I started on the CCU today and am amused that all of my patients have last names that are body parts.
I usually do the “30 Days of Gratitude” thing on Facebook, but I kind of forgot to start on the first.
But tonight I am especially thankful for the cashier at the food store on the way home — who not only let me in after he turned the sign on the door to “Closed” but also gave me the employee discount. And now my belly is full of yummy food.
I am a fan of meaningful dates. I know when I was baptized, birthdays of friends and family, the day I began calling myself a Christian, and anniversaries.
Today is a year to the day to when I had a patient with an air embolism. An air embolism is defined as “obstruction of the circulation by air that has gained entrance to veins usually through wounds.” Air in the venous system ends up in the right heart, and then travels to the lungs via the pulmonary arteries. The pulmonary arteries divide into smaller and smaller branches until they terminate into capillaries, where the red blood cells pick up oxygen. If air is in the way, like in an air embolism, it blocks the red blood cells from picking up oxygen. The right heart works harder and harder to push against the resistance the air provides, and the left heart is hyperdynamic and empty. The left heart being empty means that the rest of the body isn’t getting the oxygen it needs.
I had a guess, but I didn’t know for sure what was happening when it happened. I just knew that I needed help. The central line was out, and now the patient was gasping for air.
Thank God for ICU nurses. One rushed in and put the patient back on the monitor. He was in stepdown and was supposed to be going home the next day, so he wasn’t hooked up to anything. She put him on nasal cannula, and his saturation was in the low 90s. Not terrible, but certainly not normal. She switched him to a non-rebreather mask and called the rapid response team.
Then the SICU fellow walked in. He took a quick look at the patient, said “well, he’s just anxious,” and walked out. I was floored. There was no way this guy was serious!
I had already called my resident at this point, and he was on his way back to the hospital. He had a good idea of what had happened and showed up 15 minutes later. By that point, the patient had been sedated and intubated. He could not move his left side, but his CT was normal. His CTA was normal, and the MRI, at this point, was also normal. I could not believe how bad I felt about myself, about my away rotation, and about becoming a surgeon.
One of the hardest things I have ever done was come back to the hospital that Monday morning. I had never been more homesick in my life. I tried to safeguard myself from just wanting to lie in bed all day. I made sure that I had the “student work” for that morning, making and updating the list, seeing the floor patients. I remember being on the phone with the ex (then boyfriend), and his reminding me that yes, I still wanted to be a surgeon.
I knew I did the right thing showing up to work Monday morning when someone walked up to my resident and said, “Hey! You’re still here.” I was so grateful when, a week later, the patient walked out of the hospital with no residual damage. His kidney function was back to normal, his neurological deficits had resolved, and his family, surprisingly, did not hate the team.
I guess this event can speak to a lot of things: systems and how they fail, patient and family communication, education, student responsibility, my relationship with God, and honesty. I’ve been trying to own it, trying to share my story in all its mess and glory. It also reminds me of what a difference a year makes: in training, in attitude, in my life, in my relationship with God.
I have an MD after my name now, and I approach patients differently. I have a better idea of what I don’t know, and my own weaknesses. I know God carries me through all things. And, now more than anytime, I know how fickle my feelings are. The despair I felt then is nowhere to be found now. It’s OK for me to be OK, and even better than OK. I didn’t end up at that program — but I am where I am meant to be.