falling is like this

Sometimes I leave that hospital feeling like a 5 foot metal pylon was shoved into my chest. Sometimes when I leave that hospital I can barely breathe from the weight and heft of it, from sorrow and sadness and disappointment and disbelief. Sometimes, when I leave that hospital, I want to sit in a corner and press my head against the wall. Because that is palliative. Because the enormity of it is overwhelming. Because the depth of it is winding. 

Sometimes I want to fucking rage and scream and bite and kick. That this is considered enough. That this is the expectation. That I have to wash my hands in a patient's bathroom, next to a toilet that is covered in piss and shit and blood. That there are never any paper towels in the dispenser. That there is rarely enough soap. That this is okay. That this is expected. Sometimes I want to rip my fucking hair out that the nurses yell at me for having the charts. Because nothing is computerized. Because everything is handwritten and just barely. Because they need to do their job. And the orders are in the chart. Along with the medical record. And the pathology report. That was spit out by a printer that hasn't had it's toner changed during this millennium. Such that the report reads like this: "Impression: Moderate___________________________changes most likely indicative of______________________________________ as well as significant_____________________________. Recommend clinical correlation."

And this is okay.

That my Attending can't keep a coherent thought process for more than 37 seconds. And this is accepted. And he is the Chair of his department. That the residents all argue and speak over each other. That they are all dismissive and rude and it's hard enough that I can't understand their accents, and certainly they can't understand mine, but that asking a question, because I am a student, because I am here to learn, nay am paying out my fucking ass to be taught, is too often met with an impatient hand. That when I want to say "but wait a minute, if you have Interventional Radiology come to flush out the PICC line that isn't working right now, and that you suspect is fraught with millions of fungal colonies because the blood cultures came back positive for mixed yeast species, aren't you not only propelling those colonies from the PICC line into the blood and but also thereby cleansing the line of said, alleged colonies? Such that, if you get a negative culture, you couldn't be certain that it was true? Because Interventional Radiology did such a bang up job of cleaning out the non-functional PICC line that they also removed the yeast from the lumen? Which is where you drew your sample from?"

In other words, why not just pull the damn thing out if you really think he has disseminated fungicemia and put in a new one? Instead of getting an answer like, no we can't or won't or aren't going to do that because of (some reason I can't come up with which is why I asked the farking question to begin with) or actually we might consider that or anything remotely intelligent at all, they turn to me and say "IR stands for Interventional Radiology. A PICC is a peripherally inserted central catheter. We cannot flush it out ourselves".

At which point I want to climb out the window and jump, because clearly I am doing something irrevocably wrong.

And when I tell my Attending that I would really benefit from some extra time spent identifying and describing heart murmurs and wouldn't this be a great learning opportunity 99.97% of our patients have one murmur or another, what does he tell me? Oh. I cannot teach you that. You have to read the books.

Thanks, @#$%@. Because, you see, I've read the books. I can use all the words like crescendo decrescendo, blowing, soft and halosystolic. And I can do it over and over and over again, until my cats grow thumbs and come and surgically remove your appendix, but I still can't identify them on real people and you're my goddamn teacher. So teach me. 

It makes me want to throw a bedpan at his head.

And when the girl who I dislike the most, out of all the people in my class, the one who drives me batshit crazy, the one who saunters into rounds 10 minutes late, with no fucking stethoscope, no notes and not a goddamn clue about much else besides her eyeliner, the one who's answer to the question of "what are the causes of hyperkalemia" and she says "umm.....drugs?" and they say, "very good, what kind of drugs?" she actually says, "oh I don't know that, I only know that the answer is drugs", when this girl tells the residents that she is going to one of the better medical schools in the state of New York next year I want to rip out my own esophagus out because I will never be able to stop the vomiting. 

And when I walk the halls, when I walk into the rooms, when I come to see our patients, when I come to see the incremental end of their lives, I cannot put the two disparate pieces together. I cannot walk from the kind of discussion where frequently the gender of the patient is forgotten or unknown ("Doe, Jane is doing better. Today he ate some applesauce and said his pain was better"), where we regularly and repeatedly swat around terminal diagnosis amongst each other in an almost jocular setting, jousting for who got one terminal diagnosis over the other (I KNEW it was metastatic histosarcoma! No you didn't! Yes I did! I called it. No you thought it was osteosarcoma), as if it weren't an actual person we were talking about. As if it were some abstract exercise and we are still working out case files on paper, not people made of carbon. I cannot walk from that to the room with the woman laying beneath the thin blankets, naked beneath her worn, patterned gown, staring at me with big wet eyes, tube in her nose, mask over her mouth, IV in her hand, silent, watching, following me with her face. Waiting for what I don't know. But it is hard not to imagine that she is only waiting for someone to come talk to her, to touch her hand, to say something, anything, besides, "are you feeling better today Ms ____________?" Waiting for someone who isn't going to come and pull back her gown, comment on her third spacing, listen only to her lungs. It is everything I can do not to crawl in next to her, read her a story or tell her that the sun is out today, that maybe it will be warm tomorrow. It is everything I can do not to start sobbing right there, in the middle of rounds, because I can't breathe. Because the only thing I will ever know about her is that she has aortic stenosis and sacral decubiti. And all I can do for her  is to remember her gender, remember her name.