Hospital Rounds

As a doctor, there are certain things I can do. There are other things I cannot do and I've come to accept my limitations, particularly the emotional limitations. Doctoring is another form of care giving. Yesterday, the balance favored the do-able as I made my way through 4 1/2 hours of hospital rounds on call. My goal is always to complete whatever the tasks may be each day and most of the time I am able. But, on Sunday, emotion (mine) left me paralyzed to respond in a positive way to a particularly sad and hopeless situation. All I wanted to do was to remove myself as quickly as possible from the scene, to let someone else take on this responsibility. Fortunately there was back-up.

Doctoring is many faceted. Sometimes we are called to laugh and joke. Sometimes we are called to empathize and emote with a difficult, frustrating situation. Many times we are asked to comfort, to explain, to translate the foreign language of medicine into understandable concepts. Many times we must put on the diagnostic cap and think hard about what's going on, to explore the dilemma and to weed through the possibilities logically. All of these I could manage yesterday. I recall examples of each role as I made my way through 12 patients.

The sweetest experience was my interaction with a man who was miserably ill on Saturday and so much improved Sunday. He was able to share with me that he wanted his "life back" because he was so proud of his 26 year old daughter and hoped to celebrate her successes, belatedly. She recently graduated from Harvard, receiving some sort of advanced degree and now heads on to D.C. to work for the F.B.I. I could feel his pride; he said she was "the light" in his life. He was bummed that he missed out on her graduation.

What I could not do today was face the wife of a man suffering with the most evil and pernicious illness that I know (diabetes and renal failure), whose prognosis is so dismal that it's unlikely he will live more than another few months. The major decision about continuing or discontinuing life lengthening dialysis treatments when his quality of life is so marginal was the theme for the day. Who can define what is acceptable quality of life? I would say the decision belongs to the patient but he is not in the position to make choices like this right now. His wife feels like she is in the hot seat, looking for guidance, and in so much emotional pain that her tears and inner turmoil were so acute, rough edged, and raw that I could offer little. This is familiar territory to me; how many dozens of times have I had this conversation with people and offered myself to them? Today I could not sit with this pain and make sense of it, even when the need was so great.

Why? Because I have have been witness to so much emotional pain with my parents and experience first hand the bitter pill that life spits out when loved ones face the last months/years of their lives. We ask the same questions about quality of life and wonder, second guess, and blindly move ahead never confident that the choices are right or sensible or if they'll bring any relief to the pain. We are impotent to "fix" any of this and likewise my experience with this man and his wife today. He didn't need my input; she did. Unfortunately, I could offer no encouragement, ideas, comfort, or support. There was literally no fuel in the tank. One might think that by going through a related process personally, I might be in the position to render higher level support, a "been there, done that support". Not. I was empty, exhausted, and had nothing to give. Fortunately, there was no need for an urgent decision but she could have used some guidance, even a tender hug. I felt sorry that the wisdom of my experience was not available to me; my responses were lifeless and empty. I left this work for my colleague to handle when he returns on Monday. Wimpy? Perhaps. Necessary? Yes.

I was 90 percent doctor yesterday and 100 percent human. That's OK. Although I would have liked to assuage this woman's tears and her anguish, I know that I did all I could do in those moments. It was my best and it has to be enough. She and I will both make it through to the other side. Eventually. We both are in pain and we are both (only) human.