Friday, July 11, 2008

The Battle for My Soul

Today I concluded my first week of third year, and today is definitely the most intense day I've ever had so far. I think it is because all the human drama that has been building up all throughout this week ended with the epiphany of modern medicine in its ugliest and truest form - when the exhausted ER residents can no longer be bothered with politeness, and when the lavish lobby and colorful gift shops are stripped off to show the dirty, cop-ridden ER of Elmhurst.
I will just head straight to the epiphany - I will not yet bother with subtle things throughout the week that represent the uncorrected remainings of bad medicine, the complicated mistakes that patients rarely see.
Our Neuro consult team got called down to the ER today to see this old Korean lady who had diarrhea and lethargy prior to admission. She then became unarousable by her daughter, who promptly called 911. We arrived to find a frail, white-haired lady tugged away in the corner of the cramped ER ward, manned by her daughter. The interpreter service is unavailable in the ER, as there is no phone anywhere near the beds. We proceeded through our neuro exam awkwardly - maybe because the daughter could only speak minimal English, or maybe because the patient was a bit altered. We left with some promising exam results, but a part of me felt uneasy for reasons I could not pinpoint. In hindsight, I was probably bothered by the fact that we could not get an interpreter when one was warranted, and that the patients appear neglected, even though none of them asked our hoard of doctors for help. I think it's the way they looked at us, as if they need help but they knew that we could not help them - not because we do not want to, but because the system taught us to only relay the information to the overworked ER doctors and continue on our merry way - because that is how things are.
It did not hit me until we returned a moment later to perform further neuro exam. The lady was alone, agitated and was determined to climb out of bed, unaware of the chaos around her, nor of the overworked nurse who roughly stripped EKG pads from her chest in order to move her to another spot. It seems that when this patient became altered and confused, the inner instinct that remains at her core tells her to go home. We approached her, and as the other doctors tried in vain to talk to her, I said hi in Korean. My heart leapt when she immediately turned to me - then she started gesturing that the IV in her hand is paining her. I could not say anything else in Korean, so I gestured to her that she should wait until we found a staff who can interpret. A Korean cop came to interpret for a while, but that did not do much good since the lady seemed too confused to even understand her language. In the midst of this attempt at adjunct interpretation, her son came to the scene. We then told him to ask her a simple neuro exam question:
Doctor: "Can you ask her if she knows who we are?"
The son followed instructions, and reported that she answered no. He then engaged in a back and forth conversation with his mom, as the doctors observed and waited patiently for the findings. After a while, he paused, coping with everything that just happened, then uttered in a quiet disbelief...
"She does not know who I am"
I looked away to hold my tears. In that lonely chaos, I did not know if I should feel sorry for the old lady who had no idea what was becoming of her, or for the son who learned for the first time that he has lost his mother, the personality and the memories that make her his mother and not a few pounds of flesh. Looking back at her stretcher as we were leaving the ER, I can see myself standing in the shoes of her son - standing, because there are no chairs for family members in the ER - guarding the fleeting remaining of a stroked out loved one, waiting in the nerve-wrecking anticipation that one of the many armies of doctors will eventually come with a solution and not more questions. In the midst of arguing nurses and scary cops, the helplessness around that ER ward was overwhelming -everyone from all walks of life came to this ER and had no choice but to submit to the mercy of the medical system - one that is broken, overworked and unkind.
The scary part for me was that I wanted to cry, but it would have been inappropriate to cry then. So for the rest of the day, I held up the tears in their fort, waiting for the opportune moment to "feel". In order to appear composed and appropriate in the eyes of colleagues and patients, my soul became a numb existence - a functional machine with no sympathy. There are two paths towards MD - the path that is art and the path without art. The path without art numbs us from the human drama that is life and death, so that we can function. It is the opposite of art, where you give up your soul to emotions and feelings in order to create. The path that is art teaches us that medicine is barely a science - it is an art - the art of calming down the agitated, the art of delivering bad news, the art of following our instincts instead of impersonal numbers in the NEJM that may not apply to the human flesh sitting in our office.
And until I hang my white coat, everyday is a battle for my soul.

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