"Nothing is
permanent in this wicked world - not even our troubles."
- Charles Chaplin
It was my last
Friday on the wards for this go-round, the last day our current two teams would
spend together before all the non-interns switched over. And from noon onward,
it turned into an emotional roller coaster I struggled to navigate.
Code Blue, ICU. Code Blue, ICU.
My attending and I
were on our way down to the ER to see a new admission when a code was called in
the ICU. The ICU staff is the rapid response team, so typically the floor
doctors don't descend en masse; a few people headed over there while we two
continued our trek downstairs.
Our admission was a
very elderly lady with late-stage Alzheimer's who had fallen victim to a
vicious infection and recently stopped eating. Her family had made her 'comfort
measures only,' and she was being admitted for gentle care until hospice
services could be put in place for her to receive care at home.
Spindly fingers. Raspy breaths.
Vacant eyes.
Her room was crowded
with family and her caretakers. Her presentation, from so many angles (minus
the infection), bore strong echoes to my grandfather's last days. My attending
spoke to the children as I held her hand, thinking back to when I last saw him,
similarly cachectic and lost to the world in all ways except for the air his
lungs still pulled in, the blood his heart still labored to pump.
After talking to the
family and the ER doctor, we made our way back upstairs. Just as I was settling
into my seat to work on her admission orders, a second code was called in the
ICU for the same patient. They needed more hands on deck for CPR, and several
of us rushed over.
1--2--3--4--5--6--7--8--9--10-- x 2
minutes
The patient's room
was the one right next to the room where my patient's harrowing code had
occurred one month ago, when I was working in the ICU. Half of the staff was
the same that had been present that day. When I was struggling in the aftermath
of the code last month, one of my medical school mentors told me, "Events
like that tend to stay entrenched in your memory for the rest of your life.
You'll always remember the details." It's only been a month, too soon to
extrapolate to a lifetime, but I had flashbacks that Friday in a way I never
had before. But there was no time to indulge (there
rarely is); time to be present.
After some time, the
family asked us to stop, and the code was called. Those of us who had come to
help trudged back to the wards with a heavy heart, back to the grind of work.
My resident had finished the admission orders for me, and I began the admission
note. Soon after, my pager went off -- please
call radiology.
Peritoneal carcinomatosis.
Subcapsular splenic lesions. Periaortic lymph nodes.
They had CT scan
results back for another one of my patients, a sweet, feisty elderly lady who
had come in with intractable vomiting and unintentional weight loss. The
results were grim. She had widespread metastases, likely related to a past
cancer for which she had undergone treatment years ago.
I called her primary
care doctor to give him the update. He came by the wards within the next hour,
and we went to deliver the somber news to our patient. She took it in with her
usual stoicism, giving little hint as to how she was feeling, and little room
for us to explore that with her.
Olé!
What was left of the
day went toward tying up loose ends and finishing paperwork. And was then
followed by the final jarring event of the day -- a celebratory two-team dinner
to feast to our time together, which had been scheduled since several days prior.
I wouldn't say I ran
the full spectrum of emotions that day, because mostly I wallowed at one end of
it, and had to play-act at the polar opposite end for the final few hours of an
otherwise exhaustingly mournful day. There were too many echoes in speedy
succession -- of my grandfather, of my ICU code, of my first medicine patient I
had as a third-year medical student, who happened to be the first patient I had
to break the news about cancer to, and the first patient I had transferred to
the ICU, only to see him die a slow, sad death there.
Somehow that Chaplin
quote seemed to belong with my memories of this particular Friday. When I was
an MS-III with my first patient with newly diagnosed cancer, while
simultaneously struggling to process my aunt's sudden and tragic death, my
intern at the time would say, "This too shall pass." And more
recently, as I struggled through that Friday, and some of the days leading up
to it, another mentor/friend told me of her dance party with her adorable son
to Taylor Swift's "Shake It Off."
How can we build in
time to do that? I hadn't fully internalized what a wild, visceral ride I went
on that day until over a week later. It was after I transitioned
back to an 8a-5p schedule, had caught up on some sleep, and found myself with a
two-day weekend to finally try and decompress.
There has to be a
better structure for processing, even within the constraints placed upon us by
training. How else will we stem that empathy degradation we keep hearing about?
Things to ponder. In
the meantime, if you see me jamming to TSwift, all I will say is, don't knock
it 'til you try it.
