“Oh, no, I feel it coming on again
I must be fantasy’s best friend
I’m so crazy for happy endings
I do believe in new beginnings-“ Melissa Manchester

I have been working out how I will handle care of a patient who has an arterovenous fistula for hemodialysis. This patient’s fistula has malfunctioned, most likely from improper access during his weekly dialysis sessions in the dialysis center near where he lives. His center has been one of the worst in terms of fistula care as I often get referrals from the attending nephrologist for fistula revision/repair and other problems.

I wasn’t the surgeon who originally created the fistula for this patient but I have repaired it on more than one occasion. Part of the art of what I do in these cases is figure out if I should fashion a new structure or work with what I find. In most cases, I work with what I am given since that ends up being best for the patient for long term. Still, for this patient, I debated creating an entirely new structure of my choice which might work out better long term.

On more than one of my early morning runs over the past week, I have changed my mind many times in trying to get the best result for this gracious gentleman. As I have reviewed his imaging studies, I had finally decided to repair, more like revise his existing fistula while placing a temporary line for use until the repair was ready for use. Yes, I decided that this would be the best course of treatment under these circumstances.

The person I learned the art of fistula care and “feeding’ from was one of my favorite surgery professors. He is cantankerous, smart but a master in his art. I learned to be patient, I learned to be bold and I learned to fly with this surgeon who had gone down in an airplane crash ending up with critical burns to his hands and chest. He adapted, became a brilliant technical surgeon and outstanding teacher for me. I even called him on this case to ask his opinion; agreed with me and so I repaired/revised finding the damage moderately severe but quite amenable to the procedures I planned.

At present, my patient is coming along as I expected, my work turning out better than even I had anticipated as I check imaging and physical exam periodically. This I learned is my standard of care for those under my care. As I anticipated the case, I kept wondering if I was pushing for something that couldn’t be done or whether I just wanted this challenge. It turns out that I was wrong on both accounts. This wasn’t an extreme challenge but a chance to do a wonderful piece of work and help a wonderful patient.

I am not so self-absorbed that I would consider my challenges before the welfare of my patient in my care. In fact, I find that I am not self-absorbed  much these days because that’s a luxury that I just don’t have time to contemplate. On my runs, my meditations and thoughts are never about me but always about others; connecting, anticipating their needs and giving as much as I can give. It is in that giving that my heart is often torn from my chest with many tears shed.

Perhaps, this is my “happy ending” or even my “fantasy” but it has to work. I don’t have bad days or bad cases because I enjoy every patient and every case that comes my way. They are my chances to touch and change some aspect of my patient’s life and feel the joy in doing so. I am not anyone’s friend these days but I am not settling for just acceptance. I do not compromise in any aspect of my life. I can’t live with simple acceptance or even definition. In my life, nothing is defined, definite or ordinary. I have to reach for the extraordinary and I have to give.

I seek simple joy where I can find it. This is about me and the way I live now. From the time I sip my French Roast coffee in the early morning to the end of my day at night, I seek to live in those moments and not just “go through the motions”. I will not just accept that life has to be anything routine, vindictive, angry or hurtful. I do what others cannot do. I push myself to the limits always even in this period of free fall.


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