Monday, July 28, 2008


"My one question is, can I have this at home?"

Those were almost the last words he said before we put the endotracheal tube down his throat and started breathing for him. Mr. Baker was an old, old man with lungs that had pretty much given up on him. Thanks to the miracle of modern medicine, he now has at least a few weeks of drug-induced sleep ahead of him before he can rest eternally.

I've not been able to get those words out of my head, or the next ones, a muffled repetition of "stop, you're hurting me" to the anaesthesia resident who was clamping a bag mask over the man's face prior to intubation.

I like the guy, a lot. It had been a while since I had liked a patient, since I've spent the last month or so in the ICU, dealing with the surprising tide of alcoholics, drug abusers, and the merely testosterone poisoned who wind up, along with the occasional patient rescued from the clutches of the surgeons, on the MICU team.

The work itself is exciting. It's been amazing to see what is possible, and at the same time, I'm now the resident, responsible for supervising the interns, which is more work than I expected.

I wanted to write about that. About how I've been following orders for so long, I hadn't realized I knew anything. About how I've come to realize how much I have learned, and about how much there is left to learn. But "stop it, you're hurting me" was the first thing that really seemed important enough to write.

A lot of this month has been hellish. I've realized that, no matter how good they are with knives, a lot (I'm tempted to say most, but I do have a limited perspective here) surgeons are absolutely clueless where complicated medical problems are concerned. Most than one patient I've managed this month had their conditioned worsened by a surgery resident, and in at least one case, the surgery team managed to induce both diabetic ketoacidosis and a myocardial infarction in the same patient. I've realized that seemingly competent medicine interns still have to watched like a hawk by their medicine residents. And I've learned that even I can make mistakes.

I've changed. The show-cynicism of internship is now mostly heartfelt, as I start to see the same cases of self harm, sometimes even the same patients, and I feel the helplessness than undergirds all of what we do.

This was in even sharper perspective somehow the month before, on the heme/onc service, where I realized that all we are offering people with medicine is time. No one cures anyone. We treat and postpone, but rarely cure. Even when we do, for instance saving the third Tylenol overdose of the month with some well timed N-acetyl cystine, I know the fourth is right around the corner. And who knows, this one may come back with more success in her strivings at a later date.

I treated him, God healed him

In the last analysis, that's really all anyone is doing, even outside of medicine. The gas station attendant, the bus driver, and the coffee shop owner are all united with the physician in that all we are doing is allowing others to continue their lives. Some lucky individuals may even help improve them.

Which is of course the point, and it's what keeps the cynicism at 3am while admitting the fourth intubated overdose patient of the night from becoming full blown despair. We're all here to help people, to love our neighbor as ourselves, in the manner we're most fitted to do it. And if I can maybe relieve a little of the pain I see, and maybe give these people and their families a little more time, I will have succeeded.

I hope, or I could not live.