Percolate

Sitting in a call room, kinda just waiting. Overnight in the hospital is a strange thing. Where nurses are still up, patients are still sick, but trying to sleep. I’m just waiting. Waiting for a patient to be transferred out the ED, waiting for a possible code blue, waiting for an admission. Waiting for my birthday too, I guess. Time passes by too fast. A year has already gone by. New faces in the hospital, people that I have spent so much time with and greatly enjoyed their company... now gone. It’s another year and I’m three parts tired and one part anxious.

I’ve been so busy with hospital and step and bf that I feel like I’ve missed talking to people. I miss my old small group. I miss genuine deep conversations about the meaning of actions and other strange considerations and pseudo analysis of people. Or maybe I miss God. It’s hard to tell these days. Or maybe  now is the time where I have realized that I am no longer drowning and just trying to survive and am looking around for something more. I’ve not been completely antisocial. But dinner parties and fun events are in no way a replacement for those conversations of knowing one another. If anything, only a bandaid.

What is that quote... do not let what is urgent keep you from what is important.
And I definitely have. Because so many things are more urgent than spending time to meditate and think on the trajectory of my life. Work and studying and tests and attempting to find happiness and investing time in people. But none of those things are as important.

It’s funny how often I pray for clarity, when I pray these days, because I just want to know. To know what happens, to know what’s right, or what to do, to be able to plan for things. But that never really happens, does it. I am envious of the ones who know their path so clearly. Or have greater determination than I to forge their desires into reality. But for that to happen, you know to know yourself and your desires intimately.

I’ve realized, in the past few months, just how many more flaws I have.
Indecision, fear, anxiety about everything, worry about the future, poor communication skills, a laziness that I battle every day, a tendency towards the familiar and easy.

I think for so many months, I’ve foregone all self growth for increasing medical knowledge and just superficial enjoyment of life.
Well. Saying my enjoyment of life is “superficial” may be too demeaning. More like worldly enjoyments of life? But even that is a little condescending.
Regardless, as my next year approaches, I hope there will be growth.

I pray for the Spirit to fill my life. And yours.

Mortality

It's no surprise that I'm around sick people because I'm obviously working in a hospital.

But two days ago, I heard one of my co-resident/friend was in the ED. Jokingly, I texted him, hey, you dying? heard you were in the ED. hope you're ok. 

He texted back, haha, not dying, but i'm still waiting for a lot of tests to be run. i'll update you more when i know more.

And I didn't think too much more of it. Until later when I hear he actually went to the ED for a partial seizure, and the CT head images showed a large brain tumor. And now he was admitted to the University hospital and waiting for a brain biopsy. 

He's not even 30, he's almost done with his intern year, and then he should've gone into ophthalmology. He's pretty much done with all of the bs hoop jumping to make it where he actually wants to be. And then boom, this happens. A freaking brain tumor. A tumor in your freaking brain. 

A couple of us residents visited him and he was laughing and joking and pretty honest. But underneath it all, you could hear his fear and worry. His life has been turned around. And one of the neurosurgery residents told him the prognosis was maybe 10-15 years. Like... fuck. It's not 1-2 years, but still. But still. 

And it's so unfair. It's so unfair. This always positive, so much fun, always has a joke, hard working person that has made it through medical school and intern year and is set to be an ophthalmologist... he is so young. He is my age.  I think it's hit my entire class hard because we all think about how completely horrible it is. You make it through all this trial with the thought that this delayed gratification will pay off. We don't go through all this training and studying because it's enjoyable - but because we want to make it to the end. And with all of this... what if he can't? 

What if his tumor is unresectable? What if he loses his vision? Or his motor function? What if he needs chemo and/or radiation and it's so debilitating that he can't go further. What if he literally cannot be an ophthalmologist? Would you even keep going if you only have so many years left? What is worth it? But then what would you do with your time? 

I told him I would pray for him - and he replied, I believe in the power of prayer and I think it matters more than people think. So thank you.

I don't even know. I am surrounded by mortality in the hospital. I don't even bat an eye when a code blue is called. This is a hospital, there are deaths. But we are on the other side of the hospital care - and I forget that our best laid plans are futile. We cannot predict the future. I forget that there is always something more important, something greater than just the time we spend here. It is so easy, it is so freaking easy to let time whittle away at my life. To get the urgent and emergent and fun things done. To live life in a breeze, to live in a way where there are only earthly cares. What to eat, who to hang out with, work thoughts, studying. It is so easy to let time pass, minute by minute, months by years. But oh, when faced with these kinds of questions... what is truly important? How can I live this life in a manner that I don't regret. What would I do if I only had 10 years? Are the things I do right now worth it? Is it worth worrying about these things in light of all of it? 

What is my purpose here?

Striving

This last Friday, I think I had one of my more emotional days in the hospital just from patients and their lives.

A lady who has had 7 kids and is pregnant again. And all 7 of her kids have been taken by DHR because they were all positive for cocaine. And she is positive for cocaine again while she is pregnant. My heart breaks for those babies. And everyone of us unequivocally said, she needs to be sterilized because she is hurting so many children. And generally I am one who says that childbirth cannot be limited by legalization (who decides who gets to have kids, questions if people are trying to do a poverty sterilization, a genocide of a kind. You cannot force sterilization on someone because you think they are too stupid, too poor, too incompetent. Except maybe we do? For those with diagnosed intellectual disabilities - they are frequently put on continuous birth control.) But this is not okay. And I kept thinking.... who has the authority to tell her to stop having children? And I do think it is the place of a physician to say stop.

Two patients who were brain dead. The first was a man, a chronic smoker, a husband, a very sick patient. And he was doing just fine until he couldn't breathe anymore. So he was put on an oxygen mask and doing fine. Until he took it off to go outside to smoke outside of the hospital. Where he went into respiratory distress and lost a pulse and needed CPR. And now he is brain dead, left in the ICU with a ventilator and tubes. And the wife sits in the room, thinking that he might be able to get better. Until our team tells her he is not getting better.

The second, a woman, a wife, a mother, a sister. She fell down and now has blood pushing on her brain. The family is gathered around her. And when my attending says clearly that she is dead, she is not coming back, and the only thing keeping her from passing are the machines... the husband clenches his fist and turns away from us, and his cheeks are wet when he turns back to us.

A chronically ill patient comes back from a nursing home to the hospital after having already been here 2 weeks ago. But his son says, full code. We want everything. But he never visits the patient. And he is a heart wrenching picture of just wasting away muscles, eyes staring off, breathing shallowly, sick as can be. And it's just impossible for him to get much better than that because of his mental status, because of the status of his lungs already. So we'll fix him up, send him back to the nursing home, and he'll come back. Again and again. Because that's what we have to do. There are so many times I hate this end-of-life culture of "never giving up".

A patient that I admitted into the MICU. Initially doing alright, not great, but okay enough that I thought he could make it out of the ICU and home. And then days later, his kidneys tank and his lungs are worse, and he's going to need dialysis and chronic vent. And the family said he never wanted constant vents or machines to keep him alive - only keep him on it if there's a chance to get off of it. And that day.... our attending tells the family, this is the time because he won't get off any of it very likely. And today they will take the tube out of his throat and wait for him to pass. And I wonder, I admitted him, could I have done anything different? Could I have prevented him from decompensating somehow? Did I accidentally make his kidneys worse beyond repair when I gave him lasix before they were so bad? Did I spend enough time there?

A lady in the CICU after her surgery suddenly starts putting out blood from her chest tube and looks blue. CPR started as the CV surgery team is called emergently at 6 pm. Nurses are rushing around, blood bank is called for as many units of blood and platelets as possible, the crash cart is wheeled in, hands are busy. And 15 minutes later when she is being rolled off to surgery, the attending looks at me and says, she's not going to make it, but they still have to try.

And that was how my last day of critical care month went. All of that in one day.
None of it is about me, except that I feel so emotional about it all. Sad, furious, conflicted, inadequate, frustrated, sad, and just sad.