things change

(Warning: I'm going to describe some surgery stuff and some real life stuff that might be on the icky/disturbing side.)

For some paradoxical reason, this surgery rotation, rather than desensitizing me, has started to make me more sensitive than I've ever been before. I've never been one to be disturbed by tv violence, by the news, even by the actual trauma I've seen in the ER or working on ambulances.

But despite my rather extensive exposure to blood and guts and pain, recently I find myself haunted by a few scenes. Just more upset than I should have been. For longer than I really should have been.

I've been living in Israel for long enough to have vaguely adjusted to things exploding near me. And car crash after car crash. And shockingly substandard (or different-standard) medical care.
But it's been a weird month for me.
It started with a trauma surgery two weeks ago. We passed a nasty-looking car crash on the way in to the hospital. The driver was being wheeled in to surgery just as we arrived. He was clearly not going to make it- it took nearly 40 minutes to get him to the hospital and into surgery, his heart was not beating upon admission (but revived with CPR), and the medics who brought him in had not made any significant efforts to stop bleeding or provide patient care at all that I could tell. I'll spare boring details, but his blood tests showed levels of lactic acid and carbon dioxide incompatible with life, his pupils were unresponsive, his blood pressure was around 30.

Since his heart was still beating though, we had to go through the motions of doing everything we could. What ensued was a five hour mess of a surgery during which we removed both his legs and cut open both his abdomen and chest (twice). He finally died on the way from the OR to the recovery room.

The surgery itself was punctuated by frequent arguments between the anesthesiologists and surgeons, between the general surgeons and the orthopedist, between everyone and the nurses. For the first 15 minutes the patient's leg was spurting blood, but the orthopedist was unconvinced that this was a problem worthy of his attention- and the general surgeons refused to control the bleeding until the orthopedist had decided whether or not he wanted to amputate. This argument was punctuated by the anesthesiologist pointing out every three minutes that the patient's blood pressure had not risen about 30 this entire time, so they needed to do something. As nothing was decided about the leg, it continued to bleed while the general surgeons went ahead with exploratory abdominal surgery. (I asked the anesthesiologist if we should do something, he said it really didn't matter and went back to arguing with the blood bank on the telephone.)

I can't figure out what was so upsetting to me about all this. For one thing, it was a dramatically violent surgery on a dramatically injured young person. But also, it just felt to me like we were throwing money, supplies, time, blood, energy into this hopeless case. And it felt so deeply disrespectful to me. If he's already dead, and you're treating him as though he's not going to survive, then let him die with his legs intact and organs on the inside. And then of course I had the feeling I always do when patients die where it feels to me like we could have done so much better or more than we did.

But I've seen all that before, I can't figure out why this has been bothering me so much.

Then to follow that up there was our entirely unnecessary and disastrous two-day whipple procedure (another story for another time).

And the recent Israel drama. They've been showing footage on the news of the second Dimona suicide bomber being shot. While he's already down on the ground. And I can't argue that he shouldn't have been shot- it was certainly justified. But after all the trauma of the week, the last thing I want to see while I'm on the treadmill at the gym is a man being shot while he's down. Regardless of the situation. Don't want to see it.

And that's something that wouldn't have bothered me a few months ago. And really bothers me now.

Or maybe it's all just wildly misplaced wedding jitters :-)