Coma: A Pause Between Life and Death

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There was a flurry of activity surrounding his body – buzzing sounds, blinking lights, hands flying in and out of view. There was shouting. There was a panic. Then there was a silence. The noises and commotion had not stopped, but the patient’s heart did. An eerie, ringing silence muffled the background noise––death was knocking. The stillness that comes from the awe of gazing upon the grandeur of death’s door was broken by a team of physicians who came crashing into view. They fought to save his life. And after seven minutes, the enemy of longevity, death, retreated. The man’s pulse returned; the physicians had saved his heart. However, they were not able to save his mind. His brain had spent too much time without oxygen, and the anoxic brain injury bell toll rang. He was standing on the edge of a coma.

Twenty-four hours later, the man showed little signs of improvement. Repeated testing of his brain-stem function gave little signs for hope. He wouldn’t speak, open his eyes, or move his limbs. He was estranged from his sons, so they debated over the phone from different cities about keeping him on a ventilator or taking him off. This man who once had hopes and dreams was now alone, trapped inside his mind. And then, the next morning, his niece showed up at the entrance to his room.

Hearing her uncle’s story, and seeing his condition brought tears to her eyes. As we explained the circumstances and discussed the expectedly extended trajectory of his recovery, she grabbed his hand gently and looking at us with watery eyes said she knew he would get better. He was showing minimal signs of recovery, but she had found reason to believe in spite of what she saw. And though it was touching to hear, it seemed as if time did not agree with her.

Days went by and the man did not improve. His sons could not come to an agreement on what to do with him and his niece could not relinquish her optimism. Every morning she sat at his side, his hands clasped in hers, whispering words of encouragement. It was something worth marveling at, really––seeing hope thrive like a single flower in such a barren valley of despair.

It was a privilege to witness such courage, and an even greater privilege to see her courage rewarded. The next day the man began to twitch when his nail beds were pressed. The following day his eyes opened. The day after that he began to turn his head when his name was called, and the day after that he began show responses to simple instructions like “raise your eyebrows” or “turn your head”. Within days his breathing apparatus was removed, and he was beginning to form words again.

The next morning when I examined him, he had taken leaps and bounds overnight. With effort, he was able to follow almost all my instructions, displaying remarkable gains. He was forming sentences and it seemed as if he was the most aware he had been since I first saw him. He was possibly more aware than he would have liked to be. With the return of his cognition came the full realization of his condition––he could barely move the lower portions of his body. When I asked him to raise his legs or move his feet, he was still having significant trouble. As his mind grappled with the reality that he still could not move his limbs at will, he looked at me with a pain expression and tears started running across his face.

I didn’t know what to say. I wasn’t expecting him to cry. But his aged face stayed focused on my confused one. “Don’t lose hope.” I fumbled. “It may take some time, but you can do this.” I was at a loss for words and that was all I could scramble for. I grabbed his arm with intention, “Whatever you do, don’t give up.” He slowly nodded. He was being prayed for.

When rounding with the attending and team three hours later, I found the man was sitting up in bed seconds away from practicing walking with a physical therapist. My jaw was scraping against the floor. What is this power that moves over human life? What is the source of this hope, this courage, this strength that mankind shows in times of sorrow and duress? Who can reach into the depths of a man’s mind and lead him back to his loved ones safely? How could someone stand so close to the brink of death, and so quickly find his way back to life? Was this man’s entire recovery simply attesting to the magic of medicine? Or had I glimpsed into the eyes of a miracle? Was this the heart of the ministry of healing?

The room was lighted with smiles and laughter. The man was moving. He was speaking intelligibly. And what else would be some of his first words other than a quip against the US president? I smiled and thought of these words, “By prayer the sick have been encouraged to believe that God will look with compassion upon them. A ray of light penetrates to the hopeless soul, and becomes a savor of life unto life.” (EGW, Adv. Review and Herald, 1900).

My Waiting Game

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One Day. Ever since beginning medical school, “Match Day” felt like more a myth than reality, an elusive goal that never seemed to get any closer. And now finally, FINALLY, it’s only one short day away. We haven’t graduated yet, but for the first time, we are being told all our efforts are worthy of being a doctor. After all the time we put into the books, the clinics, the call nights… someone out there wants us to be a doctor! Match Day is the realization of a dream. Only. One. More. Day.

Keep Calm

Ok, boring stuff first (skip ahead if you want to read about my experience!): this is how “The Match” works! A big part of the 4th year of medical school is dedicated to finding a job. Graduating from medical school is not enough to practice medicine in the United States; one still needs to complete additional training after graduation to become certified in a specialty. This process begins when 4th year students submit applications in September to residency programs of his or her choice. The next few months are a blur of interviewing, trying to impress programs all while searching for the perfect place to train.

Next comes the tricky part. Each applicant makes a preference list of where they would like to work for residency, the “rank list.” Likewise, each program makes a list of applicants, ranking the interviewees in the order of its preference. All these lists are thrown into a huge algorithm, and when the switch is thrown, it tries to match each applicant as high up on his or her rank list as it possibly can.

So for example, lets say my rank list has 3 programs: Awesome is at the top of my rank list, followed by programs Spectacular, then Fantastic. If Awesome still has one open spot left when the computer reaches my rank list, it will put me there tentatively. If the algorithm later finds another applicant who is higher up than me on program Awesome’s list (boo!), because there are no more spots left, I will get bumped out in favor of that other applicant. The algorithm will then try to put me in Spectacular. This process continues until I am permanently put in a program, or the algorithm has exhausted my list of potential programs. Because of that possibility, applicants typically have a lot more than 3 programs ranked!

Hard Work

Ranking Programs Is Hard Work!

Back to my story. In my last blog post, I was finishing up interviews and ready to start creating my rank list. That was a whole lot harder than I thought it would be! Fortunately, that was because I liked most of the programs at which I interviewed, and not because I hated them all. It was a nice problem to have! I knew where my first two or three programs would fall on the list, but after that, it was pretty tricky.

After submitting my rank list toward the end of February, there was nothing I could do but wait. And it’s been the hardest waiting game I’ve ever had to play! I’ll be 100% candid with you, this whole process of applying for residency has been pretty stressful. Emergency medicine has a firm grasp on my heart, but it’s a tough specialty to get into. And even though it’s where I know I belong, lingering doubts about my application kept trying to get me down: Are my grades good enough? Did I say anything dumb during interviews? Is my repeat year of medical school going to hold me back? How do I stack up next to other applicants?

The Monday before Match Day, all applicants are sent an email letting them know if they matched or not. Those that don’t match usually have to try for a spot in any remaining programs that didn’t fill up (which usually means having to change specialties). Needless to say, this past Sunday night was a long one for me. I tried sleeping, but about two hours before the expected email arrived, I just couldn’t keep my eyes shut anymore. I rolled over in bed to see my wife, wide awake.

“You can’t sleep either?” to which she replied with an anxious, “Is it time yet?!” Those two hours crawled ever so slowly, and I was reminded of being an elementary student, staring at the clock and watching the seconds tick down to the end of a Friday afternoon. But then it happened. At exactly 8:56 AM, my phone gave off it’s recognizable notification ding, and this is what I saw:

Matched!

Next thing I know, my wife is sobbing, I’m doing this crazy happy dance, and my son is squealing with delight. I did it!! I’m going to be a Doctor of Emergency Medicine! So now here I am, with one day left to go, a guaranteed match in hand,but no clue where I’m headed. Tomorrow (Friday) at 9 AM, my classmates & I will gather in a big celebration to find out the results of the Match… To be continued…

class of 2015 GalaThe Class of 2015, Ready to Match!

 

Snow from the Sky

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“Wow! It’s snowing from the sky!” A novelty for those of us that only see snow spraying up from the ground at ski resorts. My husband and I (we got married over Christmas break) traveled to Kettering, Ohio for our inpatient internal medicine rotation. We had an amazing experience, learning lots and meeting many new people.

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On our flight over, we met three cool fourth years––Chas, Amanda, and Stephanie––who helped show us the ropes on how to prepare for rounds. Julie Dicken had everything we needed from food, transportation, housing, and our schedules organized and readily accessible. Dr. Fershko also met with us on our first day and was an enthusiastic proponent for our education. The residents also kindly took time to go over our notes and give mini-lectures, and our attendings guided us through patient management and relations.

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Throughout our stay, we saw a diverse patient population from drug seekers and ruled out chest pain to AML and SLE. We experienced patients who loved us and those that might have loved us if we had given vitamin D or “dilala” (dilaudid). We were able to celebrate with patients that recovered and for those that passed away, tried to stay strong for the families left behind. Our academic knowledge and interpersonal skills drastically grew in three short weeks.

All too soon, we were heading home. Bundled up to avoid the 5 minute frostbite (Anthony looks better with both ears), we drove through the snow, falling from the sky, our white Christmas for the year. We were sad to end our great experience and say farewell to our new friends.

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