Scriveners Online©

This piece is dedicated to the real doctors through and through…


A hospital-issued photo ID attached to his quarter-zip top with a retractable clip, granting access to countless doors, closets, wards that otherwise would be inaccessible.

A silver Zebra F-701 retractable ballpoint pen purchased for $4.99, selected for the particular click it makes when protracting its tip. The click that somehow makes signing the thousands of EKGs endlessly thrust in front of his face slightly more tolerable.

A stick of epinephrine tucked into the cargo pocket of his scrub pants. Stored there for emergencies hemodynamic in nature.

An 11-blade scalpel nestled next to the epinephrine, kept there for the rare occasion when a cricothyroidotomy is required. Though if he were being completely honest, it serves more as a talisman to ward off the evil airway humors.

A pair of size-11, race-car red Chuck Taylors allegedly worn because they mask blood stains and can be easily thrown into the washing machine when contaminated, but truthfully because they make him look cool (or so he thinks).

These are his nonnegotiables. The necessities for any shift. But they are not the only things he carries, and certainly not the most burdensome.

A 3-year-old girl who was accidentally shot through the chest, an innocent bystander at a mindless drive-by shooting. He has carried her since he was a third-year resident. It was his first shift back from paternity leave, and the image of her frantic father carrying her lifeless body into the emergency department is forever with him. Although most details of the case now escape him, having blended into the countless resuscitations he’s participated in before and after it, the visualization of her petite, button-like uvula as he inserted an unimaginably small endotracheal tube and the sounds of her father’s cries when his daughter was pronounced dead have endured.

A young father and surgeon with respiratory failure he cared for during the first year of his critical care fellowship. The patient was a young attending, not much older than he was, who’d finished residency a few years earlier. Not even 6 months into his new job, he was diagnosed with metastatic lung cancer, which had already spread to his spine, liver, and brain. He’d spent the previous 3 years in and out of the hospital for surgical resection, chemotherapy, radiation, infectious complications — all the while maintaining his practice as a surgeon. This would be his last admission: he’d recently decided to transition to comfort care, as the cancer spread through his body, impeding everyday function. On the face of it, a sound medical decision made by someone who has watched this process play out time and again, always ending in the same awful, painful demise. But theoretical decision making is a far cry from the reality of having to say goodbye to your 2-year-old daughter for the last time.

A 28-year-old woman with the most severe asthma exacerbation he had ever seen. He was fresh from fellowship, now dual trained in emergency medicine and critical care, seemingly ready for anything. And yet one look at the ventilator told him he would be powerless in the face of this unyielding pathophysiology. The patient’s mother, a security guard at the hospital, greeted him with such relief in her voice, certain he would save her daughter. But the nonexistent area under the expiratory flow curve, a mathematical expression of the severity of her illness, told him otherwise. To this day, her mother greets him in the hall with a warm embrace, thanking him for his futile efforts to save her daughter. She shows him pictures of her ever-growing grandson, who was 1 year old the night his mother died.

The Covid pandemic compounded the load, piling on countless stories of loss and death. Patients entering the hospital for evaluation, leaving their loved ones at home and never seeing them again. Being admitted for severe disease, placed on supplemental oxygen, and over the next few weeks decompensating a little further every day, requiring non invasive positive-pressure ventilation, intubation, vasopressor support, renal replacement therapy, and finally dying of multisystem organ failure caused by a pathogen the likes of which neither he nor any of his colleagues had ever seen before. Each of these stories was equally heartbreaking, made even more tragic by the fact that the patients died in isolation — each one in a personal hermetically sealed chamber, their families forced to say their final goodbyes over a tablet computer thrust in front of their loved ones’ sedated, paralyzed, prone bodies.

These are not the only patients he carries. There are others he dares not even mention, since they weigh so heavy on his frame. It is unclear to him why he carries some patients with him and leaves others behind. He just knows that with each additional passenger, their burden increases exponentially. He often wonders if one day the load will just be too much to bear.

One pair of trauma shears tucked in next to the epi stick and the scalpel. These scissors are not his — they’re communal, passed from one provider to the next, absentmindedly put down, lost, and then miraculously discovered by someone else who requires their extraordinary cutting ability.

One pack of wintermint gum tucked in his back pocket, slowly softened over the course of a shift by the warmth of his body. Intended to combat the dry mouth nearly universally experienced by emergency physicians because of food and water restriction in patient care areas and the ever-growing task list that leaves them in a constant state of dehydration.

A pair of navy blue scrub pants. Not the designer, tapered, elasticized things that pass as scrubs these days. Rather the brandless, beaten, worn hospital-issued ones. The shapeless, drawstring ones. The type that has seen more patients and been exposed to more bodily fluids then he has. This particular pair is his favorite because it has an extra pocket sewn onto the right thigh. Valuable space for all the things he carries.

Credit; The Things We Carry, NEJM Vol 394, No. 3
https://www.nejm.org/doi/full/10.1056/NEJMp2507846
Scenes of people interacting in various medical settings. vector – Free Blue Image on Unsplash https://share.google/h3Sl3wESw57o4sO9E