The White Coats.

I met a man who had so much cancer eroding his mouth that he sneezed and it broke his jaw so we cut his face in half and scraped it out and scooped out his neck and we chopped one of the bones out of his shin and sewed it into his face to reconstruct the mess we made but then his heart kept quivering after surgery and it caused a chunk of blood to get thrown to a vessel wrapped around his intestine and it plugged the oxygen supply and caused his gut to die so it rotted inside of him and his belly swelled like a balloon and filled him with sickness so we wheeled him to the ICU and put him on a ventilator and poured fluids and drugs into his veins to try to fill and squeeze all the vessels in his body to keep his blood pressure up but he was too sick and he just kept sinking farther and farther into his bed and day after day the white coats peeked in and nodded and continued on and finally his wife asked when she should leave his bedside to tend to their livestock and I realized he kept hanging on because he was the toughest man I’ve ever met with callouses on his hands and a life at home and that night I cried in my car and pounded on the steering wheel and asked the moon for answers because I didn’t know if we couldn’t help him or if we just didn’t help him but I don’t know if I’ll ever know the difference.

I met a man with a reputation of fame and success whose life had been crumpled into a hopeless cycle of heroin and bath salts and I remember how breath stuck in my throat when they removed the dressings and I saw the top of his bare skull shining back at me and later I found out that he had sat in the sun for so long that it had charred the skin on the top of his head black so they had to scrape it all off the bone and every day I would sneak into his room before the white coats to drip water on the edges of his bandages so he wouldn’t scream when they ripped them off and he would tell me that the drugs made him hear snakes hissing and women screaming being raped and he hated it but he couldn’t stop because being without the drugs was worse and I couldn’t imagine anything being worse so during those quiet morning hours in the darkness I would tell him that things would be different this time and he could have a second chance this time and he could do it this time and I told him to come back and find me to prove me right this time and he told me he would and I wanted to believe that it would be different this time but the truth is I never really did.

I met a woman who was pregnant with needle marks on her arms and powder clumped on the hairs in her nose and her wrists were tied down to the bed and her lips muttered and her eyes stared and followed you but they were blank inside because a puddle of bacteria was chewing into her brain so they wheeled her into the operating room and peeled off a chunk of her skull and dug a hole through her brain until they found the pocket of pus and when they squeezed the white curd out of her brain her body couldn’t handle it because the baby’s heart in her belly stopped beating so the white coats came running and they burst into the room with soapy hands and the nurses ripped the blue tissue paper gowns over them and they sliced her belly open and stretched the edges wide and dug deep inside and when their bloody gloves reappeared they were welcoming a new tiny human to the room and when the operation was over and the day was done I wondered endlessly around the hospital until I finally found the hidden broom closet filled with warm glass incubators and a nurse guided me to the corner and there I saw the one thing that made that day all worth it and I learned over the little bundle of new life and whispered this isn’t what the world is always like.

I met a girl who was born with two broken nerves so her vocal cords couldn’t spread apart and she had lived her entire life breathing through a tube in her throat and they had driven for 18 hours to see us and when the white coat told her we might be able to fix it her eyes lit up and I she opened her mouth to speak for the first time and even though it was only a whisper I could hear the excitement as she asked, “Dad, then would I finally be able to swim?”

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The House They Built.

Before the lands were riddled with metal and lights, a man and a woman built a house. It was in the heart of the warm months, and the nights were so clear that they merely crafted their four walls of bundled sticks and left the roof open to the stars. Building their house was incredibly easy – effortless almost – and their first months were filled with smiles and freedom, tangled on their floor laughing and whispering into the early morning light.

Then one day, a storm rolled over the mountains. Giant, grey clouds glowed bright with lightning and it’s anger shook the ground. The man and the woman trembled in the downpour, filled with fear and uncertainty about the future. Their house was flattened in the storm.

After much deliberation, they decided to build another house. This time, they would build it closer to the valley walls for protection. The woman was delighted by having the river to look out on, and they soon found excitement in building their new home. The man would return dripping with sweat, exhausted from chopping trees. The woman worked tirelessly to help clear the ground for their new home and to gather food and cook for them each night. Together, their hands created four thick, oak walls and a sturdy roof. The hours of labor and frustration and failures were dwarfed by the feeling of gratification that overwhelmed them as they slept in their warm house through the winter months. Blankets of snow and screaming winds raged outside, but they spent their nights singing old songs and playing cards in the light of their fireplace.

Then the snow melted, and the peaceful river became an angry, raging force of nature. It ripped trees from it’s banks and cut at the soil. The man and the woman watched, broken hearted, as pieces of their house were torn apart and swept away in the flood.

The man and the woman were devastated, and the storms continued to relentlessly pour over them. The man and the woman cried many tears. They both considered what to do next: try again and face another failure or depart on separate paths.

After many nights, they finally made a decision. They left the valley. The soles of their feet cracked and callused walking the mountain ridges. When they finally arrived, their tired eyes looked to each other and lips moved. They turned their backs on each other, and the man marched into the trees to find the best trees and the woman began clearing the spot they had chosen. They learned from their previous mistakes. They built their walls stronger this time. The man built the porch the woman had always wished for. The woman created a mud mortar to seal the cracks in the walls to prevent the wind whistling that had frustrated the man before. The man and the woman worked on the house for months.

Finally, the house was finished. The man and the woman were much older now, and their long talks had become clipped by familiarity. Smile lines had been etched into their faces, along with the worry lines. The man and the woman laid down for the first time in their new house. The man’s rough hands gently wrapped around the woman, and the same whisper brought the same laugh. The same familiar heart beat skipped inside their ribcages, and they fell asleep within the sturdy walls of their new, safe home.

The years passed,

and the seasons came and went,

but the storms never shook the home the man and the woman built again.

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Splinter.

You are a biologic carcinogen.

You left splinters under my skin. They don’t hurt most of the time, but when I run my fingers over their grooves they still send electric shocks through my ribcage.

You buried roots in my coronary vessels. I get angina at the mention of your name or the thought of you and it drops a weight on my chest and it feels like I can’t breathe.

You spread hematogenously.  I can feel your metastases weighing down my bones and crowding out the marrow cavities. They ache a lot at night.

You left a scar. It’s small, barely noticeable by anyone. Like a plump nodule hiding behind a clavicle, quietly heralding systemic disease.

12

Do What You Are.

I had a bicycle with ribbed pink plastic handlebars growing up.

I can’t remember much more about that bike, but somehow I can still feel those tiny ridges bending and pressing into my palms. I could probably identify that bike out of hundreds simply from the handlebars alone, down to the most minute of details. Opening this memory causes other memories from Phoenix to innately spill out as well – the plastic taste of the vibrant beads that always jingled on my wrists, the throaty call of the dove that had pulled the sun up each morning, the smell of the gritty orange scrub my dad had used to scrub motor oil from his fingers.

This is what surgery feels like to me.

Silky latex stretching over my knuckles, blue tissue-paper crunching around my waist, the steady rise and fall of a sleeping sternum, sharp clinking of steel surgical instruments, a hypnotizing metronome of a throbbing pulse.

It is a sacred world hidden from society.

A silent language of communication through eyes locking over masks in an intimate huddle of illness.

I have found my purpose.

 

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Admission Note

0012       Trauma admit arriving by air
0013       MVA w/ patient ejected from vehicle. Previously healthy, no PMH
0014       Daughter currently outside trauma bay
0015       ETA 0025
0016
0017       Alert & following commands at scene
0018       Open upper extremity fracture – pulseless
0019       1U of pRBCs and Dopamine en route. BPs running 70s/40s
0020
0021
0022       Pt arrived. Pt is unresponsive. CPR in progress
0023
0024
0025       R arm cyanosis in fingertips, immobilized in splint. Visible midhumeral bone
0026       Distended abdomen w/ bruising along flank. Absent L breath sounds
0027       Needle decompression L chest, return of rush of air
0028       Cardiac rhythm, CPR stopped
0029
0030
0031       No confirmation of airway, anesthesia at head of bed
0032       FAST ultrasound positive for intraabdominal bleeding
0033
0034       Patient being prepped for open laparotomy in trauma bay
0035
0036       Carotid pulse still palpable, faint
0037       No pulse — CPR commenced
0038
0039       No confirmed airway yet
0040       Laparotomy incision made, CPR ongoi
0041
0042
0043      Significant bleeding from abdomen
0044      No confirmed origin of bleeding
0045      Hanging 5th U pRBC
0046      Mask on and bagging
0047      Epi 5mg push
0048      Pulse check — no pulses palpable
0049
0050       Pulse check —  no pulses palpable
0051
0052       Hanging 2U pRBC
0053
0054
0055       Pulse check — no pulses palpable
0056       Rapid infusion running
0057       More than 15 min CPR
0058       Daughter bedside. Restrained
0059       Pupil check — pupils 4 mm, non-reactive bilaterally
0100
0101
0102
0103
0104       Time of death

 

Admission note transcribed by a third-year medical student during trauma activation. Identifying details of this encounter have been modified in order to protect patient privacy.

Ice Cream Sandwich Socks.

She was the most terrifying surgeon in the hospital.

In an age where white coats were to be worn only by men, she walked fiercely into medicine anyway. She took the sneers and barking from senior physicians but she held her chin held steady. Back then, medicine was not a woman’s game. With each step she climbed, she tacked on another piece of armor and she grew stronger. It toughened and polished her, and she was built into the indestructible surgeon she is famous for today.

I have watched chief resident’s fingers tremble beside her. I have watched fellow surgeons, renowned and respected in their own right, fall silent as she stepped into the room. Scrub nurses, usually bustling and preparing while chatting with the circulator,  stand alert with fingers poised and eyes glued her hands, anticipating her next move. Medical teams in the hospital, young doctors visiting from out of state, senior doctors trailing the end of their careers – they all know her name.

For weeks, we had stood shoulder-to-shoulder in silence as she performed many of the biggest surgeries known to medicine. The infamous Whipple procedure – a grueling 8 hour minimum- was her favorite. Her fingers seamlessly twirled around the surgical instruments, and I longingly watched as she carefully cut open the belly, clamped arteries, and unsheathed the pancreas. I stood perfectly still, often for over 10 hours, with my hands carefully planted on a corner of sterile draping. Others had warned me: “She prefers medical students to simply observe. Whatever you do – don’t grab anything.”

Yet something in me resonated with her. There was the smallest hint of a smile in the corners of her mouth under her mask when her eyes met mine. I recited my patient presentations I had spent hours memorizing for her clinic and could see a flash of approval in her stone cold expression before she spun on her heel to enter the patient’s room. Then one day, she handed me her suture. That day in the OR, I was taught the sacred ritual. She began to signal for me to cut her sutures with the slightest flicker of her fingers. One day, I nearly tripped over my own feet in shock as she stepped back from the operating table and silently waved for me to assist the chief resident in stapling the bowel in half.

She was like no one I have ever met. During my last day on her service, she unwrapped the ice cream sandwich socks I had bought for her and she squeezed the breath out of my ribcage. And I will never forget the words she told me:

“Hailey, you are a surgeon. I can see it in you. Do what you are.”

Scrape.

I remember this.

I was standing in the operating room. It was the first time during my surgery clerkship I had scrubbed into a surgery. I stepped to the table on the patient’s left side, his face hidden behind blue drapes. His abdomen was open and exposed, orange with iodine, with a careful incision line marked on his midline. I placed my gloves carefully on the blue sterile field. Warm, nervous breath insulated the skin beneath my mask.

The surgeon swept into the room, hands and arms still dripping. His work is legendary. Specializing in melanoma, his work targets the most aggressive of skin cancers. His ground-breaking injectable virus is killing melanoma cells, and his research has shifted perspectives in oncologic therapy.

He approached the operating table and they raised it to meet his towering height. I climbed onto a step beside him. Nurses in blue gowns and masks whirred in preparation around us, bustling with sterile instruments hot from the oven. I could hear the anesthesiologist adjusting the tubing flowing from the patient’s mouth.

“Are you ready?”, he asked, glancing at me from behind his lenses. He knew it was my first case on the service.

Until that moment, medicine had always pulled me. I figured it was my father having life stripped away from him as his brain cells shriveled with ischemia. Or possibly it was my mother’s bruises, constantly coating her body like an ever-changing mood ring. Maybe it was the lack of stable family structure during my childhood years, a love and caring found in the patients in need at the hospital.

But as I stood above the table, watching fingers twisting silk sutures and seeing the separation of the pearly fascial layers, I remembered. My body remembered. I had a visceral reaction to it, with tears and a twisting in my stomach, remembering something I have never known.