Looking Ahead in the Rear View Mirror

Amazon, formerly the Public Health Hospital

View of Seattle from the top floor of the Public Health Hospital

While sitting very high in the upper reaches of Safeco Field watching the Mariners play the Cleveland Indians, my attention was diverted to the expansive view of surrounding Seattle. In particular, I kept looking at the PacMed Tower above us on Beacon Hill, now home of Amazon.com.  It seems like only yesterday when I spent thousands of hours in training inside the walls of this remarkable old building, but in reality it is over 30 years ago, back in the days when it was the Public Health Hospital, home for medical care in the region for the Merchant Marines, as well as many of the indigenous people of the northwest and Alaska, in addition for the local folks who needed affordable (as in free) health care.  I had opportunity to work several rotations in this building as a medical student in Seattle, and to think of this place as the headquarters for Amazon makes my brain do twists.  There was so much life and death inside those walls for so many years.  Now it is corporate headquarters for a web giant, selling every gadget and gizmo under the sun and some days I feel like one of their best customers because it keeps me out of the toxic environment of the local mall.

I first walked in this building as a very green 24 year old med student beginning a surgical rotation, knowing only which end of the stethoscope to put in my ears and which end rests on the patient.  The first day I was shown how to put on a surgical gown, masks and sterile gloves without contaminating myself and the people around me.  I never have forgotten that sequence of moves, even though my opportunity to go into an operating room (other than as a patient) is rare these days.  My chief resident was an exceptionally talented but eccentric man who worked himself and all under him around the clock.  After becoming very prominent in a city known for its fine surgeons, he developed a drug problem for which he sought treatment and remains an authority on helping impaired physicians, assisting other providers to acknowledge addiction before they harm a patient.  He could only operate listening to the music of Elvis Presley.  I can’t hear any Elvis Presley songs to this day without smelling the odors of surgery–cauterized blood vessels and pus.  It is my particular burden to bear…

Those were heady days and nights of experiencing the misery of the most vulnerable of humanity in desperate need of healing, and sometimes we succeeded, but often we did not.  I still have a recurring dream of running up and down the staircases of the Public Health Hospital, bringing pint after pint of blood to the OR as our team operated on a Native American patient bleeding from her dilated esophageal varices, which had developed as a result of her damaged liver from her long alcohol dependency.  We did not save her, nor have I saved her even once in my dreams over the decades, though I keep trying to run faster. Instead I’ve spent the last 20 years of my clinical life working in alcohol and drug treatment, hoping to prevent her fate in others.

Nor did we save a classmate of mine, on a rotation on a different service, the daughter of a beloved radiologist in this very hospital, who for reasons unknown, had a cardiac arrest while napping briefly during her 32 hour shift.  Another medical student sleeping in the same room heard her odd breathing, found her unresponsive and all medical interventions were employed, to no avail.   Even when all the right people, and the right equipment, and the right medicine is seconds away, death still comes, even to healthy people in their 20s.  This was a shock to us all, and an extraordinarily humbling lesson to the pompous and overconfident among us.  We can die, in our sleep, whenever it is our time. Years later, I remember that in my evening prayers.

There was also the young surgical resident who was hospitalized with jaundice and subsequently died of Hepatitis B, contracted from a blood exposure during his training.   No vaccination was available in those days, but was developed soon afterward.  And it was in this hospital we began to see unusual cases of young gay men with severe wasting, rare skin cancers and difficult to treat pneumonias, initially called GRID (gay related immune deficiency), part of the early front wave of AIDS as it swept across the US in the late 70s and early 80s.

One night in particular sticks out for me.  It was Christmas Eve 1977, and a heavy snowstorm had brought the city to a standstill.  We had very little to do that night in the hospital as the elective surgeries were all postponed until after the holiday and no ambulance could easily make it up the steep drive to the ER, so were being diverted to other hospitals, so our patient load was light.  I was in my tiny sleeping room, on the 14th floor of the tower, facing out north to the city of Seattle, able to enjoy the view in the photo above, only everything was blanketed under snow, so peaceful and very quiet.  The freeway, ordinarily so busy day and night was practically abandoned, and the lights of the city were brighter from the snowfall.   It was an enchanting vision of a city forced to slow itself and be still, anticipatory on a sacred and holy night.

I remember thinking about how young and inexperienced I was, and how very little I knew.  My chief resident thought I’d make a good surgeon–my heart told me that I’d make a better family doctor.  The city held so many attractions and excitement with the potential of a big salary and notoriety, but my heart longed to return to a farm and a someday family.  It was a wistful bittersweet night and I slept little,  staying perched on that little bed overlooking the sleeping snowy city and wondering where my life would take me.  If I’d looked just a little to my left, and some 32 years ahead, I would have seen myself, sitting with a man I had recently met but didn’t know I’d someday marry, and our nearly grown and flown family in the top rung of a new baseball stadium.  There I would be,  gazing back up at the younger me looking out the window of a classic old hospital building, reflecting upon who I was becoming on that night long ago.

I still am amazed at how little I know,  but I do know this: for however long we’re on this earth, we do have purpose and meaning.  Perhaps mine was to be snowbound on that Christmas day, unable to go home from my shift because my car was stuck in the parking lot, spending the day singing Christmas carols for all the patients who had no other options but to stay put in their hospital beds that day.  Perhaps mine was the future blessing of husband and children on a little farm 100 miles to the north.  Or perhaps mine is to continue to share a little of life’s lessons learned while gazing in the rear view mirror–these are the reflections from a life in progress.