When a patient presents with signs and symptoms of an ischemic limb – that is, an arm or leg which is slowly dying from lack of adequate blood flow – there are a number of simple observations we can make to grade the severity of the disease process. The patient will develop pain and a loss of muscle function; the limb will become pale and cold, and eventually pulseless and avascular. Death. The very first thing to go, however, is sensation. The webbed areas between the fingers and toes will grow numb, and the palms or hands will lose what’s called “two-point discrimination.” That is, if I undo a paperclip and bend it in a “U,” the patient will not be able to tell whether one or both points of the “U” are touching their skin at a given time.
Sensation, we must conclude, is pretty important, because when our bodies are facing anoxia and are threatened, it’s the first thing to go. And failing to process what’s going on can mean serious consequences – like the loss of a limb.
But as important as it is for the doctor to evaluate the sensory capabilities of the patient, the simple act of doing so can be nearly just as important. The osteopathic medical profession places a lot of importance on physical contact – that is, assuring that the patient positively senses us. One of the most common complaints raised against physicians is “he never even touched me.”
I’ve never been a particularly touchy-feely sort of guy. I’ll give anyone I meet a handshake, but when it comes to hugs and long embraces or even a gentle rub of the back – it just doesn’t come that natural to me. I go out of my way to do so, however, because I realize it is important to most people. What I never realized was truly how important it is to me.
Yesterday I was having a terrible day. I just was. I was working with a colleague and apologized to her for how useless I had been over the past few days. She smiled, said not to worry, and very innocently and honestly gave me a gentle rub behind my shoulder. It was the strangest thing in the world – it was totally asexual, yet her hand on my back felt like white lightning. I realized that her touch was the first from a women – other than my mother or sister – that I’d experienced in a long time. I had no idea that that sort of physical contact was important to me.
It seemed I had lost sensation, and after months of gut-wrenching pain had become simply numb. Like an arm whose blood supply was cut off, I was going through the stages of ischemia, starting with the loss of sensation which would have ended ultimately in death. And this gentle touch on my back was the lightning bolt of revelation to the process at hand. It snapped me back to reality, like a rush of oxygen to my brain.
When we re-vascularize a limb – when we do surgery to make sure more blood gets to the arm or leg – it nearly instantly gets more pink and warm. But the sensation is slow to return in full. In fact, where the patient once felt numbness or maybe even nothing at all, he will now actually feel pain. That pain will eventually go away, and morph into normal sensation.
My personal ischemia left me completely numb. Now I am back to feeling pain. I only hope it is on the way towards normal sensation.
Thursday, March 31, 2011
Wednesday, March 30, 2011
Completion
He looked like any other ICU patient. He was young, sure, but other than that he was pretty typical. The endotracheal tube down his throat was attached to the ventilator, which controlled his every respiration. The Foley catheter drained his urine into a bag at the side of the bed. While he lay still, the leads from the monitors indicated that his heart was beating rather fast, and that his blood carried a healthy amount of oxygen.
The only thing is that there was really very little at all that was healthy about this boy. Because this boy was dead. Brain dead. We were merely keeping his organs alive so that they could be harvested and donated to people currently fighting for their lives. This boy had already lost that fight.
His parents said their goodbyes, and kissed him one last time. We took him to the OR where we made an incision from the base of his neck to just above his pelvic bone, exposing his entire viscera. After some brief blood tests, the process commenced.
First a preserving fluid was infused throughout his body. Then he was exsanguinated. His heart was stopped and then quickly removed in a matter of minutes. The cardiac surgeon cradled it like a baby as he hurried to get it safely packaged for travel. At that point all the monitors were turned off and the anesthesia team left. The typical bleeping of the monitors went silent – it was as if our patient had somehow become more dead.
Attention was then turned to his abdomen. His liver was next to go. The student standing next to me remarked how big it looked – the surgeon had to scoop it with both hands as he turned and placed it on a table behind him. It was big, I thought to myself – until very recently it had been rather busy keeping a young, active boy alive.
His pancreas was dug out from behind his stomach, which had become eerily white now that all the blood had been let out. Finally the kidneys were plucked from the now relatively empty body cavity.
In “Never Let Me Go” Kazuo Ishiguro writes of individuals who are forced to donate their organs to society. It typically takes two or three trips to the OR before the individual finally succumbs, a process he calls completion. We completed this boy in just a couple hours.
It was an odd thing to stand there during this procurement process. In my mind were the horrible scenes from “Never Let Me Go” that turn organ donation into horrible thievery thinly cloaked as generous science. Yet what I was witnessing was truly an incredible gift that would help save the lives of numerous individuals. He was their prayers answered. And for his parents, it was a way to never let go of his precious memory and sense of vibrant life.
Never, ever, let me go. Please. Even when I am gone.
The only thing is that there was really very little at all that was healthy about this boy. Because this boy was dead. Brain dead. We were merely keeping his organs alive so that they could be harvested and donated to people currently fighting for their lives. This boy had already lost that fight.
His parents said their goodbyes, and kissed him one last time. We took him to the OR where we made an incision from the base of his neck to just above his pelvic bone, exposing his entire viscera. After some brief blood tests, the process commenced.
First a preserving fluid was infused throughout his body. Then he was exsanguinated. His heart was stopped and then quickly removed in a matter of minutes. The cardiac surgeon cradled it like a baby as he hurried to get it safely packaged for travel. At that point all the monitors were turned off and the anesthesia team left. The typical bleeping of the monitors went silent – it was as if our patient had somehow become more dead.
Attention was then turned to his abdomen. His liver was next to go. The student standing next to me remarked how big it looked – the surgeon had to scoop it with both hands as he turned and placed it on a table behind him. It was big, I thought to myself – until very recently it had been rather busy keeping a young, active boy alive.
His pancreas was dug out from behind his stomach, which had become eerily white now that all the blood had been let out. Finally the kidneys were plucked from the now relatively empty body cavity.
In “Never Let Me Go” Kazuo Ishiguro writes of individuals who are forced to donate their organs to society. It typically takes two or three trips to the OR before the individual finally succumbs, a process he calls completion. We completed this boy in just a couple hours.
It was an odd thing to stand there during this procurement process. In my mind were the horrible scenes from “Never Let Me Go” that turn organ donation into horrible thievery thinly cloaked as generous science. Yet what I was witnessing was truly an incredible gift that would help save the lives of numerous individuals. He was their prayers answered. And for his parents, it was a way to never let go of his precious memory and sense of vibrant life.
Never, ever, let me go. Please. Even when I am gone.
Tuesday, March 29, 2011
Death Actually
It is all around us. This is what happened.
Last night a boy got into a horrible argument with his mother. She had sensed something wasn’t quite right, that they had become distant somehow, and she was devastated. She somehow found a stash of pot in his room. They fought. They cursed. And he left.
About six AM he got into a horrible car crash. At seven AM he arrived in our trauma bay. We spoke to his mother and father at about ten. We told them that he had suffered a massive brain injury and that his chances of survival were essentially zero. The pain and the guilt in their faces were devastating to witness.
The only things left to do were the brain death exams. As a trauma team we tried to elicit pain by pinching his nails; we dripped water into his eyes to see if he would blink; we brushed gauze against his corneas to see if he had any sense at all in his eyes; we blasted cold water into his ears to see if his brain was active enough to sense the temperature change; we turned off the ventilator to see if he would breath. Another physician came and did the same exam with the same results – our patient was dead.
Another women came in a few hours earlier. She was young, too young to have already survived high-grade breast cancer, and the chemo-radiation and surgery and subsequent reconstructive surgery needed to do so. She had regained her life, and was working with mentally challenged adults, helping them get to and from whatever activities and appointments they needed to life a somewhat normal life. The other day a man fell on her, and hurt her arm. Over the next day her arm became swollen and tense. Her heart raced, and her blood pressure dropped. She came into the ER with a very palpable radial pulse – that’s the one you can feel on your wrist just above your thumb. It’s the one people try to sever when they commit suicide. This morning she lost the sensation of that pulse, which meant the internal pressures in her arm were so high that it they were occluding the blood from flowing into her arm. And so we took her to the OR to explore her arm.
Her arm was dead. All of it. Her muscles, her fascia, her nerves, even her veins….all dead. We went into the operating room thinking that we might make a couple incisions and relieve some excess pressure – we ended up disarticulating her shoulder joint and amputating her entire right arm, putting on a temporary dressing, and transferring her to another hospital where they could treat her with hyperbaric oxygen – a last ditch effort to save her life.
Sometimes I feel my own pulse, just to make sure it’s there. I place my left first two fingers on my right wrist and feel the pulsations transferring from one wrist to the other hand. I think that it’s so odd, that here is the place where I (well, where others) would take their life, and it is here where I (yes, I) feel to confirm life.
It’s nice to know I have a pulse, even as death actually is all around us.
Last night a boy got into a horrible argument with his mother. She had sensed something wasn’t quite right, that they had become distant somehow, and she was devastated. She somehow found a stash of pot in his room. They fought. They cursed. And he left.
About six AM he got into a horrible car crash. At seven AM he arrived in our trauma bay. We spoke to his mother and father at about ten. We told them that he had suffered a massive brain injury and that his chances of survival were essentially zero. The pain and the guilt in their faces were devastating to witness.
The only things left to do were the brain death exams. As a trauma team we tried to elicit pain by pinching his nails; we dripped water into his eyes to see if he would blink; we brushed gauze against his corneas to see if he had any sense at all in his eyes; we blasted cold water into his ears to see if his brain was active enough to sense the temperature change; we turned off the ventilator to see if he would breath. Another physician came and did the same exam with the same results – our patient was dead.
Another women came in a few hours earlier. She was young, too young to have already survived high-grade breast cancer, and the chemo-radiation and surgery and subsequent reconstructive surgery needed to do so. She had regained her life, and was working with mentally challenged adults, helping them get to and from whatever activities and appointments they needed to life a somewhat normal life. The other day a man fell on her, and hurt her arm. Over the next day her arm became swollen and tense. Her heart raced, and her blood pressure dropped. She came into the ER with a very palpable radial pulse – that’s the one you can feel on your wrist just above your thumb. It’s the one people try to sever when they commit suicide. This morning she lost the sensation of that pulse, which meant the internal pressures in her arm were so high that it they were occluding the blood from flowing into her arm. And so we took her to the OR to explore her arm.
Her arm was dead. All of it. Her muscles, her fascia, her nerves, even her veins….all dead. We went into the operating room thinking that we might make a couple incisions and relieve some excess pressure – we ended up disarticulating her shoulder joint and amputating her entire right arm, putting on a temporary dressing, and transferring her to another hospital where they could treat her with hyperbaric oxygen – a last ditch effort to save her life.
Sometimes I feel my own pulse, just to make sure it’s there. I place my left first two fingers on my right wrist and feel the pulsations transferring from one wrist to the other hand. I think that it’s so odd, that here is the place where I (well, where others) would take their life, and it is here where I (yes, I) feel to confirm life.
It’s nice to know I have a pulse, even as death actually is all around us.
Monday, March 28, 2011
Left for Dead
A trauma victim came into the emergency room in the early hours of the morning the other day. He was clearly drunk, mentally challenged, and he had just gotten out of prison. He had been badly beaten – his eyes were swollen shut, he was missing teeth, he had broken glass in wounds all over his arms and legs, and a huge gash in his scalp which was bleeding badly. We stopped the major bleeding, made sure none of his other injuries were immediately life-threatening, and then began the arduous task of cleaning and mending his every laceration.
The most disturbing thing of it all was that, as far as we could piece things together from the police, this assault had happened several hours ago. The police found him unconscious in a pool of his own blood, hours after the nearest bar – which he had been seen at – had closed. It seemed his assailants beat the heck out of him, and simply walked away as he lay on the asphalt, with a slow, dark red pool forming underneath him. He wasn’t exactly dead, they must have known, but maybe, with enough time, he would get there. Fortunately for him he was discovered and brought to us.
I’m not quite sure which is worse, really – the physical abuse of someone, or the walking away. Because walking away necessitates being fully aware of the suffering and therefore fully aware of the solution, and yet choosing to do nothing about it.
When you are left for dead – and I pray it will never happen to you – you end up with a lot of time to reflect. “Time on my hands, could be time spent with you” quoth Sir Elton John. It turns out he knows what he’s talking about.
And what have I done with that time? Gone for walks. Starred out the window. Drank way too much. Had bad thoughts. Drank again. And again. And through it all I keep asking myself – how are you not watching? How is it that I’ve been left for dead? Like that man on the street I lay still, drunk, unable to move, with the blood slowly filling in the spaces between me and the cold pavement. It’s nice to know my blood is so warm.
And all I can do is wait patiently for the police to come, and bring me to some over-worked trauma resident to mend my wounds and stop the bleeding. I hope it happens soon.
The most disturbing thing of it all was that, as far as we could piece things together from the police, this assault had happened several hours ago. The police found him unconscious in a pool of his own blood, hours after the nearest bar – which he had been seen at – had closed. It seemed his assailants beat the heck out of him, and simply walked away as he lay on the asphalt, with a slow, dark red pool forming underneath him. He wasn’t exactly dead, they must have known, but maybe, with enough time, he would get there. Fortunately for him he was discovered and brought to us.
I’m not quite sure which is worse, really – the physical abuse of someone, or the walking away. Because walking away necessitates being fully aware of the suffering and therefore fully aware of the solution, and yet choosing to do nothing about it.
When you are left for dead – and I pray it will never happen to you – you end up with a lot of time to reflect. “Time on my hands, could be time spent with you” quoth Sir Elton John. It turns out he knows what he’s talking about.
And what have I done with that time? Gone for walks. Starred out the window. Drank way too much. Had bad thoughts. Drank again. And again. And through it all I keep asking myself – how are you not watching? How is it that I’ve been left for dead? Like that man on the street I lay still, drunk, unable to move, with the blood slowly filling in the spaces between me and the cold pavement. It’s nice to know my blood is so warm.
And all I can do is wait patiently for the police to come, and bring me to some over-worked trauma resident to mend my wounds and stop the bleeding. I hope it happens soon.
Tuesday, March 22, 2011
Going Back
Not too long ago we had a terrible trauma. A teenage driver lost control and wrecked his car, and in the process killed his best friend who was riding in the passenger seat. I wish this sort of thing didn’t happen very often, but sadly it does. The boy’s recovery was a long one. He had to have multiple surgeries to repair his many fractures, and he needed intense therapy to re-learn how to walk.
He also had difficulty with his brain. Diffuse axonal injury – or DAI – is a condition that happens in many trauma patients. In short, it is tiny foci of injury that happens to lots of areas of the brain all at the same time. It occurs most commonly in car accidents, when the rapid deceleration causes the brain to strike the inside of the skull and rattle around like a tennis ball inside a shoebox. It causes people to be incredibly slow to wake up, and to profoundly affect their behavior when they do wake. In our patient, it altered his memory. It altered it in such a way that he would forget the accident and his role in it and his dead friend – he would “remember” it, as if for the first time, every morning for months. It was like some perverted, new brand of torture.
Or was it? Maybe it was just his way of going back to that moment as often as it was necessary for him to come to peace with it. CS Lewis writes of sin in this way by making the analogy to a lengthy math problem, with several steps, each building upon the last. If you happen to make a simple error in step number two, obviously the final answer – even if you performed the next twenty steps correctly – will be wrong. Pushing onward, despite doing so perfectly, will never get you to the right answer. In fact, the only way to ever find the correct solution is to go back, all the way back to step two, and make the correction, and then complete the rest of the problem.
The boy is doing well now, I’m told. He’s been able to move on. And in a certain sense I think it’s because he had to go back to that moment of the accident and figure out a way to confront it head on. He didn’t just push forward with this tragedy in his past – he went back, found peace, and then moved on. It doesn’t mean he forget the accident or in anyway feels less pain – it just means he found a way to live with it, and not blindly go forward.
It is Lent now – a time of self-examination. I am daily trying to go back, find my errors, correct them, and find peace so that I too may move forward.
He also had difficulty with his brain. Diffuse axonal injury – or DAI – is a condition that happens in many trauma patients. In short, it is tiny foci of injury that happens to lots of areas of the brain all at the same time. It occurs most commonly in car accidents, when the rapid deceleration causes the brain to strike the inside of the skull and rattle around like a tennis ball inside a shoebox. It causes people to be incredibly slow to wake up, and to profoundly affect their behavior when they do wake. In our patient, it altered his memory. It altered it in such a way that he would forget the accident and his role in it and his dead friend – he would “remember” it, as if for the first time, every morning for months. It was like some perverted, new brand of torture.
Or was it? Maybe it was just his way of going back to that moment as often as it was necessary for him to come to peace with it. CS Lewis writes of sin in this way by making the analogy to a lengthy math problem, with several steps, each building upon the last. If you happen to make a simple error in step number two, obviously the final answer – even if you performed the next twenty steps correctly – will be wrong. Pushing onward, despite doing so perfectly, will never get you to the right answer. In fact, the only way to ever find the correct solution is to go back, all the way back to step two, and make the correction, and then complete the rest of the problem.
The boy is doing well now, I’m told. He’s been able to move on. And in a certain sense I think it’s because he had to go back to that moment of the accident and figure out a way to confront it head on. He didn’t just push forward with this tragedy in his past – he went back, found peace, and then moved on. It doesn’t mean he forget the accident or in anyway feels less pain – it just means he found a way to live with it, and not blindly go forward.
It is Lent now – a time of self-examination. I am daily trying to go back, find my errors, correct them, and find peace so that I too may move forward.
Tuesday, March 15, 2011
Forgive and Remember
Last night two trauma victims came into the trauma bay in rapid succession. The EMS gave a quick report on the first one: a woman, sixty, pedestrian, hit by a car and thrown roughly fifty feet. Her right leg was snapped right below the knee, and her tibia was sticking through the skin. Her left leg felt like jelly. Her pelvis bone – which normally is solid as a rock – was a loose, broken mess. Her right shoulder had bad bruises on it, and there was a large amount of blood coming from the back of her head. We started to work on her. Her eyes were open, and she as moving, but that was it. We got IV access, and intubated her for her own airway protection. I drew some blood from a vain in her groin and handed it off to the lab tech to get us STAT labs. But…we couldn’t get a blood pressure.
At that point the second trauma came in. A male, twenty-five, with an obvious deformity of his right lower leg. The bone wasn’t sticking out, but it looked pretty bad. Other than that he seemed to be OK. He looked up and asked “how is my mom?”
We got him out of the trauma bay right then – he didn’t need to see or even hear what was coming next.
His mom didn’t have a pulse. CPR was started. In trauma patients, sometimes this is caused by something called a tension pneumothorax, which is a collapsed lung that is pushing against the heart, rendering it useless. We placed large needles in her chest followed by large chest tubes to decompress the chest cavity. Still no pulse. We put a huge IV in her neck vein and transfused her massive amounts of blood. We ultrasouded her abdomen – all negative. I took a scalpel and made a 3 cm incision below her umbilicus, and gently placed a catheter into her abdominal cavity, looking for blood or any other signs of where the trouble might be. Nothing. Her pupils became fixed and hugely dilated – her brain was literally herniating down into her spinal column. She was dead.
The placed looked like a war scene, with blood and gowns and gloves and needles everywhere. And when it all stopped – when the code was “called” – the room was silent, and everyone slinked away, defeated. And she just remained on the table, lifeless, and cold. But yet, after that last hour of hell, she finally looked at peace.
I’d almost forgotten what it was like to lose someone that quickly. What a horrible thing to say! I’d almost forgotten what it’s like to stop, take off my gloves, and stand there quietly, listening to my racing heart and panting breath as I stood over death. There is a prayer I always say in this situation:
Dear LORD, have mercy on us all who tried to help. And have mercy on your servant who passed away. Hasten your angels to this bedside, and usher her into your presence, that, if it may please you, she may this day be with you in paradise. Amen.
In this season of Lent, we hear so much about forgiveness. What I’ve learned recently is that forgiveness should not be confused with forgetting. Forgive and remember, I say. Remember the pain, the suffering, the neglect – but forgive. For it is only in that forgiveness that we might find peace.
I pray now for both forgiveness and that peace.
At that point the second trauma came in. A male, twenty-five, with an obvious deformity of his right lower leg. The bone wasn’t sticking out, but it looked pretty bad. Other than that he seemed to be OK. He looked up and asked “how is my mom?”
We got him out of the trauma bay right then – he didn’t need to see or even hear what was coming next.
His mom didn’t have a pulse. CPR was started. In trauma patients, sometimes this is caused by something called a tension pneumothorax, which is a collapsed lung that is pushing against the heart, rendering it useless. We placed large needles in her chest followed by large chest tubes to decompress the chest cavity. Still no pulse. We put a huge IV in her neck vein and transfused her massive amounts of blood. We ultrasouded her abdomen – all negative. I took a scalpel and made a 3 cm incision below her umbilicus, and gently placed a catheter into her abdominal cavity, looking for blood or any other signs of where the trouble might be. Nothing. Her pupils became fixed and hugely dilated – her brain was literally herniating down into her spinal column. She was dead.
The placed looked like a war scene, with blood and gowns and gloves and needles everywhere. And when it all stopped – when the code was “called” – the room was silent, and everyone slinked away, defeated. And she just remained on the table, lifeless, and cold. But yet, after that last hour of hell, she finally looked at peace.
I’d almost forgotten what it was like to lose someone that quickly. What a horrible thing to say! I’d almost forgotten what it’s like to stop, take off my gloves, and stand there quietly, listening to my racing heart and panting breath as I stood over death. There is a prayer I always say in this situation:
Dear LORD, have mercy on us all who tried to help. And have mercy on your servant who passed away. Hasten your angels to this bedside, and usher her into your presence, that, if it may please you, she may this day be with you in paradise. Amen.
In this season of Lent, we hear so much about forgiveness. What I’ve learned recently is that forgiveness should not be confused with forgetting. Forgive and remember, I say. Remember the pain, the suffering, the neglect – but forgive. For it is only in that forgiveness that we might find peace.
I pray now for both forgiveness and that peace.
Monday, March 7, 2011
Cutting
It’s one thing to feel sad, and to be upset, and to cry. It’s another thing altogether to confront those feelings. In the absence of being able to properly confront them, sometimes just taking a good long look in the mirror gets the job done.
The other day I did just that. Blood-shot eyes, tear-streaked cheeks, and unshaven chin, I thought long and hard about the person staring back at me. I tried to look into my eyes but it was too painful, and felt unnaturally awkward. So my eyes strayed to my cheeks. I stared at them because there was nothing else to stare at. And I noticed something peculiar – a large, ingrown hair, slinking under my skin. It was nearly completely unnoticeable, but in the absence of anything else to do – that is, except more crying – I felt the urge to rip it out. So I picked, and clawed, and scratched…all to no avail. This just won’t do, I said to myself. I’m a surgeon – I have better ways.
The next day I found an unused disposable scalpel at the hospital. Perfect, I thought. I slipped it in my pocket and hurried home after the day had ended.
I brought my face close to the mirror and strained my eyes to focus on that spot as best I could. I caught a glimpse of those same eyes in the mirror – there were no more tears or blood-red capillaries. Only rage, and obsession. Perhaps this is progress.
I unsheathed the blade and held it up close to my skin, and marveled at the cool steel as it reflected the bathroom light. My eyes were angled such that I was straining to focus the blade and my skin in the mirror – I saw two of everything. I tried to steady my hands against each other and against my face, but they were shaking rather significantly. Not good for a surgeon. I had to focus. I brought the scalpel closer, focused my eyes, and steadied my hands. I let out a long breath.
And I cut.
And then I cut again. And then a few more times. Every stroke took off a little more skin, and shed just a few more blood cells, and came that much closer to exposing that damned ingrown hair. And it burned with every pass. It stung. It was real pain – but it was pain I was controlling. And for a moment – a precious moment – it was all the pain in the world, and all of my pain too. No other pain mattered. And I alone controlled it.
It was finished. The hair was exposed. Out it came, and into the trash went the scalpel. I caught my breath and looked back into the mirror. My eyes were hollow. My face was scared. And I am still alone, though more hideous than ever.
The other day I did just that. Blood-shot eyes, tear-streaked cheeks, and unshaven chin, I thought long and hard about the person staring back at me. I tried to look into my eyes but it was too painful, and felt unnaturally awkward. So my eyes strayed to my cheeks. I stared at them because there was nothing else to stare at. And I noticed something peculiar – a large, ingrown hair, slinking under my skin. It was nearly completely unnoticeable, but in the absence of anything else to do – that is, except more crying – I felt the urge to rip it out. So I picked, and clawed, and scratched…all to no avail. This just won’t do, I said to myself. I’m a surgeon – I have better ways.
The next day I found an unused disposable scalpel at the hospital. Perfect, I thought. I slipped it in my pocket and hurried home after the day had ended.
I brought my face close to the mirror and strained my eyes to focus on that spot as best I could. I caught a glimpse of those same eyes in the mirror – there were no more tears or blood-red capillaries. Only rage, and obsession. Perhaps this is progress.
I unsheathed the blade and held it up close to my skin, and marveled at the cool steel as it reflected the bathroom light. My eyes were angled such that I was straining to focus the blade and my skin in the mirror – I saw two of everything. I tried to steady my hands against each other and against my face, but they were shaking rather significantly. Not good for a surgeon. I had to focus. I brought the scalpel closer, focused my eyes, and steadied my hands. I let out a long breath.
And I cut.
And then I cut again. And then a few more times. Every stroke took off a little more skin, and shed just a few more blood cells, and came that much closer to exposing that damned ingrown hair. And it burned with every pass. It stung. It was real pain – but it was pain I was controlling. And for a moment – a precious moment – it was all the pain in the world, and all of my pain too. No other pain mattered. And I alone controlled it.
It was finished. The hair was exposed. Out it came, and into the trash went the scalpel. I caught my breath and looked back into the mirror. My eyes were hollow. My face was scared. And I am still alone, though more hideous than ever.
Sunday, March 6, 2011
Drowning
Today it’s raining rather hard. The sky is unusually light for the amount of rain that’s falling. Walking in, I stood and stared skyward, stretched out my arms, and tried to open my eyes. There was water all around me – soaking my cloths, falling up my nose, getting into my eyes. The light grey clouds above almost seemed like a place I could escape to.
I read an article the other day about an elite surfer. He described what happens when you wipe out on a really big, serious wave. You go under violently, of course, but then the wave keeps pummeling you while you’re underwater. You open your eyes and look up, and the blazing sun dances its way through the ocean, reminding you of the peace and safety above. But you can’t get there – you have to endure and take your beating until the wave has passed and you can surface. The trick of it all is that you have to be strong enough to not drown until your pummeling is over with.
Recently I’ve been taking a beating like I’ve never felt before. I don’t know exactly when I fell off the really big wave, though I know now that I am surely underwater. I’m taking my licks as best I can. But I’m beginning to feel as though I’m drowning.
I stood outside today so I could look upward, and pretend I could see a light, and know that there was something up above that offered peace and safety. The trick of it all is that I need to be strong enough to not drown in the meantime.
I guess time will tell. But for right now, between me and you, I’m getting close to closing my eyes, opening my mouth, and taking in a big, final, breath of water.
Fortunately for me a car drives by and startles me. I walk into the ICU where sick patients need me. The rain beats against the windows – a reminder of the wave that is still crushing my heart.
I read an article the other day about an elite surfer. He described what happens when you wipe out on a really big, serious wave. You go under violently, of course, but then the wave keeps pummeling you while you’re underwater. You open your eyes and look up, and the blazing sun dances its way through the ocean, reminding you of the peace and safety above. But you can’t get there – you have to endure and take your beating until the wave has passed and you can surface. The trick of it all is that you have to be strong enough to not drown until your pummeling is over with.
Recently I’ve been taking a beating like I’ve never felt before. I don’t know exactly when I fell off the really big wave, though I know now that I am surely underwater. I’m taking my licks as best I can. But I’m beginning to feel as though I’m drowning.
I stood outside today so I could look upward, and pretend I could see a light, and know that there was something up above that offered peace and safety. The trick of it all is that I need to be strong enough to not drown in the meantime.
I guess time will tell. But for right now, between me and you, I’m getting close to closing my eyes, opening my mouth, and taking in a big, final, breath of water.
Fortunately for me a car drives by and startles me. I walk into the ICU where sick patients need me. The rain beats against the windows – a reminder of the wave that is still crushing my heart.
Saturday, March 5, 2011
End of the Line?
You can’t make this stuff up.
This morning – after an early trip to the OR for a stab wound – as I was running around trying to get some of the paperwork together, a familiar tune came on over the hospital loudspeaker. It was Brahms’s Lullaby. And, as in this case in most hospitals, that means that a baby had just been born. It’s obviously a very calming song, and it usually has a very calming effect on me. And that effect is often magnified during a morning such as this one, where I had just participated in the care of someone who had suffered a violent injury. To be fighting death and yet be reminded of new life is a wonderful thing. But this morning, I confess, I was jealous.
I was jealous of the mother as she realized a new life had been created inside her. I was jealous of the father as he watched his wife deliver a child. I was jealous of the hopes, fears, dreams, and challenges that a baby brings. I was most jealous – can you believe this? – of the look my wife would give me right before things got really serious. It’s the look that says “can I do this? Is this real?” and the look I give back that says “of course you can do this – this is our child.”
I thought lunch might help my hurt. But after sitting down two unusual things happened. First, my colleague pulled out his phone and started showing pictures of his one-year-old baby boy. And then, right on cue, a whole train of pregnant women and their husbands came into the cafeteria. It seems they were getting a tour of the hospital, so that they and their families would be well-acquainted with the facilities during that emotional time. They were happy, nervous, and anxiously looking around, taking it all in.
That day – the day when I get to walk around the hospital, or look into my wife’s eyes, or hear the music – that day feels further away from me right now than it ever has before. It’s a day, I’m beginning to realize, that may never come at all.
And that is a horrible thing to feel.
This morning – after an early trip to the OR for a stab wound – as I was running around trying to get some of the paperwork together, a familiar tune came on over the hospital loudspeaker. It was Brahms’s Lullaby. And, as in this case in most hospitals, that means that a baby had just been born. It’s obviously a very calming song, and it usually has a very calming effect on me. And that effect is often magnified during a morning such as this one, where I had just participated in the care of someone who had suffered a violent injury. To be fighting death and yet be reminded of new life is a wonderful thing. But this morning, I confess, I was jealous.
I was jealous of the mother as she realized a new life had been created inside her. I was jealous of the father as he watched his wife deliver a child. I was jealous of the hopes, fears, dreams, and challenges that a baby brings. I was most jealous – can you believe this? – of the look my wife would give me right before things got really serious. It’s the look that says “can I do this? Is this real?” and the look I give back that says “of course you can do this – this is our child.”
I thought lunch might help my hurt. But after sitting down two unusual things happened. First, my colleague pulled out his phone and started showing pictures of his one-year-old baby boy. And then, right on cue, a whole train of pregnant women and their husbands came into the cafeteria. It seems they were getting a tour of the hospital, so that they and their families would be well-acquainted with the facilities during that emotional time. They were happy, nervous, and anxiously looking around, taking it all in.
That day – the day when I get to walk around the hospital, or look into my wife’s eyes, or hear the music – that day feels further away from me right now than it ever has before. It’s a day, I’m beginning to realize, that may never come at all.
And that is a horrible thing to feel.
Thursday, March 3, 2011
Abandonment
A “friend’s” brother has a dog – a funny looking dog – who was apparently left as a puppy. When you leave the dog alone, even for a bit, he goes crazy – barking, jumping up into the window to see you leave. It’s said. The poor dog has a fear of abandonment. He was left as a puppy, and now he’s afraid anyone who takes care of him or loves him or whom he loves will leave him for good.
Another friend of mine – an old teacher/priest – once said that, after observing plenty of people face death, that the only thing that seems to matter is how well you have loved and how well others love you.
Relationships are complex, for sure. And mistakes happen. But strong relationships are supposed to endure. They endure because they matter. Because the people involved care. Because when you commit to something, you stay committed. That’s supposed to matter.
When those commitments fall short, people get hurt. When they are terminated, people get destroyed. And that destruction takes its form in the feeling of abandonment. The feeling of being completely left alone by the one you love, and the one who used to love you. It’s terrifying how thoroughly you can be hurt by someone.
I’m the dog barking crazily. I’m a dog! I’m looking at the window at anybody I’m close to as they walk away, even if I know it’s just for a little while. I’ve now been abandoned.
Another friend of mine – an old teacher/priest – once said that, after observing plenty of people face death, that the only thing that seems to matter is how well you have loved and how well others love you.
Relationships are complex, for sure. And mistakes happen. But strong relationships are supposed to endure. They endure because they matter. Because the people involved care. Because when you commit to something, you stay committed. That’s supposed to matter.
When those commitments fall short, people get hurt. When they are terminated, people get destroyed. And that destruction takes its form in the feeling of abandonment. The feeling of being completely left alone by the one you love, and the one who used to love you. It’s terrifying how thoroughly you can be hurt by someone.
I’m the dog barking crazily. I’m a dog! I’m looking at the window at anybody I’m close to as they walk away, even if I know it’s just for a little while. I’ve now been abandoned.
Mistaken Identity
We’ve all heard stories about mistaken identity in the medical world. A patient gets the wrong procedure, or the wrong medication, or the wrong study…I can’t say I’ve ever been involved in anything even remotely serious – at least, not that I’m aware of – but I’ve had a few stumbles. I’ve had to ask patients which side we’re operating on, or make sure we’re doing the right surgery – it’s all part of the checks built into the system.
Just this morning I was trying to find a patient before the OR. The nurse handed me the chart and pointed to an elderly woman in a stretcher. There’s your pre-op, she said kindly. I opened the chart and started reading as I walked. Suddenly the chart was taken out of my hands and a new one put in its placed. Sorry, the nurse said, this is the correct chart. She gave a sheepish smile. No worries.
Yesterday afternoon I got an email that made me stop dead in my tracks and break out in a cold sweat. The title of the email was simply my last time, and the body of the email was a forward with several correspondences. I didn’t recognize the return address, but it seemed like he wanted me to review a conversation. He was a lawyer, a “family defense” lawyer. It seemed that his client – who shared my last name – was being sued for divorce by his wife. The emails were a series of conversations between lawyers who were trying to clarify the ugly details. Somehow it got forwarded to me by mistake.
I read it again. And again. And again. And every time my heart raced faster and my face got more flushed. This isn’t supposed to be me, right? Are lawyers trying to find me? Is my wife suing me? My heart was drowning myself out. No, it was clearly an accident – right? – check the names again. It’s just a mistake, but one that stung more than most accidents are capable of. It hurts to even think of it. It wasn’t me. Relax! It wasn’t me! But so close. Too close.
It’s a funny thing, to have your identify mistaken. And it’s odd to realize the different levels that it can be hurtful. There’s the simple insult of being confused with someone else. But there is also hurt in confronting the confused situation. Is it better or worse than my life? Is it too close to home? Is it possibly knife-piercing foreshadowing?
I hate being confused. I hate confusing others. Know me for who I am. And let me know you for who you are. Then, finally, there will be peace.
Just this morning I was trying to find a patient before the OR. The nurse handed me the chart and pointed to an elderly woman in a stretcher. There’s your pre-op, she said kindly. I opened the chart and started reading as I walked. Suddenly the chart was taken out of my hands and a new one put in its placed. Sorry, the nurse said, this is the correct chart. She gave a sheepish smile. No worries.
Yesterday afternoon I got an email that made me stop dead in my tracks and break out in a cold sweat. The title of the email was simply my last time, and the body of the email was a forward with several correspondences. I didn’t recognize the return address, but it seemed like he wanted me to review a conversation. He was a lawyer, a “family defense” lawyer. It seemed that his client – who shared my last name – was being sued for divorce by his wife. The emails were a series of conversations between lawyers who were trying to clarify the ugly details. Somehow it got forwarded to me by mistake.
I read it again. And again. And again. And every time my heart raced faster and my face got more flushed. This isn’t supposed to be me, right? Are lawyers trying to find me? Is my wife suing me? My heart was drowning myself out. No, it was clearly an accident – right? – check the names again. It’s just a mistake, but one that stung more than most accidents are capable of. It hurts to even think of it. It wasn’t me. Relax! It wasn’t me! But so close. Too close.
It’s a funny thing, to have your identify mistaken. And it’s odd to realize the different levels that it can be hurtful. There’s the simple insult of being confused with someone else. But there is also hurt in confronting the confused situation. Is it better or worse than my life? Is it too close to home? Is it possibly knife-piercing foreshadowing?
I hate being confused. I hate confusing others. Know me for who I am. And let me know you for who you are. Then, finally, there will be peace.
Wednesday, March 2, 2011
Community
An old teacher of mine – a friend, really – once reminisced on a job interview he had at a new school. And he remembers feeling this: that what made this particular school special was that he had an overwhelming sense that this would be a wonderful place to experience a tragedy.
It’s an odd notion to have during a first impression, maybe, but it’s an important feeling to have. Oftentimes it might be a school, or a church, or a workplace. But let me say this: it is also a wonderful thing to experience that feeling in a person.
I see a lot of tragedy at work. And I see a lot of different family dynamics take on that tragedy. I see people dying in the most dignified way, with their families and loved ones all around. And I see people dying who desperately want to keep fighting, and keep living. And I see people dye alone, without anyone there to love them except some doctors and nurses.
I often think – what will my death look like? Who will be there? I’m sure plenty of folks will stop by or be sad for a bit – but who will really be there with me? Holding my hand, and tying to make me happy, even at the last? And who wants me to be there at her death? Who really wants me there, offering my love, and my support? Anyone?
For a combination of reasons, I slept well last night. And I slept on my left, of all things, and even woke up that way. And today, for the first time in a long time, I felt just a little bit like myself.
It’s an odd notion to have during a first impression, maybe, but it’s an important feeling to have. Oftentimes it might be a school, or a church, or a workplace. But let me say this: it is also a wonderful thing to experience that feeling in a person.
I see a lot of tragedy at work. And I see a lot of different family dynamics take on that tragedy. I see people dying in the most dignified way, with their families and loved ones all around. And I see people dying who desperately want to keep fighting, and keep living. And I see people dye alone, without anyone there to love them except some doctors and nurses.
I often think – what will my death look like? Who will be there? I’m sure plenty of folks will stop by or be sad for a bit – but who will really be there with me? Holding my hand, and tying to make me happy, even at the last? And who wants me to be there at her death? Who really wants me there, offering my love, and my support? Anyone?
For a combination of reasons, I slept well last night. And I slept on my left, of all things, and even woke up that way. And today, for the first time in a long time, I felt just a little bit like myself.
Tuesday, March 1, 2011
Back Pain
Driving in the car this morning I realized how badly my back hurt. Back pain is something new to me – it wasn’t pleasant. But realizing why it was there in the first place was even less pleasant.
I love to fall asleep – I just love the whole process of coming to peace at the end of the day and realizing that tomorrow will come anew. The words of The Book of Common Prayer – so often uttered at Evensong in my childhood – wisp me away:
O LORD, support us all the day long, until the shadows lengthen and the evening comes, and the busy world is hushed, and the fever of life is over, and our work is done. Then in thy mercy grant us a safe lodging, and a holy rest, and peace at the last. Amen. (BCP)
So falling asleep is a peaceful thing. I hear these words and roll on my left side. I sleep on the right side of the bed – that’s my side – so I turn to my left so I can see.
The problem is I can’t turn on my left side at the moment because I don’t want to see. Because there is nothing to see – there is only emptiness. So I slide as far to the right as I possibly can and turn on my right. And it’s uncomfortable. And rather than hearing soft words of prayer and drifting slowly away, I grit my teeth and tense my back.
It’s no surprise then that driving this morning – a trip that is always shorter than I think it is – my back started aching. I tried driving faster, but I couldn’t help but notice that the ETA on the GPS never changed. How could that be? I even got stuck behind a truck near construction, and again the ETA never changed. I was trapped in that car for as long as it was going to take me. For a moment I felt I had lost any control on my life – on my sleeping, my psyche, my body, even where I physically was.
The only thing to do was keep driving. Eventually I would arrive at my destination. Eventually.
I love to fall asleep – I just love the whole process of coming to peace at the end of the day and realizing that tomorrow will come anew. The words of The Book of Common Prayer – so often uttered at Evensong in my childhood – wisp me away:
O LORD, support us all the day long, until the shadows lengthen and the evening comes, and the busy world is hushed, and the fever of life is over, and our work is done. Then in thy mercy grant us a safe lodging, and a holy rest, and peace at the last. Amen. (BCP)
So falling asleep is a peaceful thing. I hear these words and roll on my left side. I sleep on the right side of the bed – that’s my side – so I turn to my left so I can see.
The problem is I can’t turn on my left side at the moment because I don’t want to see. Because there is nothing to see – there is only emptiness. So I slide as far to the right as I possibly can and turn on my right. And it’s uncomfortable. And rather than hearing soft words of prayer and drifting slowly away, I grit my teeth and tense my back.
It’s no surprise then that driving this morning – a trip that is always shorter than I think it is – my back started aching. I tried driving faster, but I couldn’t help but notice that the ETA on the GPS never changed. How could that be? I even got stuck behind a truck near construction, and again the ETA never changed. I was trapped in that car for as long as it was going to take me. For a moment I felt I had lost any control on my life – on my sleeping, my psyche, my body, even where I physically was.
The only thing to do was keep driving. Eventually I would arrive at my destination. Eventually.
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