Thoughts at the End of the Day

This post may make no sense whatsoever. It is not necessarily deisgned to, but simply be a receptacle for some thoughts at the end of the day....

I have had about 3 weeks now of a very relaxed radiology rotation. It has been nice in that it allowed me mornings free to pursue some life rounding activities, such as fitness and reading texts better described as literature than educational. I have even broken my cello out a time or two! There have been a few unintended ramifications of this free time that are weighing heavily today. Mostly, it allows time for increased introspection. As is the gift and loss of a schedule too heavily burdened, you don't often have time to dwell on your own state, yet lately I have been. Today in particular. It is amazing that no matter how much we accomplish, how far we travel, what we achieve - we can often still find ourselves at a bit of a loss. Always comparing ourselves naturally to those things closest to us which often provide examples beyond our own. It is so easy to feel you have fallen short in some way, when you know this is not true. You know . . but you don't necessarily believe. Perhaps it is the sense of your own expectations that have landed you here but now that you stand here it is not as you thought it would be. Not bad, just different. You wonder if you made the right turns or recognized the correct moments to make certain choices...

This is not some mid-life crisis, perhaps it is just the normal anxiety that brews beneath the surface before imminent change. In the next few days I will find out whether or not I matched into my speciality of choice and where that match will be. As all the lists are finalized both for the applicants and the programs, it is merely a matter of time. The decisions in some way have already occured and I am only waiting for my current trajectory in life to intersect with the corresponding line that will map out my next few years. I have always enjoyed moments such as this, although this is actually somewhat smaller in scale than the ones I truly relish. Moments when the multitudes of decisions and choices in your past all converge in a single instant. At this point, a single moment, a million possible futures are generated and a million possible futures vanish, all based on . . . what? At this moment, I have a possilbe future in about 11 different cities with 11 different residency programs. Each one of those possible futures holds different people for me to meet, different choices for me to face. Each one will generate a different person from who I am right now. In some ways 10 of those choices have already disappeared because I will match at only one, but I don't know which yet so I can pretend that I am hanging in mid-air, in that moment when all 11 exist at once. Breathless at the top of the roller coaster knowing that in moments you will hurtle in some new direction. Exciting, frightening, exhilirating, nauseating. All at once.

This experience of moments is partially why I love Emergency Medicine. You are allowed to be so close to these pivotal moments for so many people. How easy is it to imagine that life full of history, choices and trajectories when they are rolled through the glass doors... a life that was heading in a direction greatly shaped by that person's choices and decisions until now. Then, perhaps out of pure chance, an unexpected event suddenly erases a thousand possible futures for this person and at the same time offers up a thousand different futures, or possibly only a few or possibly none at all. In that moment you are there, trying your best with your education and training, to intervene and be a part of that transformation. What is interesting is that we might think that by stopping their bleeding or giving the correct medication we are preserving their future, changing events from one outcome to another, but I don't think we are. We are simply taking part in the shaping of someone's future just as all the other events of their life have up until that moment. The one thing that is certain is that their time in the Emergency Department will likely change their future in some small or possibly large way.

All people react differently to life threatening injury or accident. Even when the disaster is averted, there is an effect. Some people rise up and transform in ways you could have never predicted, others wither from the fear of what is now the reality of a mortal threat where before only abstract risk existed. A spinal cord injury may seem like a death sentence to some while others will journey inward and find a life beyond any they could have imagined. You never know where this moment will lead. To me, these moments have a certain feeling to them. Something tangible I can almost reach out and touch or smell. I can't help but recall one night while on an EM rotation in Utah where I participated in the resuscitation of a 17 year old girl after a high speed auto accident. As a medical student at the time I had a limited role in the resuscitation which allowed me more time than most to appreciate the situation. As fast and chaotic as any resuscitation may seem (whether on TV or from your own life) there are moments peppered throughout where you take a breath and look at the patient and you wonder between chest compressions... "are you still here or have you gone?" I played my part and I did my best but ultimately I realized I had no power over the moment occurring for this young girl. Despite my awareness during that moment, the full effect did not truly hit me until a few days later. This is because at the time of the event I knew nothing of her past beyond the 15 minutes prior to her arrival dictated by the air ambulance crew as she was wheeled in. It was when we saw her obituary in the paper that I became fully aware of all the trajectories, decisions, experiences - and that once chance event of fate - that brought her in front of me that night. I imagined all the possible futures this girl would have had if something would have simply kept her tires on the pavement that night and from the obituary, there were many.

I have realized as I have become older that not everyone experiences these moments as I do, whether they are the subject of them or simply near them. Perhaps it is because they don't know what they are looking for or that they are not necessarily concerned with looking for them to begin with. Perhaps it is because they themselves have not yet experienced such a moment in their own life of such magnitude that they became aware of it. I am not sure, but I see these moments happen in life fairly regularly now, to those around me and myself, and I notice most people going about them without so much as a moment's pause in awe of the event they are so near. I see moments that have passed previously as well. When I drive past a broken highway barrier with torn up sod surrounding it I see the remnants of someone's various paths that were abruptly redirected or ended. These awarenesses are as evident to me as the skidmarks on the asphalt that remain, very much the same actually. You see them growing darker from their point of origin until they make an abrupt 90 degree shift in one direction. Nearby the markings of an old oil puddle.

I have never spoken with anyone that experiences these moments as I do. Perhaps my own personal experience in 1988 has something to do with this all. I am not sure. One thing I am sure of though is that these moments feel solid to me - in some way tangible - and I am unable to avoid them nor do I want to. I am drawn to them, yet they are strangely fatiguing to me at the same time. So today I sit fatigued somewhat. I am aware that my decisions for the past 5 years, a million of them mostly small, have in part dictated the changes that will become apparent in the next week. The decision to study harder for one subject, to slack on another. To skip one particular day in order to lay in the sun or to stay extra hours during some other clinical rotation. The relationships I have started and ended. The friendships I have made and the ones I have not. All the thousand little things you do and decide upon every day help to shape these moments of the future. Of course, I don't think they are all that ignite these changes. I do believe there is something else at work. Perhaps chance, perhaps something more complicated and well thought out. No one usually decides to drive their car off a cliff at the age of eighteen. They make their own decisions about other things, how fast to drive, how careless to be, but then something else intervenes. It puts rocks in the roads or gravel from new construction where you don't expect it. The next thing you know your life is changing. Perhaps these unforseem changes lead them to find the path that they were meant for. Perhaps they even realize their life's dream and purpose is to become an astronaut, to explore space and to help inspire others towards their own dreams. Who would have foreseen that? Then perhaps some random medical disqualification suddenly erases that dream and puts something else in its place. Not a decision I made, yet a change that occured. Perhaps what filled that space was a vacuum for many years until some other chance event opened a door to a path that was never there before. Now I find myself here. I have ideas and dreams of paths and doors I would like to go down but there are a million variables at work and I have done all I can to change the trajectories towards those destinations I would wish for. Now it is time for all the other unforseen forces to have their say. Did I do enough?