awarded

In a crowded auditorium full of smiling nurses, doctors, medical assistants, colleagues and their friends, my name was called yesterday to a round of applause.  I stood up, completely surprised and, as most people do in this situation, stopped being able to think, then embarrassingly crept to the stage.   I positioned the awaiting residents on stage into two rows, each with one hand outstretched towards the middle of an imaginary column that I ran through, jubilantly "high-fiving" them on the way to nab my award.

Every year, the interns in the hospital elect one resident that they feel has "unmatched qualities of encouragement, dedication and tireless contributions" which made their learning experience better.  I didn't anticipate that I would be chosen yesterday, there are many other excellent and deserving teachers.   But I will try not to disparage myself in deprecation.   Instead, let me describe how every person in this program deserves recognition for the job they do.

There are nights in the hospital when admission after admission keep coming in, and the clock indicates I've been working for eighteen hours, with twelve still left to go.   I question how to keep my eyes open and organize another complex admission, but then my nemesis, the pager, promptly informs no-time-to-think, another admission has arrived.  I head to the E.R. to find the patients chart, quickly skim through a hand full of their medical records, or encyclopedia, scan the wall for their bed number and then identify myself as their doctor.   I link together multiple medication interactions, disease processes, surgical histories and current symptoms to solve the mystery of why they are who they are and why they are sick.   In minutes I've made an educated guess which key will fit their lock and attempt to jam it in.  Sometimes the door opens and they get better.  Sometimes the door stays locked and I need another key.  Sometimes I'm interrupted by an unrelated death pronouncement on the third floor of the hospital a quarter-mile away.

My task now is to traverse the darkened halls of the night-time hospital and knock gently on an large wooden door to enter a room and evaluate a potentially lifeless body.  This is intimidating with my hand on the handle though, because I'm unprepared for who is on the other side.  Most times, it's a confused, tearful family who called the nurse when the agonal, arrhythmic breathing of their ailing loved one calmly paused.  Then, I must listen and look for signs of life in a sterile bed, only to announce in moments that indeed, their loved one is dead, and then figure out how to politely leave the room to get back to work.  Other times I enter a still and vacant room, to a bed an eighth filled with the frail, cachectic corpse of an unknown elderly woman who's died by herself.  I put my stethoscope on her sunk-in ribs, grab her delicate wrist, notice painted or unpainted finger nails, and check for a pulse.  I wait the three minutes for single heartbeat, or chest rise of breath.  With none present, I hold a solemn, personal vigil for this person who has departed the world utterly alone and pray this never happens to me.

Once I've completed my third, or fifth or I've-forgotten-how-many-and-don't-care-anymore-because-I-just-want-to-go-to-sleep number of admission, I slump my way back to the basement sleep-room.  Only, on the way down the echoey concrete stairwell a Code Blue is called on the overhead speaker.  My sore body scavenges for reserve somewhere, finding adrenaline left only in my pinky-toe.   Half-open eyes crack slightly wider and I GPS-locate on a mental map, where in the hospital I need to be for the cardiopulmonary arrest.

Once there, I enter the room where chest compressions are underway on a middle-aged overweight father who had abdominal surgery earlier in the day.   He wasn't my patient.  Only the current environment and the questions I ask now will help save his life.  Stop, breathe and organize.  What do I see?  Nurses are attempting to place large-bore IV's into his bouncing body, crash-carts are being opened and displayed on the foot of his bed, vital sign machines are alarming, gaping-mouthed wife and adolescent children are corralling, squeezed by incoming staff, into the corner,  pharmacists are drawing solutions into syringes, defibrillator pads are being applied to his chest and respiratory therapists are bag-masking breath into a life that is circling the drain.  Amidst the chaos at 430am, my job is to say "I'm doctor Ford a I will be running this code."  Like it or not, I will be running this code.   I will now purge every detail of advanced cardiopulmonary resusititation I can recall.

Ten to fifteen minutes into the code through the percussion of chest compressions and IV pump mechanics, I hear ribs begin to crack.   The vital sign machine alarms its high-pitched "oh my god there's no pulse" ding as the smell of defecation permeates the air.  Pale skin turns cold, and the gaping mouthes of family members begin to wail.   I've exhausted every tool I've been taught but I do it all again hoping to offer some solace to a family who's only just beginning to grieve.  I stand defeated and start to question, "Did I do this right?  Did I miss something?  Do I even know why this person has died?"

These are sometimes easier questions to answer though than the ones that come later, "Will I be forgiven when for what I've done?  Will I be forgiven for tying this person to the bed, for stabbing them with IV's, for injection unearthly chemical compounds into his body and snapping all of his ribs as he attempted to leave this world naturally?"  Is modern medicine anything like what was intended for the human soul?  I often can't grasp if what I'm doing in the name of medicine is appropriate and many times I'm too fatigued or shocked to think clearly about it. At the end of these excruciating shifts, sometimes the only hand reaching into the black depths of despair is that of a coworker who was there with me.

With that in mind, let me reiterate how much I appreciate this award.  What an honor to be told my contribution is "unmatched."  But I'm compelled to offer this recognition right back to everyone who does this work with me, the nurses, doctors, pharmacists and therapists.   But mostly, I identify with the residents.  No other coworker has climbed this mountain step by step with me, from day one through year three.

Thank you to each of you for everything you've done to help me get by.  Thank you for listening when I don't know what to say but just need to talk.  Thank you for your rested touch when the world seems like it's been awake too long.  Thank you for pushing me out the door when I don't know where to go next.   Most of all, thank you for telling me it will all be okay.  All of the residents in our program have worked their asses off this year and none of us would have gotten through the sleepless hours and weekendless months without each other.

And I can't extend this thanks without overwhelming gratitude to David, who's been there through all of the ups, downs and everything in-between when I finally get home.  Thank you, David, for being my support, my constant companion, my biggest source of laughter, and the love of my life.  Thank you for your patience with me when I come home grumpy and tell you to "go to hell" when all you ask for is a kiss.  Thank you for texting "Do you need time alone?" when I text you that I shattered a cup on the floor for no reason.  You give me and everyone you touch selfless joy, friendship and humanity.  Thank you for being you and thank you for being you with me.  I love you.