Random filer, watch this space

November 17, 2008

So much has come. And gone.

A new President Of The United States Of America (TM), and a black man too!

More kids dying in yet another third-world country. Same old, same old.

Appendixes. Big, turgid appendixes. Smelly, perforated appendixes. Gangrenous appendixes. All good fun.

Dead patients, dying patients and the disconcertingly familiar feeling of not being able to do anything more, anything better.

The lucky bastards who can be cured, and the (sometimes) cheap-ish thrill of having accomplished it with these two pudgy, clumsy hands.

A global economic crisis which, so they say, will be unike anything we could ever imagine. Just like stupid people making ridiculous amounts of money for doing nothing at all is unlike anything I could ever imagine. But I’m just being cynical and bitter because saving lives isn’t as financially (or, indeed, emotionally) rewarding as it should be. 

And here I am, yet again (though I realy should have known better), doing what I love doing, knowing that I shouldn’t love doing it.


Physician, heal thyself; student, save yourself

November 1, 2008

“It’s not too late to quit,” he had said. My first day in the wards, my young, ideal (and shaved completely bald) head swimming with heady fantasies of all those lives I was going to save, all those billionaires who would immediately will me their life’s fortune in gratitude, all those young, nubile vixens who would wet their panties at even the hint of a waft of my legendary raw sex appeal. My first day, and I was already being nudged not-so-subtly down the celebrated path of cynicism which, at that time, I just knew was misguided and bad and horrid and terrible and all the things that little boys are made of.

Fast forward a couple of years – and the student is now the master.

It’s just a job. A job saddled with much responsibility, the expectations of an unthinking public weaned on a dangerous diet of House and Gray’s Anatomy, and job behind only nursing and teaching in the rankings of Top Underappreciated Professions of All Time (and that, too, only because it pays better), a job that demands more of you than you can give.

So, what are all you bright sparks waiting for?

All you brilliant young things out there, and brilliant older ones duking it out in med school.

Why oh why oh why oh why?

It’s not too late. Not yet. Not ever.

Not even for me.


(Re)birth and…

October 28, 2008

Death.

Perhaps for some of us, death has become so commonplace that it has  slowly migrated from the category of “tragedy” to “merely mundane”.

And indeed, so often in the past I have found myself shrugging off yet another death, yet another passing of a soul into the night as “well, it was about time anyway”, or even worse, ” bloody hell, now I have to get out of bed to sign his stupid death certificate and offer my most unsincere condolences to family I have never met of a patient I’ve never seen.” As a fledgling houseofficer, the prevailing thought was “shit, I hope it isn’t a coroner’s case because that would mean doing a discharge summary in the middle of the night.”

And all too often, it’s become all too easy to use constant fatigue, the ongoing sense of being unappreciated as well and the general hardening of the heart and encroaching cynicism that seem part and parcel of the dreaded process of ageing as excuses for one’s (occasionally) occasional nonchalance towards what is a heart-rending and life-shattering event to others. Sometimes, it may even be necessary – for what good can come out of shedding tears over the passing of every single dead gomer, what benefit could there be, getting all touch-feely and wobbly at the knees when there is much work to be done, even more lives to be saved?

Do you remember the first time one of your patients died? I do.

He was old, and yellow, the story of his drawn-out losing battle with the ravages of chronic liver disease and subsequently cancer written all over his bruised, bloated body like the demented scrawlings of a black-hearted scribe. The day before, a couple of eager, bright-eyed newly-minted clinical students had been standing by the foor of his bed, marvelling at his deep jaundice, tea-coloured urine in the urine bag, spider naevi, palmar erythema and patchy bruising. Clinical medicine come alive!

“Is he going to die?” one of them asked softly, and I simply shrugged and nodded.

“Yes. Soon. But it’s probably for the best.”

The next day, he had become unresponsive – hepatic encephalopathy finally kicking in – and as his breathing came in deep, quick gasps, a part of me idly wondered what his hepatic flap would look like if he was only alert enough to lift his arms out straight in front of him. But the other part of me was vaguely torn, for we had not been able to offer anything beyond a bed, IV morphine and (scanty) words of comfort. And at that moment, we were unable to do anything more than hook him up to an ECG monitor and wait for him to flatline, and offer (this time quantitatively more) words of comfort yet again.

There were many more deaths in between, some tragic, some riddled with frustration at not being able to do somehting more, others met with a nonchalance that was even then just a little bit disturbing in a little corner of my mind.

Yet even until now, every now and then, just when I’ve written of all my humanity, just when I’ve dismissed my capacity to be moved by patients, something happens that makes me think that maybe, just maybe that wide-eyed, idealistic boy who could have once unflinchingly said “I want to be a doctor to save lives” might not be so dead adn buried after all.

But that (and so much more) is a story for another day, another time, perhaps for another me to tell.

Hello. This is my first post, and I like starting things off with a garbled, depressing, unstructured rant.

And having the introduction at the end.

I hope you read on.