Last Day

Today was my final day as an intern. It was also the first day of an unsupervised central line placement. It was also the first day that I felt I finally knew more than nothing about medicine (but not by much). To watch these new interns stroll into the medical ICU, neatly groomed, trying very hard not to advertise the “deer-in-headlights” feeling but only with minimal success, I began to realize how much time has passed since the beginning. In the span of 12 months time, I have grown more than I can remember or even realize – from being afraid of writing down a simple order for tylenol to directing the care of some of the sickest patients in the country. One of the things that frightened me, as an intern, was that I was responsible for ordering things which I didn’t understand – consequently, I was concerned that I would make mistakes. My order was the final order.

As I move on to next year, I am no longer afraid of writing the wrong order – now I am focused on taking care of the patient and not missing any important things in the process. It is hard to believe that I am in a position of seniority, and that my decisions will have direct consequences for my patients. This makes me want to be a better doctor – smarter, faster, more skilled. But it also makes me wonder if I am ready for this responsibility.

There is no amount of money that I would take to repeat intern year – endless nights, chronic fatigue, grunt work, pre-rounding, paperwork, and incessant pages. And to go through all of this, all the while knowing that you are at the bottom of the barrel, the lowest of the low, with so much time to go (or so it seems) before that changes. At the same time, a part of me wishes this year would go on forever – because now that I’ve gotten the hang of it, now that I know my role well and have truly mastered it, it’s time to move on.

That’s what growth is, I suppose, in medicine or any other field. But in medicine, the growth is fast, the learning is exponential, and we continue on, one foot in front of the next, challenging ourselves at every turn. And we do all of this in the setting of critically ill patients who hover on the boundary of life and death. Once you became calm in this setting, as I have, the rest of the world outside of this becomes even calmer. Once you have 3 patients crashing simultaneously and manage it best you can, ride the wave, take some deep breaths and get it done, nothing else in the world seems chaotic anymore.

If I were to leave medicine, I would be overcome by a sense of peace – at least for a short time period. Peace in knowing that everything is going to be okay, and that, even if it isn’t, it will be eventually. No matter what happens. The survival rate for everyone is zero, but the living rate for everyone at this moment is one hundred percent, even if that is about to change in a split second. This is what we are given – finite time to use as we wish.

Tomorrow, I am free from all clinical duties and from the hospital. And so, again, one foot in front of the other, I will use this time to live fully – outside of the hospital. Release the memories of my patients, who lie in their small, quiet rooms listening to the beeps of the monitors and the breaths of the ventilators…let them go. And as I embark on a new year, and a new journey, I will keep in mind this gift that I still possess – to be the caregiver rather than the patient, to be able to leave this place for a moment, to take my own breaths, to live my own life.

As I reflect on my time in the MICU, and all of the families and patients who I cared for there – young and old – the song that comes to mind is Fix You, by Coldplay. The lyrics, the rhythm have played over and over again in my mind over the last week. Not that it was meant for this, but the more I listen, the more I realize that it was. My job, for the last 365 days, has been to try my best to fix you – “you” meaning anyone and everyone, the face of the community, the people from all over the world who somehow manage to find themselves at our doorstep. In the process, I have watched families let go, I have struggled myself to let go, and I have fought for everything from the best medical care to the most dignified death. And I have fought, every step of the way. Battled through sleepless nights, combatted resistance from many senior residents and attendings who did not spend as much time with these people – my patients – as I have. I have given these strangers, who worked their way into my life, everything that I have. I have done it all with the hope of saving each and every one of them. And I have failed.

This is medicine – in its full intensity, its full intimacy. This is critical care. This is the American medical system – at its best and at its worst.

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