Sunday, September 21, 2008

"I Can't Do This..."

Some people have known since the day they got their Fischer Price medical kit that they wanted to be a doctor. Some people knew when they got to high school biology. Not me. I decided to start pre-med in college because it would be easier to transfer out and finish in 4 years than to transfer in. I thought it would be a challenge, and I like intellectual challenges. But, it also scared me to death. I thought about optometry school, so I wouldn't have to take the MCAT. I abandoned that idea when I spent a summer working for an optometrist and was so bored I almost poked my own eyes out.

So, I get to med school, and I scrape by the first two years of classes. I get to the part I really want to do -- the clinical years. Ah, the clinical years. They seemed so glamorous when you're sitting in the library studying the nerves of the brachial plexus. Students running around in short white coats -- running with a purpose! They have people that need them, that are waiting for them. So much better than sitting with flash cards about pharmacology.

So, Day #1 of 3rd year comes. I'm doing General Surgery first. Three months of surgery. My first three weeks were going to be with the vascular surgery team. Red Surgery. Our Chief is K - she's driven, determined, and a little eccentric. Ok, more than a little. She wants nothing more than to prove herself. She's transferred into the program and wants people to take her seriously. The intern is haggard already (he's been on the job for 2 weeks before we started). He just wants to survive his time on the service. He also thinks K is a whackjob. Then there are the 3 of us 3rd year med students. A, C and me. A and C are super smart, both now doing anesthesiology.

So, Day #1. K and the intern take us around to our patients. They've decided that 6 is a good number. That is, we each now have 6 patients of our very own. In retrospect, that is WAY to many patients for 3rd year students on Day #1. But, I digress.

My first patient is Mr. B. We walk into the room, the motley crew we are - 3 med students in khaki's and short white coats, an intern in scrubs who hasn't shaved in at least 3 days, and K - scrubs with ballerina flats on, hair in a bun, and eyes piercing through her glasses. She means business.

So, we go in to see Mr. B who is about 60 and has had his esophagus removed because of cancer. He now has his stomach where his esophagus was and his small intestine where his stomach was. Imagine that they just pulled the opening of the stomach up into the throat. It's called, appropriately enough, a "pull through." His course was complicatd by an abdominal wound infection and dehiscence. That means that the wound is open, not sutured close. He just has a few big retention sutures holding his fascia together. Below the fascia is the abdominal cavity. The remainder of his abdomenal wall is open -- from the skin, to the fat to the muscles, all open. So, K is explaining to me that Mr. B is my patient. As she rehashes his history, she is taking his bandages off and pulling out a long, long stretch of gauze that is packed into Mr. Brown's abdomen. She pulls out the roll of gauze, not unlike a circus clown pulling scarf, after scarf, after scarf out of his open mouth.

The gauze is called Kerlex, and it's covered in nasty pus, blood, dried skin, etc. It's about 3 feet of Kerlex. She tosses it into the biohazard bag. She turns to me and says, "So, you'll need to repack Mr. B three times every day. Whatever you're doing, whatever your day is like, you have to unpack and pack Mr. B three times. So, don't go home at night unless you've packed him." She takes the Kerlex and shows me how to wet it with saline and how to pack it into his wound. She starts again, "You'll want to make sure you pack it into the far corners, because we're trying to pull out all the infection each time we do this. We can't leave any area unpacked." Then, she adds, quite nonchalantly I think, "And don't press too hard, or you'll eviscerate him." She looks up at us: "You'll poke into the abdominal cavity and his insides will then be outside. If he eviscerates, you page me. Immediately."

I walked out of Mr. B's room feeling nauseated. We walked out to the stairway and ascended to the next floor to see the next patient. K is talking about how shit runs downhill so if the attending is having a bad day we all will be having a bad day. We, as med students, are at the bottom of the shit hill. I thought I was going to pass out. I was lightheaded, I thought I was going to vomit, and everything started to go blurry. Wow, I thought, I can't do this! I made the wrong decision. Can I get a refund on my Stafford Loans? Where do I go to quit? The Dean's Office?

We went around to the other patients. I decided that I would give it one day. After all, C and A all needed me. I couldn't leave my fellow students high and dry...we were in this together!

So, I did it. Every day for 3 weeks (I got but 1 day off in those 3 weeks). I'd pack him when I got in, at 4am. I'd pack him before lunch around 12pm. And then I'd pack him before I went home, around 9pm. Three times a day, every day. I didn't skip one. He was usually delirious and out of it. Occasionally he was combative, and I'd have to duck and weave as he threw punches at, unaware that I was trying to save his life...or at least not eviscerate him.

Well, many months after I left the comfort of my dysfunctional family known as the Red Team, I was walking into a different unit and K sees me. She tells me that Mr. B is not only awake and talking, but he's ready to go to a rehab facility on his pathway home. "You made a big difference in him," she said. "Actually, I don't think he's be alive if it weren't for your three times a day wound packing."

As you can see K, the Red Team and Mr. B made quit an impression on me. I retell his story often, both to remind the current students of how good they have it, and to show them that even one measly 3rd year med student can make a big difference in some one's life.


Julia said...

wow. crazy story. it must feel at least a little good to have an impact on someone's life like that.

christian girl said...