Thread by @TheRealDoctorT

There is something strangely hypnotic about the dialyzer, the way the blood pump keeps turning in its infinite loop.

Then again, when you’re tired enough, anything can seem mesmerizing.

It’s 2008, and I’m in the midst of my nephrology fellowship.

It’s been a long road. 1/

Being on call as a fellow usually means staying late, especially when the hospital is busy (i.e. always).

It’s a cold November night.

I’m sitting at a workstation desk in the inpatient dialysis unit, my gaze glued to the dialyzer across from me, zoning out.

“Awake doc?” 2/

The charge nurse is from Jamaica. She is calm, with the quiet competence that only comes from experience.

Her accent is soft, but still enough to be distinct.

It makes me think of places far away from here.

A warmer, more forgiving sun.

I smile, “Yeah, I’m awake.” 3/

She nods, “Good. The night is young. Besides, there’s gonna be a new president tonight.”

Ah yes.

It’s Election Night.

Barack Obama is running against John McCain.

History could be made.

I am reminded of the world outside the hospital.

That things still happen there. 4/

There are only a couple of patients being dialyzed tonight. I get up and walk to the little side office attached to the dialysis unit.

This is the renal fellows’ office. A few computers, and a couch.

The couch is crucial.

I lie down on it and close my eyes.

Dreamless. 5/

I wake up to the loud alarm of my pager. It’s only been fifteen minutes, but I must have just started slipping into REM sleep, because I’m disoriented.

It takes me a few moments to clear the haze, and focus on answering the call.

There’s a critically ill patient crashing. 6/

To those who aren’t familiar with critical illness, the delicate balance of human life can fall apart with a disorienting rapidity.

“But I just brought her in for a headache...”

“But he was playing golf this morning!”

“What do you mean by “organ failure?” You mean dying?” 7/

I reach the ICU, and find a patient in the midst of a stomach-churning free-fall.

The ICU nurses are working feverishly. Multiple vasopressors are at maximal doses. Cooling blankets and ice-packs.

The patient is relatively young, sedated and intubated.

Dying. 8/

I look at the lab data, and feel my heart sink further.

Normal lab results are in black. Abnormal are in red.

My computer screen is awash with red numbers.

Overwhelming sepsis.

I call my attending.

I need to act NOW.

It’s 2AM. The phone rings a few times. 9/

My attending’s voice is thick with fatigue, “Uh, hello? What’s up Sayed?”

I apologize for the late call, and go through the details of the consult. When I finish, the silence lingers for a moment before the attending breaks it.

“Man... OK I’m up now.” 10/

The only option is continuous dialysis.

For a moment, doubt enters my mind, “Do you really think this is survivable? Aren’t we just doing something futile at this point?”

His voice is quiet on the other end of the line, “They’re young. Youth is resilient. Let’s see.” 11/

I get my gear together for a dialysis catheter placement. As I prep for the procedure, I notice the TV in the patient’s room.

“President-elect Barack Obama.”

He won it.

I can’t help but smile, as I snap on my sterile gloves.

16 cm 12 French in the internal jugular vein. 12/

Once I suture the line in place, I ask for a STAT x-ray to confirm placement. I step out of the room.

A smooth procedure is always gratifying.

The dialyzer is rolled into the room. I update the family, and then head back to the dialysis unit and fellow’s office. 13/

The charge nurse is still dialyzing away. She sees me enter the unit and waves. I grin, “Obama won.”

She nods, flashing a brilliant smile, her wide eyes making her joy seem deeper, somehow, “Yes he did! Long road doc. Long, long road.”

I nod, “Long, long road.” 14/

Years later I will think back on that night and realize I don’t know if she meant the road to get to that moment, or the road ahead.

Perhaps both.

The patient I started on dialysis that night did survive, and to this day remains the sickest patient I’ve ever seen make it. 15/

Eventually they got transferred to our rehab floor.

As the days and weeks passed, and I continued the fragmented life of a renal fellow, I forgot about them.

They became one in an ocean of patients.

Until my attending from that night gives me a call two months later. 16/

“Hey, Sayed. Remember that super sick patient you called me on, way back when?”

“Yes, I remember! They made it!”

“Yeah. They left the hospital today, discharge creatinine normal. Walked out on their own two feet.”

I feel an unexpected wave of emotion, and fall silent. 17/

Medicine is a struggle.

Understand the depths of your knowledge, and its limits. Bear witness. Communicate.

Be vigilant.

Be humble.

Be strong.

Be human, but not too human.

Walk this sharp line, until your feet bleed, then keep walking. 18/

My attending must sense something in my silence because he speaks up again, “They’re going to be okay. You never know with youth. Youth is resilient. It’s a long road ahead, but they’re going to be okay.”

I nod, finding my voice, “Yes... long road.”

The long road back. 19/

It’s 2020, and I’m wondering why my mind is traveling back to a patient from over a decade ago.

Thoughts surface. I stare at the TV.

They just called Pennsylvania.

The long roads behind, the uncertain paths ahead.

Of life, and death, and the spaces in between.