Arrivals & Departures
Anyone who knows me could tell you that I’m a sentimental person. A number of seemingly innocuous events have the power to bring tears to my eyes, from television commercials to an especially good meal. As you might guess, I have often felt touched enough to cry during my medical education. On my Ob/Gyn rotation this was especially true as I got to see many vaginal deliveries and cesarean sections. The impact of these momentous arrivals never faded as I expected it might. Instead, each time I felt a fresh stab of wonder from a seemingly inexhaustible source.
One midnight delivery was especially memorable. It was an unplanned c-section due to arrest of labor, and the mother looked apprehensive as we entered the OR. We put up the curtain separating her head from her abdomen, sparing her from the sights to come. Then, the residents began the methodical procedure, cutting and ripping through layer after layer of the abdomen. Most surgeries are performed slowly with precision and care, but c-sections are different. They are quick, saturated with urgency. This father was brave and less pale than the others, peering over the curtain with fascination as we dug deeper and deeper. Suddenly, the uterine incision was announced, and the residents pulled the baby out ceremoniously with a gush of fluid. As usual, tears slipped down into my surgical mask as I watched the mother and father marvel over their first child and cry themselves. What came next, however, was unusual.
As we began the slow job of closing every layer we had just opened, the father began carrying his swaddled baby around the OR, making his rounds. He stopped in front of every person in the room- the surgical staff, the anesthesiologist, the pediatrician, the nurses- to introduce his son to each of us. Before this formal introduction, I hadn’t thought about the fact that I was one of the first people to meet these new humans arriving into the world, our paths crossing briefly in their very earliest moments. I met them before their siblings, grandparents, friends, neighbors, teachers, and countless others who will love them throughout their lifetimes. I was also struck with the realization that I had just shared in arguably the biggest day of these young parents’ lives.
The next week, I found myself in a similar but entirely different position. I was now on a palliative care rotation; over the span of a weekend I had suddenly moved from witnessing arrivals to witnessing departures. In the throes of a pandemic, the palliative care service had taken on even more tragedy. Over half of our patient census was COVID patients, intubated and sedated. We would peer in the windows of their isolated rooms, though there was not much to observe. Most were proning to assist their desperate lungs, giving us no faces to associate with the names. Some windows had facts written in dry erase marker – “likes classical music,” for example – sent in by families who were desperate that their loved ones be humanized, perhaps in the hope that we would somehow work harder to save them.
While the ICU doctors were busy adjusting ventilator settings and providing other critical care, our job was to talk with the families who were not allowed to visit the hospital. We were often the single thread connecting them to the world of the hospital, where patient rooms now sat eerily empty of visitors. After listening to my preceptor make a few calls, I was deemed ready to make one myself. My first call was to the family of a patient who had been admitted to the hospital for COVID the night before. He was young, only 55, and he was not doing well. His oxygen saturations remained poor despite maximum ventilator settings and proning. I looked in the medical record and found his emergency contact- his daughter.
I dialed slowly, my heart rate rising, trying to give myself time to think about the right thing to say. This task felt somehow more critical than anything else I had been asked to do in medical school. More consequential even than suturing a wound, determining the scar that will linger on the landscape of the skin for a lifetime. I knew that the effects of my patient’s infection also had the power to forever alter him and his family. Before I had time to consider the options, his daughter answered in a voice that immediately revealed anticipation and sadness. It was clear that she and her family had been waiting for this call all day. I pictured them sitting around a wooden table with an old rotary phone in the middle, like a scene in a crime movie from the 1960s. As I updated her on her father’s illness, she began to cry, and I heard sobs in the background that she identified as her mom.
She told me about her father. A picture began to form in my head of who my patient was as a person, and each additional detail sharpened my sadness. She explained that her dad was the recipient of a kidney transplant a number of years ago, and that he cherished his new kidney. He did his absolute best to honor the gifted organ by maintaining his health with the utmost care. His current illness would almost be ironic if it didn’t feel so profoundly unfair. She translated her mom’s words in the background, “My mom says that she doesn’t want to live if my dad doesn’t live. She says please, please do everything you can.” I knew in that moment that nothing I said would sugarcoat the reality into something palatable. I couldn’t think of anything but the absolute truth, which was that I was hoping along with her that her dad would pull through. When I hung up, my tears of joy from the week prior were replaced with tears of deep frustration and sadness. They stung more this time. But again, I was struck with the realization that I was accompanying this family through one of the most significant days of their lives. I left the rotation before I could find out what happened to my patient, and I could never bring myself to look at his chart later. I still hope that his immune system put up a fight and he went home to his daughter and wife, able to get many more years out of his new kidney.
As I layed on my couch uncomfortably stuffed with turkey and potatoes during Thanksgiving break, I thought about the startling dichotomy of my November. A father introducing his new baby to the world and a daughter fearing for her father’s life. Between the everyday monotonies of medicine – checking lab results, ordering Tylenol, preparing discharge summaries – it is so easy to forget the profound nature of our profession. Every day, we are allowed to walk with our patients through life altering events: the loss of a family member, a sudden disability, remission from a long battle with cancer, the slow toll of chronic illness, a lifesaving surgery, the birth of a child, and countless others. It is life, death, and everything in between. Although we may become accustomed to the weight of that responsibility, I hope that I never lose sight of the privilege and that the source of my wonder remains inexhaustible in my many years ahead as a physician.