Equilibrium
EQUILIBRIUM
My birthday week had been a whirlwind of emotions, adventures and celebrations. I had the best time ever, reuniting with friends both old and new and somehow managing to cram most of my favourite things into the space of a few days.
I spent my birthday on a boat with some colleagues and Maria – the former dive shop director who had become my adoptive grandmother over the years. We did a couple of dives in Gozo, which had me feeling over the moon, before I finished the day with a barbecue alongside some of my closest friends as we recounted our favourite tales from the previous fifteen years or so. The following day, Alessia and I treated ourselves to a day by the pool – the fanciest one in Malta – after which I had dinner with my med school buds, feeling as though our days at university had been eons ago.
The third day featured a cultural trip to some ancient ruins with my heavily pregnant Momma Bear, followed by another dinner with a couple of colleagues I had kept in touch with over the years. Finally, I spent an entire morning alone on an isolated beach, treated myself to a full-body massage and then ended the week with dinner alongside my colleagues from the ED. It had been such an incredible week!
It had only been a few days away from work, but somehow I felt ready to start afresh and was actually excited to head back in. For some reason, even though I had been away for just one week, it felt as though everything had changed.
When Reality Hits Hard
I returned to the ED to find morale at rock bottom. Everyone seemed either depressed or on the verge of a mental breakdown, and I couldn’t blame them.
The husband of one of our carers had died by suicide. She used to have the most heartwarming smile and the kindest eyes, but now she looked like a ghost of her former self. We dealt with death every day in hospital, but what the hell could you say to someone you had worked with for years when the person they loved had just taken his own life? To make matters worse, she was living in Malta while her family was back in India. I couldn’t even begin to imagine what she was going through.
Another carer, one who consistently provided some of the best care in the department, had had her permit renewal refused. She was one of everyone’s favourites, and no one had a single bad thing to say about her. In fact, I took it upon myself to try to help her sort things out. I first spoke to our nursing manager, who dealt with their contracts, and was told that she had never so much as been reported over the course of five years. Then I spoke to the private healthcare company that had arranged her employment while she was still living in the Philippines. When both told me that the situation was outside their control, I even contacted the director of the private hospital where I used to work to see whether they could offer her a job there. In the end, she decided to work as a cleaner instead.
There was some doctor drama too. Like a colleague’s father who had just been admitted with a chest infection so severe he had to be intubated. Or the other colleague who came into the department with right-sided lower abdominal pain. Appendicitis was initially suspected, so she had some blood tests and underwent a CT scan. Instead, the scan revealed an ovarian mass suspicious for malignancy. Given her strong family history of cancer, her investigations were expedited. One minute, she had been a healthy thirty-year-old woman going about her life. The next, she was being investigated for cancer.
And then there was the cherry on top. In a week’s time, I was going to be a witness at the wedding of two of my best friends – having been the person who introduced them in the first place. For the time being, however, I was taking care of the bride’s grandmother who was in really bad shape. I found myself having to discuss with the mother of the bride-to-be that, if her mother deteriorated to the point of cardiac arrest, attempting CPR would be futile. Oh, and also, see you at the wedding!
The Eye of the Hurricane
It had not been a good week. Not at all. While everything around me seemed to be falling apart, I felt as though I was standing in the eye of the hurricane. I had just come back from the perfect week, and I was fresh, rested and ready to roll.
For some reason, I also found myself taking care of seriously unstable patients who would usually have had much heavier involvement from more senior staff. With carers, nurses and doctors falling like flies, there wasn’t much choice but for the rest of us to step up and handle increasingly difficult cases ourselves. As bad as this might have sounded given everything else that was happening around me, it felt like I could finally prove myself.
In the space of just one week, I got to manage all kinds of resus cases. There was a farmer whose leg had somehow gotten trapped in a tractor while he was working in his field. It was badly mangled, and we did everything we could to save it, with rapid assessment and treatment followed by getting all the relevant teams involved as quickly as possible. In the end, he had a great outcome. Then there was a young woman who had gone swimming during a massive thunderstorm and basically drowned. CPR had been performed at the scene before she was brought into resus, where we managed to bring her back, stabilise her and transfer her to ITU. She went on to make a full recovery. And then there was the woman who walked into the ED covered in stab wounds, slashes and cuts. Within minutes, I had all the relevant specialties assembling in resus, where we managed her together. Crazy stuff.
I also got to perform a few gnarly procedures that I had never previously had the opportunity to try. One was inserting a chest drain using the Seldinger technique. I had already performed an open chest drain a few months earlier, but getting to insert one using an entirely different technique was cool, to say the least. I also got to perform a knee aspiration – something we usually leave to the orthopaedic surgeons. Sure, it’s a relatively simple procedure, but getting to do something new for the first time always came with that little adrenaline rush.
Thankfully, the week brought some good news too. Our colleague who had been investigated for cancer got the all-clear. She would still need surgery, but the malignancy we had all feared had been ruled out. The bride’s grandmother also made a great recovery and was discharged from hospital. She still wouldn’t be able to attend the wedding, but at least she was going home. Our colleague’s father-in-law recovered enough to leave hospital too.
Where Life and Death Meet
I gotta admit, all these event had me feeling confused and weirded out. While everything around me had seemed to be falling apart, I had somehow found myself thriving.
I had spent the previous week celebrating my thirtieth, surrounded by people I loved and doing pretty much all of my favourite things. Then I came back to work and it felt like everyone had some kind of disaster going on. One colleague was grieving her husband, another was losing her right to work in Malta, someone else was suddenly being investigated for cancer, and there were families sitting beside hospital beds not knowing whether their loved ones were going to make it home.
But then, somehow, some of them did. The girl who drowned made a full recovery. The farmer’s mangled leg had a great outcome. The suspected cancer turned out not to be cancer. The bride’s grandma recovered enough to go home, and so did my colleague’s father-in-law. It was a weird week like that – one bad thing after another, followed by these little moments where things somehow worked out.
I guess that’s the equilibrium of it all. This was just life. One person was celebrating their birthday while another was grieving. Someone got terrible news while someone else got the all-clear. One patient came into resus half-dead while another walked out of hospital after everyone had feared the worst.
Needless to say, these things happen every day, everywhere – to people from every walk of life. What makes the ED special is that it happens to be the place where we get to see all of it at once. Life, death and everything in between.