Doorways

Surgery Rotation Day #2:

Today was a hard day. With the recent loss of a friend and classmate settling in, I considered, like many others in my class, staying home. It felt like the right thing to do. But then I thought of this friend, of Liza, of her whispering in my ear, "Go, go now! Don't be a dumb ass!" and I put my shoes on, one at a time...

At the hospital, I drifted through rounds, I hadn't slept well last night. But then an urgent case came up. Suddenly, I was scrubbing in at the cardio-thoracic surgeon's elbow. I was all too aware that passing out in the surgical field could christen me "the fainter" for the rest of my rotation--something I desperately wanted to avoid.

But what happened next, I couldn't have anticipated: I watched mesmerized as the surgeon cut down through the skin, muscle, and past the ribs. I watched him spread the chest like a flower. I watched so many things happen there were moments when I know I wasn't breathing. And then I had a heart to heart conversation, about life and loss, about friendship and love, with the surgeon and a surgical PA....while I placed one of my hands on the sturdy bones of an elderly woman--our patient--and the other hand the surgeon guided into the woman's chest. He urged me to feel her heart beating. His own face was one of utter amazement. No matter how many times I imagine he has done this I still heard him whisper, "Amazing." And I placed my palm there--where all of the life and memory and meaning of this woman's vivid and unique existence coursed through her.

I didn't faint. I didn't even blink. What I did do was something I have only done a handful of times in my life--I fell in love. It is true, it really is: The human body is a masterpiece, inside and out. Dear Surgery, who would have thought you would make me feel this way?

And, most of all, thank you, LB, for helping to get my ass out the door.

Stepping Up to the (Surgical) Table

You know the student in high school biology class or in college anatomy class who was “the fainter”? Professors and students alike usually joked openly to this unfortunate student, “Hey, looks like you’re not going into medicine!”

Or what about the girl at the plasma and blood donation center trying to make a few extra bucks to get home for Christmas? This college student is stoic, determined, watching a movie along with everyone else, thinking maybe she is okay with this blood stuff after all. But then when that large needle withdraws plasma from her body, to be fed through a machine and then circulated back in—and that blood comes back in cooler than when it left—well, this girl faints clear off the table, taking the needle with her, and causing a hustle and bustle clinic-wide. The clinic director may have still given her $30 for her time but told her it’s probably best not to come back again…ever.

Or, lastly, perhaps we all have that friend who cuts her fingers pretty badly on a sharp drawer handle in the comforts of her own apartment. She calls to her roommate for help and by the time he arrives from the front room 3 feet away she is already on the floor with a spurting hand settled in her lap…

Well folks, that student, that girl, that friend, she is me. And, now? Well, now—as in tomorrow—I will descend into downtown Seattle at the crack of dawn for my first clerkship after a 4-month stint in family practice, and that rotation is in surgery.

This is the rotation that I have most anticipated, most dreaded, most futzed over, and now almost feel ready for? During my training at PA school I was proud of the venipuncture I was able to do, the stealthy suturing of incisions we made on grocery store pig's feet. During my clinic experiences I’ve been honored to perform incision and drainages on enormous abscesses and found, surprisingly, that I looked forward to these procedures. I was able to suture a laceration across a man's palm that went clear down to the bone. I have seen a few things, and I’ve only swayed and sweated a few times. 

But an abscess, a cyst, and a mole removal – even I know these cannot be compared to the extreme awe and utter amazement of opening up and cutting into a human body.

I have no idea why I get so faint, but think it may have something to do with my keen and overactive imagination. I have been told to look at the operation but not look at the operation; I have compression stockings, food, water, I’m going to ask for a chair, try not to get knee deep too soon, and most of all, try to enjoy this phenomenal experience before me.

I’m not privy, yet, to the surgeries I’ll scrub in on tomorrow. But, in a mere 15 hours I may be ecstatic, thrilled, horrified, or passed out cold somewhere in the OR suite (I already know not to fall forward, into the sterile field or, worse yet, onto the patient!) I’ve had well meaning friends offer me propranolol, give me fake skin to practice suturing on; I’ve spent hours watching the goriest YouTube videos I could find...

And then today, during my harried and anxious preparation, I realized with dismay that I made a significant oversight. I thought about something I hadn’t thought about before: I know, for a fact, there are at least a handful of people in Seattle tonight who are even more nervous than I am. 

It always comes back to the patients, doesn’t it? 

The Freedom (To Make Mistakes)

I’ve had a long day. As I ride the bus home sitting amongst others, with their own long days--with that dizzying numb glare on most of our faces--this cherubic little boy with the most phenomenal set of blond curls I’ve ever seen, stomps onto the bus and stammers all the way to the back, his dad in tow, yelling, “I don’t worry, I don’t care, I’m not wearing underwear!”

And while most of us chuckle, I wonder what would happen if an adult stomped onto the bus and did the exact same thing? What is the real difference that allows this adorable child to get away with this in the first place?

The answer is simple: Freedom. The freedom to make mistakes. When we were young we made many. That was how we pushed boundaries, figured "right" from "wrong." I personally appreciated that the dad didn't scold the boy but instead smiled himself. Soon enough his son would learn to sit still, with a dazed face, after his own long day. 

Tomorrow marks the end of my 4-month family practice rotation and while I am ready to move forward and learn the next aspect of medicine, I’m going to miss the camaraderie of my clinic. The next time I set foot in a family practice clinic I may actually be the practitioner, and then the room for error narrows.

But right now, and throughout the last 4 months, I’ve had the luxury of making mistakes. Of yelling out a wrong answer, of asking for help (over and over) with a procedure, of backing up my provider’s entire schedule because I misheard a critical piece of information from a patient. That last one was a hard mistake to get over. 

I’ve nearly fainted during my first incision and drainage of an abscess, and felt fairly nauseas until the patient grabbed my hand to help keep me steady.

I’ve been so enthusiastic to see my first hemorrhoid that the patient probably thought I had some kind of fetish.

I've been so sleep deprived from staying up late studying that I’ve left my house at 6am, dressed for success, in a nice sweater and thick black stockings, only to realize several blocks from the bus stop that I forgot to put my skirt on over them.

And, best of all, there was a day not too long ago when the mother of several children--who's son happened to be my patient--told me I'm one of the best "doctors" she's ever seen. That was a huge compliment given that the mother also had a few scars and undoubtedly had seen her share of medical providers herself, not to mention all the docs she's seen for her kids. Thankfully, this glorious compliment was received several hours before I inadvertently ingested too much of a key ingredient in cough syrup and remained loopy, dizzy, and with somewhat of a cough syrup "hangover" for the rest of the day. I couldn't see patients on my own. One of my pupils became extremely dilated. I apologized a dozen times, giggled, and may have told a distasteful joke. I saw my preceptor roll her eyes...twice.

I guess my point is, I’ve made mistakes and all of the wonderful teachers around me for these last 4 months have let me. Soon after, they've helped me not make the mistake again, and assured me that they were once students too and overwhelmed and excited by medicine and some of those first procedures and patients. 

So when I saw that small child after my long day, without a care, singing about not caring, not worrying, and maybe not even wearing underwear (what does it even matter?), I was reminded of how so many of us are like children. We are always learning, falling, and hoping someone will catch us, help us up and give us another chance to do it right. And while in medicine there is little room for actual error, there should be room, always, for playfulness and humor, no matter how long the day has been.

For the Animals Among Us

I swear I have funny things to write about and I will get to them, soon....but, just yesterday, my mother lost a best friend. And just last week I spoke with a patient who lost hers. The patient told me she has never experienced such loss and asked, "Is this what a broken heart feels like? Because if it is then I never want to love again."  

I read something this morning on a friend’s Facebook page that struck me. I've always been of the persuasion that if something affects me--and it could be a positive or negative affect--then it's worth paying attention too. Some things don't affect me at all and that's a good thing because none of us have nearly enough time to be affected by everything in this world. But breaking hearts, those affect me. What I read on this friend's page was something about fear and then stopping to think about being on a spinning planet and how scary is THAT!! So, even if we don't already have a healthy fear of enough already - we can think about the fact that we are spinning madly on a planet in a solar system so large none of us can comprehend it. But, I digress...  

My patient wanted something for her broken heart, was nearly demanding it, as she fought back tears. All of 25 years old, she'd just had to put down her chocolate lab, Gusto. He became sick so suddenly, she said, there was nothing that could be done. At 10 years old he'd lived a long life for a lab, a good life. Still, she hadn’t been able to go to work since, couldn't stop crying, was irritable with friends and family. Not yet the recipient of unrequited human love or a nasty divorce or the death of a loved one or even just lingering in an unbearably broken relationship, this furry animal was the first real loss she had ever experienced. And so I grabbed the Kleenex and talked her through the stages of grieving. Because they look remarkably similar - no matter the loss. Denial. Anger. Bargaining. Depression. And, finally, acceptance.

And then yesterday, when my mother called me at 10am my heart sank, because I knew why. Her cat, Tanner—the “Tan Man”—was gone. As so often happens with animals, because they can’t tell us what is wrong or even if something hurts deep inside, by the time we figure out what is ailing them, it is often too late. And so I listened, all the while feeling my own heart bend. I clutched my pets a bit harder throughout the day—my study companions, the ones who tear up my notes and endlessly want to play, and sleep as close as they can to me at night knowing that I toss and turn like a mad woman. I held them closer because they teach me about love—and how humans love, and also about how we fail sometimes at loving, because of fear.

So, if you hesitate with your heart, think of this: We are—each one of us—sitting on a swiftly spinning planet, in the middle of a vast and dark universe, probably careening towards some unknown demise hopefully millions of year down the road. Scary! But love? No, love isn't scary. 

To paraphrase the poet Mary Oliver: …To live in this world you must be able to do three things: to love what is mortal; to hold it against your bones knowing your own life depends on it; and, when the time comes to let it go, let it go. 

You will be missed, Tan Man.  

In Great and Utter Awe

I’m going to write about this because it’s something I’ve done before and it involves the funeral of a small animal on a sunny day while the rest of the world buzzes by.

I didn’t want to see the seagull stuck to the median, crumpled in a dusted heap between two rushing lanes of traffic. But I did. I always seem to notice the suffering. Because of the body’s location, it was going to stick there until a torrential rain washed it away or a street sweeper, in spring, flung its body free. So I stood, as I so often do, and thought about my life.

           

And my life right now is a bit chaotic. I was talking to a classmate this morning about our clinical year—about how terrified we are to be pushed into roles we are both excited and unprepared for. They call this the “imposter syndrome" in medical school. Because we spend a lot of time wondering: Will the school, my preceptor, or the patients discover that I don't know enough? 

I’m in my family practice rotation; my friend is in internal medicine. She told me nothing has humbled her more than internal medicine. Where doctors walk around like “medical encyclopedias” and the patients are so complex it’s hard to know what medications are helping them and which are causing more side effects. My internal medicine rotation is still somewhere down the road and I got a bit panicked by her panic.

Then I realized this is the response we should have. We should be terrified. We should be in awe. The field of medicine is enormous, intricate, but nowhere near fine-tuned. To have anything but a healthy fear for what I am attempting to accomplish would be absurd. There are so many things aside from medicine that heal and even if we don’t always know the exact lab to order, dose to give, or diagnosis to hang our hat on we can always fall back on something we do have to offer: Kindness. It has been shown that human kindness--holding a hand, extra attention, empathy--has the ability to help patients heal faster, sometimes with absolutely no biological or scientific explanation as to why. 

And that brings me back to the seagull, because even though I whispered, “I’ll come back for you tomorrow; I’ll move you to the bushes where you can rest in peace”, I couldn’t leave. It’s not ethical to compare birds to humans but the sentiment is the same—we all deserve to receive the simple act of kindness. So I sprinted back across the two lanes of traffic, grabbed a plastic bag near a garbage can, ran back, waited for honking cars to pass, and collected up what I could. As I ran back across the road, I wanted to cry not only for the absurdity of my act but also for the beauty of giving this small creature a final resting place. Under a tree, facing Green Lake, with a mound of dirt on its chest.

        I told my friend this, my internal medicine friend—and she is the friend I also count on to cheer me up, chuckle at my antics, encourage my wayward ways even if she doesn’t understand them. She is one of the many partners in crime I have through this medical maze—and she surprised me, for once, by not laughing.  Instead, she paused, gave a heart felt sigh and said, “You know, the world needs more people like you." 

R.I.P., Dear seagull, and thank you for the lesson.