One of the things I appreciate about internal medicine is its short-term, intimate relationships you have with patients. Sometimes no more than a few days, you spend hours at a time with a patient, consulting other teams, running labs, trying to piece together a puzzle that is a patient’s diagnosis. It’s fascinating.
I thought that such a short-term timespan would mean you don’t get close to patients. I was wrong.
My very first patient on the inpatient service was admitted for confusion. She had a past history of liver cancer, treated a few months ago. She was diagnosed with hepatic encephalopathy (when the liver cannot clear the body of ammonia, which reaches the brain and can cause confusion). I was running orders, making consults, finding the appropriate next steps for her. I ordered a CT of her abdomen, where we noticed some lesions in her lung. On further imaging, we found even more lesions. Likely metastatic cancer. But I wanted to confirm, the GI team suggested a biopsy. It would be run the next morning.
But the next morning passed, and no biopsy would be performed. We would switch to palliative care. No biopsy would change our treatment options. This patient had only a few weeks left to live, so let’s provide them with the most comfort possible. I was stopped.
At first, I didn’t know how to react. We were doing so much for this patient, and it seemed like we were giving up? And so when I went to ask my resident about this, he simply asked, “What would be better for this patient?” And I couldn’t answer. I found myself beating myself up because I thought we were giving up. And that wasn’t the case at all. It took a few days, some discussions with attendings and non-medical friends to identify that palliative care was the best option. My clerkship director told me bluntly. “This really sucks. This isn’t the fun part of the job. But don’t stop caring. Caring is what is going to make you a good doctor.”
It’s easy to become jaded in this work, but I don’t think it makes the work any easier. If anything, being jaded may make this work even more difficult to stomach on a day to day basis. It’s why physician burnout is so high. So I’ll leave you with a study by the New England Journal of Medicine on caring and burnout.
