The Rounding Orb

One of my ICU attendings during residency, whom I will call Dr. Cool, was not only a multi-talented, brilliant academic - English lit major at Amherst, francophone, thoracic anesthesiologist, critical care specialist, musician - but also a very funny guy, in a dry sort of way. Some people might have seen him as stern or crotchety on the outside, at least at first, but he was deeply compassionate underneath it all, and fair. During rounds if we said something stupid he would offer grumpy but, unlike many attendings, highly constructive criticism. Occasionally he would even crack a wry smile. I thought he was great.

One day when we were wrestling with some issues involving several patients, he suddenly broke away from the team muttering to himself, "Where's the orb...we need the orb..." and disappeared into his office, where we had once taken a break as a team and watched hilarious GI Joe spoofs on his computer (with him). We all stood there stupefied looking at our notes and flow sheet, murmuring to ourselves about this much IV fluid in, that much urine out, propofol infusion still at 1 mg per kilo per hour, weaning vent settings...Finally he emerged and rejoined the group carrying a small, spherical, bright orange, plush object with a face embroidered onto it. Its name, according to the tag, was Tiffany. (I'll try to reconstruct the ensuing conversation but it'll be more accurate as to the tenor of the thing rather than the specific details.)



"Now, where were we?" Dr. Cool began. "Oh yes - who wants to transfuse Mr. So-and-so in Bed 1?"

"His crit's 27. I think we should," said one of the residents.

He hurled Tiffany against the desk in front of us as hard as he could, and she emitted a loud, sarcastic, high-pitched "I don't THINK so!"

Without changing his expression Dr. Cool announced, "The Rounding Orb has spoken," and respectfully challenged the resident who had spoken up, asking for a defense of the suggestion in light of the patient's currently stable blood pressure, heart rate, and oxygen saturation. Soon our group was discussing the various problems Patient So-and-so was also facing. Another one of us made another suggestion, and this time accompanied by an almost imperceptible smirk from Dr. Cool, The Orb went hurtling once again to the desk top and then yelled, in the same, sarcastic, Valley-Girl tone, "Loo-ZER!" The resident had to smile too, but bravely began to defend the suggestion, as did others, and after a minute or so of us arguing different points back and forth Dr. Cool slammed the orange toy down a third time, eliciting from it an attitude-filled "What-EVERRRR!" The cycle was repeated several times during rounds that morning, with "What-EVER," "I don't THINK so," and "Loo-ZER!" audible from each bedside at least once.

For this memory alone I could almost look back fondly on my ICU time during residency. I hope one of these days Santa brings me a Rounding Orb for Christmas. Silly Slammers, as these toys are really called, seem pretty hard to come by these days, but I have faith. Someday I'll have an Orb of my own with which to tease hapless students or colleagues and make sure they don't fall into the trap so many folks in medicine fall into, that of taking themselves way too seriously.

On Suicide

I am very sad about the death of opera singer Jerry Hadley, who shot himself with an air rifle at his home in Clinton Corners, NY on July 10 and suffered severe brain damage. He was on life support at St. Francis Hospital in Poughkeepsie until July 16 and died yesterday.

I remember being a young girl watching a concert on TV with my mom, and after hearing him sing - he was then "new" to the scene, as I recall - she and I looked at each other and exclaimed, "WOW, who is THAT?! He's amazing!"

He was only 55 when he died. I cannot imagine how anguished his loved ones must be.

I have scanned through many posts and web articles about suicide. So many of my search "hits" opened their discussions with reasons people try to kill themselves - despair, lost love, money problems, low self-worth, and any number of contributory factors. But these are not the ultimate reason people commit suicide. I was relieved when at last I found a site that states the truth from a medical standpoint: "Simply put, people commit suicide because they are ill."

This is not an insult, any more than saying people with diabetes have an illness, or people with cancer. In fact, depression, be it major depression or manic depression, is considered by many psychiatrists and psychologists to be not just an illness but a potentially life-threatening illness.

No, you can't tell someone to just snap out of it and pull themselves up by the bootstraps, unless you also think you can make someone's islet cells secrete more insulin somehow, without medical intervention.

Neurotransmitter deficiency can be just as lethal as insulin deficiency. We are, to a degree many people don't want to acknowledge, at the mercy of these chemical messengers, for cognition, perception, and emotional well-being.


The problem with accepting mental illness as a physiologic reality lies, I believe, in the nature of thought. Thought is a very real presence for most people, yet it cannot be seen or physically grasped. It seems otherworldly, mysterious; we don't know what it's made of, but we know it's there. In part it's made of cells and electric charges and neurotransmitters, but these are so physical, and thoughts are so...ethereal. Surely despairing thoughts can be healed with something other than medicines for a physical process such as the biochemical pathways between serotonin and its receptors? Surely thought is not so bodily?



Well, it IS, like it or not. Mind is body. We would like it to be more, but the evidence we have so far is it's all right there, in the workings of the physical brain. Take the case of Phineas Gage: all it took was an iron rod through his frontal lobe to change his character completely - all those elements we think are part of some more metaphysical realm, like virtue, and personality, all of that, very physically inhabits the frontal lobe. Frontal lobe syndrome has been observed with traumatic brain injury, strokes, tumors. People all of a sudden are no longer who they once were. So who are we, really? Personality, taste, character - these all depend on the little molecules bouncing around inside our frontal lobes. Beyond those - who am I?

Through medicine I have had to confront suicide up close. The trauma ICU was a charnel house for terrible stories. Even now I don't breathe comfortably any time a guy in my family goes up a ladder, and I can't even begin to count the patients who lost the use of their limbs because of motorcycle accidents. But the patients who had attempted suicide made me especially sad and feel particularly helpless. I had to take care of a young woman who had jumped off a building and whose mother kept hoping for signs that she was "still in there somewhere." On my last ICU call I also had to admit a man who tried to electrocute himself on the high voltage line of the subway system but managed only to burn half his face off. It was awful.

I cannot help being offended by Sean Kingston for trivializing suicide in his current hit song (on a completely borrowed base line) "Beautiful Girls (Suicidal)." Suicide is tragic and terrible, not something to toss around in a pop song about getting rejected by people you're regarding merely as objects anyway.

If you know people who might be depressed, please don't blow them off for being "down" or treat them with exasperation or contempt.

If you think you might want to end your life, PLEASE don't, please get help.