Josh Smith is one of the amazing house officers joining the blog this year. Based in Palmerston North, he’s passionate about medical education, and emergency medicine.
“You are not a drop in the ocean. You are the entire ocean in a drop” – Rumi
It’s very much August in Palmerston North. Down roars the rain on my roof, pooling in the broken gutter and splattering confidently through rusted holes onto the concrete below. I am kept awake by the same triumphant sound my flatmate makes as he wakes in the wee hours to relieve himself directly onto the water. No, rain does not direct it’s stream politely onto the porcelain. It clatters down with belligerence and a hint of mocking.
Around the country, my classmates-turned-colleagues are lying in their beds and no doubt also listening to the rain. Washing piled in the corner waiting, aching for a dry day. Sock stocks are dangerously low. Down to the spare, threadbare underwear. Only the chosen ones working in the hottest corners of the country are blissfully immune.
Winter water has many modes of menace. For those who haven’t yet made the leap from student flat to yopro apartment, the taps remain fickle. The hot one takes a preposterous length of time to fulfil its promise. Once it does, your scalded hands will wish it never had. The water from the other is too cold to clean the soap from your hands, serving only to numb the pain caused by its evil sister. Some frantic crisscrossing of hands ensues. You look as silly as you feel. The rain carries on. It does not care.
You bike the two kilometres to work in a pitiful effort to squeeze exercise in while there is light. Despite being in your mid-twenties, you’ve never had a real job before. You didn’t realise that working hours coincided so closely with daylight. What cruel precision! The rain snickers at you on the way down and then cackles its way back up to strike again; your well-meaning rear wheel licks it off the ground and deposits a neat stripe up the back of your shirt.
This unhelpful deluge of water can be captured by a single noun, but it is actually made up of an uncountable number of individual drops, each falling inexorably and with military precision to thump down on its chosen spot. In the same way, the stream of admissions flowing through the doors of Palmerston North Hospital, when examined closely enough, is noted in fact to consist of a very large number of individual people (sometimes they graciously fulfil the metaphor by dripping, bubbling, and gushing on their way in; it is an exercise of the imagination to assign to each verb the appropriate bodily fluid).
In winter, these individuals come in unfathomable numbers but a small number of varieties. Pneumonia, influenza, exacerbated failures of the heart, more-obstructed-than-usual airways disease. (Gomers, FLOFs, LOLs in NAD, for those in the know). With such great numbers, the quantum weirdness and intrigue of the very small gives way to the dull macroscopic predictability of classical mechanics. Patients start to lose their individual appeal. No longer distinct diagnostic mysteries to be solved, they are infinitesimal quanta of the stream, indistinguishable, waiting to be monotonously sorted and processed. You are the grocery assistant and they are the fruits. Avogadro counting avocadoes. You are the particle physicist and they are the bosons. The hospital is your bubble chamber, your hadron collider, your House of God Particles.
The unerring stream of water is sluiced apart into various buckets, then piped up to different wards. They call it “patient flow”. The integrity of the pipelines is part of your job. A blockage or a leak can wreak hospital-wide havoc. A friend of mine received a name badge on his first day that said “Hose Officer”. Funny and perhaps not so far from the truth.
On the ward, the water is aliquoted into beds by the charge nurse. The infamous “70kg male” is 66% water: that’s 47 litres of water in every bed. The staff nurses dutifully record basic physical properties: weight, pressure, and temperature.
The doctors meet for handover. Today you have received 10 new admissions. That’s 500 litres. half a ton! Your list begins to overflow. The busy days can feel like swimming upstream. The round begins and the aliquots are studied carefully in succession. Volume and composition are tested. Sometimes there is too much fluid and you strive to get rid of some. Sometimes fluid is lacking and you have to add more. Of course, not all problems can be fixed by fluid management. Most of the water on your list is very old. From time to time you find that some of it has evaporated overnight. Usually, it sublimes peacefully. Occasionally, it is a violent boiling until the last drop is gone.
Most water stays in hospital for a few days of analysis and treatment before being pumped back out onto the street. Usually it is cleaner, clearer than when it came in, but there will be times when you’re not sure you made a difference. Those carefully separated volumes, treated in strict isolation on the ward, are slowly diffusing together out there in the wet world. Sharing fluids, bugs, beds, smoke, sugar, needles. The thermodynamic view of life is an eternal struggle against inevitable entropy, but we cannot truly live without embracing entropy. Water is the solvent that makes it possible.
Every undergraduate science student has been shown the calculation for how many millions of molecules in your glass of water have previously been drunk by Einstein (or Hitler!). In truth, all of the water you cared for today will be back in hospital eventually. The same or different problems. The same or different body.