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Fluid
Amy Long
It all comes down to fluids. Fluids, the ins and the outs, crystalloid, colloid, the maintenance in increments of 40, 20, 10, ice chips and Lactated Ringer’s solution. I have spent a good portion of the last month recording, making sense of, calculating and ordering fluids. I have been baptized by emesis, tears, sweat, gastric secretions, blood, sputum, diarrhea, lymphatic fluid and, of course, urine (particularly that of baby boys!). I have drawn fluids, injected fluids, drained fluids, held pressure to prevent leakage of fluids and suctioned off fluid.
It all comes down to fluids. “He took my belt and hit me. He told me I had to sit in the water for five minutes because I had messed up myself.” A four-year-old boy lying shrouded in a white sheet told us his story without emotion. “It hurt. I cried,” he concluded. “He cried inconsolably for hours,” said a woman no older than me hovering over the bed. “When did this happen?” someone asked. “Two days ago,” the mother answered. “I put bandages on it but he just kept crying.” I watched as my teammates gently pulled back the sheet and fought the desire to recoil from the horror of what had happened to this little boy. Huge blisters of partial-thickness burns covered his perineum, genitalia, buttocks and ankles. I had seen burns frequently on the pediatric surgery service but never non-accidental ones, never ones inflicted on a child by his father. For the first time in my career as a medical student, tears came to my eyes.
It all comes down to fluids. I dipped a white washcloth into a basin of saline and tentatively started washing the small foot. “Press harder,” my resident instructed. Liquid splattered on my gown as the blister broke, pink raw skin left behind. As we scrubbed on, I reflected. I had not been the most confident medical student in the past month. The OR, a mysterious inner sanctum of medicine, left me at times terrified of making mistakes, tongue-tied and exhausted and swollen from standing. I spent a lot of time apologizing for my ignorance. But in that moment of furious scrubbing, I forgot all of that. I found myself at the top of the table scrubbing, pasting Silvadene-coated gauze over the fragile skin and carefully coating the genitalia with antibiotics as if I knew what I was doing. My resident kept handing me the needed supplies and telling me, “It’s all you.” Maybe it was the horror of it. Maybe it was a way of keeping me from breaking down, or maybe it was because it was the 28th day of my surgery rotation; whatever the reason, I finally found some nerve to be assertive.
It all comes down to fluids. After surgery, upon discovering that the patient’s urine output had rapidly decreased, we ordered a bolus of fluid. I found a spare moment and rushed upstairs to visit him an hour later. I found him hunched in his bed, tears dripping down his face, with Mom and the nurse trying desperately to soothe him. I ran out and returned with a pitcher of ice and a Thomas the Tank Engine toy. He calmed down with morphine and ice. His mom thanked me with a teary-eyed grateful glance. I again found tears in my own eyes. I walked out and realized that what I learned from a month on peds surgery was to let go of my own expectations, misconceptions and fears. In order to truly be an excellent surgery student, you need more than technical skills. You need to be confident, compassionate, and above all, adaptable, ready to solve any problem, surgical or otherwise. Because… in the end, it all comes down to fluid. |