Critical

"Modern science has been a voyage into the unknown, with a lesson in humility waiting at every stop." - Carl Sagan

It's 5:30 AM. I just got home from work. I worked most of the evening. I love being on call, because those surgeries are often the most necessary. No one wants to remove the tonsils of a 17-year old at 8PM on a Sunday night. But when the infection is threatening the child so much that he can't speak and his airway is compromised, well...you just don't have much choice. I get home, waste some time, then go to bed. At 3AM, I get a phone call: Aortic Dissection. Hurry.

I've only done one previous Aortic Dissection in my career. Why? They happen often enough, but patients rarely survive to make it to the hospital (estimates indicate 10,000 per year in the US and roughly 17% make it to the hospital). Once in the hospital, a rapid and accurate diagnosis is essential. This is not always as easy as it sounds - generally these patients have a significant medical history and comorbidities that must be sorted through, while their symptoms are presenting as something else. They rarely make it to the operating room table. IF they make it to the operating room table they are the lucky ones, Sort of. That survival rate is, at best, about 30%. Assuming we get them off the table, we have to hope that blood flow to their brain was not compromised, that their lungs will tolerate the assault, that the graft will work, that they don't develop cardiac tamponade or some other hemodynamic crisis and ultimately, that they don't acquire some awful infection while hospitalized.

The one that I did previously was one of the most amazing moments in my career - it was truly a Hollywood-styled surgical moment. Sadly, despite the best efforts of my colleagues (who impressed me that day beyond recognition), the patient did not survive. He made it off the table, but his brain had been depleted of blood for far too long - the family chose to terminate life-support three days after surgery.

I arrived in the ER to see the patient tonight. The surgeon and the anesthesiologist were in the room examining him. While I waited for them to decide the course of events, I started an IV on the patient. It's very hard to stand around doing nothing, and I figured he'd need better access than what he had regardless of whether we took him to the OR or not. Ultimately, the doctors decided that he was not a surgical candidate and I came home. I'm pretty good at separating my emotions from the situation, but I will tell you that it's difficult when a patient looks you straight in the eyes and says, "I'm ready to get this fixed." and all you can do is smile pathetically while you pat their hand, the same hand you just jammed an 18 gauge angiocatheter into.

There's the backdrop...

I mentioned that I had an interesting chat with a man on Halloween about my career. It started as most things do at a party, "So...what do you do?" and I answered the way I always do, "I'm a nurse." With most people at that point, they ask routine questions, Where? Do you like it? Do you know so-and-so? But this man had a very big surgery in the recent past, and he was very curious, asking all sorts of interesting questions about what happens in an OR after the patient is asleep. I answered his questions as best I could and he said, "Wow. That's so cool. Thank you for doing what you do."

I was touched. The thing is, 99% of my job is so routine I could do it with my eyes closed. And to be perfectly honest, I *have* done surgeries with my eyes closed. I joke about "Saving the world, one gallbladder at a time." But when it's not routine, when it is critical, it's rewarding beyond recognition. It's awe-inspiring and tremendously humbling.

We get these strange and rare glimpses into the most personal aspect of life - death. It's fascinating to see how people react to adversity. As a general rule, people are remarkable. Given a bad prognosis, I find that most people are courageous and brave, accepting and so utterly trusting that you take your duty to them very seriously.

I recently met a new anesthesiologist. This guy is young. Young. I met him several days before I had the opportunity to work with him and thought he was a little standoffish, a little too cool. Then, I spent a day with him in the OR. I was wowed by his demeanor with the patients - he was kind and calm, authoritative but approachable. After our first case together, I told him how much I liked his countenance. He appreciated the compliment, OR people are not known for being the best with their patients - hell, that's why we're there - we love the science of healing, but the art is a bit foreign to most of us.

Our second case was a big one. It was "just" a gallbladder, but the worst one I've ever seen. The patient was septic and bordering on death - another couple hours and we probably wouldn't have been able to get him back, he would have fallen into multi-system organ failure - he was well on his way. Intraoperatively, his condition improves as the evil gallbladder is extricated in 5 pieces from his body. His heart rate falls from 140 to a nice, normal 85, his temperature begins to drop and he begins making urine meaning that his kidneys are functioning. After the case, we transport him to the ICU intubated and ventilated. Once there, the anesthesiologist pulls his breathing tube and miraculously - the guy is breathing well - far better than he was preoperatively.

This new doctor and I are in the elevator on the way back to the OR - our day isn't even close to over - and he puts his arm around me, rests his head against mine and sighs.

"How do you feel?" He asks me.

"Oh, I'm good." I answer.

"No, I mean really - how do you feel?"

I look at him, sort of puzzled. I don't know this man at all and I'm trying to determine what he's angling at.

"You just saved another life. I hope you feel good about yourself." He says, smiling at me. I smiled back at him, broadly. It rarely feels like a save, it usually just feels like another day, another surgery.

So it was wonderful to hear and I'm so thankful that all of this is happening right now, at a time when I really thought my career might change. Regardless of what my professional future holds, I'm so thankful that I have the job I do. Most days, it matters.