The one I was dancing with
Looked up at the sky and it was
I'm awake with your memory over me
That's a real fuckin legacy
This morning I was dancing in my kitchen, first to bongos by cardi b and Megan the stallion but something came over me, because I'm hoping to do my application today, or at least make progress and see what's required of me. I turned on maroon and this is what came up.
You know the thing about the career shit is that it really was a heartbreak. I was really close to my friend who was going through a divorce after like 14 years together and it was crazy how much the depth of our grief paralleled each other. My first real, deep earth shattering heartbreak was my divorce from surgery.
I actually really did love it. It was love. I was enamored with everything- the discipline it took to wake up in the morning every day at 4 am. The amount of things we got done before most people even got out of bed. The idea of having to know everything internal medicine doctors know and also know how to cut people open and take out and rearrange their organs. The intimacy of it. The weight of the responsibility of it. The knowing of people in ways they could never know themselves. I also was in love with the rejection, the doubt, the need to prove people wrong who said I couldn't do it. I loved the challenge of it. And until this day when I think about doctors, surgeons always will be my people. The specialty I fit most with. It was a real match. There was real shit behind the decision. It wasn't all a lie as I've told myself all of these years. There was love there. Real, love.
There was enough love that I was willing to endure abuse, cruelty, racism, gaslighting, neglect, rejection. I wouldn't have put up with all of that pain if there wasn't love there. It was love. It's ok to say that.
The job really was my identity. But it never fit right- like a pair of slacks a size to small that you have to unbutton in the car while you drive. There was always something about it that cut a little to deep- there was a cord that led to somewhere a bit to deep inside my soul that made a lot of the shit that we put ourselves through as surgeons destabilize me in a way that it didn't seem to affect my other colleagues.
I had to pause to think of why.
At the end of the day when all was said and done- I didn't like the actual job of performing surgery. The idea I loved- the concept of the intimacy of it all, the tangibility of healing people and respecting disease and leaving their bodies more whole through the trauma of the process. That idea in theory appealed to me. But the actual action of it wasn't enough to sustain me. I found the OR cold and anxiety provoking and draining. I didn't enjoy the pressure of it, and I never really felt that accomplished. I think if I had been in the right program where the abuse wasn't as severe as the places I ended up I may have finished, but I would have been, underneath it all, unsatisfied with my life and career. It wouldn't have been for anything other than a sunk cost fallacy. I have a lot of friends, who finally, after all of these years are just now finishing or recently finished, and when you ask them if it was worth it they laugh.
I had a patient who had a gastric wedge for a GIST tumor- a benign tumor of the stomach. Literally the surgery is cutting out a piece of the stomach like you would a pie. It's not complicated. It's simple, and usually people only stay one night and just go home. You use what's called a ligasure device which uses sound waves to cauterize (or melt) the tissue together and seal it. And that's it. You cut it out like a pie. Simple.
I got a call that night that he felt like he couldn't breathe. I saw him and a man who was as black as I am turned the color of grey sand, clutching his chest, telling me he couldn't breathe.
I thought he was having a heart attack, or a pulmonary embolism, but wasn't bold enough to bolus the heparin without getting the labs back. I did get him to the ICU. After what felt like hours, but must have been 15-20 minutes the labs came back and his hemaglobin was 4.5. If you don't know, normal is 15.
We called the ACS team and right there at the bedside they sliced open his abdomen. So much blood poured out of his belly- it covered the floor and made it slippery. To add to that one of the transfusion bags burst on the ground as we tried to massively transfuse him. So scarlet it was.
There was so much noise and chaos while the code went in it was deafening. Once the more senior residents arrived I had been tasked with the job of calling the wife. I called and called and called and called and called. Nothing.
Finally after all the blood had drained from his body onto the floor, his heart stopped and we had to pump on his chest as whatever was left squirted and slid out of his abdomen onto the floor, onto our hands, our scrubs, our shoes. It was everywhere. So scarlet it was.
Then the silence came. The code was over. What was a room rancorous with the chaos of trying to save a life fell silent with the failure. I have never heard anything that quiet in my life.
Until the sound of an iPhone pierced the air. When we found the phone, a picture of a beautiful black woman on the screen with the word "Wifey".
My senior resident later told me that the screams she let out would haunt him for the rest of his life.
That was when I knew the job wasn't worth it. I had known before. I had had a suspicion. I felt weary with the exhaustion of waking up at 4 am every single day. I was traumatized by the neglect and isolation in that program. I was isolated, I was deeply lonely. At the time, I had nothing. My immediate family was as toxic as ever and had left me to wither away and die, starved of love or support in a hostile, deserted environment. My friends were also suffering and couldn't take on the weight of my flailing arms, lest they get pulled under and drown as well. I was in love with a man who took pleasure in pretending to pull me out just to hold my head under the water again and again- a sick game of emotional waterboarding. I had nothing. And the love that had driven me to throw everything I was and everything I had into becoming a surgeon, had run dry after years of drought.
But that night, as I sewed a dead man's abdomen closed, and wiped the blood from his cold skin, put my hand on his eyelids to close his empty eyes, I knew. It wasn't worth it.
I didn't want the weight of the responsibility. I didn't want to be haunted by the memory of misfiring a ligasure device, wondering if such a small action took a perfectly healthy father away from his wife and two daughters. As doctors, we see people die all the time. Death is a natural event. Sometimes death is preventable, sometimes it's not. Sometimes the difference between life and death is a misfired ligasure or a misplaced stitch. The OR for me was already a cold, joyless, anxiety provoking place. The gravity of wondering if any move I made would haunt me for the rest of my life, rip a son, daughter, father, friend, away from this world, made it unsustainable. I had already sacrificed so much. My youth, my identity, my body, my mind, my spirit- I knew the weight of the job would eventually snuff out what small light was left of my soul.