* * Anonymous Doc

Tuesday, July 21, 2009

One of my patients has been heading steadily downhill, and now has only brief moments of lucidity. It seems like she's choosing to use those brief moments of lucidity to berate the nurses. She'll be fast asleep, and then suddenly a nurse will walk in, go over to check the IV, and suddenly the patient will wake up and be like, "Carol, go and get me more ice already!" And then she's back asleep for the next three hours.

Dealing with the patients I've had for the past few weeks has sort of reinforced how much more there is to being a doctor than just the medicine, despite what we learn in medical school. The questions the patients and their families ask-- perfectly legitimate questions-- about what they should be eating, whether there's any useful exercises they can be doing, tips for getting better sleep, how to deal with the psychological issues brought on by their illness-- I don't have very good answers. Elderly patient losing weight-- eat more? Eat ice cream? Drink milkshakes? I'm just pulling this stuff out of the "generally intelligent human being" bucket, not my medical education. I don't know how to counsel a depressed patient-- who's got every reason to be depressed, because she's dying. I don't know what to tell a patient who can't sleep, besides that we can give her more pain medication. But I'm sure that's not the only (nor the best) answer, at least not all the time. I don't know what exercises strengthen the back. I don't know if it's normal to feel tingling on the bottoms of one patient's feet, given the medications she's on. I don't know how our 51-year-old patient can start the conversation with her 82-year-old mother, to tell her she's dying.

Yet these are the questions we're asked, and the questions it feels like we should have answers to. I barely have answers to the purely-medical questions, let alone these. And it's frustrating when I can't help more, when I can't provide the solution. We're looked at as if we have such power, and yet we're really just people.

I watched an episode of TV before going to bed last night, a lawyer show called Raising The Bar, on TNT. One of the lawyers had a client who couldn't afford to pay the $75 fine he'd incurred for jumping the subway turnstile, and he was being put in jail for 30 days, which meant he was going to lose his job and (I think) custody of his kids. So the lawyer ended up paying the fine for him. And got in trouble for it. Made me think lawyers have much the same problem as doctors here, but in a lot of ways they're even more powerless-- I mean, I'm at least able to do whatever I can do to help-- it's an issue of frustration the medicine can't do more, or that someone isn't responding, more than an issue of my own hands being tied (although maybe that changes in private practice, with insurance issues coming into play). But this lawyer was limited by what he was even allowed to do, even though he was able to help and could keep his client out of jail.

Maybe there's no analogy here and I'm just seeing everything through a medical lens because I'm in the hospital 80 hours a week. I don't know. I dream about work. I dream about inputting orders into the computer, which is no more fascinating in dream-land than in real life.

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