Today I get to sit in a café and write for an hour.

Yesterday I sat at my desk in the ED and wrote for hours, but in a very different way.

I get asked a lot why I don’t take advantage of the ease of using a scribe when I work.  Scribes in the ED are young men and women who are interested in medicine, who are trained and paid to follow an emerg doc around with a COW (computer on wheels) and type the notes for the physician.  In this way the doctor saves a lot of time that would otherwise be spent dictating or typing notes into the medical record. While many of my colleagues (in fact the majority) at my emerg use scribes and thus leave relatively quickly at the end of their shifts, I often find myself sitting at my desk for two hours after the clinical work ends.

Why?  Because, as you can see, I love to write.

My notes, like this blog, tell stories.  They open a window into the life and ills of each patient I see.  Though I write them in point form, and as concisely as possible, I still manage to convey so much in them that I could never trust a scribe to do for me.  By writing my own notes, I allow myself the space to storytell all day long.  It soothes me, calms my mind, and helps me consider all the possibilities regarding diagnosis and management of each case.  Writing makes my physician vision clear; I can see through my fingertips.  It also helps me process, as you will see now.

 

Yesterday was my third day in a row in the acute area of our emergency department.  This time of year is full of flu, flu and more flu, punctuated by pneumonia and cardiac disease.  The place is so full and so busy one can hardly sit for a moment, and I think maybe I got to pee once in the ten hours I spent there each shift.  The days blend into each other, and the algorithms of medicine kick in so that each case is managed pretty much by rote.  But sometimes, the day is broken up by the purple resus light over every room, which flashes when an extremely ill patient has arrives in our resuscitation area.  This light beckons the physician, calls to me, tells me to hurry my little feet over to a room where I may truly save a life – or lose one.

 

“Code blue, resus 5”; I hear the call overhead and drop everything and go.  Purple lights galore as I rush into the room, and find a nurse doing CPR on an unresponsive patient.  I stop, breathe, and ask whose patient this is.  Turns out she is admitted to the medicine service, and it’s my colleague’s name on her case as the responsible ED physician.  But neither he nor I know this patient, as she has been under the care of another team for the whole day.  Never mind, we jump in together to try and save her, until we are told that the family and patient had decided on a do not resuscitate order.  We step back, stop compressions, and watch the monitor to see if she will recover.  Her heart tries feebly to pump under the probe of the ultrasound we place on her chest, but no pulse can be felt and the heart gradually slows to a place where it will soon stop.  We take the mask off, fold her hands over her belly, cover her body with a blanket and prepare to let the family know that she will not recover from this.

 

My phone rings, and my husband tells me he and my daughter are outside the emerg with hot soup and lunch for me.

 

I take a last look at the scene before me, the peaceful body of the life we did not save, and I step out into the clamour of triage.  Washing my hands multiple times I leave the chaos for a moment.  Outside the emergency the air is cold, so much colder than when I arrived hours ago, with a chill arctic wind blowing snow in my face.  Suddenly I see the sweet faces of my man and my little girl, and I practically dive into the back seat of the car and shove my face into her warm waiting arms.  Happily surprised, she folds me in and caresses my hair as I kiss her face over and over, bury my not quite there yet tears in her hair and smell her fresh clean healthy little person smell.  Smiling and giggling she hands me my lunch, I kiss her again with such love and thank my husband for coming and giving me this moment, this gift, in my otherwise turbulent day.  I step back, close the door, watch them drive away and remember how cold the air is when I breathe.  I breathe deeper until my lungs ache, cleansing themselves of the death I could not prevent, and walk back into the world where I may face it all over again minutes from now.

 

This life.  It’s not what I signed up for.  The contrasts, the passions, the terrible sorrows, the incredible highs.  I didn’t know.  Would I choose it again if I did?  Probably.  But it still makes me ache and bleed inside every day, as I enter my patients’ worlds and lives and take it all into my own heart.  Thankfully at home I have two beautiful sweet smelling comfy feeling tiny humans who comfort me, and a man who helps me heal.  I didn’t know, I didn’t know why I felt such a need to find a partner and start a family when I started residency.  But now I know, and inside my soul back then I must have realized that without these loves to guide and heal me, I could never ever do what I do.  To help others, I need my family to help me.

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