a dissident is here

The healthcare system is broken, I tell the interns, when we are frustrated about a patient's care.

But what I should say is that America is broken.

That the world is broken.

Everything is broken. It reminded me of this poem by Berberova with the lines-

"And if everything gets broken, there'll be nothing.
And people have broken so much inside."

I'm feeling very empty. I'm feeling like so many physicians feel these days. Broken inside, hollow. We are the hollow men (women).

The healthcare system is broken. But I went to my patient's bedside in the hospital, and this was done during my lunch hour, because these are the kinds of things physicians are encouraged to do during their break time, while also being lectured about the importance of wellness and balance. I went because the man, who I'd only met once before, was hospitalized and found to have cancer which had spread to a part of his small intestine that was making it impossible for him to eat.

He was forced to have a nasogastric tube, and he was not allowed to eat because the gastroenterologist had tried to place a stent to relieve the obstruction the cancer caused, and it had failed, so then he was awaiting a possible surgery. He was tired and frustrated, this I understood. I did not expect him to be overjoyed to see me, or even particularly grateful.

I also did not expect him to scream at me in rage, tell me that every one of us doctors were worthless, that if he could take the nasogastric tube out, he would shove it up one of our backsides. I did not expect his wife to yell at me multiple times about not being able to give her straight answers, whenever I answered her honestly about the likelihood that chemotherapy would help him.

You feel, in these moments, like a bad doctor. You've been trained to swallow these screams and rationalize them as poor coping, difficulty with accepting a diagnosis, misplaced anger.

The wife yelled when it was becoming increasingly obvious to both me and even her that all of their complaints weren't even related to anything I could control, "look, we are looking for a punching bag, and I think you should volunteer to be that person for us!"

Yes. Sure. I went to medical school, residency, fellowship, I do research, I chose to go into oncology. Specifically because I was looking to be a punching bag. Yes. I have done years of work to make sure to avoid my family's tendency to designate me their punching bag. But therapy, schmerapy, sure, please, let me be your punching bag.

I sidestepped the conversation. I redirected the way I've been taught to over the years. People tease, "wow, you've got some tough patients," or they say "just" and they follow the just with things that infuriate me.

Just walk away.
Just set some limits.
Just don't take it personally.
Just focus on the medicine.
Just remember they've got metastatic cancer.

Because sometimes as an oncologist, sometimes as a doctor, we just have to swallow the daggers down. But here is what I was thinking about, from W Kamau Bell's Private School Negro:

"When racism happens to me... historically, people of color just hold it. This is true of all the hates. Like transphobia, like homophobia, like ableism. You just hold it, and you have to take it home. But in 2018, I'm playing hot potato. I just toss it right back. Nope! I'm out of time. I'm out of time. You tell the story."

Because the reality of the matter is this patient and his wife, they saw a woman, a woman they thought to be younger (if only they knew), a woman of color. Did they lose their temper with any of the white men on the team? Nope.

I'm sure it wasn't about that.

White people say this. Maureen Dowd says this.

It's not even 2018 anymore. It's 2019. And it is racism. And sexism.

And I am f***ing very tired, and broken. And everything feels broken inside. And outside.

But I thought of W Kamau Bell's words later today. When, after a series of pages and a nearly comical carousel of communications that went nowhere, I decided to try one more time and called the patient's wife, and the patient's wife confirmed it was me and then said, "Oh! Don't bother, we're getting someone new on the case!" Then proceeded to hang up on me. Today, I thought about W Kamau Bell's words, and I decided to hand the hot potato back to her. Because today, I fired a patient, refused to see him again, and said it was best for everyone involved if we no longer communicated.

I have never done this before.

I suspect this won't be the last time I do it.