Blog block

I have been suffering from blog block, exacerbated by vacationing and houseguests, but I will change, I promise! Hopefully I won't have lost my audience...

Part of the etiology of my blog block is a perfectionism that hearkens back to my junior high days. I wanted everything I blogged to be perfect. But that's not the nature of blogging, is it? The point is to let it all hang out. Not everything needs to spring fully formed from my keyboard.

Another reason for the block is that I'm on the ICU, which has been a surprisingly uninspiring rotation, considering that all the patients are sick as hell. But I guess it's the fact that they're sick as hell that contributes to their relative tedium; so many ICU patients have no voice (they're intubated, or unconscious, or both). So when I report on events during rounds I recount the numbers that their various IV lines and tubes have generated: mean arterial pressure, respiratory rate, urine output.

The other day I was a sleep deprived asshole. It was the morning after a busy call night, and we were rounding in front of a patient we had admitted the night before, who was recently diagnosed with advanced lung cancer. He was a sweet old man, wispy hair and all, but not all there. His medical records were a hodgepodge of missed visits and history and physicals that noted: "pt is a poor historian." He was admitted to the ICU because he had developed a heart arrythmia while undergoing a lung biopsy. When we asked him whether he had any problems with his heart, he said in a completely serious manner, "Oh no, I don't have any heart problems. It's completely fine." And as an afterthought: "A little problem with the vessels running through the heart, but that's all," he reassured us.

Our medical student presented Mr. D that morning. Like all the presentations, we walked in front of the room, which in the ICU was separated from the main workroom only by a curtain. He had finished the presentation, when I exhorted him punchily, "Tell him the heart quote."

He told the quote, to the amusement of the team, which laughed as I had intended them to. Rounds are such a solemn event that I always feel that I have to improve morale by injecting the whole ordeal with humor. But as I gazed around at the audience, at my slightly embarassed medical student, I suddenly became aware of how close the patient was - closer than I would be to my TV if I were watching it from my living room couch.

What kind of person have I become that I would make a joke at the expense of a patient dying from lung cancer, right under his nose?

Later when I went to speak with him I found his hearing was poor enough that he couldn't hear what I said when I was right by at his bedside. Facing the other direction, amidst the cacophony of ICU monitors and chatter, it's unlikely that he heard our cracks. But I think of being an elderly veteran who just found out that he had likely incurable lung cancer, looking out at a crowd of twenty-somethings laughing in the hallway, and it's enough to shrink the wit out of my veins.

I never have been stand-up material.