How much am I supposed to care about a 52-year-old who's drinking himself to death? He's in liver failure, and he's still drinking. Why is he worth staying the extra ten minutes after 27 hours in the hospital? Why should I care more than he does about his health? Why should I care more than I care about finally getting to go to sleep?
There's nothing rewarding about dropping in on these patients' lives for a couple of weeks. Nothing I'm doing-- nothing any resident is doing-- even has the potential to make a difference. We're executing orders, mostly we're just watching patients die, there are very, very few moments that feel even slightly uplifting, even slightly fulfilling.
Not that there's anything we can do in the vast majority of these cases, not that there's anything left in the medical arsenal that's going to keep some of these patients from continuing to fade-- but it's awfully hard to get used to failing so often.
We go through college and med school never failing. We can't fail, or we won't get to this point. We're used to succeeding, we're used to everything working out, we're used to feeling accomplished. And then we become doctors, and it becomes all about failure. At least in a hospital setting like this. It's about staving off failure for another three days, it's about feeling helpless and tired and cranky. There is no positive feedback. Even when someone gets better, someone new takes his place and doesn't get better. There is no end to sick people. You're no longer working toward a degree, you no longer have something different to look forward to. Sick people are your life. And you can't save all of them, or most of them, or some of them. Failure is your life.
I'm good at being a student. I'm good at studying, I'm good at taking tests, I'm good at learning. I like learning. I don't really like doing. I don't like not sleeping. I don't like worrying. I don't like feeling responsible for things I have no control over. I want a normal schedule, and a normal life. I want to be able to take a breath. I want to be able to relax. I want to care. I want to run offense instead of defense. I don't want every night to be catching up on sleep, I want to be ahead of sleep, I want to feel like there's a balance. I want to have friends. I want to like the people I work with. I want the patients to know who I am and appreciate me. I want the attendings to know who I am and treat me like a person instead of a slave. I want to feel useful instead of feeling like all we do is babysit. All we do is babysit people who don't even care about their own health. We babysit alcoholics and drug addicts. Awesome. What a fucking accomplishment. What a fucking way to spend a day.
I want to know my neighbors. I want to have a life that's about more than just the hospital, about more than just sick people, about more than failing. But no one here does. Everyone's miserable, or just deluded. No one has that balance, at least not to my eyes. I think I used to be happy. I'm not sure, but I feel like once upon a time, I was happy. I'm not. No one seems to be. And if I weren't a doctor, what else? Is anyone else happier? What makes someone happy?
Because this doesn't. Then again, no one ever said intern year was fun.
Sleep.
Wednesday, August 19, 2009
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Would you be happier with a normal job, a normal life, trudging into work every day doing the same thing, seeing the same people, aspiring to nothing more than more efficient, profitable worker? As you sit at home in comfort after a short and easy day would you be content knowing that you've done nothing important, that you've made no impact in this world? At least now you are trying, and if you only help one person you've done more good than most people ever will.
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