Reflections in a Head Mirror

Things that were hard to bear are sweet to remember. 
-Seneca  


Thoughts of my first job rushed back into me as I pulled open the front door of the veterinary clinic. My son carried his sick cat past me and headed to the receptionist’s desk. I took a breath. “Oh my goodness,” I thought. “This place smells just like the animal hospital back home.”  

And it really did. When I was sixteen and thought someday I might want to be a veterinarian, I worked part-time at the local animal hospital. It was not glorious employment. I bathed dogs and clipped their nails. When I worked weekends, I spent my days completely alone taking the dogs out to the run one at a time, cleaning the runs and cages, refilling food and water dishes, and just trying to keep my furry friends calm. I did an awful lot of shoveling. My mother did not let me carry my T-shirts or shoes into the house until I had rinsed them thoroughly with the garden hose.  

One day, a family brought in their old basset hound. The vet gently led the limping old animal back to the kennel area where I was working. “Here,” he said. “Hold her while I give her a shot.”  

I put down my broom and came over to the table where the dog was sitting. Her eyes were cloudy and her tail wagged weakly.  

I looped one arm under her neck and held her close. I comforted her as I would have comforted my own dog, patting her side while the veterinarian pulled some medication up in a glass syringe. He shaved some hair from the top of her front leg to better expose the large vein there. The dog barely flinched when he inserted the needle and emptied the contents of the syringe.  

“There we go, old girl,” he said.    

The thumping of the dog’s tail slowed and then stopped. A few seconds later, her body softened and her head drooped. In a minute, she crumpled. I had not realized until that moment that our task was to put the dog to sleep.  

“Use one of those bags over there and put it by the door. The service will pick it up tomorrow.” The vet left.  

What had just happened? I was completely confused by the experience. Over the next few months, the scene was often repeated. To make some sense of my role, I always tried to remember that I was the very last person that would comfort these animals before they died.  

That summer, I figured out that I could tolerate some extraordinary things. When the opportunity arose to change jobs, though, I went to work as an orderly at the local hospital. The “people hospital” had a unique aroma as well, but it was nowhere as pungent or as distinctive as the one at the animal hospital.  

Fortunately, my son’s cat was fine. While we sat together in the waiting room, my nostrils and my memories continued to fill with that distinctive and melancholy smell.

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The following is feedback received for this blog: I know the smell. I have had the great pain and responsibility of saying goodbye to a number of my canine and feline family members. Each time I have held them and said my goodbyes to each of these friends and companions I am the last person they see. I am fortunate that my vet is caring and understands the importance of saying goodbye in a quiet room. - Judith Moudry

All the world is a stage,
And all the men and women merely players.
They have their exits and entrances;
Each man in his time plays many parts.
-Shakespeare    


“There’s a consult downstairs, Campbell. Go check it out and I’ll catch up with you later.”  

“Sure, OK.” I was a third-year medical student fumbling through my first clinical rotations. The resident headed off to whatever he needed to accomplish and I trotted down the back stairwell. I glanced at the consultation slip and found the patient’s room number.  

56-year-old man with progressive medical problems. Please evaluate for central line placement.  

Not much information. The man was on the General Medicine ward and needed a more permanent intravenous line to avoid having to put a new IV in his hand every day or two. Arranging for the new line would be our job.  

I reached the ward and found the chart that matched the room number. As I started flipping through the chart, I froze. “I might know him,” I realized.  

Finally, I worked up the courage to push open the door. “Mr. Anderson?"  I called. My medical school was only twelve miles from my childhood home, yet as I peeked into the room, I was still hopeful that I would find a different person with the same name lying in the bed.  

He looked up and smiled. “Bruce! Look at you with your white coat! Very impressive. C’mon in!” He looked thinner and a bit yellow but was as enthusiastic as ever.  

I had been very busy over the previous two years with medical school and had not seen him recently. Thomas Anderson [not his real name] had been a family friend throughout my childhood — one of those people that kids love, teenagers respect and adults seek out at a party. He was always a big, gregarious man with an easy lope and a ready smile. He was never in a hurry. He was active all over the community and had had been one of my scout leaders during my childhood. I realized later that he had volunteered to be a scoutmaster well before his own son had been old enough to join.   

As I sat in his hospital room, I remembered a weekend camping trip in seventh grade. After we had finished the evening routine, Mr. Anderson made certain that all of the kids were tucked in for the night. Not long afterwards, I peeked out to see why the adults were all laughing. There were all of the dads sitting around the table drinking beer, smoking cigarettes and playing pinochle. They were clearly having a wonderful time in a 1960s-kind-of-way. The game broke up late, yet Mr. Anderson was the first one up in the morning getting breakfast prepared and setting us to our tasks for the day.  

We sat and talked for a while, and he invited me to look at the criss-crossing surgical scars on his abdomen. “Did you see the admission number on my chart?” he asked. I had. The number told me that this was the 24th time he had been in the hospital. “These days, I spend more time here than at home.”    

I finished up my examination and turned to leave. I would spend the next half-hour writing up my report for his chart and would return later with the rest of the team to make arrangements for the IV. I stopped in the doorway to say goodbye. He looked at me.  

“Bruce, tell me something. Is this the first time you have cared for someone from your world outside of the hospital?”  

“Yes, Mr. Anderson, it is.”  

He paused then smiled. “Well, I suppose that you had better get used to it.”  

“Thanks, Mr. Anderson. I am certain that I will.”  

Thirty years later, though, I realize that I never have. 

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The following is feedback received for this blog: great post, really captures the bittersweet changing of the guard between generations. I take care of my former track coach as a patient now. It does ground you. -dr. charles http://www.theexaminingroom.com

People like us, who believe in physics, know that the distinction between past, present, and future is only a stubbornly persistent illusion.
- Albert Einstein  


The surgical case is delayed for ten minutes and I am getting restless. I anticipate a very difficult dissection. The cancer has returned after extensive prior treatment with surgery, chemotherapy and radiation. I have enlisted additional help to make certain that everything goes as smoothly as possible. Now we wait as the final preparations take place. Time passes very slowly.  

Waiting is a part of surgery. Patients wait to see the physician. Surgeons wait until a day is available on the operating schedule. Families wait in the family center during the operation. Everyone waits while the patient recovers from the procedure.  

As a medical student and intern, I remember scrubbing in on surgical cases for the first time. There were clocks by the scrub sinks that reminded us to vigorously wash our hands and forearms for ten minutes. The first days in the OR were scary. We did not know what we could and could not touch. I am tall, so I was constantly bumping my head into — and contaminating — the overhead sterile light handles as I looked around at the unfamiliar sights. Being in the operating room was such an unusual experience that time always seemed to stand still. I soaked up every little detail.  

A few months later, after I had grown accustomed to the privilege of being in the operating room, the passage of time changed. I remember one day when my resident referred to me as “a hook." “Here, Campbell,” he said. “Your entire purpose for the next two hours is to think of yourself as being a hook that was screwed into the wall as an anchor for this retractor. Hold it like this. Don’t move.” I did not do a very good job at standing still, and he reminded me of that several times. I could see nothing of what was happening. Those were the longest two hours of my life and I remember them like yesterday.  

Back to the present. The delay is eventually resolved, and we begin the operation. The dissection is, indeed, challenging, and my colleagues and I call on all of our prior experience and training to remove the large cancer. We stop to discuss the best way to proceed. We trade places for a while to get different perspectives. We quiz the trainees about the anatomy and their reading. We overcome several obstacles, changing course as needed. The cancer finally yields and is removed from the field. Soon, we are closing the wound.  

I look up at the clock. It seems like only a few minutes have passed since I had anxiously waited to begin the case. Five hours have disappeared like an instant.  

I realize that time spent truly engaged in a challenging experience follows no rules. For the residents, maybe the case might seemed like an all-day event. For the nursing staff, the clock likely slowed as the end of their shift approached. For the family, I imagine the day seemed like an absolute eternity.

Einstein famously said that “reality is merely an illusion, albeit a very persistent one.” I do not pretend to understand the mathematical or existential implications of his statement. I do know, however, that the mysterious slowing and speeding of time really does occur, and I sense the shift most intensely while working in the operating room.  

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The following is feedback received for this blog: Hi Bruce - wonderful post! I agree with you about time. It's a matter of perspective. I just wrote about it (briefly) when describing my last night with Mom. You are so blessed to love your work as you do. You've been given a gift. And no doubt have given your patients the gift of healing ..of life .. the gift of ...more time. - SeaSpray seaspray-itsawonderfullife.blogspot.com