Every accidental crack

There, on the mountain and the sky,
On all the tragic scene they stare.

Mr. Smith has recovered from the acute phase of his illness, but has been left mentally scarred by the ordeal. Part of that may be a reaction to a stressful situation, but part of it is, according to the rheumatology consultant, one of the manifestations of lupus cerebritis. Systemic lupus erythematosus is an autoimmune disease, and as it has begun to affect this man's brain, essentially his body is attacking the very cells which make him uniquely him. So though he has returned to making cell phone calls and texting from his bed (prompting a transfer out of the ICU to an intermediate care ward) he is not firing up a lap top and running Sudoku 3D. He probably never will. And I am left, as the med student following and learning, questioning where this leaves his wife and her son, now that her twenty-something husband has lost his mental acuity.

Across the hall, back in the ICU, my newest patient lies recovering from an aborted surgery. Upon exploring a thoracic mass, the surgeons determined they could not remove the tumor without killing the patient. And so this man, in his mid forties, excited to finally be starting a family, with his pregnant girlfriend in the waiting area, learns that his life is likely over, just as it has begun.

I don't speak Spanish, but one of the nurses does. And she just let our team know that the apparently very supportive and ever-present mother of one of our spinal cord injury patients is telling him, in Spanish, that because he can't walk and has lost his sexual function, he'll never be a man again. No wonder he is stressed out and not improving.

Just another day in the ICU.

One of the difficulties of going to medical school and growing up at the same time is the lack of comparison. I have no reference point outside medicine when it comes to conceiving "normal" in workplace environment.

That's a bit of overstatement, but the point is, as I mature as a person, coming more to terms with who I am, and with what life is, and how those two concepts fit together, both of them are dramatically affected by an environment which alternates between euphoria and desolation. Sometimes I wonder, as I'm giving an order to a nurse or respiratory tech, if my developing ability to make decisions and follow through is separable from my environment. I wonder, as I hold the hand of a dying patient, if other people, people who work in office buildings and go home during rush hour, develop responsibility and care for people in a similar way.

I am beginning to drift into medical conceit. But that's another aspect of what I'm developing. I wonder if other professions have the tacit assumption that what they do is so vital, it probably is more important than most jobs. Even if doctors don't admit it, most of them feel that, somewhere inside. It isn't just the environment which draws us here. I've heard more than once the quip that "I would have been a nurse if it weren't for my ego." The hours are certainly better, and the pay is comparable in many settings. But a desire for prestige and power, (which likely includes two or three mortal sins, good thing I'm not Catholic :) ) is part of why I'm here, and part of why every other medical student is where they are, if they are honest. If it was only altruism, there would be a lot more general practitioners around.

Probably everyone develops an ability to get along with others, to care for others, and to make and accept their place in the world. Probably most struggle with humility and with despair created by their workplace. I guess it's just the way I'm doing it that has got me thinking.