The Death Rate in America: A Follow Up

A couple weeks ago I wrote a post a about a patient who really touched my heart. He was a patient recently diagnosed with ALS, and the type of person that makes one ask, "Why do bad things happen to good people?" An incredible individual who had been dealing with health problems for a very long time, but kept his head held high. He was the first continuity patient of mine to hear such a grave prognosis.

I often hear physicians say it is very important to separate your work life and your home life. Not that you can't do work at home, or talk about medicine with your spouse or family, but you can't be up all night thinking about your patients. One, you will never sleep, and two that is a quick recipe for burn out. At some point you have to have mental space. With this particular patient though, I found that I couldn't keep him out of my head. I would brush my teeth and get into bed at night, and his case would creep into my consciousness. I think it was the helplessness I felt that I couldn't let go. I wanted to be able to do something. I guess this was the first time I've really dealt with the reality that doctors don't always cure. I know this has been a common theme of my posts this year, but saying it out loud helps me reinforce the idea that there isn't a magic elixir. There is no pill for age; everyone dies.

After dealing with this on my own for a while and writing about it, I reached out to one of my preceptors for guidance (something I probably should have done earlier, but hindsight is always 20/20). She helped me change the way I was looking at this whole situation. I really shouldn't feel "helpless;" that really isn't the right word, because as a physician I can help. I can try to give each person the best quality of life possible, and ultimately, isn't this what we are trying to do for every patient? She noted that patients with incurable diseases are often some of the bravest and strongest people she has ever met, and it is an honor and a privilege to spend precious moments with these individuals. There are fewer things in life more rewarding. It is often with these patients that one can make the most difference in a medical practice.

Another wise woman is my mother, who (God bless her) has been watching and reading about my early journey through medicine with a different perspective: a non-medical one. Yes, she still is the only doctor in the family (Dr. Mom?), but in a few years that title will fall to me. She told me that there is a "first" in everything that we do, and as this journey continues, there will be many more "firsts." There will be a first saved life, and a first mistake. A first surgery, and a first crazy diagnosis. Every new disease is a first. This first just hit me a little harder than I expected.

I don't want to become desensitized to either diseases or people. I understand that some desensitization is necessary: meditating on the fact that one is delving into the human body during every surgery is probably going to get in the way in the operating room. But I don't want to forget the person. I want to find that happy medium: understanding the gravity of a diagnosis or a procedure, but also turning energy on its head to help in a positive way. Appreciating the human condition, but not dwelling on it. This is a balance I've discussed with my ethics professor and a number of my preceptors. It will be a significant part of my journey.

I will be joining the hospital Ethics Committee in January, which will add quite a bit of perspective. There will be many firsts there as well, and I look forward to sharing what I can of those with you.