Intro to Peds

• one cannot assume that any tube taped/stitched in place will remain so secured (NGT vomited out, CT "fell out" 2x, IV slipped, GT leaked)
• anticipate that meds may be hidden, coughed up, refused, thrown in face
• screaming child = vocal cords adducted = block route to lungs?
• super sick kids make the world seem a terribly unjust place
  

end of med-surg rotation

The elevator doors close tightly,
the metal box cuts through the hospital floors,
passengers, like potent medication, are released
to wade through hallways of blood choked with microbes,
to circulate into rooms/cells
all this an effort to stave off organ dysfunction, paralysis, coma, death

...

I strip away my uniform,
this thin cloth that weighs so heavily on me
with the responsibility of sustaining life-
but grief has already penetrated my skin

RED

At code RED the staff ran the halls, offering reassurance to patients and closing doors. I asked a nurse what further actions we should take should we see actual smoke. Her ready answer was, “If I see flames, I’m running out and saving myself.” I at first rejected her advice- confident that I would stay behind and help patients to escape incineration. Then I imagined myself struggling to help my patient (on his one good leg) down the 10 flights of stairs. At this point any altruistic impulse was replaced by an instinct for self-preservation. I was surprised at how quickly my supposedly “kind" heart turned to lead...

sight

What would I give
to enter into that torturous passageway?
anything
to comprehend that map of faint blue lines?
anything
to spare pain
to better life


yet I fail miserably.
I am not sure who is more blind- myself or my patient with glaucoma.

"patient is no longer a candidate for lung transplant"

a cruel euphemism for "we are sending you home to die"

Again he faces death as he did in Vietnam-
but these wounds are surgically incised,
these bruises from heparin,
the choking off of air from the build up of scar tissue within and the heavy hand of bureaucracy

first clinical

Today a nurse said to me, “You’re so sweet now, but I’ll give you 10 years and then we’ll see.”

Will the hospital will change me? With care limited by time/$ resources/endurance, how realistic is it to expect to provide care that feels thoughtful, unhurried and reassuring to each patient?

What does that perfect melding of efficiency and empathy look like?

Situations in which I feel helpless:

Packing a deep wound while the patient writhes in pain
Wrapping a body- forcing the jaw to close
Jabbing a needle into a living arm- deliberately inflicting pain

I keep thinking about the distance between life and death. It does not seem as concrete as it once did.