Stefano Byer, M3, Class of 2022
The profession of medicine is one bejeweled in accolades. Walk into any physician’s clinic, and brandished on the wall are diplomas, awards, and validation. This décor is both of pride in one’s accomplishments and as a subconscious drive to authenticate one’s medical capabilities.
This framed décor is façade. That which matters is nailed into the heart, both the accomplishments and failures, the regalia and graveyard. These are forever.
My perspective and understanding of what medicine is have drastically shifted while on my time on the night trauma service. I’m drawn to its nature of dually providing physical intervention and the tending required by these patients in extremis. Over the past three weeks, I have found myself suturing head lacerations from machetes, cleaning out gunshot wounds, exploring stabbed abdominal cavities, draining abscesses, debriding necrotizing fasciitis, and placing various tubes and lines. Of equal importance, I have found myself sitting down with patient’s families and explaining injuries, accidents, and prognoses. Translating abstract medical lingo into an understanding—I’ve learned that the absence of this skill renders the prior void. But it was witnessing catastrophic failure that left the biggest mark on me, rounding out my perspective by demonstrating the confines of what medicine can and cannot do to save a life.
I was in a liver transplant surgery; the patient’s vitals were tenuous. I recall watching the EKG fizzle out, and my own heart dropping. A dance followed as the OR redirected all attention to the pulseless heart. A cascade of chest compressions is already a visually violent event to witness, but combined with an abdomen opened for a liver transplant, more and more small bowel spurted out of the gaping wound with each compression. The failed liver meant a failure in coagulation: watery blood continued to flank any cauterization attempt and filled the abdomen like a slow rising tide. Massive hemorrhage meant the massive transfusion protocol was implemented: a liter of blood whirling into this dying body every minute. Three rounds of compressions, shocks, epinephrine, etc., culminated in failure. The flat line: an ominous sign, hanging over everyone.
I found myself suturing a cold body.
The body of a man that 4 hours ago was wheeled into the O.R., joking about getting a “liver upgrade,” died. Alone in a hospital, with a liver that wasn’t his own. Surrounded by people that didn’t know him but cared deeply for him in his last hours of life. As everyone dismissed themselves, significant compartmentalization ensued, people continuing as if nothing had happened. O.R. lights, staring down carelessly, were turned off. Operating room turnover staff came in. The next case was being prepared and discussed. But in truth, everyone paused, nailing another case gone awry into their own wall of memoriam. Another grave erected across from the accolades.
We are shaped by our failures. They are our greatest teachers and motivators. Chiseling away the superfluous. Nonetheless, outwardly, we define ourselves by our achievements. But during the surgery rotation, I saw that we are molded by these harrowing defeats. Bejeweled graves line our clinical hallways, these nails in our hearts drive us to excellence.