Wednesday, August 13, 2008

Square Pegs in Round Holes

I promised to do a blog on a summary of third year... now it's fourth year and I've not gotten to it, and this blog isn't the review of third year either, sorry.

Right now I'm doing research, which I started during our (3 week) summer break. It involves surveying patients, assessing their health literacy, asking them some true/false questions and then randomizing them to a verbal or video & verbal module designed to teach them about severe dementia and the end-of-life choices somebody could make before coming to that state of being. The choices are Life Prolonging Care, Basic Medical Care, and Comfort Care. The website for the video can be viewed here:

During this research, I've often been frustrated at patients not answering my questions to fit in my neat check-boxes. I've often screamed inside, "IT'S TRUE OR FALSE, STOP HEDGING/QUABBLING OVER ONE WORD!" But then I have to remind myself, they want to do well, and have varying experiences with dementia and end-of-life decision making. Still, fitting square pegs into round holes has been hard.

I've also been confronted with my too-much type A syndrome. There are times that patients tell me things and I'm just wanting to focus on the matter at hand--doing the survey, watching the video, getting through the protocol. I feel like time is being wasted by small talk, or interjections of "one time so and so down the road had this happen..."

But, they keep my type A in check because there are times when I've been blown away by some of the stories that complete strangers have told me. One doctor from olden days disclosed some of his former ethical battles involving too few iron lungs and too many critical polio patients (I would love to go into more detail, but think it's best that I not do that in this forum). Another lady related how she was responsible for one of the first Alzheimer's nursing units in the state. Another talked about her nursing career working with mentally handicapped children.

A man told me how much pain he was in after the loss of his wife only a few weeks earlier. He said, "and I'm about to explode right now" regarding thinking about the loss of his companion after 60 years, and how, although he knew it was coming, he didn't expect it when it did occur and how much her absence had overtaken his life.

Another man, who was still relatively young (and appeared younger than stated age), told me that he had metastatic cancer, but felt fine, and so didn't know how to answer the question "In general you would say your health is ... " They always tell us that the definition of health isn't just "being free of disease" but I didn't believe them until then.

A woman related some of her distrust in the medical field due to her mother (who was DNR) being brought to the hospital after a carotid blow-out. She felt that the surgeons tried to save her just to get practice in doing the procedure, and when she relayed her frustration to the doctor, he said "Well, why come to the hospital then? You only come here if you want saved."

One lady told me that she'd never told anyone this certain fact--that she had doubts about her one of her family member's choice of a husband.

I'm almost in disbelief of how much information people are willing to share with somebody who is in the medical field, or who the person sees as fulfilling a "doctor" role. I'm just a medical student doing research--I have nothing to do with their medical care or visit during that hour, but many want to share with me. I find it hard to imagine how much I'll learn while being a "real doctor." I hope my "type A" doesn't taint my encounters and that my patients see in me a willingness to listen and hear, and thus want to share those things on their minds that day. I'm sure my healing will be much more potent and successful if I can do that.

Lesson Learned--The power given to us as doctors is immense, and part of the power lies in being a ear for our patients to be heard.

What it's Worth--It's worth being satisfied with my job, loving my patients, and having my patients be satisfied with me.

No comments: