Unsettled

Feeling kind of unsettled this evening. I"m at work, it"s almost 7pm, I"m going to be here for another hour or so, but I"m having a hard time concentrating.

Its been an odd day.

I started off with some resident teaching at a local hospital from 7-9am. The hospital is not exactly affiliated with my program, but I get paid a little to teach there, and I like the teaching. Some of the attendings come to my lectures sometimes, and they"re a friendly colleagial group.

Then I came back to my office and got organized for the day. I had a genetics clinic in the morning, but no patients showed up. So, assuming the secretary would page me if anybody came to the clinic, I set about working on my journal club presentation for tomorrow (it"s about gene expression profiling in juvenile mouse sperm... don"t ask.) I finished that up.

I went down to the ultrasound unit and did some anatomy scans to help them out. I"m not great at ultrasound, so in that way, it"s frustrating. But, there is fun in it too. Parents love to look at their babies, and I get to say, "oh, look, here are the boy parts" and take cute face shots and genetalia shots for parents to use to embarass their kids in 15 years.

Back to my office, attempted to work on a lecture for the residents. Didn"t get very far.

An attending of mine came in, and needed to talk. She"d had a rough day, so she sat in my office, I handed her tissues and tried to come up with ways to be reassuring and supportive.

Then I got paged. A patient I"ve been taking care of since Sunday has an advanced malignancy and multi-organ failure. Well, she"d been on maximal ventilator settings, in acute renal failure, liver failure, dic, etc. Getting sicker sicker sicker. She"s also 33 weeks pregnant. Unable to come up with any other course of action, we did what we thought was a perimortem c-section (because it seemed like her death was extremely imminent and her family felt that she would want her baby delivered rather than allowed to die, and she probably wouldn"t have lived/won"t live long enough for an induction). It became clear through the course of the day that this woman is going to die. We managed to complete the c-section without her dying, so I guess we got lucky*, but now I"m hanging out to make sure that she stops bleeding. She seems to be a little better, which sometimes happens after a c-section. There are times where c-sections can improve hemodynamics and respiratory status a little. Don"t misunderstand me, she"s still going to die. But it may not be tonight. I hope it isn"t tonight. I feel like I should stay until she stabilizes a little. I feel like I should be here if she dies. I operated on her. I"m her doctor. I attempted to calm her down while she was getting tubed a week ago by saying, "we"re going to take good care of you and your baby" (although at this point in my career, I know that I shouldn"t torture myself with the promise, "You"re going to be all right." when it isn"t true, so I didn"t make that promise).

I"m also on call tomorrow. The selfish part of me would like to go home, take a bubble bath, eat some pasta followed by some girlscout cookies, and have a relaxing pre-call night. But instead, I"ll sleep with my pager right next to me. I"ll answer it when it rings at 2am and the fellow on call tonight says, "I just wanted to let you know that Ms.X died this morning.", and I will come in, and I will talk to the family, and I will hand them tissues. Then I will go see her little boy and tell him that his mommy loved him (even though he"ll be a 6 hour old 33 weeker at the time, so he won"t understand, but I promised). But don"t think that I"m all that noble, because I will hate it, at least a little, that I"m obligated to come in at 2am when I"m on call the next night.

Then I will sleep on my couch in my office and be on call tomorrow night. But you know, for me it"ll be ok. I know the drill. I"ve been at work for 48+ hours in a row before. I"ll be cranky and sad on Saturday and Sunday, and probably won"t be able to sleep Saturday because I get that post call insomnia. I"ll probably sleep most of Sunday, and then Monday, I"ll start my week over.**

But for her, it won"t be ok. Because she"s going to die. Because she"s leaving a brand new little baby without a mother. Because she would have liked nothing more than to be a mother to this little one, but the universe had other plans. And this little boy will never know his mother and may always wonder why she left him. I do hope that he learns through his grandparents that she loved him, and that she wanted to stay and be with him.

* Some say that they would rather be lucky than good. I usually would rather be good than lucky (because that would mean that all the bad stuff that goes down when I"m here isn"t my fault), but today I"m at least vaugely grateful to have been lucky.

** Sometimes I wonder what non-medical people must thing about this. About my (and really, most doctors") ability to pick up the pieces and go forward and just move on to the next thing on the to-do list even when terrible things are happening. I mean, does it make me a bad or unfeeling person that I can write about this and then go on with my life? Or does it seem callous and uncaring that I can do a sexual assault eval on a 9 year old and then continue my day? It isn"t that these things don"t affect me, its that I can"t let them affect how I do my job. So, I"m not as callous as it might seem.