A laugh

This post is one of the pre-written posts I mentioned earlier. I've been sitting on it for a couple months, trying to tune it up, but at this point, I give up.

Sometimes, laughter is good medicine. Sometimes, when faced with horrible situations, the only way to deal is to throw up your hands and chuckle.

One month on ICU, I had nothing but nightmare calls. My first call I had four patients code in a row, nearly back to back, and all four expired: four emergencies, four families destroyed, four tense situations full of panic and fear, over 80 minutes of sustained adrenaline with no release, on top of an already busy ICU call night full of septic shock and DKA.

Codes are agonizing. Only about 20-30% of in-hospital codes survive 24 hours, so it's a situation that destined to have a bad outcome. When I first started running codes, I did not save anyone through my first twelve. I was ready to quit residency. I should've gotten at least three of them to come back, if only for a day.

And then there's agonal respirations. During the code, it's a good prognostic sign, but after the code? It's probably the most horrifying physiologic response I can imagine. Every now and then you hear about someone coming back after being the code being stopped, but for the most part, agonal respirations are like a knife in the back.

And it's bad enough to have a patient die, but then facing the family is that much worse. It's like tearing your heart out piece by piece. It's always the same. The wife drives in to the hospital at 3 AM, still in her nightgown, sitting patiently at the nurses station with a cup of disgusting coffee which she can barely hold onto. And to have to tell this poor woman that her husband of 40 years is dead? It makes me nauseous just remembering.

There was another resident in the hospital who helped me through some of the codes, and in the morning before checkout, we reminisced about our terrible night. He loved vasopressin because you can't chase it with epi for five to ten minutes, so that's five minutes you can sit back and think. That doesn't sound like a lot of time, but if you're running the code, five minutes is a lifetime.

"Man, I love vasopressin. Five to ten minutes? That's half the code right there! It's Code Blue cruise control!" We both chuckled. Not that there's anything funny about watching four lives slip through your fingers, or telling four families that their loved ones were dead. It's just that when you have no other protection, nothing to hide behind, all you can do to keep going is to laugh. Because laughing is breathing, and on some days, it takes all the effort in the world to take that next breath.

Hospital codes are a spectator sport

I get left alone to fend for the service quite often. Granted, my team had good reasons not to be there in the afternoon, but I know that if I wasn't there, someone would have to stick around. In any case, I got some stuff done, and I'm feeling better about my eventual transition into residency.

But the thing about being in the hospital for a protracted period of time is that you realize a lot of people die in the hospital. I mean a lot. And it's from all sorts of reasons. There are ICU patients that just are straight up dying. But there are patients on the floors too that die for one reason or another. And it gets you down after a while.

And you can only care so much. It doesn't matter if you're a bleeding heart or you're stone cold, there's only so much you can care before you find yourself cracking jokes or simply blowing things off. It's self protection. You can only handle so much before you're overcome. The human creature was only designed to tolerate so much suffering. After a while, you compartmentalize and shield yourself to the horror of it all.

And in this respect, my life has come to mirror my hospital reality. I'm slowly but deliberately shielding myself from reality. I've adopted a policy of avoidance and ignorance. I've turned a blind eye to the world around me, because to look at it, to think about it, it'd be too much: too frustrating, too disappointing, too depressing. I'd rather not think about it at all.

But on the plus side, I've got a friend in the hospital, and M is cool beans. We've been hanging out a lot in house, and it's so much fun. You know, I realize now what people mean when they say that the other residents you work with are what define your residency experience. It's nice to have a friend in the hospital, if only to have someone to lean on.

We've had a storied history in the hospital. We took call a lot together on medicine. We were there when a classmate was diagnosed with a serious illness. We saw a lot of codes together. On surgery, we were always running around together. We were like peas in a pod. I think, of all the things I'll miss about medical school, I'll miss our time in the hospital, because she single-handedly made 3rd and 4th year of med school a fun time.

And I should note that it took my attending 3 weeks, but he finally noticed my tremor. I guess he did better than my neurology attendings who didn't notice at all. My tremor, if you're curious, is exacerbated by stress, fatigue, caffeine, and anxiety, to name a few things. However, I tend to mask with creative use of hands (pockets, behind back, pen twirling, etc).

My senior resident noticed on my 2nd day on service.