During the first hours of labor and delivery the miracle of life escapes your eyes. There is a puffy, bloated woman there that is clearly either uncomfortable or in agonizing pain. She can hardly mount the bed and then you plug this weird thing to her belly to measure all sorts of things. And then the fun part comes, where you take two fingers and insert them where they need to go, and now comes the dramatic part, the pinnacle of every obstetrician's professional life - how is the cervix doing!
Well, he is doing fine, thank you very much. He is sometimes soft, and sometimes hard, he is sometimes dilated, and occasionally effaced. If you are lucky to get more involved in the drama you might feel the baby's head way up there (or way down there if "baby comin' out").
When Mr. Cervix is impressive enough the poor woman is cordially transferred to the delivery room, where the miracle takes place, but not just yet. first she is in a little more agonizing pain. some want pain medication, some want an epidural, some want to feel it all the way to a stress ulcer.
And then the amniotic sac ruptures (if it hadn't before), and then baby comin' out, but not quite yet. first she needs to feel that she needs to push. that, too, is very important. how do you know you need to push? oh, you do, believe you me. It's like a bowel movement, and funny i'm mentioning that, because baby is not the only thing coming out.
This is actually a dual process. two separate entities are actually seeing the light of day for the first time, and occasionally one might get confused on which is which. You see, the most repetitive process during labor and delivery is wiping a pregnant patient's behind.
And now comes the times to push.
So she is pushing, and everyone around her is hysterically encouraging her to push push push push, and push she does, and there you see a little bit of hair.
"let's lubricate", says the wise midwife, and a nurse pours incredible amounts of a vaseline-equivalent, which she smears and rubs very proficiently in the vaginal canal.
baby almost comin' out, but not just yet.
So she keeps pushing and pushing, and you take her legs and pull them almost all the way to her head and around her neck, and you implore her to push, to not give up, just a few more pushes, and people count to ten, and people count to twenty, and baby slowly comin' out, and Mr. Turd during a much better job at it, and nurse wipes it, but then she forgets, and that piece is stating right at you, and at some point you take a piece of gauze and give it a good wipe, and now you know you've done your time. and the the contraction ends and everybody relaxes for a bit. you hear the fetal heart tones and know they are not too slow so that's OK, and you look at the monitor and see that things are fairly in order, and not two minutes pass and there's another one coming up!
"push, push, push!", an excited family is shouting cheerleader style, I can almost see them going "give me a P! give me a U! give me an S!" and so on, and the poor woman is pushing and pushing, and Mr. Turd is actually beating Mr. Baby again, but baby's on his/hers way out, that's right, he/she is right down there and comin' out.
It is very symbolic that birth is involved with so much shit. it's almost like god is telling you, kind of very subtly hinting you, it's going to go hand in hand from now on. don't you be expecting any good stuff without a good dose of crap with it. However we don't quite seem to get it, we don't even remember that Baby-Turd race until we find ourselves in the delivery room, and something kind of sort of feels familiar.
another contraction.
and she's pushing. and pushing, and it's really quite incredible an entire head can fit right in there, which makes you feel a little incompetent. and baby's pushing against vaginal wall and it looks like he's going to make it this time, but not quite. mommy's pushing pushing pushing, but then needs to rest. we need another contraction.
and another one comes along, and baby's pushing, and slowly, gently, almost there, and you support the head so it won't pop out too quickly, and gently, baby pops out, and leaving that remaining turd way behind. it's looking to the side, my right side this time, and I grab him by the neck, my god this is scary, and I make sure there is no umbilical cord around his neck, like I had when I was born, and then I pull on him a little, and I pull him outward and downward to deliver his/hers upper shoulder, and I pull a little longer and this time upward to deliver the lower shoulder, and then head and shoulders coming out, and all that's left is to give a little tug and entire baby's coming out, and he looks dead.
but they often do, and sometimes they look blue, too. and a good rule of thumb is that pink baby better than blue baby, and you immediately start ticking him off, you rub his belly really strong, and you stick a nozzle in his nose and mouth to vacuum secretions, and after a few seconds there is usually a cry, and you want to cry with him, because you have been working too much and have been around for 30 years (my god has it been that long?), and so you really have something to cry about. but instead you clamp the umbilical cord one time close to the baby, and then one more time a few inches up the cord, and then you might let the dad cut in the middle, if there is a dad around, or maybe a grandmother, or whoever, and then baby is ready for shipment. and next stop is little baby thingie in the corner of the room, with the nurse waiting to tug on his and annoy him a little longer, and after that give him to mommy for warmth and breastfeeding and just bring mommy and baby together. but for this you have to carry baby, who is slippery anyway, and wiggling as well, on your bloody gown from mommy's stuff, and you are terrified that right then and there baby's gonna splatter all over the floor, and you are going to hit the news, and he will sue you when he's older, and you will harm him, and after all he just got here. but then you overcome this fear, and you hold baby real tight, you grab him by the ankles and support his head, and you bring him close to your bloody gown, and you say "please god don't let this thing drop off my hands", and these three feet seem like a half marathon, but eventually you make it, and you put baby in his baby bed, and you say thank god, and you go back to mommy, and now the battle of the placenta commences.
the battle of the placenta includes you, mommy, and a pair of clamps. you see, baby coming out is really nice, but delivery is not over just yet. Ms. Placenta is actually part of baby, and like any chick, she is taking her time, she might take up to 30 minutes to come out or even longer, and like any chick that's getting ready to go out, you better not rush her, otherwise something bad is going to happen. so you are giving little tuggings to the umbilical cord, just to see if she is ready yet, and you hold the uterus on her lower abdomen so it won't come down along with her, and you give the little tuggings, but placenta ain't comin' out just yet. she needs her time. so you wait there with the clamp clamping the umbilical cord, and your back hurts by now because you are bending forward all this time, and eventually, when you give a little tug, you can feel it giving way, and then you put a bucket underneath and you tug on placenta as she moves, and lotsa blood comes gushing out, and now it's time to give a uterine massage, a deep, decisive one, so the uterus will constrict, and there won't be as much blood coming out, and also to make sure everything that needs to go out will. and you give that massage and you check the placenta, that everything that needs to come out really did, and then you tell yourself that delivery is over, but we are not over yet, because now comes damage control.
so there is a lot of pushing going on during delivery, you could call this the defecation of your life, and a lot of pressure, and an entire baby coming out of there, so you can understand why there might be tears and bleeding and stuff like that, and some of them need to be fixed. so you need to check all over there if anything is bleeding, if anything is torn, and you might want to suture that, so there will be no bleeding, and also to keep the husband happy, and of course to keep mommy happy, because you don't want her to curse you all her life, because you never know which one of those actually work.
and after you have done your laceration repair you take all the fluids and blood and tissue and shit and you wrap it in a big plastic bag, and you put it on the table and you tie everything nicely, and you tell mommy "felicidades" and they shake your hand, and they are happy, and you are kindda happy, although you still have to stick around until the end of your shift and you are tired anyway, but then again, that's life, right?
And then I see my name on the poor thing's birth certificate, and now I know he is branded for life, and that he might come get me one day, when he is all depressed, and fed up with it all, and probably wishes I shove him back in there, because i'm the first person to see him out, but to tell the truth, I can't help a smile in the corner of my lips, because me and him are in some weird kind of bond from today on, and he doesn't know it, and I don't realize it, hell, i don't even know his name because his parents haven't decided yet, but maybe one day he will cure cancer, or be the president of the united states, or abolish commercials, or legalize nudism, or something important like that, and I wouldn't know it because I wouldn't recognize him, but I can say I was there where it all started, when baby beat a turd and came into this world.
Wednesday, September 2, 2009
A Visa to freedom
Dr. Noah won the lottery and wanted to go to America.
Seemingly this should not pose much of a challenge, especially post-lottery-winning. However, he faced some difficulty.
"Try again in 2 years", the guy in the governmental office told him, and Noah thought he actually got lucky - some people wait for years before they are allowed to go to America.
And he knew what he had to do now.
As an expert in minimally invasive surgeries, one of only a handful in his home country, he knew exactly what the government now expects him to do, and indeed, he worked harder. He worked hardest. He worked hardestest. He hardly saw his wife and son, as he worked 8, 10 12, 20, 30, 50 , 50 , 80533452 hours a day, a week, a month. And they loved him at the hospital, he was the best minimally invasivologist in town, and even doctors from out of town came to see the him at work.
But after two years he got a letter from the government. It congratulated him for his fine work and was cordially informed that he was so good, they want to keep him. He can, if he wants, go to Venezuela and be a part of a doctors program. If he works hard enough, after 4 years he will get 10000 dollars. After he comes back home, of course.
Realizing this is not really going the way he wanted, he decided to make a run for it. Well, that is hard to do when you are on an island, which is exactly why Hector, his buddy's friend, who is a very talented carpenter, came in handy. Hector used to built ships from the time his father would sail into the ocean to catch fish and lobsters. When Noah told him he wants a ship he agreed, but on one condition - "I come too". I guess if you are about to cross an ocean, it might be nicer if there was a doctor on board, and Noah thought to himself that a ship builder most probably also knows how to handle ships, and though he was very wrong, he didn't know it yet.
So the ship was built, and they all hopped on board. it was actually more secret than that. Hardly anyone knew about the plans. Noah's mother wept quietly. It was so quiet that the air molecules weren't sure if they should vibrate or not, which is exactly why Noah himself always thought he is hearing his mom crying. Even now, when he tells me this story. He hears her mostly at night, even though she is thousands of miles away.
A GPS is a useful tool when you are about to embark on a sailing mission to a far away destination with a carpenter as your captain. Two problems persisted, though: 1. you just can't get a naval GPS on Noah's island. 2. The captain is the one making the decisions anyway and, being the happy, carefree person that he was, he decided a GPS is not really necessary. With Noah trying to convince him, because he was genuinely fearing for his life, Hector made a compromise - "we sail to Cayman islands and we buy there. And", he added, "that is where we will have our first breakfast".
It's been 5 years from that journey, and Noah hasn't been to the Cayman islands yet. Maybe one day, on his way back home from America he will go back there, just to check out what he might have missed.
They made their way to America eventaully, overcoming stormy weathers and ridiculously high waves. Noah lost 20 pounds, but he probably needed it anyway. There were lots of fish to catch, but no Einstein thought of bringing a fishing rod, or anything like that. I am thinking about those fish right now and I know they are fresh and delicious. They ended up on the coast of some south American country, which I can't remember right now, and somehow found their way to the promised land.
Noah told me this story while sitting on a bench during a 5 minute break we had between patients. We were interrupted a few times by the nurses who came to update us on this or that patient's condition. He looks tired and over worked, like the rest of us. he is in his first year of residency, like myself, but in a different field. It is much different than his lifestyle as a surgeon. as a senior surgeon. However, it's more practical for him right now.
I am looking at his tired eyes, and know that he is actually happy. ier. he made it, he is here. He beat his government, and they did not break his spirit. Just a few things to take care of right now, like bringing his parents. They won't let them leave, and they won't let him, the traitor who escaped his country, to go back. He tried once to come back, when his grandfather was dying. He knew he didn't have a chance, but owed it to him to give it a shot. "We are unable to approve your request" was laconically written on a sheet of paper that was sent to him in an ugly little envelope, and that was it. His grandfather is now watching from above, as his grandson broke the watery wall and made it into freedom.
He just misses those damn cigars.
Seemingly this should not pose much of a challenge, especially post-lottery-winning. However, he faced some difficulty.
"Try again in 2 years", the guy in the governmental office told him, and Noah thought he actually got lucky - some people wait for years before they are allowed to go to America.
And he knew what he had to do now.
As an expert in minimally invasive surgeries, one of only a handful in his home country, he knew exactly what the government now expects him to do, and indeed, he worked harder. He worked hardest. He worked hardestest. He hardly saw his wife and son, as he worked 8, 10 12, 20, 30, 50 , 50 , 80533452 hours a day, a week, a month. And they loved him at the hospital, he was the best minimally invasivologist in town, and even doctors from out of town came to see the him at work.
But after two years he got a letter from the government. It congratulated him for his fine work and was cordially informed that he was so good, they want to keep him. He can, if he wants, go to Venezuela and be a part of a doctors program. If he works hard enough, after 4 years he will get 10000 dollars. After he comes back home, of course.
Realizing this is not really going the way he wanted, he decided to make a run for it. Well, that is hard to do when you are on an island, which is exactly why Hector, his buddy's friend, who is a very talented carpenter, came in handy. Hector used to built ships from the time his father would sail into the ocean to catch fish and lobsters. When Noah told him he wants a ship he agreed, but on one condition - "I come too". I guess if you are about to cross an ocean, it might be nicer if there was a doctor on board, and Noah thought to himself that a ship builder most probably also knows how to handle ships, and though he was very wrong, he didn't know it yet.
So the ship was built, and they all hopped on board. it was actually more secret than that. Hardly anyone knew about the plans. Noah's mother wept quietly. It was so quiet that the air molecules weren't sure if they should vibrate or not, which is exactly why Noah himself always thought he is hearing his mom crying. Even now, when he tells me this story. He hears her mostly at night, even though she is thousands of miles away.
A GPS is a useful tool when you are about to embark on a sailing mission to a far away destination with a carpenter as your captain. Two problems persisted, though: 1. you just can't get a naval GPS on Noah's island. 2. The captain is the one making the decisions anyway and, being the happy, carefree person that he was, he decided a GPS is not really necessary. With Noah trying to convince him, because he was genuinely fearing for his life, Hector made a compromise - "we sail to Cayman islands and we buy there. And", he added, "that is where we will have our first breakfast".
It's been 5 years from that journey, and Noah hasn't been to the Cayman islands yet. Maybe one day, on his way back home from America he will go back there, just to check out what he might have missed.
They made their way to America eventaully, overcoming stormy weathers and ridiculously high waves. Noah lost 20 pounds, but he probably needed it anyway. There were lots of fish to catch, but no Einstein thought of bringing a fishing rod, or anything like that. I am thinking about those fish right now and I know they are fresh and delicious. They ended up on the coast of some south American country, which I can't remember right now, and somehow found their way to the promised land.
Noah told me this story while sitting on a bench during a 5 minute break we had between patients. We were interrupted a few times by the nurses who came to update us on this or that patient's condition. He looks tired and over worked, like the rest of us. he is in his first year of residency, like myself, but in a different field. It is much different than his lifestyle as a surgeon. as a senior surgeon. However, it's more practical for him right now.
I am looking at his tired eyes, and know that he is actually happy. ier. he made it, he is here. He beat his government, and they did not break his spirit. Just a few things to take care of right now, like bringing his parents. They won't let them leave, and they won't let him, the traitor who escaped his country, to go back. He tried once to come back, when his grandfather was dying. He knew he didn't have a chance, but owed it to him to give it a shot. "We are unable to approve your request" was laconically written on a sheet of paper that was sent to him in an ugly little envelope, and that was it. His grandfather is now watching from above, as his grandson broke the watery wall and made it into freedom.
He just misses those damn cigars.
Tuesday, August 25, 2009
The little dictator
Whenever I see Dr. J I think about Benito Mussolini. I can't quite explain it, but lately it has become a reflex of almost Pavlovian proportions - See figure walking down hall -> Recognize figure as Dr. J -> Think about Mussolini with dancing bundles of wheat around him.
"Why wasn't this patient extubated?", he would typically ask me, typically very early in the morning. If you don't know what "extubated" means, it actually doesn't matter, you can put any word there instead, like "violated with sunflower seeds" or "dressed like the little mermaid". It's the thought that counts, you see.
"I don't know, I just got here".
"Don't talk to me like that! I want to know who extubated her right now".
"Ok, who should I ask?", I turn my head for a second to get the patient's chart and grab the phone, but he already moved on to the nurse on bed 15 demanding to know why the patient had his urine bag on the right side of the bed, while he specifically demanded the bag be put on the left side of it.
He is a funny little guy. 5"5 with an extra inch from the shoes, it definitely has something to do with it. A little goat beard decorates his chin, and a noticeable-despite-all-efforts east European accent comes out of his mouth, which sometimes makes his temper tantrums funnier. He is a resident in his second year, which means he is actually not that high up in the food chain, and a food chain it is, but that is a story in itself.
I sometimes wonder about this guy. He mainly looks very lonely. I imagine him dreaming at night of little bundles of wheat, not too tall, doing all sorts of tricks at his command. Man, the intoxication of power. I wish I had dancing bundles of wheat at my command. I could do wonders. What will become of him in a few days, when he will no longer be able to order me around? He was clearly born to lead people, even if it is all the way to the river Styx.
"Why wasn't this patient extubated?", he would typically ask me, typically very early in the morning. If you don't know what "extubated" means, it actually doesn't matter, you can put any word there instead, like "violated with sunflower seeds" or "dressed like the little mermaid". It's the thought that counts, you see.
"I don't know, I just got here".
"Don't talk to me like that! I want to know who extubated her right now".
"Ok, who should I ask?", I turn my head for a second to get the patient's chart and grab the phone, but he already moved on to the nurse on bed 15 demanding to know why the patient had his urine bag on the right side of the bed, while he specifically demanded the bag be put on the left side of it.
He is a funny little guy. 5"5 with an extra inch from the shoes, it definitely has something to do with it. A little goat beard decorates his chin, and a noticeable-despite-all-efforts east European accent comes out of his mouth, which sometimes makes his temper tantrums funnier. He is a resident in his second year, which means he is actually not that high up in the food chain, and a food chain it is, but that is a story in itself.
I sometimes wonder about this guy. He mainly looks very lonely. I imagine him dreaming at night of little bundles of wheat, not too tall, doing all sorts of tricks at his command. Man, the intoxication of power. I wish I had dancing bundles of wheat at my command. I could do wonders. What will become of him in a few days, when he will no longer be able to order me around? He was clearly born to lead people, even if it is all the way to the river Styx.
Wednesday, August 12, 2009
Giving up
It is harder to withdraw care from a patient than to unsuccessfully treat him. There is a sense of "giving up" when you decide that the patient, and you, have had enough. You just can't treat him or her anymore. They are simply dying, almost dead, and there is nothing you can do about it. They are not conciouss, they have a tube down their throat, they are getting multiple drugs, and every now and then somebody moves them around, or gives them food through the veins, or cleans their shit. That, obviously, can hardly be called a life. Though it is, still, kind of, maybe, who the hell knows.
And then, after the patient only keeps getting worse, and basically it's your chemicals that are keeping him alive, in some form or another, and then all these infections do their thing, and decubitus ulcers every now and then, and when you get swollen as a balloon, and your balls are the size of a tennis ball, and you hardly have any lungs left, you can almost feel that this thing is not human. It was, at some point, not long ago, just a few days, but now everything seems helpless.
This was the case with Mr. B in bed 5. He was most probably drunk and hit by a car, and it all went downhill from there. At first we thought he might actually make it. At some point we even considered getting him off the vent so he can breath on his own. But then his lungs got crappy, and red stuff came out of his feeding tube, which was obviously blood. And then he couldn't keep his blood pressure up, and he needed three kinds of prsesure meds. Usually in medicine we try to keep people's pressure down, but this guy's blood pressure was so low we actually had to bring it up again. And of course infections didn't pass on this poor alcoholic, and his liver wasn't doing too great to begin with, and the last time i saw him blood was coming out of his eyes. Now you don't need to be a rocket scientist, or a doctor, for that matter, to know that this is a very bad sign.
Quickly thereafter we tohught it might be a good idea to withdraw care from this poor soul and let nature take its course. Although we can be very persuasive, this decision is not up to us, but up to his family, which was somewhere in mexico and either too busy, too poor, or without the right papers to cross the border and see their uncle. Eventually they did come, and did agree, and saw his gasp his last breaths, and then he died.
I saw him quite often during his last days on this planet. He always seemed in such pain and agony. Always breathing from the top of whatever lungs he has left, gasping for air. But today he didn't move so much. In fact, he didn't move at all. His room was quite still. I don't think there was one molecule of air in the room that was moving. Everything stayed in place.
That's the way life is in the ICU, that is usually how they go. They just do.
Having a patient die in the ICU is different than having them die in the wards. I say "different" and not "better" or "worse" because that's what it is - different. It is both better and worse. On the one hand you don't know them personally, because from the moment you got them they were unconcious (usually. If they get better to the point which they can talk to you and then die on you, you usually feel like jumping out the window). On the other, you don't know them, and the questions keep pricking you - who were they? what was their story? What do they look like standing and walking? Probably very different than the edematous face and bleeding conjunvtivae they sometimes have in the ICU. What were they like when they were kids? What did they want to do when they grew up?
I find myself asking these questions over and over when our patients comes and go. In the wards your patients are concious and go home, so there is less of a mystery. In here, it is all guessing. Sometimes it feels like a prodcution line. They show up, you load 'em on the bed, you start pokin' 'em 'n' movin' 'em and radiate their pants off with CT and daily X rays, and the occasional MRI, and then you have other people evaluate them, like a Neurosurgeon, or a Respiratory therapist, or a dietician, and all that jazz, and once you're done they are usually not dead, and you move 'em on to the next station, which is usually rehabilitation or what we call a "regular bed", meaning just hospitalization in the wards for a bit longer.
That's what it sometimes feels like when you are overworked, and not sleeping enough. Dr. Eden was my teacher, and he was (or is?) and anestehsiologist turned ICU. And on the first year of medical school he talked to us, and introduced me to an outrageous concept: "We don't heal people", he said, "we provide them with the means to heal by themselves". Now was is that crap all about? I tohught we are the big smart docs and our patients make it just because of us. My short experience in the medical field taught me otherwise. It's amazing how much we don't know, and how, like Mr. K, some people make it and how, like Mr. M, some people simply don't.
And then, after the patient only keeps getting worse, and basically it's your chemicals that are keeping him alive, in some form or another, and then all these infections do their thing, and decubitus ulcers every now and then, and when you get swollen as a balloon, and your balls are the size of a tennis ball, and you hardly have any lungs left, you can almost feel that this thing is not human. It was, at some point, not long ago, just a few days, but now everything seems helpless.
This was the case with Mr. B in bed 5. He was most probably drunk and hit by a car, and it all went downhill from there. At first we thought he might actually make it. At some point we even considered getting him off the vent so he can breath on his own. But then his lungs got crappy, and red stuff came out of his feeding tube, which was obviously blood. And then he couldn't keep his blood pressure up, and he needed three kinds of prsesure meds. Usually in medicine we try to keep people's pressure down, but this guy's blood pressure was so low we actually had to bring it up again. And of course infections didn't pass on this poor alcoholic, and his liver wasn't doing too great to begin with, and the last time i saw him blood was coming out of his eyes. Now you don't need to be a rocket scientist, or a doctor, for that matter, to know that this is a very bad sign.
Quickly thereafter we tohught it might be a good idea to withdraw care from this poor soul and let nature take its course. Although we can be very persuasive, this decision is not up to us, but up to his family, which was somewhere in mexico and either too busy, too poor, or without the right papers to cross the border and see their uncle. Eventually they did come, and did agree, and saw his gasp his last breaths, and then he died.
I saw him quite often during his last days on this planet. He always seemed in such pain and agony. Always breathing from the top of whatever lungs he has left, gasping for air. But today he didn't move so much. In fact, he didn't move at all. His room was quite still. I don't think there was one molecule of air in the room that was moving. Everything stayed in place.
That's the way life is in the ICU, that is usually how they go. They just do.
Having a patient die in the ICU is different than having them die in the wards. I say "different" and not "better" or "worse" because that's what it is - different. It is both better and worse. On the one hand you don't know them personally, because from the moment you got them they were unconcious (usually. If they get better to the point which they can talk to you and then die on you, you usually feel like jumping out the window). On the other, you don't know them, and the questions keep pricking you - who were they? what was their story? What do they look like standing and walking? Probably very different than the edematous face and bleeding conjunvtivae they sometimes have in the ICU. What were they like when they were kids? What did they want to do when they grew up?
I find myself asking these questions over and over when our patients comes and go. In the wards your patients are concious and go home, so there is less of a mystery. In here, it is all guessing. Sometimes it feels like a prodcution line. They show up, you load 'em on the bed, you start pokin' 'em 'n' movin' 'em and radiate their pants off with CT and daily X rays, and the occasional MRI, and then you have other people evaluate them, like a Neurosurgeon, or a Respiratory therapist, or a dietician, and all that jazz, and once you're done they are usually not dead, and you move 'em on to the next station, which is usually rehabilitation or what we call a "regular bed", meaning just hospitalization in the wards for a bit longer.
That's what it sometimes feels like when you are overworked, and not sleeping enough. Dr. Eden was my teacher, and he was (or is?) and anestehsiologist turned ICU. And on the first year of medical school he talked to us, and introduced me to an outrageous concept: "We don't heal people", he said, "we provide them with the means to heal by themselves". Now was is that crap all about? I tohught we are the big smart docs and our patients make it just because of us. My short experience in the medical field taught me otherwise. It's amazing how much we don't know, and how, like Mr. K, some people make it and how, like Mr. M, some people simply don't.
Monday, August 10, 2009
Basic things
Mr. S has a bleed inside of his skull, but mostly he misses his mom. His wife is standing next to his bed in the ICU, and so are his daughters. They are all extremely worried.
He has never been like this. Ever since his mother died he had not been the same. In fact, he was quite devastated. And when he started getting dizzy a couple of days ago, he knew why. And when the world was really spinning around him, until he fell right on the concrete floor, he was still thinking about his mom.
Other than a small bleed around his brain he was actually ok. He really scared us at first, because he lost his consciousness. The older you get, the less you appreciate blows to your head, or bleeds around your brain, or just a plain loss of consciousness. Your body starts taking it rather personal, and overreacts. You bleed more, and you heal less. But Mr. S was able to save himself from the statistics. He was really doing ok, except he really missed his mom.
"The Rosary is Tuesday, can I go?", he asks me, his eyes imploring. When he first told me his mom had died, I thought I didn't hear him well. To be perfectly honest, I also thought he is being delusional. We often see ICU psychosis. The name is pretty straightforward, and it means that all the pain, physical and emotional trauma, the daily needle poking, shitting in a diaper, not getting any sleep except on meds that can put down a horse, and all that jazz - can really mess you up. And drive you a little insane. And the older you get, the more at risk you are. And I thought he is being like that.
I mean, He looked like a grandfather himself. In fact, he WAS a grandfather. And we tend to assume grandfathers were just like that all the time, unaware of the lifetime they had gone through, and the fact that they, too, were someone's little child. "I promise I will do everything I can to make it happen", "but you have to help me, too". I thought to myself that this is a great bargaining opportunity. "Try to get some rest, and even sleep. You need your strength. We can't let you go if you are not in good shape". We made a gentleman's agreement that each will do his share, and waited for the next morning when the big boss will actually decide what to do.
We put a lot of effort in Mr. S's expedited management and probably took some risks, too. We got a social worker and a case manager on it, and managed to work it so he will be able to see his mom. Hell, I still don't even know what a Rosary is. I only know it was important enough for that little child that wanted to see his mom one more time.
He has never been like this. Ever since his mother died he had not been the same. In fact, he was quite devastated. And when he started getting dizzy a couple of days ago, he knew why. And when the world was really spinning around him, until he fell right on the concrete floor, he was still thinking about his mom.
Other than a small bleed around his brain he was actually ok. He really scared us at first, because he lost his consciousness. The older you get, the less you appreciate blows to your head, or bleeds around your brain, or just a plain loss of consciousness. Your body starts taking it rather personal, and overreacts. You bleed more, and you heal less. But Mr. S was able to save himself from the statistics. He was really doing ok, except he really missed his mom.
"The Rosary is Tuesday, can I go?", he asks me, his eyes imploring. When he first told me his mom had died, I thought I didn't hear him well. To be perfectly honest, I also thought he is being delusional. We often see ICU psychosis. The name is pretty straightforward, and it means that all the pain, physical and emotional trauma, the daily needle poking, shitting in a diaper, not getting any sleep except on meds that can put down a horse, and all that jazz - can really mess you up. And drive you a little insane. And the older you get, the more at risk you are. And I thought he is being like that.
I mean, He looked like a grandfather himself. In fact, he WAS a grandfather. And we tend to assume grandfathers were just like that all the time, unaware of the lifetime they had gone through, and the fact that they, too, were someone's little child. "I promise I will do everything I can to make it happen", "but you have to help me, too". I thought to myself that this is a great bargaining opportunity. "Try to get some rest, and even sleep. You need your strength. We can't let you go if you are not in good shape". We made a gentleman's agreement that each will do his share, and waited for the next morning when the big boss will actually decide what to do.
We put a lot of effort in Mr. S's expedited management and probably took some risks, too. We got a social worker and a case manager on it, and managed to work it so he will be able to see his mom. Hell, I still don't even know what a Rosary is. I only know it was important enough for that little child that wanted to see his mom one more time.
Friday, August 7, 2009
the saddest room in the ICU
Room number 9 is usually dark and a little chili. Although in the middle of a busy intensive care unit, it is surprisingly calm. A clean smell comes out its door, and the windows are half shut. Mozart's 21st concerto is playing calmly, very appropriately at the Andante chapter. It is the room of Mr. K, and it holds the questionable title of being the saddest room in the ICU.
Mr. K had a seizure disorder and a dad. The three of them lived in a small place far from anywhere. Dad was sick and K took care of him, but he didn't want to take care of his seizure disorder.
"Take your pills", dad said to his only son, but K was a big guy who didn't want to, for reasons we will never know. I am wondering what he sounded like. Did he have one of those deep voices? Did he have a Spanish accent?
One day dad came back and found K on the floor. Being disabled, it took him a while to get to a phone, but even that didn't matter much - with the nearest hospital 70 miles away, Mr. K was clearly having odds against him, and since that moment of being found unresponsive by dad he remained so. A quick imaging survey done at a hospital revealed he had a very bad stroke and also, for whatever reason that we will never know, he broke his neck.
And he has been here ever since. At first we hoped that he would get better. Every day I would check his Glasgow Coma Score, pinch him here and there, and ask him to blink his only open eye. But he would move his eyes randomly across the room and not quite follow my orders.
Maybe he IS seeing things, but just things I myself cannot see. Maybe he is alive and alert, but in a different world. Our minds are our souls are our hearts, and they are full of wonderful, magnificent worlds. Maybe he does exist on one of them, chewing on a freshly picked mango or dancing a tribal dance with a well developed mulatto.
But we are not seeing it here, on our part of the world. we just see Mr K lying there in his dark room, listening to Mozart.
Nurse R likes Mozart. She is a round, very talented ICU nurse that likes to work nights. "Too many people around during the day", she says. She is taking care of Mr. K, and figured that since he is not moving and most of the time stares at the ceiling with his one eye, he might as well listen to some good quality music. If he is not a fan, he will be by the time she is through with him. Stranger things have happened in the ICU, believe me.
In the meantime she is taking care of his ventilating machine, recording his heart rate, giving him medications, and counting exactly how much he peed. I recognize her hand writing by now, and she is the only nurse that would write the patient had peed 1500.35 milliliter during the day. She is quite thorough.
Until yesterday Mr. K was CMO, which is a clean word for a dirty meaning - Comfort Measures Only. So we only need to keep Mr. K comfortable, until he dies. For example, give him pain medicine. This was in agreement with his dad, which never comes to visit.
I really hate CMOs, and I didn't think Mr. K deserved it. First, he was moving his eyes! (ok, eye). Now that can be a meaningful thing. If you haven't seen the film "The butterfly and the diving bell", now would be a good time to do so. Second, he was on sedating medications, which might make him even worse than he really is. Third, he broke his neck! So we can't quite expect him to move his 4 limbs now can we? And fourth, he is still recovering from his injury... Maybe, perhaps, he would be better once his injuries healed a little?
As crazy as it may sound, sometimes Mr. K's quiet little room, with his Mozart and devoted nurse R feels to me like an island of sanity in our crazy ICU. I sure will miss him when he leaves, wherever that might be, and wish him lots of fun and light with his mangoes and dancing mulattoes.
Mr. K had a seizure disorder and a dad. The three of them lived in a small place far from anywhere. Dad was sick and K took care of him, but he didn't want to take care of his seizure disorder.
"Take your pills", dad said to his only son, but K was a big guy who didn't want to, for reasons we will never know. I am wondering what he sounded like. Did he have one of those deep voices? Did he have a Spanish accent?
One day dad came back and found K on the floor. Being disabled, it took him a while to get to a phone, but even that didn't matter much - with the nearest hospital 70 miles away, Mr. K was clearly having odds against him, and since that moment of being found unresponsive by dad he remained so. A quick imaging survey done at a hospital revealed he had a very bad stroke and also, for whatever reason that we will never know, he broke his neck.
And he has been here ever since. At first we hoped that he would get better. Every day I would check his Glasgow Coma Score, pinch him here and there, and ask him to blink his only open eye. But he would move his eyes randomly across the room and not quite follow my orders.
Maybe he IS seeing things, but just things I myself cannot see. Maybe he is alive and alert, but in a different world. Our minds are our souls are our hearts, and they are full of wonderful, magnificent worlds. Maybe he does exist on one of them, chewing on a freshly picked mango or dancing a tribal dance with a well developed mulatto.
But we are not seeing it here, on our part of the world. we just see Mr K lying there in his dark room, listening to Mozart.
Nurse R likes Mozart. She is a round, very talented ICU nurse that likes to work nights. "Too many people around during the day", she says. She is taking care of Mr. K, and figured that since he is not moving and most of the time stares at the ceiling with his one eye, he might as well listen to some good quality music. If he is not a fan, he will be by the time she is through with him. Stranger things have happened in the ICU, believe me.
In the meantime she is taking care of his ventilating machine, recording his heart rate, giving him medications, and counting exactly how much he peed. I recognize her hand writing by now, and she is the only nurse that would write the patient had peed 1500.35 milliliter during the day. She is quite thorough.
Until yesterday Mr. K was CMO, which is a clean word for a dirty meaning - Comfort Measures Only. So we only need to keep Mr. K comfortable, until he dies. For example, give him pain medicine. This was in agreement with his dad, which never comes to visit.
I really hate CMOs, and I didn't think Mr. K deserved it. First, he was moving his eyes! (ok, eye). Now that can be a meaningful thing. If you haven't seen the film "The butterfly and the diving bell", now would be a good time to do so. Second, he was on sedating medications, which might make him even worse than he really is. Third, he broke his neck! So we can't quite expect him to move his 4 limbs now can we? And fourth, he is still recovering from his injury... Maybe, perhaps, he would be better once his injuries healed a little?
As crazy as it may sound, sometimes Mr. K's quiet little room, with his Mozart and devoted nurse R feels to me like an island of sanity in our crazy ICU. I sure will miss him when he leaves, wherever that might be, and wish him lots of fun and light with his mangoes and dancing mulattoes.
Saturday, July 4, 2009
hippies in the middle of the desert
santa fe is the capital of new mexico. one might expect it to be the biggest, or the busiest, at least, but that is not the case. Santa Fe feels like an alternative capital city, oe perhaps, the way a capital city should be. the houses downtown look as if they were made of mud, with a clay, spanish-mexican style of building. it is full of colors and smells, and stuff to see. there are a lot of art galleries, and people seem to be very friendly.
god bless you, you have a wonderful smile, i can truly feel you, said Norma, the lady that cleans the breakfast table at the hotel. please, keep on smiling. When I told her I am from Israel, she nodded, "I am not surprised". and when she asked me when I was born (December 25th), everything seemed to be very clear to hear.
I kept walking around town and found myself in a carpets shop. hundreds of them, in all sizes and shapes. I told the salesman that I am just browsing around, but he stlil gave me a lesson in carpetry basics, which was very interesting.
I then walked into an art gallery, with the lady looking at me and saying that she likes my smile, and that I am probably happy. I guess smiling goes a long way in this town. We kept talking and talking, and she gave me some tips on places to go and see. I invited her to join me, but she regretted that she has to stay in the gallery
We parted, and I found myself walking into an indian arts gallery, where alex, a california-born jordanian waited for me, all fire and sulfur, that he almost managed to hide. I am not quite sure what was on his mind, but he tried to be very friendly, except the occasional remarks of you-know what. He then asked for my phone number, which I gave him, and I am wondering what exactly he is going to do with that.
The forrests outside of santa fe are beautiful, and I did some hiking in one of them. a coyote bumped into me on the way, but he seemed far anxious about the encounter than I was, since he ran straight into the woods, with me asking him to wait while I turn on my camera. there are trees and forrests as far as the eye can see, through hills and velleys.
And right now I am sitting on a bench with the entire valley in front of me, all the way up to albequerque. this land is wild and raw, and definitely has something about it.
and so do the people.
god bless you, you have a wonderful smile, i can truly feel you, said Norma, the lady that cleans the breakfast table at the hotel. please, keep on smiling. When I told her I am from Israel, she nodded, "I am not surprised". and when she asked me when I was born (December 25th), everything seemed to be very clear to hear.
I kept walking around town and found myself in a carpets shop. hundreds of them, in all sizes and shapes. I told the salesman that I am just browsing around, but he stlil gave me a lesson in carpetry basics, which was very interesting.
I then walked into an art gallery, with the lady looking at me and saying that she likes my smile, and that I am probably happy. I guess smiling goes a long way in this town. We kept talking and talking, and she gave me some tips on places to go and see. I invited her to join me, but she regretted that she has to stay in the gallery
We parted, and I found myself walking into an indian arts gallery, where alex, a california-born jordanian waited for me, all fire and sulfur, that he almost managed to hide. I am not quite sure what was on his mind, but he tried to be very friendly, except the occasional remarks of you-know what. He then asked for my phone number, which I gave him, and I am wondering what exactly he is going to do with that.
The forrests outside of santa fe are beautiful, and I did some hiking in one of them. a coyote bumped into me on the way, but he seemed far anxious about the encounter than I was, since he ran straight into the woods, with me asking him to wait while I turn on my camera. there are trees and forrests as far as the eye can see, through hills and velleys.
And right now I am sitting on a bench with the entire valley in front of me, all the way up to albequerque. this land is wild and raw, and definitely has something about it.
and so do the people.
Subscribe to:
Posts (Atom)
