#2. "You Think You've Got Problems?"
I spend most of my time in a children's hospital. Now, I know we all have struggles in our lives, but there's nothing like a children's hospital to show you that you're the biggest pussy in the world for moping because you cracked your iPhone screen.
It gets so bad that the clowns actually seem comforting instead of creepy.
At the risk of darkening the mood here, there's a particularly horrible brain tumor called a pontine glioma. It grows in the brainstem (the part of your brain that knows how to keep your body alive) and tends to strike children. Initially, the child has minor symptoms -- double vision, trouble swallowing, maybe some weakness. Then the tumor mercilessly and inexorable kills them. And there's not a goddamn thing I (or anyone else) can do about it. We try. We radiate it. We give chemotherapy. It buys the kids a few months. But they all will die in about a year. And I'm often the one who has to break the news.
Telling parents that their healthy little boy is going to die in a year sucks. It's emotionally crippling, but I can't let that show on my face when I deliver the news because, well, I'm the professional (although if I'm too cold and clinical, I'm just an asshole). But no matter how that conversation starts, it nearly always ends with the same lines from the parents:
"We'll go to a better hospital."
"We'll find a better doctor."
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"Let's try that shaman again, dammit. She had pep."
And that's perfectly understandable. You're losing your kid; you can vent all you damn want, and I'll never think less of you or even make a comment in my defense. But then, after dealing with that, I have to go to my adult spine clinic and immediately deal with the guy with a nearly invisible disc herniation who's demanding narcotics and a disability statement. So you can see why a person would get cynical in a job like this. And even more so when we have to say things like ...
#1. "You Really Don't Want Grandma to Survive This."
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I vividly remember sitting a family down to give them "the talk" -- explaining that grandpa was going to die, and that medical science could do nothing to stop it. He'd had a head injury, and the pressure on his brain was way too high and we couldn't bring it down. Right as I was telling them that he'd never wake up, one of his daughters asked me: "Is he supposed to be getting out of bed?" And that's exactly what the old badass was doing, medical science be damned.
The family members have all since died, but grandpa's going strong.
So why did we seem so quick to give up on him? Well, that's one of the horrible calls you're forced to make in this business.
Let's take something like a ruptured brain aneurysm -- around 15 percent die before ever reaching the hospital, and we know statistically that 50 percent will be dead or severely disabled (think: vegetable) within a month. Most of the other survivors will have a permanent disability. All told, only about 1 in 5 patients comes out of it as the same person.
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Statistics are confusing. Brain aneurysms are even worse.
So when we get one of these patients whose odds are even worse than that -- say, your 75-year-old grandma -- what do we do? Do we go for broke to try to save her life, knowing that we're almost certain to create a completely dependent nursing home patient who may spend the rest of her years in a vegetative state? Remember, it's not a "better safe than sorry" situation -- every operation I perform with no chance of a good outcome means less time I have to work on people I might actually help. Doctors aren't obligated to perform futile operations -- I have to make that call, and I have to do it knowing that sometimes we're wrong. See the old man above.
There are even times where we'll all agree -- doctors and family both -- that if the patient starts to "code" (have a life-threatening crash), we'll stop treatment. Then it actually happens and everyone panics -- including the doctors. So, we save their life and feel like heroes. The problem for these families comes three or six months later, as the grim reality sets in that we didn't actually save them.
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"Damn you, primum non nocere!"
And that's actually worse. If a person dies, the family grieves, works out their anger, and then gradually hits acceptance. You remember the person as they were. If we turn a perfectly good dead person into a chronically vegetative person, then we've just prolonged the grieving process for months or years, and the person they knew is gone either way.
Life is short, is what I'm saying. So, hell, if you want to cram something into your ass, go for it.
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