The trees in front of the hospital were filled with crows.
Shifting, flapping black shapes huddled on the bare branches, silhouetted against the glowing blue of a winter pre-dawn. There must have been hundreds, weighing down the branches, their harsh cries shattering the silence. Cries, crying, crying.
I walked out of the hospital parking lot that cold sunday morning and stopped short in the middle of the street when I realized that all of the crows in the city seemed to be converging at the entrance to the hospital. No one else was around. No cars. My breath curled in little clouds in front of me. It was just starting to get light - that beautiful light when black transforms itself into blue just above the horizon. The TCF bank tower flashed "6 degrees." I walked past the restless, cacophonous trees and into the hospital.
A few hours later, I found myself in the burn unit, touching the distorted face of a dying man, saying "its ok, its ok." I had given the order to stop the blood pressure medications that were keeping him alive, and remove the endotracheal tube that was connecting him to the ventilator. I had given the order to let this man die. And he died. His organs had failed, he was bleeding internally, his skin had been completely degraded, and the phrase "medical futility" had been scattered through his hospital chart for days. Futile. That complicated, heavy word. The simple answer: discontinue. We discontinued. And he took his last deep slow gasping breaths - breaths originating from the most ancient part of the brainstem, disconnected from all consciousness. He ceased to continue. He was surrounded by sterile strangers, in a cold city, with crows filling the trees outside.
Two of my patients died that day.
The crows were beautiful against the sky.
Last night was one of those nights in the Emergency Department where things seemed to have come slightly unhinged. This is something that simply happens sometimes. The right combination of weather conditions, economic climate, phase of the moon, and some intangible mysterious vibe of the city all come together in the exactly the right way to form a sense of collective restlessness. A faint aura of instability seems to permeate everything.
The edges of sanity start to fray and tangle.
The result is that for some reason, everyone in the city feels this inexplicable desire to go to the Emergency Room. Its like this supernatural force gets its grip on the populace and instills this nagging idea that a variety of minor complaints must get examined IMMEDIATELY. Either that or it compels people to leave their homes, get wasted, and inflict varying amounts of violence upon themselves or each other. And then they go to the Emergency Room.
It leads to this odd, divergent combination of patients - either they have a mild cold or a yeast infection, or they have multiple horrific fractures and are about to die.
When i walked past the waiting room on my way into my shift yesterday afternoon, it looked like a small convention. People milling around, not enough seats for everyone - a foreboding sign in and of itself. Then I arrived to find that the computer system was down, multiple patients had not even been logged in, we were using - gasp- a white board, and the department was forced to operate with PAPER. Like, if I want something to happen, I have to find the appropriate piece of paper, write the appropriate things on it, and then find the nurse, who then has to find someone to get someone else to do something. Whereas before, when the computer system is functional, everything happens by magic at the speed of light.
This interesting exercise in post-apocalyptic medicine, combined with the trillions of anxious people milling around in triage and in the hallways (not to mention the roving bands of stray dogs and farm animals and the blazing trashcan fires) put everything at a standstill and caused me to run around ineffectively for many hours, drowning in my own private sea of inefficiency.
Good things that happened:
- I got to put in a chest tube
- I got to drill a pin through a man's tibia. This process involved a humerus (!) exchange between myself and the orthopedic resident who has what I am interpreting as a thick Russian accent. At one point I am holding this heavy power drill and am in the process of grinding a large drill bit through a man's leg (in order to put him in traction and reduce his femur fracture), and he is yelling something that I interpreted as "Slow speed!" "Slow speed!" so I am barely engaging the drill, thinking that I want to proceed slowly and cautiously so as to not damage any delicate cortical structures. Turns out he was yelling "Full speed!" "Full speed!" To be honest, full speed was much more fun.
- I got to show a young lady ultrasound images of her 14 week old fetus
- I got to do approximately one million pelvic exams
- I got to stay 2 hours late catching up on my charting
Wait, the last two weren't exactly awesome, but they are par for the course.
On a sidenote, I have discovered the joy and the tragedy that is hulu. A blessing and a curse. It allows me to indulge in my various guilty sitcom pleasures and watch Master and Commander of the Far Side of the Earth at 3 in the morning that one time when I couldn't sleep. But then again, I find myself wasting an hour today of my precious day off by watching the first half of Dragonheart. Everybody's favorite dragon-slaying movie, starring Dennis Quaid and Sean Connery as the critically acclaimed award winning portrayal of the voice of Draco the dragon. OH MY GOD. And then, as if that weren't enough, I found myself accidentally watching The Legend of the Seeker, a ridiculous hollywood medieval fantasy-drama-comedy. Why would I?? Why would I ever do that? (Why would I ever admit to that?) There is, deep within me, a 14 year old fanboy who is drawn to epic stories of ancient realms and dragons and magic and ... ahem.. hobbits. But for the most part, they are all embarrassingly awful and not worth anyone's time. Specifically, mine.
Dear lord, I need to get out more.
What do you say to a man when you are hunkered down at his bedside, stitching up the lacerations in his wrists that he had made, just one hour previously in a bleak act of utter desperation, with a large kitchen knife?
Needless to say, the silences inherent in such interactions can be long and profound. Not that I mind working in silence - some times it is preferable, especially when your attention is needed to fully inspect the entire extent of a deep laceration for evidence of vascular or tendon damage, and then carefully pull the edges together, bridging the tension with a couple well-placed horizontal mattress stitches. But, never one to be defeated by situational awkwardness, I attempted to cheerily fill the conversational void.
"So, are you a Vikings fan?"
I can't remember exactly, but I'm pretty sure he started crying. I'll be the first to admit that this particular interaction could have gone better.
- - -
This took place at the midpoint of a recent day at work that began with a man who had called 911 because his armpits itched. He took an ambulance to the nearest emergency department because his armpits were red and itchy. Seriously! Ah, tax dollars at work.
In stark contrast to its humble beginnings, that day ended in a drama that was as emotional as it was bloody. This lady also came in by ambulance, but the appropriateness of this transport choice was quickly vindicated when she began vomiting massive amounts of blood. Profuse, incredible, insane amounts of blood. And we couldn't stop it. We did everything else: put in a breathing tube, put in an orogastric tube, put in a large central line in her internal jugular vein, put in a line in her radial artery to more accurately measure her blood pressure as it dropped and dropped and dropped.... gave her blood transfusions, gave her saline, gave her one, then a second, then a third medication to artificially raise her blood pressure... but we couldn't stop the hemorrhaging that was occurring somewhere deep inside her gastrointestinal tract. Unreal amounts of blood. The pride and satisfaction that I felt as a resident physician who got to successfully place tubes and lines and assist in critical medical decision making was easily overshadowed by the incredible sense of impotence one feels when faced with such a losing battle. That feeling is indescribable. It is nagging and it is deep. When the battle was finally lost, and all the monitors became quiet, and a sense of heavy cold calm weighed down on the messy stabilization room, I found that the adrenaline that had propelled me through the preceding three hours quickly left me. I don't think I have ever felt so tired. I finished my charting (which at this point seemed a little absurd), I got in my car, and, finding that I couldn't go home just then, not just yet, i went to one of my favorite bars and had a beer and a vegetarian version of "bangers and mash" and stared out the window. It was a very good veggie mash. It had portobello mushrooms.
The 35W Bridge is open again.
They remade it. Built it up again, re-connecting the two sides of Minneapolis that have been for the past year so inconvenienced by detours and extra commute time.
In a sort of morbid gluttony, I drove across the new bridge four times yesterday. The first time was just because it was close and I was there and all it would require for me to ride the wings of this shiny steel phoenix was simply to go one stop past my normal exit. And suddenly I was on the bridge, hastily but very carefully re-constructed after the tragedy of one year ago that had so briefly thrust Minneapolis in to the eye of the international media frenzy - remember when it was the top story on both CNN and BBC? And for like 45 seconds everyone in the entire industrialized world was afraid to drive across bridges? And there I was, driving across this particular bridge, with the skyline of the great City of Lakes rising dramatically from its reflection in the Mississippi, and all I could think was, "Is this all?" I don't know what I was expecting - perhaps something a little more... momentous. But it was just kind of a regular bridge, made of grey concrete, with railings and arching streetlights and a distinctive lack of fanfare. Well, to be fair, there seemed to be a vague sort of squiggly blue sculpture at either end that was designed to maybe represent the river? A tribute to the 13 fallen? The inevitable passage of time? The slow march of all things towards death? The perils of rush-hour traffic?
At some point on one of my trips across the river last night I thought it might be an appropriately symbolic event to mark my return to the world of the weblog, my own attempts at narrative having collapsed abruptly into their own whirling river over a year ago. The rescue efforts were valient, but at the time unfruitful. And yet here I am, in a testament to midwestern stoicism, still a resident, still working at the hospital, still trying occasionally to go out into the world and have some fun.
Now I am officially a second year emergency medicine resident, a title that holds more responsibility, more work, worse hours, and, yes, slightly more respect. And my passage into the brave new world of the G2 was, like the bridge to which this thin veil of symbolism clings, quite unmomentous and without much fanfare at all. In fact, on the night of our end-of the-year graduation party (which is perpetually Hawaiin-themed because of its title, The Aloha Party), I was on call in the hospital on Cardiology.
But despite the well-lit concrete harshness of it all, every day reveals more about the strange tragicomedy that is human existence. Last week I saw two patients in as many days who had parasite-based delusions. Each sat on their little hospital gurney and told me that the cause of their pain, without a doubt, was the large parasite that lived inside of their organs. And then last night, before embarking on my symbolic journey across the bridges of Hennepin County, I was stitching up the head of a 17 year old kid who had been shot a bunch of times. One of the bullets had gone into the top of his scalp, grazed his skull, and exited a few inches away from another part of the scalp, without damaging his brain at all. He was incredibly lucky, and I told him so. Standing behind the head of his bead, clipping his hair away in little clumps, fiddling with the familiar process of numbing, cleaning, prepping, setting up for suture placement, I witnessed the reunion between this boy and his parents. He half cried to his mom, "I don't want to be in Minnesota anymore." This was his second time being shot since he moved here a year ago. She said, "You don't have to, baby." And then she screamed as the water that I was using to irrigate his wounds shot through the tunnel that the bullet had formed in this kid's scalp and squirted out like a little fountain from the top of his head.
ps I'm back!!! Catchy new title, eh?
The churchbells were ringing in Minneapolis as I made my way home. Riding my bike home in the warm sunlight, trees swaying in the breeze, a cacaphony of sombre bells echoing across the lake as a solemn reminder.
The city is recovering from this enormous disaster, the aftermath of a major thoroughfare being practically swallowed by the Mississippi in one sudden gulp. I am recovering too, in a way.
Man, am I tired.
I just got home after a long night at the hospital. 17 hours? Something like that. I was called in to provide emergency assistance a few hours before my overnight shift, and then stayed this morning for conference and lecture and the obligatory departmental debriefing.
I wish I could say that I was saving lives all night long, but after my first two patients who literally had the bridge collapse from under their feet, I spent most of the remainder of the night treating drunk people who had gotten into fights. A bit anticlimactic.
All I can say is that i feel very proud to be affiliated with Hennepin County Medical Center, the hospital that took the brunt of the disaster casualties. My hospital. And I feel even more proud to be part of a field whose mission is to prepare for and treat the victims of such awful situations. It felt good to be able to help out during something so momentous.
My heart goes out to the victims and their families.
And now, sleep.
