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Thu April 17, 2014
'Why Am I Dead?' He Never Asked. Here's The Answer He Never Heard
Shara Yurkiewicz is a med student. She's doing rounds now, moving from department to department. Much of what she sees, she's seeing for the first time. Not yet a doctor, there are moments, many moments when she has the eyes of a patient. She gets scared. She feels helpless. She's too involved. She's at that place in her training where everything is so sharp, so new, she feels the full, fresh stab of it, and sometimes, very privately, she bleeds.
This is one of those moments, which (with her permission) I am re-blogging in full from her wonderful online column at Scientific American, This May Hurt a Bit.
By Shara Yurkiewicz
It's okay that you don't remember me. My name is Shara, and I'm part of the surgical team. I'm checking to see how you're doing after your surgery.
Do you know where you are right now?
Actually, you're in the hospital. You had surgery a few hours ago, for a broken hip. You used to be able to walk before you broke it, so it was important to fix it as soon as it was safe to.
We're not sure how you broke it either. You said you couldn't remember falling or even having much pain. Your daughter noticed swelling in your leg a few days ago and brought you here.
She went home for a bit, but she's been here with you the past few days.
We waited a few days before the surgery to make sure you were medically ready. You had some fluid in your lungs when you first arrived, so we gave you medications to help get rid of it.
It probably wasn't related to what you ate or drank. You were eating a lot, though. You're the only person I've ever seen with a broken hip with that good of an appetite. Do you remember the last thing you ate before your surgery?
It was a big chocolate chip cookie.
I was there during the surgery. I'm still a student, so I didn't do much. But you can learn a lot from watching. Thank you for letting me watch.
I was there when they wheeled you into the room. Your surgical cap was too big for you, and it kept falling off. We asked you your name, and you said it. All three names. We didn't even ask you for the middle one, because we didn't know you had one.
We then put you to sleep. You took deep breaths through an oxygen mask, before we turned off your consciousness and paralyzed your body. I held your hand as you closed your eyes. The nurse whispered to you that everything would be okay.
We fixed the bone. It took a few hours, because your bone is fragile. There was bleeding, but that's normal. Bone bleeds a lot. We gave you blood and fluids to replace what you lost.
Did you know that many surgeons play music during operations? It was going so smoothly that we were humming along to "Who Says You Can't Go Home?" It was during the bridge of the song that your blood pressure suddenly dropped. The anesthesiologist called it out. I looked at the monitor and saw numbers flashing in red.
There was a lot of red, actually. Blood in the wound, blood in the suction container, blood in transfusion bags, bloody footprints on the floor. No more than with any other patient. But I think somewhere along the way I learned to take the sight of liters of blood for granted.
I was scared. I stopped watching them stitch and stared at the monitor, which suddenly seemed like my closest connection to you. They called out the medications they were giving you to raise your blood pressure.
After a few minutes, it worked. Your blood pressure slowly climbed to green numbers. I was still shaking as I silently willed the numbers to stop bouncing around.
But the numbers stubbornly drifted down. Even though they were keeping up with the fluids. Even though you were on medications that force your blood vessels to clamp down and your heart to beat harder.
The red returned and was unrelenting. Your blood pressure was too low, your heart rate too high, the tracing of your heart rhythm irregular and non-shockable.
"We can be done in ten minutes," the surgeons said.
I've never seen surgeons work so fast. They're usually so particular about their stitches, getting the perfect angle and length for each one.
I've also never seen so many anesthesiologists at the head of an operating table.
I've never seen an ICU bed booked so quickly.
I've never seen someone lose their carotid pulse.
Apparently it's rare to die on the operating table. They almost always get you to the ICU first.
Twice in eight years, said the anesthesiologist. Once in fifteen years, said the surgeon.
Once in eighty years for you.
I couldn't bring myself to touch your hand again. I watched, though.
I watched as the room slowly cleared and people tried to figure out what to write and who to call.
I watched as they kept your eyes shut and handled your body just as gently as they had a few hours ago.
I listened to the final zip of the body bag. I don't know who had the time to switch off the radio, but I'm glad they did.
I listened as the nurse asked God to rest your soul.
I watched you leave in a different kind of bed, to a different place. I'm not sure where.
You can learn a lot from watching. Thank you for letting me watch.
We fixed your hip, sir.
Reprinted from This May Hurt A Bit at Scientific American, with permission from Shara Yurkiewicz.
Shara Yurkiewicz is now a fourth-year student at Harvard Medical School. Her blog, This May Hurt a Bit, describes small moments, people she's met, patients, doctors, diagnostic puzzles, challenges and, every so often, as in this piece, outcomes that make no sense, tell you little and make you feel very, very small.
Her work has been published by the Los Angeles Times, Discover, the Hastings Center and various anthologies, including The Best Science Writing Online 2012 and 2013.