Lessons Learned

Somedays, I absolutely love my job. And like most people, there are day where I hate it. And then there are sometimes where the love and the hate are one in the same. Yesterday was one of those days...
A patient who broke my heart into a million little pieces. I was called to intubate this elderly woman who had been discovered down in her home. Without heat. She hadn't had the resources to pay her electric bill and her core body temperature was 74 degrees. She was in that shape for days before she was discovered by a relative. And the family! So guilt-stricken, not only because she had asked to borrow the money and they told her they didn't have it, but because nobody had checked on her in days.
A patient who made it all to real for me. A nice-looking, clean-cut guy. Dressed casually in a fleece and a pair of jeans, much like I do on winter days. I was sitting at a computer in the ER, charting away, when he came up and handed me this folded piece of paper, asking if he could use the phone to call these people. I unfolded the square of paper, soft and worn so that it was about to split where the creases had been, and dialed the number for him. It was for the emegency cold shelter the city sets up for the homeless on freezing nights. My first thought, considering his manner of dress and the way he spoke, was that he was calling for someone else. Since he carried on the conversation right there at my desk, I couldn't help but hear his end of the conversation. He had been carrying the paper around with him, too proud to use it, until it just got too cold and he had no choice. I heard him tell the person on the phone that he hated to take a bed from someone who needed it more, and so he had never used their services. But on that night, he didn't have a coat, either, and so he couldn't sleep on the streets. He even offered to sleep on the floor to take as little space as possible, if he could just sleep indoors that night.
The patient who was a reminder. I got called to the NICU for a preemie. 23 Weeks, 3 days. She or He wasn't delivered yet, but mom was dilated and her membranes had ruptured. They were doing an ultrasound because they suspected placental abruption, in which case an emergency c-section would have to be performed. They were trying to send her across the river to the OB Mecca where I was sent many times during both of my pregnancies. Apparently OB Mecca was full to bursting and so had to triage. This means they were only accepting patients to which they could provide the most help. 23 weeks is on the cusp of viability. 24 is the magic number, and so they turned her away. Her doctor had to explain to her the odds of the baby surviving with any quality of life intact. At a certain point of gestation, we automatically resuscitate, no questions asked. 23 weeks is not that point. And the mom had to make the decision that we were going to let her baby die peacefully in her arms.
People ask me all of the time how it is that I do my job. I usually tell them that for every single one we cannot save, there are several we can, so there is a balance. And for the ones we cannot save? I get to go in that room with that patient who is terrified of death, and I get to do something, anything, to make it a little easier for them. And then there are nights like yesterday.
Heart-breaking, soul-crushing nights. Nights where I take each and every one of them home with me. These happen to be the nights I get something out of my work.
The hypothermic woman reminded me to hold my loved ones closer. To never, ever take them for granted.
The homeless man, at a time when I am financially drained from the year we have had, reminded me that I may not be able to buy myself anything and everything I want right now, but I have a warm home filled with love on these cold, cruel nights of winter.
And the mom. Oh, the mom. She brought every contraction back. Every hospitalization for not one, but two pregnancies. I swear I could feel the needles in my hips. I could feel my belly torque and twist deep down. I was 18, 19, 20, 21, 22 weeks pregnant all over. I was in fear for my babies' lives all over again. But this time, instead of the depression that follows each time I deal with a preemie since my return to work, something very different happened. In the same instant those horrible things were brought into my mind, my head filled with other images. Evan's first cry, first step, first day of kindergarten. Those nights this past summer where the pregnancy was over and I spent five blissful weeks just getting to know Zachary. Zach curled into my chest, deep asleep. His beautiful smiles and giggles. Candles on birthday cakes and tiny baby feet. The smell of baby lotion and the sounds of John playing with our boys. Squeals of delight at a new milestone conquered. I was reminded of what could've happened to us and of what didn't happen. Of what we've survived and what we've escaped. And while I know that my last pregnancy did something to me emotionlly, I am on the way toward healing.

We are, all of us, just minutes from a moment that could destroy us. That family never dreamed they would never speak to their mother again. I'm sure the polite, clean-cut man never dreamed he would be homeless. And I'm sure that mom never dreamed she would have to make the call to allow her baby to die. Any of this could happen to me. Instead of letting this consume me and depress me, I am choosing to let this be a lesson learned: to appreciate everything I have, to love the family I have, and to focus not on the ways in which my children came into this world, but the moments I have had with them since.