when real life catches up with medicine

I’m not sure how to begin this post, other than to admit that I’m exhausted.  I’m currently on rotation at an outside hospital, and although the operative experience has been incredible thus far, the long hours in the operating room and the random pages in the middle of the night while I’m at home have been taking a toll.  Rare is the day that I leave the hospital before 7pm and make it to the gym.  If it sounds like I’m complaining, I’m not – I’m greatly enjoying the amount of operating that I’m doing, but it would be a lie to say that I’m not constantly tired these days.  Needless to say, the number of thoughtful and witty posts on the blog have declined significantly.  Hopefully in the new year that will change a little.

The one thing about a crazy and hectic schedule that works well for me is the need to push aside all the extraneous things in life that don’t really matter.  Staying constantly focused on work only leaves room for the important things in life, although I’ll admit that I’ve had trouble staying engaged in the sometimes mindless chatter at holidays parties this season given my “one track” work mind.  That all changed today at work, and life caught up.

When people find out I’m a surgeon, they are often impressed and comment that I’m doing great work and “saving lives.”  I’ll be completely honest when I say my job is not an episode of ER or Grey’s Anatomy, and that there is nothing all that glamorous about repairing hernias and removing gallbladders (although to be fair one could spin that as improving a patient’s quality of life).  I’m going to say the thing that doctors should probably never admit, but on my worst days, I tend to view medicine as just a job/career and nothing more.  On the worst days, taking care of patients is the duty I’ve signed up for.  Thankfully those days are few and far between, and most of the time I find medicine and surgery incredibly rewarding.  I currently have an elderly patient in the ICU who is slowly improving after being very sick and undergoing a very large surgery.  Knowing that I’m playing a part in her care definitely makes feels good.

Sometimes, all it takes in medicine is one patient to remind you of who you are, what you are doing in life, and what you’ve given up to get to this point.  That patient was a 40-something year old man who came to the hospital with what he thought at worst was appendicitis and turned out to be a tumor that had already spread to his liver and likely his lungs.  His charming wife, three months pregnant, sat by his side this morning when the bad news was delivered.  The look on his face spoke volumes as he was clearly overwhelmed with information and grasping for some sort of understanding.  The idea of curative treatment slowly slipped out of his grasp, and his spirit was visibly crushed.

I walked out of his room knowing that we had done the right thing, giving him all the information he needed to make educated decisions about his future care.  My attending had prepped him for the worst while maintaining hope.  But I couldn’t help but feel devastated myself, the conversation and my patient’s history taking me out of “doctor mode” and forcibly throwing real life in my face.  We as physicians often forget what our patients go through, the “hula hoops” we make them jump through and the “tight ropes” we make them walk.  Our patients often put their lives on hold, at least temporarily, for the treatment they seek.  They endure pain and suffering, sometimes at our own hands, for a cure – no matter how elusive it may be.  We forget because it is easier to forget rather than dealing with the pain, suffering, and death. This man and his plight made it all too real, and it took every fiber of my physically exhausted being to hold it together.


About justgngr

the ramblings of a medical professional by day, judgmental ginger by night
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2 Responses to when real life catches up with medicine

  1. cat says:

    justgngr, just came across your blog and this interesting entry…..I think you are going to be a fine doctor and surgeon. Reflection, emotion and connection with the patient can provide a path to a successful practice and career. In addition to your own realization and insight; your travels to Haiti show a compassion for the human spirit that many cannot offer.

    I have been in the healthcare arena for over twenty years as a non-medical professional. I worked for and with physicians and surgeons; so I know well of the personalities of the trade. The last ten of which I have been struggling with health issues and have undergone multiple surgeries, PT and follow-up. During that time; I have assembled the finest personal medical team possible. For the most part, I have been in long term relationships with my doctors and care team. Folks tell me how fortunate I am to have stumbled upon such fine doctors. Luck has nothing to with it…

    Skill is clearly the first attribute I look for in a doctor, but if we cannot relate or communicate then all is lost. Living and working in Boston provides a plethora of opportunities for skilled medical professionals so my options are bountiful. What I look for however is a doctor who can look me in the eye when discussing my medical issues; someone with compassion and understanding beyond the medical problem immediately before them. I choose to have my medical care from a teaching hospital which would otherwise indicate care that is cold, impersonal and somewhat rushed. Generally not the case for me. I am direct, but respectful, in my dealings and expect the same in return. In my opinion, selecting a physician is very much the same as hiring the right person for a job opening.

    Without getting into much detail, I highlight some instances when I knew I had the best doctor for me:

    1.) Upon my first meeting/appt with my PCP; I was told ‘out of respect for your time and mine; I start my appts on time – unless there is an extenuating circumstance or medical emergency. I would ask that you too be on time for the appt’. 15 years later and I have not had to wait an inordinate amount of time for my visit with my PCP. Don’t know many patients that can say that.

    2.) Ten years ago I had a major emergency surgery that required a very lengthy stay and recovery. The day after my surgery, I awoke from a medically induced nap to find my PCP sitting bedside holding my hand. S/he was very concerned about my health, recovery and future. The PCP (not a hospitalist) stopped in regularly over the course of a month long stay, arranged for social workers to stop by daily to talk to assist me with my acceptance, dealing with my prognosis and recovery. Later months after my discharge, my PCP admitted to wondering if there were signs/symptoms that s/he may have overlooked, that possibly could have avoided the emotional stress and physical problems that had plagued me. I believe it was genuine concern for me – and not concern regarding malpractice as some would suggest.

    3.) Years later I would encounter complications and again emergently ended in the hospital. The diagnosis was not surprising, but the admitting team proposed treatment plan was concerning and not at all what I could fathom. Due to family issues; it was not a good time for me to have life altering surgery and encounter months of recovery. I spoke with my surgeon (Chief from another department) who had a basic understanding on my home situation and a detailed understanding of my medical situation. S/he consulted with the admitting team Chief and then suggested an alternative solution that would enable me to have care that would get me thru the immediate medical situation and deal with my family situation. My surgeon offered an option that might be only a temporary reprieve but allowed me to return home sooner without jeopardizing my health. For the admitting team Chief, s/he felt so strongly about taking the more extensive and life altering procedure; s/he actually called a psychiatrist to speak with me. For the surgeon that did not know me, things were black and white. Diagnose the problem, identify the standard course of action, perform the standard course of action, send the patient home to recover and learn to deal with the new normal. There was total disregard for my needs beyond the immediate medical issue.

    Thankfully my surgeon took the time to know care about me beyond the end of the scalpel. For my surgeon; I am part of the medical team! The alternative surgery was performed successfully well. It has been 4 years later and I have not required a return for the original suggested course of treatment. I continue to see my surgeon for follow up care and continue to work together to keep me in good health.

    After the lengthy relationship I have with my doctors; I am involved with the interns/residents more closely than most patients might be. When I am inpatient; I am usually the last patient on rounds which allows a bit of extra time during the visit. I usually am involved in providing feedback to the residents and attending’s. We have a quasi-agreement: Residents learn from the books rotations, but I can enhance that knowledge from the other side so that the care provided is above and beyond the standard. Medicine that treats a patient as a whole being provides a better outcome….as they say the sum is greater than the parts.

    As you continue your residency; you will need to follow the path set forward by the institution and department of your chosen specialty. Upon graduation and establishing your own practice take those ‘basic’ skills and adapt your style to what works for you. You may find that integrative or holistic medicine is for you. And you may find that sometimes the patient provides the ‘pearls’ needed for you to be a success in whatever direction you choose to go.

    Be well and the best to you as you move through your residency. Catch every bit of shut-eye possible and remember to breath. Medicine is a job/career, but as you are coming to understand; it is so much more.

    • justgngr says:

      thank you so much, means so much to hear from someone who just “stumbled” on the blog. Hope you enjoy reading some of the other posts as well, and feel free to share with friends

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