Thread by @TheRealDoctorT

“...One thing is certain. When you come out of the storm you won’t be the same person who walked in. That’s what this storm’s all about...”

- Haruki Murakami, “Kafka on the Shore.”

It’s 1979, and a powerful storm system lashes the city of Managua, Nicaragua, with heavy rain. 1/

A teenage boy is driving his father’s truck. He has a delivery to make.

He squints through the sheets of water slamming against his windshield. He can barely make out the tail lights of the cars up ahead.

He doesn’t see the oncoming drunk driver until it’s too late... 2/

It’s 2019 in San Antonio, Texas, and I’m watching the lightning flash in the distance through the hospital windows.

Looks like a storm is coming.

But I know better.

The storm is already here. 3/

The patient comes in late at night to the ER via EMS. “Found unresponsive by a friend.” Young, woman, no known medical history.

Broad differential diagnosis.

Septic physiology. Shock.

ICU admission. Kidney failure.

No one to give me any background, or any history. 4/

The lab values look terrible. The patient looks worse, ashen and unresponsive.

In times like this I’m especially grateful for my team.

As the ICU nurses skillfully go through their protocols and stabilize the patient, I sit down outside the room, next to the cardiologist. 5/

Sitting across from the two of us is the PA from the Infectious Disease service. She’s a brilliant clinician and I’m glad she’s here.

In the patient’s room, at the bedside, is the intensivist.

It’s 1AM, and the teamwork is real.

No one faces the storm alone. 6/

It looks to me, based on the data, that we are probably headed towards urgent dialysis. But there’s hope still.

The urine output in the Foley catheter is picking up. With improved hemodynamics maybe we can finesse our way through this without needing dialysis. 7/

The intensivist walks out of the patient’s room slowly. He has just intubated the patient and put them on a ventilator.

He washes his hands with sanitizer, as he leaves the room and walks over to where we are all sitting.

His gait is slow, with an old limp.

He smiles. 8/

“Thanks to you for coming in,” he says, his accent heavy.

His name is Juan. He’s in his late fifties, with graying hair. He walks with a cane, stooped, with a pronounced limp.

He has a sharp mind, and excellent judgment. Crucially, he is a kind man.

I respect him. 9/

He sits at the workstation next to me.

“It’s going to be a stormy night, Tabatabai. I think she’s gonna be okay without dialysis for now, but we will see where things settle, eh? Bueno.”

He flashes his trademark smile, full of warmth, then looks out the window at the sky. 10/

I wonder where his mind is going, as the rain starts to really pour, clattering loudly against the window in torrents.

Nicaragua, 1979, a teenager is driving his father’s truck, making a delivery.

A drunk driver veers into his lane. 11/

The car hits his truck head on. The impact kills the drunk driver instantly, and the boy blacks out. A passerby pulls him from the wreckage as his truck catches fire.

When he comes to, he lies on the asphalt, staring up at the dark skies.

The rain feels icy.

Shivering. 12/

He can’t feel his legs.

He can’t feel much of anything, but the cold.

A creeping numbness.

His blood mixes with the rainwater, as it pools around him, a slowly blossoming red supernova with him at its center.

His body is shattered.

He closes his eyes and awaits death. 13/

Only he doesn’t die.

He makes it to the local hospital and receives stabilization surgery and dozens of bags of blood products, before being airlifted to a larger regional hospital.

He will go through numerous surgeries, and spend almost the entire year in a hospital bed. 14/

Eventually he has to learn to walk again, and he does it.

The experience will change him completely.

The boy who had been somewhat aimless before, now knows what he wants to devote his life to.

An entire year of surgeries, of being a patient, will teach him compassion. 15/

Now, as Juan sits beside me and the flashes of lightning reflect in the lenses of his glasses, I wonder if he’s thinking about it.

He senses my gaze, and meets it with a smile.

“You know, a storm once changed everything for me, Tabatabai. It broke me, to make me strong.” 16/

I nod in silence, understanding where he’s been.

He looks away, and I follow his gaze.

Both of us look into the patient’s room, watching her vital signs on the monitor.

“She’s young, y’know? This is the critical part of the storm. But I think she will make it through.” 17/

With that, he finishes writing his note, and gets to his feet with his cane. He says goodbye to us, and slowly walks away.

I listen to the clicking rhythm of his steady and methodical gait as it echoes down the hallway, into the night.

I think of the stories that make us.