This post is part of our collection of “Gold Nuggets” — our way of alerting the medical community to original artwork, poetry or multimedia that stimulate discussion and reflection. If you have something you think would make for good discussion by the medical community, you can submit a Gold Nugget by following these instructions.
Leaky Pipes by Melissa McCoy
Drip.
Drip.
Drip.
Sweat poured like a river out of my pores, streaming down my back as I tugged at the giant tumor with my trembling hands. I held the soaking monster out of view of the surgeon as he meticulously tied one-handed knots around the neck-vessels threatening to burst.
Drip.
Drip.
The patient’s blood puddled on the stained floor, swirling into a tributary on its slow journey toward the drain four feet away.
Drip.
Drip.
The mold-encrusted air-conditioner gasped, desperately attempting to expel air. A three-inch spider scuttled past. It sank in that I was far away from my pristinely sterilized, disposable-everything, rigorously documented surgical rotation in a world-class teaching hospital.
I focused on this mother of six, with her soft dark eyes, wisps of gray starting to appear in her tightly braided hair. I held her hands before the anesthesia took hold, and remembered how rough and strong they were, hands that told a story of harvesting manioc and groundnuts. I needed her to be strong right now.
More blood dripped.
Her massive tumor, a surgical “zebra,” was caused by iodine deficiency (a rarity in my own country). “How ironic,” I thought, “in Sub-Saharan Africa-land of the zebras.” I had to remember she was one of the fortunate ones with the meager funds to receive treatment. As I placed a drain and sutured the gaping incision back together, I imagined sewing the broken pieces of her life back together, in this drippy hospital, part of a gushing, broken system.
Drip.
Drip.
Drip.
The bleeding stopped as I applied pressure to the dressing. “All bleeding stops eventually,” the detestable surgical mantra chimed in my head.
I walked home, still dripping in sweat, thirsty and exhausted. I was still not accustomed to the baking sun of the dry season of the southern Sahel. A crowd gathered ahead of me on the road. A broken pipe jetted water into the air. The pipes here are practically constructed for failure. Brittle plastic pipes which, beneath the dirt road, are exposed by erosion from rainfall. With time, passing vehicles inevitably rupture the pipes, leaving all those downstream affected.
Precious water snaked its way toward my host family’s little home at the bottom of the hill. Where does the blame lie in a cracked community water main? Who would pay for this damage and the strain it caused? Surely working through this together would be more useful than making accusations, as was now happening. For now, assigning blame was a purely human response in the face of stress. The exasperated crowd looked on with voices escalating and fingers pointing.
The next morning on my walk back up the hill, the water still flowed, my sweat still dripped, and my mind still brimmed with questions. How was my dear patient recovering? Would the 54-year-old with charming crow’s feet and the soft, French-speaking voice I had listened to so attentively still remember me? When I arrived, I glanced to her bed. She was nowhere to be found. Odd. My heart pounded. Where had she been transferred?
A vital pipe had burst.
She had died in the night.
The foreign surgeon tensely explained to me he was sure the nurses had been negligent. The nurses found her after the vessel in her neck had ruptured. They desperately grabbed sponges, removed the drain to divert the flow away from her airway, and did the best they could with what they had. It was too late.
Had the nurses been negligent? Perhaps they would tell a different story of poorly written job descriptions, inadequate training, and corruption that had led to missing paychecks for the last five months. This system was leaking in so many places; it was practically constructed for failure.
Drip.
Drip.
Tears streamed onto my green surgical scrubs. My heart threatened to burst, pounding so hard I was sure it would be overheard. Overwhelmed, I sank into an empty rust-covered wheelchair in the cluttered corridor, sobbing. This scene would have played out so differently at home. Anger was palpable in the air around me.
On my way home, the crowd still surrounded the burst water main. Now using buckets and bottles to detain excess water, my neighbors made the most of their scarce resources to alleviate the issue. I wondered who was responsible. Maybe the manufacturing company was at fault for making such weak pipes. What about the driver who ran over the pipe? Maybe the leak was just another consequence of a government failing to invest in infrastructure for its citizens. How could my neighbors, women selling 10-cent bags of groundnuts for a living, solve all these problems?
Likewise, who was responsible for the tragic death of my humble patient? Was it the powerful surgeon, giving commands from the high ground? Was it the overworked nurses, trying to follow the post-op orders from below? Maybe the lack of functioning equipment was to blame. Looking closer, maybe it was the hospital itself, an essentially for-profit institution selling health as a commodity rather than a human right.
The desire to pinpoint blame is powerful and instinctive. Shifting culpability to those downstream makes life easier in the short term, but our ultimate challenge in healthcare is difficult, one that requires moving counter to the current. To ensure quality healthcare in all parts of the world, we must discern and address the core issues fueling the current problems. Though multifaceted, the roots of these networks of blame can be traced back upstream to power and privilege. Acknowledging a steep gradient of personal agency, we must recognize where the streams of privilege have historically flowed.
Drip.
Drip.
Drip.
Privilege and power do not easily trickle down. The memory of my humble patient has inspired me to charge upstream, alongside nurses and neighbors, in more authentic partnership. We must work toward more cohesive system, one that starts with the problems upstream, in order to stop the hemorrhaging downstream for the ultimate realization of a world with fewer leaky pipes.
This poem is from the Literary Liniment, an anthology of original poetry, writing and artwork by health care professionals in training and in practice. The anthology was created with support from The Arnold P. Gold Foundation.
Discussion Questions
- What does “Drip” mean to you in this piece of literature?
- The author expresses numerous perspectives on vulnerability and helplessness in medicine. How has your sense of vulnerability in medicine evolved throughout your medical training?
- What role does blame play in the medical community? How does this affect patients, families of patients, students, and healthcare professionals?
- What role has hierarchy played in your experience in medicine?
- Vivid imagery can stimulate the reader to be pulled into a story by evoking visceral sensations from the reader. Is there a particular sentence in this story that is most viscerally provoking for you? Can you think of a parallel experience in which you feel that same visceral sensation or reaction?
