Print PageNotes from a Healer
Where the Blue Line Leads
Brian T. Maurer
btmaurer1@comcast.net
Deftly I roll and stretch, extending an arm full length, grabbing as much water as I can muster. As my hand flashes back past my face, my eyes focus on the tiled blue line below me. I turn my head to take a breath, then plunge my face back into the water. The mosaic blue line leads me to the far end of the pool; and marks the point where I will snap my torso down, throw my legs up over my head, find the wall with my feet and capture enough momentum to propel my body back down the lane.
Through two decades I’ve followed a morning aquatic exercise regimen. Although I strive to count my strokes and laps while fixed on the blue line that stretches the length of the pool, some mornings my thoughts wander.
When I was a student in training, one of my instructors—a hot headed young doctor—periodically flew off the handle with patients. His anger would suddenly erupt, and a vein would puff out across the middle of his forehead. To the initiated underlings, this prominent blue vein served as a barometer to gauge his foul disposition as it surged. On one occasion he flew into a rage, yanked his stethoscope from his neck and whipped it across the office. I sat at my desk, watching this improvised bola sailing through the air in my general direction. (I had nothing to do with provoking him.) It crashed into the wall above my head and dropped to the floor at my feet, leaving a definite impression on the plasterboard—and on my naïveté.
Three years later, well into my pediatric residency, I was summoned to the bedside of a young girl in respiratory failure. This girl suffered from a form of muscular dystrophy. The accessory muscles in her chest had reached a point of terminal fatigue. Slowly she was dying from lack of adequate ventilation of her lungs. A blood gas had been ordered hours before; drawing the sample fell to me.
I reached into the deep pockets of my white coat for the paraphernalia that I needed to take the sample: an IV butterfly needle with 12-inch tubing, a syringe, a bottle of heparin to flush the tubing so the blood wouldn’t clot. I had been on my feet in the hospital for nearly 36 hours without a break. I babbled throughout the procedure, explaining to the exhausted little girl what needed to be done. She hardly winced as I plunged the needle into her arm. Thankfully, I got an immediate return of blood. It was dark—almost blue—as it flowed along the length of the plastic line. Three quarters of the way to the syringe it clotted. Upset, I pulled the needle from her arm and applied direct pressure to the wound.
Once more I prepped a new setup and plunged the needle into the arm, searching for a vessel. Once more I got a good return of blood. Once more it clotted halfway down the tubing. My throat thickened at the sight of the stark blue line: another failure.
For the third time I prepared a setup. This time I noticed something odd. The print on the small vial in my hand was purple, just like the heparin bottle; but a wave of nausea hit my stomach when my glazed eyes focused on the label: “Sterile Water.” In my state of exhaustion, this mistake had caused needless pain for an innocent child as she lay on her death bed.
A decade later a toddler came into the emergency room in recurrent supraventricular tachycardia. The child’s pediatric cardiologist had directed the parents to bring their son to the hospital for an intravenous dose of adenosine, the drug that would interrupt the transmission of the electrical impulse at the AV node, kicking the heart into normal sinus rhythm. A team of residents worked with the cardiologist to secure intravenous access. Like most toddlers, this little boy had pudgy arms and legs; his blue veins were buried deep in fleshy fat.
I picked up an intracath needle and prepped the skin over the saphenous vein at the ankle. At least, it was the site where I suspected that the saphenous lay. A blind stick brought an instant return of blood into the catheter. We flushed the needle and secured the site to administer the medication. The adenosine broke the rapid heart rate, and we all breathed a bit easier.
“Where did you learn that trick?” the cardiologist asked me afterwards.
“From a resident I was on call with one night years ago. He now practices cardiology in Iceland.”
Now that I’ve been working in primary care pediatrics for three decades, I seldom perform such procedures anymore. If a patient needs blood drawn, I send him to the lab. If she is sick enough to require intravenous fluids or medications, I send her to the hospital. In this era of modern medical practice, where time is at a premium, I no longer have the luxury of doing these procedures for my patients.
These days I continue to swim three days a week. At 55 years of age my heart remains healthy, my overall fitness sound. I continue to follow the mosaic blue line as I pull my body through the water one stroke at a time. Sometimes during these morning workouts my thoughts wander, and I remember how the practice of medicine used to be.
About the Author
Brian T. Maurer has practiced pediatric medicine as a Physician Assistant for the past three decades. As a clinician, he has always gravitated toward the humane aspect in patient care—what he calls the soul of medicine. Over the past decade, Mr. Maurer has explored the illness narrative as a tool to enhance the education of medical students and cultivate an appreciation for the delivery of humane medical care. His first book, Patients Are a Virtue, recently reviewed in The Yale Journal for Humanities in Medicine, is a collection of patient vignettes illustrating what Sir William Osler called “the poetry of the commonplace” in clinical medical practice. Interested readers can read more of the author's writings at his website and blog.
Published: July 5, 2009