One of the things that surprised me about palliative care in the beginning was how happy the team members seemed to be. Everyone on the service has been consistently cheerful, and the days have been filled with laughter and utterly inappropriate jokes that can only be appreciated by people who spend their days surrounded by death. The mood of the team has been almost enough to make me forget about the suffering that we deal with every day.
But today it got to me. Maybe it was the cumulative effect of three weeks of moving patients from the list of people we're following to our list of the deceased. Maybe it was finally changing my longest-standing patient from active treatment to palliation. Maybe it was being witness to a death, my first on the service, rather than simply hearing about it after the fact. Whatever the trigger, today was a day that left me feeling drained and world-weary.
I was reminded today of the attraction of actively treating patients, of the appeal of being involved with sustaining life. It's comforting to believe that if you merely pick the right therapy, or if medical science only develops the right new drug, that you can prevent anyone from dying. When I started medical school, that was what I naively believed - that if we could just throw enough time and money into research that we could cure all illnesses and somehow escape death. My work on palliative care is a constant reminder of life's finite nature, and some days it is just so inescapably sad.
So tonight I'm self-soothing, indulging in warm cardigans and cold chocolate ice cream and hot baths filled with smelly bubbles. Instead of devoting my evening to textbooks and spending time with friends in need, I'm immersing myself in the happiness and superficiality of Glee. Some at-home escapism to get me through the last three weeks before vacation. It's not the wisest way of spending my evening, but at the moment it's about all that I'm capable of.
10 comments:
I really appreciate this post. More often than I thought, in my few months of working, we saw people off to hospice. One of the patients in particular, and his lengthy painful process of deciding to go to hospice, remains dear my to heart. I have never lost a patient (after the fact yes but never while I was caring for them).
But I am going to be orienting to volunteer with hospice as of February. And I am so wary of it, because I have no idea how I'm going to handle it so much sadness, how I'm going to handle my own grief.
Some people are unfortunately beyond physical healing and the only thing left for us to give them is to maintain their dignity as they pass. I'm sure my insights will grow over the next few months as I have experienced no such loss yet.
I can imagine it gets heavy. Take care of yourself.
wow I read back through that when I was done posting it and I couldnt stand all my errors :) you catch my drift though.
I can't imagine how difficult it must be to have to make the decision to stop treatments and to witness your patients' decline. I wish there was something I could say to help, but at least you've gathered together some of the things in life you appreciate... hope you feel better in the morning.
I always find it strange when I hear a doctor say something like "walking just 30 minutes a day will reduce your overall risk of death by 21%." That actually came from a physicians mouth. It can be found by going to http://www.youtube.com/watch?v=aUaInS6HIGo. I've heard other doctors say it. When my doctors say it I remind them that humans have an overall 100% risk of death. When you live with a fatal disease, you acclimate to the fact and it ceases to shocks you. Probably most of the people that you are dealing with have wrapped their mind around that for a long time.
I think it's weary to be in the down in the trenches with a patient , whether it be a palliative or curative goal (ESP in oncology) . For good reason, Sick people are usually scared people.
Ice cream and Glee are good means of self palliation, also very important in the practice of medicine.
I find Glee (especially Chris Colfer) extremely uplifting :-)
Also, I watch kittens and puppies on You Tube. I swear it ups my dopamine instantly.
Being a physician is a special calling. You are witness to the most intimate and sacred moments of your patient's lives. In order to bear witness, you really do need to put your own physical and mental health first.
I hope your smelly bubbles helped revive your spirit.
NurseyNurse - I wish I had some great advice on how to cope with the sadness, but I think we all just have to learn our own coping skills as we go along. (Something I'm still working on.)
Thatgirl - It's often pretty obvious when someone reaches the point of no longer benefiting from treatment, but the hard part can be getting the patient and family members to recognize the futility of further treatment. The conversations about changing the treatment goals can be very draining.
Emmy - One of the favourite sayings amongst doctors/nurses in palliative care is that life has a 100% mortality rate. I think it's an important but sobering thought for everyone. While I agree that many of my patients have come to terms with their mortality, unfortunately some of them have never been told that they have a terminal disease before we see them, so there can be some very difficult conversations.
Red - Darn...I was hoping that it was going to be easier on me when I got to doing oncology on a full-time basis! I agree entirely that self palliation is important, although I seem to be doing a bit too much of it lately.
Penelope - I adore Chris Colfer. I absolutely loved this week's episode, even though I'm not a huge fan of Michael Jackson. It definitely put me into a better mood.
Well now, that would suck to arrive at hospice without ever knowing you were dying. I guess that's another thing I can thank my doctors for, being honest enough to tell me that what I have is potentially fatal.
I think this sounds like an extra-wise way to spend an evening after a rough day!
Emmy - Absolutely!
Missmccracken - It was certainly enjoyable, and a nice break. Sadly, I have to get back to work soon.
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