Balls and Walnuts
more than you ever wanted to know
Saving lives
Me here, maundering again.
A conversation with Karen last night sparked this post. She’s convinced I’m trying to save my friend’s life.
I don’t know why, exactly, but the idea of saving anyone’s life disturbs me. Aside from a few dramatic cases — crash tracheostomies or cricothyrotomies on suffocating patients — I can’t think of many instances where I directly and unequivocally saved a life. Ear, nose, and throat docs are not ER docs, nor are we critical care docs. The big S just doesn’t come up that often.
Some patients, however, perceive that I’ve saved their lives. Most common situation: prompt diagnosis by me followed by correct referral, when the patient had been bounced around from one doc to the next. Does that count, I wonder? But I usually deflect the credit in those cases. Don’t forget, I tell them, I’m not the one who operated.
It’s not humility. I feel an almost physical discomfort when these folks try to thank me. Here’s a thought: maybe I don’t want the responsibility. If I take credit for the saves, I have to take credit for the losses, too.
I’ve touched on this before and I’m not sure I can say it any more eloquently. Disease terrifies me. Death terrifies me. Becoming doctors, we gain no mystical control over the health of our loved ones. I can’t keep myself or my family from harm. I suppose I’ve learned how to control the terror, learned how to do what’s necessary and not be paralyzed*.
So, yeah, I can get the job done. Dealing with my feelings, dealing with my patients’ feelings, that’s the tough part.
It has taken me all day to write this much.
What am I trying to do with my friend? What do I try to do for my patients? Am I really trying to save lives? I guess so. Mostly, I’m trying to make a difference. You know, we’re taught in medical school that just caring helps all by itself. “The laying on of hands” — touching people helps, too.
Selfishly, I’m trying to do something to combat this awful feeling of helplessness I get not only with my friend, but with every patient in whom I diagnose (or others diagnose) a life-threatening disease.
In a perfect world, I wouldn’t get sick or die. My loved ones wouldn’t get sick or die. The only people who get sick and die would be the evil people. Often, though, it seems like the only ones who get sick or die are the good people. It really does seem that way.
D.
*Maybe that’s what those crash situations are good for — the emergent tracheostomies, or, better example, removing half a pigeon skull from a toddler’s windpipe (true story). You feel that paralysis gripping you but you get past it because you have to. Inaction is not an option. And when you learn it in those situations, it’s easier to carry the feeling over to other patients . . . the ones who won’t die in the next five minutes, but will die in the next five days, weeks, or months if you dick around and don’t do the right thing.
Hmmmm.
Well, I’m not sure that most doctors (surgeons and ER doctors aside) really go into medecine to save lives. Or at least I would be surprised to hear that a large majority of all doctors did.
From my experience with my horse vet, C., whom I first met when she lived on my aunt’s farm while she was in vet school, I’d say that mostly she wants to make the daily life for most horses better and more pain-free. Flushing a wound isn’t immediately lifesaving, nor is staining a cornea to see if there’s an ulcer or a scratch, but if she gets a call such as those, she leaps into her truck and beats most speed records. The *idea* of an animal in pain deeply bothers her.
On the other hand, being a vet, she has to euthanize a lot, so that’s an entirely different view on death. I guess it’s not really analogous to human medecine, now that I consider that.
However, in truly life and death situations, I’ve seen C. display true bravery and skill–but it’s not *why* she became a vet. I don’t think most doctors or vets truly believe that they have the power to save a life. Doesn’t stop anybody hoping, I guess.
So, what would be the very worst thing that could happen if you ARE trying to save your friend’s life? That you would be deeply hurt, sad, and disappointed if she were to die? Isn’t that what you’re going to feel anyway–tinged with a touch of anger? Disease sucks. Really, it’s OK to say that. Pain hurts and death is no party. If you end up depressed at the end of this journey, is that truly the very worst thing that could ever happen? (I’ve fought depression for most of my life, so maybe I’m just more used to it than most.)
You’re damned if you care deeply about another person and you’re an ass if you ignore a person in pain. I’d rather you not be an ass if at all possible.
Although I’m sure you want to *show* me your ass, right? 🙂
Oh, Suisan, you’ve already seen my ass. Clothed, admittedly, but you can imagine the rest.
I don’t think many of us go into it to save lives (I certainly didn’t, but my path here was anything but typical). But do we go into it to gain some control over illness and death? I think that’s a given (except for those douchebags who go into the cash-pay kaching kaching disciplines with dollar signs in their eyes).
To answer your question — what’s the worst thing that could happen — I could end up feeling like I’d failed her. That would hurt.
“She’s convinced I’m trying to save my friend’s life.” And why not? Whose life better to try to save? I’m eternally grateful to my friends and doctors who saved mine. Is it better to not try? I guess I don’t understand. Having had breast cancer and fought the battle, you lose a few friends along the way – believe it or not. Some don’t like your brush with death because it reminds them of their own mortality. Some don’t want to advise you. Some think bald is not beautiful. Some don’t understand when you are too tired to party. I hope you are the friend with the medical knowledge that comes out fighting for your friend with both fists.
How very differently we’re coming at this, cd. My point is, if I try to save her life, I could fail. That bothers me a lot, so I’d rather not think of it that way.
I want to help her. Of course I want her to live. But when Karen phrased it that way — I figured you were trying to save her life — I had a bug-eyed moment.
Yeah, I’m really not expressing this well.
I reread my last comment (above) and you know, I’m getting sick of myself here. On the one hand I want to blog to help think through these things, but on the other hand I’m uncomfortable with the way I’m making this all about ME. Feel free to call me on my bullshit, people (my wife has no hesitation in that regard 🙂 )
Doug,
So, I can’t totally understad, but I can empathize. Who wants responsibility for another’s life. When I first held my son in my arms, I cried. I cried because it was *my* son, I cried because he was healthy, and I cried because I had to watch over him, keep him safe, and ultimately be responsible for him (at least for the next 18 years or so). I mean, who gets blamed for it all, psychologically or otherwise but the mother.
So, maybe I can understand not wanting to put or phrase it that way. That by saving their life, possibly, you are then responsible for the losses as well.
But, despite not wanting the responsibility it’s there. You’re a doc. I’m a mom. We are responsible, because we stepped up to the plate. It’s like not wanting to become a parent, but flubbing through it the best you can.
That’s how I see it. Take the good, with the bad. But, hope for the best, and do your best to bring out that outcome.
In the end, it’s all you can do.
Rella
Leave it to a spouse to cut through the b.s. and see the things you can’t – or don’t want to.
As for this being all about you, I’m sure that it’s not. It’s just that here’s where you can explore how it affects you, and deal with it–sort of a pressure valve. It’s a good thing.
I’m not afraid of death or dying…we’ll all do it eventually.
However, the dying *process* freaks me out.