How did I get here?

How did I get here?

jtopin

And you may find yourself
Behind the wheel of a large automobile
And you may find yourself in a beautiful house
With a beautiful wife
And you may ask yourself, well
How did I get here?                         -Talking Heads

 

A middle aged father, critical care physician, triathlete, water polo goalie and Bob Mould stalker wakes up one day and asks, “How did I get here?”

The answer to that is probably longer than what is appropriate for this blog, the human attention span being what it is. But that question along with its logical follow up, “where am I going?” has been on my mind quite a bit.

How did I get here? Where am I going? My past. My future. With change coming just around the corner, it’s hard not to have my headspace taken up by these questions. But with some more introspection, I find that this is my brain’s default; to be looking forwards or backwards. I can be in the middle of a long run or bike ride, but instead of seeing the countryside around me, my eyes focus on last week’s battles with the kids, wishing for a “do over”.  Or I fail to see the sunrise in front of me, on my morning drive to work, as I have already mentally dived into the ICU to deal with the overnight admissions.

My past. My future.

But what about my present?

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We Failed Her

We Failed Her

jtopin

The alarm sounds, a painful reminder that it’s my week to cover the ICU. I take off my favorite sweatshirt, stripping away its warmth and comfort. I quickly jump into and out of the scalding shower, racing to get ready. Making my way toward the kitchen, I roll my eyes at my teenage daughter who is eating ice cream and waffles for breakfast. Her ride waits out front but before she can escape, I get a rare hug, her wet hair cool as it brushes against my cheek. I spy her melting, unfinished breakfast and I shovel what’s left into my mouth. The cold vanilla ice cream and maple syrup drips down my chin. Wiping away the evidence of my indiscretion, I get into my jeep with the top down. The twenty-minute ride is a guilty pleasure, with the spring air cool across my face. The coffee in my hand warms me from the inside out as I make my way to work. Read more →

A Little Help From My Friends

A Little Help From My Friends

jtopin

The patient in front of me is trying to die. Elderly and frail, he is lying in the bed. His ribs outlined under skin that should be smooth. His temples are concave where they should be flat. Both are an outward display of internal damage from his lung cancer. More striking than his cachexia are the strained muscles in his neck and his pursed-lip breathing. He is working hard for each breath, drowning in the air around him. From his cancer or pneumonia or more likely both. It is my first night on call as a senior resident in the ICU.

It’s early in my second year of residency at the University of Chicago, where I am splitting my time between internal medicine and pediatrics. The ICU is outside my comfort zone, with its rapid pace, large volume of data to process, and the complexities of multiple failing organ systems to manage. I am both intimidated and inspired by those who seem to recognize patterns, synthesize information and anticipate problems with ease. I want to be like them. I want to face my fears head on. I have chosen to be here, to prove to myself that I can do this. I am capable of caring for the sickest of the sick. And now, in the middle of the night, without a supporting daytime cast of residents and attendings, I am anxious for my first test. And it happens to be the man in front of me struggling to breathe.

I want to be here. I want to be a critical care physician. I know what to do. Read more →

Injuries of the Heart

Injuries of the Heart

jtopin

He sat next to the judge in the witness chair. Of medium height and build with a clean shaven head, he recalled the night in the hospital where he lost his dad, role model, grandfather to his newborn son and best friend. In the small courtroom he spoke directly to the jury about the fear and apprehension the night his father was admitted to the ICU. He talked about the pain his father experienced just before his eyes rolled up in his head. He recounted running into the hallway, desperate, yelling for a nurse, for anyone to come to his father’s aid. He described the profound loss, the hole left in his family’s life after his father arrested and died that night, five years ago. I was sitting 15 feet away, almost directly in front of and facing this gentleman. Because the hospital and I were on trial for the wrongful death of his dad.  Read more →

His Voice

His Voice

jtopin

I pause in front of the door. On the other side, you all wait. A spouse, sons and daughters, sometimes with their own small children in tow. Today it’s your husband and father you have come for. Yesterday it was someone else’s mother. You have come from near and far, across the street and the country. Your weary eyes are unable to mask your sadness. Over the past week, you have witnessed a steady stream of nurses, residents, phlebotomists and x-ray techs file in and out of his room.  Your dad has withstood a barrage of insults to his body.  Radiation to his chest for daily x-rays. Needles piercing skin and veins for IVs and blood draws. Catheters inserted in his neck, his groin and his bladder. Still you hold on to a cautious optimism, clinging to hope. But family meetings usually imply things are not going well, and today is no exception. Taking a deep breath, I open the door and walk inside, leaving for now, the rest of the world behind.  Read more →

Sixteen Redux

Sixteen Redux

jtopin

IMG_1488

There you are, in the big chair, half curled and snuggled up against me. A tangled clump of hair covers part of your face.  You’re somewhere between wake and sleep listening to Goodnight Moon and my made up stories of butterflies and rainbow fish. You are warmth to my perpetual chill.

There you are, lying sideways asleep in the bed. Crumpled sheets draped over you rhythmically rise and fall with each breath. You are eight or nine years old? The stillness of this tableau a striking contrast to your boundless energy and movement during the day.  I stand, a sentry in front of your door making a silent promise to protect you always from the darkness. All the while fighting back my own fears. Fears of the randomness of the fates that even a father’s love sometimes cannot overcome.

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Sunrise

Sunrise

jtopin

What do you do when you know someone is going to die? I’m not talking about death when it comes at the end of a long protracted illness or a terminal diagnosis. Or the final act at the end of a “good” life, when the body and mind have ultimately given way. I’m talking about when you realize the twenty-five-year-old woman in front of you, who you met five minutes ago, has no idea she will not survive to see another sunrise.

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