Robin Tribute

CMO CORNER

It is what it is (continued) As summer broils to an end and the harvest season is again upon us, the fecundity of the Great Midwestern Soil gives up its fruit. In the same way the plans long in the working have begun to hatch and what particular chickens will come home to roost will take some time to ascertain. It has personally been a bittersweet summer. Many opportunities pursued and some accomplished. Not every plan and concept moves directly forward. Probably you already know that. One of those Zorba summers of Full Catastrophe Living.

I went with my wife, children, and a few sundry others to India for a couple of weeks. The day before I was to depart, one of my best friends departed instead; suffering a cardiac arrest in his home, very near to Columbia Hospital where he had been a patient quite a number of times over the last 3 years or so. A few days later he died after the ventilatory assistance was removed. He had been somewhat successfully field resuscitated to present in the late evening to the ER. Because of some problems with his airway he underwent a tracheostomy late that evening. It was a somewhat surreal but strangely wonderful experience. The loving care in the ER and OR. The captains of the shipmanship displayed alternately and completely by Drs. Gerschke, Boulanger, Gogan and Mosleth, to whom I will be forever indebted. Indebted as well to the Cancer Care Center where after consultations from across the country his malignancy had been successfully managed by Tom Zukowski. The grand technical and team skills of all involved were on display. Steve Becker, fresh from the Bog Invitational (he didn't as I recall mention his score) popping in to see what was up, lent his grand smile to the occasion. The RN nurses and surgical techs did their beautiful dance, the machines purred and the monitors monitored. An eerie quietude descended on the room, the blood pressure stabilized, the trach functioned perfectly, the seizure activity began and the patient was transferred to the ICU. One more evening, one among many and whilst we sleep*

As the morning sun rose up over the lake the fog of the night's activity cleared. The all too sharp Midwestern sun shining on endless fields of corn made clear the grim prognosis. The appropriate confirmatory testing was done, with Dr. Carter calling me that afternoon, clearing away whatever optimistic (not a trait I claim) notions I might have been harboring. The family, consisting of but a sister and brother-in-law, were called in to view and bless the scene. The passing of a renaissance man. Versed in epic literature, fluent in French and German, a translator of Chinese and Tibetan, dabbler in Greek, Latin and a few others. Newly accomplished player of Piano, lover of classical music, opera and Buffy the Vampire Slayer. A piece of my own heart. There as he lied supine, attached by his lovely trach to the machine, I embraced his sister. By now it was clear that he was likely not going to cognate again. The great irony of this was that it was the sheer power of his previous brain and heart, that brought fields of inquiry and people together, like collecting sticks in the yard after a hearty late fall breeze. Only the heart remained.

A few hours later, I was on a plane to Delhi and on to Leh, Ladakh one of the few extant homes of Tibetan Buddhism, the true source of our connection. Ironic in the extreme, visiting 11th century monasteries and trekking in the Himalayas as he sat in his hospital bed, and following the requisite discussion died a few hours after the proverbial switch was switched. Off. We walked and watched the cremation Ghats of Varanasi. We saw the fort at Agra and the Taj. We had hot oil massages in Delhi and went south to visit the families who that hosted my daughter most of this past year. A wonderful time was had by all.

If there is one thing I would like to say, it is that though the Taj is beautiful and the Himalayas impressive, the loving care received by my friend was what will always sustain me. As we work in this field, seeing pain at some distance, it is easy to forget the incredible poignancy of the moment. The shared experience we have of providing care and occasionally oneself requiring care.

I spend some part of my day, as some of you may know, reviewing safety and teamwork data that we collect. Not very surprisingly some of this data would reflect that our ICU's are difficult stressful units. I would say though that it was the care he received there that made me the most proud of all that we do together.

There may be a time when all of our perspectives are found to be limited and all that we now know to be true is found wanting. When the ground itself melts away and we are left naked in the night. When our hearts cry out to others and the morning sun lights our way. In this way humanity is constantly reborn and renewed. And it is this harvest season that makes all this clear again.

(My monthly column written for our Hospital/Physician Newsletter)

David Shapiro, MD Chief Medical Officer and VP for Medical Affairs Columbia-St. Marys Milwaukee, WI