First, do no harm …

Yesterday, a news story came up on my FB feed.  I’m still thinking about it and trying to figure out how I feel about it.  I decided to write about it, hoping it might help me process my thoughts.  It’s about a 29-year-old woman with stage 4 brain cancer (glioblastoma, the same kind of tumor that Dr. Greene (Anthony Edwards) on ER had) and she is going to die on November 1.  She lives in the U.S., in a state where, apparently, there are laws in place that allow patients to take their own life when terminally ill.  She states she’s not committing suicide, rather, she is taking control of her illness and deciding when and how she will succumb to it, not the other way around.  Most of the comments posted after the article are all like, “Wow, what a brave woman”, “Good for her”, “I’d do the same”.

Really?  I was kind of surprised that no one seemed to question the ethics here.

I can’t even begin to imagine what this woman is going through. To be diagnosed at such a young age with terminal cancer, it’s truly heartbreaking and tragic. One of my colleagues said she’d probably do the same if she were in that situation.  I’m really not sure I would, to be honest.  Or maybe I would? How can one ever know until faced with the reality?

I have three children.  This young woman has none.  Would her decision change if she had kids?  How would you explain to your children that you are going to end your own life before the cancer gets a chance to?

Death is a natural part of life – granted, dying at 29 doesn’t seem all that natural.  Dying at 90 on the other hand, does.  Still, we are all going to die, none of us can ever know when or how, that is, unless we are diagnosed with a terminal illness and even then, no one really knows how long we have.  Last spring, I visited a patient dying of prostate cancer. I saw him about 12 hours before he passed, peacefully, at home, surrounded by his family. When I spoke to his wife the following morning, she struggled with the fact that she was asleep when he died.  I wondered if it would have been easier for her to witness his death? I’m sure it would have been difficult regardless.  To the very end, my patient hoped and prayed for a miracle.  It was never stated, but you could see it in his eyes. He didn’t want to die; he didn’t want to leave his wife and children. He should have had more time. He kept fighting to the very end.  I admired him for that.

I have a hard time knowing that this young woman is going to actively end her life. That she picked the day she was going to do it, much like one picks a wedding day.  It’s two days after her husband’s birthday.   She has been told there is no cure, that her final days will be spent in pain, perhaps with multiple seizures and it’s not something she wants her family to witness.  I understand that, I really do, but there are ways of helping dying patients be more comfortable in the final stages of life.  It’s the whole reason Palliative care exists.  The process of dying has to remain a natural part of life, once we start helping patients to die, we no longer adhere to the Hippocratic Oath, in my opinion.

First, do no harm.  A physician, in good conscience, cannot be a party to the death of another human being. I can already hear those on the other side of the argument – NOT assisting a patient to “die with dignity”, causes harm.  I don’t believe it does and I don’t think this is what Hippocrates had in mind when he wrote the Oath.  I don’t wish for any individual to suffer on their deathbed, far from it. Medicine has come a long way in the past 150 years – expected death can be painless for the vast majority of patients.  I think we are actually inviting more harm to patients, their family, and society as a whole if we decide that assisted suicide, euthanasia, dying with dignity – whatever you want to call it – is okay.

It’s just not.

 

The Biggest Time Waster in Modern History.

NaBloPoMo – Day 11.

What the hell did we do before the Internet? How did one waste time prior to 1994?  I say 1994 because that was the year I got my first email address.  It went downhill from there.

The Internet is a huge time waster.  Or, I should say, using the Internet is a huge time waster. Seriously though, how did we pass the time before we had laptops, iPhones, BlackBerrys, Androids, iPads and tablets?  If I wanted to know who was in such-and-such movie, I’d have to go to the local library and find their copy of Leonard Maltin’s Movie Guide.  If I wanted to talk to a friend, I would have to, [gasp] pick up the telephone!  Who does that anymore?  I know I certainly don’t.  The only people I ever call are usually my parents, ie people who don’t use the Internet. Now if I want to contact a friend, I text her or send an email or write on her FB wall.

Had I had children prior to 1994, how the hell would I have passed the time with a newborn?  God forbid, would I have read a book??  I have lost count of the hours I have spent surfing (where does that expression even come from?) the Internet while the baby nurses.  Be it Twitter, Facebook, Pinterest, any number of message boards or blogs, it is how I spend my time these days.  While I do have other hobbies, in particular my cross-stitching, it is difficult to do with a newborn.  (Excuses, right?).

I also wonder where my attention span went to.  It’s no wonder I haven’t been able to finish a novel.  Who can concentrate these days for more than 5-10 minutes at a time when we are constantly “clicking” from one page to the next?  My news updates are one, maybe two sentences long. Sure, I can read an editorial online, but let’s be honest,  I usually skim the first sentence or two of each paragraph.  I have to force myself to concentrate.  It’s sad, really.

Ironic that I am writing about this on a “weblog”, isn’t it?  Back in the day, I’d be writing in a journal that no one, other than me, would read. But now, with the Internet, anyone can read my thoughts and vice versa.  In fact, part of me is happy that others are wasting their time on me.  How is that even remotely healthy?  The Internet isn’t a real thing, it’s a collection of 1s and 0s. You can’t touch it, smell it, really see it, yet it’s probably the first and last thing I go to on a daily basis.  Frightening when you think about it.  Frightening when I think about it.

I need to stop now.

A Difficult Week.

The office has been in some turmoil these past few weeks.  Just when I thought it couldn’t get worse, I walk in today to find that one of my secretaries decided to take the day off  with no notice. Just a message on voice mail that she was sick with a “stomach thing.”  Oh, and did I mention it’s the Friday before a long weekend and I’m working alone in the office today, covering 3 practices?

I’m tired.

I’m grumpy.

I’m pissed off with my staff.

I hate being a boss. I don’t want to deal with delinquent staff who think it’s okay to just call in “sick”, especially on a long weekend, when it’s so bloody obvious that she was fine yesterday and suddenly got a “stomach thing”!  Not to mention the fact that she had a 3 day weekend last week!  I have enough to deal with and don’t really want to be doing her job as well as mine today!

I’m also pissed off with myself.  Something came to light regarding a patient that has me completely freaked out that I might be named in a lawsuit and though I did everything I could to rectify the situation, in the end, after a series of miscommunications and communication breakdown between myself, the patient, the specialist and the hospital, I may just end up losing a lovely family to another physician.  I feel sick inside.

Us doctors, we’re not perfect. I know, shocking right?  Sometimes things get missed.  Mistakes happen.  And though I haven’t done anything horrible like leaving a surgical instrument in someone’s chest,     how I am feeling right now, I might as well have.  I am being pretty hard on myself, I know, it’s just who I am.

I am mad.  I want to be a perfect doctor.  I don’t ever want to make a mistake or miss a diagnosis.  I’m supposed to be the expert.  But try as I might to be perfect in this job, I have been reminded just how much I’m not.  It stings like a sonofabitch. I am managing over 900 patients with their test results, consult letters, referrals and office visits.  To say it’s challenging is an understatement.  Ugh, it sounds like I’m trying to make excuses.

Truth is,  I have no excuse.

This is my job.  I should be more vigilant. More cautious. More attentive.

Lesson learned. But at what cost?