Sick Satisfaction

Yesterday I felt somewhat pleased with myself, when a young man showed up in the ER unable to breathe. He was a nice dusky blue, and the decision was made to intubate him. The intubation itself fell to me, and it was an easy one, certainly not particularly challenging from a skill point-of view. The patient didn't improve as quickly as we'd hoped, but he did improve nonetheless. In any case, I then proceeded to place a femoral central venous line into his groin, which gave us plenty of intravenous access.

Placing lines isn't one of my strong points, a fact I'm happy enough to admit. Of all the central venous lines, I like the subclavian best - mostly because it's hard to miss. The internal jugular - pet place of the internists and anesthetists (vs the subclavian which the surgeons all like) - is close to the carotid, and somehow I've always feared going into the carotid more than puncturing the lung. Mostly because I can't fix carotid punctures, but I can fix pneumothoraces.... In any case, buddy needed a line. So I put one in him. And I got it in with hardly any trouble, with my supervisor watching.

I went home after the shift still feeling happy about my performance. Today I checked in on my patient and he isn't doing so well. And now I feel odd - satisfied but odd nonetheless - because I'm not sure if it's "right" that I feel satisfaction even though his life is in the balance. I feel kinda happy but shouldn't I be feeling sad for him? So complex - anyway it just has me thinking that sometimes I think I'm never going to really understand the complexities of being both a doctor and - well, just a person. I guess my identity is sort of split equally between both.