“What can you tell me about this one?”
It was the first day of rounds. I always hated this part, teaching new kids who have never interacted with people before.
“I believe he has cancer, sir.”
One of the ones in the back. I pressed my fingers to my temples, a migraine coming on.
“Yes, but what can you tell me of his condition?”
A nurse shuffled by the group and took the man's vitals, she asked him how he was feeling today and if she could get him anything. I envied her; she could interact with them much easier than I could, the nature of the job needing me to remain distant.
“It's late stage lung cancer, all treatment options have been expunged, I believe he is on hospice and comfort care.”
“Very good.”
We moved on to the next room.
“What can you tell me about this case?”
"An 18 year old male, came in with a sore throat and cough, has been ruled to be tonsillitis."
A routine procedure. Those normally go over well. Only one death in every 30,000.
"Next steps?"
"Tonsillectomy is scheduled for this afternoon at 3."
"Very well, we will check-in afterwards."
The issue with hospitals, I have come to realize, is that there are just so many people. While it may be incredibly cost effective and efficient to put all the sick people in a single building, it is incredibly easy for infection to spread. All it takes is one nurse not doing proper precautions because they don't have time, one doctor who doesn't want to wash his hands because he was wearing gloves anyways, one helpful family member not understanding the risks, to send everything into a spiral. We moved on to a middle aged woman.
"And here?"
"Appears to be a broken leg, female, mid-30's, I'd say."
Its almost like they are barely paying attention.
"Listen, I understand that we have seen a lot of people today, but it is incredibly important that you get all the details right. It may not seem like it now but one mistake can have severe consequences. Mixing up one of these people can have ramifications on your career that you may not fully comprehend at this juncture. All the details are important as our decisions affect whether these people live or die. Do you all understand me?" A class of bobble-heads were nodding at me. "Now lets try this again. What do you see here?"
"Female, age 35, broken leg as the result of a dirt bike accident, she swerved to avoid a dog that had gotten away from their owner and hit a tree. The bone has been set and casted, she will need physical therapy but there is a chance she may never gain 100% mobility with the leg."
"Very good."
The thing with being a doctor is this. It is incredibly hard to know and predict everything with the human body. Someone can come in complaining of a stomach ache and end up having a burst appendix. It is thus important to assume the worst. The trouble with this is that the human body is unpredictable. Tumors grow without causing any effects, blood clots will form and cause death almost instantaneously. There is too much to prepare for and some things are not easily accounted for.
"Last one, please tell me everything you can."
It was a boy of six or seven. This is the part of the job I hate. His mother was sitting next to him, reading a book aloud. He had been in a car accident a week earlier and was showing no signs of recovery. His father passed on the scene. I wasn’t there but I saw him when he came in, it was pretty obvious. But the kid, I honestly thought he might pull through.
“Child, age 6, severe trauma to the left side including kidney failure, broken ribs, punctured lung and broken arm from a car crash. Has been here for six days, has not improved. Initial surgery was deemed a success but nothing can be done until there is improvement.”
There were a lot of flowers in the room, pollen could be seen drifting lazily in the sunlight from the window. A giant card sat in the corner, most likely from the child's class. His mother was sitting next to him.
“What is the next step?”
I don’t like ones like this, especially when parents are involved. I try not to interfere until they aren’t in the room. I don’t like the look on their faces, a pleading anguish. It is... unfortunate.
Monitors started going off, and the mothers face melted.
"No", A whispered word, a quiet prayer
"No, please, no!" Tears started to well in her eyes, battering against the dams weakened by sleepless stressful nights.
Quickly her words turned from silent prayers to frantic screams, the rivers broke free as her voice cracked, she screamed into the hallway for help, nurses ran by and into the room, started to do compressions. One of them ushered the mother out of the room. She stood helplessly in front of the windows, hands over her mouth, eyes closed rapids crashing to the floor. A crash cart was wheeled into the room, but his pulse had been gone for a while now. They pushed epinephrine and got the shock pads ready. Someone yelled clear and the boys body tensed. The mother was visibly shaking now, frantic whispers amidst the torrential downpour.
They tried a few more times before calling time of death. The mother slumped to the floor, silent, and dazed. Grief and worry having pushed her to the edge of understanding. She was alone now.
"I guess, to give them the news?"
I walked over to where the mother was standing and bent down, face to face with the boy. He couldn't understand why his mother wasn't paying any attention to him.
"Mama, whats wrong? Why are you sad?", He gave her a hug. A lump caught in my throat. 700 years and some things still get to me.
"Come with me" I said and gave out my hand. He took it staring back at his mother, and we walked down the hall, the class trailing behind us. We would come back later for the others.
(Copyright Lavecki 2016)