"You seem like a really personable person. That's a great quality to have. Y'know, it takes someone that's sincere and honest to be a good doctor. I'll bet your patients love you. You're going to be a fantastic doctor once you're done."
Take a guess who told me this. Student? Colleague? Attending? Fellow? Nurse? All good guesses. And I'd love to hear it from any of them. But those guesses would all be wrong.
The correct answer is stripper.
"Ifinding, what's up with your blog? After reading it, I wanna run out into traffic." This is the subtle way my friends tell me that I've been a tad morose in my blog. I've been working a lot of days straight. My last day off was 3 weeks ago. It's been dragging me down.
So, it feels nice to finally have a day off again. I feel better, like there's a little hope in the world. I'm tired, as I slept only about 4 hours, but it's a good kind of tired, the tired after having fun.
Still, though, I know that there's so much missing in my life. And maybe those things will work themselves out, but for now, I think I'm content with a day off, so I can feel like a human again.
When I wrote this post about deaths in the hospital, a fellow blogger pointed me to a short story called "Zanduce at Second." It's about a baseball player for the Orioles who has managed to kill eleven people with errant foul balls. There's a wonderful line in it: eleven [deaths] isn't really worse than one for me, because one was enough by itself. It doesn't double with two.
I had a patient who was terminally weaned today. The patient was old and had risk factors. The patient had significant, severe disease. By all accounts, it was this person's time. Compare this to this young lady that I was following earlier. She was 30 something, young, without medical problems, and generally well until a vessel in her brain decided to explode.
If you look at things objectively, you'd say the younger patient is far more tragic. She was young and in the prime of her life, leaving behind a family with children, and the children she could've had. Her life was cut 40 some years short. It's awful.
But the thing I've learned is that you can't quantify tragedy. There's no yardstick for it. This old patient and the young lady, one is not more tragic, not more sad. It's all tragedy, and that's something that can't be added or subtracted. In such unequal circumstances, there's always equality in sadness.
I was driving into work yesterday, and I was listening to Jimmy Eat World, and the song, "May Angels Lead You In" came on. It's a great song. And I was suddenly bawling, in the parking lot of the hospital. I had to sit in my car for a couple minutes to compose myself.
Maybe it's all the tragic cases I've been seeing lately, with patients dying left and right. And I can't help but remember my aunt. There's just so much death out there, and sometimes it catches up with you. And I'm normally very good at compartmentalizing my feelings, locking them up in a little box and putting that box in the back of the fridge.But not this time.
Sympathy can be a dangerous thing sometimes. Because there are so many tears to shed, and if I were to cry for every sad case, I'd have no tears left to shed.
Today, we were talking about hypoglycemia, and if you talk to people who finished their training only a few years ago and you'll hear the words, "Hyperglycemia doesn't kill anyone. Better to be high than low." This has been dogma until recently, when several nice studies have shown that poorly controlled glucose in critical patients increase mortality up to 15%. Now, the thinking is the opposite. I've actually told patients that hypoglycemia is the price you pay for good glucose control.
Then, there's pulmonary artery catheters. 4 years ago, this was a bread and butter procedure for internal medicine residents. Now, I don't know any resident that's done more than one. Looking a little further back, there's beta blockers in heart failure, the use of thrombolytics, stenting versus CABG, anti-TTG Ab versus duodenal biopsy.
My point is that medicine is a field of constant change, and not little change. Big change. Talk to a doctor 15 years ago, and if you told him that you thought that his heart failure patient didn't need a Swann and should be on a beta blocker, he'd accuse you of malpractice (and 15 years ago, he'd have been right!).
Some people like fields that are understandable and consistent. Medicine is not such a field. If the thought of continually keeping up with the changing world of medicine scares you, then you'd best stay away.
