mahiwaga

“If you don’t have much soul left and you know it, you still got soul.” — Charles Bukowski

This post about a medical student wondering what the hell happened to her empathy got me thinking about the times that probably messed me up really bad, but I’ve just been suppressing it and trying to act like a normal human being.

Probably the worst thing I’ve ever witnessed was an 8 month old baby actively dying of cancer. I was only cross-covering but I spent a lot of time in that room standing dumb and feeling utterly helpless, just listening to that little baby struggle to breathe while we gave him a ton of morphine. I had nothing to tell his parents that they haven’t heard in the endless days of their ordeal. I’m sure they didn’t expect anything from a cross-covering resident, anyway. I don’t remember much of the rest of those 30 hours. In the morning, the attending thanked me, and I felt like asking “for what?” I drove home and remember crying myself to sleep. It wasn’t like wracking sobs or heartrending wailing. I just lay down face down on my pillow and the tears just kind of leaked out before I finally passed out from exhaustion.

Probably the worst thing I have ever done was lose my shit at a dad who accused me of poisoning his son who had been actively dying inside the hospital for weeks, and I just couldn’t take it anymore. My intern was going nuts trying to figure out how to give him phosphorus in his TPN without totally sclerosing his veins because his serum phosphate level was absurdly low, and after a while of struggling with the calculations on no sleep, I couldn’t help but think “Does it really matter if he has a phosphate of 0.9 mg/dl? He’s dying!” Well, we figured something out anyway, but the dad lashed out at us, because there wasn’t any damn thing anyone could do. A nurse had to calm me down, and I got my shit together and apologized. The kid died on my weekend off. I remember signing him out to the cross-covering resident, warning them that the kid was circling the drain and would probably end up in the unit. They called a code probably about four hours after I left the hospital, and the kid did indeed end up in the unit, and the resus was a disaster, and he lingered for a a long while before he died.

So, yeah, holding on to your empathy can be tough. You still have to try, though, because being a heartless bastard actually makes everything even harder. Given how long and how much effort it takes to become a physician, inevitably a lot of your identity ends up based on your profession. And if your success in your profession depends on giving a shit about other people, if you stop giving a shit about other people, you inevitably stop giving a shit about yourself, and from there, it’s a downward spiral into realizing how worthless all the sacrifices you made to get where you are have been, and now you’ve pretty much got nothing left to live for.