What Oops Means to Me

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My husband, who I’ve loved for over three decades, has one (and only one) little annoying habit.  He says “oops!” for almost any reason.  It ends up being a generic exclamation that could mean anything from “I just spilled a little milk” to “There is a fire on the stove”.    If I’m driving and he’s a passenger, an “oops” from him might mean an impending crash or just a plastic bag flying across the road.  It is unnerving, to say the least,  to not know immediately what he is exclaiming about, or its significance.

What he doesn’t realize is that “oops!” can cause a PTSD response in someone with my history.

I was a very nervous third year medical student when I walked through the doors of the giant hospital high on a hill for the first day of my Surgical Rotation.  I had never been in an operating room other than to have my own tonsils removed at age four, and that experience was not exactly my happiest memory.  I worried I was not “cut out” for the OR, and wondered if I would faint watching patients being opened up, smelling the thin trail of smoke of the cautery burning bleeding vessels, or hearing the high pitched bone cutter saw.

The first lesson on my first day was to learn how to gown and glove up without contaminating anything or anyone.  It took several hours for an extremely patient nurse to get me to the point of perfection.  She taught me what to do if my nose itched (ask a circulating “non-sterile” nurse to scratch it over my mask), or if I thought I felt woozy (back away from the operating table so I don’t fall on the patient!).  I was ready to watch my first surgery by the afternoon.

It was fascinating!  I wasn’t lightheaded.  I could handle the sight of blood, wounds and pus, and the sounds and smells didn’t phase me.  I went home elated, eager for the next six weeks of caring for patients in a wholly new way.

Each day I helped in three or four surgeries, being asked to do different tasks by the surgeon, from holding retractors so he could see what he was doing, to doing the suctioning of blood in the surgical field, cauterizing blood vessels, and putting staples and sutures in the skin at the end.  The chief resident I worked with most frequently was a very high energy guy, talking non-stop during the surgeries, sometimes teaching (“what’s this that I’m holding? what does this connect to? tell me the blood supply to this?”), all the while listening to Elvis Presley tapes blasting over the sound system.  He’d dance in place sometimes, and sing along.  To this day, I can’t think of gall bladders without hearing “You Ain’t Nothin’ But  A Hound Dog” in my head.

So when the surgery got complicated, I could tell because all the surgeon’s antics stopped.  He got very quiet, and he focused on his hands, including getting more demanding of the staff around him.  Shadow swept in, covering his normally sunny personality, and he’d bark orders, and sometimes grab my gloved hands and move them where he needed them.

One day, we were involved in a high risk surgery on a patient with late stage liver disease, who had a recent near fatal bleed from dilated blood vessels in her esophagus, caused by back up of circulation that could not easily pass through her scarred liver.  The blood vessel shunt procedure the surgeon was doing would allow the esophageal varices to deflate with less chance of breaking open again.   The surgeon had been intently working, without singing or dancing that day, so when I heard him softly exclaim “oops!”, I looked up at his face.  His eyes were big and round, his forehead sweating.  I looked down at the large blood vessel he had just nicked accidentally, and then the wound filling rapidly with blood.

“We have big trouble here!” he shouted.  I was moved out of the way, and the surgical team launched into action.  I was sent five floors down to the lab to retrieve as much blood for transfusion as I could hold in my arms, and spent the next hour running blood up those five flights of stairs.

That patient didn’t make it.

Sometimes in my dreams, now thirty five years later, I am running those hospital stairs carrying bags of blood, swirling in a vortex of red.   I never do save the patient.

And “oops” always means big trouble.

On the Edge

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In our medical school lecture hall, George always sat on the edge of his seat in the front row. That way, he could be closest to the professor and not miss any detail of the slides projected on the screen, the nuances of the overhead projector diagrams, or the patients paraded into the lecture hall with memorable symptoms. From the first day, it was clear George would be the go-to person if one of us missed a lecture, as he kept the most accurate notes of any medical student in tiny neat almost verbatim script. To read his notes was almost as good as being there and he was willing, with coaxing, to share what he knew. He was, to put it simply, the best and the brightest among us.

Working on a double Ph.D/M.D. degree, he hoped one day to be a physician laboratory researcher in a teaching hospital, although getting that much personal information from him took much coaxing. He was a first generation college graduate in his immigrant family and their hopes and dreams were riding on his success. It was clear he was their bridge to success in their new home and new life. He rarely socialized with other students after class, nor did he join in study groups. At the end of the day, he would cram every book into his huge back pack, sling it over his slight frame and head out for the city bus to return home to his parents’ house located near the north end of Seattle’s Aurora Bridge.

My opportunity to work with George came during our first clinical experience in our first year of classes, working in pairs to interview patients in hospitals, practicing our skills at taking histories. When we divided up the questions beforehand, George was more than willing to let me ask about our patients’ family and spiritual support systems, their interpersonal relationships and sexual history, and their struggles with depression or other mental illness. He was much more interested in the detail of their illness and physical symptoms, so we made a good team documenting excellent patient medical histories. George admitted to me that talking to people was a challenge for him. His passion for healing was in the lab, in his future research and in his hope for discovery of new treatments for disease. He knew his best work would not be at the bedside.

Once our class started full time clinical rotations in hospitals in our third year, students were assigned in small groups together, working under attending physicians, residents and interns in the traditional teaching hospital hierarchy.  Medical students do the grunt work for the medical team, with most of the patient contact being the duty of the medical student.

Despite his quiet nature, George excelled in the clinical work of his internal medicine rotation, and then went on to his 6 week surgical rotation. He was assigned to a particularly difficult chief resident who had a reputation for grilling students over the operating table about anatomy and being very picky about how his patients were cared for. George was always ready for the questions in the OR, never missing a one, and worked beyond the 36 hours on, 12 hours off schedule to make sure all his work was complete. He was barely getting home to sleep, just to turn around to catch the bus in the early dawn to head back to the hospital. One morning, in his exhaustion, he overslept by an hour, and rushed to arrive barely in time for 6 AM rounds at the hospital. He was unable to gather his patients’ lab results or organize information for the chief resident. When it was clear George was not prepared, the chief resident, irritated, told him to leave and not bother to return.

George grabbed his heavy back pack, caught the city bus and in morning rush hour, got off on the south end of Aurora Bridge and started walking toward home. He stopped in the middle of the bridge, set down his back pack on the sidewalk, climbed over the rail and standing briefly on the edge, staring at the water below, he jumped.

At his funeral, his pastor shared the following with his stricken family, instructors and classmates:

“George worked very hard to reach the goals he had set, in his hope to cure diseases. What we must remember is that to reach our goals we must pass over the deepest valleys of our lives. The darkest pit can appear to swallow us up. The Lord is there to bridge that gap as the firm foundation under our feet, ready to hold us up when we teeter on the edge. Don’t ever lose sight of the other side, where the valley will be no more.”

I hope, –no, I know—George is waiting for us there.

Looking Ahead in the Rear View Mirror

Amazon, formerly the Public Health Hospital
Amazon, formerly the Public Health Hospital
View of Seattle from the top floor of the Public Health Hospital
View of Seattle from the top floor of the Public Health Hospital

While sitting very high in the upper reaches of Safeco Field watching the Mariners play the Cleveland Indians, my attention was diverted to the expansive view of surrounding Seattle. In particular, I kept looking at the PacMed Tower above us on Beacon Hill, now home of Amazon.com.  It seems like only yesterday when I spent thousands of hours in training inside the walls of this remarkable old building, but in reality it is over 30 years ago, back in the days when it was the Public Health Hospital, home for medical care in the region for the Merchant Marines, as well as many of the indigenous people of the northwest and Alaska, in addition for the local folks who needed affordable (as in free) health care.  I had opportunity to work several rotations in this building as a medical student in Seattle, and to think of this place as the headquarters for Amazon makes my brain do twists.  There was so much life and death inside those walls for so many years.  Now it is corporate headquarters for a web giant, selling every gadget and gizmo under the sun and some days I feel like one of their best customers because it keeps me out of the toxic environment of the local mall.

I first walked in this building as a very green 24 year old med student beginning a surgical rotation, knowing only which end of the stethoscope to put in my ears and which end rests on the patient.  The first day I was shown how to put on a surgical gown, masks and sterile gloves without contaminating myself and the people around me.  I never have forgotten that sequence of moves, even though my opportunity to go into an operating room (other than as a patient) is rare these days.  My chief resident was an exceptionally talented but eccentric man who worked himself and all under him around the clock.  After becoming very prominent in a city known for its fine surgeons, he developed a drug problem for which he sought treatment and remains an authority on helping impaired physicians, assisting other providers to acknowledge addiction before they harm a patient.  He could only operate listening to the music of Elvis Presley.  I can’t hear any Elvis Presley songs to this day without smelling the odors of surgery–cauterized blood vessels and pus.  It is my particular burden to bear…

Those were heady days and nights of experiencing the misery of the most vulnerable of humanity in desperate need of healing, and sometimes we succeeded, but often we did not.  I still have a recurring dream of running up and down the staircases of the Public Health Hospital, bringing pint after pint of blood to the OR as our team operated on a Native American patient bleeding from her dilated esophageal varices, which had developed as a result of her damaged liver from her long alcohol dependency.  We did not save her, nor have I saved her even once in my dreams over the decades, though I keep trying to run faster. Instead I’ve spent the last 20 years of my clinical life working in alcohol and drug treatment, hoping to prevent her fate in others.

Nor did we save a classmate of mine, on a rotation on a different service, the daughter of a beloved radiologist in this very hospital, who for reasons unknown, had a cardiac arrest while napping briefly during her 32 hour shift.  Another medical student sleeping in the same room heard her odd breathing, found her unresponsive and all medical interventions were employed, to no avail.   Even when all the right people, and the right equipment, and the right medicine is seconds away, death still comes, even to healthy people in their 20s.  This was a shock to us all, and an extraordinarily humbling lesson to the pompous and overconfident among us.  We can die, in our sleep, whenever it is our time. Years later, I remember that in my evening prayers.

There was also the young surgical resident who was hospitalized with jaundice and subsequently died of Hepatitis B, contracted from a blood exposure during his training.   No vaccination was available in those days, but was developed soon afterward.  And it was in this hospital we began to see unusual cases of young gay men with severe wasting, rare skin cancers and difficult to treat pneumonias, initially called GRID (gay related immune deficiency), part of the early front wave of AIDS as it swept across the US in the late 70s and early 80s.

One night in particular sticks out for me.  It was Christmas Eve 1977, and a heavy snowstorm had brought the city to a standstill.  We had very little to do that night in the hospital as the elective surgeries were all postponed until after the holiday and no ambulance could easily make it up the steep drive to the ER, so were being diverted to other hospitals, so our patient load was light.  I was in my tiny sleeping room, on the 14th floor of the tower, facing out north to the city of Seattle, able to enjoy the view in the photo above, only everything was blanketed under snow, so peaceful and very quiet.  The freeway, ordinarily so busy day and night was practically abandoned, and the lights of the city were brighter from the snowfall.   It was an enchanting vision of a city forced to slow itself and be still, anticipatory on a sacred and holy night.

I remember thinking about how young and inexperienced I was, and how very little I knew.  My chief resident thought I’d make a good surgeon–my heart told me that I’d make a better family doctor.  The city held so many attractions and excitement with the potential of a big salary and notoriety, but my heart longed to return to a farm and a someday family.  It was a wistful bittersweet night and I slept little,  staying perched on that little bed overlooking the sleeping snowy city and wondering where my life would take me.  If I’d looked just a little to my left, and some 32 years ahead, I would have seen myself, sitting with a man I had recently met but didn’t know I’d someday marry, and our nearly grown and flown family in the top rung of a new baseball stadium.  And now the older wife/mother/farmer/family doctor I have become,  gazes back up at the much younger undefined medical student looking out that upper window of a classic old hospital building, reflecting upon who she was becoming on that night long ago.

I still am reminded every day at how little I know,  but I do know this: for however long we’re on this earth, we do have distinct purpose and meaning.  Perhaps my purpose was to be snowbound on that Christmas day, unable to go home from my shift because my car was stuck in the parking lot, spending the day singing Christmas carols for all the patients who had no other options but to stay put in their hospital beds that day.  Perhaps mine was to be the future blessing of an incredible husband and delightful children on a little farm 100 miles to the north.  Or perhaps mine is to continue to share a little of life’s lessons learned while I gaze in the rear view mirror~ the reflections of a life in progress.

Crippled

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All of us come to the study and practice of medicine through different pathways: some because of family members who were doctors or patients, some out of our own illness or woundedness, some out of intense drive to achieve and serve.

I came to medicine because of my grade school classmate Michael.

My grade school represented a grand social experiment of the early 1960’s.  It was one of the first schools to mainstream special needs children into “regular” classrooms.   At that time, the usual approach was to warehouse kids with disabilities (i.e. “handicaps” in 60′s parlance)  in separate rooms, if not whole separate schools.

During those years, the average class size for a grade school teacher was 32-35 kids, with no teacher’s aides, rare parent volunteers (except for field trips and room mothers who threw the holiday parties) and no medications or special accommodations for ADHD or learning disabilities.  I’m not sure how teachers coped with a room full of too-often noisy unruly kids,  but somehow they managed to teach in spite of the obstacles.  Adding in children with mental and physical challenges without additional adult help must have been  very difficult.

So the more capable kids got recruited to mentor the kids with disabilities.  It was a way to keep some kids busy who out of boredom might otherwise find themselves engaging in disruptive entertainment. It helped the teacher by creating a buddy system for the special needs kids who might need help with class work or who might have difficulty getting around.

I was assigned to Michael.  He was a spindly boy with cerebral palsy and hearing aids, thick glasses hooked with a wide band around the back of his head,  and spastic muscles that never seemed to go where he wanted them to go.  He walked independently with some difficulty, mostly on his tiptoes because of his shortened leg muscles, falling when he got going too quickly as his thick orthopedic shoes with braces would trip him up.   His hands were intermittently in a crab like grip of contracted muscles, and his face always contorting and grimacing.  He drooled continuously so perpetually carried a Kleenex in his hand to catch the drips of spit that ran out of his mouth and dropped on his desk, threatening to spoil his coloring and writing papers.

His speech consisted of all vowels, as his tongue couldn’t quite connect with his teeth or palate to sound out the consonants, so it took some time and patience to understand what he said.  He could write with great effort, gripping the pencil awkwardly in his tight palm and found he could communicate better at times on paper than by talking. I made sure he had help to finish assignments if his muscles were too tight to write, and I learned his language so I could interpret for the teacher. He was brave and bright, with a finer mind than most of the kids in our class.    He loved a good joke and his little body would shudder as he roared his appreciation.   I was always impressed at how he expressed himself and how little bitterness he had about his limitations.

He was the most articulate inarticulate person I knew.  As an eleven year old peer-opinion-driven preadolescent girl, I’m amazed I could even recognize that about Michael.  It was so tempting to be oblivious and insensitive to the person that Michael was inside his disabled shell.

Sometimes I wanted to hide as Michael appeared around the corner of the grade school building every morning. He would be walking too quickly in his careful tip-toe cadence, arms flailing, shoes scuffing, raising up dust with each step. He would wave at me and call out my name in his indecipherable voice, a voice I knew all too well.

There were many times when I resented being Michael’s buddy, socially crippled myself in my 5th grade need to be popular and acceptable to my peers.  I didn’t want to be constantly responsible for him and my friends teased me about him being my boyfriend.   And in many ways, he was just that.

As he would approach while I stood in my clump of friends on the playground, a group of boys playing tag would swoop past him, purposely a little too close, spinning him off his feet like a top and onto the ground. Glasses askew, he would lay momentarily still, and realizing I was needed, I would run to his side. Despite all he endured, I never saw Michael cry, not even once, not even when he fell down hard.  When he got angry or frustrated, he’d get very quiet, but his muscles would tense up so much he would go into even greater spasms.

I would help him up,  brush off the playground dirt from his sweatshirt and pants and look at his grimacing face. Although he would give me a huge toothy smile of thanks, his eyes, as usual, said what his mouth could not. He looked right past my hardened preadolescent pretense, into my softening heart. Michael knew I needed him as much as he needed me. I was a lifesaver that had been thrown to him as he struggled to stay afloat in the sea of playground hostility.  And he was the first boy who loved me because of who he saw beneath my outer shell.

After two years, the social experiment was over and the school segregated the special needs kids back to therapeutic educational classrooms.  Though I never saw Michael again, I heard him on the radio six years later, reading an essay he’d written for the local Voice of Democracy contest on what it meant to be a free citizen.  His speech was one of the top three award winners that year.  I was so proud of how he’d done and how understandable his speaking voice had become.

I’ve thought of him frequently over the years as I went on to medical school, knowing that my initial training in compassionate caring came as I sat by his side for hours, even when I didn’t want to be there, learning to understand his voice and his heart.  I didn’t appreciate it then as I do now, but he taught me far more than I ever taught him:  patience, perseverance and respect for the journey rather than the destination.    He taught me life isn’t always fair so you make the best of what you are given.

Michael, wherever you are, you did that for me and it set me on the road to practice medicine.  You helped me reach deep into my too often selfish heart to reach out to help others.

And in my own imperfect special needs way, I know I loved you too.