Monday, September 15, 2008

Tedium and tragedy

Originally posted at Random Dafydd.

It is Monday morning, and I am recovering from my weekend at work. I often describe my job as "tedium punctuated by tragedy." Now, this weekend was not a bad weekend, and nothing really horrible happened. We didn't have to work for twelve hours without a break. We didn't have any crash cases. We all got lunch. None of the surgeons were assholes. It was just a typical weekend. But thinking about it can be depressing. There was the fasciotomy. A fasciotomy is done when a patient has a condition called compartment syndrome. This is when a muscle becomes traumatically injured and starts to swell. However the fascia, which is a tough membrane surrounding the muscle, won't allow the muscle to swell, causing pressure. The pressure can be so great that it can cut off the circulation to the muscle, killing it. The solution is to split the fascia, relieving the pressure. If this is done quickly enough, the muscle can be saved. This patient had been pinned under a truck for upwards to twelve hours. The surgeon told us that he had treated people with similar injuries after an earthquake in the Philippines when he was in the military. Every one of them died within a few days.

The same surgeon fixed three broken hips. I like these operations. They are technical, but I understand them well. They keep me busy and they don't last too long. There is the satisfaction in moving through a well-rehearsed dance. Underlying it all, however, is the knowledge that half of these patients will be dead within a year. Old people's health, and it is almost always old people who break their hips, is often like a spinning top. One push can destabilize it quickly and lead to its collapse. My grandfather died this way.

I got lucky and didn't have to do the PDA on the 1 Kg baby in the NICU. I hate going up to NICU. There's no space, it's hot, and there are too many people. The babies are all so small. They always run all the parents out so that we can operate and I know from experience how frustrating that can be for the parents of the other kids. There is always a gaggle of parents crowding around the door as we leave. The all seem so young, and so tired.

On the plus side we did a couple of normal appendectomies. Nice healthy people, with a single problem, that we fix. People used to die a horrible, painful death from appendicitis. We are saving these people's lives. But it is all so routine.

The weekend is over. I have the satisfaction of knowing that we helped people. We even saved people's lives. Perhaps the fasciotomy patient will survive. Perhaps all three of the hips will be in the half of people whose tops keep spinning. The appendectomy patients will hurt for a week and continue with their lives. Their surgery will a become a minor part of their past. The other patients will likewise continue. By next month I will have forgotten about most of them. Because although the job can be depressing to think about, the dirty secret is we don't. We do the job and move on. That is all.

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