I find that it is often hard to remember why I'm a doctor. The long hours, the politics, non compliant patients, a broken system, and the expectation that you are supposed to be superhuman. It is not a job where people say, "this is just my job." No, it is a life. You are always held to a higher standard. Just when I think......Aggghhhhh...God reminds me of the reason why I am a doctor.
Yesterday I was in the University ER (in the city, not the small town) and a patient came in who was ready to die. She had lived hard.....drugs, alcohol, unprotected sex, and I'm sure a lot of things that I can't imagine. She has Hepatitis C and combined with her lifestyle she found herself suffering from end stage liver disease. She had a rapid decline over the last 4-5 months which happens when the liver finally quites working. She had been discharged from the hospital 4 days before and told that she had a very poor prognosis. She went to a nursing home in hopes that she would be able to stay off of drugs and alcohol. As she put it, "I have been to every treatment facility in the south." To get on the liver transplant list you must have 6 months of documented sobriety and AA meetings......that is just to get an appointment with a liver specialist. Even if she did get completely sober she would be looking at somewhere around a year to 18 months before she would be able to get on the list. And then the real waiting would begin (assuming she ever got that far). Like most people, she would have died waiting for a transplant. And this is not a pleasant death.....I have told Mere on multiple occasions that long, drawn out liver failure must be one of the worst ways to die.
Anyway, she came in from the nursing home with severe shortness of breath secondary to her huge abdomen (full of fluid because her liver is failing) and a desire to be put on hospice. This woman had spent time working for hospice and knew exactly what she was saying. Essentially, she was ready to die. No more working towards sobriety, no more doctors, no more needles, no more suffering. She just wanted to be made comfortable. This poor, emaciated, bruised, yellow woman was clearly in so much pain (physical and emotional) and she was by herself. Her dad and sister had unrealistic expectations and she knew they would not be ok with her choice. She has 2 adult children that would not be ok with this choice. But she knew this was the only choice she could make. She had made her peace and "was right with God" and wanted to be made comfortable. One of the things that I was able to do to make her comfortable was to draw some of the fluid off of her abdomen, otherwise known as a paracentesis.
Usually when I do procedures I go look for med students or interns to help and often guide them through the procedure. But today it was just the patient and me. I couldn't even find any nurses to help. So it was her and me, alone, for almost a hour. I put the needle in and started draining fluid, 9 liters to be exact. The fluid doesn't flow super fast so essentially I was sitting there holding the needle and we talked and talked. She alternated between crying and being very composed. We talked about her life, her children, her business, life, death, what to expect, how much time, and a few other things. I sat on the edge of her bed (after she offered) and allowed myself to connect to her. We are from 2 separate worlds but in that moment I let my guard down and found myself feeling very close to her. It is hard to explain. I was the first person she told that she had decided to go to hospice. I was the first person that she had really discussed death with and it was a honor to be that person. No judgements, just compassion and love.
She said, "I guess I'm pretty lucky that I almost made it to 50 living the life that I led." I just can't imagine being in that situation. Knowing that you are going to die and knowing that you did it to yourself. She said, "I wish I could tell people that it is not worth it." I finished up the procedure and reassured her that she would not be alone, that hospice would be there for her. I thanked her for letting me sit with her and I left. But, she did not leave me.
There is a growing handful of patients that I know I will always remember. Some for very profound reasons, some for funny reasons, and some because they were just so sad. But they all gave something back to me. They all reminded me what a honor and privilege it is to be a doctor. To be trusted with such intimate moments, to have the ability to comfort people when they need it most, and to connect to people on such a primative level.
So, in the end...........these are the reasons why I am a doctor. Despite all the daily shit it IS worth it.