On being mortal

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On being mortal

Postby Hendrick Laursen on February 18th, 2020, 2:03 am 

"Mama! Mama! I am ill!
Send to to the doctor to give me the pill!"
"Doctor! Doctor! Shall I die?"
"Yes my child, but so shall I!".
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Re: On being mortal

Postby Serpent on February 19th, 2020, 5:00 pm 

I concur: we shall die.
Is there a topic for discussion?
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Re: On being mortal

Postby Hendrick Laursen on February 19th, 2020, 9:04 pm 

Hello @Serpent!

Due to my occupation, I spend a lot of time in the hospitals. I often visit the dying, and many times I've actually witnessed someone die. It sounds quite self-evident that as humans we all will die sometime.

But the interesting aspect of this phenomenon is, I sometimes find, even seasoned physicians, quite detached from their patients. "Don't carry the baggage around you!", "Have a life outside the hospital!", and even much more curiously "Don't let them get to you!", are examples of some "time-honored" advice I get from my seniors.

One might argue, I don't want my doctor, while performing for example cardiac surgery on me, to have a poetic moment on that operating theater, have a "moment" of self-discovery, or whatever; I want them to cut through the right stuff, sew the right things and make me better! This is what psychologists call "Isolation of Affect", acceptance of reality without typical "human" response.

So, while we may have advocates for isolation of affect during tiresome or complicated, "life-saving" surgeries, we probably don't want it to stand between the doctor and his patient, to disengage the rapport and trust, to eliminate the human touch.

A tumor is a tumor is a tumor. But when you get to know your patients, sit at the edge of their beds, talk to them about themselves, and not necessarily about their disease. Perhaps then we can grasp that humans aren't interchangeable, and the effect the tumor will have on their life will be much idiosyncratic and personalized. So perhaps a tumor isn't just a tumor.

What made me start this topic was, when you ask medical students, many will answer they've chosen the profession to care for people, to save them, to become a doctor. But as they run up the hierarchy, the human dimension gets dissolved and diminished, and sometimes just forgotten. The job just becomes the job, the question is not whether I'm gonna save 3000 people or 4000 people this year, it's am I gonna make 250 grand or 350 grand. Quoting from Samuel Shem's legendary work, patients turn into "gomers".

So, what exactly makes the transition? Does understanding the disease, knowing it's pathophysiology makes us think we're immune to them? Does knowing everything about MI make you immune to it? Does seeing patients die in the wards regularly, with the infamous "we tried to save your child/husband/mother to the "best" of our ability, we're sorry that we had to let them go", make it less a tragedy of seeing a life wither and extinguish?

This is exactly what resonated with me when I was reading this poem. In the last line, the physician acknowledges his mortality, implying that he is no different from his fellow patient, as of "mortal"-ity, as of being a human like them.
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Re: On being mortal

Postby Serpent on February 19th, 2020, 11:09 pm 

All right, I see that. Some of it, anyway.
I've spent some time in hospitals as a technician and as a patient, and I've spent some time in a forensic laboratory - the 'after' picture, if you like. In all of those capacities, I've had a fair amount of contact with doctors.

So - Thing 1.
They're all different, just as patients are all different. If i were to generalize, the pathologists are most detached, since they have the least interaction with a live patient. (Except, I knew one who had to be physically restrained from attacking the father of a little boy on whom he'd performed an autopsy. Even they get emotionally involved.) Surgeons have to detach themselves, for the reasons you cited, but also because it takes a certain kind of personality to cut people; they need terrific self-discipline and confidence (arrogant is what they mostly are, not infrequently narcissistic or borderline sociopathic - but don't tell them I said so) ... except there was this one guy who was really, really stuck up with staff, and a complete pussycat with child patients - so, figure! And, of course, surgeons don't usually spend much time at the bedside, never mind sitting on it! No doctor I ever knew did that - though I had a kindly oncologist pull up a chair, when he had time, and when he didn't, he'd just poke his head in the door and demand: "Are you eating?" Some are gruff, some are sweet, some are friendly, some are cool.
And each person who deals daily with tragedy - paramedics, nurses, social workers, veterinarians - has to figure out their own unique way to balance compassion with self-preservation.

Thing 2.
Time is an issue - I believe a serious one.
Interns and residents are run ragged; sleep-deprived, anxious, emotionally drained. This is wrong: we need more doctors, and they need an introduction to the environment that allows them to explore it and their own responses - at least to identify their liabilities.
Staff doctors in hospitals tend also to have too much work-load, plus teaching, plus administrative chores, plus trying to keep up with the literature - and the drugs!! - and still live a life.
In private practice, there is monetary pressure, office administration and staffing, patient records and follow-ups - and of course, the literature. Specialist appointments are booked at fifteen minute intervals - how much chat-time does that allow? In family or general or geriatric practice, anywhere except a major city, there is a chronic shortage of doctors and inevitable overbooking.
In so many situations, the doctor simply doesn't get enough opportunity to interact with the patient - and it's detrimental to the mental health of both, as well as the treatment.

And then there are the legal obstacles.... and the financial ones....

For me, though, the single biggest problem is the Cult of Medicine.
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