At the end of a long day I'm scooting
along on the train bound for Toronto. The rail cars
sway and jump with a noisy cadence that forms a rhythm
of irregular regularity. Each noise, screech, bump,
waggle or jump of the car is different from the last.
Together, however, there is a regularity that is soporific.
The rhythm has similarities to clinical practice. Each
patient encounter is different from the rest but together
they give a regularity that can, at times, be mesmerizing.
But some days you get a case that stops the whole show.
I remember a busy Friday afternoon
clinic more than a few years ago. There were two of
us working with two nurses and a receptionist. It was
busy. Very busy. Lots of the Friday afternoon colds
and flu-like illnesses that people worried would take
them to an emergency department over the weekend. Lots
of problems that people realized had not gone away and
that they needed to have seen to before the problem
ruined their weekend.
I was seeing an obese man with
chronic stasis edema who had a multitude of other obesity-related
problems. His wife, not a patient at our clinic, was
sitting in the packed waiting room with her winter coat
on. Like most physicians, I tend to keep my distance
from the waiting room. It just reminds us how far behind
we are. On this particular day I was talking to my patient
about compression stockings, about elevating his legs
when he sat, about his diet… when an urgent knock on
the examination room door put a sudden end to my rant.
One of the nurses said that the receptionist was concerned
about a patient in the waiting room. Could I come out?
Reluctantly, I did.
In the middle of the back row of
chairs in the waiting room sat my patient's wife. She
was between two other patients who were looking concerned.
She was ashen in colour and clearly unresponsive. I
suspected she had been this way for several minutes.
Her pupils were dilated. We laid her on the floor between
the rows of chairs and started CPR. I called for my
medical colleague and together we intubated her and
got an IV and oxygen running as we continued chest compressions.
The ambulance arrived and I continued on with them for
the 20-minute ride to the hospital. At the hospital
she was found to be in ventricular fibrillation and
converted easily with ECT to sinus rhythm. This was
before the days of defibrillators in ambulance rigs
or in public places. While her cardiac output returned,
her brain never recovered from the insult.
"MEMORIES
FLOOD BACK"
Most clinic days have their typical cadence and rhythm
that sees you through from patient to patient. Usually
the quick visits for blood pressure or viral illnesses
are balanced by the anxious or depressed patients who
require more time and reassurance. Occasionally a complex
case takes up a large swath of your time as you try
to sort out the medical issues and get them back on
track. Sometimes it seems the rhythm never gets established
and those days go by slowly and unproductively; other
times you look up to find only a few people left to
see and find time has raced by.
Like the train the days run relentlessly
into weeks and months and years. Sometimes you suddenly
remember a patient you looked after years ago and who
has been dead for some time, like the woman in the waiting
room. Their medical care, the nature of their personality,
their medical illnesses, a joke they told you many years
ago — the memories will flood back for a short
minute. It's difficult to believe they've been gone
for some years. That is when I most resent the accelerating
passage of time.
The moment passes and you barrel
on into the dark night with the train bumping and screeching
its way forward.
|
