Anonymous Doctor

Thanks for the advice regarding my medical student. I'm sure he's not reading this blog, but he did somehow seem better yesterday. Maybe it was some sort of psychic energy I was giving off, after venting about him on here. I don't know. I don't want to jinx it. But I guess writing this post is probably jinxing it.

Ever see a bladder explode? You don't want to.

Feels like it's going to be a slow day. Which, again, I don't want to jinx, but I'm jinxing. Taking a risk here, but I'll take post requests in the comments if there's anything anyone wants me to write about. Reserving the right to pass.

Sad about Elizabeth Edwards, incidentally. I saw the articles on Monday, and any time doctors are stopping treatment and saying any further action is likely to be futile, it is not a good sign. From my rotations in the cancer wing, I saw patients getting treatment long after any objective third-party would say that the treatment was hurting more than it was helping. That's not to criticize-- if death is the alternative to treatment, then it's hard to fault someone for doing everything he or she can, even if the odds of any sort of success are dwarfed by the likely pain and loss of quality of life for whatever time is left. But it's just to say that stopping treatment, in most cases, isn't something that's done when there's a lot of time left on the table, or there's even any longshot reason to hope.

And that goes double-- triple? quadruple? orders of magnitude higher?-- when you're talking about someone with access to absolutely anything that might be out there, the money to pay for it, and the connections to know that no stone is going unturned. It is hard to imagine that there could have been anything untried in this case-- having had years to find the best doctors and the newest treatments, and the money to pursue anything that might plausibly help, it's really just reinforcing the lesson that we can't beat this yet. I feel like this is the same kind of statement about metastatic breast cancer that Peter Jennings and the quick course of his illness was for lung cancer. It doesn't matter if you have access to everything-- this stuff still gets you, and not that slowly.

I think, to some extent, it's easy to lull ourselves into a false sense of health-related security sometimes. There are a lot of diseases that society has pretty much eradicated, at least among people who aren't living in poverty, who have health insurance, who have enough food. But there are still a lot of diseases that don't discriminate, that don't care how good your doctors are and how much money you have. You still lose. And it's scary, and sad. I saw it most often when I was in the cancer wing and had young patients who had done nothing to deserve their disease, but I see it in every rotation. And it's why it's absolutely harder to emotionally deal with those patients than with the drug abusers and alcoholics who, to whatever degree you're comfortable believing, have some culpability. There are reasons what's happening is happening. We can trace the origins. It's easier, to be blunt, to watch someone die when you can trace the origins of what's happening and assure yourself that this could have been avoided. It's much more frightening to deal with things that can't be.