* * Anonymous Doc

Wednesday, August 26, 2009

"I toldja so" is a bittersweet feeling when it's about correctly diagnosing a terminal illness.

One of the patients had some vague complaints last night, that no one was taking particularly seriously-- elderly woman, likes to complain, no one likes her but I'm new to this rotation so I hadn't been poisoned against her yet. As I checked the chart, and matched up these new complaints with what she's already being treated for, something clicked and I had an idea that we might have misdiagnosed and it might actually be something a lot more serious than we'd been thinking.

Mentioned it to the attending, he told me to order a couple tests to rule it out-- and told me it was a nice catch, which made me think maybe I was onto something. Third-year resident said no way, fellow said no way, my co-intern thought I was crazy for questioning a diagnosis, but, hey, it wasn't like I was trying to show anyone up, I was polite about it, I just wanted to make sure we weren't missing something.

I get back tonight for my shift, check in on the patient-- sure enough, tests came back and I was basically right (not entirely, but close enough). Yay me. Boo patient never going home.

So I'm supposed to be happy, right? I caught something. I made a diagnosis others missed.

But you know what? If I were the patient, I'd probably wish the intern had kept his mouth shut, because if I'm going to die anyway, why not have a couple more weeks blissfully(?) unaware, until more symptoms pop up? Why ruin some fraction of the limited time left? What's the point?

In medical school it's all about hypotheticals-- of course you want to make the right diagnosis, because that's the whole point-- of course you want to do everything you can for every patient, because that's the whole point. But my biggest lesson so far this year is that we really do too much, try too hard, for too long. Why are we bringing terminal patients back from the dead? Why are we wasting (limited) resources on people who don't have any hope for any sort of quality of life? I'm not talking about adding productive and healthy years to people's lives-- of course we should do that, no matter whether they're in their 50s or their 90s. I'm all for organ transplants to 80-year-olds if we can buy them another decade and they're otherwise healthy enough. But there becomes a point where it's futile, wasteful, and sad. Death is sad. But everyone dies of something. There are some miracles we can't perform. Two weeks of painful half-comatose death versus six weeks of painful half-comatose death, what's the difference? Bring you back tonight so you can die tomorrow? What's the point?

And again the post turns into this horribly depressing thing, even when I start with something that should be good news-- not for the patient, but at least for me. Yay, I feel like a doctor. A depressed, jaded, lonely doctor. Awesome.


  1. Our culture sorely needs to address what really happens at the end of people's lives. We don't want to face the grim reality that at some point life isn't worth living.

    It's a Catch-22 in a way; the empathy which motivates people to become doctors is what prevents them from coping with the needless suffering they are surrounded by. Yet another injustice of our society brought about by ignorance and fear. I suppose that you will get used to it eventually, our emotional triggers can only be pulled so many times before they no longer work. Hopefully you will learn to separate those who you can help from those you can't and pour your emotions into the ones that still have a chance at a better life.

  2. http://www.smbc-comics.com/comics/20090529.gif

    this comic made me think of this post.