Brought to you by Ambien

Lately, I can't sleep. I do my work. I come home. I'm exhausted some days. I eat dinner. I watch TV. I play around on the internets. I go to bed. And I lie in bed for 2 hours. It is utterly frustrating.

I know all about sleep hygiene. I have given this talk a ridiculous number of times. It is advice so trite that most of my patients thumb through a magazine while I give the talk. You've undoubtedly heard it before: set a fixed bedtime and waking time, don't nap, avoid caffeine and alcohol, exercise regularly...

Most of the time I am giving advice to patients, I am being hypocritical, but except for the caffeine part, I actually follow this sleep hygiene stuff, and still! Insomnia! It is utterly frustrating and agonizing. It seems like there should be some way to sleep better, some way that I can relax and get a good night of sleep every time. I wish I knew how.

Don't Become a Doctor #12 - Limited resources

One of the main principles of medical ethics is something called distributive justice. What it means is that resources should be allocated as fairly as possible, and when resources are limited, they should be aimed towards bringing the greatest benefit for all, not some.

When students think about distributive justice, they often call to mind health care expenditures and waiting lists for specialists. They think of MRI's and other expensive tests. It is a little detached, but the truth is that distributive justice is a harsh reality in medical care.

The easiest example is mass casualty situations. The first rule of triage is treat who you can save. If you can't save them, then don't waste your resources. It's cold, but it's society's competing interest.

But you don't have to have a mass casualty to find limitations in resources. I have been in a lot of tough situations as a resident. I've had a full ICU and patients needing a unit bed. I've had simultaneous codes. I've had three patients all go into respiratory failure at the same time. There are a lot of tough choices to be made there.

Now, most non-medical folks cringe to hear things like that. 'We need more nurses' or more financial support, or more beds, or whatever else. They mean well, but they miss the point. There will always be limits, but the most precious resource isn't any of those things. As a physician, I am the limited resource. My attention is a valuable commodity, and how I allocate it can be the difference in who lives and who dies. That is a tough call to make, and if you want to be a doctor, it's a call you'll have to make.


Some days, I worry that I don't have enough heart to do medicine. I worry that I don't have enough compassion for it. I worry that it will burn me out, and I'll find myself resenting my patients and wishing they'd stop bothering me. Everyone looks to the doctor for the answers, and I don't have any answers. I don't have any cures. I can't fix things. I worry.

Compassion isn't something that comes easily. It takes work to try to understand someone's point of view. It takes a lot of energy to see someone else's perspective. It is hard to show understanding in the face of something that you can't understand.

I wish that I had all the answers. I wish that it came easily. But some days, it's a lot of effort just to phone it in. Medicine is hard work. I can see why so many new students are looking to fields like radiology where you never meet your patients. Because there is something very attractive to never getting to know your patients. It would be nice not to become entangled in their lives, and sit up at night wondering if cancer got the better of Mr P, or what I can do to convince Mrs C just to eat. I am paid to care about these things, but a person can only care so much.