Ten Years in Medicine

On May 9, 2018, just after 8PM, I marked the end of my first decade as a doctor.

Without question, the past ten years have challenged both my technical and diagnostic skills… for what either are worth.  I’ve had to irreparably bend a pair of iris forceps to cannulate an impossibly small infant’s impossibly small umbilical artery, a willful destruction of hospital property whose cost was thankfully not deducted from my resident salary.  I’ve manually provided positive pressure ventilation to a baby in the back of a screaming ambulance with a broken ventilator, counting “one-two-breathe, one-two-breathe” at least 1,200 times on the hour-long ride.  Once after spending hours with a partner trying to place a central line I remember looking over my mask and up to the heavens, saying a Hail Mary, and twisting the catheter in one last pass before throwing in the towel.  We both stared in amazement as the line slipped effortlessly into the infant’s umbilical vein, as if all along it was just waiting – quite literally – for a wing and a prayer.

Yet the most defining moments of my career to date aren’t those that pushed the limits of my technical or diagnostic prowess.  Rather, the moments most deeply etched in the marble of my mind are those that pushed the boundaries of my humanity, forcing to grow not just as a doctor but as a person.

Moments like the countless nights I’ve spent parked at the bedsides of babies with pulmonary hypertension.  Persistent pulmonary hypertension of the newborn is a wily and relentless adversary whose war obeys no clock.  As a fellow, for the most severe cases I’d perch next to a warmer bed like an owl in the night, coffee in hand, eyes on the monitor, prepared to pounce.  These battles were my first experiences in staring down death, fixed firmly as the shield between his sickle and a newborn’s soul.  Toeing that last line of defense requires a combination of audacity and humility and has a way of engaging man with his own mortality.  For what after all defines our humanity if not the deepening of one’s personal relationship with the fragile space between birth and death?

On a different night I remember being called to Labor and Delivery to speak with parents whose infant was about to be born too early for our team to resuscitate.  I walked to their room, sat next to the bed, introduced myself, and asked them to share their understanding of what we faced.  The father talked about his wife’s labor, the raging infection in her uterus, and why we could not stop her labor.  We then talked for an hour about the kinds of things we normally try to save a premature baby’s life, why we could not begin resuscitating a baby born near 21 weeks, and why a single week matters more in the womb then at any other point in a human’s life.

As the conversation drew to a close, he looked up at me with his hands clasped so tightly that his knuckles were as white as the bedsheet.  He was a little younger and much more muscular than me, and the veins in his forearms looked about to burst.  His eyes reddened and locked on mine as he finally said “Doctor, is there really nothing at all you can do to save my daughter?”

I can hear his words as clearly today as I did nearly a decade ago.  I thought then as now about my own kids, about the depths to which I would go to save their lives, and about the warped relationship between powerlessness and things over which we most want to have power.  My hands trembled, not from nerves but because his words had pushed me to the edge of my own humanity.  I knew I had to step into a darkness I’d never before tread and had no idea what, if anything, would be there to catch me.

I’ve never fought harder to hold back tears.  It didn’t work.  My eyes watered, my voice wavered, and I said “It is my job to bring all that medicine has to bear to save babies.  If there was literally anything I could possibly do, I would do it.  But I can’t.  And I am infinitely sorry.”  There is nothing more human than the realization that, no matter how powerful we become on earth, there will always be things we are powerless to change.

In truth, I was first drawn to our profession by the rawness of the humanity etched into the person-to-person practice of medicine.  What I didn’t expect, and have now grown to cherish, is how my practice has pushed me to learn and grow as a person.  I’m a more complete, more human version of myself because moments like these keep nudging my capacity for humanity.

While healthcare is always changing, and today’s waves of population health and rapid-cycle technological advancement will without question make my practice look different a decade from now than it does today, I am confident one fundamental will remain constant: it’s the humans at the center of this most human endeavor that make medicine most meaningful.

About the Author

Dr. Chris DeRienzo is a dedicated husband, a proud father, and a mediocre triathlete. He’s also a doctor dedicated to improving the quality, safety, experience and sustainability of healthcare for all Americans. You can read more about him at www.drderienzo.com or follow him on Twitter

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