Talking about the dead
Now that I know what I want, I've been thinking alot more about what it means to be a doctor. I don't mean the play doctor that everyone was in Med 1 and 2, but the real thing. Even now as a med 3, I'm still in the safe bubble of not making the decisions. Right now I stand on the sideline and encourage the intern who is making a decision. Sometimes I feel superior because I'm sure on my course of action and can see that it doesn't really matter which beta-blocker we pick from the hospital formulary. To the intern, it is much more 'what if the beta blocker I pick has side effect X and I just killed another human being?'I would say in the past month and a half, I have been more profoundly affected by the ER and woundcare patients than I would have been before on my other rotations. I think it is because I have a little more time to think, whereas IM and OB kept you so busy you never processed the people ill/dying around you. I've had alot more time to see abuse and neglect now, and it makes me wonder what the rest of my life is going to be like.
With all the HIPPA regulations, I feel like I can't even talk about some of the things I have seen to anyone who is not a peer or an official med representative. Even when you do, it feels like some type of evaluation of your character. There is still this feeling that outsiders aren't supposed to see the dark side of the physician's soul. Or insiders for that matter. That may sound dark and twisty, but it's true. My patient is dying of X and no one on my service will use the word 'die' in a conversation about his/her care? We can say the treatment fails or the patient expires, but the mere word die cannot be spoken.
Honestly, how does anyone go home and talk about this stuff? Is there a normal well-adjusted way to say 'today we shocked a guy back to life . . . but he's sort of brain dead so he won't enjoy it . . . he's in the ICU and I might check up to see if I did anything wrong . . . he was a really cool case.' Did I refer to the death of a human as a cool case?
Or what do you say on that crappy day when you didn't shock him to life? Can you tell your mom about getting the couple to sign the death certificate for their 18 week gestation baby that did not 'live' in the eyes of the state? It scares me that I can be affected by all of this, and that there is a question of who I am when it stops affecting me.
And then I worry about what that will eventually mean to whomever I eventually end up with, and partially makes me wonder why I even bother. No one understands what it is like to be a physician like another physician/nurse and so forth. It also helps that you spend most of your time around other health professionals, so it makes sense to date them. Except that part where its a bad idea to date people you work with, especially if you eventually can be their superior (Grey's Anatomy isn't completely untrue). Which leads back to dating outside of that realm. Not that I have time to meet anyone outside, or, even if I did, explain to them how my life is going to work; let alone welcome them into my world of 'so-and-so died today.'
If, at that point, I can even use the word 'die.'
posted by Allie @ 3:51 PM
1 Comments:
it kills me when people talk about death in very obtuse terms (no pun intended...). one time in clinical, i had a patient who was pretty much forced to decide between having open heart surgery and not having it. usually, an easy choice, but the patient was elderly, and the sole caregiver for his wife, who had alzheimer's. so, the decision was more like: should he have the surgery, and essentially be unable to care for his wife because the recovery process would pretty much take him out of the game, or should he not have it, and die in a year or so. i really wanted to say to the patient, "well, the choice is essentially: how do you want to die?"
death is an inevitability: the only questions that need to be asked about it are "how?" and "when?"
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