January 27, 2013

my soft voice


Earlier this month, I did an overnight call and around 10pm, a trauma alert was called because a young person was in a car accident and was on her way to the hospital - with a big head injury.  She arrived in the ICU after going directly to the operating room to have a large hole cut in her head to make room for her expanding brain.  We checked her in, noting that she was in decerebrate posture (meaning "without the brain", and that she had a brain injury that was low enough to interfere with her brain's signalling to her spinal cord).

Staring at this young woman, all I could think was: this could so easily be me or any of the young people in their 20s who are in cars that I know and love.  A few hours later, one of the ICU nurses who is about my age came into the ICU, in regular clothing, not scrubs.  We all looked at her and said, "Alison? (*not her real name, obviously) What are you doing here in the middle of the night when you're not working?"  She told us that she heard that her friend (our patient) was at the hospital, in the ICU, but she didn't know what had happened.  She turned to the resident with whom I was working - who was, basically, the first line of the ICU during the patient's admission - and looked at him, questioningly.  He used a soft voice and said, "Alison, her pupils were fixed and dilated in the OR."  At this point, Alison screamed, covered her mouth and crouched down on to the floor, as if she needed all of her energy to bear the news and had none left over for standing.  My resident, for better or worse, kept going and described the situation in grave and great detail, continuing to use his soft voice.  Even though the news was terrifying, there was something about the tone, the volume, and the caliber of his voice that was almost eerily comforting. It seems like an important skill for a doctor to have - this soft voice - because some words are so important, yet so horrifying that they cannot even be said by most people in most voices.

And with that story, so begins my last week of being in the hospital as a medical student.  This Friday I start my TA month (hello sleeping in until 7 and sipping coffee slowly while someone teaches me...yessss) and then I'm finally taking a vacation in March and April.  More on that soon.


"I prefer winter and fall, when you feel the bone structure of the landscape - the loneliness of it, the dead feeling of winter.  Something waits beneath it; the whole story doesn't show."
- Andrew Wyeth

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