An incredible post from an incredible friend.
Inspiring. I have goosebumps.
Current location: Barnes Hospital/St. Louis Children's Current mood: All Current music: DMB: Christmas Song
Tug of War
I've never been more nervous or more excited about what's going to happen from day to day. I'm blessed to be on the path to the greatest profession I could possibly imagine.
The first time a patient calls you "Doctor," it's really cool and really scary. I am not, in fact, a doctor yet, but it's fun to pretend.
I make sure to correct them immediately. I make it a point to introduce myself as "Eli, the MEDICAL STUDENT." I emphasize that I cannot prescribe drugs, order tests, or make any decisions regarding their care. I likely have never encountered their particular problem before. This is, in fact, the first time I have ever sutured, or used an Ultrasound machine, or done paracentesis. Beneath the facade of calm and confidence that I attempt to put up whenever I stroll through the hospital in my short white coat, I guess the trembling of the foot-long needle I am about to stick into your abdomen must have given me away. The real doctors will be in to see you when I'm finished talking to you. I will be allowed maybe three minutes to tell them everything that we've talked about for the last thirty minutes to an hour, and then they will need all of five minutes to figure out what's wrong with you and how to make it better. No, I don't know how they do this. Yes, they are very good at what they do. You are in very good hands here...that much I do know.
Here's what I can offer you. I can get you a blanket. I will listen to whatever you want to tell me. I will even pass something along to the doctor if you think it's really important. I cannot guarantee that the doctor will think it's important; sometimes they will and sometimes they won't. But, I will be happy to tell them whatever it is that you forgot to tell them earlier. I will talk to your family. I have time to be polite, to talk about things outside the hospital, and to try to distract you from all the madness around you in this place. I am good at getting glasses of water, and sometimes I know where they keep the food trays. I have to check with the doctor before I let you eat, though. I don't know how to make that thing stop beeping, but I can find a nurse who does know. I can make sure your arm is really numb before I suture for the first time, and I promise somebody will check my work and do it all over again if it's not up to par. I will be back in just a few minutes to make sure your pain/nausea/cough/chest pain/bleeding/withdrawals/delusions are better. If you need anything in the meantime, please let me know, I'll be at the station out in the hall.
I have been in third year of medical school, and thus an official part of the hospital, for three months. It's a much sadder place than I ever thought. Before, I always thought of hospitals as places where people come to get better, as hopeful places. And they are that too, if they weren't hopeful and if people didn't get better, then being a doctor would be about the worst thing ever. But the sad thing is, people rarely get all the way better. One of the most hopeful things I have seen is seeing an acutely psychotic or depressed patient emerge as a functional, interactive human being again. One of the most troublesome things is seeing that person back on the floor or in the emergency room a month later. It's really cool to see a patient walk out of the emergency room when they came in on a stretcher in severe pain, but that victory is dampened when you realize they've been in with the same pain every month for years, or if you know they're leaving now because it's time for them to get another fix or start having withdrawals. Learning to be a good doctor is learning to not get taken advantage of and to not be disillusioned. It's learning that not all real problems have real explanations. It's learning a lot of stuff about a lot of stuff, and knowing how it all fits together, and knowing that in a second because you don't have time to look it up. It's learning how to give somebody bad news without crushing their will to fight, and it's learning how to know the worst possible outcome, the worst probable outcome, and not losing your will to fight. At least, I think it's all of those things, but I'm only three months in, and I'm pretty sure it takes a helluva long time to learn how to be a good doctor.
I haven't seen a patient die yet; I don't know what I will do when it happens. I have come to see a patient and found an empty room. I followed two kiddos in comas during my two weeks on pediatric neurology. One of them came in the night before I started; she was the first room my team visited. The other guy came later in the week. Both kids had a lot of problems, neither was a "normal" kiddo outside of the hospital, and both had very little interaction with anyone around them. Parents love those kiddos just as much as any "normal" kid. One set of parents hung on every word we said, wanted to know what we thought, made sure to be there every time the team came in. The other set of parents wanted nothing to do with the doctors on my team, didn't care what we thought because they didn't believe us anyway, and would have preferred different doctors. Somehow I managed to connect with both sets of parents...I think it was my bow tie. I told one of the moms that I was rotating onto a different service and wouldn't be taking care of her kid anymore; she told me there was no rule against visiting. My friends on the service after me told me that the other dad, the one who really didn't like doctors, asked if the "bow tie guy" was going to be coming back. Unfortunately I got busy and distracted with adult neuro, and I didn't make it back to visit for two weeks. I went back on the first day of my Emergency Medicine rotation because I had an afternoon off. I rounded the corner of the PICU, expecting to see the dad arguing with a doctor or hovering over his son like always, mom sitting in the corner convinced of a miracle and unwilling to accept any talk of anything less. The room was empty. The kiddo died early that morning. I went and saw my other kiddo down the hall. I read her chart; she had gotten a little better in some respects, and worse in others. Her mom wasn't there, so I just went in briefly and then left. The next morning I got a text from my friend on the service...."Eli, I just wanted you to know that your kiddo died this morning. Her lungs had gotten really bad, and the only way to fix them was surgery. Her mom had promised her no more surgeries, so they withdrew care."
There are a lot of ups and downs in the hospital. They don't equal out, but they don't have to. Sometimes you just do all that you can, and that has to be enough. It has to be. And emotions, emotions are completely messed up. You try, usually without complete success, to stay focused on your patient, to keep compassion as your primary emotion, but so often incredulity or stress win out. And you can't be really happy about every happy thing, or really sad about every sad thing, because there's another happy or sad thing coming, and there's not enough time to sort it all out. So here's what you do, if you're lucky. You try to put the patient first. You try not to look dumb in front of residents and attendings. You try to do both of those things at the same time (which is hard, because when the attending asks about something you forgot to ask or check, you have to say "I don't know," and go back and do it because it's best for the patient, but it makes you look really clueless). And you play a delicate tug of war between your brain and your heart. If they balance out just right, you can get your brain to not think about things too much as long as your heart doesn't feel about things too much, and hopefully neither one falls into the pit in the middle when you're not paying attention.
Sometimes your eyes get wet, or you go on a really long run, or you spend a night angry or lonely or worried or scared. Sometimes you have no fingernails left to chew. Sometimes you whistle in the shower, and sometimes you smile at strangers. Sometimes you cry at something on TV, or read websites like givesmehope.net, or drink one or five too many beers. Sometimes you just really want an Oreo Blizzard. Sometimes you just really need a warm body next to you. Sometimes your dreams wake you up three times a night. Sometimes you lose hours in the deepest sleep you've ever had. Sometimes Paul wrote an epistle directly to you. Sometimes you just can't go to church because it seems too easy and too good to be true. Sometimes you just really, really hope God knows what he's doing. Sometimes you know deep down that of course He knows what he's doing, but you wish it were more like what you wanted him to do. Sometimes you just don't know how to say what you're feeling.
And you usually pretend that none of this is because of the empty rooms.
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