I have a consult for you...

My beeper goes off at 3:30 pm and as I answer the page; I am hoping it's not a consult when my brain is trying get home but then the voice says, "I have a consult for you..." Hmm, why didn't you call me up earlier I wonder as I start scribbling some details. So, I go see the consult. I get paged again while I am gathering information on my consult patient and this time it's a voice from the ER and the voice says what I didn't want to hear at 5 minutes to 4; "I have an admission for you." Hmm; so here I am. I really enjoy seeing patients; they are a huge part of who I am. Then why do I feel like someone should've called a consult earlier or that I shouldn't be getting an admission so close to my time to sign off? I love what I'm doing; then why do I feel that tinge of resentment when I get paged late? Shouldn't I jump with enthusiasm at every opportunity I get for learning and applying what I have learned so far. There are a few things which I realized as I was thinking about these times...one was that when you are mentally prepared to go home or call it a day; something which upsets those plans just happens to create a little resentment; or if you had plans to do things which were part of life apart from being a physician; then you get a little upset or if you're just really tired; or if it just hasn't been your day and you want it to end sooner than later or if you just want to go home! But life as a physician will always be about those moments which can never be planned for. That is both the joy and bane of being a physician; you can have a life and you can have a life but whatever you do; the very essence of your existence will be in being a physician first. The late consults/admissions are perhaps meant to prepare us as residents for the world at large; to accustom us to the uncertainties of being called upon at any time; of having plans postponed; of having to cancel birthday celebrations; of having to miss some important moments in our families; of being there and yet not being there because you're really needed more somewhere else...
Then is it cool to feel the resentment? Nope. Obviously, it's easier said than done. Being able to maintain that eagerness to learn and the drive to give it your all irrespective of the time of day; irrespective of your situations is what being a physician is all about. Someday, I'll get there; for now my beeper can keep going off whenever I'm needed whether it's to save the world or just give my opinion; I'm in training and will take it all in my stride!

When your best is not enough...

I am currently training at a university hospital which not only has a busy Neurology service but happens to a big referral center for complicated cases. I am seeing patients with some of the most bizarre presentations which are defying known diagnoses. It's great to be doing all the things by the book, then thinking outside the box and knowing that you gave it your all. But what if that didn't work? What happens when your best is just not enough? You fight back anger and all emotion and let your patients know you tried. What makes it worse is that they know it too. They know it all too well, that you fought till the end for them. What makes it worse is when they console you; when they say, "I know doc, you tried your best but what's got to be will be." And I can't help but think that it doesn't have to be this way! It's just not fair. Some of the worst diseases strike some of the best people; people who have been living by the book of good health and should have been promised longevity because they were so honest and unwavering in their approach. It just makes you realize that we still don't have the answers to the question; "When I did everything right, why did this happen to me?" A lump arises in my throat every time a patient asks me this question and all the marvels of modern medicine just fade away and all humour fails to dissolve the pain. Why is my best not enough to let someone dream on; to let someone live on and not die an untimely death?

What needs to be done, needs to be done now!

I was telling one of my patients that they need to quit smoking and perhaps the best way to do it would be cold turkey; pick a date and kick (the) butt! He obviously had tried numerous times and had failed. We didn't even go into the details of his attempts to quit. This important piece of advice was only a small part of my extensive interview with him and I already had more patients waiting to be seen. I wasn't the first doctor asking him to give up a habit which had only caused him harm.
So many things I ask my patients to do, are easier said than done! I might be persuasive, authoritative, gentle or even nonchalant in my approach to giving patients advice. I might be timely in my approach or very untimely. How many of my bad habits have I been able to kick by the very same approach I ask my patients to adopt? They aren't heroes who can change the ways they think and act at the drop of a hat even if it means it’s a question of life and death; and what if it is more preventive than therapeutic; does that make it easier to postpone your plan to change? How do I tell my patients that this process is going to be tough and they have to stick it out? How do I tell them that I will be there every step of the way on their good days and bad days when they're raging a battle against smoking/ drinking or any other addictions when truly I am not going to be there with them every moment of their emotional turmoil. It's their families and friends who will be; people who have been affected by the process of their spiral down will be the people who will help them climb up step by step. Of course I'll be there to check on them once in a while. So, it’s only more important to speak to the patients and their support systems at the same time; so they’re both prepared, so they both understand.

But what needs to be done needs to be done. Why are things easier said than done? Why are habits so hard to break? Why are good habits so difficult to form and sustain? It's not always a lack of motivation. It's sometimes about timing. You need to receive or give good advice at the right time, be able to strike the right cord and at the right time. But sometimes you nor your patient have the luxury of time. So, do what needs to be done as honestly and as urgently it needs to be done and hope and pray that it works.