Sweets and Lemons

After shadowing a few doctors around, I definitely have my own opinions of bad doctors and the better ones, and sometimes I wonder if the patients would agree with me. For me, I have my own opinions of which doctors connect to patients in meaningful ways, and the patients surely have theirs. Since we are all humans, I hope that after trying my best to put myself in their shoes, the patients and I would agree on who cares and who only pretends to. I can tell, to some extent, which ones know their shit and which ones are just making stuff up, but unfortunately the patients mostly cannot.

But people relations and knowledge do not a doctor make. It's the craft of weaving the two together that does, and the glue, in my humble opinion, is confidence. To the unknowing eyes of patients, confidence seems to be everything, and it should be everywhere. Because patients cannot tell when doctors make stuff up, they look for correlations, and the sure-fire correlation with knowledge, in the patient psyche, is confidence. If a doctor acts like he knows something, he probably does. If he is soft-spoken, flustered, confused-looking, he is probably a lemon.

But from my observation, the correlation is, unfortunately, hardly reliable. Many doctors are solid on their medical knowledge but are regrettably un-confident, while the confident-appearing ones are sometimes just shooting in the dark. Both are bad doctors, but not to everyone. The former are bad doctors in the patients' eyes, while the latter are worse doctors from an insider's point of view. The former may do harm, while the latter are just ineffective. It's like choosing between...Hilary Clinton and Sarah Palin, except both of them were so bad I don't know if Clinton is necessarily worse per se.

Either way, it is simply sad that good doctors don't shine, while the bad ones successfully send patients to the wrong test over and over again, and it all hinges on confidence. It is the glue that make candies sticky...

While the lacking lemons go sour...

The First Death

Today, I experienced the first death of my medical career

I first met her on a Wednesday afternoon. She was a sweet 81 year old lady, and she has survived many things that would have killed others of her condition in an instant - she survived a left lung collapse and was talking without much effort with just one working lung. Her X-ray shows infiltration that whites out her entire left lung. We were consulted because of a left facial - it turns out whatever signs the doctors thought were neurological, were really physical, and she recuperated without residual neurological symptoms the next day. She seems to be doing fine after that, hanging out in the hospital because her sons would not make a decision about what they want to do with her. She was instantly our favorite, because she was so sweet and funny, even when she was sick. Every time we do a Babinski on her, she would exclaim "Ooh!" and looked around at us, as if to say, "Wow, did you guys feel that?". She would ask all of us where we are originally from, and she would say she loved us because we were the only people who came to visit her. She was from Armenia, and she seems like one of those tough old ladies from another unfamiliar land, where everything is tougher than our cushy American life. For a while, I believed that whatever neurological symptoms might have come upon her were gone for good.

A few weeks later, she had a seizure and was intubated in the RICU. I was worried, and our team went to see her as soon as we heard. I was relieved to see that she was conscious and seemed exactly like she was but with a tube coming out of her mouth. One day later, she was extubated and was back to normal. We visited her every day after that, and she seemed to be back to her usual sweet self. Now, if an old, 81 year old lady with one working lung can survive an extubation without a scratch, the last thing that could happen to her in my optimistic heart, was death.

Today is the last day of my neuro rotation. I was exhilarated since I just finished the shelf exam and, therefore, my first rotation. I was also happily surprised to run into my favorite neuro resident, when she told me the bad news that my patient has expired, and because she is not our patient, we do not know why she passed. I was shocked, but I did not cry. I was really in disbelief, because of all the patients I had at Elmhurst, she was not one of the people I thought would pass away, definitely not this soon. What sets her apart is the fact that she was such a resilient woman in our eyes, and because she was so sweet, death does not really have a place for her in my hopeful opinion.

When I ran into another student on my team later on who also liked our patient very much, I ran over to relay the news and simply broke down as the words came out of my mouth. I sobbed like a little girl with a broken toy. It was unexpected and uncontrollable. The 5 stages of grief ran through me, as I skipped from bargaining to acceptance. I rationalized that it is better for her to finally leave the hospital, but with her beautiful spirit, I do not really know if she really is better off. I know the world has definitely lost one of its good citizens, and that is a big loss in today's world.

I don't know what I would do if I actually saw her die - I really don't know, but I guess that's the journey that every doctor has to go through. It is the growth that we as doctors have to experience and come to terms with it ourselves. No one can really hold our hands through it, because as hundreds of our doctor friends hugged us with sympathy, the death does not go away until we have learned to accept it.