* * Anonymous Doc

Thursday, August 6, 2009

What I'd really like to say when patients say stupid things.

Patient: "You look too young to be a doctor!"
Me: "You look too old to be alive."

Patient: "Do I really have to take all these pills?"
Me: "No. Just pick your favorite two."

Patient: "When can I leave?"

...okay, this post sucks. Because not even at my most frustrated, not even at my most jaded can I even pretend that my problems come anywhere to close to the problems of the patients I'm dealing with. Or that I wouldn't be tempted to ask exactly the same questions they are. But if we stop to really put ourselves in our patients' position-- if we stop and really think about what they're asking us, think about how scared they are, and the good reasons they have to be scared-- then how can we get through the day without losing it? We walk by family members crying in the hall, and if we really let ourselves think about it from their perspective, how can we not break down too? A patient asks, "When can I leave?" and the only honest answer I would be able to give is a horrifying, awful, terrible answer. "There's a good chance you're not leaving here alive." But then is the right answer to lie? Is it bland reassurances-- "we're doing everything we can, and hopefully you'll be stable enough that you can go home soon."

I mean, I don't know, these first two rotations I've had have started to make me forget that people get better. That regular patients on regular hospital floors come in, we fix them, they leave. They smile. They live. Instead, I've been dealing with end-stage everything, and I can't do it. I don't know how anyone does it. I don't know how anyone can be an oncologist, I don't know how anyone can adjust their point of view so that good news has such a low threshold-- so that "you're still alive today" is good news, let alone "you're healthy, go and live your life."

In the outpatient setting, as a med student in clinic, I liked getting to know the patients a little bit, asking them what they did, finding out about their lives. I miss that part of it-- making that connection. Because you can't do it here. Not just that we don't have time to spend talking to the patients, because we have too many to cover and too many tests to order and follow up on-- but because no one here has lives that are ever going to be normal again. None of these patients are in any condition to have a conversation even if they wanted to-- most of them aren't even able to feed themselves. Their lives are their illnesses-- which means their lives aren't much of anything. But this is what doctors do. This is what I signed up for. This is what I'm going to be doing for the next 40 years.

And that means at some point I'm going to get used to it. And death won't faze me. And disease will seem normal. And illness will seem ordinary and not so bad. Great. That's a great recipe for happiness. What a great way to see the world-- as a landscape filled with death and disease.

I need a rotation with good news. Where people get better. Where people can smile.

Patient: "You look too young to be a doctor!"
Me: "Well, I feel too young to be a doctor, too."

1 comment:

  1. My father-in-law entered the hospital on May 17 and died the next day. Most of the time, he was under the influence of a morphine drip. We knew this was his last trip to the hospital and that he would not leave there alive. One doctor said as much, but his tone was not matter-of-fact, it was empathetic.
    I learned the term empathy years ago from a friend who was attending nursing school. As I get older and watch friends and family enter health care facilities, be they clinics, emergency rooms, or hospitals, empathy has become a valued quality in a health care provider.
    The attending nurse for my father-in-law was amazing in her capacity for empathy. She helped our family through one of the hardest days of our lives. When dad died, she looked right in my eyes and I really felt that she could sense what I was feeling.