Monday, October 11, 2010

I'm Starting to Get It

From Ellen Lerner Rothman's book, Becoming a Doctor at Harvard Medical School (she graduated from our program about a decade ago, and her book chronicles her experience):
At times it felt as if death were everywhere.  In anatomy lab we finally uncovered the facial shroud and opened the skull to dissect the brain, and that was okay.  I talked to a patient who had nearly died the previous evening and would certainly die within the next months, and that was okay.  I came home, and my goldfish had died, and that wasn't okay.  I sobbed for half an hour.
This past week culminated in a similar sense of emotional drain that is very new to me.

On Monday, I met a 48-year-old patient who had been in and out of the hospital for severe abdominal pain for the last five years.  He had been forced to retire, lived alone, and had only his dog for company.  After the interview, he didn't want me to leave the room.

On Tuesday, I shadowed a neurologist for several hours.  I saw a 29-year-old man who had just been diagnosed with multiple sclerosis and couldn't feel his legs, a confused elderly gentleman who had had a series of seizures resulting in his increasing levels of incapacitation, and videotapes of two patients suffering intense seizures.

On Friday, Saturday, and Sunday, I attended a conference on palliative care, with physicians, nurse practitioners, nurses, managers, social workers, psychologists, and chaplains from all over the country.  Every person there experienced dying on a regular basis.  They shared details about basic mechanistics and interventions during the actual dying process, how to communicate prognoses and do emotional "damage control" after a patient has exhausted treatments, how to support families, ethical and legal dilemmas on withdrawing or withholding care, and how to deal with fatigue and burnout.

This Thursday we start dissecting cadavers.

Suddenly academic rigors do not seem like the hardest part of medical school anymore.

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