Tuesday, November 13, 2018

Yes, yes, y'all.

A life was saved. Yours. And I was there and involved and there to bear witness to it all.

Yes, I was.

No, it wasn't in that sexy or thrilling way. You know, like the kind where someone tears into the room and dives upon your chest for compressions in a single bound. It was nothing like the ones they recreate for melodramatic television dramas with people running beside fast-rolling gurneys steadying wayward IV poles and charging up defibrillator paddles at the same time.


But still. A life was saved. Yours. And I know it was because I was there and have been doing this for a while now.

Sometimes we miss it. Those moments like this one. The ones where just one tiny shift in the path does something game-changing. A teeny, tiny nudge toward a seemingly insignificant fork in the road that moves the patient inches away from a giant cliff. Or maybe not a cliff because those are big and obviously treacherous. This was different. More like a slow, downhill trainwreck.

Yes, that.

See, a student listened to you and then shared your story on rounds. Described what you said in detail and all that had been done. And the way he honored your truth helped me to make sense of your perspective but simultaneously recognize that some aspects of our direction didn't make sense at all. And so, I asked one question. Which led to another question. That became a discussion with the whole team.

"Why is this?" I asked. "This doesn't make sense to me. Does it make sense to y'all?" This is what I asked my team. And yes, I said "y'all" because I think easy and calm learning and working climates help us think easier and take better care of patients like you. Or not even just like you. Like any patient who comes before us. I do.

So that student wrinkled his nose and thought about it. And so did my resident and my interns, too. And, though I could not see myself, I am certain that I did the same. Because it didn't make sense. The path we were on and that you'd been on for months and months did not.


We came up with a plan. To bring in a consultant to look at some aspects of your case. The parts that weren't readily explainable by the standard pathophysiology of your working diagnosis. And that--that call? It was a game-changer. It was.

And, I think, it saved your life.

No, not in the fireworks and confetti way. Not like that old TV show "ER" or even the newer ones like "Grey's Anatomy." More like with the subtlety of shaking a tiny shard of glass out of a shoe that could ultimately lead to something bad or even adding a drop of much-needed oil to a bike chain and popping it back into place before the entire thing is irreparably destroyed.

Yeah. Like that.

And I thought about it the whole way home. I thought of you and the story you told and the student who listened and the socioeconomic challenges that you face. I reflected on the barriers all around your care that day and how God let this tiny ray of light slip in. And how all of it working together saved your life. I thought about that for my whole drive. Then the next day, I talked to my student about it and cried right in front of him.

I sure did.

"We don't always get it right," I said in our team room later, "but on some days, we do." And I wanted them to not miss what our team had done. They didn't.

A life was saved this week. Yours. And I was there and involved and there to bear witness to it all. A life just as worth saving as my own. Or any person involved in your care. I am so proud of the care our team gave to you and the privilege we had to be involved. Damn, I am. And no, we don't always get it right. But this time we did.

Yes, yes y'all.

Happy Tuesday.

Thursday, November 1, 2018


I tell myself: Speak in tones that aren't patronizing and sorrowful or as if you're irrevocably broken. Then coach yourself away from the fear of not being able to help.

Like really help.

I think what gives me the most angst is the math of it all. The numerator of too much always, always, always divided by that denominator of not enough.

Remainder: Too much.

It looks like a lattice. This network of scarred remnants of self-mutilation covering your limbs. I heard this lady say on television once: "Why would someone take a knife and cut themselves on purpose? Why would someone do that?"

The girl she was talking to on like Dr. Phil or whatever it was countered sharply: "You sound stupid. It is never about the cutting." Then she rolled her eyes hard in this way that made that point stick for me. Focusing simply on the concrete act is asinine. Because it is never just that.

"I think we can discharge you from the hospital," I said. "How does that sound?"

You nod and shrug. "That's fine." And that's it. Your eyes float over my head and somewhere else. Where I do not know.

"Are you still hearing voices?" I ask. You shake your head no. "Good," I say. Though I feel everything but.

The medical part has resolved. The psychiatry team has given their recommendations for the mental health parts. Our team has kept you firmly on the balance beam through this hospitalization even after a few topples. Now is the time to prepare you for the dismount. But that's the problem--the dismount. This life that awaits you just won't let you stick the landing.


The math is bad. Too much divided by not enough. Too much is left over every time.

You are sitting on the edge of the bed. Yawning and rummaging through the sheets for a cell phone or a wallet or some other personal item. Shoulders slumped and resigned to whatever is next. I stifle an inward sigh. Whatever is next? It's just too much. Still divided by not enough.

But too much what? Divided by not enough what? Too much awful divided by not enough better? Too much need divided by not enough resources?

Or am I a part of the problem? Too much learned helplessness divided by not enough optimism? Too much ignorance divided by not enough courage? Too much darkness divided by not enough light?

I tell myself: Speak in tones that aren't patronizing and sorrowful or as if you're irrevocably broken. Then coach yourself away from the fear of not being able to help. Like really help.

Then help. Like really help.

Or at least make up your mind to try.


Wards, Day 1.