For those of you who know me, you know that sometimes I speak in letter form.  For instance, "Dear person driving the Honda in front of me, Please move over to the right lane.  Love, Kari", or "Dear Rain, Please stop.  You are making my plans difficult.  Love, Kari".

I haven't written a letter here since the letter to the person who smoked inside the public restroom, so I decided it would be an appropriate form to say some goodbyes.  Some are sad.  Some aren't.  They are all letters.  Because letters are cool.  So here we go.

Dear burn  patient with the hands,
     Yes, I realize that all the patients in the burn unit have hands, but yours are the only ones I wrote about.  But that's beside the point.  You died on Saturday.  Even though I wasn't there, I knew it was going to happen because your family chose it.  They thought that you wouldn't want to live like you were.  The odds were against you from the start; we all knew that.  You only had a 25% chance of surviving, and that didn't take into account your functional status should you survive.  Functional status?  That sounds too medical.  The fact is, your life could never have been the same.  When we got into the OR and saw your hands, especially your right hand, we knew that they would never do much.  You probably would have ended up losing  many of your fingers.  And you hands, arms, back, they would have all been scarred, stiff, contracted.  Maybe if you'd been younger, or not had the stroke a few years ago, things would have been different.  But you would have been wheelchair bound, completely dependant, living at home at best, and in a nursing home most likely.  Your wife, you sisters, your mom, they all agreed that this was not you, this was not what you would want.  I admit, it was hard to give in, give up.  Not 24 hours before they chose to withdraw care, we'd spent 8 hours in the OR with you.  We could have kept going.  It wasn't my choice, or any of our (your medical teams) choice.  But we are trained to treat.  We are trained to do the things to make your survival most likely.  Surgery, fluids, medications, procedures, therapies.  We could have kept going.  The result in the end would have most likely been the same, but then we could say we'd done everything possible.  You were the first real burn resuscitation I'd seen.  The medicine, the critical care, the surgery involved in it was academically fascinating.  We can save people that, 20 years ago, would have had a 120% chance of dying.  Yes, that's > 100%.  Crazy, I know.  I admire your family for letting you go.  I don't question that your life would not have been anything that you'd have wanted.  But I don't know if I could choose it.  It's so... final.  We found out on Friday night that the plan was to withdraw care.  We switched everything to comfort care.  We planned to extubate you the next day, when all of your family and friends could be with you.  I wasn't there on Saturday, but I know it was a sad day.  Even when you know something is right, you still hurt.  Especially your mom.  But I think she hurt more watching you suffer for the week and a half you were with us.  From what I heard, you went peacefully.  Your family was there.  They told you they loved you, prayed, they cried, they said goodbye.  There's not much else to do. 

Rest in peace,
Kari

Dear toughest 86 year old lady I've ever met,
   You would get sent home from rehab early, wouldn't you?  You're that kind of lady.  I'm glad I got to see you before you left, with your hair all done up, real clothes on, walking (although somewhat unstably...).  I am so proud of you.  I know the last 6 weeks have been hard, and I don't know how you've managed to keep a positive attitude and a smile on your face.  But you have.  You never complained, even in all the indignities that we put you through in the burn unit.  You always read, more books that I've read all year!  I bet you are a smart lady.  I wish I'd had time to sit down with you and listen to your story.  I know you had a good one.  I also wish I'd had time to ask you about your husband, and your dogs.  I know you must miss them terribly, and I can't imagine what it's like to lose your home, your family, and you Independence all in one night.  Many of the patients in the burn unit have a story that makes you say, "well I could have seen THAT coming!"  Not you, though.  You were just the unfortunate victim of a house fire.  And you lost everything.  But you were so POSITIVE!  I guess that's how you go on.   You even had to spend your birthday in surgery!  I know it was lonely with your family up north.  But I'm unbelievably happy that you get to go live with your sister.  I bet you two made trouble back in the day ;)  You probably still will.  It's patients like you that I wish I could follow up with, call in a couple months and see how your doing.  But you have to go on living your life, and I have to go on to other patients.  I know you'll do well.  Better than well, you'll thrive!  When I'm 86, I'd like to be like you. 

Goodbye,
Kari

Dear Burn Unit,
    Well, we've made it though another month.  This will be the last, though.  You've taught me lots.  This month was much more eventful that last month.  You taught me the normal lessons:  don't smoke on home oxygen, don't blow up meth labs, don't hunt bears while high, don't throw gasoline on a fire, TNT is bad for hands.  You also taught me harder lessons, but I think I covered those pretty well a couple letters ago.  I saw a lot more critical care medicine this year.  I also spent a LOT more time in the OR.  We set records, although they probably are not appropriate for mention here, but we'll just say we worked very hard for them.  I ate a lot of chocolate ice cream, to make up for the calories burned in a 104 degree OR.  This is my last surgical rotation.  So it's a goodbye to surgery also.  I will miss it.  But I can't do everything.  Sad, I know.  So adios, burn unit.  I will miss you, your friendly nurses and therapists, your PA's, your nutrition room always stocked with ice cream, your fridge with space, place to put my bag, par stock room with mastisol, and hard wood floor that always makes me trip over my crocs. 

Adios, but I promise to visit.
Kari

Dear hospital,
    You've gone by sooo many names in my tenure, and I think your name is about to chance again.  So I will just call you "hospital".  Not only is this my last surgical rotation, but its my last rotation in the hospital.  From here on out, all of my rotations will be outpatient.  Some will be at the undergrad campus, some will be in clinics, but none will be within your walls.  Don't worry, though.  I'll come back to visit for meetings and appointments.  It seems like just yesterday that I was walking onto the floors, completely lost and confused as to where I was, terrified to walk into a patients room because I didn't know what to say.  The only landmark I knew was the red wooden tower outside the window.  I don't even know where it was, I just knew it meant I was going the right way... I feel like I've just figured you out!  Seriously, you have too many hallways.  But really, it's taken all of the last year and a half to figure out how to get around efficiently.  And now, I'm leaving.  It's bittersweet.  Sometimes I get sick of the undertones of politics and hierarchy that ripple through your hallways.  But it's also impressive to see the machine that is a big academic hospital.  I know this is not goodbye forever from that setting.  I still have residency, after all!  But who knows where I'll be for that.  Maybe here.  Maybe not.  But for now, I'll miss you.  I'll miss Christmas Coffee and Einsteins, and seeing the friendly transportation guys, and using my new found knowledge to direct lost patients to their destinations, and walking onto a floor or into a unit feeling like I actually know whats going on.  I won't miss the carpet with two patterns and randomly placed triangles on one side of the wall.  I won't miss that AT ALL.  Who decided that was a good idea, anyway?  Okay, so besides that, it will be strange to not rotate in the hospital again.  But I think I'll live.  I'll see you around, but only occasionally.

Goodbye (for now),
Kari

On Monday, I start a student health rotation, and next week I also start my interviews.  New roads lie ahead. 

Drive on,
Kari