I'm not really all that mysterious

a song in my head

As I finish off my residency, I realize that no matter how awful some of the remaining hours and the minutes can be, this experience is finite and bounded. My senior resident on my very first in-patient intern month took a sardonic aphorism from the seminal medical novel “The House of God” and added a hopeful corollary which has become something of an unspoken mantra. “They can always hurt you more, but they can’t stop the clock.”

Pages from the Emergency Department that I would’ve reacted to with an apoplectic fit have started to become surreally ludicrous. Take one of the consults they had me see the other night while I held the neurology service’s pager. I am beginning to appreciate just how much insanity and ridiculousness the neuro service probably shields the medicine service from . They don’t necessarily diminish the number of painful, nonsensical (I think the technical term is “cockamamie”) admits we have to take, but they at least get the ER or surgery resident to focus and come up with a coherent reason as to why we should take the patient.

Still, it was with some trepidation and loathing that I walked into the resuscitation room down in that madhouse. One of the worst chief complaints we learn to dread is “patient found down”, because generally it means that we have absolutely no past medical history to go on.

Worse, their neuro exam was not very hopeful. Pupils fixed and dilated. Unresponsive to noxious stimuli. Serious badness.

Then again, the patient had just received massive amounts of sedative/hypnotics, with paralytics on top of that, for the alleged purpose of airway protection. Before I could even muster my sentiment of incredulity at having to perform a neurological assessment on someone who had just been drugged out of their mind, they were already apologetic. “I know the neuro exam isn’t going to be very illuminating, but we just wanted you on board.”

As I assessed the patient, I couldn’t help but sigh in resignation. They weren’t kidding about the fixed and dilated pupils. I couldn’t elicit a doll’s eyes reflex, either. I poked at her eyes with cotton swabs and got nothing.

I know it’s ridiculously early in my career, but I think the death and destruction is starting to get to me.

It occurred to me just how much pain and suffering occurs in the hospital. Me and the hem-onc fellow were bantering about the different levels of emotional damage that results from watching people die, ranking experiences according to how horrific they were. We never decided whether it was more awful to watch a baby die versus a young adult on the verge of attaining their goals and dreams. That’s when a “Code Blue” got called.

I think that it suffices to say that there is probably something wrong with you when you decide to go to a code because you don’t have anything better to do. So despite the fact that I wasn’t on the medicine service, I tagged along anyway.

It was with some horror when I realized that the patient who was getting chest compressions was a very sweet old lady whom I had admitted a few months ago. The family was in the ICU, weeping silently, and I grew painfully aware of the fact that it was a good 20 minutes before anyone went up to them to explain what was going on. I was tempted to do it myself, but they didn’t recognize me, and it seemed odd to be coming from an entirely unrelated service not at all involved in her current care.

I wouldn’t blame the ICU resident from wanting to kill us, though. As he got massacred by the sheer number of intubated people coming up from the emergency department, me and the back-up resident (who performs factotum duties between 1 am and 7 am) were shooting the shit about the recent study that showed that the concept of relative adrenal insufficiency is probably a farce, staying up until the ungodly hour of 3 am for no good reason. To be fair, the back-up resident did help him with putting in a central line.

The reason why I was loathe to go to sleep, though, was that housekeeping had neglected to fix the call room I was staying in. I ended up sleeping on top of the covers but that didn’t stop me from waking up feeling itchy all over. The thing that worries me and grosses me out is the fact that there’s some kind of lice infestation on the general medicine wards. They kept talking about this guy who was completely infested with lice, and the notion just gives me the heebie-jeebies.

And entirely unrelated to all this madness, this song kept popping up in my head last night:

1 w1ll f0ll0w y0u 1nt0 th3 d4rk from Monkmus on Vimeo.

No blinding light or tunnels to gates of white
Just our hands clasped so tight
Waiting for the hint of a spark
If Heaven and Hell decide
That they both are satisfied
Illuminate the NOs on their vacancy signs

A white rabbit and a brown rabbit

“What is Real?” asked the Rabbit one day, when they were lying side by side near the nursery fender, before Nana came to tidy the room. “Does it mean having things that buzz inside you and a stick-out handle?”

“Real isn’t how you are made,” said the Skin Horse. “It’s a thing that happens to you. When a child loves you for a long, long time, not just to play with, but really loves you, then you become Real.”

“Does it hurt?” asked the Rabbit.

“Sometimes,” said the Skin Horse, for he was always truthful. “When you are Real you don’t mind being hurt.”

“Does it happen all at once, like being wound up,” he asked, “or bit by bit?”

“It doesn’t happen all at once,” said the Skin Horse. “You become. It takes a long time. That’s why it doesn’t happen often to people who break easily, or have sharp edges, or who have to be carefully kept. Generally, by the time you are Real, most of your hair has been loved off, and your eyes drop out and you get loose in the joints and very shabby. But these things don’t matter at all, because once you are Real you can’t be ugly, except to people who don’t understand.”

Margery Williams The Velveteen Rabbit
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