As I’m working through my medicine sub-internship (the closest to on-the-job doctor training as we ever get in med school), I have met a handful of memorable patients that have forced me to ponder our place in medicine as doctors. Like, in a non-ironic non-philosophical way.
There are that cohort of patients for whom hospitals are built. Examples: our man with pancreatitis in whom we flushed out the triglycerides and he went home; our lady who bled into her abdomen in whom we cauterized the errant bleeding vessel and sent her to a specialist; our dude who drank too much and had seizures for whom we controlled his withdrawal and hooked him up with rehab. They come in sick, we help fix that sickness, and we send them where they can safely get recover. Doctors should be first and foremost healers, and I think they actually do appropriately heal these people.
Doctors are experts in biological death, and for some reason society has come to expect them to serve as the modern experts in spiritual and emotional coping with death. So when a family rolls in an grandfather at the brink of death, every doctor must be ready to counsel families at the drop of a hat (if hat = blood pressure). Shepherds in death, if you will.
Sometimes doctors can do nothing at all to reverse the course of a disease, like in the case of an inexorable disease like ALS. Yep, I got another end-stage ALS patient, a throwback to my first. Fortunately, this guy was understanding and realistic and we’re now figuring out a way to retain his mind and feel connected with his loving family until the day he passes. That’ll be soon, but that’s okay.
Sometimes doctors make the situation way worse, like the patient who’s in medical limbo because the medical establishment put him there. Dialysis has gifted him with 15 years of extra life, but another doctor gave him a drug that interacted badly and burned out his bone marrow, and the doctors here are keeping him hobbling along with constant transfusions and fantastical fortune-costing therapy. He’s suffering because of us meddling doctors.
Then there’s this last patient. She came with a simple cough, but thankfully we found some neuropsychiatric illness smoldering in the background. She was lost to medical follow-up between moves and now I think that there’s no reason for her to be so sick at her age. It’s the kind of workup that takes dedicated social digging and extensive conversation with a skittish patient, something that just isn’t possible over the weekend between five residents and five attendings all juggling many patients. That means it’s up to me. Maybe. I dunno.
It is our place to interfere in such matters? Clearly we are supposed to fix her cough (that’s easy), but is it our obligation to scoop her up and keep her in the hospital to hunt down these ghosts? How far does our responsibility to heal reach? This is one of those times when I have to decide what I will actually do to deserve that label of doctor in a year’s time.