Day 1

Welcome to my blog- which is really a brief daily journal of my life as a young doctor in training. I am a fellow in a Boston academic teaching hospital. I am in my 12th year of training including college (4 years), medical school (4 years), residency (3 years) and now fellowship. I make less money than most of my friends. I have very little time for my family or friends- but I love what I do, and I care about my patients and learning as much as I can in order to be a well-trained physician. (More on this another day). For now, let me give you a flavor of what to expect from this blog:

So tonight I was called to see a consult on a man in the intensive care unit (ICU). He has chronic pancreatitis from alcohol use and frequently comes in and out of the hospital when he decides to drink himself into a stupor. But this admission was different. He presented with his usual nausea and vomiting, which the medicine team treated with various medications- but on the second day of the hospitalization he felt weak, fainted while walking down the hall, and quickly deteriorated into a cardiac arrhythmia (heart was beating very irregularly) and subsequent cardiac arrest (Code Blue). He was stabilized by a rapid response team and placed on a ventillator. (Yes, the stuff we see on TV does actually happen every day in hospitals.)

I was called to see him in the ICU to help the many teams caring for him decide what was next. But soon after I arrived it became clear to me that everyone was watching him through tunnelled glasses. The pulmonologists were busy deciding whether or not he had aspirated his blood and vomit during the cardiac arrest. The kidney doctors were worrying about the state of his kidneys and his ability to clear toxins from his blood in the form of urine. The cardiologists were worried about the state of his heart. The surgeons were concerned about blood surrounding his pancreas. But all I saw was a dying man. Only 42, this guy- but certainly dying. Doctors were scurrying about- charts in hand. Some were arguing quietly outside the room. A med student was pushing gently on his stomach. Tubes and lines dangled from him like tangled fishing lines. I was there to push and pull and write my note and take part in this giant random production, and I did so reluctantly. But all the while I was mindful of the inevitable truth to this alcoholic man: he would be dead by tomorrow, and there was nothing we could do to stop that. No medication. No surgery. No hail mary pass. Nothing.

The secret of medicine is that when you step back from the room, and look at the big picture, you see amazing things. Everyone is often working separately- but together there is a symphony of ideas. Everyone had the same goal today- fix this man. But no one can do more than their part. It's like the 5 minutes before a show- when each instrument is tuning up- and the cacophony of sounds that fill the air are somehow exciting and make sense even though the notes are random and out of sync. So rarely, however, does anyone step back. That moment, in American Beauty- when Kevin Spacey lies dead at his kitchen table and Wes Bentley's character (Ricky Fitts) stares into his reflection in a perfect pool of still blood- that is the moment we need to capture more of. There is, I have no doubt any more, beauty to be found in death. There is a natural, inevitable, silent awe that overtakes you. The first time a patient died before me I was terrified. Eventually I realized that it is the one absolute guarantee in life, and the one moment that is unique in every way to each person. The day I made that realization I stopped fearing death altogether.

So my patient will not live through the night- but I gained something valuable from meeting him- in the saddest of circumstances, and for that, I will forever be grateful. Now off to sleep- I worked many hours past the rules this week (they say 80 hours is appropriate- but get mad at us if we clock 81) and I'm tired.

Ask me questions- send me thoughts- I'd love to hear from whomever is out there.

'Night