I totally set this one up.

The Chief of Surgery was hurrying us along to prep the patient to quickly start the operation. Having some difficulty inserting a foley catheter for the patient, an uncircumcised male, I replied to him without thinking: “Sir, I’m sorry but I don’t have much experience with foreskins.”

Surgery moments

Today, as I was leaving the SICU in the evening, I spotted a couple sitting alone in the OR waiting room. It was 7:30 PM and the place was quiet, with only an occasional resident briskly passing by. I wondered if they were waiting on a family member, perhaps the patient who had just been taken to the OR by my attending for emergent repair of an incarcerated hernia. I had wanted to scrub in on the case, but decided to go home to study, as shelf exams are next week. Priorities, priorities…as I passed the OR control desk, I couldn’t help myself; it didn’t feel right to just leave. I walked back to the waiting room and asked if the couple had eaten dinner. No, they hadn’t. Their family member was undergoing surgery right now. I went and got them some sodas and cookies, and hoped that the surgery went well. The world felt right again, and I went home.

It’s moments like these when I realize what the important things are in life. The little things.

Thanksgiving misgivings

Tomorrow is Thanksgiving Day. Today the weather outside is beautiful. The clouds are illuminated against the soft blue sky. In the ICU, my patient remains in status epilepticus, intubated, while his ammonia level remains too high to be quantified. Last week he was joking around about how everyone wants him to have rheumatoid arthritis. His only problems then were myalgias, arthralgias, swelling in his joints, neuropathic pain, and a twinge in his rib. Two days ago he was drowsy, which made sense for a guy who had just recovered from several episodes of new onset atrial fibrillation with rapid ventricular rate. Yesterday he was comatose. His serum ammonia level jumped from 150 to the 400’s to “greater than 1000” in 3 days despite all the measures that were done to bring it down. No one knows why. I have been reading on the pathophysiology of hyperammonemia. Cerebral edema, seizures, and death. I still have very strong feelings with regards to this situation. I’m not sure I can put them in words yet. This is one I can put in words: all over the country, people will be celebrating Thanksgiving tomorrow. I wonder how his family will feel. I wonder what Thanksgiving must be like for them in the ICU. I wonder what else I could have done, if I could have done anything. I’m not sure if I should try to enjoy Thanksgiving anyway, or if you would consider me heartless for trying to do so. I’m just thinking too much right now.

// j.

The Journal Project: “Frosty magic”

I admit this entry was inspired by events that happened this morning.

Frosty Magic

Chilled
In the pale gray dawn light

The sharp cold air
Stirs up the magic of an October morning

Cozy
In the bed-nest of blankets
You summon the strength to start the day

Heavy
A white shadow lands

The purring wall
Presses its furry weight on you

Soft
You cannot escape
The warm love of a dusky, snow-colored kitten

// j.

Protected: Sorry, a rant.

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