I remember asking myself this question almost a year ago, when I’d just started my rotation in internal medicine. Theoretically speaking, that was my strong suit. I had buzzed through and aced every single test in that department during my time in medical school. I had the mind for clinical reasoning, or so I thought.
I had been prepared for a pretty boring time. Most of these illnesses were chronic and changes in the patient’s condition were seldom dramatic. My mind was ready. I had cleared the cobwebs in my head. My eyes were wide and shiny -to look out for the tiniest details. My white coat was sparkling. My walk was confident- stethoscope in tow. I was what the love-child of ready and prepared would look like.
Internal medicine here I come.
What I wasn’t prepared for was how quickly patients could turn from stable to unstable to critical to dead.
My first night on call, I had just started taking over when my attention was drawn to the man. Before I could say Jack Robinson, I was dealing with asystole. You best believe that my arms literally fell apart from giving CPR. As the lactic acid stung my muscles, I prayed harder and harder that some miracle would bring him back. After exhausting myself twice over, I finally summoned the courage…
Pupils were fixed and dilated.
I had barely left his bedside when another breathless nurse came in
“Doctor there’s a woman downstairs, she’s gasping… ”
By the time I had flown through the steps, the first thing I noticed was that she was no longer making respiratory efforts. Another frantic round of CPR began. I couldn’t identify any airway obstruction, her intanasal oxygen was ongoing. She had just lost out to End Stage Renal Disease.
My hands were still on that woman’s chest when the next code came in. I became confused. How do you place a value on life? Who deserved my attention more? Why couldn’t I split myself in two? Why did I have to take care of two wards, with upwards of 60 patients between them, by myself?
I had to delegate proceedings to someone else and see what was wrong with the other patient.
Then I returned after 45 minutes to certify all 3 of them dead.
My head hung on my shoulders, my eyes were red and puffy from trying not to cry, my heart was pounding and I literally jumped at the sight of any nurse. I was physically fagged out and exhausted, but nobody thinks of getting any rest in such circumstances. The grim reaper was on rampage through my wards tonight and I was determined to put up as brave a fight as I could.
He beat me black and blue…
And this was only my first night here.