Woohoo! I made 3 sales!

I must admit, being an author is pretty awkward!

The book was launched this week, as many of you know. But then again, many also don’t know, because I’ve been absolutely terrible about spreading the word. That is my flaw #1 as an author: I am afraid. I tremble at the thought of anything that resembles self-promotion in any way. Instead, I expect everyone I know to read my mind and to ask me about my book so I don’t have to be the one to bring it up in conversation. Anyone who doesn’t read my mind in this way, I assume would not be interested in reading my book.

I even had a book signing! I was told a little bit beforehand about what this would be like for an unknown author. Basically, I would be sitting at a table with my pen and stack of books, and people passing by would try their best to avoid eye contact. Well, my event was part of the medical school graduation festivities, sponsored by a local health foundation, and took place at an art gallery; each of these organizations brought in guests who obviously took a special interest in the art of healing. There were three other medical students showcasing their works of art as well, so we all had families and friends in attendance. Notwithstanding the unusually safe and supportive environment, I still at times had the experience described above.

What I find so dreadful about this new experience is the constant guilt about “selling something,” EVEN THOUGH I’m donating all of the proceeds to charity and I won’t see a penny of it myself! I have loved writing and sharing my stories over the past two years, and I am extremely proud of having accomplished one of my lifelong dreams of writing a book. It was a tremendous amount of work compared to writing blog posts. But suddenly, I’ve turned from an awesome writer to a saleswoman. Seems a little counter-productive, doesn’t it?

Let me just say I’m really glad that I have a real job where I earn a living by showing up and doing what I’ve agreed to do. If my life were to depend on me selling my writing, I’m confident that I would just starve to death.

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Trauma, Death, and the Big Picture

In reading this eulogy of Steve Jobs written by his sister, I was tickled to learn that on his ICU bed, Steve was inventing hospital gadgets.
One time when Steve had contracted a tenacious pneumonia his doctor forbid everything — even ice. We were in a standard I.C.U. unit. Steve, who generally disliked cutting in line or dropping his own name, confessed that this once, he’d like to be treated a little specially.

I told him: Steve, this is special treatment.

He leaned over to me, and said: “I want it to be a little more special.”

Intubated, when he couldn’t talk, he asked for a notepad. He sketched devices to hold an iPad in a hospital bed. He designed new fluid monitors and x-ray equipment. He redrew that not-quite-special-enough hospital unit.

For the really big, big things, you have to trust me, he wrote on his sketchpad. He looked up. You have to.

By that, he meant that we should disobey the doctors and give him a piece of ice.

I just came off my first overnight call in the Trauma ICU, after working 31 hours straight. This sketch of Steve is just like the patients I’ve met this week: can’t eat, can’t breathe, can’t move, but would like to go back to skydiving ASAP.

I think there are generally two types of ICU patients. There are the vegetables subsisting on life support, and the rest are feisty. The bull-rider with multiple spine fractures insists on bull-riding again the next day, even as he struggles to sit up. The teenager, whose ATV accident required brain surgery, asks me every hour whether we can take out the tube draining the bleed within his skull: “Will it be later today? Not ’til tomorrow? I can’t sleep with this thing coming out the back of my head.” As I write this, a man whose brain is exposed by gaping holes in his head, is trying to pull out every IV and monitor and walk right out of the hospital.

It seems as though these patients have an entirely different set of priorities than their doctors have for them. We want to manage their fluids and electrolytes. We want to make sure they have an airway. We want to save them from dying of pneumonia, of ischemic bowel, of cardiac arrest. But all they want is to continue whatever they were doing that landed them in the hospital in the first place. Don’t they learn from their mistakes, and don’t they realize that they can’t live without these devices and measures we are taking for them?

But as damaging as it can be to a doctor’s ego, I get it. I don’t believe our work is more important than the lives we save. We bring out the defibrillators and ventilators to make people continue living, but that is not what I consider “saving a life.” People don’t live to have normal potassium levels measured in their blood. People live to bull fight, to dirt bike, to invent computers, to be home with their family.

Obviously the basic needs have to be met in the hospital. It can be a cruel process, and patients may not get that ice cube after they’ve already starved for days, but we take great consideration in the treatment plan and believe that what we’re doing is for the best. But after the healing is done, when bodily functions return to baseline, then what? Our story ends with the hospital discharge.

But the hospital discharge is the beginning of a longer road to recovery and life. Lots of changes and arrangements have to be made at home. The patient may be a burden to their family for a long time yet. That is why, beyond getting to leave the hospital bed, my hope is that these patients can survive to the next time they can do what brings them joy, whether it’s strapping on a parachute or bouncing their child on their knee. To me, that’s when their life has truly been saved, not a moment sooner.

Passage

A husband and wife were about to bring their baby into the world. She lay across the surgery table. He sat with scrubs, cap and mask, anxiously waiting by her side. She grinned, even as her eyes glistened with tears. He spoke reassuringly as he squeezed her arm.

They had imagined this day over and over. Within minutes, with this birth, their lives would change forever.

A curtain of sterile draping fell between her head and abdomen, separating the excited parents from the hectic operation about to take place on the other side.

It was my first day in the OR since Anatomy dissections. She looked strikingly like a cadaver, except that she actually bled—multiple suction tubes flooded with blood. The OB with a flock of residents were frantically cutting, digging, and cauterizing.

“This is the uterus,” they held up something huge and nodded at me. When they pierced it, amniotic fluid gushed out as if a hose had exploded.

From the chaos they pulled out a small bundle. The nurses rushed to it with a bulb syringe and sucked the fluid from its mouth. Then it began to cry.

The dad stood up when he heard the sound. First his head emerged above the curtain, and then a video camera pointed in our direction.

I gasped. Everyone froze. Without missing a beat, the doctor held up the baby, smiling at the camera. Nurses quickly wiped off the blood. Then they swept the baby off to a table along the side of the room, and the video camera followed.

Work on the mother resumed. Placenta out, uterus closed, skin stapled.

The whole thing only took about 20 minutes. Nothing went wrong. It was a great case for a first-time medical student. And I found it to be horrific.

Only a thin veil separated the family’s experience from ours. For them, a beautiful beginning of a new life together. For us, cutting and sewing and blood and guts. I almost felt it was out of place to say congratulations.

This is how I was born into the world of Medicine. I was thrown in headfirst, unprepared and alone. I would learn, over the years, that some of life’s most precious experiences—birth, healing, death—are gruesome. I would witness many more than my share of such moments, again and again, as part of the routine of my career. I would struggle to find the beauty in the madness of this reality. Yet I would find it.