First Week at the Emergency Department – A Memoire

First Week at the Emergency Department – A Memoire

Monday morning. 8 am. My ER phone rings for the first time. It’s loud around me, I can barely understand the soft female voice at the other end of the line. I manage to make out:

„ Hi, … from Neurology. I am calling about … patient is …dead … candidate for pancreatic transplant donation … pre-surgical CT-scan … what protocol should we order?

„Uhm… sorry, did you say you’d like a pancreas CT-study for transplant planning on a dead patient?“
(See, not that I’m an expert or anything after only 1,5 years, but isn’t a heart function necessary to, like, move the injected contrast agent through the body?)

„Oh no, just BRAINdead“.

I’m not in Kansas –a.k.a. the outpatient imaging center– anymore.

Two hours. Nothing happens. A couple of unremarkable X-ray studies. One finger over here, one knee over there… But I feel very tense. Must be the calm before the storm. I have no references. There’s no way for me to know what to expect. Everything seems just so… unpredictable.
How bad can it get? What could that imply for me? How often and likely is it that it will get to that level of severity on my very first day here? How critical is it that I see and understand everything right away?

As people start getting out of bed an into the world, a whole new day full of accidents starts to unravel. And then, all of a sudden, helicopter sounds start to become louder and louder.
First polytrauma patient.
Traumatic brain injury. I step into the trauma room. An unconscious, intubated person is presented by the emergency service. An internist, a surgeon, a neurologist, and a group of nurses all start to move around the victim puncturing, placing catheters, drawing blood, attaching monitors, checking vital parameters. So quick. So efficient. All done. Emergency CT-scan is next. Unenhanced brain, middle face and cervical spine study. After hundreds of CT Thorax/Abdomen stagings, this must be my 4th or 5th time ever looking at a brain. With my more experienced ED partner and senior attending by my side, I feel reassured. Though there’s no way to miss the large subarachnoidal bleeding and parenchymal concussions. Someone shouts out the results of the ABG. Someone else arrives with information about the designated neurosurgery OR. „Are there any cranial or facial fractures?“ Our senior makes a quick assessment. Someone else shouts something else and soon after everyone has disappeared, taking the patient with them.

And so, in a flash, it’s all over. What did just happen? And how did everyone manage to remain that calm?
I’m in awe. It’s amazing what training, experience, motivation and well synchronized, well guided team work can do. I guess I will get used to this just the way everyone else does. But for now, I can’t help but feel deeply moved and impressed. There’s something undeniably beautiful about the whole process.

And just like that, I just know: this is going to be great.

The week passes by quickly. Many polytrauma patients, intensive care unit emergencies… a suicide attempt, an overdose, a small child struck by a car, bike accidents, many brain injuries and even a blunt ocular trauma with bulbar rupture. Seeing my old colleagues from the eye clinic show up with the portable slit lamp in hand and diagnose a corneal rupture with iris prolapse on the spot filled me with pride and reinforced respect. Just a couple of hours later, the eye has been saved at their OR.

„Wow. This week has been very intense. It is usually less hectic,“ says my partner as we meet on Friday morning. I’ve been assigned the TGIF task of bringing something sweet to snack on, so I place the muffins carefully on our table. „Not bad for a first week“.
At this point, I still feel a bit anxious and tense in the back of my mind. But the amount I have learned in just one week, all the support from our amazing supervisor and the excitement of what is to come cancels everything else out.

I admire my older colleagues for the way they master during their night shifts at the ER. After one week of routine day shifts the gap between me and them becomes more apparent to me. But according to our Dienstplan, I’m only three months of training away from becoming one of them myself.
Scary and exciting at the same time, I can't wait to achieve that level of diagnostic confidence, competency and skills, and to become really useful and reliable in the process of helping and saving lives in the acute setting.

Bring it on.

To Geiersnest (a.k.a. Best Ride Evah)

It all started with an innocent text.

Are we still on for that bike ride after work?

What is up with all those rhetorical questions of obvious answers? Because I'm not a quitter. But when I was met with a candid smile and his casual “It's a 800m climb”, a part of me kinda wished I were.
Oh look at the time. Oh, my legs hurt because of the 70 k I did yesterday. I think it will rain soon. I forgot to feed my hamster.
Instead, I nodded and went with it. Needless to say I couldn't really accurately appreciate what 800m actually looked like.

Half an hour later, we were dodging disseminated goat crap on the road just like playing bike Minecraft. It was not easy to focus on anything other than the 2m right ahead of us, my heaving breathing and my heart pumping like a Drum and Bass beat.
Racing heart and legs on fire, I was semi-oblivious to how the most gorgeous Schwarzwald landscape was slowly (as in 6 km/h slowly) but surely unfolding in front of us.

After a (very steep) wrong turn, two peanut protein bars and half a bottle of water we finally made it to the parking lot on top of Geiersnest.

Oh. My. Word.

Wide eyes. Jaw drop. Beaming smiles. Just as bright as the breathtaking sunset taking place right before our eyes ―behind luscious pine trees, golden hills, puffy clouds, a wide horizon to France and beyond.

It's always good to bring someone here for the first time and see their reaction.

Absolute bliss. Monday feeling instantly replaced by weekend ―no, holiday feeling.
Like stepping into a fantasy world, escaping reality, entering a dream where dim light, nature sounds and warm, scented summer breeze envelope everything.

And the way back down left nothing to be desired.
Speed. Alternating currents of cool and warm air against my skin. Crossing paths with the last brave cyclist still fighting against the mountains as we had been an hour before.

Freiburg greeted us back with the first artificial lights against a purple sky right after Blue Hour.

It wasn't my legs hurting this time. But my face from smiling.

A good friend, my favorite bike and a gorgeous landscape.
Perfect recipe to start feeling like myself again.

And goat poo stuck to my tires to prove it.

Inverse Naïvity

Inverse Naïvity

This world –its mere existence– is a miracle. And by extension, so is everything existing in it. This fact is so blunt and obvious, that it undeniability transcends all human interpretations and approaches. Religion and science cannot help but agree on this one: The miracle of existence can be taken in a literal sense –in God creating the Universe and all its creatures as an act of literal wonder. On the other hand, there's the astounding unlikelihood of just the right combination of subatomic particles and atoms ever coming together, integrating, interacting, changing over billions of years to find a way through the universe. The perfect conditions, beating all odds, that would slowly but surely create the right chemical bridges, complex molecules, genetic structures, cells, and compound organisms eventually leading to human life, intelligence and self-awareness. Nothing less than miraculous in this scientific sense either.
Finally –out of billions of potential combinations off all gametes that ever came to be through this miraculous process, of all those that ever existed inside your parents' bodies, it was the one that constitutes you that actually made it into this unlikely world. And that, in itself, is a miracle within a miracle as well.

And now here you are: a living human. Blessed with an amazing set of senses to take it all in and help you make sense of and navigate the world. But as complex and wondrous as we are, we are just as cognitively biased and subjective.

What we perceive through our filtering senses is just a consequently simplified interpretation of a higher reality that we have evolved to justifiably assume as evident, not actual reality itself. And so, even though every aspect of reality exists within an infinite spectrum of possible manifestations, it is through the simplifying tendencies of our minds that we tend to classify everything into more compact categories for the sake of practicability and sanity. We turn greys into blacks and whites. In this sense, things always exist in contrast to one another –including all emotional and abstract aspects of human experience. Coldness exists because of warmth. Betrayal only exists because of trust. Conflict exists because of peace. Evil exists because there is Good. And darkness exists because there's light.
And all these are taking place everywhere in the human world every day, every second. All these things –at least in the figurative sense when applicable– are consequences and manifestations of human choice. Do we act. Do we not. Do we move, do we stand still. How do we act when we do so. Where do we go when we move. What's the pace. Do we accept, do we reject. Do we talk. What do we say. How do we say it. What do we believe, what do we deny. What do we assume, what do we inquire. This all implies a certain degree of freedom. Internal, individual freedom, to construct our own humanly simplified version of the world through our senses and voluntary behaviors.

Now, all choices affect their makers, but also many others around them. Within the arbitrariness in which we are subdued to others' freedom and hence the way their choices directly or indirectly impact us, you could be tempted to believe there is not much you can do to define your own existence and determine your own faith.

Yes, there are many things that will shape our existence on Earth that we have no control over whatsoever. But the one thing we can control that will undoubtedly have a greater impact on our experience, is humbling acknowledging the way we choose to interpret what uncontrollably happens to us and to create our own beliefs is up to us – and that, within out individual frame, we have the capacity to deliberately seek situations, places, experiences and people that will confirm, reaffirm and protect those interpretations. That's the advantage of being biologically subjective to a fault. And how incredibly freeing in that is!

We will never be objective because we just biologically can't. As I said before, our senses and brains just weren't made for that. We will always look at the world through lenses. Lenses filter and distort reality. To a higher or lesser degree, in individual proportions as varied as the number of human souls wandering the Earth, everyone experiences some of the bad and some of the good throughout their lives. But freedom allows everyone to decide which to embrace, which to get familiar with, which to project and expect and exercise. Especially to those living in dignified societies, whose basic needs are covered and secure enough to actually allow for the privilege of vital room to voluntarily invest and reflect on these matters.

Given our completely subjective and delusional human experience, why not base our beliefs on the one thing that is a fact in every sense: that the world is a miracle after all?

According to the Cambridge Dictionary, cynicism is the belief that people are only interested in themselves and are not sincere.
Now, the world is not fair. Tragedy and loss are imminent and omnipresent. But, if all bad things only exist because of an equal, if not greater measure of good… With all our given freedom to shape our world, why choose a perspective more inclined to assume the former is the baseline state of everything? That's easy, it's comfortable, it's safe. No disappointment, no hurt, no crushed hopes. Sure. But also, no thrill, no dreams, no connection, no higher reward.

Through my lens, life's blows, hardships and downs are not punishment for gravitating towards or believing in the good, or evidence of falsehood, but an upgrading mechanism, an opportinity to fine-tune my radar for goodness.

In contrast, through the lens of cynicism, vulnerability can easily be mistaken for weakness. For a cynic who subconsciously or voluntarily chooses to believe in the bad as the preset baseline to be assumed, anything good and beautiful that conflicts with this view is nothing but an error in the matrix, a deviation, a deceit to be uncovered, a trick with small print hidden away in the imperfect edges of whatever evidence of light they happen to come across.

According to the Cambridge Dictionary, naïve is a person too willing to believe that someone is telling the truth, that people's intentions in general are good, or that life is simple and fair.

Now, if we leave the “too” out of the definition, this is what a happy person looks like.

Pain hurts the same for everyone –maybe even more so for someone without a wall to protect a heart that is avid for meaning and connection. But a broken, candid heart is nothing but an upgrading, self-improving system sharpening its selective skills to relentlessly strive for better. No matter what, forever.

Cynicism, on the other hand, leaves no room for that.

Cynicism reassures itself feeding off hardships.
Cynicism is narrow-minded and judgmental.
Cynicism is arrogant and condescending.
Cynicism is safe. It's weak.
Cynicism is also a choice.

Cynicism is the opposite of what it considers itself to be.

It's not enlightened.
It's blind.

Cynicism is nothing but inverse naïvity.