Monday, July 12, 2010


It's been too long.

It feels like it's been too long.

I spent a whole 5 years on my pre-med course, a whole 4 years on studying medicine, a year of post-graduate internship and a nerve-wracking board exam. I got through it then moved onward to practice medicine.

I'm two years into residency -- seeing patients, greeting them, diagnosing and treating them, knowing some secrets, building relationships -- and it feels like it has been forever.

We get patients, walking, talking, breathing human beings in our ER and sometimes, it would just feel good to be able to say that "You're gonna get out of here in one piece," or "it's gonna be alright," but we don't. It's not that we don't want to say it.

It's because we can't.

We don't know what's lying around that corner. Some unforeseen complication, some undiscovered comorbidity that just lurks in there and takes you away from us.

Or sometimes, we do everything we can, yet it still falls short.

I spent the better half of the past 3 weeks pondering what I could have done more at that ER table while writing down the orders for my patients to change the outcomes of the certificates I had to sign. I asked people who knew more than I did, who had seen more than I did, yet they just smiled, comforted me with words like, "it wasn't your fault," and moved on.

You see, here in impoverished Philippines and I assume in the better part of Third World Asia, we get sick patients who most of the time, do not even have the opportunities for a cure. We get a patients who don't even get a chance to swing for that home run, or that open three-point shot to tie the game. Instead, we get patients and their crying families, and we have to look them in their eyes and give them the options, surgery, a thousand-peso antibiotic to be given for two weeks, an ICU stay, eight units of blood, and what have you, but all we get in return are more tears. Then they wipe them away and all that's left are faces with clenched jaws, and flushed skin, and the realization that this is the end for a loved one. The hand is dealt and they've lost.

It's hard to be the one on that other side.

I spent a week trying to convince a patient with a manageable cerebellar stroke to undergo a needed decompression -- wall, no money.

I started two large bore IV's and got blood without delay for a patient with an upper gastrointestinal bleed and stabilized her in the ER before sending her up, but she exsanguinated and bled out 3 days later on her rebleeding probably due to massive peptic ulcer -- she was awake the whole time until the last minute, where I stood from a distance knowing full well the Do Not Resuscitate form was signed.

I did my first child intubation two weeks ago, mainly because I was at my ER post when they came. He was blue, unresponsive, and severely dehydrated. Somewhere from the first hospital they went to until they reached us, that poor kid was lost to his mother and family, and the screaming, bawling was enough to remind us of how much pain we try to prevent each single day.

I lost another patient to a puzzling diagnosis that really can't matter now because his daughters have brought him back home for his funeral rites.

We've had so many losses.

And everything goes slow each time we do that I look around and I feel that it goes on too long.

The grief, the sadness, the pain...

Sure we are not your family, we are not your friends and we are strangers but that doesn't mean we don't care.

Walk one day in my shoes as you go through the wards and the hospital rooms and see how many people we try to bring back to health. See us as we break the news to more than one family. We feel the pain too, two, three times over.

And I do.

I hurt when I lose a patient.

Each time I walk out there to talk to someone about what treatment someone's wife, or someone's mother, someone's brother, or someone's boyfriend needs, it is from the deepest, most well-intentioned part of my heart, that they heed my advice. And if by some way fate deals us something that we can't overcome, well, I am not going to pretend that choosing or making a decision is easy, but I'll be there, and I'll listen, because I do feel pain. It might not be the same as their pain, but pain and hurt nonetheless.

Like the faults that people easily notice, losses seem to count more than gains.

Reflecting, I realize I admit as few as 10 to as much as 20 people in a span of a 12 hour duty and 1 out of those 20 might die, 2or 3 might need an ICU stay, and some fraction could refuse treatment, but nobody sees the 15 or so that I help cure.

I realize that.

People can say that at times doctors are heartless and cold because we move on so quickly from a death to the next patient that walks in our doorway, but the truth is, the losses do hurt, but more people are out there who need our help, and the only way to make it hurt less, is to make the losses matter.

If the time comes when losing patients doesn't hurt anymore, it would be the time to hang up the white coat and stethoscope and stop because to what end are we working for?

For Mrs C, Mr. P, it will matter. It will count.

I'm scared every time I take that ER floor. But it is easier to accept that I am there determined to have you smiling walking out the doors, handing in your discharge papers and knowing your free of pain and sickness.

And a faint fleeting flicker of memory flashes at the back of my mind, and I remember the losses and how I should make them matter, how I should count more the gains, and move on to the next patient because I am a doctor, and that's what doctors do.