Friday, July 10, 2015


Recently, I found a collection of things I had written as a medical student. I didn't have a blog in those days and saved them as Gmail drafts hoping to finish one day. It feels great to discover an old memory, as grim as this one may seem. It’s one of my few distinct memories from my surgery rotation.
The alarms forced my body to wake up at 5 AM. By 5:30 AM as day break approached, my body resorted to muscle memory to push the accelerator pedal and turn the steering wheel in order to guide my ugly early 90’s era sedan through the quiet streets of inner city Brooklyn. There was only enough cognition at that hour to determine what color the traffic lights were. Decision making was limited to stop or go. By 5:57 AM, my brain would arrive at 2 rational thoughts. First, I had 3 minutes to make the walk from the parking lot to the STICU. The second completely rational thought was that 3rd year of medical school was making me regret my career choice.
By 6:05 AM, the team collected behind the central counter of the STICU (surgical trauma ICU) and descended upon the resident on-call the preceding night. On this particular night, it was a middle aged, overweight, Turkish anesthesia resident who appeared especially sweaty. From his bloodshot eyes you could tell he was feeling too old to be doing residency all over again here in the United States. Marty, a precocious and social urology resident appearing clean and freshly shaved looked at the exhausted resident and said what the rest of us were all thinking.
“Rough night buddy?”
The on-call resident gave us all a brief look and regretful smile. It was 6:06 AM and although I had been up for over an hour my brain did not register enough of the world to make a reasonable and appropriate response. I wanted to somehow support this resident who had a difficult night but simply couldn’t muster the energy to do anything. In fact, this was as far as I would let my mind explore the emotional realities of being a member of this dungeon. The next 12 hours was not about feeling or learning. It was simply about reacting and doing whatever needed to be done for the 8 occupants of the STICU.
Bed 1: Gastrointestinal bleeding. Draw a blood as soon as the meeting breaks and every 6 hours after that. (I hated drawing blood)
Bed 2: Motorcycle accident: Find out from the pulmonary doctors if he can extubated. (I hoped the pulmonary fellow wouldn’t bark at me for bothering him)
Bed 3: Nasal Bleeder: Ask the ENT doctors if he really needs to be here (More scut work)
Bed 4: Aortic Dissection: Call his pharmacy or family and find out which blood pressure medications he should’ve been on (Even more scut work)
Be 5: Empty. (Mr. Marcellus apparently coded for 45 minutes the night before. The bed looked really comfortable. I didn't care someone had died on it)
Bed 6: Smoke inhalation, Acute Respiratory Distress Syndrome, Sepsis and a deeply pious Orthodox Jewish family. Go to radiology, get a report of today’s x-ray and bring it upstairs. (Apparently, family was in and out of the STICU all night praying at his bedside.) Talk to the family and let them know they can only come inside during visiting hours or if there’s any acute change in his status. (I’m sure a grieving family loved having a 3rd year student restricting access to their loved one)
Bed 7: MICU boarder. Medical ICU patient. Go talk to the medical ICU residents and see if they have a bed available to take her back. (I was sure the answer would be no.)
Bed 8: Liver failure in DIC. Check his labs every 6 hours. (He was a goner, but I knew he’d keep us all busy.)
Later in the day we coded bed number 8 several times until he died. I remember the final horrific experience of doing chest compressions on his bloated dying body. My arms were tired from several rounds of CPR and my neck became sore from trying to keep my head turned away from his face. After a while, I couldn't stand to see that lifeless zombie stare where instead of words coming from his mouth there was only regurgitated stomach contents. And instead of tears there were only drops of crimson blood oozing from the corners of his eyes, 
Through the entire process, I did what I was told by our code leader. Rather than thinking about what was happening to this poor unfortunate soul, I remember counting the chest compressions in my head wondering how events in my life could've culminated with me bearing witness to this horror.
By 2:30 pm after taking care of some odds and ends, I had the opportunity to go eat lunch. I had to hurry because although Bed #8 was empty now, a replacement for Bed #5 was on the way.


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