Doctors are the worst patients

chestxrayphotobomb

There are plenty of reasons why doctors shouldn’t get sick. The best one being – we make the worst patients. I, of course, am no exception. Despite having had plenty of practice in the past of being a patient, somehow, I just don’t seem to learn. Every time I get sick, I am always a doctor, trying to be a patient.

So why are we such bad patients? Because we think we know better. We are the one saving lives, and sometimes we refuse to admit that we are the ones that need saving.

6 weeks ago, I caught a viral infection, not hard when you work with sick people all the time. I kept working, because as far as I was concerned, if I wasn’t intubated on a ventilator in intensive care, or in a casket, I was not sick enough to stop working.

Reason #1: We don’t realise how crap we really feel until we stop worrying about how crap everyone else feels. When you are deeply buried amongst blood and gore during an operation, you concentrate on what’s in front of you, rather than the tightness and clogging in your own lungs.

Two weeks later, instead of improving, I developed a hacking cough which sounded like I was trying to expel my lungs in piecemeal. As I was struggling for breath whilst talking to patients in my clinic, one of my colleagues suggested that I go and have a chest x-ray done. I did. I looked at it with my colleagues (bear in mind we are both plastic surgeons who rarely ever have to look at chest x-rays), we decided that my lungs looked normal, that I would live and carry on. However, just to be on the safe side, I texted a photo of my x-ray to my husband, who is a lung surgeon, and looks at chest x-rays every day.

Reason #2: For every doctor who self-diagnoses, there is an idiot patient.

I received a text from the husband. Go and see a real doctor. I shrugged it off, he was obviously happy to look at everyone else’s x-rays, but couldn’t spare two minutes looking at his own wife’s x-ray.

Reason #3: Sympathy is sparse when you are married to a fellow medico (and surrounded by friends who are doctors). You have to be showing signs of multi-organ failure before you get breakfast in bed.

I carried on with my afternoon operating list, during which, couple of times I had to sit down because I felt light headed from being short of breath. I felt tired, and was taking more care than normal, but the list went on smoothly without a hitch.

Reason #4: It takes a sledgehammer to slow  down a surgeon. Because we are so focused on our work, we often don’t realise we are pushing our bodies to the limit until we collapse in a heap.

I got home late that evening, at which point my husband looked at my bluish lips, my ashen complexion and yelled, ‘What the F$#@ are you doing at home? You should be in hospital.’ He pulled up the x-ray photo I texted him and shoved it into my face, ‘you have right upper and middle lobe pneumonia.’

Reason #5: When we self-diagnose, we either completely miss the obvious, or become total hypochondriacs with the worst over-diagnoses. In my case, it was the former. Also, note to self- I obviously am not qualified to read a chest x-ray.

I climbed into bed in my work clothes. I couldn’t think of anything more mortifying than going into hospital for a cold and cough. There was no way I was going into hospital for this. So exhausted was I that I fell asleep within 10 seconds.

Reason #6: We never think we are sick enough to seek medical attention.

The next day, as I was doing an early morning ward round, I ran into a friend/colleague who is a general physician. He took one look at me, frowned at the sound of my wheezing and coughing, and promptly declared that I needed to be admitted to hospital for treatment. I told him that I had a full clinic, and will have to check into hospital later that evening. He suggested that I get myself into hospital as soon as possible; I told him that I couldn’t cancel all my appointments and let my patients down at such short notice.

Reason #7: We think that the Earth would stop spinning without us, and that our patients couldn’t possibly survive without us.

The day was particularly long – like a train in slow motion. Several patients looked at me in concern and told me I didn’t look well. I asked my secretary to shift all my appointments and operating lists for the next few days, so I could be admitted into the hospital. Some patients were angry and upset, some complained that they are busy people and already had arrangements in place for their booked surgery. Apparently my illness was going to interfere with their plans. Some were worried that their treatment were delayed and felt that I was neglecting them.

Reason #8: Some of our patients think they couldn’t possibly survive without us.

So I checked myself into hospital that evening. I was put on oxygen, given nebulisers, antibiotics and tucked into bed to rest. It was only when I was forced to do nothing that I suddenly realised how terrible I felt. My chest felt tight, my ribs ached, and my body gave in to the continuous coughing that rattled my bones. My limbs were like jelly and my muscles barely contracted, behaving like useless slabs of soft meat patties. I couldn’t sleep as the call bells pealed throughout the night, sounds of doors opening and closing interrupted my light slumber, and occasional moans and yells from other patients made me toss and turn. The next morning, the physiotherapist spent half an hour bashing on my chest to clear up the clogging in my lungs. We then decided to venture out of the room for a walk, and that is when I saw one of my own patients walking down the corridor on her zimmer frame with her physiotherapist. I looked down at my pyjamas in shame and high-tailed it back into my room. I started thinking about leaving the hospital.

Reason #9: Even though as doctors, we spend the majority of our lives in a hospital, we actually really hate staying in one.

When my physician came to see me, I spoke to him about the possibility of having my treatment at home. He was able to adjust my antibiotics and decided that I could be discharged as a ‘hospital-in-the-home’ patient, where I will be going home with my IV cannula in place, and just come back to day hospital for my IV antibiotics, physio and nebulisers once a day.

Reason #10: A colleague will always assume that as doctors, we would be trust-worthy, compliant, sensible patients. WRONG.

As soon as I arrived at home, I headed to the study and switched on my laptop. I reviewed all my dictation and letters, chased up lab results of my patients and caught up on some bookkeeping for my practice. The day after I was discharged, I had a case which could not be cancelled, so I asked my anaesthetic colleague to remove my IV cannula so that I could scrub for surgery, then to replace it after surgery before I headed back into hospital for my treatment.

Reason #11: We know how the system works and we have connections. Doctors will always find a way to circumvent treatment regimes to suit their activities.

But as I sat there at the end of the day, with the IV antibiotics dripping into my veins, and the nebuliser oxygen mask on my face, I suddenly felt so tired. So tired of it all, of putting on a brave face, of carrying on as if nothing is wrong when I felt so unwell, of worrying about my patients when I should be concerned for my own health, and most of all, I was just simply tired. My bones ached from exhaustion, and my mind was so worn out, it was completely devoid of any emotions.

Mentally, I was waving a white flag. My body was shutting down because it had reached its limits, and it was time I surrendered to the consequences.

Reason #12: It is terrifying for doctors to admit that we, despite our abilities to help people and save lives, are just like everyone else, mere mortals, in bodies that have limits.

After four frustrating, agonising weeks, I am finally on the slow road to recovery. It is only now that I have started to contemplate changes in my life, ways of improving my health, and strategies of looking after myself. In a moment of déjà vu, I felt that I may have been down this path before. Regardless, I was, at last, being a sensible patient.

That is, until next time.

The Frustrations of Caring

Sometimes I wish I didn’t care.

I remember when I was an intern, the professor of surgery once said to me, ‘the trick of lasting in this gig, kiddo, is to stop caring so much.’

I thought at the time that he was referring to caring about what other people think.Then I realised he meant caring about patients. I was outraged; absoluately convinced that he was just a cynic.

Now, I think he is actually just a realist. A very experienced one at that.

Caring about patients need to have limits. I have learnt the hard way, that if not, the patient will start pushing boundaries with their expectations, my whole existence becomes one big worry-farm, and then my personal life deterioates.

When I meet my patients for the frst time in a consultation, I take the time and effort to explain everything to them. I care about how much they understood and whether they feel reassured. During surgery, I do my best to be efficient, methodical and meticulous, because I care about the success of their surgery. While my patients are recuperating, I make sure they have all the information and instructions to follow and a contact number to call if they are concerned, because I care about decreasing their distress and anxieties while they are recovering. And at their final followup, I care, in particular, whether they are happy with the result.

This translates to worry. I worry if they have had enough time to digest the information and ask me questons. I worry if I have done my best with their procedure. I worry if they are going to develop a complication after surgery. I worry if they are having problems at home after surgery. I worry if they are dissatisfied with their result and if there is anything further I could do for them.

I worry. And it’s tiresome. But after many years, this constant caring and worrying becomes part of normal living – a bit like the constant background hum one hears in an airconditioned room. Some days the humming is louder, like when I am working over 100 hours a week and I have lost count of the number of patients I have seen. Other days, it’s like a sledgehammer, when I am dealing with problematic patients and complex surgery. Rarely does it becomes silent, even when I am asleep (yes, I do dream of operations and patients), or when I am on holidays (I still receive emails of lab results, letters etc).

Sometimes I resent it. Like when I receive a text message from a patient at 1am with a selfie of their wound or surgical site. I feel like yelling in frustration. But I constantly have to remind myself that it’s not the patient’s fault my life is like this. They are only doing the right thing – contacting me when they feel something is not right. It’s my fault. My fault because I care. I care enough to ring them back and listen to why they can’t sleep, talk about their concerns, and address their anxieties. Then I lie awake worrying. By the time my caring has finished, it is time for me to get up to start my 12-hour day again.

Sometimes my husband resents it. ‘Why do you have to go in to work on Sunday?’ Because I worry that my inpatients may have deterioated overnight, or need an increase in their painkiller prescription. I worry that they are sitting in hospital on a Sunday, feeling abandoned by their doctor (who feels too guilty to have a day off). ‘Why can’t you switch your phone off for dinner?’ Because I worry that my patients may need me and I won’t be there for them. ‘You are thinking about work again and not listening to me.’ I was worrying about what I could have done better in surgery, instead of giving the one most important person in my life the attention he deserves. I worry because I care.

Believe me. I tried. I tried to stop worrying, and erect a wall against caring. I tried to emulate some of my colleagues who has Not-Caring down to an art. But my conscience kept me awake, and my attempt lasted for all of 10 seconds. I know I don’t have to care, I just have to provide a service to my patients. I have seen very capable and successful surgeons who don’t seem to care and still have excellent results. They shrug off complications, they don’t take their patient’s problems home, and they brush off complaints at the office door. They live by the ‘Shit-Happens’ Rule. They don’t ever look worried. Either it is because they aren’t, or they have lived with it for so long, it is unrecognisable.

The problems with caring, is it’s closely associated with feelings and emotions. More and more, I have had to find the strength to put it aside. I have seen that too much caring can cloud one’s judgement, especially if I worry too much about how they might feel. Sometimes, cold clinical judgement to do the right thing, which may not be what the patient want, is the only way to make sure they have the best outcome. The hardest part is stepping away from their expectations, so that the bigger picture can be see in perspective. Thus lies the basis for not
treating our own relatives.

And now I understand that the advice was given to me to prevent ‘Burn-out’. I have learnt that sometimes I am unable to solve all my patient’s problems, and that I am not responsible for all their woes. I have also realised that just because I can’t help them, it doesn’t mean I don’t care. It is often enough for people to know that someone cares.

I have discovered that I need to reserve some ‘caring’- for myself and people who love me. I need to care about my health, that I shouldn’t live on chocolates and coffee. I need to care about my husband, what problems he’s having at work and why he’s wearing a shirt with missing buttons. I need to care about my mother, who still refuses to have her home security installed. I need to care about my 90-year-old neighbour, who still push my bin out every week for the rubbish truck but can barely manage to climb up the stairs of his porch. I need to care about my ever-loyal staff, who stays behind in the office and keeps their family waiting in the evening because I have two extra patients to see.

But how does one measure ‘caring’? And how do you dish it out in equal portions? What is enough and what is too much?

Caring is frustrating. It brings with it tiresome worries, sleepless nights and at times, total helplessness.

If I could talk to Prof now, I would ask him, ‘But, how do you NOT care?’