My least favorite thing....

Although there are LOTS of things I LOVE about being a doctor, there are still plenty of things that overwhelm me and are tough to do. Trying to manage very sick patients in the ICU. Figuring out which antibiotic is best. But the hardest thing for me is having to have a certain conversation with patient's family. Now that I'm back on medicine I feel like I'm having this conversation almost every day, the conversation about when to stop treating someone.

We have lots of very aggressive treatments in medicine. We can breath for people. We can keep their heart beating. We can use a machine to act like their kidneys. We can give them big whopping doses of strong antibiotics to try to treat a raging infection. Usually when someone is admitted to the hospital, we start doing these things. We use the technologies we have available to try to do everything we can. But some people are incredibly sick. They have bodies that are aged, broken down by years of living in this fallen world. And even with the most aggressive therapies, some people are not going to recover. They have terminal illnesses like Parkinson's, Alzheimer's, or cancer and even if we use these treatments, we will not fix those problems.

It is my job to go to that patient or their family and tell them that I'm sorry, but nothing can be done. I have to try to get them to understand that instead of continuing to use these aggressive measures, we should stop fighting against the inevitable.

And I have such a hard time. It's hard to know what words to use, how direct to be, and how to make sure they know that I'm so sorry for what I'm saying, and sorry that medicine does not have all the cures. It's even harder when it's a patient with something like Alzheimer's who is no longer able to eat and drink. Sure, we can give them IV hydration, or try to force food into them, but really they are just at the end of their life. Nothing that we do will fix the underlying problem they have. But it's hard to know when withdrawing care becomes something more sinister. I want to respect people who are made in God's image and honor the life that God has given them. During medical school, I thought that it would always be very clear what was the right thing to do. When you are actually in a hospital room, sitting at the bedside of a dying patient, things can be a little more muddy.

So I continue to refine the language I use with my patients, and pray that God would use me in the lives of those who are dying, as well as in the lives of their families. And also that he would continue to help me see when I need to fight strongly against death that is NOT a part of his original plan, and when it is OK to realize that simply prolonging life should not always be the ultimate goal of doctors.

Comments

Totallyscrappy said…
What a blessing you are to those families. They may never know how you struggled and seeked God's guidance for just the right words for such a difficult conversation. May God continue to bless you as you become the doctor He wants you to be.
The Balls said…
i'm so glad that you stumbled upon our blog and then i in turn stumbled upon yours! it's such a great way to keep up with friends. i hope you and jeff are doing well! love, han

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