Me: "I hate Foleying women. I always catheterize the vagina"
Dave the RN: "That's why you always bring two Foleys. You leave the one in the vagina and the other one will be in the right place."
Me: "But some women can fit more than one Foley."
Dave the RN: "This is true. Some, probably a couple."

Ironically, months of sustained inpatient care has made it more difficult to separate my own judgment of meaningful care from the care currently decided on. Ideally, as we are taught (albeit subconsciously), we work up ever minute problem, sustaining livelihood at the expense of practicality. How many patients stay on endlessly in the hospital, accumulating, rather than resolving problems, until they become virtually lifeless, forgotten by their families, trailed only by a stack of excess charts documenting the person they once were and their slow deterioration into a meaningless existence. But it is precisely those words which I feel compelled to censor, though at times it feels to be a tacitly understood sentiment, both by those who make the decisions, and those family members whose common sense have not been superceded by feelings of love, guilt, or worse, expectation. In my ability to only palliate, and not to cure, as was promised to me in my formative years, I have become perfunctory in my actions, limited by my futility. No one ever warned you that inpatient medicine does more to discourage enthusiasm than to feed the desire for knowledge. In my brief career as doctor, I have already become so jaded.

Today, a day replete with anxious family members and arguments about petty electrolyte supplements, reminds me of the banality of our purpose as residents. To dangle false promises of imminent discharge, to report artificially saccharine prognoses to family members of those without prognoses at all, to direct the anxious mothers and wives away from the forest and toward the trees. Yes the cancer has invaded his liver, but today his sodium is up to 133. To this end inpatient medicine is an endless cycling of those trapped in the limbo between life and death, whose so-called livelihood consists of a constant shuffling between the hospital and nursing home, whose bodies, with each hospital admission, become petri dishes for increasingly tenacious organisms, who, not unlike saprophytes, effect bodily erosions no masochist could even dream of. And of dealing with family members who readily testify to their neglect with their inconsistent appearance, whose presence is characterized by so much misdirected anger, whose guilt is as latent to them as it is blatant to the observer. Moreover I am frustrated at how our medical culture advocates the superiority of meaningless life to dignified death, thinking of death only as failure, and not often enough of the relief that it inevitably brings. Such that our quest for the optimal potassium becomes paramount, and our respect for these poor persons become secondary.

Every day Mrs. M has the same set of complaints, only in various forms. I know that the minute I enter room 563, the same script will run - where I yell into her 96 year old ears at the top of my lungs, asking her how she's doing, whereupon she informs me in which direction her bowels are misfunctioning on that particular day. Diarrhea prevented her discharge last Thursday. "What if she has C. Diff?" (says her octogenerian idiot attending, totally ignoring that her diarrhea has been idiopathic, recurring, and in large self-limiting in the past month we've kept her.) "We can't send someone out who's sick." These past few days it's been constipation. I honestly can't remember if I have her ON the senakot or off. Always is this nausea, and this weakness. In the beginning I have tried to placate her by setting up her meals, bringing her to the bathroom, cleaning her bedside table. But now all I want to do is get out of the room.

The cynical part of me has begun to think of patients as perpetual complaint-manufacturing machines. Ask for complaints and you shall receive. Some complaints you will fix, only to generate a new set. And some complaints you can't fix at all. I'm tired, I'm weak, I'm bored, I'm dizzy, I hate blood draws, my neighbor is noisy. As if they expect a pill for everything, and are suspicious you are purposely depriving them of it. I have stopped thinking of my hour of rounding in the morning as a valid clinical experience. I have become a wastebucket for complaints. Like a concierge, a hostess, a pin-cushion. (How was your night madam? How can I make your stay more comfortable") By the eight O'clock hour I am already worn out. It is like as my precepting attending says. Some patients take a long, thick swirly straw, drill it into your head, and suck all your brain matter out, slowly and painfully. This is the life of in-patient medicine.

I would like to think of myself as still-compassionate. But what good is compassion if you cannot relieve suffering? The revelation I have come into is that so often, their suffering is inevitable, incurable, and self-perpetuating. It will drown you if you continuously seek to dowse it - if you take your failures to the heart. Far easier to turn a blinded eye, fix what you humanly can, and send them to rehab. (I have become so callous).

Me: That patient in bed four has that Jabba Look. She has those mean eyes and she's always frowning. When she talks it's like [deep voice] I'm hungry, feed me, grunt grunt. And I swear when she opens her mouth there's a thread of mucus that connects the two lips.
Resident: And do you write Christmas cards too?

Medical Term of the Day:

Extracorporeal Hydration (ECM). def - When the IV line has fallen out of the vein and the IV fluid is wetting the bedsheets.
ex. Dr. Wang wondered if the continued deterioration in kidney function, despite 125cc/hr IV NS for the seventh straight day could be due to extracorporeal hydration.

A few months ago a fellow intern/friend ended a brief courtship abruptly, after several dates which she had described to me as wonderful. He was, on all accounts, on par with her intellectually, professionally, and religiously. It seemed infalliable. But without warning, she, who advised me never to cry over a boy, was crying inconsolably.

And only until recently do I understand the circumstances that led to the end of the affair; can sympathize, rather than empathize. It seems, when initiating courtships, we as the fairer sex are treading on thin ice. And not entirely of our own doing, of course. I have traced this problem to that nefarious word -"expectation", or the fear thereof. And although we may not (albeit consciously) be exerting the pressure of expectation, its presence is felt - ubiquitously, unequivocally. And it is met with terror, amplified to disproportionate magnitude, and becomes reason to abort mission, no matter how successful the take-off.

And this is what I believed to have happened in her case, and is occurring, recurring in my own melodrama, like a movie stuck in a loop. It is the curse of this age, this stage in our lives, that women are expected to want to settle, while the thought of "expectations" renders their unwilling suitors veritable deers in headlights, that they feel compeled to begin courtship with a series of disclaimers.

And to add insult to injury, they justify their said disclaimers with their own self-proclaimed fear of "hurting you", perhaps not realizing that, by the very act of agreeing to invest time, intimacy (the very acts which have largely been performed previous to the disclaimers), we have already positioned ourselves in the line of fire, that there is no way to dodge ths bullets, no matter how well-meaning the other claims to be.

I do not mean to be bitter. I trust that these are good people. But to some extent this sort of behavior is nothing short of cowardice. While it is acceptable to wish to wade before one dives, it is unrealistic to expect that, because one did not wish to hurt (honestly, who does?) that hurt will not happen, that these sweet disclaimers will curb the disappointment and that one can remain inculpable.

Sadly I have been negligent of my poor blog, to such an extent that writing here seems awkward and strange. Perhaps it has been the lack of complaints, and that 3 weeks of vacation/clinic has taught me how it is, again, to be rested.