October 2008 Archives

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.