My job is an odd one. I can’t talk about the details ever, because that would violate patient privacy, and yet the generalities resonate throughout my and everyone else’s life like a gong.
You can read about what I do in the papers, and hear the stories on the news. In the course of 30 years, I’ve seen things that would curl your toes, straighten your hair, and change your religion. The guy who got hit by a train/forklift/plate glass/rebar. The one whose ponytail got caught in a paint mixing machine. The unspeakable things humans do to one another in fits of rage. The end result of the curious notion our society holds about guns. Improper uses of sex toys/vegetables/household objects. What happens when you drive drunk/tired/elderly/angry. How physics works, especially the laws of motion, mass and gravity, Every. Single. Time. Why you really, really, really shouldn’t do drugs. Especially injectable ones. 12 reasons to hate the Fourth of July (hint: they’re all essential body parts). Why I believe Darwin’s theories should be allowed to run their natural course.
The most important thing to learn if you want to keep working in a trauma center is how to separate oneself from one’s patients, to lock one’s private self in and let only one’s professional self show. Many stupid people tricks provide amazing surgical challenges, and keep my job interesting. Since I work in a teaching hospital, I get to learn, and watch others learn, from the best. Most of the time, humor saves the day. If you can find what’s funny in the situation, you are free to do whatever it takes to make the case bearable, and to get the job done.
Sometimes, though, reality breaks through. When I was pregnant with my each of my boys, I was working at Children’s Hospital, which is a terrible place to be pregnant. Every new disease I saw, every birth defect, every child gone wrong sent me into a tailspin. Was this genetic? Environmental? Could you test for it? Did it develop in utero? Could you see it on ultra sound? I came home at the end of every week, exhausted, frightened, worried. Migraines became a Friday occurrence. Each of their healthy births made me gleeful as few parents are. 10 toes! 10 fingers! They can breathe! Their skin does not slough off! Look! Poop! Oh, he can swallow! Isn’t that sweet? The oddest things made me rejoice. Because, really? Perspective is a wonderful thing.
After I returned to the trauma center, other things would set me off. Freak accidents are the worst, of course, but my paranoia surrounding lawn mowers bordered on the extreme. I still lecture the neighbors about the dangers of ladders. When a child came in who happened to walk behind his/her parents’ SUV as they backed down the driveway, I would come home and hug my babies so hard they woke up and questioned me. As my boys age, different things keep me up: the new driver who got drunk and killed her sister, in the passenger seat; boys long-boarding behind cars, kids playing with cigarette lighters. The sheer terror on the faces of parents as they look down the tunnel of a far different future than they had ever imagined is one of the hardest things I have to face. Because I know it could be me.
Sometimes my patients are mirror images of my kids. Sometimes they have the same eyebrows, are the same grade in school, like the same music (we ask, because we like to have a comfortable environment for pre-anesthesia) or play the same sports. Sometimes it’s just the age. Every parent of an infant goes home to cuddle their wee one every time a shaken baby comes in. It’s not possible to be unmoved.
I can dissociate myself from an adult yahoo who chose to bull ride a barrel full of fertilizer based explosives, or was drunk driving with a suspended license. It’s much more difficult with a teenager (poor impulse control, thy name is teen) who made a stupid choice once and will go handless through his life to pay for that whim. To me, the “hold my beer and watch this” set is far different from the “Gee I wonder?” set. Maybe it’s because I so often have a house full of wondering dorks, many of whom I have spent years yelling at to “put the towel down and back away from the window”, and other bits of silly advice. Maybe it’s because I have hopes that these boys will someday grow out of their stupid behaviors and become sensible. Or maybe it’s just that I live in fear that one day I will recognize one of the faces that wheels into my room. Whatever it is, it’s powerful. There is no doubt about it, kid trauma is more difficult. There is definitely a part of me that wants the teens to have a second chance, and I think no one can stomach the notion that bad things happen to children….
Recently, I had a case that shook me to the core. The kid’s head was round, just like my son’s. He was my son’s age, and had Type One Diabetes, just like my son. The stupid thing he had done was unfixable for the most part, and will complicate an already complex existence. I couldn’t help wondering what his blood sugar was when he made the choice he made. But what really got me was his bravado. He kept trying to calm his Dad. He clearly felt the weight of his consequences, and knew that his parents were going to take a huge hit, and he felt guilty. My son would have done the same. The resident kept saying she thought he was in shock, but I knew better.
When you grow up with diabetes, you grow up fast. You realize the consequences of not eating right, not taking your insulin, not doing your exercise, almost as soon as you can reason at all. What you choose to do with that knowledge depends on your maturity level as a person, and varies throughout your life, and through adolescence, particularly. But the base knowledge is there. This kid knew, as my son knows, that we are mortal. That is something a lot of teens don’t realize at their core, and many adults even, are surprised to learn. When I said to him “bummer, dude”, he replied, “you play, you pay”, though he was blinking back tears at the time. Responsibility is such a difficult thing to teach as a parent. It’s funny how the kids with the most issues learn it the fastest.
Dry Gin Martini, MD, and sober as a church mouse.
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