Thoreau once said that talent writes with coffee, but genius writes with wine. Tonight, I write with gin.
What seems like a lifetime ago someone very special gave me a book entitled “Mortal Lessons.” It is written by a surgeon, Richard Selzer, and it’s less about surgery and more about his observations on life while being a surgeon. One of his more memorable essays is called “The exact location of the soul.” It raises probing questions about what makes us who we are.
Flash forward a few years and I’m now an aspiring trauma surgeon. One of the popular texts written by a giant in the field – Kenneth Mattox – has a chapter titled “The wounded surgical soul.” Mattox describes the “seat of the soul” as a “spherical area, not much larger than a silver dollar, centered on the head of the pancreas.” He calls injuries to this spherical areas soul wounds because “they are more lethal than any other type of abdominal trauma.”
The mortality of these wounds stems from the critical anatomy that is in this area. The portal vein, the superior mesenteric vessels, the pancreaticoduodenal arcade, the inferior vena cava, and the origin of the right kidney all converge here. Furthermore, accessing this area for the surgeon can be impossibly difficult under the chaotic circumstances likely present.
Last night a young man came into our trauma center having sustained a single gunshot to his surgical soul. We operated for hours, and nearly depleted the blood bank, but it wasn’t enough to save him. The multi-focal exsanguination was too much and he died with our hands inside him trying to stop the bleeding.
It’s interesting to think of a soul as something less abstract than we normally do, but rather to think of it as a space with defined borders. A space that, when violated, has predictable – and catastrophic – consequences.
Of course, the thing about our souls is that – unlike our bodies – they are eternal. Everything we do is not about building up our lives but more about building up our souls. Every action we do to one another, and everyway in which we react, and everything we preach in the process all serves to impact our souls.
It is nice to think that I can sometimes help individuals whose surgical souls are wounded. But it’s nicer still to believe that my own soul is being mended by someone far greater than I.
My glass is empty - more gin?
Thursday, May 26, 2011
Saturday, May 21, 2011
Robbed
One of the amazing things about being a physician is getting to know your patients. This, I suppose, is obvious, but nonetheless it is one of the things that medical students look forward to.
Spending so much of my time in the world of trauma and surgical critical care has altered that aspect of medicine for me. For one thing, most of our patients are so sick that they are not able to talk or even capable of forming a relationship. And for another thing…a lot of our patients are, well, quite honestly, not people that I would normally befriend. A lot of our patients are not exactly stand-up members of society. It doesn’t mean they don’t deserve the best in care – hence what I do, and the hours I serve – but it does give one pause. The majority of our patients are drunk drivers, addicts who had an accident, or victims of violent crimes who are almost never as innocent as they proclaim.
The other night a bunch of kids got drunk, held up a store, and pulled a gun on the clerk. Shots were exchanged, and one of the kids ended up taking a bullet in the eye. We spent all night – and the next several days – taking care of him. He’s minus one eye, but should do fine.
Driving home yesterday (always an interesting task after a 30 hour shift) a homeless man approached my car at a stoplight. He held a sign that simply read, “I don’t rob, I don’t steal, I’m just homeless and need money.” Hell, if he’d only start robbing he may risk an eye but he would at least end up off the streets for a few days. Would it be worth it? I didn’t have any cash on me. All I could think of was that if I were homeless, I bet I would steal. God forgive me, but I probably would.
I recently remembered the French root for the word “bereavement” is “to have been robbed.”
Speaking of forgiveness, today is supposed to be the end of the world. Do you ever wish it would be so? Do you ever find yourself wanting to have things so completely taken out of your hands? So much of trauma surgery is about eliminating the mayhem that surrounds critically ill patients. It’s exhausting. The rapture of God’s creation is one scenario that I wouldn’t be expected to try to control. It’s a refreshing thought.
Well, I fully expect to wake up tomorrow morning and go to work. I’m sure my one-eyed patient will be waiting for me.
Spending so much of my time in the world of trauma and surgical critical care has altered that aspect of medicine for me. For one thing, most of our patients are so sick that they are not able to talk or even capable of forming a relationship. And for another thing…a lot of our patients are, well, quite honestly, not people that I would normally befriend. A lot of our patients are not exactly stand-up members of society. It doesn’t mean they don’t deserve the best in care – hence what I do, and the hours I serve – but it does give one pause. The majority of our patients are drunk drivers, addicts who had an accident, or victims of violent crimes who are almost never as innocent as they proclaim.
The other night a bunch of kids got drunk, held up a store, and pulled a gun on the clerk. Shots were exchanged, and one of the kids ended up taking a bullet in the eye. We spent all night – and the next several days – taking care of him. He’s minus one eye, but should do fine.
Driving home yesterday (always an interesting task after a 30 hour shift) a homeless man approached my car at a stoplight. He held a sign that simply read, “I don’t rob, I don’t steal, I’m just homeless and need money.” Hell, if he’d only start robbing he may risk an eye but he would at least end up off the streets for a few days. Would it be worth it? I didn’t have any cash on me. All I could think of was that if I were homeless, I bet I would steal. God forgive me, but I probably would.
I recently remembered the French root for the word “bereavement” is “to have been robbed.”
Speaking of forgiveness, today is supposed to be the end of the world. Do you ever wish it would be so? Do you ever find yourself wanting to have things so completely taken out of your hands? So much of trauma surgery is about eliminating the mayhem that surrounds critically ill patients. It’s exhausting. The rapture of God’s creation is one scenario that I wouldn’t be expected to try to control. It’s a refreshing thought.
Well, I fully expect to wake up tomorrow morning and go to work. I’m sure my one-eyed patient will be waiting for me.
Sunday, May 15, 2011
Wrong
I recently heard an interesting presentation by the journalist and author Kathryn Schulz. In short, the talk was about being wrong. The part of the talk that most stood out to me was an analogy using Roadrunner and Wile E. Coyote. It seemed that in every episode there was that scene when the roadrunner ran off a cliff and the poor coyote followed. The roadrunner simply started flying, but the coyote kept running. And it took a few moments for him to realize he had just run off a cliff. In other words, there was a brief second when he was thought he was still running and in fact he was about to fall.
The lesson, Schulz tells us, is that being wrong doesn’t necessarily feel like that anything. Or more specifically, it feels exactly like being right.
And that got me thinking. There are so many parts of my life that could potentially turn into Wile E. Coyote moments of disaster that it’s simply terrifying. The trauma bay, the operating room, personal relationships, my faith…Am I about to fall off a cliff without even realizing it? Who is going to get hurt most in that process?
We’ve all heard that beautiful sentiment of the wings of faith: that when we come to the edge of all that we know, we must believe that we will either be given hard rock to stand on or wings to fly. Lovely – but it never seemed to happen to the coyote. How does that fit in?
Schulz argues that being wrong is fundamental to being human – it’s what makes us who we, as a species, are. She mentions that Saint Augustine – nearly a thousand years before Descartes wrote “I think therefore I am” – proclaimed “I err, therefore I am.”
I guess it’s comforting to realize that we live in a world full of mistakes, many of them our own. I don’t think it means that we have to accept them, but it does mean that, one way or another, we will encounter them. Lots of them.
I just went for a walk. It’s a lovely evening, so I figured I might as well enjoy it. I walked up long flight of steps leading to art museum and turned to gaze at the city skyline. I stared at those buildings and those lights, and as I did a warm breeze touched my face. How many mistakes, I wondered, had I made up until now and never realized it? What can I do to start realizing it before it’s too late?
The lesson, Schulz tells us, is that being wrong doesn’t necessarily feel like that anything. Or more specifically, it feels exactly like being right.
And that got me thinking. There are so many parts of my life that could potentially turn into Wile E. Coyote moments of disaster that it’s simply terrifying. The trauma bay, the operating room, personal relationships, my faith…Am I about to fall off a cliff without even realizing it? Who is going to get hurt most in that process?
We’ve all heard that beautiful sentiment of the wings of faith: that when we come to the edge of all that we know, we must believe that we will either be given hard rock to stand on or wings to fly. Lovely – but it never seemed to happen to the coyote. How does that fit in?
Schulz argues that being wrong is fundamental to being human – it’s what makes us who we, as a species, are. She mentions that Saint Augustine – nearly a thousand years before Descartes wrote “I think therefore I am” – proclaimed “I err, therefore I am.”
I guess it’s comforting to realize that we live in a world full of mistakes, many of them our own. I don’t think it means that we have to accept them, but it does mean that, one way or another, we will encounter them. Lots of them.
I just went for a walk. It’s a lovely evening, so I figured I might as well enjoy it. I walked up long flight of steps leading to art museum and turned to gaze at the city skyline. I stared at those buildings and those lights, and as I did a warm breeze touched my face. How many mistakes, I wondered, had I made up until now and never realized it? What can I do to start realizing it before it’s too late?
Friday, May 6, 2011
Souls at All
Sometimes I just have to wonder.
Consider my two most recent patients. The first is a young woman, barely twenty. The father of her child found out that she had moved on to another boy, and so he quietly followed her one night. When he saw them coming out of his house, he ran over her with his car. He crushed her spleen, caused massive internal bleeding, and broke her neck. More specifically, he caused an atlantoaxial dissociation, which is a fracture at the very top of the spinal column. It’s what we call “functional decapitation” because, while the head is still attached, it has been severed from the rest of the body. These patients don’t do well.
Another young woman – this one just over twenty – got into a fight with her boyfriend. He simply pulled a gun and shot her in the neck. The bullet managed to blow apart her esophagus and trachea on its way to implanting in her back muscles. The five-hour surgery is an indication of how long her path to recovery will be.
And when I hear stories of my friend’s ensuing custody battle, I hurt – and get sick – on a totally different level. Anger, betrayal, deceit, manipulation…words whose meanings are so painful that even typing them unnerves me.
These days, I find myself spending much less time wondering about the eternal destination of our souls, and more time asking if we have souls at all.
The world changes when you start actually entering the idea that we are soul-less, purposeful-less, utterly useless creatures here for our own devices and desires. This world sucks. I hate it. I hate living in a place full of soulless creatures.
One of my favorite places in Philadelphia is the garden outside the Rodin museum. At the entrance to the museum stands his impressive masterpiece “The Gates of Hell.” Standing over twenty feet high, it depicts humankind’s ultimate condemnation. It’s inspired, in part, by Dante’s description of the gates of hell in his Divine Comedy, with the famous inscription “Abandon hope, all ye who enter here.”
But I know I have a soul. If not, then what am I feeling, and why is it so powerful? I’ve seen in so many others, and I know (think?) I’ve felt it in my own self. I don’t think it’s just my wishful thinking. As Annie Dillard writes in her essay An Expedition to the Pole, “What are the chances that God finds our failed impersonation of human dignity adorable? Or is he fooled? What odds do you give me?”
And maybe that’s just it. Maybe we do have souls, we’re just really, really bad at knowing how to use them. And as depressing as it may be to realize we’re not quite as good as life as we may think, at least – at least – we have hope.
And that is good enough for me for now.
Consider my two most recent patients. The first is a young woman, barely twenty. The father of her child found out that she had moved on to another boy, and so he quietly followed her one night. When he saw them coming out of his house, he ran over her with his car. He crushed her spleen, caused massive internal bleeding, and broke her neck. More specifically, he caused an atlantoaxial dissociation, which is a fracture at the very top of the spinal column. It’s what we call “functional decapitation” because, while the head is still attached, it has been severed from the rest of the body. These patients don’t do well.
Another young woman – this one just over twenty – got into a fight with her boyfriend. He simply pulled a gun and shot her in the neck. The bullet managed to blow apart her esophagus and trachea on its way to implanting in her back muscles. The five-hour surgery is an indication of how long her path to recovery will be.
And when I hear stories of my friend’s ensuing custody battle, I hurt – and get sick – on a totally different level. Anger, betrayal, deceit, manipulation…words whose meanings are so painful that even typing them unnerves me.
These days, I find myself spending much less time wondering about the eternal destination of our souls, and more time asking if we have souls at all.
The world changes when you start actually entering the idea that we are soul-less, purposeful-less, utterly useless creatures here for our own devices and desires. This world sucks. I hate it. I hate living in a place full of soulless creatures.
One of my favorite places in Philadelphia is the garden outside the Rodin museum. At the entrance to the museum stands his impressive masterpiece “The Gates of Hell.” Standing over twenty feet high, it depicts humankind’s ultimate condemnation. It’s inspired, in part, by Dante’s description of the gates of hell in his Divine Comedy, with the famous inscription “Abandon hope, all ye who enter here.”
But I know I have a soul. If not, then what am I feeling, and why is it so powerful? I’ve seen in so many others, and I know (think?) I’ve felt it in my own self. I don’t think it’s just my wishful thinking. As Annie Dillard writes in her essay An Expedition to the Pole, “What are the chances that God finds our failed impersonation of human dignity adorable? Or is he fooled? What odds do you give me?”
And maybe that’s just it. Maybe we do have souls, we’re just really, really bad at knowing how to use them. And as depressing as it may be to realize we’re not quite as good as life as we may think, at least – at least – we have hope.
And that is good enough for me for now.
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