Although it's been a minute since I left clinical practice, I still strongly identify with those who wear scrubs, work hours that are hard on the body, and engage the people and fluids that causes those in polite society to avert their gaze.
The reason those people seek care in the emergency department is for variations on a theme: betrayals of the body.
I had my opportunity to experience that first significant betrayal when I returned from our summer's travels to notice a lump near my left groin: an inguinal hernia. This probably had not been helped by three decades of lifting weights on and off, but the cause didn't matter: there it was, an asymmetry I could not deny.
I felt the other side, and sure enough, a companion inguinal hernia was just beginning to create a bulge on the opposite side.
A hernia is a weak spot in the muscles of the abdominal wall through which one's intestines can bulge during moments of increased pressure in the abdomen (coughing, lifting, straining). The danger is that a loop of intestine can bulge through the weak spot and get trapped, cutting off the blood supply to that loop of intestine and leading to a surgical emergency.
In an emergency situation, a surgeon must either un-trap the intestine in time to restore blood flow and allow it to heal, or else remove the section of dead intestine before the gut contents spill from inside the dead intestine into the rest of the abdominal cavity, resulting in a life-threatening infection.
In a routine situation (weak spot containing no trapped intestine) a surgeon sews a patch of mesh over the hole, a principle not unlike the iron-on mom used to repair the knees of my jeans in the 1970s, and then sends you back out to play.
Not being in an emergency situation, I made an appointment with a local surgeon I knew, liked and trusted, waited 6 weeks for the first available appointment, and then showed up.
He pointed out a third small umbilical hernia (a.k.a., the belly button), less than a centimeter in diameter, that I'd considered more of a nuisance than a problem, and said that a few stitches would take care of that.
So with a sense of another minor task to knock off of my checklist, I scheduled my outpatient surgery for my hernia trio (the term alone brings to mind an a capella trio, maybe covering Simon and Garfunkel or Dylan or even Nirvana in a way you didn't expect but kind of makes sense after you hear it).
The couple of weeks before my surgical date, I happened to be listening to the audiobook version of 4000 Weeks by Oliver Burkeman, an insightful book that delights in its reflections on the inevitable truth that we will all die.
It was an unusual mental juxtaposition for an upcoming date with a scalpel and some anesthetic, but it helped me arrive at the date of surgery feeling: I don't fear death, I just really love my life.
If I'm being honest, I was somewhere between that aspirational feeling and the old Woody Allen line: I'm not afraid of death; I just don't want to be there when it happens.
The morning of my surgery, fasting, I woke to find the main area of the house papered with hand-made signs of encouragement from my daughter - something she's been doing since she was in elementary school to delight us on our birthdays - and it meant the world to me. I followed that discovery with the wonderful distraction of a walk with a close friend.
Around noon, I showed up for my OR date starved and ready to get things over with. The registration clerk, who had worked with me for years in the ED, caught me up on her health, her children, and her ten grandchildren.
The nurse who checked me in recognized me from my clinical days, and welcomed me kindly even as he waded through a morass of digital documentation.
A couple of surgeons I knew from my days consulting them passed by inadvertently and stopped to chat.
My surgeon checked in, and we began to talk about the miseries of our high school age kids' college application process. The anesthesiologist arrived and was an absolute delight, an experienced and compassionate fellow who confided that when he began his practice, there were no oxygen saturation monitors - he had to carefully watch the patient's lips turn blue to detect that their oxygen was dropping.
A dose of fentanyl and versed as they wheeled me out of the waiting area, and the next thing I knew it was evening and my abdomen felt incredibly sore.
Some delightful nurses chatted with me in the recovery unit, ultimately helping me into a wheelchair and out to my wife's car.
I have never felt as frail, dependent or slow as I have in the past 24 hours. I have also never been so grateful for the kindness of family and friends.
I've been remarkably fortunate to feel healthy into my early 50s, and getting to experience a touch of what many people I love endure every day (pain, distrust of your body, gait instability) has softened my edges. It takes very little to undergo a reversal of fortune.