Spent

This is the true joy in life, the being used for a purpose recognized by yourself as a mighty one; the being thoroughly worn out before you are thrown on the scrap heap; the being a force of Nature instead of a feverish selfish little clod of ailments and grievances complaining that the world will not devote itself to making you happy. - George Bernard Shaw

I'm whipped. Completely and utterly beaten-up from my job. The purpose of this post is to vent, to clear my head and also to serve as a gentle reminder that I love what I do. I spend far too much time at work angry now, so I need to reflect and sort it out. But first, a glass of wine to temper the fact that my computer does not serve my needs at all, and to even write on it is beyond frustrating. But it works. So does wine.

Monday and Tuesday were great days. Nothing to complain about. Business as usual. Wednesday, I was on call and my call schedule has been frustrating lately. I've been clustering my monthly call into one week - it makes for a fairly miserable week, but then the rest of the month is quite pleasant. However, I clustered January's week at the end and February's week at the beginning, so I'm wiped out. I'm not blaming anyone but myself for the stroke of genius that organized it, I'm just whining.

Wednesday began with a spine case, so I know going in that I'm going into a room with 6 men who think terrorizing me is the world's greatest sport. Don't get me wrong, I love the banter - for the first hour. Four hours into it and it's pretty exhausting to hold your own when the barrage is constant and coming at you from six different directions. No worries, I got through it just fine - a couple of them may have suffered irreversible damage to their psyches, but hey - a girl's gotta do what a girl's gotta do. Survival.

I had a couple of cases after that one that I don't even remember, then I got called in to a lung case. I hate lung cases for two reasons. First, I'm pretty sure it's going to be me laying all funky on my side like that one day, and two - they stress out my anesthesia person a lot. I mean, when you can only ventilate one lung for a good part of the surgery, things can get really ugly really fast. At any rate, this one went pretty well, all things considered (how well can removing an entire lobe of a lung for cancer really go?). After the case, I'm transporting the patient to the ICU, helping getting him all tucked in and the same surgeon is checking in on a patient that he had operated on a couple days prior.

He decides that he needs to intervene immediately, so I get stuck in the ICU basically doing bedside surgery. The ICU nurse couldn't handle the surgical aspects - I'm not knocking her, she was doing a great job managing the 10 or so vasoactive drips this guy was on, and I couldn't manage that. So, we're all working together and it's going well, except this guy is breaking my heart. His significant other has maintained a constant bedside vigil since the assault began (which to date has included 3 open heart surgeries, two full codes and no real hope barring a heart transplant that he can't get at our hospital) and looking at this scene breaks my heart. But, we do good work for good people and I can say with 100% certainty that everyone is rallying for this man and doing absolutely everything they can. I'm curious as to why the surgeon has so much invested in this guy - I can also tell you that many others would have walked away a long time ago. He is very young, and I think that must be the reason. Either that, or the surgeon is just a really good guy. Maybe both are true.

So, I'm in the ICU dealing with this mess (and it's a horrendously bloody and murderous scene) and my cell starts ringing. Guess who? The front desk of surgery, a nurse is tired, wants to go home, wants to know if I can come finish her case. By some miracle, I do not kill her. Probably because I was three floors away. I didn't really want to kill her, but I would have maimed her. Happily. Anyway, I get home super late, with no food in the house and just sort of feeling sorry for myself because I'm so tired - but I can't sleep, I can't write and I can't take a sleeping pill because I'm on call.

Thursday morning, my first case is another lung. Are you kidding me? We rarely do lungs at all, to have two back-to-back is unusual. Good news with this one though - it's thoracoscopic (through cameras) so it won't be nearly as messy, and it's a younger patient who does not have cancer, just an intractable infection. Phew.

Nope. First of all, she's a whiner. I go to get her into the room and she's bitching at me about everything. Now, I'm pretty tolerant. I know that anxiety makes people behave differently and I always do everything I can to make my patients feel as good as possible going into a scary situation, but this chick is making it really hard. So is her very inquisitive husband who asked ina his little squeaky voice why he couldn't come in to watch the surgery. It was almost painful to inform him that couldn't because I said so, but in retrospect, perhaps he should have.

Nonetheless, I smile at her and heave her 300 pounds of flesh onto the OR table since she won't move herself, then hold her grubby little paw as she's drifting off to sleep promising her that she'll be fine and that we'll all take very good care of her. Oops. I sort of lied. You see, the floor nurse "sort of forgot" to hold the blood thinners that she's been on. Then "sort of forgot" to mention it. So, the surgeon makes this tiny little incision...and the bleeding starts.

Our nice little lung scope quickly became a very major lung surgery. With lots of blood loss. And lots of blood replacement. And another trip to the ICU. Damn, she's going to hate me when she wakes up. She's also going to hurt. But, ultimately, the diabesity will kill her long before her lung problems do.

After that, I get another cardiothoracic case. I take a minute between cases to get my game face back. I go to get my next patient...and instantly fall in love. My little 70 year old dude is going to have major surgery on his carotid artery (one of the big ones going to your brain) and he's so stinking adorable I can't stand it. This is good. So, I take Mr. Cutie to the OR, and he's laughing and joking with me (just the way I like my patients preoperatively) and we get him all set and ready to go when he looks at me and says, "Sweetie, will you hold my hand, I'm a little scared."

There's something about this level of vulnerability that really appeals to me. Perhaps, it's just because it's so fucking honest. I mean, of course you're scared. It's natural and normal to be scared in that situation - but no one admits it and they just stoic-it-up. Perhaps it's because it's so hard for me personally to be that vulnerable, and I'm one of the ones that would just lay there stoically. It matters not - the bottom line is that by one simple sentence, I've now taken ownership of this man - he is my responsibility, his very being is now something that I take very personally. It happens, but not as much as you'd like to think.

So, I squeeze his hand tightly and lean in really close to him and tell him that he is going to be OK. I tell him how great the surgeon is. I tell him how great the anesthesiologist is. I tell him that I'll be watching over him the entire time and that he has my word that nothing bad will happen. Then, I ask him what he wants to dream about. He looks at me blankly. I tell him to pretend he's just laying on a beach and that the warm blankets I'm piling on him are the sun and the hard surface under him is soft white sand. He's looking straight into my eyes as the sleepy drugs begin to transport him to my beach and I tell him that it's OK to take a nap in the warm sun, that he won't have a sunburn when he wakes up. He mouths a sleepy "thanks sweetie" as he drifts off.

Things are going along swimmingly until...the electricity goes out. Now, I don't want to sound all melodramatic or anything, it's not like the power was out for very long. But, when you've got someone's carotid artery dissected seconds feel like minutes, minutes feel like hours and time sort of stops. You're in a pitch black room chock full of alpha personalities and for that brief moment, everyone is utterly helpless and there is quite literally a life on the line. Like I said, it's just a moment, but it's a powerful moment.

We finish that case and my dear man is just fine. I leave a little early, exhausted again. Today was challenging as well - another patient that I know well and care about who is quite sick and has lived a lifetime avoiding that situation, a miserable case with one seriously whiny surgeon who I'd love to see get hit by a city bus (yes, literally) and another big back case. Everything went well, I'm just tired.

I'm tired of the politics in the hospital. I'm tired of my crazy boss who just keeps getting crazier. I'm tired of being pushed and pushed and pushed without even an ounce of respect for the rest of my life. I'm tired of having to sweet talk orderlies into doing their jobs, I'm tired of stupid nurses that make my life much harder than it needs to be, I'm tired of primadonna surgeons that think I should kiss their ass.

On the flip side, I'm thankful for the lives I do get to touch. I'm thankful for the coworkers I have that care and that are truly exceptional men and women that I respect tremendously. I'm thankful for the good surgeons that go far above and beyond just to try and give someone a chance. I'm thankful for the laughter that I share robustly every single day with some genuinely brilliant people.

But at the moment, I just want to cry. And I've still got tomorrow to conquer.