July 13, 2016

end of the rope

The following is not FACTUALLY accurate. Details have been changed, things deleted, stuff made up, all to protect identity. But it is 100% absolutely true.

     Every month I am a different doctor.  One month I am a family doctor managing patients in the hospital.  One month I am an ER doctor.  Next month I am a surgeon.  And you have to embrace that because they each approach problems very differently, and deservedly so.  But underneath it all, I am still me.  On this particular day, I was a surgeon, more specifically, a colorectal surgeon.  That may sound like a big stretch but not as much as it could be. I am one of those rare family docs who is also learning colonoscopies.  And if one is going to learn colonoscopies, learning about colon cancer comes with that.  It is my way of saving someone from having to experience bone metastases as without colonoscopies, we usually find colon cancer once it hits the bones.  And if you have read my blog from a few years back, you can imagine what bone mets feel like.  It ain't pretty.  And so on a day where the clinic day is colorectal patients, one can imagine a fair share of them are there for colorectal cancer appointments either as follow ups after surgery or to be assessed as surgical candidates.
     This particular patient had been referred by their medical oncologist to assess whether they were a candidate for surgery after they had completed chemotherapy.  A common scenario.  In fact, I had dealt with it two times already that morning, neither of which had any hope of surgery improving those patients' quantity or quality of life.  But the third one of the day.....they had completely mistaken notions of the results of the most recent CT surveillance scan.  Their cancer was not in remission.  In fact, it was back with a vengeance.  And I simply could not do it.  I could not bring myself to tell a third patient that day that their results meant that surgery held no hope for them.  Maybe it was it was because I was exhausted.  Maybe I was tired of playing the surgeon.  Maybe consoling two before lunchtime had left me devoid of any further ability to empathize.  Maybe I had reached the end of my emotional rope because of my own baggage with cancer.  Regardless, I let the attending tell them. 
     I felt horrible afterwards.  I apologized to the attending.  I felt as if I had let the patient down.  That if a family doctor can't console someone then what the hell is that doc worth?  The attending looked at me and reminded me it wasn't my job.  It certainly wasn't expected that an off-service resident should be able to interpret a CT scan and interpret whether surgery was off the table or not.  But for me, it was not about being able to make the medical decision.  It was about being able to be there emotionally for the patient.  I left that day feeling worse than if I had made an actual medical error.

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