Miracles

I really did not so much believe in miracles until one very, very late Christmas Eve night 12 years ago. You see I was a rational, clear-thinking, scientific kind of person (except for that weird superstitious streak when anyone said "this is going to be a really easy call night" - I KNEW that brought down the chaos). But I digress.

That Christmas Eve morning I was working in the pediatric ICU. There was no fellow so it was just me and a poor peds resident trying to care for 31 very, very, very sick patients. Not very holiday like but I had healthy children back at home waiting for Santa Claus so I absolutely had nothing to complain about. And there were many sad stories to tell that night but one was especially difficult.

A 3 year old girl had fallen between the bed and wall of her new bunk bed 3 days before Christmas, cutting off oxygen. She had had a full cardio-pulmonary arrest and was really critically ill. Her lung disease progressed until she was at the point of not being able to be oxygenated or ventilated. Her brain function deteriorated until she was near brain-death status. A horrible situation made worse as her parents made their final good-byes.

I took over her care that morning and was told that all treatments had been attempted and the family knew that it was just a matter of time until she died. I was told that I was to expect her death sometime in the next 24 hours. That was tantamount to saying "Don't spend much time at her bedside since there is nothing that you can do."

I was always one to believe in taking care of things that should be taken care of and knowing when to step back. Well that endless day, I could not seem, even with the best intentions from coming back to her bedside, altering the ventilator settings, putting in yet another chest tube for yet another pneumothorax, transfusing her when her hemoglobin dropped, and generally not "stepping back" at all. This was in the midst of taking care of all those other sick children as well. But no matter what, she seemed to be getting worse. Finally by 3 am, I was beyond exhaustion but strangely (for me) intent on saving her life. It made no sense to me then but I just could not stop. Something was pushing me beyond the limits that I had set for myself.

At 6am she seemed a little bit better but "was that my imagination?" I called my partner who was the real expert on ventilator therapy at 7am (boy was he thrilled to hear from me!) and made a few more changes. "Maybe I was making a difference", I thought. To make a long story short, she left the hospital 3.5 weeks later, looking almost like her old self. I will never know what pushed me that night, made me go against common judgment, but for me she will forever be my first "miracle.

Where the balloons go

Dr. K swore that if Luke had come to her ER, he would have survived. When the car he was in flipped over, the thing he needed most were pediatrics surgeons. But Luke was not brought into Dr. K's service. Instead, Luke was transferred from hospital to hospital, seeking surgeons, until it was too late.

Dr. K's son was in Luke's first grade class, and she now bore the burden of explaining why her son could no longer play with his friend. How do you explain death to a five-year-old? How do you explain death to anyone?

"But where is heaven?" Dr. K's son asked her.

"Heaven is...Heaven is where the balloons go when you accidentally let them go," she answered.

For the next two years, Dr. K's son would make her buy him balloons so that he could release them into the sky.

Old School

Use your imagination.

This picture is from one of the very first weeks of school, when we were just starting to learn about innervation and dermatomes. The moment people starting giggling in the lecture hall was the moment I knew I would love medical school.

(This slide belongs to DMC. I will tactfully refrain from naming the professor.)

Speaking of Naked People...

Today, a treat. This story comes from a REAL doctor. She's a friend of mine who is an anesthesiologist (did I spell that right?) in California. Here's her story...

"10,000 years ago in 1978, I was a MS3 ready for my 1st clinical rotation. I was actually going to be able to assess patients alone with all that amazing knowledge that I had been cramming into my poor brain. Well I could assess the patients but of course I would have to then synthesize the info into a rational description for the resident. Nevertheless I was so excited and scared. Well I was until receiving my assignment - yes the worst in my school - on the locked psychiatry ward at the VA Hospital.

But I was brave and fearless, or so I thought. So Monday morning dawned and I arrived at the locked doors ready to CURE DISEASE. Well at least to get through the day. The ward clerk buzzed me in. (Have you gotten the idea yet that this would be a MEMORABLE day?) I had my clean white coat, my little black bag and arrogance enough to believe that all that information I had recently crammed into my brain would be enough. My 1st day, my 1st patient. Woo hoo. So I walk past all these locked doors with small shatter-proof glass windows (think jail). The head nurse gives me my assignment: it was a new patient admitted during the night.Smiling, he said he would take me to the patient and let me interview the patient. Like an idiot I thanked him and walked right into the room. There I was, white coat and all, staring at a totally naked 6'2" man in a room with a bed bolted to the floor in the center of the room. My 1st patient was looking at me like he had just been given a treat. Then ensued the race of my life. Mr Sanderson (the patient) chased me around and around the bed. Each time I passed the door, I would yell, "Help!" This went on for at least 2 years - no about 10 minutes. The nurse opened the door and let me out. There I was, disheveled and panicked, facing 6 people who were laughing so hard they were crying. It was a total set-up. I was no longer an innocent. In my mind everything else would be an improvement."

How It All Started

In about one hour, more than twenty first year med students are going to invade my room for some tea and snacks, and instead of using the time wisely and studying, I've decided to finally write the story that made me want to start a blog.

(By the way, in true HIPAA fashion, I'm changing all the names used in these stories. I think I'll use Lost character names, seeing as how my newfound obsession is probably going to make me fail out of school.)

So, me and Juliet were doing a shift in the ER. And keep in mind, please, that as MS1s, pretty much all we are allowed to do is ask our patients what they have for breakfast and whether they have siblings. So, imagine our excitement when one of the residents told us to come with her while she examined a patient!

"What's he in for?" we asked.

"Rectal bleeding," she answered.

Juliet and I looked at each other in panic.

So, we walk into the little exam room that already smells. But this guy- this sweet 70 year old guy who is convinced that he got sick from eating some of his friend's soup or something- smiles at us and tells us why he's here and where it hurts.

The resident turns to him and says, "Okay, these are two medical students, and they are going to do a rectal exam."

I swear, my life flashed before my eyes.

Then, this sweet 70 year old guy drops his pants. I think I died a little.

Instead of attending to him, the resident turns back to us and starts pimping us. "How can you tell the difference between a upper and lower GI bleed? What color should the blood be? What tests do you want to run?"

Juliet and I were dumbstruck but we BSed some answers. Juliet, once she regained her composure (I was still standing with my mouth hanging open) politely told the resident that we were first years and aren't allowed to do exams on patients yet. The resident (thankfully) was like, "Oh yeah!" and turns back to the patient and tells him to pull his pants back up with total and utter nonchalance.

I was reminded of when I read Sandeep Jauhar's book Intern. He wrote about his first time doing a rectal exam- his stomach started turning and he puked into a trashcan. Right there in the room. With the patient watching.

That is so going to be me.

Practical Histology

In honor of our histology final yesterday, I've decided to make the first post about one of our microscopy slides.

I don't know about you, but to me, this slide looks a lot like a monkey wearing aviators.

Do you want to know what it actually is? It's a cross section through a penis. Ridiculous, right?



(This slide belongs to DMC, not to me!)