clinical

Heavy Stuff

What a clinically heavy week it’s been. There were two sudden and unexpected deaths… After the shock, the first things I thought of as the primary care doctor in both cases were: What did I do wrong? Did something I did or didn’t do contribute to this person’s death? I felt culpable, despite the fact that on objective assessment, it’s extremely unlikely that anything I did or didn’t do contributed to either death. So, I did the best that I could to put aside that nagging, self-centered paranoia. I reached out to the families, and I’m so grateful. To hear a whispered thanks, and no blame… well, there was no more powerful medicine for my aching and anxiety. Of course, then I felt guilty for feeling relieved…

It’s been a difficult week, for sure. There’s more…. I had a telephone confrontation with a patient who I suspected was diverting their narcotics. Despite being calm, reasonable, and well within our hospital’s mandatory prescribing guidelines, the profanities and insults hurled at me from the other end of the line left me shaken. I politely hung up, and then showed a colleague my trembling hands.

That same day, leaving the office in the evening, I had a frightening encounter with a drug-seeking patient. Nothing happened, just an insistent request for a prescription… But the office was closed, and I was the only one there. It made me realize that I needed a better plan for a situation like that, and luckily, the whole office was on board with that. Within twenty-four hours, there was a list of new security measures.

These things all came on top of other clinical challenges: a surprise (very) positive imaging stress test; an unintended pregnancy; an ultrasound suspicious for ovarian cancer.

And, of course, there’s also been all the usual bread-and-butter primary care: the patient who’s been cheated on and tearfully requests STD testing; a stoic lady admitting that she’s dangerously depressed; a pillar of society revealing that she’s drinking too much. Twisting knee and ankle injuries; a diabetic with cellulitis; mystery fatigue. Mononucleosis; excruciating shoulder pain; vertigo. New breast lump; itchy rash in the groin; wheezing. The end-of-visit “Oh, and I forgot to mention, I need this paperwork filled out, today.”

I feel bad for my family, as I’ve been later than usual coming home, and somewhat distracted. But, at the same time, I’ve felt more alive, really engaged in my practice.

The more that’s going on with my patients, the more I enjoy my job… But, at the same time, it’s exhausting, draining, and gets in the way of quality family time.

Of course, when I have gotten home, I’ve been less likely to freak out about things like, the kids having a yogurt fight, or Babyboy pooping his pants yet again, or the cat peeing on the floor (all of which happened tonight).

I’ve been more likely to just smile, and hug my kids a little longer.

There’s a lot of heavy, bad stuff out there. People get sick, suffer, and die. Right now, I’m not sweating the small stuff.

6 replies »

  1. Reading this post makes outpatient primary care sound really fun 🙂 (I’m a hospitalist and sometimes I feel like I am delivering care that prolongs life without adding to quality…there have been a LOT of 80+yo demented people on my service lately….)

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    • Hi Zelda, that topic is a very tough one… Having recently had a few difficult conversations with patients and families of patients who sound similar to yours, I can say, I also struggle with this. It’s sad, and frustrating.

      Liked by 1 person

  2. I’m so impressed that weeks like that make you more tolerant at home…they always make me less tolerant. Like, say, this past Thursday night when I yelled at my kid and it was really because I have three people under 55 in my inpatient hospice unit….

    Liked by 1 person

    • Hi Jay, That sounds especially hard to deal with… It must be impossible not to absorb some of the families’ grief…. But, I’m not immune to being stressed and short… That’s me more often than not. But what triggers it for me is when the self-care lags… When I’m not making sure that I get sleep, exercise, quiet time, healthy food… Especially sleep. Sleep-deprived me is NO fun.

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