Dulce et decorum est…
“Doctor, you’re some hard to get in to see”.
“Doctor, I couldn’t get an appointment to see you for another week, so I figured I’d ask you here…” (in the grocery store, children’s birthday party, restaurant, karate class)
“Doctor, your patient has been calling in all day for this prescription refill. No, they haven’t made an appointment, and by the way they need it in the next 20 minutes before going out of town for a month”.
“Doctor, I know you’re running behind and need to pick up your sons but Ms M says her little boy has frothy pee and some swelling and needs to be seen. No, she says they can’t get to the walkin clinic and she hasn’t got childcare for the rest to be able to wait in ER”.
“Doctor, the office of the specialist you referred Mr R to called and said you need to fill out this stack of forms instead of the consult you already wrote. Yes, it requests the same information you already gave, but look; here they have special blanks for each bit of information. They say it helps triage patients and streamline their clinic…”
“Doctor, you’re turning an amazing shade of purple…”
This week, I told a patient she needed expedited investigations to rule out likely breast cancer. I delivered a baby whose heart rate had dipped into the 70’s, precipitating cutting an episiotomy to deliver quickly, then managing a moderate post-partum hemorrhage in the babe’s mom who had a retained piece of placenta. I did a biopsy on a young lady who possibly has scleroderma. I told a young man that the reason he and his partner could not conceive was that his sperm count was far too low and had no apparent reversible cause. I told a middle aged lady whose brother was on dialysis that she had the first signs of chronic renal failure. I had to discuss all these things, put investigation or management plans into place in collaboration with the patients, or in the case of the intra-partum scenario, I had to work fast to manage issues that could end up in a baby and/or its mother dying or being compromised for the rest of their lives.
It is only recently striking home that clinical stuff like this is the nicest, most relaxing part of my job. Hard on the heels of that thought is “Oh, my God” (or some iteration thereof). It is easier to tell a patient they have cancer than it is to hear day after day how hard it is for patients to make an appointment.
What demented logic has fostered this? “What rough beast, it’s hour come round at last, slouches towards Bethlehem to be born?” (Keats, The Second Coming). I, like most others, went into medicine to help others. It is often assumed that physicians hang out their shingles to make some serious cash, but when you take a closer look, if money played the leading role then choosing medicine is the most asinine decision a person could make. It would be like agreeing to simultaneously take on six sumo wrestlers so that one could get some exercise. Physicians have a hypertrophied sense of responsibility. No, not hypertrophied. More like responsibility on ‘roids. Pair this with the sense that we are only worth anything as people if we give everything we have to others, through medicine, and really we end up early-on queuing our own brainfuls of schoolyard bullies as sort of self-flagellation devices. Really, if you want a job done right, do it yourself. Who else could be as hard on ourselves as…well…ourselves? And what other motivation could be as effective as the internal rod and weal? For the perfectionistic, obsessive and vulnerable physician-prototype, there can be a comfort and relief in adopting this approach. Pre-emptive martyrdom takes away those scary senses of intolerance of existential uncertainty and dread of worthlessness and inferiority. Those nice little baskets full of self-actuation earned when we give of our extra time to help our patients make it all worthwhile. We don’t always fully realize that the value we ourselves place on these prize baskets increases based on what we (or our friends and families) must sacrifice to win them.
To be the eternal unfailing hero and to be human are incompatible. To strive for both while understanding and accepting limitations is admirable. To try to hold with utmost care, compassion, and competence the lives and health of others is the honor we assume day to day. To give of the self until the self is defined by the giving, to hold one’s own reflection up to the harsh light of day often enough to burn away any shadow of illusion, to continue to guiltily hold those illusions hostage as we try, again and again, to be everything to everyone; that is to be a physician. Medicine is easy. Co-existing with medicine is the hard part.
…pro patria mori.
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Guest Blogger Bio:
Dr. Gina Higgins - "I'm a 37 yo family doctor, in a full time group practice including obstetrics. In the past, I have worked at everything from critical care and hyperbaric nursing to shelf stocking at Walmart. I work with the Newfoundland and Labrador Medical Association Physician Care Network, Faculty of Medicine of Memorial University as Student Affairs Director (Distributed Sites) and Master's student at the University of Western Ontario. I have two lovely little boys, and a cornish rex cat. I just got my yellow belt in karate and have a narrative published in a family medicine textbook."
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