What do you do when?

I seem to have the worst luck on call. Not that it’s oh so busy, but I seem to attract all the totally devastating cases. Of course, I also seem to only write when I am post-call and the tragedies are fresh.

I just wrote a long and literary description of a stroke code the other night, but then I realized the things that make it interesting also make it a HIPAA violation, try as I might to change the details. Damn you, HIPAA!

I suppose that, like most people, I hate it when crap things happen to young people. I mean, crap things happening to anyone is bad, but permanent disability as a result of sheer bad luck frustrates me. I’ve had a fair number of near misses myself over the years (including recently falling asleep while driving home from work) and sometimes it fucking terrifies me when I see myself or my family in my patients. It angers me, like Lear on the heath anger, to see how random death and disability can be. And it saddens me to realize how very little we can do in most of these cases. On balance we are probably better off than a hundred years ago, but it still feels like despite all the trappings of civilization and pharmaceuticals and Modern Medicine, there’s a hell of a lot of random violence in the world. Inflicted violence, of course, but also the arbitrary-ordinary violence of stroke and infection and cancer.

I’m reading A History of the World in 10 1/2 Chapters, by Julian Barnes, who is a pointy nosed genius. It’s a short story cycle, which I love best from a craft point of view — each tale stands alone, but reading in sequence you see threads and throwaway references that make you feel like the author is winking at you with a series of inside jokes. Anyway, one of the themes here is the caprice of selection. It starts on Noah’s Ark and continues all the way down the ages. That’s what I’m driving at, really, and Mr. Barnes puts it far better than I.