Synaptic

Taylor’s essay came out of a set of journal assignments about working. Her evocation of shadowing a “hospitalist” over two days is humbling and harrowing by turns. The real key to this essay is its timing as it builds to the surprising climax.

-Keith Ratzlaff

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Many believe that a physician’s training starts in med school, but it actually starts much sooner. In order to even have a chance at becoming a physician you must be an outstanding student, be involved in extracurricular activities, volunteer, conduct research, and shadow a physician. My first official shadowing experience started at the Thyroid Clinic with Dr. Mova. I followed Dr. Mova around for one day. He performs thyroid biopsies and I arrived almost a whole hour prior to his first appointment to get the full experience. I had a seen a breast biopsy before, so I wasn’t at all nervous, and I had bragged that I could watch surgeries online (even while eating), so as I walked into the tiny room I was just excited, and probably a little cocky.

The room was so bright, it was almost blinding. As I squeezed into a corner between the patient, ultra sound monitor, and Dr. Mova, my heart quickened, not out of nervousness but actual, full body excitement. There wasn’t a lot of room so I stood leaned against the wall, my knees locked. I felt bad for the patient as I watched a four inch needle penetrate her neck, which I could see on the ultrasound screen. The thyroid is a light grey gland that wraps around the front of your throat, and sits directly next to the carotid artery, which appears black. At first, if you don’t know what you’re looking at, you could miss the mass that needle is aimed for since it’s only a slightly different colored grey than the rest of the thyroid. I remember thinking that it wasn’t normal to be able to see this, and that I was lucky to be in this position.

Then, I realized how hot the room was, and that I had a headache. I looked over at Dr. Mova, who had a bead of sweat running down his nose, I cringed at the thought of it landing on the patient. My head swam and I told myself to stay still and to focus on the screen, pushing myself to remember everything, because I didn’t want to miss a single detail. I tried breathing in my nose and out my mouth, I tried focusing on something across the room, I even tried holding my breath. All I could really make sense of was that the room wouldn’t stay in focus, it started to get really far away, like I was zooming in and out on a camera lens. Despite that, I told myself not to quit, to push through because I would be out of the room soon.

When I woke up, I was on the floor, and my entire body was drenched in sweat. There were four nurses crowded around me, and the patient looked at me with wide eyes. I immediately started to apologize and tried to get up, but eight hands told me to stay on the floor. Being my stubborn self, I convinced them to let me sit on a chair and covered my face in embarrassment; I told myself not to cry, and told the nurses I didn’t need a cold towel, but my sweaty body told them otherwise. When one handed me a juice and I told them I didn’t want any applesauce, they laughed at me, explaining that I needed to relax, that I was very confused.

I went home early that day because I was overwhelmed that I had been so weak in a room full of such strong people. I frantically Google-searched my way to answers, trying to make sense of why I had fainted. I worried that I had spent the last 6 years of my life chasing after a career I wasn’t tough enough to achieve. I remembered how I had doubted myself earlier that year, when I struggled with my class load and didn’t think I was smart enough to become a physician. After an experience like that I dreaded returning to the hospital the next day and shadowing another doctor. I couldn’t imagine telling my parents that I had given up on my dream that easily, so the next day I woke up before the sun and arrived at 6:30am to shadow a hospitalist.

A hospitalist is a new type of doctor; they typically specialize in internal or family medicine and do a fellowship in hospital medicine. This type of doctor works only in the hospital, since most primary care physicians can make more money staying at their practice all day many don’t “round.” This is where a hospitalist comes in; they are in charge of patient care in the hospital. They diagnosis and treat a variety of admitted patients. I was lucky enough to shadow Dr. Baustian, a man who made it his two day mission to make sure I knew what it was like to be a physician.

I stayed in the hospital from 6:30am-5:00pm the first day, only stopping because I had told my mom I would be home for dinner, and more pressingly I had developed huge blisters from sprinting to keep up with Dr. Baustian’s long strides. I saw thirteen patients that day, and watched as he admitted two. The first man had tattoos all over his body, and had had his gallbladder out the day before. He came back because of intense stomach pains and he when showed the doctor his stomach, it was obvious something wasn’t right. It stuck out, but not from fat; it looked inflated, like it was blown up with a pump. Then, Dr. Baustian tapped on the patient’s stomach. It sounded like a basketball. I had never heard a stomach sound that way before, but Dr. Baustian didn’t even flinch. Instead he admitted the man and explained that he had a little extra air in his abdomen. When someone has gallbladder surgery, the surgeon enters through small holes, and adds some air so that it’s easier to maneuver. Usually, the air dissipates on its own, sometimes it stays inside the patient for too long, causing discomfort. The man was discharged the next day, after, as they put it, “he passed gas.”

I had so many experiences that day that I talked to my parents about it until I went to bed. I was so surprised that I had made so many connections with patients I only saw for a few minutes, and couldn’t wait to get back to the hospital the next day to check on them. The next day, I wore tennis shoes to keep up, and to help my blisters heal.

That day, I ate lunch in 10 minutes and saw 16 different patients. Even though I had had nothing to do with their recovery I felt a sense of accomplishment as many of the patients I saw the previous day were sent home. I think my favorite moment of that day is when Dr. Baustian got to tell a man he hadn’t had a stroke. I have never seen someone so relieved, and I immediately hoped that one day I would be able to give someone news like that. Contrastingly, I also saw someone die that day.

I had decided to stay for Dr. Baustian’s entire shift, 7:00am-7:00pm. At 6:50pm, the call overhead came for a code blue on the ICU. I looked over at Dr. Baustian, and asked if I could go, or if I would be in the way, when he told me of course I was going my heart rate quickened, and my palms felt drenched. I wiped them on my khakis and stood up quickly. He, on the other hand moved in slow motion. He saved his chart, and then walked towards the stairs. For the first time, I walked quicker than him, and as we pounded down the stairs he said, “This is too quiet, this isn’t good.”

When we got into the room, the nurses and techs were waiting for a doctor to intubate. I couldn’t believe how calmly Dr. Baustain strode through the group of people to the patient. I envied his ability to remain stoic in a room full of chaos. I stood by the door, out of the way, recognizing that I was by far the least important person in the room. Three nurses were already switching off doing compressions, while a fourth was using an ultrasound to find a pulse. There was another nurse writing everything down, and yet another making sure he wrote it correctly. The last person I noticed was the patient. Probably because I could barely see her unless I strained my neck and stood on my tip toes, and only if the nurses stood in the right place.

At first I didn’t notice that the woman was completely naked in this crowded room; her gown was pushed aside to do compressions, and the nurse looking for a pulse was checking her pelvic arteries. After the patient was intubated, the group looked more like a cohesive whole than individuals, the three nurses switching who did compressions perfectly, while the doctors called out orders. There were two small nurses, and one larger one, who pushed into the old woman’s chest so hard I thought she would go through it as the frail body bounced with compressions.

“I found a pulse!”

The cry set caused me to jump, but I was immediately hoping that the patient would recover. I scooted closer, taking off my cardigan since I’d started to sweat, and reminded myself to keep my legs bent so I wouldn’t faint. The patient’s skin was pale, and looked like glass, except for her chest, which moved like rubber as the nurses did compressions. One of the smaller nurses asked for a wash cloth to put on the woman’s chest, because the wire from her previous surgery had begun poking them as they pushed on her. Then, they lost the pulse.

I let out an audible sigh and found myself praying, as I watched the scene unfold, “Dear God, please stop the suffering of this woman, give her strength to let go.” As I finished my prayer, I saw what looked like fruit punch start to come up the intubation tube, I realized a few seconds later it was blood. That’s when the pulmonologist, the patient’s doctor, walked out, spoke with the family and returned a few moments later telling the team to stop, the family wanted them to quit trying to bring her back. The doctor called the time of death, 19:22.

It was at that moment that I realized that watching the woman die was a privilege. More importantly, I realized the trust that patients and their families put into physicians to make the correct decisions about their health care is the biggest honor I could ever ask for. It is a responsibility that takes more than a strong stomach and intelligence; it is empathy, it is passion, and it is acknowledgement that life is fragile. After that I knew that my life wouldn’t be full unless I earned that privilege.

My heart rate didn’t steady until Dr. Baustian and I were standing in front of the elevator after a 30 minute briefing meeting. He seemed even taller as we stood listening to the elevator beep down floors closer to us. Eventually, he asked if I was okay, and I told him I was fine, but what I was actually feeling was much more complicated.