She asked me if she was going to die. Normally I would have said that she was going to be just fine, but I couldn't get the words out of my mouth. All I could say was that we would do our best while I watched the pool of blood well up in her abdomen.

By a quirk of scheduling I'd put my vacation a week before the end of my Surgical Oncology rotation. And to make sure that I wasn't on call the night before my vacation started, they'd squeezed my calls together pretty tightly. So I was worn down from a stretch of Q3 and Q2 calls, but my vacation was coming soon and I just needed to get through Sunday call before I could take a break and relax.

As soon as I walked into the hospital Sunday morning, I got a text from Cristina, who was on call Saturday night, about an emergent thoracotomy that was about to start. I went down to the OR and scrubbed in just as the case was starting. We scooped out a couple of liters of blood that had collected in his right lung space and stopped the area of bleeding. While we were waiting to take the patient back to the ICU, I heard about an appendicitis waiting in the ER. And so it went for the rest of the day. Things had settled down a bit until a nurse came to me at 2 AM and told me that Mrs. R was bleeding from her wound.

Mrs. R had gotten a liver transplant a year and half ago, and hadn't stopped having complications since. Most significantly, she infarcted most of her bowel sometime after her original surgery and was made a candidate for a small bowel transplant. We don't do many of them, and they almost never seem to do well. Mrs. R was no exception. Since receiving her new small bowel two months ago, she'd been taken back to the OR a dozen times. Finally, it had seemed like she was slowly making her way back.

As soon as I walked into her room, I could see that the dressing covering her abdominal wound was soaked with blood. I took one look underneath and told the nurses to start giving her IV fluids and blood transfusions, whatever they had, as fast as they could give it. A rushed call was made to the Transplant fellow and attending, while Mrs. R's blood pressure sank down to the 50s. She was bleeding to death.

We got her down to the OR and did everything we could to save her life. We sacrificed the transplanted bowel, surtured a hole in her aorta, then placed a stent across it, all the while the anesthesia team was desperately trying to keep up with the hypotension from the massive blood loss. She was brought back up to the ICU in critical condition and that marked the end of my call night.

Later that day, I got a text from one of my coworkers saying that Mrs. R had died that afternoon. All for naught.

Now I'm on vacation, sleeping in, eating out, keeping my mind off of work, of life, and of death. I can't always wait on the sick and dying, but I know they'll be waiting for me.