Heartburn and Humility

Whew, what a week...am writing this as I hit the home stretch (12 hours to go) of my 48 hour marathon call weekend....am tired but it could have been much worse. :)

...survived lastTuesday night call (narrowly) with a whopping 45 minutes of sleep. You know it's going to be a long evening when your call night starts at 5:00 and the pager starts going off (have Pavlovian response of fear and loathing to that sound) at 5:00:37. I had a lot to do and "miles to go" before I slept. Called to ER (to back-up intern) to see patient transferred from Kinder (usually a sure bet for what I have termed an SOS patient {sick as snot}. For those not immersed in the nomeclature, it is a highly technical phrase {joking} meaning you ain't lookin so good.)

This lady had circulation problems, kidney problems, heart problems, lung problems....do I sound like Bubba from Forest Gump yet? Heart too weak to pump out all the extra volume retained by kidneys that don't work and won't put out urine....the body is a closed circuit so all that has to go somewhere, which happens to be the lungs, which causes more strain on the heart, which in turn lowered her blood pressure, thereby effectively ensuring that what extremely small amount of functional kidney was left did not get enough blood supply. Normally, some of the fluid can be removed by dialysis, but you can't dialyze a patient with a blood pressure of 85/48....and so it begins...I've been here before, and I suspect that no matter how long you've been doing this, it never gets easier (God help me and my patients if it does) ...you rob from Peter to pay Paul, no single decision is the "right one."

You try, and try some more and call the specialists to see if they have anything else to offer...you talk (and sometimes weep) with the family, who sometimes (like in this case, refuse to acknowledge the patient is very ill).....and you watch them get sicker and think and pray and question what you have missed, what else can be done? Why can't I be smarter and fix this? And then you sit, somewhat overwhelmed and inadequate at the bedside of someone who, 2 hours ago was a total stranger to you but has now become the center of your life, and no matter how tired you are you don't sleep because until 7 am the next morning, they come first. Before your wants and needs, comfort, sleep, your fears and insecurities.

You do this because, aside from the fact that it's your job, it's also your calling, your life; you would want someone to do the same if the roles were reversed...and even though you know you've done all you can, the reality is that any next breath could be their last and that makes you feel like a failure. It's an indescribable mix of emotions: you've reached the end of everything you know; you've stepped off the cliff of all that's familiar and proven and landed smack in the middle of a thorny patch called the unknown --it is a very humbling reminder, humility personified, actually......so you wait while time drags and trust and believe that the clock never stops and daylight is coming. Sometimes, amazing things happen-miracles actually-and you feel so rewarded (and relieved). It's like you're finally able to let out the breath you've been holding for the past 14 hours.

Occasionally you give hope in someone's darkest hour; (there is, conversely, no other feeling like this) and are rewarded-sometimes with a "thank you" from the patient or family, sometimes with an acknowledgement by an attending or colleague-- People pat you on the back and say things like,"good work," or "great job," but you just want to say, "thank you, Lord, that learning experience is over....pass the pepcid..." Sometimes no one notices....so you celebrate privately with the joy of fulfillment-of doing what you were called to do. You feel so small, a little in awe that you were an instrument in something so much beyond yourself.

I realized while I was typing this (forgive me; I'm occasionally dense) that becoming a "grown up" doctor is remarkably similar to becoming a "grown up" (mature) christian. You answer the call, easily trusting while still resting securely in all that you know, but before too long you're out in the middle of nowhere with no one to trust except yourself and your God. It is often said that the greatest lessons in medicine, the most lasting knowledge obtained, is in situations like the one from Tuesday. I can't help but think that those situations are where we learn the most spiritually as well.

Isn't that what God (who, by no coincidence was called the Great Physician) does, after all? He moves you out of your comfort zone, cozy in your nest of complacency and own strength, to a place where you are reliant on Him. He called 12 ordinary men from all walks of life to leave everything they had ever known to follow Him. He called Peter to step out of a boat and onto the water during a raging storm. He called Paul from a life of hatred and persecution toward believers....and He called Timothy despite his youth and inexperience....to step out into the unknown, step up to their calling, and step into His will (and consequently into his loving, protective arms)..... and look what happened as a result: We have example after example of God's faithfulness and how He used His people to further His kingdom. The Gospel was spread and the early Church was born.....and it just gets better from there. (Read all about it :) .)

So this is what I think: yes, my job is sometimes hard; whose isn't? But at the end of the day (or next day since sometimes they run together:)) it's not necessarily about being comfortable in your place, it's about being confident in it; that you're obedient and even though some situations are difficult and painful (and downright scary!), between the heartburn and humility, you will emerge.... stronger, smarter, and refined....into a closer likeness of whatever you are and what you long to be-whether it be doctor, teacher, carpenter..... or follower of Christ.