Saturday, January 24, 2009

No Second Chance At Second Chances

We found him upstairs.
He was wedged in the far corner of the largest room of a huge home at the end of a circuitous driveway in a secluded, wooded neighborhood where million dollar homes dot the rolling hills by the dozen.
If happiness were merely the product of our trappings, than this man should have been delirious with joy.
But in today's economy, happiness is a commodity that can no longer be bought. The market has re-set its value, and some are unprepared for the change.
Our patient was one of those.
In his late 50s and obviously a man who'd enjoyed significant professional success, his wife reported that he'd come home despondent over the loss of his job earlier that day.
After dinner he'd said he was tired and wanted to go to bed early.
Four hours later, when the wife had gone to bed herself, she found him, here in the corner, his mouth full of vomit, his heart not beating, his lungs sitting idle, and several bottles of empty antidepressants lying nearby.
We tried desperately to bring him back, to give him another chance to see a different way out, but nothing worked. He'd been down too long, taken too many of the wrong drugs, and ultimately he was pronounced dead in the emergency department.
I'm hoping that this call was just part of the normal ebb and flow of life that we see on the ambulance, that his death, while tragic, statistically fits what we expect to see from time to time.
People commit suicide in the best of times as well as the worst. Our patient was taking medicine for depression, and for all I know this was not the first time he'd attempted to take his own life.
It's hard, though, not to see him as a casualty of a war on whose front lines we unknowingly sit every day.
No matter where you work, ambulances -- and by extension, emergency departments -- are always dealing with a particular population of people for whom daily life is itself a task.
Think about the chronic drunks and junkies for whom life is one endless chase for the next bottle or the next fix, and who take residence in the backs of our buses so often that we know their names and dates of birth by heart, whose medication list is as known to us as our own, and who can be identified by the time of day and location of the pay phone from which the 911 call is made.
But I worry that my patient represents the early stages of a new wave of casualties who are having to cope with an economy in the worst condition since World War II.
Does my patient represent the start of a wave of people overmatched by the conditions of early 21st century America, or is his death simply a normal part of the process of life for the rest of us?
Time will tell.
I'm an optimist by nature, which of course means I'm conflicted because I don't know that either possibility leaves much about which to be optimistic.
I do know that I wish my patient had been able to see beyond whatever it was that led him to take his own life.
I wish he'd been able to see that tomorrow is always a new day.
Mostly I just wish we'd been better able to give him that second chance ourselves.

Wednesday, January 14, 2009

Neurosurgeons are people, too.

Anyone looking for a good book would do well to consider "Another Day in the Frontal Lobe" by Katrina Firlik.
Dr. Firlik is a Connecticut-based neurosurgeon with a spare, compelling writing style who gives her readers entre into one of the most challenging and probably least understood (at least amongst the lay public) fields of medicine around.
The book mostly covers the period of Firlik's seven year neurosurgery residency in Pennsylvania, and while there are some war stories, they are brief and always in the service of the deeper introspection and naked honesty she brings to her examination of her chosen profession.
It's this last point, in fact, that I find to be the most interesting facet of the book, that Firlik would admit to some indecision about whether becoming a neurosurgeon was even the right choice in the first place.
It's clear that she has made an uneasy peace with her decision. As compelling as she finds the work, it's obvious that Firlik has interests and passions that extend far beyond medicine, and it seems that she's not entirely happy to, say, defer her wanderlust and love of travel in exchange for frequent call nights and the tyrannical power of the pager.
Firlik is at her best when wrestling with such issues, and she manages to bring flesh and blood to the neurosurgeons, those ethereal creatures most of us are lucky enough never to need.
It's a great book and a relatively short read at 270 pages.
Check it out, you won't be disappointed.