Tag: Surgical rotation

What Oops Means to Me

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My husband, who I’ve loved for over three decades, has one (and only one) little annoying habit.  He says “oops!” for almost any reason.  It ends up being a generic exclamation that could mean anything from “I just spilled a little milk” to “There is a fire on the stove”.    If I’m driving and he’s a passenger, an “oops” from him might mean an impending crash or just a plastic bag flying across the road.  It is unnerving, to say the least,  to not know immediately what he is exclaiming about, or its significance.

What he doesn’t realize is that “oops!” can cause a PTSD response in someone with my history.

I was a very nervous third year medical student when I walked through the doors of the giant hospital high on a hill for the first day of my Surgical Rotation.  I had never been in an operating room other than to have my own tonsils removed at age four, and that experience was not exactly my happiest memory.  I worried I was not “cut out” for the OR, and wondered if I would faint watching patients being opened up, smelling the thin trail of smoke of the cautery burning bleeding vessels, or hearing the high pitched bone cutter saw.

The first lesson on my first day was to learn how to gown and glove up without contaminating anything or anyone.  It took several hours for an extremely patient nurse to get me to the point of perfection.  She taught me what to do if my nose itched (ask a circulating “non-sterile” nurse to scratch it over my mask), or if I thought I felt woozy (back away from the operating table so I don’t fall on the patient!).  I was ready to watch my first surgery by the afternoon.

It was fascinating!  I wasn’t lightheaded.  I could handle the sight of blood, wounds and pus, and the sounds and smells didn’t phase me.  I went home elated, eager for the next six weeks of caring for patients in a wholly new way.

Each day I helped in three or four surgeries, being asked to do different tasks by the surgeon, from holding retractors so he could see what he was doing, to doing the suctioning of blood in the surgical field, cauterizing blood vessels, and putting staples and sutures in the skin at the end.  The chief resident I worked with most frequently was a very high energy guy, talking non-stop during the surgeries, sometimes teaching (“what’s this that I’m holding? what does this connect to? tell me the blood supply to this?”), all the while listening to Elvis Presley tapes blasting over the sound system.  He’d dance in place sometimes, and sing along.  To this day, I can’t think of gall bladders without hearing “You Ain’t Nothin’ But  A Hound Dog” in my head.

So when the surgery got complicated, I could tell because all the surgeon’s antics stopped.  He got very quiet, and he focused on his hands, including getting more demanding of the staff around him.  Shadow swept in, covering his normally sunny personality, and he’d bark orders, and sometimes grab my gloved hands and move them where he needed them.

One day, we were involved in a high risk surgery on a patient with late stage liver disease, who had a recent near fatal bleed from dilated blood vessels in her esophagus, caused by back up of circulation that could not easily pass through her scarred liver.  The blood vessel shunt procedure the surgeon was doing would allow the esophageal varices to deflate with less chance of breaking open again.   The surgeon had been intently working, without singing or dancing that day, so when I heard him softly exclaim “oops!”, I looked up at his face.  His eyes were big and round, his forehead sweating.  I looked down at the large blood vessel he had just nicked accidentally, and then the wound filling rapidly with blood.

“We have big trouble here!” he shouted.  I was moved out of the way, and the surgical team launched into action.  I was sent five floors down to the lab to retrieve as much blood for transfusion as I could hold in my arms, and spent the next hour running blood up those five flights of stairs.

That patient didn’t make it.

Sometimes in my dreams, now thirty five years later, I am running those hospital stairs carrying bags of blood, swirling in a vortex of red.   I never do save the patient.

And “oops” always means big trouble.

Looking Ahead in the Rear View Mirror

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Amazon, formerly the Public Health Hospital
Amazon, formerly the Public Health Hospital
View of Seattle from the top floor of the Public Health Hospital
View of Seattle from the top floor of the Public Health Hospital

While sitting very high in the upper reaches of Safeco Field watching the Mariners play the Cleveland Indians, my attention was diverted to the expansive view of surrounding Seattle. In particular, I kept looking at the PacMed Tower above us on Beacon Hill, now home of Amazon.com.  It seems like only yesterday when I spent thousands of hours in training inside the walls of this remarkable old building, but in reality it is over 30 years ago, back in the days when it was the Public Health Hospital, home for medical care in the region for the Merchant Marines, as well as many of the indigenous people of the northwest and Alaska, in addition for the local folks who needed affordable (as in free) health care.  I had opportunity to work several rotations in this building as a medical student in Seattle, and to think of this place as the headquarters for Amazon makes my brain do twists.  There was so much life and death inside those walls for so many years.  Now it is corporate headquarters for a web giant, selling every gadget and gizmo under the sun and some days I feel like one of their best customers because it keeps me out of the toxic environment of the local mall.

I first walked in this building as a very green 24 year old med student beginning a surgical rotation, knowing only which end of the stethoscope to put in my ears and which end rests on the patient.  The first day I was shown how to put on a surgical gown, masks and sterile gloves without contaminating myself and the people around me.  I never have forgotten that sequence of moves, even though my opportunity to go into an operating room (other than as a patient) is rare these days.  My chief resident was an exceptionally talented but eccentric man who worked himself and all under him around the clock.  After becoming very prominent in a city known for its fine surgeons, he developed a drug problem for which he sought treatment and remains an authority on helping impaired physicians, assisting other providers to acknowledge addiction before they harm a patient.  He could only operate listening to the music of Elvis Presley.  I can’t hear any Elvis Presley songs to this day without smelling the odors of surgery–cauterized blood vessels and pus.  It is my particular burden to bear…

Those were heady days and nights of experiencing the misery of the most vulnerable of humanity in desperate need of healing, and sometimes we succeeded, but often we did not.  I still have a recurring dream of running up and down the staircases of the Public Health Hospital, bringing pint after pint of blood to the OR as our team operated on a Native American patient bleeding from her dilated esophageal varices, which had developed as a result of her damaged liver from her long alcohol dependency.  We did not save her, nor have I saved her even once in my dreams over the decades, though I keep trying to run faster. Instead I’ve spent the last 20 years of my clinical life working in alcohol and drug treatment, hoping to prevent her fate in others.

Nor did we save a classmate of mine, on a rotation on a different service, the daughter of a beloved radiologist in this very hospital, who for reasons unknown, had a cardiac arrest while napping briefly during her 32 hour shift.  Another medical student sleeping in the same room heard her odd breathing, found her unresponsive and all medical interventions were employed, to no avail.   Even when all the right people, and the right equipment, and the right medicine is seconds away, death still comes, even to healthy people in their 20s.  This was a shock to us all, and an extraordinarily humbling lesson to the pompous and overconfident among us.  We can die, in our sleep, whenever it is our time. Years later, I remember that in my evening prayers.

There was also the young surgical resident who was hospitalized with jaundice and subsequently died of Hepatitis B, contracted from a blood exposure during his training.   No vaccination was available in those days, but was developed soon afterward.  And it was in this hospital we began to see unusual cases of young gay men with severe wasting, rare skin cancers and difficult to treat pneumonias, initially called GRID (gay related immune deficiency), part of the early front wave of AIDS as it swept across the US in the late 70s and early 80s.

One night in particular sticks out for me.  It was Christmas Eve 1977, and a heavy snowstorm had brought the city to a standstill.  We had very little to do that night in the hospital as the elective surgeries were all postponed until after the holiday and no ambulance could easily make it up the steep drive to the ER, so were being diverted to other hospitals, so our patient load was light.  I was in my tiny sleeping room, on the 14th floor of the tower, facing out north to the city of Seattle, able to enjoy the view in the photo above, only everything was blanketed under snow, so peaceful and very quiet.  The freeway, ordinarily so busy day and night was practically abandoned, and the lights of the city were brighter from the snowfall.   It was an enchanting vision of a city forced to slow itself and be still, anticipatory on a sacred and holy night.

I remember thinking about how young and inexperienced I was, and how very little I knew.  My chief resident thought I’d make a good surgeon–my heart told me that I’d make a better family doctor.  The city held so many attractions and excitement with the potential of a big salary and notoriety, but my heart longed to return to a farm and a someday family.  It was a wistful bittersweet night and I slept little,  staying perched on that little bed overlooking the sleeping snowy city and wondering where my life would take me.  If I’d looked just a little to my left, and some 32 years ahead, I would have seen myself, sitting with a man I had recently met but didn’t know I’d someday marry, and our nearly grown and flown family in the top rung of a new baseball stadium.  And now the older wife/mother/farmer/family doctor I have become,  gazes back up at the much younger undefined medical student looking out that upper window of a classic old hospital building, reflecting upon who she was becoming on that night long ago.

I still am reminded every day at how little I know,  but I do know this: for however long we’re on this earth, we do have distinct purpose and meaning.  Perhaps my purpose was to be snowbound on that Christmas day, unable to go home from my shift because my car was stuck in the parking lot, spending the day singing Christmas carols for all the patients who had no other options but to stay put in their hospital beds that day.  Perhaps mine was to be the future blessing of an incredible husband and delightful children on a little farm 100 miles to the north.  Or perhaps mine is to continue to share a little of life’s lessons learned while I gaze in the rear view mirror~ the reflections of a life in progress.