I am Here

I spend a lot of my life, more than I like to admit, right now wishing I could speed up or turn back time. I want optho to be over, I want my surgery rotation to end, I want medical school to move along so I can just do what I think I want to do with my life. Four months ago I just wanted to be done with class, then then the boards, then orientation. I day dream in a great deal of my precious free time, I dwaddle over pictures and blogs. I complain a lot. I am discontented and restless. I want the future or at least my vision of it or even the past sometimes wouldn’t be all bad. I would rather be where my sister is I say in college having a great time, working at camp for a summer. Or I would rather fast forward 10 years and be married with kids and doing child health work in some corner of the developing world. Any where but here, please God I find myself praying, Here Am I, send me…somewhere, please.

Today I tried to study for my surgery shelf which turned into a futile fight to focus on my textbook rather than the summer sunshine or my endless day dreams or journeys into nostalgia. I could barely sit still. I whined to myself about my inability to focus and then I whined about my whining. Then I had a thought in the mist of my whining. I found myself in the mist of the familiar near prayer of please send me somewhere and I found God whispering Here I Am, I am here. And I felt a great deal aware of the foolish, whimpy 6 old that I have been the last week or two.

Here is somewhere. and its the only time I will ever be here. Maybe its not my favorite place and maybe it never will be but its where I am. And its where God is because its where God wants me.

Big People

They are making me take care of BIG PEOPLE. GROWN UPS. ADULTS. I swear the first three patients who came I just didn’t know what to do with them. I just didn’t seem to know how to start a conversation with them. My usual bag of tricks of cartoons, books, sports teams and Hannah Montana was useless. I finally managed to have a half-hour conversation with a woman in the pre-op area about Budapest. And she thanked me profusely saying none of other “surgeons” in the past had ever offered any sort of distraction during the pre-op process. I then began to wonder if I was supposed to do such things with grown ups. No one seemed to care one way or the other. Sheesh I am terrible at all this professionalism and seriousness that goes into taking care of grown ups.

Today they let me take care of little folks’ eyes, it was a relief. Its not that I hate taking care of adults, I just don’t enjoy it.

culture shock…

We are waiting on a Spanish interrupter and I am sitting trying to look busy while my attending and an the anesthesiologist talk. I am trying not to eavesdrop but they are talking right above me and its hard not to hear. They are talking about private schools in the area. They go on and on about the various pros and cons of each and various other attendings’ children who attend school X, Y and Z. The conversation moves on to Aspen. I shift uncomfortably in my chair. I will never be that stereotypical, American physician who sends their kids to private school, goes skiing in Aspen and drives a SUV. Its ironic really, here I am a doctor’s child, a third generation physician no less and such conversations make me uncomfortable. Its not that any of these things are inherently wrong I just seem to have very different priorities than most of my peers and mentors. Maybe its the navybrat, maybe its the wandering in Eastern Europe, maybe its my crazy hippee Christanity but for better or for worse I find myself in many ways in an alien culture of affluence and prestige that I am supposed to be excited about but am somewhat wary of.

On my first day of optho, I find myself explaining my life plan to an attending. I want to be a general pediatrician I explain. He asks me if I know how much the average pediatrician makes. I said yes. He looks at me strangely, you are too smart for that job, do a fellowship, this is a good medical school use your education wisely. I smiled and brushed off the comment but again was struck by how different my conception of using my education wisely was from this respected physician. It wasn’t that his ideas were wrong or less worthy, it was just very different from mine.

doctors yet again such strange people, I have much to learn of their ways before I ever understand them.

the baby

I could tell a lot of tales from the last week of peds surgery. If you talked me recently, you probaly know I saw my first case of child abuse in America this week. I am not going to blog about it because of the sensitivity of the issue not even under password protected. I was surprised how hard it was for me. I seen so much gross neglect and abuse of children overseas. But most of it has been at the hands of the state and not at the hands of the child’s own parent. But it didn’t make me want to run from pediatrics, if anyting it motivated me. Little kids are so worth fighting for, there are few more just causes than protecting a child from harm and comforting them when they encounter it.

Today I was on rounds call. I went in and we were done by 7. I learned how to do an arterial blood gas and then found myself wandering the NICU. An idea came to my head. I presented myself to the nurses and asked if I could feed a baby. I explained that I had volunteered before I came to medical school. I spent 45 minutes holding a baby who happened to also be my patient. He had screamed all morning and his Mom never comes to see him. The nurse sent me to him when I asked to be put to work. I put on the gown and and sat in a rocking chair and watched the sun finish coming. I kept waiting for some doctor to walk in and send me off to do scut. But no one ever came and bothered us. I sang softly to him and stroked his little head and watched his eyes slowly droop When I left him in his crib, he was content and for the first time all day not crying. The nurses offered me a grateful glance. I nodded, grabbed my white coat and headed home.

There is more to these children than numbers and orders. My profession is really good at forgetting that.

Signs of life

Three weeks ago: I stepped up to the table entirely unsure of what to do with myself and somewhat terrified of being in the way. I clumsily took my gloved hands and placed them on the table at the gesture of the scrub nurse. I found my hands resting on the mound of green sheets. Suddenly I found my hand rising and falling and realized my hand was on the patient’s chest. So peaceful, his chest rose and fall. Somewhat anticlimactically, the attending asks for a 11 blade and fresh blood flashes on the yellowed skin. The fascia and fat are burned through deliberately and still his little chest rises and falls. I know of course that behind the green curtain is a team of anesthesia folks regulating each breath but I am still in awe of the peaceful rise and fall of this child’s chest as we probe into his body with our knives. It was horrifyingly easy for a moment to forget that under all the drapes was a living human being.

Two weeks ago: He has never eaten a day of his life and rarely spends any time outside of his little crib in the corner of the ICU. And he is post-op from his third operation in 2.5 months of life. His little baby hands are failing and he is crying almost to himself. His arms are restrained so he won’t pull out his tubes (which he loves to do). He looks me in the eyes as I peer into his crib and seems to beg. I place my hand on the soft tuft of hair on his head and stroke gently. He looks in my eyes again with a look of contentment, of peace. The tears stop and his eyes follow the steady rhythm of my hands.

Today: I got to our emergency bowel obstruction case early and asked the Anesthesia people if I could tag along. I spoke to the Mom and the child before even the Anes people came by. I knew the child he had been on our service for several days. He had a ruptured appy and now unfortunately had a complicating SBO. He was not thrilled about returning to the OR. We started to roll him away and I start to the OR then turn around and find the Mom sobbing. I go back and comfort her and try to reassure her. A nurse takes over and gestures for me to return to my duties in the OR. “Take nice deep breaths.” she says with her arm around the mother’s shoulder.

When I got the OR I showed the kid his x-rays and helped get him arranged on the table. The Anes attending pulled me aside and explained to me he wanted me to hold cricord pressure (helps position the trachea for intubation). He instructed me to place my hand on the patient’s chest while they gave him the inducing drugs (sleep drugs…). This time there was no peaceful steady breathing but the rapid flutter filled with fear and a bit of dread. Then all of the sudden, the flutter turned into the steady drum that I had learned to anticipate with each procedure. His chest rose and fall. My hand flew to his throat and in went the tube.

This morning I walked into a room of a child with a gunshot wound to the head. He had limited if any sensation and movement of his lower extremity, his grandmother is in the corner quietly crying. On the bed is the child naked except for a sheet with an oozing wound and a look of despair and exhaustion. I held the penlight so my upper level could examine the wound and I again found myself with my hand on the child’s shoulder. and it rose steadily with the rise and fall of the chest. And I found myself wanting to whisper to him, you are still with us, stay with us, just keep breathing.

From beneath my feet appears a brown heap of curls. A heart shaped face peers up at me with a impish grin. She tugs on my white coat and crawls into my lap with ease despite the cast on her arm. While many of her size run away from me in all my medical student get up, she is not fazed and is intent on sitting on my lap rather than in her bed. She puts her head on my chest. She seems to be looking for something. I talk to her as I write an order. She looks up at me again with a million dollar smile as if to say I found it. You are still alive. You are still human.