The man relaxes after a few more milligrams of Dilaudid on top of the Versed. His muscles and face visibly unclench. Two pairs of hands are dissecting through the soft tissue and muscle that hold his ribs together and forceps are a finger’s depth into the man’s chest.
It seems savage and caring at the same time, placing a chest tube. Empathy has to be selective in the Deli sandwich of sensitivity and disregard that comes with needing to burrow a hole in a man’s armpit betweet the 4th and 5th rib.
This is my first day in the emergency department in 17 years. All the pain and smell of the world’s suffering and compassion tweet into my presence in a dense emergency department that thankfully will be demolished and rebuilt over the next few months.
I find the man I am trailing today, Faiz Khan, to be “Routinely Heroic”. The kind of ‘day to day’ in some people that does the right thing, and compulsively is thorough. Divine presence influencing the world of ordinary events.
The patient wants to know why he has a spontaneous pneumothorax. “It can happen from any type of lung disease, or from trauma, none of which you have. We don’t know, that’s why we call it ‘spontaneous’.”
It’s VERY important to tell the patient ‘we Don’t know’ when we don’t. Otherwise his mind will ascribe blame to something he did wrong, or bad luck, or being cursed.
Sometimes, we just don’t know.
A man with a spontaneous pneumothorax is rescued from his breathless existence. The chest tube is in and his pain is relieved.
Two doctors, an attending and a trainee have to switch off enough sensitivity to dig into the sacred space of the man’s chest cavity. “Slice, not stab” is the instruction. He is right
Just enough sensitivity to relief pain.
Our unique heart. Receptive and immune.
Tags: chest tube