Saturday, October 13, 2007

Bad Friday

Warning: Though I usually try not to be a "downer," the following post isn't super-cheerful and will strike many as an example of wallowing in whiny self-pity. Please refrain from pointing that out - I already know it - and skip it if that sort of thing annoys you. This blog often serves as a venting journal for me, and I definitely needed an outlet yesterday where I could let it all hang out! :)


"Happiness is a how, not a what, a talent, not an object." -Herman Hesse

I have this cute little book by David Niven entitled 100 Simple Secrets of Happy People, which outlines a number of ways that essentially happy people approach life. It suggests things like laugh often, get enough sleep, enjoy a hobby, make time for friendships, etc. and backs up each suggestion with an anecdote and a relevant research finding. One of its suggestions is not to take failure personally.

I consider myself a happy person. I find life filled with blessings, and I enjoy it. But I also tend to take failure personally, and I ascribe this to a kind of perfectionistic temperament that leads me to be hard on myself and demand the best work I can do.

Yesterday I was asked to help one of the docs on the 2nd floor with a spinal tap. He had tried that morning and found it difficult. I went up and gave it a try, and I found it difficult. I wasn't able to get it either, and I'm supposed to be an expert at this procedure. Everywhere I inserted the needle, I found a wall of bone, bone, bone. I tried different positions, angles, and techniques, but nothing worked, and after putting the poor patient through discomfort for a while, we decided to give her a rest and reconsider our options.

To make matters worse, this was a patient I had cared for before. She was the same patient in whom I had heard a murmur a couple of weeks ago in the area of the mitral valve. At that time the combination of her extremely low blood count and her family's description of a 30-pound weight loss over a relatively short period of time had made me extremely suspicious for cancer. I called her primary care physician from the recovery room to discuss this as well as her surgical course with him, and what I had observed from her history and physical exam, but that was the last contact I'd had with this patient, until yesterday. She lay back down on the hospital bed after our failed attempts at obtaining spinal fluid to assess it for cancer cells and said, "I'm gonna die." When patients say this, and it's not because they have a martyr complex or have a tendency toward melodrama, but rather because they really feel it "in their gut," I listen, because it's like a prophecy, almost always fulfilled in the months that follow. I was sad.

Happy people don't let rough moments define them, personally or professionally. But I've been trained to look at everything as evidence, to exalt the importance of proof and observable reality. Wanting to be a good physician doesn't make me one. Yet hundreds of well-cared for patients and expertly-managed airways and other procedures all seem to disappear in my memory every time a difficulty disappoints me. I know there's more to being a good doc than being slick at lines and needle sticks. My husband blames my training experience for the way I take all these setbacks to heart and don't acknowledge the good I supposedly do. I think it's just me, the way I respond to things and the demands I impose on myself. A lot of my so-called "bad days" are "all in my head," but that knowledge doesn't help much.

Imperfection wasn't tolerated in the ballet studio when I was young or on the medical wards when I was older, and with good reason for the latter. I do recognize that it's easy for ego to be all wrapped up in our good intentions for our patients. Of course I want to do my best, be at my best, for them, but I also don't want to fail because of how important it is to me to be a good physician. The motivation's neither completely selfish nor completely unselfish. There are those who judge altruism harshly, saying that doing good for others is all about the do-gooder wanting to feel good. I say it's never only one thing or another. I do believe many people sincerely care for and want to help others but also want to feel good about their own work.

That's certainly how I feel about it. Which is why I feel bad, on both counts, right now.


While I'm giving vent to my frustrations, let me go ahead and get off my chest all the other things that made yesterday not-my-favorite day at work.

-Neither electroconvulsive therapy session for which I provided anesthesia was straight-forward; my first patient desaturated sharply during the induced seizure and was difficult to mask ventilate;

-I almost had a medically unnecessary C-section added on to my schedule which was going to be done because the mother didn't want to push the baby out vaginally - a practice to which I strongly object because of the increased risks, present and future, to both mother and baby (as in, the baby is 3 times more likely to die) as a result of "electing" to have the abdomen sliced open for major surgery;

-I had a spat with my boss over my objections to something I felt endangered patients and compromised my standards for delivering good patient care.

Is mercury in retrograde or something?! Thank goodness it's the weekend!

On the up side, my kids are adorable, my husband is wonderful, I'm looking at a gorgeous view of Lake Winnipesaukee right now with fall foliage just beginning to color the landscape in the foreground and the White Mountains clearly visible in the distance, I have oboe goals, and I am safely ensconced in a cozy cabin writing to my heart's content. For all this happiness I am deeply thankful.


patty said...

Call me silly, but I found this post to be very good, not at all a downer. Really.

(And, to be honest, you also sound like an oboe player. How 'bout that?)

But I'm sorry about the day. One good thing? You helped ME relax about my procedures next week. Somehow just "meeting" you and realizing that people in the medical profession really do care helps me, to be honest. You add a face to what is frequently, for me anyway, a fairly faceless profession. (Yes, I DO see my physicians ... they don't wear literal masks ... but sometimes I feel as if there are invisible masks. Of course they might feel the same with me as we all dance around in this life together.)

Not sure I'm making sense.

Anyway ... I always love your writing, and you always teach me something.

patty said...

(Hah! Took me THREE tried to get that comment posted ... sometimes the "word verification" feels like a test i can't pass! ;-)

rlbates said...

Nice post T. Hope your weekend it a good one. I certainly know what you mean.

T. said...

Thanks, Patty, and Dr. Bates, for the supportive comments!

Yes, doctors have feelings too...

It's tough, we do have a responsibility to put on some kind of professional persona - one that allows for a little distance, for objectivity, and to let knowledge and expertise serve their purpose, but without failing to leave room for kindness and compassion.

I remember one heart surgery that was basically futile, where the surgeons were battling against frail body parts and physiology, and we anesthesia folks were pushing drips and syringes trying to resuscitate. The cardiothoracic surgical fellow just put his head in his hands afterward and leaned on the empty table after the patient had been removed. I also remember sobbing to my husband on the phone, in private, after having to discharge an abused baby to a foster parent, and how saddened I was when one of the hospital chaplains seemed surprised we felt so deeply for our patients. Sometimes caring about our patients means feeling anger for their sake, in a way that can be channeled constructively, one would hope, toward fighting for their needs and rights.

We do care. I think there's too much hardship, physically and psychologically, in medical training to stay with it for any other reason.

It's so taboo to admit our vulnerabilities, because we're expected to be SO perfect (and want to be, I think for the sake of our patients, and should certainly strive toward high ideals). But it's a hard balancing act - people on both sides, doctors and patients alike, want us to be human and super-human at once, it seems... It's comforting to know of other docs out there who can understand, and patients willing to accept physicians' humanity...