I had an 80 year old, nearly deaf, MVC patient lock eyes with me across the trauma bay, give me the thumbs up, and yell at the top of his lungs, “Comme ci, come ca!”  For those ‘Mericans reading this blog, that’s French for “so-so” or more literally “like this, like that.”  I laughed so hard I lost it a little.  This was funny for two reasons: 1) he was not French, 2) I had not asked him a question.  He was a gregarious young soul who took his trauma in stride.  I unfortunately have taken care of many more patients who did not share his good outlook, good fortune, or good outcome.  Thanks to my old pal Lizzie, I have been thinking a lot lately about the things that I’ve seen that cannot be unseen and the things I’ve heard that cannot be unheard.  It seems to be a theme lately among my other co-residents as well.  There have been some side conversations about the things which are a part of our daily lives now which are so far removed from the reality that most people experience.  Things which some people can only imagine, and beyond that, things which most people cannot begin to imagine.  I have re-structured my life around taking care of people in their darkest hours and thus am exposed to the darkest of situations.  I am in the good company of the attendings, co-residents, nurses, techs, social workers, EMS providers who stand alongside me in the ED day after day.  I do not want to dramatize this concept, because I think the very essence of what I am trying to convey is that the dramatic has become the commonplace, the norm.  A child tells me a tale of sexual assault, I feel sick to my stomach hearing the story, and then I walk out of the room and eat a sandwich and frankly don’t think about it again.  A lady is in an accident so bad that she crushes her skull to pieces and has to have her eyeball removed, and I walk out of the room and into the next where I joke with the patient about the weather.  It’s not that these things don’t matter to me, or that I have lost my humanity.  It’s just that if you see and hear truly horrible things constantly– things that most people would only see or hear once in a lifetime– your emotions re-calibrate a bit.  My thoughts and feelings about these tragedies just go into their own space now, and admittedly it’s not a space I revisit much.  Sometimes I go home and beat myself up over things that I could have done differently, but rarely do I curse the universe for these injustices like I used to.  Rarely do I internalize these happenings.  I can’t, actually, or I wouldn’t sleep at night.  And I probably wouldn’t love.  And I would almost definitely stop doing the activities that interest me out of fear.  I once learned that “the cloud” is not a place in the air that stores data in the form of waves (as I embarrassingly thought), but that it is basically an underground fortress in Nevada (and other such places) where mega hard drives basically store our stuff.  I think there is a cloud in my heart as well where all of this tragedy goes.  I can’t delete it, and I’m pretty sure it automatically saves whether I like it or not.

I feel this way about life a bit as well.  Life is overall good and despite all the beautiful, and despite all the nasty and ugly, it just keeps going.  The Earth keeps spinning.  The most horrible thing in the world could occur and unless that horrible thing is armageddon (!) the sun will continue to rise and set as if nothing happened at all.  I’ve had many a pondersome moment over the past few years where I thought to myself about all the heartache I’ve experienced.  Kind of makes you at least consider the things you’d be willing to unexperience to save yourself the chaos.  This is sounding very depressing but I’m actually feeling pretty optimistic overall.  It’s just strange to go through life with the perspective of an ED doc– seeing firsthand that despite all the joy, badness may only be a misstep away.  Tonight I literally turned around really quickly and smacked right into my dresser.  Instead of exclaiming “Ow!” or “Fuck!” or “Boohoo!” I actually said out loud as a knee jerk response, without even thinking, “That’s how old people die.”  A little food for thought on the topic of perspective…

All this typing and no resolution (as is often the goal when I start writing).  It’s a beautiful and tragic world, and I don’t know the answer to how to balance the two.  Comme ci, comme ca!

(The goal, this guy’s got it squared away.)