Tuesday, April 14, 2009

How would you describe yourself? Tell me.

We got a new attending doc today on the service. Lets for the sake of HIPPA call him oh, I dont know.... Dr. Kill.

Let me set the scene. I went in silly early in the morning because unlike the Turns/Rez. I dont work the 30 hour shifts. So I come in at about 0530. Get in early and I see the old gommer who I thought for sure would be dead by now still up and on the vent. I am getting the X-rays up on the screen and ready for the rounds to start. A nice old guy comes up and it turns out that he is the new attending. First question that he asks of me is "How would you describe yourself? 1. A healer 2. A palliator 3. A benevolent executioner"

I said that I was not a healer. The more I work in this whole “medicine” thing, the more I realize that I really can not “heal” anyone. I think that it is wrong to think that I cure anything. I don’t. I don’t think that the medical community offers a cure. We can aid the body in defense or make you feel better when you are sick, but cure, I don’t think we do that much.

I don’t think that I am a benevolent executioner. I would hope to avoid that if I can.

I do think that I am somewhat of a palliator. I try and alleviate pain when I can, try and not inflict any extra for no gain. Really, I feel that the profession of medicine is about palliative care. Perhaps this idea that “we” in medicine NEED to cure, we need to heal the person’s illness. There is a constant pressure to perform to the ER standard. To do chest compressions and shock the person and they will cough a couple times and then get up and walk out the door. That is not reality. Real life is that people all die, it just depends on what that death looks like.

It makes me sad that the guy is still on the vent. Last week when he came into the hospital there was a horrible thing that happened. Its messed up beyond my explanation how a man can come into the hospital with a valid DNR/DNI. Fill out ANOTHER one in-house so that we have a full copy of his wish to NOT be intubated right in the front of the chart and now he is “living” on the vent. It makes me sick.