Human Side of Medicine

Not so long ago I worked a code (cardiac arrest = patient’s heart stops and they neither have a pulse nor are breathing) in the field. The patient was middle-aged and had a complex medical history. The patient’s father, visiting from out-of-town, found him unresponsive, started compressions, and called 911. We did all we could—did compressions, ventilated, pushed epinephrine and other medications, and analyzed for a shockable rhythm. As we worked the father knelt at his son’s head. The patient’s fiancée sat outside the house. As it became clear that we were not getting our patient back, my crew chief reviewed, outload, all we had done. She asked us if we could think of any other interventions we hadn’t yet done and then she engaged the father, explaining why we were going to stop resuscitation. Once we had stopped she went outside to talk to the fiancée.

As heartbroken as the patient’s family was, they were calm when we stopped CPR. They had seen us sweat over their loved one, try everything we could, and ask for suggestions. We included them in our decision to stop our efforts. We lingered after our care was done to answer questions and offer condolences. This call showed me how it is within the pauses between action that we connect with our patients.

The human side of medicine comes through when we take time to ensure our patients understand what is happening and our plan for treatment. It comes when we include our patients and, when appropriate, their family in decisions about their care. And it’s completed by taking a moment to share their feelings, whether of relief after a successful procedure or sorrow after the loss of a loved one, before we scurry on to our next case.

Amid medical histories and assessments of signs and symptoms that lead to differential diagnoses it can be easy to let the presence of a disease or condition consume our attention. We can focus so intently on the disease that we forget humans bear the illness. But, below the clammy skin and wheezing is a person with a family and life experience just like you and me. And, what the patient will remember from their time during the flurry of a medical crisis is how someone treated them. It’s the offering of a kind word or an act of kindness on the worst day of someone’s life, not just the hope and likelihood that we have a cure, that defines good medicine. I try to remember to take advantage of the pauses by offering a blanket or bit of conversation to my patients. There aren’t always many pauses in my day, but when there are I don’t like letting them go to waste. It’s in the shared moments between points A and B that we build our humanity, but we must be attentive or we’ll miss the opportunity.

Advertisements

In Arlington Cemetery

This summer we held a memorial for my grandfather in Arlington Cemetery. His name will be on one of the niches in the columbarium. He was in the Navy and served in the Korean War. The service was short and concise. I think its precision and simplicity was well suited to my grandfather who was a high school and college math professor and liked things to be just right but not conspicuous. The chaplain was empathetic and caring and the soldiers who performed the flag ceremony were on point. As we said our formal goodbyes a trumpet’s song floated in the air above us.

My grandmother used to comment how they enjoyed when I visited because I’d sit all day and laugh as my grandfather told stories. He was a particularly gift storyteller with the dry wit that ignites my science-loving and logic-focused brain. He told stories of the Navy (usually when he and his comrades were causing trouble), his struggles as a student (he went for a doctorate in math but didn’t finish his thesis because of a disagreement with faculty), or his adventures as a teacher (he had many years of teaching from which to draw).

In EMT lingo, my grandfather had an “extensive cardiac history.” When I called my grandmother after hearing of my grandfather’s passing she told me, “The EMTs who responded to my call were wonderful. You do good work.” She said that even though they couldn’t get him back. His heart had stopped and he had no cat-lives left. When my grandfather died, I’d been volunteering as an EMT for several months.

I’m still and EMT and I also work in an emergency department. An interesting thing about providing emergency medical care is that your mission is to lessen pain and ward off death, but you end up seeing a lot of both. You end up being there when medicine meets it limits and the time of death is pronounced. I sometimes wonder what the EMTs at my grandfather’s death thought. I wonder how they ran their emergency call. What did they do to make my grandmother feel like they’d done the right thing? I hope the families of my patients have the same impression when we determine it’s time to stop CPR.

I used to visit Arlington National Cemetery periodically when I lived in DC. I like cemeteries because I enjoy walking the tombs and imagining the histories of the people they memorialize. Now when I visit Arlington, I won’t have to invent my grandfather’s story because I know it. I’m a product of it. I think of him often, partly because I wish he’d send me some of his math-genius as I continue my medical studies. Mostly, I think of him because he is one of the few people I know who successfully and completely built a life he loved. His only unfinished business is the family he left, especially his wife, but we’ll join him again one day if afterlife exists. Until then, we’ll keep making stories worth telling just as he always encouraged us to do.

Photo Credit: Mary Lou (family friend)

Night Shift

A few months ago, I started working the night shift in an emergency department (ED). Those who have known me awhile were surprised that I decided to work owl hours. When no other forces are at play, I happily get up at 5 a.m., even 4:30. Until I took the ED job, I got up early to study or run before going to work. In college, I worked the opening shift at Starbucks. In high school, I got up to work out or study before my sibling hooligans stirred. I love the stillness of dawn before most people rise. Growing up, I saw deer, foxes, and herons in the gray hours of misty summer mornings. I like the dampness of dew on the grass before it’s evaporated by the sun. I enjoy watching the sun creep over the horizon as I listen to the bird songs crescendo.

I wasn’t particularly surprised I started working the night shift. I’d suspected it’d come to that a few years ago, when I was still in Paraguay. I remember thinking about my return to the US, and my terrible tendency to lay my paper planner out in front of me and plot how to fill the blank spaces. I remember thinking, “Going into healthcare is very dangerous for someone like you. It’s a 24-hour business. Make sure you block out time to sleep or you just might not get enough rest.”

The night shift was the most practical choice when I started my ED job. The wage is higher and it leaves the day for studying or errands. Flipping my sleeping schedule was no light matter, however, especially because I started going to bed an hour before I used to get up. It’s also been a challenge finding a new eating schedule that works for me–I now eat meals at completely different times than before I worked nights.

There’s a strange stillness in the ED when the early hours of the morning approach – 1 a.m., 2 a.m., 3 a.m.. Even when a very sick person arrives who requires many hands to care for them, the ED is strangely quiet in the morning. Many patients are sleeping or too sleepy to chat with their family members anymore. The patients staying with us until a bed opens in a facility that can help them heal their mental health challenges are usually sleeping or partaking in quiet activities. Sometimes a drunk patient arrives and disrupts the silence, but often they too fall quiet as the morning creeps onward.

Now instead of waking to stillness, I head to bed in its midst. As I drive home from the hospital, the birds are just starting to sing, but the sun’s rays aren’t yet seeping into the sky. The roads are empty save for a few souls coming home from a party or, perhaps, going to work. I arrive at a silent house, those there are sleeping. Not even the dog, when he’s visiting from my parent’s home, greets me when I open the door.

When I first started working nights, I was always tired. But, now that I’m used to it, I’m no more tired than I would be after any long day at work. There’s something about the night shift that keeps you coming back. Perhaps it’s because I like quiet, or perhaps it’s because I like the self-efficiency that’s required when you’re providing quality health care without all the resources of regular business hours that excites me. More likely, it’s that the people who work the dark hours are different than those who work when the majority of society is awake. Many of us won’t work nights forever, but we have some reason to do so now. It’s the fact that we have a reason to be nocturnal, I think, that creates a sense of comradery that’s different from any dayshift vibe I’ve known.

Springtime Rambling

My goodness how quickly time passes. It’s hard to believe that the last time I wrote was in the dead of a cold, dark winter—the hallmark of New England. I won’t bore you with the reasons why there was no time to write for so long, except to say that I know a great deal more about equilibrium, acid-base reactions, electromagnetism, circuits, batteries, optics, quantum mechanics, and special relativity than I did in February. Science.

Spring arrived in Vermont with the timidity of a mouse crossing a barren stretch—one step forward, three steps back. But, the soft, new leaves are starting to unroll; the grass needs to be cut, the flower gardens need weeding, and the fruit trees fill the air with soft scents. It’s the lilacs more than the tulips and daffodils that make me think the warm weather will stay a while.

The winter was long and cold. I dared not count the gray days that melted into rainy days between frost and flowers. It goes without saying that spring is a time of new beginnings and the return of the sun.

How I missed the sun! When I went on a walk today rays of golden light danced on the path between the yellow-new, pink fresh leaves. The spirals of young ferns lined the walkway and the damp mix of old leaves and new growth saturated the air. I paused on a bridge over where the river meets the lake. There in the flooded marsh lands a fish swam almost lazily in circles. It was over a foot long. A fin lined its back waving back and forth like a ruffle along its spine as it waved its tail. What a bold fish to be out in the open in eagle, kingfisher, and heron territory!

I’m sure you guessed, but the sun makes me think of Paraguay. I completed my one-year anniversary of my return to the States in April. This is my first full spring in Vermont in many years. And the humming of the frogs, bugs, and birds make me think that this coming year will not only be as productive as the last, but more hopeful.

It is a new beginning because I’m taking my learning out of the classroom. Not so long ago I started running as an EMT. I’m still quite a newbie, but I’ve learned that every patient is a puzzle, and that solving each puzzle is more thrilling than anything else I’ve yet encountered. To realize what I can do to help someone by looking at a few measures—for example breathing, pulse, and blood pressure—is far more interesting than piecing together the clues of a physics exam question.

I’ve been thinking these days about how much I’ve learned since last spring. This time last year, I could not have told you what a healthy blood pressure was or if 5 was basic or acidic on the pH scale. Today I know those things and a great deal more. But, for some reason, Plato’s Socrates and his comment about what makes one wise has been on my mind as I take my spring walks, a translation of which reads:

“I am wiser than this man, for neither of us appears to know anything great and good; but he fancies he knows something, although he knows nothing; whereas I, as I do not know anything, so I do not fancy I do. In this trifling particular, then, I appear to be wiser than he, because I do not fancy I know what I do not know.”

The more I learn about the human body and illness the more I realize how much I don’t know. And what I’ve come to see, now that the frost has cleared, is that the doctorhood quest will not end when I pass my last board exam. It’s a quest for knowledge and better understanding that will only end when I stop practicing medicine. And despite the weight of learning so much for so long, the length and breadth of my journey does not seem daunting. I know that even if there are stretches like a Vermont winter as I make my way, they will always be followed by spring. After spring comes summer. And summer is full of life.

Photo Credit: my father

 

The Doctorhood Quest

It seems timely to quote Carrie Fisher, who said:

Stay afraid, but do it anyway. What’s important is the action. You don’t have to wait to be confident. Just do it and eventually the confidence will follow.

That’s a decent summary of how I try to live. Going to Paraguay was a leap, but a longer jump is starting my quest to be a doctor. Becoming a doctor is a 7-year commitment at its least, and it’s looking more like 10 years for me. What a trip to start in my late 20s, don’t you think?

Can you imagine striving for 10 years even though there is a real possibility of losing your way at each turn?

I’m not sure if I can picture it. I’m not certain the path is clear to me, but I’m going for it anyway…because my end goal and vision are vivid. Fear and confidence. They go hand-in-hand. They balance each other. When one is strong, it is wise to foster the other.

I wonder every day if dedicating myself to becoming a doctor is what I should be doing right now. It’s not exactly doubt that makes me wonder, but more of a need for reflection. Ten years is a long time. It’s a little more than a third of my life so far. It might drive some people crazy constantly questioning themselves, but I’m comfortable with the uncertainty. You see, I’ve learned that doing things that initially make me uneasy usually yields the best outcomes.

It is easy to fall into a routine and a pattern. The path of least resistance is to continue along whatever path you’re on—Newton: an object in motion stays in motion along a straight line unless a force acts upon it. It is hard to stop and go and change direction. But, I like challenge. Sometimes I rest, but most often I act as my own force and alter my own direction.

I started the doctorhood quest back in May 2016. That’s when I took my first “real” science classes. But, I’ve known since 2014 that I’d be a doctor someday. Why such a delay? Life. The doctorhood quest is not about speed. It’s about endurance. I know I’ll reach the grail. I know that when I do, I will be happy to dedicate myself to medicine and improving the world in my small way. But the word for the doctorhood quest is “patience.” There are plenty of people who need healing today and there will be plenty tomorrow and the next day. Right now, I’m learning and doing the small things I can. When it’s my turn to heal, I’ll be ready.