Working on Thanksgiving. The thankless life of an intern, making most decisions with uncertainty whilst picking up holidays and weekends. But today was more exciting than usual. We didn’t optimize someone’s blood pressure regimen or counsel them on the importance of tobacco cessation. Today, we saved a man’s life. What an astounding goal. The most grandiose and ambitious, almost arrogant goal: to thwart death when it reaches forward with a come-hither stare and curled finger, and give someone back his fleeting life.

Mr. Jones was a middle-aged guy, 40-something, who had the terrible misfortune of developing prostate cancer. An old man’s disease in a new father who was still young enough to shamelessly dye his hair bleach blonde. He was a California guy, with a countenance and affect like those of the lead singer of Everclear. A mild degree of flamboyance shone through the gravity of the situation.

We prep him for an arterial line. He writhes as the needle pricks the skin, unknowingly throwing a hand into our sterile field.

“Sorry — did I mess up your shit?”

The last thing this guy needs to do is apologize. He is dying.

He started the day telling us about the hidden surf breaks accessible from Philadelphia, coasting through his postoperative day one with a hemoglobin of 16. However, over the last few hours, it had nosedived to an abysmal 6.3. His abdomen was the kind you’ve only read about in textbooks. It was the midsection you had hoped to discover on an emergency department rotation, one hand on the epigastrium, and the other paging surgery for an acute abdomen. On a normal day, the local color was marching through the ED door with nothing but tummy aches and constipation, but finally, a “real” sick person was here.

He was rigid. Rigid like a tabletop (as professors taught us while aggressively swinging fists into the lectern) doesn’t do it justice. It was as hard as Earth’s bedrock, growing ever more ecchymotic like the evening sky in late August.

The phone rings — “Lab on line 2,” they page overhead.

The lab never calls with good news. Not once did they find it urgent to notify us that “Howard has great cholesterol!” or “Hemoglobin stable! Nice work!”

“Brian with cardiology,” I answer.
“Lab calling with a critical value for bed 13.”
“Go for it,” I respond, pen in hand.

“pH 7.01, lactate 14, bicarb 11.2”
I repeat the values as they come in, both to inform the surrounding team and confirm their receipt.

My senior resident’s face grows a bit paler, as though her hemoglobin is dropping as well. “I’m gonna throw up,” she says. But we all know that our individual problems can wait. We talk out the plan as the first unit of blood goes in. And in managing this fellow in extremis, everything returns back to basics.

IVs. More IVs.
Blood, fluid, more blood.
Page anesthesia for intubation.
Bicarb drip.
Surgery consult.

Our surgical colleagues evaluate him. He’s forced to sign a consent for exploratory laparotomy on the back of a box of gloves, and they immediately wheel him off to the OR.

Two days later, I return to our service, and find he is not in his room. Fearing the worst, a celestial discharge, I stalk his chart. He has been transferred to the surgical floor. The nursing note from 6:47 AM reads, “Out of bed to chair, talking with family at bedside.”

While it probably wasn’t the “Happy Thanksgiving” that either of us were expecting, I’m quite sure that next year, both of us will think back to this trying day, and unequivocally have something to be thankful for.