The first four weeks of my fifth semester

It has been an eventful couple of weeks in this, my fifth semester of medical school. I have begun to do clinical rounds with physicians in different services around the hospital. I started with radiology, moved on to anesthesiology, and this week I am in ICU.

Radiology was interesting, but it was cold and removed from the reality of the living, breathing patient being examined.

Anesthesiology was more revelatory. I witnessed many surgeries on anesthesiology week. I have dissected a human cadaver before, but nothing compares to a living person being cut into alive. Blood spurts from small arteries being transected, fat and muscle are laid bare to a group of masked personnel peering into the newly-created void in which the surgeon must work. There were two hysterectomies, a diabetic foot being debrided, a young kid who had his small intestine herniated out of a hole cut into his abdomen—he claimed it was a bike accident, but a knife wound is more likely—and a woman who had broken her femur in two and needed to have it realigned, reattached and set back to as close to normal as possible.

Surgery is a bloody but fascinating affair. At the crescendo of the procedure the patient gapes there on the table, dozens of clamps sticking out of the incision. The surgeon makes his final manipulation or resection, and then everything is sewed back up, layer by layer. The patient, violated by metal and hands lies there peacefully in a cocoon of anesthetic, none the wiser

Today was the beginning of my ICU experience. The surgeries I witnessed the week before were all happy endings. These were people, who were basically healthy aside from the problems that brought them to the OR, who would recover and walk out of the hospital eventually. They had shocking injuries or illnesses, but the virtuosity of the surgeon saved them to live life just as before, almost as if nothing had happened. But in the ICU, you meet a different kind of patient. Many stabilize and recover, but there are some who teeter on the brink and slip finally to the void, the inevitable merely delayed for a few days by our artificial contrivances that support life when the body can't.

I saw a woman today whom I fear will meet such a fate. She was 22 years old and perfectly healthy looking except for gauze and bandages around her head. Looking over at the CT films that had been ordered by the ICU physician, the problem was clear. She had a brain abscess. I had studied this entity in pathology, but to see it in the flesh is something else. Her eyes were fixed in a deathly gaze, completely unresponsive to light or any other stimulus. I was allowed to draw blood out of her femoral artery for analysis. Not a flinch or any sign of pain was evident as I jabbed a syringe into her leg and drew out blood.

Her heart beat irregularly due to a probable electrolyte imbalance and the only reason she was breathing was the respirator pumping oxygen and air into her lungs, coldly and imperturbably. She was the victim of an ear infection that had gone too far. An infection that could have been cured by a $2 course of antibiotics was now refractory to four separate drugs, because they can't penetrate the pouch of brain liquefaction that is consuming her. No one is to blame. Had she been aware, had she gone to the doctor earlier, it would have been treated as a matter of course, as routine as taking an aspirin. But now, survival is possible but hardly assured.