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Saturday, October 13, 2012

What I Love about Medicine

Rain on the roof, a steady off-beat ticking in the darkness. Another challenging sermon from John 12, on dying, both literally, to self in community, to the familiar, to busy-ness. Another week of work, draining, but in a good way. In spite of working to make up for the time off at midterm, covering both ICU and Nursery at once, dealing with a switch in interns and the absence of both our CO's and most colleagues, as I walked away from Saturday morning rounds, I felt a sense of completeness or satisfaction or whatever it is one perceives when in a spot where the way we're created fits the job we're given.

Which led to some thoughts about just what that is. As a child I learned the catechism, and for some reason the attributes of Jesus as Prophet, Priest, and King came to my mind. Because Jesus was the epitome of what it means to be fully human, those are roles that reflect the image of God in human flesh. Mind, Heart, Will. Prophet, Priest, King. The prophet perceives, analyzes the present and looks towards the future, teaches, calls for action, warns, weighs, moves ahead guided by the Spirit. The Priest listens, prays, represents, advocates to God, sacrifices, bears the burden. The King makes decisions, directs, takes responsibility, leads, moves others. And medicine affords abundant opportunities for all of that, the environment in which one can plumb depths of being fully human, and therefore more like Christ.

On Friday for instance, as a doctor-prophet, I started the day teaching on rounds. Organizing the data in the present, anticipating what might happen, asking my team to think through it, challenging them to take action. Sometimes chastising. But continuously exhorting. Why is this baby jaundiced? How should this sodium level impact our fluid management? What tests should be done in response to this fever? What plans should we make for the next few days? I like this kind of teaching, and my team grows on my heart day by day, as I see them grasp the concepts, make the effort. As a doctor-priest, I spent a large portion of Friday listening to parental concerns. Praying for them. Sacrificing lunch or rest or seeing my kids or a breath of fresh air to be available. Advocating. Making a phone call, begging a mother to consent for a certain study, holding out hope. And as a doctor-king, there was a pretty intense sequence of decisions and action in the middle of that day.

We had been warned for a couple of days that the OB team planned to deliver baby L by cesarean section, the mother had complications and the baby on ultrasound had what was described as "trivial pleural effusions" (fluid in the lung cavity) and "possible ascites" (fluid in the abdomen). Though we hoped it was much ado about nothing, I made a list of what I wanted the nursing staff to be ready with, equipment and people. I texted the paeds surgeons in case I needed them, to be on standby. I went to the operating theatre and read the mom's file while she was being prepared for surgery. And when the intern on OB pulled a lifeless slippery purple body out, with much difficulty, my heart sank. The intern kept patting the baby's back. Just cut the cord and hand her over, I told her, and whisked the baby off for care.

Faint slow pulse. No cry. No breath. Grossly swollen baby, an almost frightening froggish look to her edematous face and distended belly. Not a normal baby. I put the bag over her face to force in some air. Not much movement of the chest. So in less than 30 seconds I just decide to intubate her. Even with a tube, little air seems to move in and out, though now her heart rate picks up towards life. She moves a little. Coughs. We warm and dry, we push the air in and out, she is still dusky. We run to nursery. And there the prep pays off, I have an xray within minutes and paeds surgeons immediately after. The xray does not show any lungs. Solid or liquid, but no air. Yet I can hear some breaths as I bag. We have the portable ultrasound. Seems to be fluid, both in lungs and abdomen. Both kidneys are there. The heart is beating. There is a moment when I wonder, should I be trying to save this baby, or is she beyond hope? Her terrible swelling dehumanizes her. I can sense the hesitation from the rest of the team. She's still pretty blue. The list of conditions that can result in this picture is LONG, maybe 50 conditions, and at least 40 of them are devastating diagnoses.

But I know we have a chance, and we have to keep going until we understand the real issues, or until we fail. Our helpful paeds surgeons put tubes in her chest on both sides, the fluid compressing her lungs begins to drain, and her lungs expand more. Breathing for her becomes easier. We draw blood, do more detailed scans, I replace her tracheal tube with a slightly larger one. I push hard for an ICU bed, and in between other crises manage to get her there on a ventilator. And over the evening and then the night she improves. The teamwork of surgery and pediatrics, doctors and nurses, radiographer and lab, nursery and ICU, all has been pulled together for this one goal. I know I"m out of my depth, not an expert, just plunging ahead with courage and doing my best. I ask my partner Erika to come have a look, give me a little reassurance. That kingly responsibility can be lonely.

Teaching and thinking. Listening and loving. Directing and organizing. All these roles flowing together, and in the process a resurrection from death to life. This is what I love about medicine, the fully human-imagio-deo aspect that any day can bring. And while there are many jobs that require focused thinking, tender empathy, and decisive leadership . . .it is good to find one that combines all three, and all for a purpose beyond self or profit or dominance, instead a pouring out of one life to give life to another.

As a mom, and working at a school, I would encourage kids to look at the future through this lens of Jesus-like humanity.  Isolated mind can lead to harsh, cold, amoral, distancing intellect.  Isolated heart might lead to paralyzing sorrow.  Isolated will to bossiness and self-promotion.  But a braiding of the three carves out a tiny territory of Heavenly Kingdom for the true King, be it a thriving home, a few interns and rooms of patients in an African country, or on to more glorious responsibilities of classrooms, businesses, armies, countries.  


sakurasojourn said...

This is a beautiful post. God gives you some incredible insights regarding your labor of love with WHM. I shared your site with a friend today over dinner; she's a pediatric hospice nurse who dreams of doing exactly what you write about here. Thanks for sharing your journey instead of just keeping it in Africa. You bless so many!

Ann Mara said...

Your posts blow us away each and every time! Thank you.

Eli and Krista said...

I just discovered your blog and am greatly encouraged by your stories. My husband and I are planning to do medical missions in Africa once he's done with residency (he's currently a 2nd-year family resident in Minnesota). God called us to medical missions about 7 years ago and we are still plodding along, trying to get through the mire of med school and residency. Now we have a baby boy and are excited to move to Africa in the future as a family. We keep looking to the future, waiting in anticipation for the day we can finally "go" as God has called us to. It's good to read your stories and let our own excitement be renewed!