Thanks so much for all the comments on the previous post -- certainly gives me reason to keep doing this, and the feedback's much appreciated.
You know, sometimes this job feels less like being a doctor and more like being a detective. In the past few months, I've tracked down missing test results, missing blood samples, and, of course, missing patients.
And missing family members.
One of my patients has been in and out of jail for the past thirty years, completely estranged from his family, and we had to tell him yesterday that his cancer has spread and there's really nothing we can do to help. He wants his sister to know what's going on-- only problem is, he has no idea how to reach her, and hasn't been in touch in years. We asked where she lives, and he wasn't sure. We asked if he knows anything about her-- and all he knew was her name... sort of. "Her last name is something like [Johnson], but not exactly, and I don't know how it's spelled."
And he had an old address from years ago.
So I Googled. I found a reverse address lookup site, plugged in the address, and after a few clicks, found a name that was close. Then I plugged that back in and tried to find current information. Seems like it's an unlisted phone number, and nothing on Facebook or anything like that. But I found a current address in the white pages online.
So he asked me if I could write her a letter-- he dictated what he wanted to say, I typed it up, and sent it off. Will she come to visit, like he's asking? I have no idea. I don't know what caused the rift between them, although I'd assume it's related to the reasons he's been in and out of jail for all of these years. Will she forgive him? I don't know. Did any of this relate in any way to anything we learned in medical school? Nope.
I feel like residency has taught me that being a doctor, especially in a hospital setting-- and really especially in a public hospital, where you're dealing with patients who don't have all the advantages in life, don't necessarily have a support structure or a family or a stable life outside of the hospital-- is about a lot more than the medical piece of it. For some of these patients, we're their only allies, and part of the job is to be therapist / advocate / counselor. And, sure, sometimes they'll reveal something that does help us make a better medical diagnosis. But sometimes it feels just as important to listen to our patients merely because it's the human thing to do and they have no one else to talk to.
The hard part is that the human interaction is always bumping up against everything we have to do that is judged to be more critical-- writing notes, following up on lab results, doing admissions. There's always more to do, always more time we can spend with a patient, or a patient's family. And knowing what's enough-- when it's okay to leave-- is also a big part of the job, and something I think most of us are still working on.
That's part of what scares me as intern year comes to an end soon and I become a second-year, in charge of the interns. I don't want to have to wait around for the slowest intern, but I also don't want to neglect the patients. I want the interns to have a chance to learn, but I feel like I'm going to be compelled to do their work for them just so it gets done and we're not here until midnight every night and back again at 6. I'm less worried about the medicine, honestly-- I do feel so much more confident about the medicine as I did a year ago-- not quite competent yet, but I've seen so much more than I'd seen, I've made decisions, I have more confidence in my instincts. But it's the people management part of that's a little frightening. I'm not a patient person, all things considered. I don't like waiting around, I like sleep, I don't have the work ethic that some of my colleagues have. Work ethic is the wrong phrase-- I'm not insane like some of my colleagues are. I don't feel compelled to be here 24 hours a day. I don't feel responsible when it's not my shift. Is that a good thing? I hope so, but from a patient's point of view, probably not. In any case, time for rounds.