Lowest on the totem pole of the medical hierarchy, medical students were expected to stand near the surgeons and hold retractors, the long metal hooks that kept unwanted tissue out of the surgical field. Balancing on tiptoes, I could barely observe the progress of the operation over the shoulders of green-gowned interns and residents adjacent to the cardio-thoracic surgeon. I could see enough, however, to follow the opening of the chest, the establishment of the heart bypass detour and the beginning of surgery on the tiny coronary arteries.
The work proceeded slowly and methodically, even as my patient's muscular heart bobbed and weaved with irregular contractions. My eyes often wandered to the fragile machine near the table through which thin tubing was guiding my patient's blood. I worried that this mechanical collection would fail in its critical job.
After an eternity, the artery replacement was complete. We all held our collective breath as the blood detour was shifted back to the heart for the heart to resume its regular rhythm. It didn't. Medications, defibrillation, direct massage. All futile. My patient's heart lay devastatingly still. His tomorrows were gone.
The primary surgeon, deathly pale, sat alone in a corner of the operating room, silent, holding his head in his hands. I looked at my patient's still form, lying peacefully among the now-silent machines. His eyes were closed, his mouth was slightly open, and I could still hear his words in my ears: "Am I going to make it?"
And the tears came as my mind cried, "I don't know, and I am so sorry."
Not so long ago, I turned 47. And I remembered my patient. He was very young. And, unlike that medical student who sat with him years before, I am well aware that the happy endings and tomorrows we pray for don't always come. When I get the question now, "Doc . . . ?," my answer hasn't changed. "Of course. You'll do great."
Despite my white coat, I am, in truth, just like them, only making a wish for a good outcome, one that I sadly can't guarantee. My patients are seeking a shaman, but I'm just a medicine man. All I can give them is hope.
Dr. Linda Reid Chassiakos is director of the Klotz Student Health Center at Cal State Northridge and an assistant clinical professor of pediatrics at UCLA.