Tuesday, May 01, 2012

don't let them change you or even rearrange you

Well, time flies when you're not having fun. Or when you are. Pretty much either way. That's the thing, isn't it?

Anyway, it's funny, this stupid blog. It just sticks around and takes up space, and I am often remiss about posting to it. It's foolish to write a blog like this, so turned inward and self-absorbed, for anyone else. So most of the time I write assuming no one is reading anymore, and it becomes a place to have a conversation with some conjured up version of myself.

All of that is true, and yet it always seems like magic when I find someone is reading all of this, following along with all the silliness. I can't explain why exactly but it means a lot.

I definitely reached my limit last month, and now I am recovering. The catch with medical training is that you want to change. In some ways. You want to become more competent, more confident, more facile with figuring out a diagnosis, better at having difficult conversations, more efficient. You want to become a good doctor, or at least a better one. But as you strive for that, in residency, there are dark forces at work that seek to change you in other ways. Outpatient clinics filled with patients with a million problems they have no interest in fixing and coming to you because they want a prescription for pain medications or want someone to fill out disability paperwork. (All of that would probably be a lot more tolerable if you were not so stretched thin for time that you can not give any of it your proper attention) Uninsured patients who get admitted to the hospital over and over and over again because they can't get any proper medications or care outside the hospital (good job, US healthcare, once again- very cost efficient). Attendings who treat you like you're a sucker and a sap for spending more time talking to a family about their mother's desire not to have invasive measures taken rather than spending that time running medications like pressors to keep a patient's blood pressure artificially normal when their heart has already decided it doesn't have the energy to do it anymore. And, most recently, patients who actively use methamphetamines, develop a variety of heart problems, which you spend time treating, only to be assured that the patient will reverse all of your work and return to the methamphetamine use as soon as you discharge them from the hospital.

Very dark forces.

I fell victim to them last month, and it was disheartening. I'm hoping I'll never feel that way again- never feel that frustrated with patients and my work. It's as much the fault of the powers that be. The cardiologists treat patients like all they are is a heart- they don't look at the whole patient and their context and what they will and won't be able to do when they leave. On the other hand, maybe they shouldn't. Everyone should have access to care, which includes medications they need and clinic visits that are required when they leave the hospital. No doubt, it would save money to the system in the long run. But then, and this is the very dark part, but you are basically deluded and Patch Adams-ing it up if you do not acknowledge this- there are a small subset of patients who just don't want to take care of themselves. They will drive you insane because despite your best efforts and myocardial infarctions and stents and scares, they will leave the hospital and go right back to self-destructing, and show right back up at the hospital a short time late. You have to face that fact and accept it and choose to treat everyone anyway. Ultimately, that makes you a better doctor, I think. But it's certainly not easy.


pied piper said...

I've gotten the strong sense that the first few months of 2012 have been a period of "very dark forces" all around, in general. I know you're also talking about something more timeless than that, but there's something about what you're saying about last month for you that feels like it fits a bit too perfectly in time and place and rings a bit too true. For whatever little that might be worth....

maya said...

I don't check in every day, Brimful, but once in a while I need to read real thoughts. You always have real thoughts and you articulate them fluently.