just here and said he couldn't do it."
"Alrighty, then Dr. Y is coming tomorrow at 3pm so will then be able to ask him when he would like to do the case"
"Ah yes," sighs the NP. "But, the baby really needs the surgery sooner."
I reiterate..."Dr. X said no. Dr. Y is not coming until tomorrow afternoon, at which time Baby B's case will be presented, and surgery planned accordingly.
The NP sighs again, "ahhhhh, but he really needs surgery now."
Blink. I decided not to try again..
I think.... I think, he thought I had some sort of magical power. The ability to create an Attending out of thin air, who could then do surgery on cue and then *poof* disappear again.
Or another great memory of the week, when a couple of the general pediatric hospitalists ganged up on us about a patient. Wagging fingers and shaking heads, casting blame. "This is surgery's fault. This is YOUR fault!" It doesn't matter that I'm in that room talking with the family everyday, explaining everything. The patient has been operated on by three different surgeons, none of them our own pediatric surgeons. There's no one around to actually claim her as their patient. No one taking ownership, and seemingly zero continuity.
“This is the land of Narnia,' said the Faun, 'where we are now; all that
lies between the lamp-post and the great castle of Cair Paravel on the
We call it Narnia. We walk by these windows on our hurried ways to and from the ORs. Somedays the desire to find the wardrobe and escape reality is rather strong. I look out the windows and want to leave. At the same time, its calming to see a kind of peace and to be reminded that our current reality is so very small and quickly passing. I look out the windows and then move on.
Afterall, “She remembered, as every sensible person does, that you should never never shut yourself up in a wardrobe.”
I don’t mind all the little appy’s that come in. They’re
often quite cute, each with their own uniqueness. We take out their appendices
and then they go home. Easy peasy. Unfortunate it is, when that cuteness turns
very. very. ugly. When the cute little appendix opens up and spills it’s
undesirables all over someone’s unsuspecting and undeserving abdomen. I really
don’t like perforated appendicitis. I’ll say it again. I REALLY don’t like
The other day I went to the ED to see one of the cute
appendices. He looked at me. He looked at my ID badge. Then he looked back at
me and asked, “Why do people always look younger in their pictures?” Cute. Ha.