ndab Ah Yes, Medical School: County Potential

Friday, September 09, 2005

County Potential

Three patients. Three stories. One consistent path. All roads leading towards the same end-game, each in a different way, but each with a similar final tragedy that has already revealed itself, or will do so very soon more likely than not. As I reflect on my last three weeks on the vascular and trauma surgery teams at one of my school's county hospitals, I would like to set aside my usual mildly humorous ranting and excessive self-parody, and in it’s place write about three patients that affected me deeply, each serving to teach me about what doctors (and society for that matter) really face on a daily basis:


During the first week of my service, our team was called to consult on a four year old female patient who has been sporadically and incompletely treated for childhood leukemia, presenting to the emergency department during a blast crisis at the sickest time, in the most precarious position, and with the least chance for survival. When we saw her, she was in the pediatric ICU, with at least four different tubes running in and out of her, and her mom sitting anxiously at her bedside. She had just survived a crisis with the quick administration of blood pressure drugs, but an unfortunate side effect was that the persistent blood vessel constriction so severely decreased the blood flow to her extremities that her petite legs were darkened up to the knees, her hands darkened to the wrists...

I was assigned to one patient a few days ago, a 17 year old male who ripped apart his radial artery and some of the tendons to his hand after punching through a glass window. When I first met him, he was in the ICU, having been operated on throughout the night to restore and preserve as much hand function as possible. He was mildly sedated, but not so much that I couldn't sit down with him and talk about what had happened. He had a bad day. He could not find his keys to the house. He had to use the restroom extremely badly. So what happened next? I punched through the window. After being transferred to a regular bed and being reunited with his family and girlfriend, this patient became a lot more animated, now proudly displaying a beaming smile plastered across his face, much more glimmering than the soft cast plastered across his arm. He could not move his thumb, he could not sense touch on his thumb or first finger, but with the attention he was receiving, he hardly noticed...

The ER bell rang and a cacophony of pagers went off. "GSW [Gun shot wound] times two to the back, times one to the neck." An urgent trauma was on its way, and the trauma team and its adopted medical students for that night's call began preparing the tools necessary to resuscitate this patient. Then came the next message. "ETA [Estimated time of arrival] 15 minutes." 15 minutes? The man had been "found" on the street after a supposed gang altercation, brought to our trauma center because the previously closest center to him had been shut down recently due to cost concerns. After that second message sprayed through the room, everyone's tension level decreased. No chance. No stress about messing up the opportunity to save someone’s life, because this life had already passed. About 15 minutes later, he finally arrived, and the standard resuscitation procedures ensued. Chest compressions, breathing, two attempts to shock the heart. The attending physician pointed out to us the abrasions all over this man's legs, indicating that he had likely been run over by a car multiple times. This man's blood started pooling on the floor of the ER, seeping out his back while a nurse frantically pushed on his heart, one beat at a time...

After examining the extremities on the four year old with leukemia, the attending physician looked at us, then said rather bluntly, "It's all coming off." Auto-amputation. This child's legs, blackened by an acute case of severe lack of blood flow, were becoming necrotic. Her body would soon recognize this process and wall off the dead tissue over the course of the next few weeks, culminating in this poor child’s extremities literally falling off, without the aid of any knife, scalpel, or blunt object. This child, sedated and unaware of her fate, slept peacefully in her bed. Her mother, upon hearing the news, looked out the window and cried, too ashamed and afraid to look any of us in the eye while the tears rolled quickly across her tired eyes, knowing full well that had she been able to take her sick daughter to the hospital more frequently, more urgently, this fate might have been prevented. The attending walked out of the room, and our chief resident instructed us to clean the dead legs and arms still attached to her body and bandage these wounds as if there was still a fighting chance for their survival. What choice did we have? What chance does a leukemic child with no legs have? We carried out these orders, more for our own peace of mind than for the patient or her mother.

The next day, I went to sit down with my window-breaking friend one more time. Except when I walked in, I found his girlfriend in bed with him. They were cuddling. I apologized for the intrusion, but explained that I needed to do a quick exam as part of my daily routine. While doing the exam, I asked this 17 year old what he was planning on doing with himself. Finishing high school? Plans for college? Any ideas to avoid punching out windows in frustration again? None. He had everything he needed: his friends, his girl, his right hand in due time. Discharged that afternoon, he was back on the street that evening.

20 years old and three bullets to the back and neck. It didn’t take long before the attending physician waved his hand in a back and forth motion across his own neck. This man was dead. Likely dead on arrival, surely dead shortly thereafter, and absolutely the first person I have ever witnessed die right before my eyes. However, it was his eyes that struck me most – his eyelids were still open and I could see for the first time that glazed look of death, with one eye rolled in one direction, the other pointed in a completely different direction, and neither with any purpose whatsoever. The doctors quickly scrubbed out and moved on to see the next potential surgical patient in the ER, but I stayed to watch as the nurses carefully removed the tubes forced through this man’s body in an attempt to save his life just minutes before. They then took off the blood-soaked sheet under him and replaced it with a clean white sheet, which they draped over his body and face before wheeling him out of the ER and into a storage room. Unidentified upon arrival, he was just another pulseless John Doe, lying forever peacefully while waiting for a tearful family to discover him one last time.


Three weeks at a county hospital on a surgical rotation and I can finally say that I have received my first taste of what real life medicine is all about. There have been plenty of funny moments, some that would be more than appropriate to share in this forum. There have been some truly touching moments for me personally, as I have followed some patients from surgery to complete recovery. But thinking about these last three weeks, I could not shake the lasting impression these three patients made on me, because each was young, and each came to the hospital in a state that would have been totally preventable had the circumstances of their lives that led them to this point been even slightly different. Instead, their potential was cut short, or would most likely lead them down a shortened path in due time.

So many people think that medical professionals have a simple goal to make people who are sick become healthy again, but as I am just beginning to appreciate, it is far more complicated than that. How do you change someone who shows up almost literally on a deathbead, having never seeked out medical care before, with no means or access to any basic health care in the past? Where does one’s own potential, developed from years of upbringing in a certain environment, around certain people, and with certain predispositions, come into play, regardless of any intervention the best doctors in the world could come up with? I am not going to pretend that I have any clue what the answers to these questions are, and I am not even convinced I am asking any or all of the right questions in the first place. Perhaps it is a complete lack of sleep that has taxed my brain in this way and led to this rambling of a post, but I find that I can only sit here and vent my frustrations about what I have seen, that I cannot even go to sleep in spite of my exhaustion until I get my anger out in words.

As it stands, I can only hope that in a public health care system so obviously set up for failure, there are enough successes to make us feel good enough to continue treating these patients and get through the day. That there are enough treatable patients to make us feel like we are actually helping people reach their full potential.

9 Comments:

Anonymous Leah said...

It's funny because as I read this I starting thinking about how a lot of the babies eyes in NO seem empty. It bothered me that these little kids seemed to have lost trust.

The system failed them too and I worry that, like with your patients things are only going to get worse before they (maybe) get better

Hope that makes sense

2:10 PM  
Anonymous Anonymous said...

I was at a Shabbat dinner last
night and the featured Rabbi
speaking about happiness in a
messed up world "don't concern
yourself with things you have no
control over; do your best, give
a full effort at what you have
chosen to do"

7:45 PM  
Blogger Sarah said...

You're hilarious! I love your sense of humor and your site. I'm a nursing student in Hawaii. I got a laugh (and fright) hearing about some of the things I'm in for :)
Good luck,
Tina

12:00 AM  
Anonymous Anonymous said...

I only recently discovered your blog and I enjoyed it so much that I went to the beginning and read all of the posts in order.

I was going to wait until I finished the most recent as of today (10/8/05) to post a comment telling you how much I loved your writing. I agree with the comments that you should pursue writing professionally. As soon as you finish med school, send a query letter to a whole bunch of publishers. Your request for an offer to have your blog published will very likely be answered. It's not unprecedented. And then, please, immediately begin another one on being a doctor. And get that one published every few years. Like you've mentioned, it's cheaper than therapy. And we just love it.

Still, as hilarious as I find almost all of your posts, this one is a very powerful addition. In the midst of all the laughter, it is incredibly moving.

I’m a little puzzled, though, that there seems to be an element of surprise. Surely, you must have expected to encounter situations of this nature? After all, you’ve watched “ER”. And no one of your age can be unaware that there are way too many incidents of needless suffering, unnecessary tragedy. Also, one can only imagine that there will be many more experiences at least as difficult through the rest of your training and your career. Wasn't one of your posts about how "relative" these things are?

You seem to be a person of strong faith. I wasn't always, so I'm maybe just learning what you have known for years. But, as far as questions and answers go, maybe you just need a little reminder. Do the best you can and, when you reach your limits or recognize your helplessness in any given situation, turn it over to God. As mentioned in a previous comment, there are things we have no control over. Acknowledge it and pass them along with a request for attention.

The more faith became ingrained into my daily life, the more sensitive I found myself becoming to the suffering of others. And, at first, I just didn't know how to cope with it. Almost every night I would hear something on the news that would hurt my heart and make me want to cry or scream out in rage. And, of course, the magnitude of suffering in the wake of Katrina is almost unfathomable. Having grown up on a Louisiana bayou and driven countless times along the Mississippi coast, it was particularly horrifying to me. I went to college in New Orleans.

Every time I started to feel overwhelmed by sorrow, grief, despair and/or anger.... which was almost by the minute during those first several days of being glued to the TV.... I would just ask God to help them. It seems so simple, so obvious, but I had never really been in habit of praying for specific strangers until recently. It’s amazingly effective in dealing with the helplessness that is underlying all the other painful emotions. Although there is much made of the “God complex” of doctors, I’m sure a sense of helplessness is a very familiar companion.

There's only so much we, as mortals, can do. For me, "God help them" is not just a reflex phrase anymore. "Dear God, please help them" is my most frequent and fervent prayer.

You only hoped for “enough treatable patients to make us feel like we are actually helping people reach their full potential”. That certainly seems “doable”. What you’ll likely sometimes get in addition to that, though, is success when you expect failure and vice versa. “God have mercy on him/her/them” is my second most frequent, but every bit as fervent, prayer.

I find peace in immediately turning over everything that is beyond me. I hope you will too.

It would be a shame if you let any feeling of helplessness turn into hopelessness. There's no reason for that. We are weak, we are imperfect, we are capable of making mistakes of enormous magnitude. No one knows that better than God. He loves us anyway and continues to give us innumerable chances to do better. Let Him help you. He's right there, waiting for you to ask.

I know this was long-winded and I really did not want to be "preachy". I just wanted to help, even a little, if I could. I hope I did. I sincerely wish you all the best.

Rebecca

11:16 PM  
Blogger SPC said...

This older post is so much more serious than the newer ones. What did they give you? Prozac?
The answer to your questions of humanity's condition are not simple, but I can tell you from my own experience that there are not all victims. Some are volunteers that you come in contact with in ER and if they make it, you will see them over and over again.

5:33 PM  
Anonymous indiadoc said...

i can quite get the picture.i am studying medicine in india.things are very much the same here although such a HUGE amount of government money goes into public health care.mostly its the patients who don't care about themselves.the govt pumps so much into TB treatment regimens and most of the medicines are given out free for those who cannot afford them.but i often see these people come back after a year because they discontinued treatment in a month.then we break our heads about how to solve his drug resistance problem.and then we once had a patient with a MASSIVE scrotal ulcer...14*10 cm.he hadn't the slightest care about it.
fakedoc,despite all your raving and ranting about medschool i understand you are a nice guy.remember what can happen to a 'wounded physician'.

8:18 AM  
Anonymous indiadoc said...

i can quite get the picture.i am studying medicine in india.things are very much the same here although such a HUGE amount of government money goes into public health care.mostly its the patients who don't care about themselves.the govt pumps so much into TB treatment regimens and most of the medicines are given out free for those who cannot afford them.but i often see these people come back after a year because they discontinued treatment in a month.then we break our heads about how to solve his drug resistance problem.and then we once had a patient with a MASSIVE scrotal ulcer...14*10 cm.he hadn't the slightest care about it.
fakedoc,despite all your raving and ranting about medschool i understand you are a nice guy.remember what can happen to a 'wounded physician'.

8:21 AM  
Anonymous pimp ass new surgery resident said...

I thought you were just some greedy tool who didn't care about the patients' well-being, but you have totally redeemed yourself.

Some people you just can't help, but you try anyway because if you don't, who else will? That's why we're here. Keep up the fight.

9:43 PM  
Blogger sexy said...

情趣用品,情趣用品,情趣用品,情趣用品,情趣用品,情趣用品,情趣用品,情趣用品,情趣,情趣,情趣,情趣,情趣,情趣,情趣,情趣,按摩棒,跳蛋,充氣娃娃,情境坊歡愉用品,情趣用品,情人節禮物,情惑用品性易購,A片,視訊聊天室,視訊,視訊聊天,視訊交友網,免費視訊聊天,聊天室,UT聊天室,免費視訊,視訊交友,免費視訊聊天室

免費A片,AV女優,美女視訊,情色交友,免費AV,色情網站,辣妹視訊,美女交友,色情影片,成人影片,成人網站,A片,H漫,18成人,成人圖片,成人漫畫,情色網,日本A片,免費A片下載,性愛

A片,色情,成人,做愛,情色文學,A片下載,色情遊戲,色情影片,色情聊天室,情色電影,免費視訊,免費視訊聊天,免費視訊聊天室,一葉情貼圖片區,情色,情色視訊,免費成人影片,視訊交友,視訊聊天,視訊聊天室,言情小說,愛情小說,AIO,AV片,A漫,av dvd,聊天室,自拍,情色論壇,視訊美女,AV成人網,色情A片,SEX,成人圖片區

情趣用品,A片,免費A片,AV女優,美女視訊,情色交友,色情網站,免費AV,辣妹視訊,美女交友,色情影片,成人網站,H漫,18成人,成人圖片,成人漫畫,成人影片,情色網


情趣用品,A片,免費A片,日本A片,A片下載,線上A片,成人電影,嘟嘟成人網,成人,成人貼圖,成人交友,成人圖片,18成人,成人小說,成人圖片區,微風成人區,成人文章,成人影城,情色,情色貼圖,色情聊天室,情色視訊,情色文學,色情小說,情色小說,臺灣情色網,色情,情色電影,色情遊戲,嘟嘟情人色網,麗的色遊戲,情色論壇,色情網站,一葉情貼圖片區,做愛,性愛,美女視訊,辣妹視訊,視訊聊天室,視訊交友網,免費視訊聊天,美女交友,做愛影片

av,情趣用品,a片,成人電影,微風成人,嘟嘟成人網,成人,成人貼圖,成人交友,成人圖片,18成人,成人小說,成人圖片區,成人文章,成人影城,愛情公寓,情色,情色貼圖,色情聊天室,情色視訊,情色文學,色情小說,情色小說,色情,寄情築園小遊戲,情色電影,aio,av女優,AV,免費A片,日本a片,美女視訊,辣妹視訊,聊天室,美女交友,成人光碟

情趣用品.A片,情色,情色貼圖,色情聊天室,情色視訊,情色文學,色情小說,情色小說,色情,寄情築園小遊戲,情色電影,色情遊戲,色情網站,聊天室,ut聊天室,豆豆聊天室,美女視訊,辣妹視訊,視訊聊天室,視訊交友網,免費視訊聊天,免費A片,日本a片,a片下載,線上a片,av女優,av,成人電影,成人,成人貼圖,成人交友,成人圖片,18成人,成人小說,成人圖片區,成人文章,成人影城,成人網站,自拍,尋夢園聊天室

8:55 PM  

Post a Comment

Links to this post:

Create a Link

<< Home