Thursday, June 22, 2006

Death and The Doctor

I had a lot of patients die recently and it was weighing heavily on my mind. It is interesting where your thoughts go when you sit down and start writing:

In the hospital again. Lots of death is always here. Watched a 2 year old girl whom I had delivered, slowly die. Nothing I tried worked. She faded right in front of me while her mother cried. For a while I had dreams about her. I would wake up frantically trying to save her only to realize the child had died a week before. Later on call, I ran a code on a woman for almost an hour. All her ribs broke. We shocked her again and again but nothing worked. Then the other day I sent a gentleman I have cared for several years to hospice. I always liked him, although he never cared for doctors. He said he was tired of treatments and check-ups and was ready to die.

Working in medicine is an odd job. I can think of no other role that brings one so close to death without any real danger involved. Soldiers or law enforcement put their own lives in danger in their jobs that involve for life and death, but the doctor or nurse almost never fears harm. Other than the occasional cold caught from a patient and being kicked by a drunk patient I have never experienced any physical harm or danger in medicine. Doctors are like the television-watchers who absorb violence after violence from the safety of a living room. We may struggle to save our patients or mourn them when they die, but in the end we are observers and not participants in the suffering we see. I wonder if it is healthy for the mind to see death so often and have no immediate threat of it to force fear in us?

I have often noticed that soldiers and police officers I encounter seem cool and distant, but their experience with death is different. They have known their own lives to be in danger. The modern hospital may be a unique place in society where those who intimately interact with life and death are immune to being harmed. (In some ways even literally immune; I get more vaccinations than the average person.)

I wonder if there are threads of voyeurism in our desire to help the suffering? It is a job that must be done, and we are proud of our opportunity to "help people," but we are not the ones who would be just as contented helping people from a distance or even helping those we might never see. We want to help from up close where the blood and crying is.

I didn't consciously recognize this in myself when I chose medicine as a career. However, I cannot deny that when I run to a code it is not only altruism that drives me. I want to be where the action is. I suppose this is the same instinct that keeps us glued to news broadcasts of wars and plane crashes.

There is something in us that seeks to watch death and suffering. Perhaps we seek catharsis—to somehow improve our souls by empathizing with the suffering of others. At least I hope it is reflection and improvement we seek.


Johnny P said...

Hey, Jonny! I'm back in good ol' Chattavegas. I hope we can catch up soon. Thought I'd suggest this book... haven't read it myself, but the manager of RTS's bookstore highly suggested it. It's a book on death that is suppose to be excellent. It is called "Sunsets" by Deborah Howard. Just thought this might interest you seeing all the death that surrounds you. Keep in touch. Peace! -John Porter

anna marie said...

I can believe that this patient's death "almost" made you cry. It made me cry just to read about it!

Of course it is the reminder of our own mortality that we mourn most in the death of a stranger, perhaps even in the deaths of those we love best.

But we do need to be reminded, nonetheless. And you have reminded us well.