YOLO

Heralded by screaming lights, a man was dropped on our doorstep. Sepsis. Diabetic keto-acidosis. The brink of death.

He was also cachectic from decades of drug abuse and malnutrition, and didn’t have much reserve to fight the illness. He was struggling to breathe. He looked on with hollow eyes. We knew right away he wasn’t going to make it through the night.

Because the foreseeable outcome was so extremely grim, we were upfront in asking this man exactly what he wanted from this hospitalization: How did he want to die? Would he have us pave for him a comfortable end? Or would he have us wring out every last drop of frail existence before throwing in the rag?

To our surprise, he didn’t give us permission to let him go. In previous months, his life had been repeatedly spared in hospitals. But each time, he was restored to lessons unlearned—if he was better, he was better enough to overdose. So said his family, but he didn’t believe it.

So onward we fought.

These are Medicine’s most trying moments. I have sent off many people from this world, now—always when they’re ready, and sometimes when they’re not. It’s humbling and gratifying to be the last friend in a well-lived life, the one to bestow a parting IV and hospital blanket in the final glow of sunset. It’s frantic and dissonant to be the desperate arm over the cliff, the one obliged to hang on until the last futile chest compression. So often I’m assigned the latter role by patients with too many regrets in too little time.

Miracles are doled out too, in small packages of insulin and antibiotics. This man survived to wake up tied to a hospital bed, and—this is the miracle—to think to himself, “This ain’t me.”

The next few days were excruciatingly painful. We gathered everyone—patient, family, and doctors—to have a big heart-to-heart. The man expressed his resolve to come off all narcotics forever. The family had heard it all before. The medical team decided to test his resolve by taking away his pain medications gradually. We had legitimate reason to be skeptical, as he had legitimate reason to be in pain. Every morning, I asked about his pain. The answers went from “Okay” to “It’s 8 out of 10, but I can get used to anything” to “It was more than I could take last night, but I’m bound and determined to do this.” I don’t know how, but every day his smile grew wider and he was able to walk farther. All the while, his severe joint deformities were a constant reminder of his strength in coming face to face with this pain for the first time in so many years.

He later told me of the transformation that came over him. The morning light was breaking through the blinds. He was strapped at his waist. The nurses were eerily quiet in the hallway. He thought of what we had told him, that we expected him to die from the consequences of his habit. “I haven’t been scared since I was in Vietnam crawling through the jungle. But that night, I was ready to put on my street clothes and run!”

I don’t know if all this will last. But thanks to him, I’m willing to give a second chance to many more of my future patients. I wouldn’t have believed that, with either his body or his mind, he would make such a recovery. Now I’m starting to think I’m in Medicine to be proven wrong—and, in the process, to be made better.

Advertisements

Graveyards In A Hospital

I survived my first week of doctorhood! And, more importantly, so did my patients!

During one of our orientation lectures, we were told that as interns, we are “entitled to stupidity.” Despite all that we’ve been doing the past 4 grueling years, no one expects us to know anything right now. Therefore, we should take advantage of this time to ask questions and make mistakes… you know, as long as we don’t kill anybody.

Well, that’s awkward! In any other profession, I feel like “Don’t kill anybody” would be setting the bar pretty low. Granted, outside of medicine, customers generally aren’t dying to begin with; when people walk into a grocery store, they aren’t complaining of chest pain. But I’ve read enough textbooks and passed enough exams to know how not to kill any given patient, don’t you think?!

I changed my mind at about 3AM today.

My first shift covering the hospital’s Medicine service was overnight on a weekend, after a full regular workweek. Having never even pulled a true all-nighter in college or medical school, I had no idea how this would go. At 7PM I showed up to meet my day-shift counterpart. He was holding a handful of lists, and after about 5 minutes of brief introductions, all 25 or so patients on those lists became mine. That was a chilling moment!

I took the lists, and a slow deep breath. I asked, only half-jokingly, “Are you sure you trust me with all your patients?” He said, “Of course I trust you!”

By midnight I had admitted a couple more patients from the ER, written a handful of orders, and successfully fielded several pages from nurses. I’d finally gotten used to introducing myself as “Dr. Meservy,” and I was starting to feel like it too.

At 2AM, my fellow night intern and I were sitting side by side, typing up our notes on the new patients we’d admitted. I was trying to read up in the literature about my patients’ conditions so I could incorporate good reasoning into my notes. I was constantly interrupted by the pager. Neither of us could stop yawning. We agreed that pulling a life-saving all-nighter was just about the craziest thing anybody had ever expected us to do.

Shortly after 3AM, I received 3 consecutive pages from the same nurse. A critical lab value! Something might kill a patient! After calmly telling the nurse that I would call her right back, I ran over to my senior resident and asked, “WHAT ARE WE GONNA DO?!” Together we made a slew of fast decisions that ultimately reversed the danger and stabilized the patient. This was followed by more deep breaths and more note writing.

In the morning, our management was met with both praise and criticism. We did the right thing overall, but we overlooked some minor details and we didn’t meet everyone’s preferences. In the daylight, our little mistakes became blatant. But in the moment, we were scared and tired and didn’t have much time to act. If the situation had been more critical, with less room for error, maybe it would have made the difference between life and death for that person.

This all leaves me wondering, was it in a hospital that they came up with the term “graveyard” shift? Now I know: if somebody were to get killed, this is probably how and why!