Black Clouds

by Alyssa Brown

     “You won’t see much with Dr. C on call this weekend because he’s a white cloud,” mumbled my attending.  I immediately asked what he meant. He gave me a withering look, like he always did when I asked too many questions, and went on to explain that a white cloud was a doctor to whom nothing bad or crazy ever happens while they are on call.  He stopped walking, turned around looked me in the eye and said, “We are black clouds.”

        I was only three months into my third year, and I had already seen six patients die.  I had never been called a black cloud, but it immediately stuck. Wherever I went on rotation, trouble and patients seemed to follow.  On one particularly crazy night on Labor and Delivery, they finally sent me home after the sixth C-section in a row.

     We didn’t talk much during third year about the patients we saw die.  It was a hidden knowledge that some of us had probably seen more than our fair share.  It didn’t stop any of us from continuing, but those patients weighed heavy on my mind some days.  I still remember my first patient who “coded”. We ran into the ICU after receiving the page and I saw blood everywhere.  The nurse quickly filled us in with details; he had had an esophageal surgery the day before, vomited bright red blood twice and quickly lost his pulse.  His family had left thirty minutes before to finally shower after a few days of staying with him in the ICU. Maybe that’s what struck me the most, that he died alone surrounded by strangers.  None of the doctors, residents, or medical students knew him—we were just the teams there for the code blue.

     The surgeon who first called me a black cloud shared a rough call with me on my surgery rotation.  I got a text from him at 6pm with just a room number. I slowly slid into the dimly lit room, where I could hear him already speaking to the family in hushed tones. .  He turned and motioned for me to follow him out of the room. No sooner than he had made it into the hallway, he was on the phone with the OR staff, “prep the OR, this isn’t looking pretty.”  Without breaking stride or looking at me, he described the case, The patient is an 81 year-old male, small bowel obstruction, renal failure, left against medical advice, 7 days ago for small bowel obstruction.  I knew it didn’t sound good, but I figured he could fix it.  As we hurried down the stairs to the basement of the hospital, he muttered that we would be lucky if the patient ever made it off the table.  To keep a long story short, the patient made it through the operation, but died the next day from complications. The next morning at lecture, the surgeon asked me what could have been different to help him survive.  I think I answered with something along the lines of better fluid management, but he cut me off. He said we couldn’t change what had happened seven days earlier. We did not give up on the patient, but the patient also chose to leave with a fixable problem and come back seven days later on death’s door.  That stuck with me. Sometimes the dice were rolled before you got there.

     Through all this there were many moments of light.  I will never forget seeing a pediatric heart transplant for a patient I had been caring for on the wards for months.  I was on my pediatrics rotation when I overheard one of the residents talking about how someone was getting a heart that night.  I thought it might be that patient, so I emailed the cardiothoracic surgeon, who told me she was on the flight to the procurement from the donor and invited me to attend the transplant.  The case started at 3am– I was tired but excited. There was nothing more magical than seeing a heart beat on its own for the first time. The bypass was turned off, the muscle began to pink up, and the “new” heart took its first quivering beat in its new home.  Third year of medical school was a hodgepodge of beautiful, funny, and poignant moments. I can say now that I was not prepared for it, but I don’t think any of us are/were. Maybe being a black cloud isn’t a bad thing. Maybe some of us are just magnets for long call nights and days.  My mentor is a black cloud. She always joked that someone must publish her call schedule because more patients show up to the Emergency Department when she is on call. I found solace in her through my medical school years. She never really complained about her crazy nights, besides saying that she was getting too old for this.  Losing a patient hasn’t gotten easier, and I hope it won’t.

Alyssa Brown grew up in Chattanooga, TN.  She went to Centre College for a B.S. in Biology and minor in History.  She fell in love with surgery after seeing her mentor perform an anoplasty during the first year of medical school.  In July, she finished her third year of medical school and wandered off the beaten path to get a PhD, before finishing her MD.  She is receiving her MD degree from University of Louisville School of Medicine, and her PhD in Biomedical Engineering and Physiology at Mayo Clinic School of Biomedical Sciences.  She is currently working on research projects involving pediatric ulcer disease, diaphragm sarcopenia, and benign breast disease. She currently works as part of the AWS Blog Subcommittee and AWS Instagram Subcommittee.  When she is not being a black cloud, you will probably find her in the pediatric surgery OR, baking sweets and pastries that she saw on “Great British Bake-Off”, or off on an adventure. You can find her on Instagram @alyssabrown1013 and Twitter @Alyssa_B_MDPhD

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