Me v Gravity

The irony of my situation was not lost on me. A street sign that said “No Standing Beyond This Point” and had directions to the Emergency Room caused my visit to the Emergency Room. I gingerly touched my forearm, and silently prayed it wasn’t broken.

The meteorologists had warned there was a storm brewing, but the angry charcoal clouds overhead and gusting winds told me as much. As a result, like everyone else that day, I was in a bit of a hurry to get home. I was walking towards the parking lot when I saw something move out the corner of my right eye. Six years of martial arts had instinctively trained me to cover my head. Next thing I knew, there was a parking sign on my right arm, inches away from my head and my glasses lay on the sidewalk with one lens missing.

For a split second, everything froze. There was no noise. No cars honking. No people talking. Just me, and a giant sign resting on my right arm. Before I even realized what had happened, a man materialized out of thin air and helped me place it back in the ground. Just when I started to think that maybe chivalry wasn’t dead after all, he disappeared without a word. A woman started yelling, “Get the police officer. He’s right there.” Not being able to see her made seeing where she was pointing to that much more difficult.

I dusted off my glasses and started waving my arms. She did the same, and the police officer made his way over to us. The next hour was a blur. I gave the same statement to both the hospital police and the Baltimore City police, which was then corroborated by an eyewitness - the same woman from before. They informed me I was to be “fast-tracked”, as I was a member of the “hospital family” and while escorting me to the ER, they quibbled over whose jurisdiction a falling hospital sign fell under.

The waiting room was nowhere near as sterile (Spartan?) as the rest of the hospital and welcomed me with the glow from its soft yellow light and its warm peach and pink palette. I nervously eyed the woman in the corner with a hacking cough, the man clutching the armrest of his chair until his tendons bulged and his knuckles turned white and a lump of sheets in the middle of the room. And then, the lump moved, revealing an arm glistening with sweat.

Strange as it may seem, there was slight comfort in the waiting room. Despite the fact that a sign with directions to the Emergency Room made me wind up in one, I wasn’t as sick as the rest of them.  And just as the policeman had promised, I was fast-tracked. Even though I was the last person in the room, I was the first triaged. I heard the groans as I stood up to go inside, and I knew if looks could kill, I would’ve been dead in the time it took me to stand up completely.  I went to get Xrays right away.  I wasn’t forced to take a pregnancy test prior to imaging and I didn’t get bumped from Xray. I was even able to see the Xray myself, all in the name of “professional courtesy”.

I returned to the waiting room relieved with the knowledge that I didn’t have a fracture and nervously examined my pulses and range of motion in my arm and hand.  The physician in me worried about avascular necrosis of my scaphoid, compartment syndrome of my hand, and whether my tetanus vaccine was up to date. The girlfriend in me wanted to update my better half and tell him to have dinner without me. The daughter in me wondered how to broach a conversation with my mother 4 hours away without inspiring panic. “Uh…mom? Don’t worry, but I’m in the Emergency Room right now” didn’t seem like a prudent opening. But, most of all, the human in me looked around and saw a waiting room full of familiar faces. There was no comfort for them yet; they were still waiting for answers to burning questions. They were all someone’s parent, sibling or better half too. 

When I left a little later with a brace for my arm, and discharge instructions that listed my diagnosis as “hit by flying sign” they were still there. The rumbling in the room was masked by the rumbling in the clouds.  The storm was just beginning.

Throwback Thursday....

Written a little over a year ago (9/11/2011), but kept in my private collection until now...

-------------------------------------------------

September 11^th was a Tuesday again this year. Everyone remembered where they were at 8:46 AM eleven years ago when a jet careened into the north face of the North Tower. Seventeen minutes later, while a city was still reeling, another jet hit the Southern Tower. The aftermath of those moments became my generation’s defining moment, the same way Kennedy’s assassination had unified a nation almost fifty years ago. The indelible memories from that day are still fresh, forever preserved in a collective national memory.  From the firefighters and first responders who selflessly risked life and limb, to the countless women who carelessly threw off their stilettos and left a trail of bloody footprints across the Brooklyn Bridge, to the nameless man who somersaulted to his death from one of the higher floors, and was forever preserved in a time-lapse series, to the photographer who captured many of those harrowing images, but got lost in the rubble, leaving only his camera and a roll of undeveloped film behind.

It was the beginning of my senior year of high school. I was a smart-mouthed, fresh-faced, optimistic teenager who had her whole life in front of her. I remember first hearing about the attacks as I was dropping off my gym clothes in my locker after gym class. One of my classmates mentioned that a plane had crashed into the World Trade Center. I laughed it off, thinking it was a fat cat who didn’t know how to control his new Cessna, but as I had a free period, I went to the library to investigate.

The first thing I noticed was an eerie quiet. There was no one crouched in the corner talking on their new cell phone and no whispering over homework assignments. For once, I was able to sit down at a computer without a wait, and when I tried to load a web page, I realized why. The internet wasn’t working.

On the screen next to mine I saw a picture of the World Trade Center for the first time, and immediately apologized to no one in particular for my foolish comment earlier. There was a sinking hole in our twin iconic skyscrapers, matched only with the sinking feeling in my chest. Somewhere, a television went on. We gathered around it, still unsure of what had happened, but realizing that it was bigger than anything we had ever experience before. Together, we watched the South Tower morph into a heap of smoldering rubble.

Through all of this, the North Tower continued to burn. A giant plume of smoke mercilessly choked Lower Manhattan. The reception on the television continued to deteriorate, and we turned on the radio. We huddled even closer together as it wasn’t very loud, and we heard the North Tower fall right before the images cut out on the television. The frantic commentary from the radio was accompanied only by static and the occasional sob as unfathomable confusion suddenly transformed into an all too palpable fear.

The irony of having no television, no cell phone service and no internet at the height of the dot com bubble was almost suffocating, and the news that the subway system was being shut down indefinitely made me downright claustrophobic. Hours later, I was finally able to reach my parents using a borrowed cell phone. My mother picked up and, upon hearing my voice said “I love you.” Hearing those words for the first time that day, I didn’t even realize how much I had been longing to hear them until that point. I had always known she did, but we as a family, didn’t say things like that. We just didn’t. I wanted to say I loved her too. I opened my mouth, but for once in my life, I was at a loss for words.

Mom, you probably thought I was being a surly teenager, but years later, as a weary-eyed, pragmatic twenty-something with a past, my biggest regret is not being able to tell you how I felt that day. All you were asking for were four simple words, a grand total of eleven letters. I couldn’t do it, and I still don’t know why. For that Mom, I’ll always be sorry.  The amazing thing about moms however, is their incredible capacity for forgiveness. I know you’ve long since forgiven and forgotten, but I just want you to know I love you too. There, I said it.

Blood, Sweat and Tears

Having to change out of a set of bloody scrubs once during a shift is an occupational hazard. Twice becomes somewhat of a nuisance, and after three or more, you’re “that person”. I was that person.

Saturday nights during the summer (or “trauma season” as we affectionately refer to it) is when everyone brings food and their A-game. Last night was no different. To celebrate Cinco de Mayo, we had a lovely Mexican spread and lots of chips, and one “hit” after another.

The environment is always one of controlled chaos. Nurses, doctors, aides do what they know how to do best, and somehow everything turns into a smooth, carefully choreographed routine. In that sense, last night was no different. Everyone had their own patients that they were involved in, but since I was carrying the team pager and dealing with bowel regimens and repleting phosphorus and magnesium, I only took one “hit” and my night was broken up by four bloodstains.

One of the first patients that came in was mine. Typical enough story. A gentleman who swore he never drank came in after the curb broke his fall. The first responders at the scene were kind enough to put a gauze bandage on his forehead, giving away immediately where the point of maximal impact was. He had no injuries elsewhere, so we turned our attention to his head. We applied gentle pressure as we unwrapped the gauze bandage which got more and more soaked the closer we got to his skin, until we saw the gash from one of his eyebrow to another.  His skin was adherent to the last piece of gauze we removed, revealing an actively pumping vessel underneath.  We covered it hastily with a fresh piece of gauze, realizing that we needed more tools to address “the pumper”, but not before the front of my scrub top looked like a cheap impression of a Jackson Pollock. And surprise, surprise, his blood alcohol level was a little more than four times the legal limit.

As soon as we were done suturing him up, and as soon as I was in a fresh set of scrubs, we got a call about two motorcyclists. We divided up into two teams with most people involved with the sicker of the two patients as he would need more hands on deck. The less sick of the two patients came first. Just as he finished telling us his name, the next patient rolled in with an EMT straddling the stretcher while performing chest compressions. I’m ashamed to admit that my first thought was that it must be a nice day outside if people were motorcycling, and that I had no idea since I had fluorescent lighting to keep me warm. I took a deep breath in and I knew it was going to be one of those nights. I also knew that as soon as I was done taking care of this patient, I was going to help on the other side of the wall.

By the time I got there, large IVs, a breathing tube and chest tubes were already in. They just needed help with compressions.  CPR was the natural choice given the fact we couldn't feel a pulse. But there is nothing “natural” about pummeling into someone’s chest about 100 times every minute or feeling someone’s breastbone (sternum) crack under the force of your body, or seeing them change from warm and dying to cold and dead. There is no worse feeling in medicine than doing everything you could and having that no be enough. Defeated, drenched in sweat and spritzed with blood (yes, again), I went to get a fresh set of scrubs, hoping for either a brief lull or a good save.

My prayers were answered shortly afterwards. The good save came in next. It took the form of a gentleman who had fallen and was bleeding profusely. There was a stream of blood that outlined the route to his bed. He was ashy grey, unable to speak to us and struggling to stay awake. There’s a saying that all bleeding does stop eventually, but we didn't want this patient to be discharged to heaven as well.  After we put a breathing tube in, we turned him to take a closer look at the site of his bleeding on his back. Still paralyzed, thanks to the anesthesiologists, I turned him towards me so that my colleagues could get a good look at him and try to stop him from exsanguinating. I struggled to hold him still while my colleagues put in a few stitches, while his hand, caked with blood, flopped over the side of the bed and cupped my behind. After laying him back down, I needed (you guessed it), a fresh set of scrubs. His blood was all over the front of my pants where I was leaning on him to hold him steady and there was a bloody partial hand print on my behind.

Changing for the third time, I slumped over in the locker room and let myself be tired. Other people had been able to survive this before me, and there was no reason I couldn't  Granted, I was 20+ hours in without any rest. I had operated all day and responded to about 200 pages already. I was in desperate need of a shower, and I couldn't remember the last time I had a chance to pee. But with each passing minute, the end got nearer and nearer. I downed a big glass of water, prayed I wouldn't get a kidney stone and headed back to work.

I saw a crowd of people standing in the corner and so I went to investigate. A new patient had just arrived. He was complaining of pain in his scrotum, and once we pulled down the sheets it was easy to see why. His "manhood" was approximately the size of a cantaloupe, beefy red and tender. I had no doubt that he needed to go to the operating room to get control of this infection. Debridement of Fournier's gangrene is probably the least satisfying operation possible. Yes, it's a surgical emergency. Yes, my hands get rid of a potentially lethal infection. But taking electrocautery to a man's family jewels to evacuate pus and dying tissue hardly ever feels satisfying. The thick smell of burning skin, hair and infection is smothering and ligers for hours. The anatomy is never really clear cut and you're left with a giant hole to patch up and a patient in excruciating pain.

We cut, suctioned and sent cultures. We dodged spurts of blood and cut some more. It wasn't pretty. I left work two hours later numb, exhausted and immensely thankful that I had remembered to wear a visor for that last case. The only remnant was a solitary drop of blood on my right shoe.

What Day Is It?

Currently, I'm doing q3 trauma call. Meaning every 3rd day I work 26 hours dealing with people who come into the hospital shot, stabbed, drunks that fall down, etc. And fortunately, or unfortunately, depending on your point of view, I'm currently living in one of the most violent cities in the US. And, yay! the syphilis capital. (Seriously.)

My last week has looked like this: 

Call Friday 6AM to Sat 8AM (slept for about an hour on my arm until it fell asleep), call Monday 6AM to Tues 8AM (ditto), Wed 9AM to 5PM, Thursday 6PM to Friday 6PM (maybe two hours of sleep overnight as since it was a school night, people fought the urge to beat each other up), and work again on Sunday from 9AM to 5PM. For those of you keeping track, that's 2 calls and one reverse call...meaning I've reversed my sleep wake cycle about 3 times in the last week. And then people wonder why napping, has turned into one of my favorite pastimes...

The beauty of q3 call is that every day is either pre-call, on call or post-call. Call really is an interesting phenomenon. At least for me. Precall, I eat everything in sight, get food ready for call and drink lots of water. The days I'm on call, I snack constantly, but there is a minimal amount of time for drinking water and bathroom breaks. I'm the tiny person with the "Keep Calm, Carry On" bag attached at my hip in the trauma unit. Post call, I'm always cold and extremely irritable. Like sand in your underwear after a day at the beach irritable. Sleep takes precedence over food, and pretty much everything else. 

I'm really not surprised that aside from a select few people, no one ever really calls me. They're right to assume that I'm either working or sleeping, and >95% of the time, they'd be correct. I actually got into an argument about this about a week ago with the guy I've been seeing. He's unlike anyone I've ever dated...he's not a New Yorker reading, gallery opening going pretentious prick. He works in real estate, DJs a radio station, and collects toys. But he's also the guy that has texted me good morning pretty much every day for the last almost two months and came down to visit me on my weekend off. He's the kind of guy that says what he means and means what he says. No pretenses and no bullshit.

Anyway, one day when I was post call, I realized I hadn't heard from him in two weeks. We had texted, but not actually talked, and so I did the only logical thing. I attempted to break up with him. I left him a very matter of fact voicemail saying that I felt like he hadn't been a part of my life. He called me right back, and of course he hadn't heard my voicemail. So I repeated everything I said before about how I felt he wasn't "there" for me, trying not to sound rehearsed or hysterical, and he says to me, "But I"m here for you now." There is still a spot in my apartment where I pretty much melted. 

And we talked. And talked some more. And the amazing thing is, he listened.

I'm thankful he didn't let me go.

I'm also thankful the hospital doesn't charge me rent.

Hello...

There are two ways to achieve immortality; one can either bequeath one’s personality disorders on one’s children, or one’s oeuvre. Since the former isn’t happening anytime soon, I’ve chosen writing this blog as a way to record my work and share my humble musings.  I’ve always found writing to be therapeutic, but never shared it with anyone except a select few friends. It was always too personal, too raw, and sharing it made me feel too exposed.

However, a good friend of mine, Amanda, recently started a powerful blog (http://thebunniesmama.blogspot.com) to chronicle her life as a new mother and inspired me to start blogging as well. Maybe I’ll be able to help someone as she has, or maybe I’ll be another small, barely noticeable blip in cyberspace. Only time will tell I suppose.

A little more about me: I’m a physician, currently living in exile from one of the greatest cities in the world (Go Yankees!).  I believe in only a handful of things: the transformative power of love, the Golden Rule, evolution, karma, hard work eventually paying off and myself.

The last two go hand in hand, as my current job situation is in a bit of flux. It’s been an uphill battle, and as of late, it feels more like scaling an ice cliff…without the right tools…or arms. Ok, maybe that last part was a bit of an exaggeration, but you get the point.

The title of this blog is Hindi for “from my heart” in case you were wondering.