I wonder how much of what we experience in life is either not perceived at all, or is remembered only briefly. Phone numbers, inter twined small town genealogies, what I had for breakfast. The kind of information that I either don't need to have available to me, or that can be quickly referenced by my smart phone or my smarter wife.
But sometimes there are moments of clarity; occasions when you see, hear and perceive more than usual. Often they are times of stress.
It is two generations ago. I am in college and getting ready to take the MCAT, the standardized test that Medical School admissions folks look at with such great interest. I have no memory of studying for it - nowadays I strongly suspect it is standard practice to do extensive prep.
But I do recall the early evening before the test. I think it would be spring of my Junior year. In any case it was a day with the pleasant warmth of Spring. I walked over to the banks of the Mississippi river on the University of Minnesota campus. There are steep limestone bluffs there and if you walk along a little path down below you are soon in an area where you can have solitude.
I had along a book of Tolkien poetry and remember reading one of his early efforts that later mutated into the Hobbit, a piece called "The Hoard". I had a black marker pen with me for some reason and I amused myself drawing little runes on flat bits of rock and setting them up in a row. Rather ritualistic now that I think of it. Down in a river valley you get an interesting juxtaposition of stimuli. There is a steady hum of traffic and urban activity, but you can't see any of it. It seems to be a combination of sound that travels over the surface of the water and vibration that comes up from underneath you. The limestone where I sat was dry, warm, lit by a sun that was just starting to dip down to a descent that would give me full illumination. I was calm and relaxed. Justifiably so as it turns out, I did very well the next day. Not too long after that I was starting my First Year studies in a stark, modern building atop the same cliff.
Scenario Two. A few months back.
It is generally true in medicine, and particularly so in Emergency Medicine, that problems are rarely the fault of one individual. Multiple small mistakes cumulatively add up to a crisis. The patient, the EMS crew, the triage nurse, they all have roles to play. But in the end it is my job to put all together and deal with it, because ultimately it is my responsibility. And make no mistake, doctors are fallible. Did I spend too much time on that other patient because it was a charming, cute kid or an uncharming,demanding drug seeker? Was my mind on something else when a crucial clue was briefly offered up to me, only to be replaced by a whole different set of information on another patient?
It works much the same in non medical crises too. A situation you think is under control is not, and you are at the "purple and gasping" stage of things.
You have to dig in and deal with it. Figuring out how things went awry has to wait.
I find myself again sitting on a rock. I am having a very direct conversation with somebody whose job it was to manage a problem. Said individual has gone on vacation and is not sure when a critical deadline is. And expects that everything will work out somehow. And has a dodgy cell phone connection.
This time is is not Spring but Fall. The weather is as I sit is changing from still and humid into a cool, breezy day with storm clouds swirling like angry jellyfish overhead. A nearby factory has a retro noon hour whistle and I hear it sound, sending rising octaves up into the charged atmosphere.
I'm in a little park and in front of me is somebody's failed project, a sort of "water garden" that was once supposed to high light native plants but is now just a muddy puddle with weeds. Probably it got that way due to some combination of distraction, diversion of resources, maybe some kind of blight or fungus, hard to say. The plants look sad and ill.
This being Wisconsin there is a brief whiff of brewing beer that brushes past me. Hops and malt doing their subtle, aromatic dance.
What I am hearing over the phone does not make me happy. How long has the "patient" been slipping into distress? What really is the underlying condition here? How much time do we have before Full Code, an event from which so very few recover in a decent state?
I take a few deep breaths, the air around me having cooled considerably during the half hour chat. A few pleasantries are exchanged of course, but it is time for direct instructions, repeated several times. This must happen. It must happen by this point in time. I must be given confirmation that this has happened. I must have this confirmation by this point in time.
It is not me at my best. I am in default mode a mildly introverted guy whose take on the world around him is mostly whimsical. But when I must do so I can throw a switch and go into Emergency mode. I can be Direct. I can ignore extraneous input when necessary. I can be bossy.
If you live your entire life this way you will not have many friends. But in the unusual circumstances of an impending Code Blue it is not only acceptable but necessary. I have never had a patient that I have pulled back from the brink ever complain about it. I consider such griping unlikely but in theory it could happen. I simply regard is as far less probable than a patient I let die coming back to tell me what a kind and gentle bedside manner I had when they were blue and gasping.
I am musing on allegory this week. Those few who know the back story will understand and should not feel a need to comment. The land of Allegory can be a difficult place but also a whimsical one. I find myself, crisis now past, still sitting on a solid rock, and still smelling the faint hints of brewing beer, a Promise of better times ahead with my treasured friends and family.