Probably why I learned to like my job more is the fact that I have minimal contact with people on the outside. If you're just in the lab working, you only get to interact with a few set of names most of the time. Not that I dislike people, it's more along the lines of my workplace is a place of doom and gloom from all sources.
I tried doing my rounds during the early days of medical training and part of the routine was just checking on people on palliative care when I was rotating under Family Medicine. We get to ask patients how they were doing and you can see that some of them already accept their fate, those in a state of grieving, and some may even be in denial.
One particular patient that made me nope out of the interactive field of medicine was a woman on her late forties with uterine cancer that spread through her GI tract. It was inoperable and she was just waiting for her time at the ward with family. I asked what she was thankful for today (this was just small talk and routine to check on their mental health), she just said "I'm thankful that I'm still alive and my husband didn't abandon me. That I still have my kids visit me. Despite my insistence of not selling our Carabao for funding my treatment, my family sold the animal because they love me even if I am being a burden right now".
That's a lot of baggage to unpack and I wasn't really up to stomach that in when I skipped breakfast. But she wasn't the last person I asked, it was an entire ward of people with their emotional baggage I need to process. Yeah, I'm not going into a field of medicine where I have to constantly interact with people, it's just not my thing. There's a mental compartment of memory allocated for recalling my exposure with the psychiatric ward, women and children's desk and mental institution but maybe that's for another time.
So moving on to the actual motivation I got making this post. There are rare occasions where I get to interact with a few people to follow up with some ancillary studies for their cases. This comes with the usual learning their backstory and it's usually not a pleasant one.
When you are the one making the report and it says malignant. The knowledge of having a poor prognosis and the cost of treatment with seeing the similar cases a lot of times isn't going to paint your perspective bright. I had patient I've been following up because they had their cancer spread through their supraclavicular lymph node. The clinical diagnosis was lung mass with brain metastasis.
Stage IV. It's the first thing that comes to mind by reflex when I read the report. It's the same feeling when someone says apple and you associate it with the word red. That's just how natural these things come and stage IV with the word lung mass means months (to my own viewpoint). So I was trying to get the patient to have those tests done just to locate where the tumor came from because the lung mass could just be another manifestation of a cancer originating from somewhere else than the lung as an origin.
I tried meeting up with the guy, late 30s, probably a breadwinner, seaman, can't get onboard for work anymore due to his illness, and still has the expression of being hopeful for his case. He was a jolly fellow and probably someone you'd get along easily as a team player on first impression.
I was talking to him on a hot weather and the guy sweat a lot but it wasn't just due to the weather. It was probably his high metabolism from malignancy. This guy looked like he shouldn't even be the one walking long distances just to process the paper work but here he was conversing with me on what to do next. I tried to explain the purpose of the tests and why it's relevant but at the back of my head I can see the morbid images of this person months down the road.
It's an acquired habit to assume the worst. My specialty happens to be in contact with dead people for clinical autopsies so we're used to thinking grim. I was once asked why I opted to go pathology instead of being a surgeon, I just said dead people don't complain when they are cut and they're good listeners. If you haven't guessed, dark humor is my thing.
So after I'm done detailing what they would need to do next, I ask them if they understood it. They would look at you with the expression of confusion. Ok, the guy is sick, is believed to have a tumor in the head already so processing maybe slow, I had to redo it again slowly. I didn't mind.
I lived with the experience of being with a loved one that slowly died of cancer. It was a slow process and your patience was often drained especially during the later stages of the disease when they are no longer in control of their mental faculties out of depression. So after doing it four times, even slowed down the calculations for costs and everything, they'll look at you with their bright eyes and facial expression of full of gratitude. Like for some reason you lifted a lot of weight off their shoulders but you just gave instructions where they could seek financial help.
I don't even know how many hurdles people have to go through just to get that small portion of financial aid they need to cover their expenses. I just know where they can find it and hope it works out for them.
A week has passed since I heard from the patient. They came back telling me they opted to have those tests done on another institution where they can have those test run cheaper with a larger discount. This only added another week to their delay right after that news because these tests are done in batches given how costly they can be for the lab if done daily.
Then they come back telling me they only had few of those tests processed because they couldn't get anymore discount. This already meant another week of waiting. Figuratively, they were suppose to pay 10,000 to have it all done but with a discount, it's going to be 7,900. But opted to go to another institution for to have it for free because they can't event pay 5,000.
Speaking from a position of financial privilege, that amount is just pocket change and if they tugged a few more heart strings I may have just reduced their waiting time for 2 weeks by throwing in my personal funds. But they didn't made the request. You see, once people start spreading the news that you hand out free stuff, they are going to expect free stuff and these tests can be expensive if extensive workup is done. It's not the first time I covered for someone else's debt just to let them have the result.
Sometimes you just play the secret sponsor so they can get timely treatment because some institutional policy mandates they have to settled their debts before getting the results. I don't know how it works for people outside the Philippines but this is common practice. Call it being benevolent but I just look at it as something that could remove a nagging feeling behind my back. Putting yourself into their shoes and then realizing you wish someone was there to help you when you're in dire financial need.
In the broader picture, getting the report done is just a small hurdle compared to the amount of chemotherapy sessions one has to endure, the process of palliative care, the coping, counseling and frequent clinic visits that are costly. I only get to think about those things to a full extent rarely because once I just see a lump of flesh on the specimen dissection area with an attached accession number, it's just another case I'll have to report about.
Whether it's malignant or benign, what's important is getting it done and learned a lesson from training. But at the end of the day, someone is going to celebrate or be in despair when they receive the report. People are smart enough to Google medical terms and gasp at the word "carcinoma" thinking that's their definite diagnosis. Sometimes people are just lost to follow up because they see the results without seeking their primary physician to clarify what they mean. And this happens often than you think.
If you made it this far reading, thank you for your time.
I guess one of the most difficult things for a doctor is creating the perfect balance of emotional detachment and empathy. Also, how do you stop feeling responsible if you can't make someone well? I'd be in a permanent state of guilt.
Hope you're having a good weekend and can put work to one side occasionally!
We have a saying in my specific field of training, we are the doctors of doctors. While any clinician could take a guess what tumor they find on the body, it will end up dependent on what the pathologist would see anyway. And management decisions cascade to what the report means after. I don't get to be present on counseling and interdependent patient meetings tend to put us at the backseat view right after we gave our report. Some rare instances where we just have to be in contact with patients when they ask why some tests are necessary do happen especially when these tests aren't the usual routine and also tend to be expensive.
Hope you had a great weekend. Can't say I look forward on Mondays but tomorrow is another grind.
Yeah, it's not an easy profession. My father moved from pediatrics to pathology for similar reasons
If I don't end up finishing this training, there's probably doing some moonlighting or quit the profession entirely. This subspec has all the rational answers I need to stick with medicine and even with all those yes, I still struggle finding satisfaction dealing with the grind.
At the end, no matter what you do, it's all grind. I've quit quite a few things and started others and while I'm not "successful" in the eyes of most, I try and find some enjoyment in each day. I can recommend not getting too stuck in any groove but rather going though phases of exploring whatever interests you. You'll be despised by your relatives and secretly envied too, hahaha
Congratulations @adamada.stem! You have completed the following achievement on the Hive blockchain and have been rewarded with new badge(s):
Your next target is to reach 80 posts.
You can view your badges on your board and compare yourself to others in the Ranking
If you no longer want to receive notifications, reply to this comment with the word
STOPTo support your work, I also upvoted your post!
Check out the last post from @hivebuzz:
Support the HiveBuzz project. Vote for our proposal!