Tuesday, August 25, 2009

last week of medicine! and other thoughts...

i'm done on friday, and i'm quite excited to move on to ob/gyn. not that i hate medicine, i actually like it a lot, but i'm ready to try something new.

for the book club we are going to read "the last goodnights" by john west this month. it's about a guy who assisted his parents with their suicides. i'm really excited about reading this book because i feel very strongly about end of life issues...namely that we don't really talk about them that much in our society. and it's interesting to see how various doctors handle asking patients their code status. so far the way i've asked patients is "if your heart should stop beating, do you want us to do chest compressions and deliver shocks to try to restart it", and "if you should stop breathing on your own, do you want us to put you on a breathing machine to breathe for you". i feel that way is truthful and explanatory. and if they don't understand, i can explain further, but at least i've been honest. i've heard people ask "when the angels are coming to take you away, do you want us to stop them", or even "in the event that you 'go', do you want us to save you". wtf?! like, what does "go" mean! go outside? go smoke? go take a crap? alas.

one frustrating patient we have is a person who is my age and basically has end-stage AIDS and every infection that goes along with having AIDS. the last CD4 count was like 5 or something like that. that is very bad. (basically, these days, if you are HIV positive, the medicine we have is so great that you will die of SOMETHING ELSE, not from HIV if you take your medicines. HIV is not the death sentence it used to be, and that is a wonderful thing, really.) the patient repeatedly comes to the hospital for various complaints, but yet, refuses to take medicines that will drastically improve the quality of life and prolong it to that of a normal healthy person. and when you're in the hospital with a nurse handing you the pills, where you don't have to count them out yourself, dose them, and remember the correct times, you have no excuse! then they'll say "i want everything done". this person will surely die soon if they don't take personal responsibility for their disease, but yet, wants to be "full code". full code for what? so you don't take your medicines and live? it's very frustrating, especially since it's someone who is YOUNG. i'm 24, and if i had an HIV infection, you better believe that yes, i would have my phases of denial, grief, and acceptance, but ultimately i would take my medicine. HIV is not a death sentence anymore unless you make it become one by not being responsible. i completely understand if this patient just wants to let the HIV take its course and succumb to it, but you can't have "everything done" if you can't do your part as well.

i could go on and on about other frustrating patients, but i guess the theme of this post was end of life issues. i try my very hardest to not become jaded or to judge people, but i can't help being frustrated at times. but then again, i can't fault people for being scared of talking about death. it's just not in our society to really talk about dying and the various stages and feelings and whatnot. and the whole "death panel" thing just didn't help that out either. i've been very fortunate to have great attendings that address death and dying head on with the patients seen by our team. i just hope that when i'm ultimately the one in charge that i won't be afraid to really talk about those things with my patients. i'm trying to set a good precedent now of being honest and up front with all the facts and impressions so i don't bumble and make vague statements in the future. i know that if i were a patient needing to hear about end of life issues, i would be super pissed if my doctor was vague, not confident, and nonsensical with me.

with that, it's time for dinner. i made kimchi chigae the other day. it's a korean soup/stew made with kimchi, pork, and tofu. you eat it with rice. it's super delicious.

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