Wednesday, July 19, 2006

Tick, tick, tick.....

Ticking away, the moments that make up a dull day...

Time.

It's a mercurial thing -- never seeming to go fast enough when you need it too, and all too short for the majority of folks on the planet. And yet it plods along, dragging us along for the ride. I often feel that time is less like the sand slowly falling in an hourglass than a whirlpool sucking me swiftly down while I'm desperately trying to grab hold of any piece of driftwood to let me catch my breath. I know I'm not alone -- all of my brothers (none of whom were silly enough to go into medicine) feel that they never have the time to finish the day's work and still spend a few quality hours with their kids either.

But for the surgeon, there exists a place where time seems to run as slowly as the words coming out of a Southerner's mouth. No, it's not in the OR, which is generally a pleasant place (for me) to be. It happens when you are not sure if a patient is going sour or will be OK. It happens when a complication occurs, and you are waiting to see if the remedy you provided is the right solution. It happens when you have done a major, complicated operation on a fragile patient. It happens, in most cases, in the dead of night.

This is the part of surgery that largely goes unspoken --- the worry that is involved with caring for sick patients. Most of the time, the operations I do are "routine," although nothing is ever routine about surgery for patients. But certain situations generate enough worry to make me feel as if the devil himself has taken up residence in my stomach, stoking the furnace of hell. The profound uneasiness that comes with taking care of the acutely ill is something that I have never been able to fully conquer. Maybe that's good --- I'd hate to think that I would ever not worry about a sick patient --- but it doesn't seem to be beneficial to my sleep deficit (nor to my graying scalp).

I'm sure I have kept SWIMBO up many a night, rolling around in bed in a fruitless search for a few moments of peaceful sleep. The clock silently progresses, but never with the speed needed to get me to morning with my sanity intact. The sleep I do get is fitful, and every time I rise to the surface of consciousness the apprehension starts in again, pounding its fist on my forehead to remind me that the time for fretting has not yet ended. There is little else to do; just as it takes time for water to boil, it takes time for patients to "declare" themselves, either improving or not.

In the vast majority of cases, all the anguish turns out to be a long night of self torment, and the patient does just fine. But the need to worry never changes, because not every patient sails through their hospitalization without a few squalls, and correcting their course early is critical to prevent catastrophe. And so I fret. I brood. I stew. I agonize. I worry. Because, as my old program director once told me, "...that's what a good surgeon does. Nobody knows what went on in that operating room except you and God, but only you can correct a problem."