Doctors measure things. Obstetricians count down the 40 weeks of a normal pregnancy. Pediatricians plot the height and weight of growing children. Surgeons estimate blood loss. All of us measure vital signs, and almost all of us measure “I’s and O’s,” which we learned to do as medical students.
“I’s and O’s” are “ins and outs” and we record them in hospitalized patients. On a given hospital day, patients eat or drink. They receive IV fluid and medications. They urinate and sometimes throw up, or they have diarrhea 20 times after a bad clam or a trip to Mexico. In the hospital we chart all of it, and at the end of every 24-hour cycle, the I’s and O’s are summed up. It’s accounting, medical style.
For years I thought of I’s and O’s as nothing more than patient physiology. Patients ingest food and fluid. The miracle of metabolism transforms these into the tools and energy required to fight disease. The byproducts of this battle exit the body in some new form. We measure it. That’s I’s and O’s.
From 2005-2008, I wrote for the News & Observer about my life as a general surgeon. I never wrote about I’s and O’s which seemed as interesting as sand.
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About a year into my column, I got an email from a reader. He encouraged me, very politely, to write about something besides death.
I bristled when I read the email. He’s wrong, I thought. I write about things other than death. But when I went back through my columns, I realized he was right. In one form or other, death was lurking in many of them. I wrote about the first patient that I had who died and about the families of the dead. I wrote about gifts that dying people had given me and I wrote about obituaries. Every month I thought that I had written something new, but actually I hadn’t. One month after another, I had wrestled with the same old thing.
As I pondered my death obsession, I began to think about I’s and O’s in the lives of doctors. We work with sick people, and as we do, we absorb fear and sadness and pain. We are different people as a result. Eventually, the things we’ve seen come pouring out of us. Unlike hospital I’s and O’s though, ours are immeasurable.
Certainly the rawest of doctor I’s and O’s are the patients who enter our lives alive, and then exit our lives by dying. If we’re smart, we mourn each one as she comes and goes. But often, we’re just too busy with the next person and the person after that. All of a sudden, years go by and the unmourned are piled up inside us.
My early columns were my way of finally letting them out.
By 2013, when I re-enlisted as a Community Voices writer, I’d mostly made my peace with death. Sure, I still carry the dead around inside me, but having given them voice has made more room for the living, and it’s the living that I’ve written about in my recent series of columns.
As I sat down to write this last column, I had to accept that I can’t actually write about all the living. I haven’t yet, for example, written about the World War II vet who won the Silver Star as a combat medic, or about the medical student who gave his shoes to the undocumented immigrant after the patient lost his shoes in a car wreck. I haven’t described the man with thyroid cancer who carved miniature baskets from peach pits, or the woman with a breast cyst who taught me about fainting goats. I’ve neglected my mother-in-law’s hospice nurse.
These are my I’s though – my patients and colleagues – and my O’s are moments of awe at their resilience, inventiveness and generosity.
It’s not a bad gig, this doctor job. And writing about it has made it even better. So, as I write this, my last column, I want to embrace the patients and co-workers who have created and are creating the rich world in which I live. And I thank my readers and correspondents, for nudging me along, and for pushing me to think in different ways about the unquantifiable I’s and O’s embedded in the work I do.
Editor’s note: Next month, we’ll welcome a new Our Lives columnist into our mix.