Sunday, August 26, 2012

The O.K. Corral

I had already decided that I wasn't going to be a pediatrician.  So my third year rotation ended on a high note.  I was working in the cardiac care unit.  Most of the admissions were short stays, teenagers with a history of congenital heart disease coming in for their annual cardiac catheterizations.  They were healthy.  They stayed for a few days of intensive testing, and then were discharged back to their normal lives.  Occasionally we would take care of a sick kid, but the majority was routine.

My days were filled with conferences.  I enjoyed the banter between the pediatric cardiothoracic surgeons and the interventional cardiologists.  The room was alight with spirit and bravado.  Later in the morning we rounded on the new admissions.  Lastly, I would see our only frequent flier

Jeremy was a twelve year old with end stage congestive heart failure.  From the outside, he looked like your average pre-teen.  But if you watched him walk down the hall, you would notice his face turn blue and his respirations increase.  He basically lived in the hospital.  Waiting for a heart transplant, he was confined to the cardiac unit and tethered to his IV pole with life saving infusions continuously dripping into his veins. 

No one knew exactly how long he had been confined.  He often stood at the nursing station and chatted with young nurses and the secretary.  He sometimes followed behind the medical students as one of the attendings gave an interesting lecture on the pathophysiology of disease. 

He was a funny kid who was beloved by all.  More than one staff member said a prayer each night while kneeling in front of their beds hoping he would receive the heart he so badly needed.

My last weekend on call, I arrived to the floor Saturday morning to find that Jeremy was gone.  A poor family's tragedy became his possible triumph.  The report from the OR was that they were sewing up his chest with a perfectly viable, beating heart. 

Later that night I accompanied fellow doctors, secretaries, and nurses to visit him in the ICU.  His angelic face was swollen, and his mouth was distorted by a breathing tube.  But his vitals were stable.  We all felt sure that he would make it through just fine.

I beamed with pride upon leaving the room.  I was beginning the journey into the profound profession of medicine.  I, like the brave cardiothoracic surgeon, would deliver life saving care.  I would make people whole again.

Years later, I realize that such pride is very common in medical students.  It's a time before reality sets in.  A time before we willingly jump into the meat grinder that is our modern day health care system.  It's spits us out rough, haggard, and much less idealistic.   Many will say that it is the training process that beats the spirit out of us. 

I think this view is much too simplistic.

How often are we wounded when a loved one or family member dies?  How deep does the dagger cut?  How long before the wound heals?

The problem with being a physician is that we are sliced and diced every single day.  We fight so many battles that from the outset can never be won.  We watch helplessly as death stakes it's claim, and try haplessly to deal with the remnants of destroyed life

Over and over again.  Year after year.  We are marked by the tragedy that we witness.  We carry the extra burden of culpability and responsibility.  And we ruthlessly try to wash the blood from our own hands.  Victories are transient and far in between.

And patients wonder why their doctor is distant.  They wonder why in desperation they reach out to the stone cold figure that stands distractedly in front of them.  They become angry, suspicious, and sometimes downright accusatory.  The net effect is that the wounded doctor crawls further into his shell of protection.  Facing an angry public and afraid of litigation, the isolation becomes greater.

Once again we are stuck with a doctor-patient relationship that is dysfunctional.

It's like we're both gunslingers at the O.K. Corral.  As we stand with our guns pointed at each others chests, we realize the silliness.  We need deep, meaningful communication so badly, we just don't know how.  But in order to avert grave misfortune, one of us has to be brave enough to re holster his weapon first.

Can you see what I'm trying to do here?

I'm trying to lay down my gun.

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