Battlefield, ballet theater, hospital, and church. What could these four possibly have in common?
I started reflecting on this after I visited the current edition of SurgeXperiences, a blog carnival hosted this week by Chris over at Made a Difference for That One: a Surgeon's Letters Home from Iraq (I hosted the last edition a couple of weeks ago). He centers his collection adroitly around "the love-hate relationship between surgery and war," and offers this introductory thought:
"What I realized most as I reviewed the excellent submissions this week, is that surgery, both for the patient and the surgeon, is very much like war. There is an urgency to fight against a foe who may kill if left unchecked. Both are activities with high contact and there will be blood. Both are better, far better, when over."
I don't know a whole lot about the military, but I'm pretty familiar with the ballet world, medicine, and my dear old ecclesia. Here's what struck me as comparable features among all four of these seemingly disparate arenas:
1. Training: those 10 or 15 years you spend preparing to participate fully. It's often hard and painful and can feel incredibly unfair. But what doesn't kill you makes you stronger, right...? (I dunno - I actually have a bone to pick with that idea, because I've seen it make people morally weaker or emotionally scarred, too, in some cases...)
2. Hierarchy. Many Americans or folks with egalitarian sensibilities might chafe at operations conducted, and in fact reliant upon, a fairly rigid hierarchy. But though I strongly believe all people have equal dignity and equal rights, their unequal abilities / education / training / experience make hierarchies useful when used properly, without abuses of power or disregard for people's intrinsic worth.
3. Inside jokes, jargon, language, customs, rituals, and familiar experiences. I'm a "native speaker" in three out of the four cultures, but I can see how foreign each of them must look to those who are just "passing through," and how possessive the "natives" can be of their special knowledge of the world they inhabit.
4. Near-total outpouring / investment of onself required - and, on a related note, "the show must go on." It can't stop because you're tired or uncomfortable or emotionally stressed. You're needed for a purpose higher than satisfying your own needs. I'll admit I've often resented this. I once heard the O.R. nurses complain bitterly (and with good reason, I thought) about a time when they were called to work on the obstetric floor because the obstetric nurses were "de-briefing" all day over a traumatic loss that they hadn't even directly been involved with. For most combat medics, docs and anesthetists, surgeons, residents, performers, etc. there's no "de-briefing" allowance. If you're needed, you go to work, even if you've just seen or experienced something traumatic and wanna curl up under a blanket and cry for a while. Sorry. You're needed elsewhere and you gotta put aside your needs and your feelings (what business do you have having THOSE anyway? That's "weak!").
Just the other night I had to re-intubate someone for respiratory insufficiency in the PACU under stressful circumstances, with the next surgeon chomping at the bit wondering when we could start his case, and when I finally got the patient all settled in the ICU the phone rang with the surgeon (actually, a cardiologist who, unlike most surgeons who take about half an hour to place a pacemaker, often takes two to three hours) wondering when the heck we could get started. It was 7:30 p.m. All I wanted to do was go home and cry out some of the tension and fatigue, but instead I had to go back to the main O.R., smile, and greet the next patient as if nothing had happened (Bongi at Other Things Amanzi writes about a similar phenomenon of having to be all bright-eyed and bushy-tailed for the next person after you've told the last person the worst news she's ever heard). This is one of the things I find challenging about my job (besides the fact that you never know what's coming and that possible disaster's always looming around the corner): the fact that you have to commit to be strong for others regardless of how bad you feel inside, and perform at your peak no matter what, no excuses. It's a little unforgiving, but I also do believe doctors, medics, and most nurses have to try to be at their best all the time while they're working, because people's lives are at stake. So, no "de-briefing" for us - that has to wait until we get home. If we ever do, that is.
The "outpouring" of care does have its rewards, of course. I am on call for four days straight this weekend and this morning had the chance to help a young boy through a procedure to reset his broken forearm. Boy in tears in the preop area, then father in tears, then mother in tears, but in the end all went well, and it was one of the smoothest anesthetics I've given a child that age in recent memory. Child woke up fully in the PACU sleepy but comfortable and calm. One can't ask for more than that.
Did have a chance to come home for a little while...just in time to wave goodbye to my family as they drove off for a school vacation week ski holiday without me. With any luck I'll be able to join them some time next week...maybe "de-brief" a little...