Hanging by a moment

I want to be a pediatrician when I grow up.

I've always known that. The question nowadays is, what kind?

In undergrad, I thought maybe Infectious Diseases. Then I thought, hm maybe ICU. But in the back of my mind, I always thought, hmmm, maybe hematology/oncology.

Maybe it's just because I read all of those trashy "One wish to live" books as a teen. You know what I'm talking about...where the main character is this rebellious goth girl who is forced to do community service at the hospital where she meets this guy dying of terminal cancer and falls in love with him, and learns to live the life she was meant to live. And at the end of the book, you cry buckets as Donovan passes away, with Margaret curled up in the ICU bed with him. And Margaret's dad turns out to be Donovan's doctor, and he sweetly calls her away, telling her she got too involved with the patient...

Yeah, so what if I still remember the character names?

Today during preceptorship, I met Lily, who is my little sister's age. I was sent in to do a full history (chief complaint, history of present illness, past medical history, social history, family history, blah this, blah that), but something about how she was so much younger than the usual patients (and relatable!) made me stray from the the script and start chatting about Gossip Girl (so hot!) and Tila Tequila (so trashy, yet addictive!).

She was a funny kid. And totally adorable, with her big double dimples and bright blue eyes, and blonde peach fuzz hair that was just starting to grow in again.

True story - as we were gossiping about celebrities, she mentioned how she was okay with losing her hair (from getting chemo). "I mean, I figured I was just gonna be bald like Britney Spears, and that's kinda what got me through it. My daddy used to tease me and call me Miss Spears when it first started happening. And I was okay with that. Because she can sing and dance and she has killer abs. But now, I don't want anyone to compare me to Britney, 'cause I don't wanna die."

I laughed. Like I said, she had a good sense of humor. I took some more vitals, and then headed off to present her case to my preceptor.

My preceptor was seeing a different patient at the time, so I walked in, introduced myself, and started listening to random heart sounds. (Okay, maybe not so random, as her heart sounded very textbook.) In the midst of the heart and lung exam, my preceptor's pager went off. Except, this time, it was different from the usual pages that usually interrupt patient visits. Instead of three quick staccatos, there was an arpeggio. Huh, what is that? I wondered through my stethoscope-impaired hearing.

"Excuse me real quick...I need to step outside for just a second," my preceptor said to our patient. Slowly. Calmly.

Our patient was a little surprised. We were, after all, in the middle of the physical exam.

But she nodded obediently as my doctor walked towards the door. I took off my stethoscope, dutifully ready to follow him wherever he went next. As he opened the door, I realized something was going on. There were footsteps - lots of footsteps - coming in our direction, and the overhead loudspeaker was paging my doctor to a patient room. And then I realized.

One of our patients had just coded.

The moment I closed the patient's door behind us, my preceptor took off running. Not wanting to get in the way, I hung back, as a stampede of doctors made their way to the patient, to do whatever they could do to help.

I wasn't quite sure which patient had just coded. Running through the possibilities, I figured it was probably our frail and fragile ninety-one year old and headed towards her room.

And that's when I saw the crowd outside Lily's room.

Holy crap. What did I do?

Five minutes ago, I was talking to a perfectly healthy (minus the whole cancerous tumor thing) teenage girl. And now here she was. With no heart beat.

Thankfully, Lily came back. Turns out she had merely collapsed as a nurse was trying to flush out her port catheter and her heart had stopped as a result. And after the initial scare and stabilizing her, my preceptor was still in there making jokes, "You know, I know you're angry with me because I'm behind schedule and I'm making you wait...but you really have to come up with a better way of getting my attention than a code blue!"

She laughed and agreed, considerably weaker from the excitement and drama that had just played out.

Deciding to let her rest, my preceptor finally let go of her hand, and walked slowly out of the room, glancing back at the room a couple times - as though he were worried that something new might go awry. We headed back to his office to discuss what had just happened, and once we were inside, he started tearing up.

These are the kinds of cases that will make or break you, he said to me. In this field, you get a little hardened and things don't phase you so much when things happen to your elderly patients. They're meant to go sooner or later, and you just want to make them as comfortable as possible. You just want them to leave this life as high-functioning as is possible. But with Lily, it's a little different. No, it's a lot different. If Lily's goes into remission, I will be able to keep going for... for a long time. But if she dies, well... to put it this way, every time I send her blood work off to a lab, or I know a CT scan is supposed to come in for her, Lily's the only patient I can think about until I get the results. And even then - when I get the results, I kind of don't want to see what they are...because there's a chance, a very big chance, that they might be the results I don't want to see. This is a case that will make or break you.

I have a feeling I'm going to get too attached to my patients. But after seeing my preceptor today, I'm thinking that might not be such a bad thing after all.