Confessions of an Intern

Week Thirty

Be careful what you wish for...I was complaining that things were a little boring last week along the patient front (don't be mad...I'm okay with that sometimes, it just means I've been taking care of people who weren't that sick). My week blew up with my "special" cases. I have been dubbed the black cloud on certain services. Maybe not the bad luck resident, but I love to keep it interesting. My patients just love to throw me curve balls. My attending also made the mistake of mentioning that the patients on our team were boring...bad move.

I have one patient that is just hanging out, and the hardest part is they ultimately need to be placed on hospice for an unusual reason. Severe schizophrenia and endstage kidney disease. Dialysis is terrifying for them. In order to keep their body alive, we must sedate them. They go through every day drugged and sedated, restricted in activity and freedom. When not on dialysis they are combative, hear voices and strike at caregivers or hurt themselves. (I am talking in third party so as not to disclose identifying info). What kind of a quality of life is that? You have to have dialysis to live, but in order to be forced to undergo a procedure you are terrified of, you must be drugged and held down. And between treatments, more sedation. If you don't take dialysis, your kidneys don't work at all. You will die surely in a month or so. But does that matter? You don't realize it because you're on whopping doses of psych drugs.

Then, last Friday I was able to assist two patients to go on hospice. One with end stage liver disease who was no longer responsive and the other with terrible bone pain from metastatic breast cancer. One the family knew it was coming and they went willingly and with relief, the only thought that their loved one would soon be out of constant suffering. The other fought tooth and nail to resist accepting something they already knew to be true. Neither was easy or done lightly. I was so glad when we were able to sit together as a group with family and myself and the hospice nurse and just say the truth. Too long this family refused to say the word cancer, called it a shadow, but underwent radiation and planned chemo for something they wouldn't call cancer. And I was chastised for using the word hospice around the patient. Finally, the patient was alert enough and finally said "Enough! I want to go home and be with my animals in my house. Let me be!" She had come in saying to restart her heart if it stopped. But the reality of the matter is, even if her heart was restarted, she would still have terminal cancer, with severe debilitating bone pain from metstasis, and she was now having cognitive changes from her disease. And she is a tough lady. Fought it for 5-7 years. It is okay to say I've had enough.

The writing is on the wall for me. Despite the fact that I never thought about palliative medicine, it seems I'm good at comfort care and talking about the realities of life and death. My attending asked me to do "the talk" today. She didn't think the patient would take it well from her. o.O

I'm emotionally exhausted. I'm physically exhausted. I'm lashing out at little things while I'm trying to save all my compassion for my patients. I need to save some for my family. The only thing keeping me going is that nearly every single patient I saw today and yesterday told me I was a good doctor. They told me that I had been given a gift of compassion, something people couldn't learn. I thank God for that gift and must remember the responsibility I've been given. I have the ability to make and break lives. I will never have the authority or the knowledge of God. I'm only given the knowledge that He is in control.