Monday, April 16, 2007

Moving the Rock and getting Out of the Hardplace

So I have to admit to something: I've been inordinately spoiled in my working life. I have had a variety of jobs that I loved going to and never felt like I had to drag myself out of bed to get to them. My Medicine rotation has been a bit of a rude awakening for me because of this. Oh, I still really enjoy taking care of patients and I've meet a character or two that have always managed to put a smile on my face at 6:30 in the morning. But I find the various rounds, sometimes up to four times a day, somewhat inefficient and impersonal to the patient we interrupt.
Added to that is just a general feeling of frustration. A lot of the problems which bring people to the hospital are problems they leave with. Yes, their acute issues are dealt with and for the most part they're stabilized back to baseline. But so often what we can do for them is only a small bandage over a hemorrhaging wound. Admittedly, today was a bad day. We essentially told a patient who came into the hospital, functional and relatively healthy, that they were probably going to die during this admission. Beyond supportive care, there isn't anything that can be done. I can only halfheartedly imagine what is going on in their mind. My own reaction to this has been more visceral than it should be: I like this person, I care about this person, and this just freaking sucks! A part of me longs for the caring but separated reaction of my residents and attendings, but I'm not sure if I'm ready yet for that kind of emotional detachment. I know that it has to come in order to develop the necessary professional objectivity, but getting to that point means that I have truly lost touch with the individual I was three years ago. And sadly, I liked that person quite a bit better.
Ultimately, I really admire people who can go into internal medicine, but I wonder how they can stand it sometimes. You loose the majority of your battles. People you've known for years die on you slowly and piece by piece till there is either nothing left of their body or their humanity. Obviously, this experience has been very disheartening for me. And yes, I realize that this is the reality even in surgery. But there you seem to win enough cases to give you some sense that hope isn't just a pretty word.
Ah well, tomorrow is another day and to paraphrase: If I can get one warm blanket I shall not live in vain.

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