Today is Sunday, I worked at the hospital.
Work is tedious on weekends but slow and steady. Not much happens. There is a lot of time to talk and connect with the patients as they are not getting rushed in and out of the room for various tests.
I was covering my colleague’s patients today. I see a familiar name, Carlos is admitted to the hospital. He was my patient 1 year back. He was way sick. He has bad diabetes. Due to increased blood sugars both his legs needed to be amputated above his knees. His kidneys have failed and he is dependant on dialysis for his survival. Carlos was my patient when he had pneumonia – infection in his lungs.
This time he is admitted as his lungs were filled with fluids and he couldn’t breathe. He is waiting to have some tests done on his heart tomorrow.
We start talking. He is watching TV. Steve Perry from music band Journey is making a come back. He knows everything there is to know about music. He plays a trumpet whenever he has enough energy to do so. He is missing his bigger than life TV in his living room. And that’s all he cares about.
Carlos can’t walk. He needs to be dialyzed three times a week. He can barely see. His heart is failing him. He gets admitted to the hospital every few months as his body is failing.
I wonder about his quality of life. But who am I to ask that question? Every awake hour he spends listening to his favorite bands – Journey, Rolling Stones, Carpenters, Billy Joel….
Carlos is happy with his music and I guess that’s what matters!!
Wasn’t it the 1960s or the 1970s.
I recently read a story about Santana and Woodstock. He was the heart of the gathering. High on his music, high on the drugs – drumming away. People lived those days. There was no fear of HIV, money was surplus, and the moral boundaries were lax.
Today, while at work, it’s 2018, I meet with a patient. Marina is 72 years old. She grew up in New York and Connecticut. She remembers the glory days of her youth. She was in college, making some money bartending, and always had a cigarette in her hand. Santana is and was her favorite band. Brown Skin Girl is what she liked.
Now Marina is admitted to the hospital with Pneumonia and Heart Attack. She, when not sick, can barely walk as all the smoking has eaten up her lungs. Walking a few blocks for her is like running a marathon for me. She hasn’t seen a mall in over a year and hasn’t been out of the house in over a month.
I start talking to her. She has the same zeal to live. The same twinkle in her eyes (her family members have pasted her picture from her youth on the wall). Does she regret her decisions? Does she wish she hadn’t smoked so much?
It’s so hard to say. She wants to not suffer, she wants to go the mall, play with her grandkids, not be hooked to the oxygen tank.
As they say, HOPE SANTANA AND WOODSTOCK WAS WORTH ALL THE TROUBLE!!
I’m sitting at my hospital doing a graveyard shift.
And as I sit I wonder about the purpose of life. IS there anything that’s meaningful. Maybe it’s sitting here at the hospital 12 hours at a stretch that’s forcing me to think.
What’s the purpose of our life? Are we all just a whim of some Super Power who created us for some laughs?
Do we have a bigger purpose – after all we all die. Eventually, nothing really matters in life once we are dead. I have a patient – Louis is 70 years old, her lungs badly damaged by all the cigarettes she smoked. Isn’t that what they all did at that time – even Curious George used to smoke. She has no regrets. She is happy she had a good life – laughing, long drives, picnics with her family and friends. And she has a vivid picture of always holding Marlboro Light in her hand during these outings. She will soon die. She wants to go home with her family enrolled in hospice.
Anyhow, who am I to say she did something wrong. She had a good life. What really matters? Isn’t it all a big game we play – trying to find a meaning in life when none exists. Maybe staying laughing should be the purpose of our life. Period.
Amazon buys a pill dispensing start-up company for a billion dollars.
GetRoman is a multi-million dollar company. They are selling medicine on line to make men feel like men – Viagra, Cialis, hair loss treatment.
Health Tech is a fast going field. Tons of companies focussing on big data analysis, artificial intelligence, or genetically targetted medicine.
Atul Gwande was recently appointed CEO of a new health care company masterminded by three giant companies.
What will this company headed by Atul Gwande try to achieve?
The physicians are getting lost in paperwork. Empathy is disappearing. Patients are identified by the room numbers and not the names. We are all busy doing our job – treat one patient at a time. Walk from one room to another where one patient blurs into another.
In this fast-paced world, we need more time. We need fewer computers. We need less technology.
Today a friend of mine calls me. I have changed my job and hence not working with the same team at the same hospital. She started work with me almost five years back. This is her first job. I have worked at a different hospital for eight years before her.
I acted as her mentor, a friend, or a confidante. Let’s call her Monika.
Monika is 35 years old and has two kids. I saw her being pregnant, go through the nine months of agony and happiness and now her daughter is three years old.
Monika calls me and she is unhappy. She is feeling helpless. Over five years, I have come to admire her for her resilience and hearty way of living life. Monika received a call from the hospital that her 35-year-old patient who was transferred to the hospital yesterday night due to internal bleeding has died.
Once again mortality hits in the face. The patient has two kids – the same age as my Monika’s kids.
There are no words which can dampen the blow. There are no ways to console her. Only time will heal it all.
We see Death every day – staring right at us. I don’t think anything in our medical training equipped us to deal with emotions. We have each other at the hospitals. Friends, acquaintances, co-workers – we talk, we share and life goes on.
I see Mr. Miller while I’m covering my colleague’s team. The medical students and residents present me the stories, medical decisions on the patient on the team. The plan was already made by my colleague as he was off for a day.
Mr. Miller was diagnosed with cancer of the kidney a few years back. He is getting chemotherapy and his cancer is advanced. He has fallen multiple times at home. This time the fall was ghastly, leading to visit to the emergency room. He had bleed around his brain and he was kept in the hospital for observation.
One thing let to another. Eventually, Mr. Miller was seen by a physical therapist and he was deemed unsafe to go home. It was thought he was not at his baseline physically and would likely benefit from going to a short-term rehabilitation place. By the time I saw him, the decision was already made that he is getting discharged later during the day to a nursing home.
I talk to Mr. Miller. I introduce myself. I ask him the usual questions about his pain, medical conditions or else anything I can do for him. I confirm with him if he is aware that he is getting discharged to a nursing home today to get stronger.
He gives me a half-hearted look. He is cachectic, his legs are as bone thin. There is no muscle mass. His eyes lack the luster or the desire to live. He states – I want to go home!!!
Why are we sending him to a nursing home? Has anyone asked him what he wants to do? What his desires are. We are trying to do the right by him – decreasing the risk of him falling again. But is it even possible in Mr. Miller who has advanced cancer and his muscles have shriveled to being paper thin? All he wants is a few months at home – live with dignity, defining the life on his terms and spend quality time with his family.
While in medicine we face disillusions every day. We expect a certain outcome because we are influenced by our medical knowledge, our biases, and desires.
Mark was admitted to the hospital yesterday. He is 50 years old and suffers from widely spread colon cancer. His abdomen is caked with the tumor. I saw him in the emergency room where he had presented with nausea and vomiting.
A surgeon had already seen him the emergency room and told him not much can be done to help with his symptoms as his intestines were completely blocked by compression from the tumor.
I admit Mark for dehydration, pain control and to manage some alternate way of keeping him fed.
There goes all the medicine I have learned over time. I was completely disillusioned with medicine. I studied for over 10 years and have worked for over 10 years and I could do nothing to help Mark to prolong his life. All that is left are few months of life with medicines to control his symptoms.
How does one keep disillusionments and anger at bay and provide Mark with the care he needs. Health care providers are human as well. We want to feel good about what we do. Its the reward center which makes us feel good. There is no place to go and talk about this. We continue doing what we do every day.
I’m talking to a friend about being a minimalist. We start discussing about being a minimalist versus being a hobo. And it reminds me of a patient I saw a while back.
Where I work, its a beautiful county with picket fenced houses. The other day, police brings a man from the train station to the hospital as he is confused. Brian apparently is confused when admitted by the night shift physician. The lab work is normal and so are the vitals. He is admitted with the diagnosis of altered mental status and deemed a social admit.
Next day we examine him. He looks withdrawn. He is least keen on talking to us. All he wants is get discharged and continue with his life. On examination, all 10 of his fingers and toes are self-amputated from frostbite. The stumps are black – but he doesn’t care. He wants food, a lot of food.
We have MDR (multidisciplinary rounds) – the nurses, doctors, social worker, dietician all sit together to discuss every patient. Someone suggests that Brian is incapable of taking care of himself and making poor decisions. He should be committed to a long-term nursing home.
Brian is a hobo. He has no home, no address, no ID. He lives on the streets, in the trains. He begs, borrows or rummages through. He doesn’t want to be tied down.
Is it all that bad??? I read a story yesterday where a man leaves his perfect girlfriend as he thinks getting married to her, will make his life perfect and he doesn’t want perfection.
Do we all need fancy clothes, good exotic food, big houses, big cars, perfect kids, tons of money? Or we all are hobos somewhere in mind who are afraid to admit so?
I am in the process of changing my jobs. So much to think about. I had applied for a managerial job, but my junior was chosen over me.
Am I unfit? Or Am I unfit for the job?
As much as I want to think I’m unfit, I realize I’m unfit for the needs of the job. My current superiors need a “yes man” person and I’m far from it. They want someone who prioritizes work over everything else – and again that’s not me.
I have been talking to some other hospitals. A job has opened up. I will move there soon. In interim, I’m working a few shifts here and there – few hours a week. Enough to my bills – but can’t go on forever. I’m sort of master of my life for a change. I refuse to work weekends and more than eight hours a day.
It’s time to move on. Hopefully the new place is not run by one commander in chief, and hopefully, it will be possible to find a work-life balance.
It was an uphill battle, with tons of self-doubts.
But, I realize it’s not me. It’s them. I didn’t fit the job. I’m not incompetent.