Last day today of my first rotation. And, unbelievably, I'm actually looking forward to my next month, in the critical care unit, because it won't be as depressing. Yes, bad things happen in critical care. But good things also happen! We fix people! They get better! They leave! They don't come back! For the past month, all I've delivered is bad news, and all I've seen is patients get worse. There is virtually no good news to deliver in hospital-based cancer care. In an outpatient setting, sure. People go into remission, people have often years and years and years of quality living. But at the point you're coming to the hospital, and staying here, it's never good news. And most of the time the patients don't realize that until we're in there telling them. It's "yeah, I know you weren't feeling any pain and thought you just had a cold, but actually your kidneys are shutting down and you have seventeen hours to live." Or "no, it's actually growing really fast, and there's nothing left for us to do." Or "yeah, that pain you're feeling, it's only going to get worse, and you're going to suffer for the next eight months until you die." It's young people, old people, everyone. With something we can't really fix and can only stave off for a little while, and maybe, if we're lucky, get you a year. Maybe. A painful year, filled mostly with doctor's appointments and toxic chemicals swimming through your system. It makes me thank my lucky stars that I'm healthy, and wonder how anyone can really be healthy.
My big internship lesson so far-- I don't want to practice medicine in a setting where no one gets better. I don't want to be the doctor they only see when they're dying. I don't want my entire day to be spent delivering bad news and running tests that can't possibly have good results. I want to feel like I'm helping people, not torturing them. I want to feel like I'm adding to their quality of life, not hastening their demise. Frankly, once they're dying, I want to pass them off to someone else. That's why I'm doing internal medicine, that's why I want to work in an outpatient setting, where often enough my patients can walk out without crying. I want to be their partners in health, I want to tell them how they can live well, I want to get them on the right medication, I want to figure out what's making them feel bad and try to fix it. I want to know them when their lives aren't just about staving off pain and lying in a hospital bed. I want to know them when they're not crying.
Maybe it's crazy for a doctor to say he can't take death. But isn't it worse if a doctor says he's comfortable with it? Don't we want doctors who want to do whatever they can to avoid dealing with death? Who won't just give up and decide there's nothing more they can do, and throw their patients into hospice? We become doctors because we want to help people, not because we want to watch them suffer and die. Yet all too much of medicine is about watching people die, about throwing up our hands and telling a patient there's nothing more to be done.
Once again, I wish I had the grades for ophthalmology. Or dermatology. Or the inclination to be a psychiatrist. Or the talent to play for the Dodgers. I wish I was a shortstop. That would be a happier career.