Fall is finally in the air. After a brutally hot summer that seemed to last forever, the calendar has been flipped and the weather seems to be slowly complying. The mornings are cool and clear, as are the evenings, and every once in a while I spy a tree with some fading leaves. I even had to kick a few dead ones out of my way leaving work last evening.
And as is the case at this time of year, the dying trees signify the start of so many things. The academic cycle starts anew, and with it come new crops of medical students and interns to the hospital - full of knowledge, and needing experience.
It's hard not to get a sense of the cycle of things at this time of year. Seasons come and go, as do the interns, but all that seems so much more obvious at the transitions. I guess it's when we're just more aware of that change.
The other day, in the operating room, while removing a patient's gallbladder, it became abundantly clear that there were four individuals working on the case, each of whom had a predictable level of knowledge and technical ability. There was the attending surgeon at the helm, following by the chief resident, followed by me (a "mid-level" resident), and of course followed by the medical student. Knowledge, skills experience -- it all flowed downstream. And it was so obvious that I couldn't help but think that I was simply just part of a system - a grueling system that took young, helpless interns and put them through five years of exams, sleepless nights, oral presentations, clinical rounds, computer simulations, difficult patients and their families, central lines on obese patients, trauma activations, massive blood loss…five years, to produce a surgeon. And as predictable as the seasons, so too are the abilities of the resident.
On the one hand that's comforting. After a couple more years, I tell myself, I'll be that good, and that smart. But then I begin to wonder - am I just a product of a system? As sure as I'll progress, so too will fall fade to winter, and winter blossom into spring. It's automatic.
I like fall. It's beautiful, and it's a fresh start for so many phases of our lives. And it's a time for progress.
Friday, September 10, 2010
Thursday, March 18, 2010
He shoots...
The other day a man came in to the emergency room. He was 89 years old, partially deaf, yet somehow living on his own. The medics brought him in quickly – he was nearly unresponsive and his blood pressure was dangerously low. The ER doctor was able to feel a pulsating mass in the patient’s abdomen, and that’s when I got the call. You better come quick, she said, we may have a ruptured AAA.
I dropped everything and ran. A “triple A” stands for abdominal aortic aneurysm, and when they rupture patients normally exsanguinate rather quickly. We had to move fast. An ultrasound and then a CT scan to confirm the diagnosis. Calls to vascular surgery, anesthesia, and the OR. A central line to assure good access. A sample sent to the blood bank – they would need to have blood available for transfusions.
The man ended up doing well. He survived the surgery, and last I saw him we had a nice conservation. In medicine, this is called a “save.” A nearly certain death that, through the efficiency of the system and those in it, results in a second chance. “Good save” people would say, and pat me on the back.
As a former goaltender I’m used to people telling me “good save” and patting me on the back. And at this time of year – the overlap of hockey and lacrosse seasons – my memories are thicker than ever. The dull yet satisfying thud of a puck hitting an outstretched leg pad, or the quick snap of a lacrosse ball hitting the strings of a stick – in a real sense, the prospect of making the incredible save is what attracted me to a life in surgery.
What we would later learn about our gentlemen is that he had known about this aneurysm for several years, and that a vascular surgeon had offered to repair it electively – in the cool safety of outpatient surgery – 5 years ago. For whatever reason the patient decided not to have the surgery then. Our efforts – termed “heroic” by insurance companies – were entirely preventable. Statically, he should have died.
My friend is a priest, and her soon, nearly 7, had been battling a rare form of cancer for about 2 years. They did everything parents could have done, but their boy finally died just recently. There was simply no “save” to be had.
In surgery, we have a front row seat for the apparent randomness of survival. In 21st century America, we’re getting further and further away from survival of the fittest and moving a lot closer to survival of the luckiest. It is a strange thing to witness on a nearly daily basis.
I guess all I can do is save the ones I can.
I dropped everything and ran. A “triple A” stands for abdominal aortic aneurysm, and when they rupture patients normally exsanguinate rather quickly. We had to move fast. An ultrasound and then a CT scan to confirm the diagnosis. Calls to vascular surgery, anesthesia, and the OR. A central line to assure good access. A sample sent to the blood bank – they would need to have blood available for transfusions.
The man ended up doing well. He survived the surgery, and last I saw him we had a nice conservation. In medicine, this is called a “save.” A nearly certain death that, through the efficiency of the system and those in it, results in a second chance. “Good save” people would say, and pat me on the back.
As a former goaltender I’m used to people telling me “good save” and patting me on the back. And at this time of year – the overlap of hockey and lacrosse seasons – my memories are thicker than ever. The dull yet satisfying thud of a puck hitting an outstretched leg pad, or the quick snap of a lacrosse ball hitting the strings of a stick – in a real sense, the prospect of making the incredible save is what attracted me to a life in surgery.
What we would later learn about our gentlemen is that he had known about this aneurysm for several years, and that a vascular surgeon had offered to repair it electively – in the cool safety of outpatient surgery – 5 years ago. For whatever reason the patient decided not to have the surgery then. Our efforts – termed “heroic” by insurance companies – were entirely preventable. Statically, he should have died.
My friend is a priest, and her soon, nearly 7, had been battling a rare form of cancer for about 2 years. They did everything parents could have done, but their boy finally died just recently. There was simply no “save” to be had.
In surgery, we have a front row seat for the apparent randomness of survival. In 21st century America, we’re getting further and further away from survival of the fittest and moving a lot closer to survival of the luckiest. It is a strange thing to witness on a nearly daily basis.
I guess all I can do is save the ones I can.
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