Homeward

It’s funny, being away from home.  As part of my job I stay in the hospital at last one or two nights per week.  Those nights are a mix of lots of things…so much happens at night.  With less people around there is more chance for real disaster, and it’s often here that our skills are really tested.  And of course there are the occasional slow nights – nights when we can relax a little, and reflect. 

The simple math is that I spend more time away from home than in it; the majority of my time is spent within the hospital walls.  More time is spent in the trauma bay, the wards, the OR…more energy is spent talking to colleagues, staff, and nurses…than home with my own family. 

A part of me is totally ok with that.  A large part of me is a workaholic, type A go-getter that wants to – even needs to – spend all night in the trauma bay and the OR with strangers doing what I do best.  But another part is crushed when I have to leave in the morning and know how long it will be until I return. 

I’m reminded of a story of an old surgeon sitting in the lounge between cases.  A younger doctor was also there, complaining about work.  He turned to the older doc and said, “with the way reimbursements are going, soon, we’ll have to pay to operate instead of getting paid!”  The older doctor thought about this, looked at him, and simply asked “how much?”

We love of our work.  We have to.  If we don’t treat this work with real passion, mistakes happen.  And in this line of work, mistakes translate into deaths.  And while the work gets me out of bed in the morning, keeps me up reading late at night, and gives real meaning to my life…I don’t think it will ever be everything to me.  I think home – family – will always be…more. 

It’s hard to explain, but being home brings a certain peace that nothing else can provide.  Even though it’s often chaotic, it has a certain calm.  There is such obvious purpose, such hope for the future, such…peace.  I miss it.  And I love it.  And being away from it makes me desire it even more.  As much as being at the hospital or preparing for work is a part of my life, and as much as being in the hospital feels totally comfortable and natural to me, it’s just not really home. 

Today is my last full day here at conference in Chicago.  Tomorrow I get to go back home.  

Review

My program director use to always preach this simple axiom: read as if somebody’s life depends on it, because someday it will.  It may sound a bit dramatic, but in a very real sense it’s true.  And it was that severity of our work – that true sense that it mattered – that made the endless hour of studying, the endless hours in the library, the blood-shot eyes…it’s what made it all so manageable. 

Of course, there is nothing so helpful as experience.  Just last week we were working-up a post-op complication.  I was explaining things to a concerned family when one of the daughters interrupted and said “But doctor, have you seen THIS before?  This scenario?”  I was glad I could look her in the eyes and answer that I had, and that I knew what to do, and what she might expect.

But that is not always the case.  Some circumstances are rare.  Or some are variations.  We have to be prepared to handle situations that we are less experienced in; that’s why we study so hard. 

So now I find myself in a board review course.  It’s somewhat surreal, really.  Some days I can close my eyes and surgery is still a distant dream; other days I still can’t believe how far I’ve come.  To be here, this close to the end – 2 months! – just seems unbelievable. 

But there is no romance in a review.  The most common question running around these hallways is “what is the board answer?”  Here we are not reading in the hopes that it will save someone’s life.  No, here we read with the anticipated bias of an examiner, hoping to out-guess the question regardless of how we feel about it. 

I guess it helps to stay focused on the bigger picture – I do, after all, have to pass this stupid test if I want to actually be a surgeon.  It’s just one more ridiculous hoop to jump through.

And I can take it for this too – surgeon is an immense undertaking.  It is easy to lose track of some details that shouldn’t be lost.  It’s easy to get swept away in the minutia of life, or of one particular institution’s habits…it is nice to see what others think is truly important, regardless of their motive. 

With that, I better run or I’ll be late!  Here’s hoping for a productive day.  

Less than Super

People often ask me what is the most realistic medical TV show. My answer comes without hesitation – Scrubs. I get confused looks right away, but somehow that quirky show with the lengthy inner monologues captures the spirit of what actually goes on inside hospitals.




The opening credits to Scrubs run to the Lazlo Bane song “Superman.” And the credits are timed to end with the lyrics “I can’t do this all by myself. No, I’m no Superman.”



This is, of course, not what a budding trauma surgeon wants to hear. My whole goal is to be a surgical superhero. Someone has a horrible thing happen to them, and I rush in and – nearly anonymously – fix the problem, only to fly away to the next patient, never to be seen again. A secret angel of the night.



Periodically this fantasy gets just enough reaffirmation to persist. Not long ago I was making early morning rounds with one of my co-residents when we went into the room of a lady who had underwent several large abdominal procedures. We were there to do an extensive dressing change and update her on the plan, just like we did every day before the sun came up. She slowly opened one eye, then the other, and then allowed herself a half grin – there are my supermen, she whispered, good morning! I allowed myself a little smile in return – it’s nice to be appreciated.



The only problem is that, in medicine, something is bound to come around that knocks you right back to earth. And, in medicine, that trip normally takes casualties.



It was Easter Sunday and I was on call in the hospital. I got a routine consult for abdominal pain, which quite honestly didn’t sound that exciting. The story was vague – intermittent colicky abdominal pain over several days, worsening this morning. Her labs were normal, an x-ray had some minimal changes in her intestines, but nothing crazy. Cardiology had some concerns, so she was put in the ICU and I put in a central line.



Within 24 hrs she was dead. She got really sick the next morning, and a CT showed pneumatosis intestinalis – air in the walls of the intestines, which we only see with necrotic bowel. It’s a surgical emergency, and one that doesn’t normally end well. In her case there was nothing to do. She was rushed to the OR, and her stomach, small bowel, gallbladder, and part of her liver were all dead. Her family withdrew care shortly thereafter.



Did I miss some obvious red flag? Everyone tells me no. Should I have been more suspicious and ordered the CT when I saw her? Everyone says there was no reason at that time. Are people just being nice to me? I’m not sure.



I know this much – that poor lady was dying when I saw her, and I didn’t realize it. I was her last chance at survival, and I failed at that task, the only task I had. Not so super at all.



There’s no good end to this story. A family lost their mother. I could go on and say that I’m more inspired to learn and work harder and all that, but that would just be rhetoric. I always try hard. That makes this even harder.



Perhaps the truths of Scrubs strikes again. I am not perfect; I’m no superman. I got that one loud and clear.