Metamorphosis

When I heard the phrase, I couldn't quite believe what I was saying. Not only were the words cruel and unforgiving, they were intentional and calculated.

I hope you sleep well tonight knowing that you tortured this poor lady in her last moments before death.

I could hear the sounds of CPR in the background as the nurse paused to digest what I said. I imagined strong arms pushing against the cracked ribs of a frail, demented, elderly woman whose quality of life had been minimal for the last few years. Even though I spent months trying to convince the family, they had only agreed to the Do Not Resuscitate order a few days prior. I dutifully placed the paperwork in the hospital chart, but apparently it meant nothing till the power of attorney signed the form.

Days later, as my patient was coding, it was noticed that the order had never been signed by the family. The nurse was unapologetic.

We've got liability issues doc. No order....No DNR!

I slammed the phone down in anger. I hoped the sting of my words would at least convince the code team to move in slow motion.

*

I grew up the youngest of three boys. I was shy and withdrawn. I spent a good deal of my youth afraid of my own shadow. I was soft and supple, pliant. By the time I reached medical school, it was safe to say that I had never raised my voice to anyone.

It is impossible to explain the deluge of medical education to someone that is unexposed. Students and residents learn to fight for scarce resources. In an attempt to advocate for patients, voices are often raised, threats are made.

I learned quickly that in order to protect those under my care, I either had to become a master of confrontation or get trampled. For the first time, I used cruelty and anger to force the unwilling hand.

And it worked: the X-ray tech would schedule the MRI early, the specialist would leave a full clinic to meet me at the bedside. The more voracious my attitude, the more I could accomplish.

*

A few minutes later my thoughts were interrupted by the jolly ringtone of my cell phone. It was the nurse again. The code was over. I took a deep breath and began to apologize for my inexcusable behavior. She interrupted me.

It's okay Doc! If it was me on that table, I would've wanted someone like you as my doctor!

I thanked her for being gracious.

I hung up the phone.

And then I wept.

*

It's only now that I realize that the anger of training wasn't about advocacy or about getting the job done.

It was about grief.

We fought so many unwinable battles that we grasped at any form of control that was available to us. We may not be able to cure the disease, but we certainly could get our patient to the front of the line.

We yelled, we threw things, we were cunning and underhanded because that was better then crying.

Ten years out of training, I realize that I've seen enough suffering for a lifetime.

And it has changed me.

Often in ways that I'm not proud of.