Bob the Butcher.

Abstract

The path to a career in paediatrics is not always linear. Many of us will arrive at this destination after a series of detours, as we search for true north. One of my own exploratory diversions involved a stint as a registrar in adult medicine at a busy regional hospital. My naive enthusiasm for the role was soon threatened by the realities of workload, competency gaps and supervision in absentia. And so it was, enveloped by self-doubt, that I first encountered Bob B. A gregarious, affable man in his fifties, a butcher by trade, Bob was a temporary resident of the coronary care unit, adjusting to the news that he had suffered a myocardial infarction. Bob had been progressing well. His positivity was uplifting. He seemed the patient least likely to cause trouble in the CCU that day. I wrestled with the challenges presented by Bob's fellow travellers in the unit, secretly wondering how I might rise to them. I was soon drawn out of this anxious fog by a cacophony of alarms, emanating from Bob's direction. The most genial of patients now lay unconscious. The telemetry display revealed the ugly explanation. All hands to the bedside! Ampoules were cracked, a chest compressed, a therapeutic electrical storm delivered. A brief pause to evaluate. As we stared transfixed at the monitor above the bed, breathlessly awaiting the return of a more favourable rhythm, an unexpected voice……our patient! ‘What's happening, Michael?’ Unexpectedly lucid once more, Bob had freed himself of his air viva mask, and posed a not-unreasonable question. It was hard to deny that something had happened. I stood frozen, holding the paddles out in front. A defibrillating deer in the headlights. ‘You tuned out for a bit, Bob, but all is well now’. That was pushing it. A cocktail of cardio-helpful drugs, a pacing wire, all-you-can-breathe oxygen, and a liberal dose of finger-crossing saw Bob through the next few hours. We radioed for air support. Bob departed the scene via helicopter, bound for the tender loving care of the interventional cardiologists at our tertiary hospital. On the way out of CCU, Bob managed to put aside his own anxiety to give us a thumbs up. We had done our best to get him that far. Would he be OK? Some weeks later, our team was in the midst of an on-take day. Pagers were blinking regularly, like fairy lights on a Christmas tree. We were neck deep in admissions already. One of those days. Then……yet another call. Oh no!! We all know this feeling. The medical gods having a laugh at our expense. Another invitation to the Emergency Department, I'll wager. I could not have been more wrong. The message read: ‘Bob B is down at Reception. He wants to thank you for saving his life’. Years later, now a paediatric trainee, I stood once more at the doors to an intensive care unit; a combined adult and paediatric facility at our tertiary cardiac centre. Today's assignment: checking in on the post-op children. Those tiny hearts held together with fine sutures and inotrope infusions. The Voice in My Head posed the question, ‘Do you really think you can get the job done today?’ Mind hazy from lack of sleep, full of trepidation, I stepped into the unit to commence my pre-ward round reviews. Glancing up at the whiteboard, my gaze was drawn to the name at the top of the adult patient list. Bob B! I sidled over. A hefty paper chart sat on a table at the end of the bed. At the very back of the correspondence section, a handwritten referral letter, compiled by myself on that eventful day years earlier. A piece of history connecting us. The most recent entry joined the dots. ‘Post-op: coronary artery bypass graft’. So the surgeons had decided it was time. The subject of the medical notes dozed peacefully. Despite the bandages, wires and tubes, I recognised him instantly. As I stood at the bedside, flashing back to another time, his eyes opened. ‘Hello Bob……remember me?’ I offered. A broad grin appeared on his friendly face. ‘Remember you? I could kiss you!’ * * * * I carry this tale around with me, in my mental filing cabinet. I open the file periodically, whenever in need of a moment of wonderment. Each time Bob and I had crossed paths, I had been transported from doubt and overwhelm to gratitude and joy. Medicine has a habit of creating such stories for us all. Events that you cannot script, which restore faith in what we are doing. Treasure them!