Dichotomy

“Never permit a dichotomy to rule your life, a dichotomy in which you hate what you do so you can have pleasure in your spare time. Look for a situation in which your work will give you as much happiness as your spare time.” - Pablo Picasso

Dichotomy has always been one of my favorite words. Probably because it has been present and celebrated in my life for as long as I can recall. I learned the word when I was 12 and I have used it almost as much as my other favorite descriptor: malingerer. My parents are black belts in like a million and a half styles of martial arts (our garage is actually a dojo and there was an interesting ER visit back in the day when my parents were sword fighting with katanas and my mom nicked my dad on his forearm and he said he cut himself cooking). My mother also practices traditional Chinese medicine, add the Korean siblings and we are are very much an Eastern-Western family. One of the mainstays of Eastern philosophies is the symbol of the yin-yang. While often the image of many misguided tattoos, it holds the truth about the dichotomy of life.

There is a balance between dark and light, masculine and feminine and within each lies a little of the opposite. I believe this is true of all of us. In my life I have been both the only biologic child as well as the lower middle child, I am a trained fine artist and a surgeon-to-be (a woman of both art and science). I believe in the science of the universe and evolution though I believe there are things we will never explain scientifically and those are the spaces in which God resides.

I am also, clearly, a fan of quotes. This Picasso quote seemed exquisitely appropriate. I try to spend what little free time I have (usually my drive home in the morning) debriefing and processing the events of my night. On trauma nights you have the fortune/misfortune of treating patients that run the gamut from innocent pedestrian struck by car to drunk, high unhelmeted motorcycle driver who ran into a car. We are bound by oath to care for each of them to the best of our ability, even though it can be hard when a drunk guy who just hit a car with an innocent family comes in combative and curses at you for trying to save his life.

Unfortunately I had what I consider the starkest illustration of life's dichotomy the other night. We had a bunch of add-on cases for the OR (meaning cases that would be done as rooms became available throughout the night), mostly lap gall bladders and lap appendices. After one of the lap appys, my pager goes off that reads a trauma alert for a category 1 trauma (the most dire) with a young girl who was hit by a car and was in full arrest. We all run to the trauma bay, get set up for CareFlight (our paramedic helicopter service) to bring her in. All of our hearts sank because we knew that she would likely be dead on arrival and our worst fears were confirmed by EKG and echo of her heart. A few hours ago, she was sitting on the curb watching fireworks, then some driver jumped the curb and drove off. This was a little girl who took the care to paint each of her toenails a different color. I said a prayer for her, and allowed myself to privately mourn the loss of someone who never got to really experience much of life. I prayed that her last moments were filled with awe of beautiful bursts of fireworks and not everything that came after. Immediately following this I was due in the OR to do an incision and drainage of a peri-anal abscess, or as we like to call it butt puss. These patients are usual poorly controlled diabetics or drug users who miss their veins or are "skin-poppers". At the time it didn't register how disparate these two situations were, I just knew I had more work to do and I was expected to seamlessly ease into one from the other. On my drive home it registered how bizarre my job is. I mean, cutting people open to "fix" them is bizarre enough (and I have a great post planned about the surgical personality), but going from such profound sadness to an illness that a person brought on themself by having little regard for their own life really struck me. My psychiatric colleagues would probably diagnose all of us with some form of dissociative disorder, because you can't perform without it. I like to think we just have found a way to master the dichotomy that lies within. Perhaps it is another space in which God resides.