The time will come when you will do everything “right” and still have things fall apart on you when you least expect them to.
It is, perhaps, the most difficult lesson medicine has to teach its practitioners.
That in the end, there’s so much we don’t control, or understand. 1/
It is, perhaps, the most difficult lesson medicine has to teach its practitioners.
That in the end, there’s so much we don’t control, or understand. 1/
It hits you in different ways.
Sometimes it happens quickly, leaving you stunned.
They call them “crashing” patients for a reason. The smashing of one destiny into its end, with a sick whiplash you feel in your very soul.
And sometimes it’s slow.
A creeping realization. 2/
Sometimes it happens quickly, leaving you stunned.
They call them “crashing” patients for a reason. The smashing of one destiny into its end, with a sick whiplash you feel in your very soul.
And sometimes it’s slow.
A creeping realization. 2/
In the ICU, a patient is crashing hard.
Their nurse calls for help, and soon the room is filled with people.
Working together in a coordinated dance of efficient, goal-directed, movement, they course correct and buy some time.
I don’t yet know this patient.
But I will. 3/
Their nurse calls for help, and soon the room is filled with people.
Working together in a coordinated dance of efficient, goal-directed, movement, they course correct and buy some time.
I don’t yet know this patient.
But I will. 3/
One of the aspects of medicine I love the most is the teamwork.
The reality is that almost nothing happens in isolation. There are teams within teams; people looking out for the patient, and for each other.
These teams make all the difference.
You’re never truly alone. 4/
The reality is that almost nothing happens in isolation. There are teams within teams; people looking out for the patient, and for each other.
These teams make all the difference.
You’re never truly alone. 4/
Teams react to good news in pretty much the same ways. Smiles, joy, elation, congratulations, nods, fist bumps.
The dramatic saves become war stories that are told when spirits need lifting.
But when things go south, every team reacts differently. Every teammate is unique. 5/
The dramatic saves become war stories that are told when spirits need lifting.
But when things go south, every team reacts differently. Every teammate is unique. 5/
The consult request is on a very very sick patient.
I find myself scrolling through pages upon pages of notes in the system, covering several months of hospitalization.
Like a hawk, circling high above the battlefield, I seek out the big picture. 6/
I find myself scrolling through pages upon pages of notes in the system, covering several months of hospitalization.
Like a hawk, circling high above the battlefield, I seek out the big picture. 6/
The truth is most doctor’s notes don’t help much.
Billing requirements have reduced the average chart note to an overstuffed list of diagnoses and findings that are too often simply templated, then cut and pasted forward.
But there are still some good notes out there. 7/
Billing requirements have reduced the average chart note to an overstuffed list of diagnoses and findings that are too often simply templated, then cut and pasted forward.
But there are still some good notes out there. 7/
The sickest patients usually have a roster of consultants on their cases.
I look through the names in this chart, and smile. This is a great team.
We all have our favorites, even if we never admit it.
People we work well with. People we understand. People we trust. 8/
I look through the names in this chart, and smile. This is a great team.
We all have our favorites, even if we never admit it.
People we work well with. People we understand. People we trust. 8/
The cardiologist is a thoughtful and caring man.
When I think of him, I remember the first time I saw him. He was sitting at a patient’s bedside, so focused, so compassionate, I thought he was a family member.
As I got to know him, I understood: he always cares. 9/
When I think of him, I remember the first time I saw him. He was sitting at a patient’s bedside, so focused, so compassionate, I thought he was a family member.
As I got to know him, I understood: he always cares. 9/
His knowledge is extensive. He thinks through problems carefully and systematically, never ruling things out too early and keeping an open mind till the end.
I know nephrologists and cardiologists are supposed to butt heads all the time, but this one makes my life easier. 10/
I know nephrologists and cardiologists are supposed to butt heads all the time, but this one makes my life easier. 10/
The infectious disease specialist is smart, perpetually upbeat. Her sense of empathy is why I admire her.
Her sense of humor is why everyone loves her.
A patient once told her she looked like Lindsey Lohan.
She replied without missing a beat, “Parent Trap or Mean Girls?” 11/
Her sense of humor is why everyone loves her.
A patient once told her she looked like Lindsey Lohan.
She replied without missing a beat, “Parent Trap or Mean Girls?” 11/
She’s the one who’s sitting at the workstation beside me right now as I go through this voluminous chart.
“Tough case,” she says, her voice quiet, “sick as heck, and I’m thinking my antibiotics might be part of why you’re here.”
I nod, “Perhaps… but they’re needed.” 12/
“Tough case,” she says, her voice quiet, “sick as heck, and I’m thinking my antibiotics might be part of why you’re here.”
I nod, “Perhaps… but they’re needed.” 12/
The gastroenterologist walks into the workroom and sits down beside us.
Perhaps it’s because he’s primarily a proceduralist, but he’s very blunt in his assessments.
I admire his honesty.
Sometimes I wish I had his clarity.
He glances at us both, “This patient is gone.” 13/
Perhaps it’s because he’s primarily a proceduralist, but he’s very blunt in his assessments.
I admire his honesty.
Sometimes I wish I had his clarity.
He glances at us both, “This patient is gone.” 13/
The ID specialist flinches at his words. I know she’s grown attached to the patient’s family. And I know her well enough to know that her optimism is still burning.
“I don’t know, they’re sick but there’s-“
“Trust me. They’re gone. We’re building a bridge to nowhere.” 14/
“I don’t know, they’re sick but there’s-“
“Trust me. They’re gone. We’re building a bridge to nowhere.” 14/
A silence falls over the workroom. The only sound is the “click-clack” of keyboard keys.
People have different typing styles. The gastroenterologist is an angry typer. He uses his fingers like bludgeons, mashing keys with force.
His typing sounds like hail. Angry. 15/
People have different typing styles. The gastroenterologist is an angry typer. He uses his fingers like bludgeons, mashing keys with force.
His typing sounds like hail. Angry. 15/
It occurs to me that perhaps it’s easier to keep things at a distance if you stay angry.
Maybe the angry typing is really just the laying of bricks in a Great Wall of Protection.
The gastroenterologist leaves, and a melancholy silence descends. 16/
Maybe the angry typing is really just the laying of bricks in a Great Wall of Protection.
The gastroenterologist leaves, and a melancholy silence descends. 16/
The last person to enter the workroom is the intensivist. He is a good man, technically skilled and possessing that rare quality of being both detail-oriented and aware of the big picture.
He sits down, and sighs wearily.
The kind of sigh that’s familiar in the COVID era. 17/
He sits down, and sighs wearily.
The kind of sigh that’s familiar in the COVID era. 17/
“You know what I’ve realized?” He asks nobody in particular.
The ID specialist turns to him, “What?”
“That I know jack squat about jack squat.” He says it without smiling.
She scratches her brow, “Well, if YOU know jack squat, Sayed and I are screwed!”
He has to smile. 18/
The ID specialist turns to him, “What?”
“That I know jack squat about jack squat.” He says it without smiling.
She scratches her brow, “Well, if YOU know jack squat, Sayed and I are screwed!”
He has to smile. 18/
We start to discuss the details of the case.
Each of us brings our particular expertise to bear. Focusing through our individual lenses, between all of us on this consult team, we have over 100 years of clinical experience combined.
Teamwork is our lifeblood.
Always. 19/
Each of us brings our particular expertise to bear. Focusing through our individual lenses, between all of us on this consult team, we have over 100 years of clinical experience combined.
Teamwork is our lifeblood.
Always. 19/
In this way the days pass. We all see our patients, and collaborate in their care.
The sick patient in the ICU takes up most of our time, most of our bandwidth.
Every day I talk to at least three or four other clinicians about them.
Unfortunately things aren’t going well. 20/
The sick patient in the ICU takes up most of our time, most of our bandwidth.
Every day I talk to at least three or four other clinicians about them.
Unfortunately things aren’t going well. 20/
Not all crashes happen suddenly all the way through. Some begin dramatically, and then shift into slow motion.
It fools us, makes us think the crash is over, when it’s actually still happening, slowly.
The GI doc was right.
We gave it our best, but the end was inevitable. 21/
It fools us, makes us think the crash is over, when it’s actually still happening, slowly.
The GI doc was right.
We gave it our best, but the end was inevitable. 21/
It hits us all in different ways.
Some of us seem to move on quickly, unaffected. Some are devastated.
It’s the cardiologist who sits down at my table one day at lunch, and finally addresses the ghost lingering by my side.
“Still thinking about that patient, Sayed?” 22/
Some of us seem to move on quickly, unaffected. Some are devastated.
It’s the cardiologist who sits down at my table one day at lunch, and finally addresses the ghost lingering by my side.
“Still thinking about that patient, Sayed?” 22/
I nod, picking at my food, “I keep trying to figure out what happened, if we could’ve done things differently.”
He nods, his voice quiet. “I’ve been doing this a long time. Let me tell you, we had a damn good team, and we tried… but when it’s their time, it’s their time.” 23/
He nods, his voice quiet. “I’ve been doing this a long time. Let me tell you, we had a damn good team, and we tried… but when it’s their time, it’s their time.” 23/
We all understand this, on some level.
When it’s our time, it’s our time.
The last bridge we build is always the one to nowhere. Or, perhaps, to the one place that matters.
I thank him for his words. He nods.
And we move on to discuss another patient.
The next one.
When it’s our time, it’s our time.
The last bridge we build is always the one to nowhere. Or, perhaps, to the one place that matters.
I thank him for his words. He nods.
And we move on to discuss another patient.
The next one.
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