Sunday, September 5, 2010

Being a Physician

She had recently celebrated her Emergency Board Certification. After completing her 12-hour shift, which had consumed two extra hours of paperwork and transferring of patient data to her peer, she had finally left the hospital at 1 AM. It was a clear still night; the stars were out in their full majesty. Somewhere in that 25 miles of car ride between work and home, her eyelids grew heavy with fatigue. And then there was a veteran rheumatologist moderately obese from the love of Cheeseburgers who had just completed his “patient-rounds” in the hospital and had made his way back to the parking lot. He felt tired that evening, so instead of starting his car and rushing back home, he wanted to just sit in silence in his car for a moment, to luxuriate in the oft desired but mostly elusive of life’s benefits; respite, unfortunately for him that moment never ended.

Those arduous moments of loss have a pungent vulnerability to them. They sting your senses and dissolve the cloak of aloofness. They come too close for comfort. The sun was still beneath the horizon although the faint echoes of the reddish hues were just beginning to stream the sky. I walked lockstep with my surgeon friend. It was a chilly morning, cloudy with doubt and question of rain and the fine misty breath of my friend dissipated quickly as he spoke of his late night encounter with a ruptured aneurysm. He rubbed his hands while we walked in through the automatic doors together and said, “You know, I think I will go to the ER, I don’t really feel that well.”  Twenty-four hours later after a three vessel bypass he was recumbent in the intensive care unit watching the flickering nonsense on television.

It is a strange life we have, I thought. Strangely attractive for the lofty goals to help human survival and banish misery, and strangely repulsive for the loss of self and banishment from living. So the following day when work had depleted all sense of personal thought and subjugated the sense of loneliness, I made my way to the hospital to care for my patients. It was a cold and chilly day once again but a beautiful clear blue sky as a rejoinder to the recent past. Things were looking up? I thought.

“I walked five steps today.” He said, with a tremulous voice bordering on great joy. He was an elderly man laid up for all the wrong reasons. Medicine was a labyrinth of chutes and ladders for him. He would make the arduous climb to slowly feeling better and then something would eject him down the chute. It gave him comfort to have this modern day vision of healing around him while he lay in the hospital bed. This was not a path he chose and neither was this the environment he preferred; yet there he was concealed behind the dubious smile of doubt and concern. Lets call him Joe.

“So Doc?” Joe asked with that quintessential cliffhanging question that lingers on the edge of the tongue barely able to roll of it. I knew where he was going with this daily dose of salutation. “Well Joe it will be a few more days.”

“I was afraid of that.” He said, his smile vanishing behind the obvious layer of despondency. I had barely turned to withdraw myself from the room when he asked, “Will I ever be back to myself again?”

I held that question for reasoning a bit longer than I normally would. “Depends Joe, what you mean by that. Are you referring to your thirties, forties, fifties, sixties or your current seventies?”

“Forties would be good but I know you are no magician.” He said, again the smile back on his face.

“Back to where you were functional and all before you came in. That is very possible provided you keep that smile and follow along with my advice.” I don’t know what made me say that to a dying person, but there it was all laid out. The sound waves had crashed against both our eardrums and the promissory handshake and a mental agreement between two parties was hammered out. Although the very premise of such a promise was out of frame with reality I had uttered it and we had both committed it to memory. Even though life and death are extreme colors within the same spectrum, he, unfortunately had by circumstance and age, been granted a passage to the “undiscovered country from whose borne no traveler returns.” But there it was a promise spoken, assimilated, accepted and expected.

Time dilation did take pace as I searched and broke some spines of books and journals that had never been opened in the hospital library. Day after tedious day, the ordeal of finding the right peg to fit the circular hole became a trying ordeal and an emotional drain. Somewhere in there the consequence of reality disturbed the manufactured realm of fantasy. I continued to cheerlead. He needed my best and I was not going to disappoint him. I felt he could see through my limits and yet he played along. Then on the sixth day of searching, I discovered this obscure letter to the editor in a medical journal describing a similar patient in a nearly identical situation. I discussed that with Joe and his family, the ramification of such a trial of medication. He agreed whole-heartedly saying, “I trust you doc.”

A sense of trust weighs heavy on the conscience. It has a way of redefining how you see the world. It provokes thoughts of success and failure. It energizes the spirits and with one turn of the screw pulls the plug. It fills you with promise as equally as it depletes the soul with worry of inability. It is the very essence of humanity based on kinship and yet it has a heavy ball and chain attached. It is the root of the bifurcated self and non-self.

The next morning after that “Hail-Mary” pass, I found him lying in his bed barely coherent with his left atrophied leg hanging over the bed-rail. His responses were barely discernable from known linguistics. The decline was dramatic. The torture of that decision had just begun to weigh in and would lead to a sleepless night of “shoulds and coulds.”

What drives us to spend countless hours advocating an imperfect science? To spend decades of life in the pursuit of learning a science that changes with every season like the colors of the leaves. Science is a constant river of knowledge that flows and remakes the shores of understanding, keeping the delicate sense of balance between right and wrong in constant flux. Ethics abound in the issues of nurture, care, compassion, and comfort and agony-sparing decisions made by the bedside, daily. All those years of experience in that complex grid of nature makes it no easier to fail against her fury.

What drives one to suspend sleep for the care of another? What makes physicians commiserate with the family faced with the difficult decision of life and death for their loved one? What makes a person shun the darkness before daylight and the darkness after sunset to work through and call it a “work-day?”  What makes a physician, eat on the run, sleep on a wink, surround himself/herself with the prattle of pain and grief and call it a life?

The rewards lie in the memories of smiles on faces. The comfort afforded and the lives saved from the brink of death. There is no other profession quite like a doctor’s that lives with the misery of his or her patient only to grant both the dignity of respect, virtues of comfort and in most cases a future.

Patients are like butterflies caught in a gale, confused, frightened and totally overwhelmed. To sooth, to heal and to allow them to circumnavigate the jagged rocks and swirling deep pools of nature’s wrath is hallowed ground.

The word physician relates to metaphysics and is derived from the adjective “physikos,” meaning nature. This nature’s dislocated confusion is remedied by the art and the right sprinkle of science by one such individual called a “physician.”

It is in the healing of the sick and the love of such an endeavor that those inflexible hours of demands compacted between unsocial timelines creating great personal stresses make the trauma to forge against another’s worth the while.

Getting back to our story of Joe; On the third day after the trial therapy Joe was found sitting by his bedside, eating a full breakfast that had alluded him for weeks.

“Doc how did you do it?” he asked as he rubbed his thumb and forefinger on his cleanly shaven chin. I had not. “You did it Joe. Your strength of character and determination.” I said.
“Doc it must be rough on you. Isn’t it?”
“No Joe, seeing you like this makes it all worthwhile.” I replied.

He wheeled himself under the concern of his transporter to the lobby to meet with his family under the banner of balloons and get well cards.

So Dear Joe, whoever and wherever you are, know this that the doctor tending to you has lost the virtues of societal living, worry-free comfort of his/her daily life so he/she can vouch for yours. His/her years of knowledge and experience are there to provide you with the best care and comfort modern medicine can afford. Limit not your thoughts with the media’s snippets of “good doctors and bad doctors.”  The media makes up things as they go along. Their vested interest is as long as the next broadcast and ratings. Diseases are not cured in an hour after subjecting “patients” to countless biopsies of every organ and diagnostic tests as shown on the TV program “House, MD” nor are the doctors crippled with reliance on narcotics with irascible demeanors. Physicians are humans who take pride in healing. Do not cross into the cynicism that plagues the politics of medicine, for many will disavow the goodness in medicine for the sake of personal ambition. Understand this that your physician is there for your healthy life. To him or her you are a person with a past, present and above all a future and that he or she will try, forearmed with the knowledge and the experience, to win the fight for you against the vicissitudes of what diseased your body. Your health is a testimony to his or her endeavor. Trust him/her and have faith in his/her abilities. Let your physician find the key to unlock the virtues of good health for you. It will make you both happy.
So for now Joe, “Live well!”

1 comment:

  1. Excellent. Should be required reading for medical students.