Tuesday, June 1, 2010


In The Blog, it would seem like everyone is a troublemaker, intoxicated, or both. It would also appear that the core of my job is to act as a wall between these folks and the rest of the world, to sort them out and send them back into their little corner of the world where they linger until their next trip to the ED. And from time to time, showing “tough love” (or at least “tough medicine”) is what some patients need. But there are some patients for whom I’m a total pushover. Patients with cancer can be rude, mean, and demanding, and I’ll do anything they want.

Truth be told, I really like caring for patients with cancer. I wish I could say it’s because I can empathize with their situation. But to be frank, empathy has never been a strong suit of mine; it’s not part of my wiring. I have great difficulty putting myself in the place of others. Even when I’m sick, I feel uncomfortable with the situation rather than empathetic towards other’s ills. (This is why I think that on days I’m feeling bad, there should be a sign in the ED that says “You must be sicker than me if you want me to care.”) I wish it weren’t so, and I try to make up for it with thought and reason. So rather than being able to sense someone’s pain or discomfort, I try to think how I would cope with a similar problem. It’s an exercise that sometimes works, but often fails as an ineffective rationalization.

Maybe I like cancer patients because, despite every possible reason to be angry at the world, most of them are incredibly polite and grateful. I’m not sure why. I would think my reaction to cancer would be to grow angry that I had to spend some of my limited time in the chaotic environment of the ED instead of comfortably at home. Perhaps their attitude is different because their perspective changes. When you know your time is limited, maybe you’re willing to spend a small amount of inconvenience in the ED to buy more quality time in the long run. (I do know that for me, the only time I become conscious of time is when it’s limited.)

Maybe it’s because they’re pretty easy to care for. You already have the diagnosis in hand, and most of the time your efforts in the ED are focused narrowly on one of three things. They may have pain, which is easy to treat. (There’s no argument over pain medications here). If the pain gets under control, you write them a prescription and they go home. If not, you admit them. The patient could have a fever, in which case you check their white blood cell count. If there are enough cells there to fight infection, you write them a prescription for antibiotics and they go home. If it’s too low, you admit them. If they feel weak, you check some basic labs to make sure there’s nothing too out of whack, and them let them decide if they want to be admitted or head home to rest.

Maybe it’s because the baldness caused by the chemotherapy makes them all look younger, with the fuzzy scalps of newborn babes hidden by a jaunty baseball cap.

Maybe it’s because I feel like my job is to do something to make them better, but they’re staring down the barrel of the gun and there’s not a silly thing I can do about it. So giving them what they want may be a way to assuage my own impotent guilt. And maybe, in treating myself, I’m able to make everybody happy.

1 comment:

  1. poignant that some of those patients so much closer to death in fact seem so alive. and how is that they can so strongly affect so much of our living? The deepest truths indeed lie somewhere hidden in the space between what appear to be contradictions. You as the agent of change they entrust their care to, you choose to trust and to believe, not to doubt or fear. That is not impotent guilt. That is unadulterated faith, strength and wisdom.