Presenting the 2023 Essay Series and the launch of the 2024 Ethics Committee Art & Essay Festival
The AAS Ethics Committee announces our 2024 Art and Essay Festival. Click HERE to learn more about this year’s event. And to celebrate its launch, we’re pleased to also begin a series of blogs showcasing our 2023 essay entries…
It isn’t okay, but maybe it can be?
Written by Braylee Grisel BS and Krista Haines DO
“Come straight to the OR. Ex-lap, Room 23.”
Room 23. I had spoken with her every day for the past week. She loved to tell me about her grandchildren, stories about how she lived before she got sick. A lifelong resident of North Carolina, she had a deep connection to the ground. In her younger days, she plowed the Earth and wrought sustenance from its soil. Daily, she asked if I was eating enough.
I picture her short grey hair and beautiful, asymmetric smile as I rush to the hospital. Darting into the changing rooms and haphazardly throwing on my green surgical scrubs, I glance at my reflection, white coat dangling off my tiny, weary frame. God, it’s so big on me.
It’s 5:00 AM; I have not had coffee. This is the second to last week of my 8-week surgical rotation and I feel the full effects of its toll upon my body. My feet ache and throb as I stand at the OR sink, unable to cover up the dark, purpling bags underneath my lower eyelids. Despite how desperately I long to crawl back into my warm, comforting bed, I know I must go on. I love my work. I love my patients.
I am here before the second resident arrives, the one I had been working with for the past week. I do not recognize the first assist or the attending. When I arrive, the patient is already splayed open upon the table. Thankfully, the drapes are already drawn, and I cannot see her face. This is an emergency. I must not get in the way. A retractor is shoved into my hands, and I pull it back to reveal swollen, erythematous bowel.
I hate dead bowel. As necrosis sets in, the intestines lose the typical markings of peristalsis, becoming smooth and unnaturally large, spilling out of the abdominal cavity like some sort of Cronenberg-esque body horror. For this patient, it extended throughout the entire colon, and her vitals were already losing stability.
Mind whirling, I start to dissociate. However, my body continues to do everything the attending says. I am so tired. I become a zombie. My arms and hands ache as I am pushed into unnatural contortions by the first assist, holding the skin taut with all my might. I am so tired. By the time my resident arrives, we already know the truth. This was a waste of time.
Don’t think about her family. We keep her stable as my resident completes fascial closure and asks if I want to do the staples. I do, of course. Don’t think about it. When it is safe to take down the drape, I see the patient I had come to know and return to myself. Can’t think about it. But I can’t help it. She is going to die. I am a passive voyeur, a stranger who ruffled around inside her internal organs for my own selfish educational purpose. And she is going to die.
Feeling quite ill, I approach my resident. She sits at the OR computer intently documenting the Op Note. My head continues to swirl as a wave of nausea crashes over me. Can she see my hands trembling?
“Hey, we have had a lot of hard cases this week, and this one was rough for me. Can we talk about it?”
“What, like a debrief? We don’t have time for that.”
A debrief never came.
It was a tough week. It was my first time seeing real death as a medical student, and we had a death a day. I repressed my feelings about it. The number one rule as a medical student is to always be as enthusiastic as possible. Plastered across our faces is a superficial veneer of “Oh it’s no problem” and “Is there anything else I can help you with” even when inside our hearts are breaking, our resolve necrotizing into unhealthy coping strategies of dissociation and denial.
We have several hours until the next case. I wander aimlessly through the hospital, contemplating mortality. I wonder what all the people I pass are here for. Would they die horribly too?
Eventually I text a friend who is stationed across the street on internal medicine at the VA. She completed the same surgical rotation a few weeks earlier, and I remember that she too struggled with the physical and mental toll it took on her. To my surprise, she drops everything and tells her resident an emergency has come up. Within minutes she meets me in the hospital courtyard, Starbucks cup in hand. My favorite kind.
Away from my resident, away from my attending, I can’t keep it in anymore. I do not care who else may see me as grief washes over. Wracked with sobs, I tell her it isn’t fair. It isn’t fair. None of this is fair.
She puts her arm around me and tells me, “No. It isn’t.”
As healthcare providers, we all swim in the same soup of misery. We build connections only to have them violently ripped away, sometimes even by our own hands. We sit by and watch as the loveliest people suffer horrific circumstances. A torturous existence for individuals specifically selected for their can-do, perfectionist attitudes.
However, sitting in that courtyard, mourning my patient, I realize how special medicine is. I did everything in my power to make the end as bearable as possible for her. She trusted me enough to share her life, let me be by her side at the end of it. As providers, we fight to save everyone knowing it may shatter us. I am grateful that if I shatter, I have people willing to pick up the pieces. Even when we cannot save the patient, we can save each other.
Leaning into my friend, I wipe my eyes and prepare for the next case.
Braylee Grisel
Krista Haines, DO MA
Latest posts by Krista Haines, DO MA (see all)
- It isn’t okay, but maybe it can be? - August 24, 2023
- The AAS Ethics Committee Essay & Cover Art Contest - March 29, 2021