A Doctor’s Life: Ready, Rinse, Repeat

“Hey, man, I’ve been getting destroyed all night running four OR’s and haven’t eaten. I am going to eat dinner before I get out of here.  If anything emergent comes up, I can help out.  Just let me know.”

As I wash my hands right after I hang up the phone, the overhead call come out:  “Attention.  Your attention, please. A Level 1 trauma code has been activated in the adult emergency department.”  It was a gun shot wound to the right chest.  I rinse my hands off, and head down to the ED.. just another night in A Doctor’s Life.

Ready. Rinse. Repeat.

Ready.  The patient arrives.

The patient sounded like they were in a bad place before they even got to the ED.  Massive transfusion protocol in place. The patient arrived as unstable as they sounded.  They were already intubated and on pressors.  Bags of blood hanging as part of the multiple transfusions received.  The patient had obvious neurologic and vascular injuries.

After a quick work up, it was determined that the patient was coming to the operating room for an attempt at emergent operative intervention.

Unfortunately, the injuries were devastating.  Our resuscitation couldn’t keep up with the injuries he sustained despite a cross-clamped aorta; and despite our massive transfusion through large-bore venous access.

After realizing that we had already lost the battle, we stopped.

The patient died on the table.

The family

Sunset in mountains
Enjoy every last sunset and precious moment you get. Never know when it’ll be your last.

I hate these situations.  I always like to talk to the family after a bad event happens in the OR.  It’s probably helpful to them to see the people who helped try to save their family member.  And, God knows, it is helpful to me in processing these events.

After staying two hours later than my shift should have ended to care for this patient, the family still was not present.  He had been transferred to us.  Wanting to talk to the family, but not knowing when (or if) they would arrive, I headed home.  It was well after midnight by this point.

I obviously cannot go into specifics on this patient’s case, but it never ceases to be any less devastating.  No matter how many patients we lose.

I lost several in training, and this was my first as an attending physician.  Though there was little I could do and the deck was stacked against my team, it hurts none the less.

I just hope and pray that the family is okay and will make it through this.

I want to rinse this bad night off

As we wrapped things up in the OR, I looked my residents in the eyes and asked if they were okay, and asked if they needed to talk.  As with any debrief, we talked about what happened.  We discussed if there was anything we could have done better.  We all agreed that the outcome would have been the same regardless of what we did.

As I leave, still having not eaten dinner, I drive home with the windows down.  Its 40 degrees outside. I just need to feel the air in my face while I think.  It had been a busy night.  The short drive at this time of night isn’t long enough to process it all.

I arrive home to find my front door is not only locked, but so is the storm glass door (to prevent my 19 month old from running out the door, I am sure).  The key for the storm door is different, and I don’t have one. I call my wife multiple times.  No answer. Finally, I check the inside garage door. It’s fortunately unlocked, and I walk inside.

I brush my teeth.  Get in bed.  Lay there for an hour trying to fall asleep while thinking about what happened.  It’s now 1:30am.  With my eyes closed and my heart heavy, sleep finally comes.

The next morning

I wake up the next day to the morning hustle and bustle of helping my wife get our three kids out the door.

After my family leaves, the quiet sets in again.  And, I realize that I get to do this whole thing called being a doctor over again tonight.  I often feel like an imposter being a doctor, but it really is a privilege and an honor.  It’s also really hard sometimes.

Ready. Rinse. Repeat.

Working in medicine is tough.  We don’t always acknowledge that, and expect everyone to just keep moving along.  What have you found to be helpful in these tough situations?  Leave a comment below.

TPP

6 thoughts on “A Doctor’s Life: Ready, Rinse, Repeat

  1. Thanks for sharing this poignant post. Even though I’m in a different specialty (rads), I can relate to a lot of what you experience. Being a doctor takes a toll on our emotional well being. We often have to compartmentalize our fear, insecurity, and sadness, and reset each day to serve our patients. I trained down the street from you at a level 1 trauma center. Every night on call was the gun and knife club. Add in MVAs with panscans and you always had an exciting but exhausting call. Back then we didn’t have much attending backup so it was all on the resident. It was stressful making critical decisions with the surgical team breathing down my neck. “Do we take to the OR or not” , “What’s that thing there?” Thanks for the awesome post. Stay strong brother.

    • Thanks for the support, MD!

      It is a stressful life for sure. And I can relate to rads in one other way, it is a thankless job. While we are both on the “ROAD (Rads, Optho, Anesthesia, Derm) to happiness”; neither you nor I ever get the credit when it goes well. But we sure do face down some demons when it doesn’t. Banding together and discussing the tough topics helps us all cope.

      Thanks for being one of the good guys!

  2. PP sorry for your loss.

    I was in the drug store where I live a couple weeks ago and I whipped around an aisle corner and there was an old man standing there with 2 bottles one in each hand. He looked up and said “Hey Doc, which one? I grabbed the bottles since the old eyes aren’t so great and hand them back and said “this one”. He was grateful. I didn’t know the guy from Adam, but I probably took care of his wife or brother or neighbor and he knew who I was.

    I was standing in line at the UPS to send a package. Couple people back were 2 girls whispering to each other. I finally overheard “that guy was my anesthesiologist when I had my baby, he did my epidural…” Finally I looked back and she said “Remember me?’ I just looked at her and said “turn around and lemme see” cracked her right up.

    You have no idea who you touch and the cosmic ripple it causes. You train yourself to be the one at the head of the bed who doesn’t have the luxury to loose his mind while everyone else is loosing theirs. Be that man/woman, there is no guilt. Teach your residents to be the same. Only later can you take a little of that luxury.

    • Thanks for being a good example to us young guns, Gasem.

      Glad to hear you’ve seen the real impact of your work outside of the hospital. It sounds like you’ve had quite the positive influence in the community there.

      And you are exactly right. We don’t know who we touch and when, or what effect that may have. I am thankful for the privilege of being able to do my job every day. I’ll keep passing the torch to my residents.

  3. As an emergency physician I get to watch people die on a regular basis. It definitely takes its toll, but it does make you appreciate the frailty of life. The family you speak to during these events may not always remember what you said, but they will remember how you made them feel. I can’t tell you how many times in the past 10 years I’ve taken care of a patient who previously had been a family member crying in the conference room. Be kind. Have patience. You never know when those family members will cross paths with you again.

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