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The Dealer



She was not sure how it happened, but it happened. The sun had set, the rain had started, the roads were slick, cars were moving slower than usual, and drivers being vigilant. She did not see it happen. She felt it. A terrific bang from behind as her car was hit. She was pushed forward, her seatbelt quickly catching her in a tight grasp. Still, her head lurched forward and then abruptly pitched back to the headrest. The night was going to be a long one.


As fate would have it, the consequences extended far beyond her immediate understanding of what had just happened. She expected that she was going to need some physical therapy for her neck strain. Then there was going to be the long and involved interactions with the insurance companies, the repair shop for the car, the need for a car rental, and well, you can fill in the rest. However, there were a few other nuances that would complicate her life more so than what she just anticipated. In the passenger seat was a twelve-year-old boy named Jason, known for his headstrong nature, who had been playing a game with his seatbelt, keeping it intentionally loose to escape its restrictive hold. He had mastered the game until that very moment when it turned against him. The impact flung his head into the dashboard, teaching him a lesson in the vulnerability of physics. When his mother looked over at him, and realized that all was not well, she screamed and finding her phone made the call. 911. He had lost consciousness and was swiftly taken away by paramedics, and when he arrived at the hospital, I stepped into his life as the attending doctor on duty in the pediatric intensive care unit.


It is quite remarkable how life creates connections. In the sterile world of monitors and tubes, an unusual relationship formed between Jason and me. It was a one-sided conversation all the same, with me doing all the talking providing updates, insights, and sometimes delivering hard truths. Weeks passed by with a mix of discouraging updates and glimmers of hope. Jason remained unconscious; his existence intertwined with the rhythmic sounds of the machine assisting his breathing. And amid all this, his story of the consequences of his injury. blended with mine. Not to say that my story was, is, one of a physical injury, but one of moral distress, trying my best to keep patients alive, not realizing that at times, there was a more significant reason to be there for my patients. I had always thought that my place in medicine was to take care of patients, to save their lives. It was that very naiveté as a young pediatric intensivist that brought angst into my world of understanding the real reason for me practicing medicine. A reason I’ll share with you in due time.


As the weeks passed, he continued to linger in a world of unconsciousness some of which was medication induced due to the swelling of his brain, and the rest due to his brain itself, needing rest for whatever healing was going to materialize. As we became more convinced that whatever was going to happen was going to happen, we moved to letting him wake up. When he finally awoke, it felt as though two parallel universes had collided. He did, and by some miracle, not necessarily the miracle of modern medicine, but the miracle of his own body making right what was broken, he opened his eyes and said a few words right after we removed his ventilator. His world had been dramatically altered by the injury, and he faced it with a calm acceptance that seemed beyond his years. He did not complain about the hand he had been dealt; instead, he adjusted his game plan. It was a stark contrast to the way some often react when faced with adversity, where we lament our luck and hope for a miracle.


And here is where the Dealer enters the story. The Dealer—that mysterious force of chance. We often beseech it through prayers or pleas to sometimes a higher being, hoping for a different set of cards. But Jason's journey offered a different perspective. His awakening was not accompanied by bitterness; it was an acknowledgment of the limitations that became a part of his life. He embraced his altered life, a life challenge that would eventually shape him into a motivational speaker, traveling across the country to share his experiences.


Through his eyes, obstacles became stepping stones. He was not merely surviving; he was thriving, infusing his life with purpose despite his limitations. As he navigated college, grappling with learning disabilities and challenges, his mother remained steadfast by his side. Their bond grew stronger through shared trials, and she, too, found her own purpose in the path they walked together.


As promised, I will now share with you my understanding for the reasons why, practicing medicine is more than just taking “care of” patients. The taking “care of “can be viewed as procedural in nature. I can do this; I can do that. And yet, there is more to practicing medicine that sometimes takes courage. I learned that “taking care of” patients are, yes, paramount in medicine, yet “caring about” and “caring for” patients brings the practice of medicine to the bedside with our patients. Getting to know their “who” and not always their “what”. We “care about” and “care for” our patients by being present when present. I found in my mind that it is not only about saving lives but doing my best to ensure that my patients have a meaningful life once they move past the disease, the injury, and how they view their illness. By “caring about and for” them, we give what we can and do our best to give them what they need to move on. Whatever those needs are. To live a life, not just to live. For Jason, it was about making sure he had what he needed to move forward on his journey, on the roads that he chose. No more, no less.


So, the cards we are dealt are not random; they are part of a larger design, a design that expects us to play our hand to the best of our ability. I may be stepping out on a limb with that statement. Yes, that is my personal view, and perhaps not yours. The Dealer, in whatever form it takes, I believe, doesn't burden us beyond our capacity. It is not about folding or asking for new cards; it is about recognizing the potential within our hand and crafting our own story.


And that holds true for patients as well. Ultimately, the cards may not be what our patients expected, but their significance is theirs to uncover. How they decide to play them, and how we decide to partner with them is the hard taskmaster. We can partner with them by being present when present. By being there in partnership caring about them and caring for them. Helping our patients use the cards they have been dealt. Not unlike how it was with Jason.

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