Physician warriors don’t cry


i need to run

i need to run
in the rain
or something i need to run
i need to rest but i need to run, 
i need to wash the blood off my pants and 
i want to talk to someone but i cant 
can i, i never did. never have talked, much.
i need to rest, and eat, and hydrate but i cant , can i.

they said he had prior visits 
for depression, 
they said they heard him say the rain was making him depressed
they said he jumped into the highway
in front of the 18 wheeler.

he arrested, coded, en route to a trauma center, and so
he goes to the nearest ER
and our team

my pants are in the washer now with my underwear
and sneakers
extra detergent in the tub

i probably should take a shower, i washed my hands and arms more than sufficiently
and my face
just in case
i should eat
havent for a long while except for one health bar and a cup of coffee
from the doctors lounge
i stole down there
i needed to 
which is a stupid word, a stupid idea.

i want to go running in the rain.
i need to rest
but my mind wont let me go into that good night.
i cant eat or drink, or 

i called my son. but its three hours later in brooklyn. and 
he gets up early
and its a bit late to call him, isn’t it
in more ways than one, and 

i want to go running in the rain, but my legs can barely move

and i think i shall rest a bit.

tom fiero

~ ~ ~

Wow. I really want to publish this.
or have you publish a book of medical poetry.
Can u?
Will u?
Did this suicide happen today?

~ Pamela

~ ~ ~

Yes, Pamela.
Confidentially, I am sick from it.
The warrior pretend shield has hardened.
But I slept an hour about. Deeply.
The “ poem” I wrote as soon as I first got home.
It helps me.
It happened today.
You should see the poem I wrote yesterday before this occurred.
Couldn’t eat.
Went to the local gym and punished myself on the treadmill and other stuff.
Just got back.
Finally hungry.
Thank you for you.
I’ve written about 2000, but have no idea how to publish.
You certainly may use it any way you think best.

Ps: YouTube: clamshell thoracotomy.
That is what I did simply with a scalpel , (finger thoracostomy bilateral, got a lot of blood from the right chest hence the pants and sneaker blood), and then with trauma scissors I cut right across from right to left across the sternum, had two techs pull up and down and explored for repairable wounds.
No cardiac activity, despite my hand massage.
Had a big gash on his head.
I had done maybe three unilateral thoracotomies over the last 30 years. 
This was my first clamshell.
I have been studying and preparing for this for years.
Running a real trauma code is something different.
Mentally I think.
The trauma the horror is the young man who took his own life.
I just need t get tougher.
We are a community hospital (not trauma center) in California.
Our team did great, all of them.
You are magnificent.
I’ll send you more poems.
Maybe an occasional happy one.

 ~ ~ ~

Sorry t email so late.
Just wanted t say thank you.
I think perhaps this trauma code might b affecting me more than I let on , even t myself.
Or especially to myself
Will call the therapist this weekend , shall use your link provided.
Don’t worry
I’ll b ok.
I just feel this uncertain rumbling below my surface.
Don’t call.
I’ll cry, and warriors don’t cry.

Physician PTSD—Are you a victim?

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5 comments on “Physician warriors don’t cry
  1. Author - another poem says:

    its funny (episode 2

    my patient a young mom maybe 22 was one of 19 patients i saw today
    “SOB”, short of breath,
    smoke exposure
    last night 13 hours before
    house fire
    “i put her in the family care room”, said stephanie, a good nurse
    (yes , they are all good nurses),
    “her two babies died in the fire last night”
    “her children? ”
    jesus christ
    and i went into FC room
    she was sitting, not short of breath
    her sister at her side

    and tonight as i was leaving, a Hmong woman
    maybe 50,
    was in room 2
    the code room
    and so i stayed and helped my partner, Denver.
    and the code nurses flashed around the code room and did their special acts of heroism
    and i made gentle suggestions, and we scanned her beating heart
    slow about 30, pulses barely palpable
    and i showed him how to make push-dose epi

    there were 18 to twenty others, i don’t recall
    oh yes the tattooed man 78 from the nursing home who was paralyzed on his entire left side from a stroke , here because he was beating up on the nurses, and bashing his head against a wall.

    and 17 others, i don’t recall.
    oh yes the 15 year old teen, who wanted to die.

    16 others i don’t recall.

    acute cholecystitis, and diverticulitis and asthma, BP 250/120 with congestive heart failure, and the 2 year old gash in his lip , ketamized, and repaired, and

    i dont remember
    i do not remember.

    i remember Anna was 5, sitting outside the schoolyard with claire, little curly haired claire,and anna lost her stuffed, her stuffed, was it a cat. rabbit. and she was sad.

    and i don’t remember that all she wanted for her birthday was for her dad to be there like he said he would
    but he was doing public health service payback in coachella 2800 miles away.
    doing everything but
    the only damn thing he should have been doing, and she didn’t get the one thing, me , that she wanted for her sixth birthday and

    now as i watch 24 with k.sutherland
    i feel that this world this alternate world of 24 is where i am. like a mirror or rabbit hole i have fallen into, where i am safer, and i do things right
    i am in a fake world
    because i can’t live in the real one.

  2. Another poem says:

    the man

    was fifty.
    he’s dead now, but he was alive and fifty a few hours ago.

    there was vomit everywhere, and blood coming up the ET tube.
    not a lot of blood, but some.

    we got the call from medics
    found down.
    asystole, then V-fib, then pulseless with a heart rate of 40.

    intubated, and CPR in progress.
    ETA 5 minutes.
    they had already given him a hundred amps of epi, and shocked him for V-fib a hundred times
    and had no ROSC (return of spontaneous circulation) after thirty minutes.

    so i went into code room 2. and warned Ted, a very good nurse, that a fifty year old cardiac arrest was coming in.

    i had just heard my millionth lecture on resus last night. scott weingart (my hero) was talking to Dr Robert Sutton, a peds
    resuscitationist from CHOP. about how to best bring dying folk (children in dr sutton’s case) back from the edge.

    and so

    alone in room 2, i put my gloves on, raised the code stretcher to my desired height, pulled it away a bit form the monitors, turned on the ultrasound machine, and also got the glidescope ready.
    to intubate if needed, or just to check tube placement.
    bagging for thirty minutes pre-hospital into the esophagus and stomach would have been unfortunate, but needs checking.

    the team started trickling in.
    then the patient.

    jason is big and strong. he started on the chest
    i had already assigned three nurses: one to lead the code, one med nurse, one defibrillator.

    and we had maybe eight or more people in there, and i asked the fellow to get my brand-new Decanto suction device from over my desk (there was just too much vomit in the oropharynx.
    it was the first time i ever used it.
    i had heard the SALAD lecture twice on emcrit, and requested two free samples
    and it worked amazingly.
    the yankauer was useless.
    and we gave epi, and bicarb and one or two amps of calcium, and defibrillated several times.
    i asked christie to charge the defibrillator to 200 joules 15 seconds before “pulse check, so that the “hands off “time
    the time of no CPR, no chest compressions, was probably less than 10-15% for the whole code.

    but after at least 20 minutes, including the 30 plus minutes in the field,
    i said, “team, i am going to call it after the next pulse check, if no success. does anybody disagree,
    and there was silence
    the techs were sweating
    i ran outside the room to see if family was there, so they might say goodbye.
    but there was no one yet.
    they came after.
    and at pulse check there was asystole, and the ultrasound showed cardiac standstill
    and i asked everyone to stop and have a moment of silence
    for the soul who had just passed
    and i said this is the part i begin to cry
    and i thanked everyone for their good hard effort.

    and i turned
    an went to the sink.
    and then the men’s room.
    and i washed my hands and my face

    and i saw 25 other patients
    and as i left
    the hospital i wanted to call someone, but i felt that wasn’t fair

    to burden anyone.
    unless you had committed to a real permanent relationship.
    and short of that, the on-off, here sometimes, sometimes not, are we having a lifetime-together-or-not decision, short
    of that
    i had no right to call
    not at 1010pm
    from the hospital parking lot in the central california valley and felt ill.
    and there was tingling down my left arm.
    either cervical neuralgia from a disc in my c-spine, or
    a cardiac ischemia equivalent
    maybe a stroke
    but i was almost too burnt to really care
    not so much burnt, but feeling sorry for myself, that i had had no one i should be allowed to call. this late.

    this late.

    and the music from my cell into my car was offensive, and painful, even leonard cohen whom i love. so i turned it all off.

    mars was bright red over yosemite the last two nights, but i was too distracted tonight.
    and it was bit overcast
    unusual for the central desert valley

    and the 54 year old with complete heart block and chest pain,
    and the 37 year old
    (was she really that young?
    with chest pain and an EKG that looked very much like the one’s that dr stephen smith (my other hero)
    had been drilling into me, including last night on his blog
    stephen smith’s ECG blog, which i forced myself to read and watch (he had a cute little video abut how his interpretation of the ekg led the cardiologist to review the cardiac cath, while he was still in the cath lab, and reposition the stent. amazing)
    last night
    and this 37 year old with chest and jaw pain had the same RCA , right ventricular MI type EKG,
    and so i heparinized her , and shipped her lights and sirens to the nearest cath lab hospital.

    and 23 others , and
    although i had some really neat food from the hospital cafeteria ,
    i really felt ill
    with pain in my left arm.

    and need to tell someone. about stuff. so i
    am talking with key punches to my laptop, and
    shall rest a bit.


  3. Michelle says:

    Tom, your writing is part of your healing, I cannot imagine what you went through with this. Glad you have this gift of expression. Keep writing and we will keep reading. Michelle (your friendly PC recruiter;)

  4. Tom Fiero says:

    the bed

    well its over , and I’m sad.
    won’t be able to sleep on my parents king size bed
    lying there safe
    between the two
    any more.
    the house is sold, as of twenty minutes ago

    twenty minutes and maybe 45 years ago
    when I first moved out.
    that was the real selling
    when I moved out
    from the old Canarsie farm house
    and moved into a condemned high rise apartment building on 125th and Amsterdam
    and within fifteen minutes of being on my own
    a very sweet man banged on my door
    “hi man!! you new here? cool. welcome!! I’m Charlie. if you ever need anything , you call me, I’m just one apartment above you!!
    hey listen. I need a favor! my wife , she ‘s in labor. may I please borrow five bucks for a cab?? please ”

    and I had just barely walked into the place , and I thought a moment , and said “sure”, and I turned , found my wallet, had only a twenty, and handed it over, and
    “thanks man!!” and I never saw him again, nor the new born baby, and the super said , yeah, he’s a con whose been hitting up all the newbies,
    and I was thinking, I hope his new-born baby doesn’t turn into a con , too.

    but that’s when I really moved out of my parents king size bed. 1973.

    but I am sad.
    because we just sold the house,
    about 45 minutes , ago, now,
    (I’m a slow typer)

    and although my parents are dead, I shall get to sleep in their kingsize bed maybe just one or two more trips , back to Canarsie, before the deal is done done

    and I guess, then I must really move out. and really think about growing up.


  5. Columbia FIERO says:

    Love this poem! It is great.
    But I am his sister. Does that count?

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