“Life is not measured by time. It is measured by moments.”
―
I have always felt there is a special moment on each shift…..but it’s only there if I am paying attention. And this latter part is the key.
We can often be distracted on shift, either with other things going on within the shift, or things outside of the shift, in our own lives.
Our own plans for how the day is ‘supposed to go’ can often be a big part of our own discontent. For the record, there are no “supposed to’s” in life. Definitely not in the ER.
For me, I take public transit to work. This means for late afternoon shifts, in order to catch the last train home, I need to have things wrapped up by a certain time. By midnight, to be exact. It’s the only way to catch that final train.
Once the clock strikes twelve, if I am not ready to change and head out of the department, it’s a long, expensive taxi ride home.
However, occasionally, it just isn’t in the cards, and I’m going to miss that train… and have to let it go. Both the last train home, and the idea that I needed to catch the last train home.
Recently, I had one of those late afternoon shifts.
I had an early morning trip out of town planned the next day and my goal was to get out on time and make sure I catch that last train. It was busy however… I was running around from section to section, trying to get everyone dispositioned before midnight.
One of the patients I had picked up mid-shift had metastatic cancer with massive ascites — a rather stoic man in his late 60’s. Jaundiced. Here for increasing abdominal pain and girth.
I felt for him. He looked really uncomfortable. He needed a paracentesis, but I was busy. I had been waiting to get an INR back …so in between I saw other patients. Waiting for the nurses to call once everything was set up in the room… waiting… waiting. As it goes in the ER sometimes……but why today?!
The clock slowly progressing towards midnight…
Frustration
The nurses clearly didn’t have my schedule in mind…again! For that matter, neither did the patients. What’s with all the demands?! Doesn’t anyone else know this is the shift where things have to align?
Finally I got the call everything I needed was located and in the room, but of course, I was in the middle of seeing another patient, and said I would be by when I could. Eventually I got back over and started the procedure.
Tick, tick, tick….
The shift chugged along, but the finish line still seemed far away. There was still another litre of fluid to drain as I tried to tidy up other patients as quickly as I could.
An X-ray on another patient was still pending.
Checked the clock. 1140pm. Gonna be down to the wire.
A nurse called for a sick note for a discharged patient of mine, I scrambled over to a different section to sign it. Then another call for an admitted patient, with increasing pain. I provided some orders, and checked my watch as I quickened my pace back to my paracentesis — the stars were going to have to align in a hurry for me to catch that train.
3 litres had been removed and as I entered the room I was glad to see his belly was half the size it was when he first came in. I had just taken the catheter out and put some pressure on the site.
I looked up at the clock. 1157pm.
A nurse called me. The last xray I needed was back on my other patient.
I looked down at the paracentesis site. Drip. Drip…damn! He was leaking through. I had tried a z-track but the skin was so taught and thin I knew it was a possibility.
The nurse came back in and was hoping I could look at an ECG from a new patient. Come on! She is supposed to ask a newer physician but… I was right there.
I kept my finger on the man’s insertion site as I looked it over. Looks fine.
Then back to the man’s abdomen.
Another look. Drip. He was going to require a stitch.
I looked up at the clock…..1201 am.
Damn.
Learning to let it go
I gathered myself. Sighed and tried to stop thinking about catching that train. I thought about the last two hours. They had felt so rushed. Too rushed. Why was I so frustrated?!
It was all of my own accord, I realized.
So at that moment… crouching at the side of the bed as I asked the nurse to please bring me a suture kit… I looked back up at the clock… and just, let it go. It wasn’t in the cards tonight. Strangely, I felt some relief in this. And it was at that exact moment that I heard the voice of the man in the bed.
“Doctor… thank you so much”.
I looked up at his jaundiced eyes. He gave a warm smile. His face gave a genuine look of… relief. And acceptance. He seemed aware that he didn’t have much time left in this existence.
“THIS is why you come to the hospital”, he said.
“My stomach feels so much better, but more importantly, I felt cared for. I know you guys are busy here, but someone always popped in to check on me.”
And that moment — as I glanced over my mask at his eyes — was the moment of the shift.
That moment could have been missed. Not paid attention to, like so many others.
Gone, like the last train.
I touched his arm and said we were happy to be able to help in some way.
And with that I remind you to try and remain aware about what’s most important each shift. And despite what your mind may tell you some days, it’s not all about your personal schedule…..or what’s best for you.
That’s not why you are there.
A special moment is waiting each shift — the reminder of why you do what you do. You just have to make sure you’re open to receive it.