A Rough Day in the Sandbox.

12 myocardial infarctions (heart attacks)- 3 fatal, one of them a mother of three lovely little girls and only 36 years old.

One patient brought in who was "found down" (unconscious and unresponsive) after falling for some mysterious reason and lying on her right side for eight days. Her entire right flank was burned by the chemicals in her own urine. Her right hip looked like a rotten apple, bruised and liquefied to the bone under damaged skin. The wasting of her muscles caused a massive dumping of creatinine into her bloodstream, which in turned completely destroyed her kidneys. Nobody knows who the hell she is. She will almost certainly die tonight from multiple organ dysfunction syndrome (MODS), septicemia, complete right pneumothorax, and acute respiratory distress syndrome (ARDS). This was somebody's daughter, best friend, sister(?), mother(?). She must have been somebody to somebody on this earth at some time. And now it is very likely that she will die alone.

And I could not start an IV today to save my life. Veins disappeared, blew out like a cheap tire, or rolled saucily away from the catheter again and again, defying my experience and my confidence. It was just my day "in the box". Some days I'm hot, and some days I just look at all those torturous, valve-infested, ropy veins and can almost hear them mocking me, and so I go get the charge nurse to have a bash at them because I know that today I couldn't hit a bull in the ass with a grand piano.

That was my day at the office. But at least I got to go home and take my wife out to dinner. I got to hug my kids. I got to sit here and drone away my thoughts for you, my dear dear readers. Tomorrow is another day, by the grace of God, and I will do my best to make it better for someone else. I love what I do, and for all the tragic vignettes and collisions with other broken human beings- some grievously and humiliatingly so- into which I step, I wouldn't trade what I do for anything else in the world.