A Palindrome Birthday

The sun sparkles in my windows and alights on the forest of plants I nurture in my apartment. I’m recovering from a whirlwind trip to Oregon to celebrate the wedding of a long-time, dear friend. I stepped away from reading about acid-base disorders, electrolyte abnormalities, and the general unruliness of the kidney to write this post. Residency programs started reviewing applications yesterday; I wait for interview invites to trickle in. By this time next year, I’ll be in the throes of residency and I’m sure medical school will feel like a distant memory. But today, a few days before my 33rd birthday, I’m still in medical school.

Looking at the blue sky and the trees with leaves that are turning red, orange, and yellow, I’m reminded of the mountains that are hidden beyond the horizon of buildings that I see. The mountains are quiet from a distance, but hum with streams, wind, and birds when I embark on their paths. I’ve done 57 hikes (not all in the mountains and some trotting more than walking) since my last birthday.

This has been a long year filled with joy and determination. The number of hikes I’ve done reflects finding a balance between those two forces. Medicine consumes. Yet, since starting my last academic year of medical school, the harrowing nature of academia has dampened and the delight of caring for patients, solving medical mysteries, and contriving medical plans have returned to my lived experience. As I begin my residency interview season, I find myself thinking about life beyond school again. It’s a relief to be nearing graduation.

This year marked a big change; I got married. It’s interesting to shift from plotting my activities and setting goals to stepping back and thinking about sharing my life’s journey with another person who has their own activities and goals. To balance the individuals and the team who form a marriage is a daily endeavor. Of course, my partner and I have been unified for some time now, but something about making our union official and forever makes our collaboration seem more central to daily life.

Birthdays are my favorite time for reflection because they mark my personal new year. I looked back at the previous birthdays I’ve written about – 30 (happy and grateful), 28 (excited), 26 (seize the moment), and 25 (goal oriented). Thinking about their themes, what’s this birthday about?

When I walk along a ridge gazing out at the sky on either side or down a woodland path, I find myself quiet. Quiet in the sense of calm and content and, also, in the literal sense that there is less noise in the natural world than in the cityscape. I hope to hold the quiet I find on the hiking trail in my soul no matter what activity I’m undertaking. The hospital bustles with a din and the street outside my window screams with activity. Yet, I believe coexistence of noise without and quiet within can always be achieved; the way, however, seems as varied as the trails I’ve explored this year. Varied by person and varied by situation.

It’s fitting to focus on quiet movement as I wait to start a new life chapter, the chapter where I close the door to official school (potentially and likely forever) and open the door to learning from a new job. I love new chapters with that accentuated first letter, hopefully a quote, the foreshadowing of the chapter that just ended, and the delights hidden behind crisp pages. I can’t wait to see what this palindrome year brings. At the very least, I know it will bring change, for which, I’m grateful.

Windows to the Soul

I looked into the eyes of a patient for brief moments when they opened their eyelids before falling asleep again. Their eyes were like wells, but there was no sparkle in them like there is in a healthy person. The patient had a bacterial infection of the blood that had attacked their heart resulting in a large vegetation (collection of bacteria and other gunk) on one of their heart valves. Pieces broke off this vegetation, traveled through the blood vessels, and seeded infected clots in the patient’s lungs and spleen. That wasn’t all though. Their body was so inflamed some of the proteins in their blood were destroyed, consumed, or their production reduced. At first, the patient needed transfusions of red blood cells and platelets to survive.

In other words, the patient was sick. They were not just sick, their chance of death within 30 days increased by 16% each day their blood had bacteria in it according to one study.1 Their chance of death was about 40% by another estimate.2 It took us about a week of antibiotics to clear the infection from the patient’s blood, but that wasn’t the end of the patient’s need for antibiotics because of their heart infection and septic clots. They would need at least 6 weeks of antibiotics and likely several procedures and surgery to fix their heart.

I looked into the patient’s eyes each day, hoping to see a sparkle there that would suggest they were awakening from the depths of illness. I hoped and yearned to meet them rather than just examine their feverishness. I was rooting for them. I root for all my patients, but this patient’s eyes were so empty I knew they needed my thoughts more than the other patients I was caring for at the time.

It would take over a week, but one day the patient’s eyes shone with the flame that I think of as the soul, that spark of life. The patient was here with me. They could tell me their name and what was going on. They were awake! How the weeks ahead would unfold could not be predicted. In medicine, we don’t have a crystal ball that tells the future any better than a meteorologist can forecast the weather 10 days out.

My rotation would end before the patient was close to healthy enough to leave the hospital. They were sleepy when I last saw them because they were recovering from their first heart procedure. I touched their shoulder briefly and looked into their eyes. They were so strong and so brave. I reminded them of this and of how much they’d healed since we met. I told them to hang in there. It wasn’t much, I knew, but it was the best I could offer as I prepared to join a different medical team.

In the hospital, we often meet people at the worst crossroads of their lives. We do our best to help them navigate to a destination of better health, but we often don’t get to see where our patients end up after we care for them. We must be comfortable with unfinished odysseys. So, to conclude my telling of this patient’s story, the last time I saw the patient with the wells for eyes, their eyes shown with the brilliance of victory. I will remember them by that brilliance.  

References:

1. Minejima E, Mai N, Bui N, et al. Defining the Breakpoint Duration of Staphylococcus aureus Bacteremia Predictive of Poor Outcomes. Clin Infect Dis. 2020;70(4):566-573. doi:10.1093/cid/ciz257

2. Kuehl R, Morata L, Boeing C, et al. Defining persistent Staphylococcus aureus bacteraemia: secondary analysis of a prospective cohort study. Lancet Infect Dis. 2020;20(12):1409-1417. doi:10.1016/S1473-3099(20)30447-3