For the last 3 weeks, I've been working as a "sub-intern" on the family practice inpatient service in one of the local hospitals. It's been quite a time! I've sure been kept busy, but learning a lot and seeing a lot. With a moment of downtime, I wanted to share a reflection I had yesterday.
We're all familiar with the glamorous "saves" in medicine. It's the car accident victim that undergoes helicopter evac, immediate surgery and whose life is saved. It's the acute peanut allergy that receives the almost magical dose of adrenaline and is almost instantly better. The list goes on. We're often very succesful at treating these conditions, though sometimes they do die. What I think is a common misperception, though, is that this is the norm in medicine. That most illness is out of the blue, is something that just "happens" to people, that there was nothing you could do. But most medical problems are not caused by being in the wrong car on the wrong day.
What I see day in and day out is complications of simple, easy to manage problems like diabetes, high blood pressure, asthma, etc. These are things that we KNOW how to treat. We know how to prevent complications. And yet, I just had a man last week who required half of his foot to be amputated as a complication of untreated diabetes. I had a woman this week who came in seeing snakes on people's clothing, because her blood pressure was so high it was affecting her mind. Last month, I saw a man who had large amounts of yeast growing in his mouth and groin because his blood sugar (and thus urinary sugar) was so high.
This morning, I'm caring for a truly pleasant gentleman with COPD (bad chronic lung disease usually caused by smoking). He hasn't smoked in the last 15 years, but he smoked quite heavily before that. Even though he's been doing things all right as far as his lungs are concerned for the last 15 years, he has to live with the consequences of his actions prior to that. For the last several days, I've seen him decompensate and gasp for air, feeling like he's drowning, because he can't get the air to move through his lungs like he should. How did this kind old man get to this point?
Day after day, I see patients on dialysis because diabetes has destroyed their kidneys. The treatment of diabetes is simple! Some pills once or twice a day, sometimes insulin is necessary, diet and exercise. These are not miraculous innovations! But are they DAMNABLY hard to do.
"Physician, heal thyself" haunts me. As I tell my patients about the importance of eating well and getting regular exercise, I think about how I'm going to grab a Big Mac and a large Coke as I race from the hospital to the clinic. I think about how I'm working 60+ hours a week and have no time to go on a run. I know I've gotten 4-6 hours of sleep per night, most every night for the last several years. I think about all the bad habits I have, and how I have full knowledge of the right thing to do, and what the consequences are if I don't. But sometimes, it just doesn't matter. I do what I know is harmful for my body, anyway.
And this makes me think two things:
1) It makes me compassionate, and humble. There's no point in me lecturing someone about not following the obviously right path. Yes, it's simple, yes it's straightforward...but life isn't always that easy.
2) It drives me to keep encouraging them. Sometimes, we just need that EXTERNAL voice to nudge us in the right direction. We know what's right, but we need a little kick in the seat to push us down that road. I'm happy to be that benevolent kick.
3) Ok, one more. It pushes me into trying to make at least one extra right choice today. Maybe I'll grab a salad in the cafeteria before I leave the hospital, instead of a Big Mac. We'll see.