I Know You, I Know You Not
Anna Burkhead -- It was only my second day on the rotation when you were admitted after your tanker jack-knifed on the highway and you sustained 35% total body surface area burn from the gas explosion that followed.
I watched as my attending used the Bovie to perform escharotomy on both of your arms. I calculated your resuscitation fluids using the Parkland formula.
I learned how to do my first central line on you. I also did my 4th, 9th, 14th, and 20th central line on you. I’m sorry for all the pressure and needle pokes. Sometimes I could tell from your heart rate that you were in pain. I explained to you the need for frequent changing and rotation of central access in burn patients; I hope you understood.
I watched as the chief resident and attending trached you. You don’t have a lot of neck, and it looked hard.
When you were stable enough to go to the operating room, I put all 100 lbs of my body weight into holding up the hip of your 400 lb frame. It was a long operation. Your back was a massive area to cover with skin grafts.
When the graft on the back of your head sheared off because of your C-collar, I called Neurosurgery to talk about how we could clear your spine. You are too big to fit in an MRI machine. You weren’t responsive enough for flex/ex films. We didn’t have many other options, and the C-collar stayed.
I examined you in the most intimate of places when you developed a complication related to all your swelling.
Every morning I reported your ventilator settings, blood gas, and labs to my attending. Sometimes he asked questions about what to do about this lab value or that blood gas. Sometimes I got the questions wrong. Don’t worry, there was always someone overseeing me in your care. Sometimes patients don’t like medical students caring for them. I don’t think you are one of those people.
I talked to your brother every afternoon and updated him on your progress. I got so used to seeing him in the yellow burn contact precautions gown and gloves that I didn’t even recognize him in the cafeteria one day.
I followed you as a patient for the entire month that I spent in the Burn ICU. I talked to you every day, although you didn’t respond. Eventually you kept your eyes open and moved your arms a little bit. During rounds on my last day in the ICU, we decided to start weaning your sedation. I hope you wake up soon. I would like to meet you.
Quite profound. Now that I'm (finally!) in clinical school, I can actually understand. (Granted, most of my patients go into cardiac arrest and yell that they want another doctor when they see me approach, but still.)
I know how patients can grow on you when they teach you so much - I'll never forget the first patient who let me take blood from him. (He'll never forget me either, thanks to the subdermal haematoma I gave him.)
Posted by: The Angry Medic | Nov 18, 2008 10:07:08 AM
Very touching account. Thanks for sharing
Posted by: Trish | Nov 18, 2008 10:11:15 AM
Wow Anna, that just gave me shivers. Remindes me of something from our experience with the Healer's Art...
Posted by: Kirby | Nov 18, 2008 2:47:11 PM
Glad you liked the post, Kirby! The Healer's Art has been a big influence in my writing and my learning these past two years! See you soon.
Posted by: Anna | Nov 20, 2008 12:37:23 PM
That's a great post Anna, both intuitive and informative on the management of a patient with burns. The "Art of Medicine" with a humane touch at work.
Posted by: Madhu | Nov 22, 2008 9:42:45 PM
Lovely. You're rightly focused. Now keep that human connection, Anna. Don't ever let the bureaucratic !@#$%^&*()_+| get you down.
Posted by: Ginny Rober | Nov 25, 2008 3:59:53 PM
Your a great writer and a compassionate individual. Please dont change.
Posted by: Jean | Nov 25, 2008 4:33:09 PM
Keen observation,great sense of care and a marvelous post.
Posted by: Burhan | Nov 26, 2008 2:21:31 PM
May your skill as a healer be surpassed only by the compassion in your heart. Beautiful.
Posted by: Rahnuma | Nov 26, 2008 2:51:49 PM
Thanks for sharing the story.. I agree, you are a great writer full of compassion!
Posted by: Jess | Nov 26, 2008 6:01:38 PM
I hope there will be more doctors like you!!! Don't ever spare good words and compassion,use them as much as you can,and whenever you can!!!
Posted by: lussa | Nov 27, 2008 7:25:17 AM
Thank you for sharing such a moving piece Anna. I recently completed an emergency rotation where I too experienced similar feelings. I feel as though I've spent the first two years of my education learning the SCIENCE of medicine. Now I'm finally beginning to understand it's ART.
Posted by: David Z | Nov 27, 2008 1:39:12 PM
i totally agree with david, now that there's only 3 months before i finish med school i'm very convince that medicine is the marriage of science and arts =)
Posted by: farah | Dec 1, 2008 1:51:49 AM
That was touching and inspirational. Nicely written.
Posted by: Sharon | Dec 3, 2008 9:35:08 AM
come meet him. he's awake and i'm sure would like to meet you...
Posted by: Courtney | Dec 4, 2008 7:10:22 AM
i'm sure u'll make an excellant humane doctor
Posted by: ghalia | Dec 5, 2008 3:39:51 AM
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