The Lord Provides: ICU

It's amazing how quickly I can go from being completely overwhelmed by anxiety, thinking "what have I gotten myself into," with this whole medicine thing to thinking "I'm glad I'm a doctor." The beginning of this week were some of the most anxiety-filled days I've ever experienced. I could barely sleep. I was confounded by my own inadequacy.

But yesterday I felt confident for the first time in the ICU, a rotation I started a week ago. I got my first "procedure" as a new intern. As we rounded on our patients in the morning we decided to do a lumbar puncture on a man with altered mental status. The year-2 resident asked for one of us interns to volunteer to do the procedure. He was my patient so I figured it would be bad form for me not to volunteer. So I said I would do it, thinking to myself that I would really just try to do it but probably not succeed. When I told one of my fellow interns what I was going to try to do later he quoted Yoda to me saying, "Do or do not... there is no try." Going into the room, about to perform the lumbar puncture, I asked for God's mercy and I asked for success in getting this procedure.

The other resident and I gowned up under the watchful eye of the ICU attending. I first injected the morphine, just under the skin, then toward the patient's spine where the large lumbar puncture needle would travel. After he was all numbed-up I inserted the much larger needle, first hitting bone then redirecting once and then going much deeper. I felt the deep tissues "give" three times, each time hoping that I had reached the spinal canal with it's precious cerebrospinal fluid (CSF). Each time I felt a give I would withdraw the stylet from the barrel of the hollow needle hoping to see clear cerebrospinal fluid drip from my end of the needle. After withdrawing the stylet twice I thought to myself, "alright, as I expected the resident will have to take over but at least I tried." I replaced the stylet and went a half centimeter deeper with the needle. I felt the tissue give once more. I removed the stylet and there it came, a sight for sore eyes, perfectly clear fluid dripped from my end of the needle, CSF, the last give had been the dura surrounding the patient's spinal canal and now the tip of my needle was within the spinal canal, among the cauda equina of the spinal cord, draining a miniscule quantity of CSF which would help us to diagnose the cause of our patient's problem, potentially guiding us in the treatment of an encephalitis.

Admittedly a lumbar puncture is a pretty simple procedure. But I have seen it unsuccessfully attempted by residents in the past so my success in completing it was definitely not a given. I had only tried it once before my third year of med school and had been unsuccessful then. I left the hospital Friday night happier than I've been in a long time.

And while I am very thankful to God for my success and my current happiness, it does bother me that it takes something like this to make me happy these days. For I know the King of the universe, and I know about His cross, His shed blood in my place, for my sins and the sins of the whole world. I know about His glorious resurrection on the third day when He erased all doubt about His victory over sin, death and the devil. Knowing all of this I should be continually rejoicing and I should be able to obey the words of my Lord, "Therefore do not be anxious (Matt 6:31)." But I fail miserably and I fail daily. And knowing my failure to "trust and obey" I am redirected again to the glorious gospel of God's grace, that my standing with God is not based upon my success or obedience but solely upon Christ's righteousness. And while I often foolishly fail in trusting God to bring me through the every-day trials and struggles of life, I do trust God with complete certainty in one area. And I know that this trust, this faith, has not been manufactured or achieved by me but has been given as a free gift of His grace. And this faith is that Christ died to save sinners, even a sinner like me.

This is my Father's world;

why should my heart be sad?

The Lord is King; let the heavens ring!

God reigns; let the earth be glad!