Oct. 19th, 2014

c1: (Star of Life)
Last night was a largely uneventful shift. Hit the sack (literally*) about 23.00, and slept mostly unmolested until about 6, when my alarm went off, fell asleep again until 7.30 when I got up. It's nice that if your dorm door is shut, you're left alone to finish sleeping. (We do station chores before bed to facilitate this.) 

Of note was a fairly routine interfacility transfer (urgent care to hospital) of a cancer patient. Since my mother had cancer,* it's a fairly personal issue for me, and this one hit home. The patient in question was actually doing fine, despite having a very advanced form of one of the more terrible cancers out there -- somehow, surviving was a reality for this person, and given the totality of the circumstances, the person was doing quite well indeed. Anyone who was otherwise the model of health could have had the same acute condition as this patient (that is, sans cancer) and been transported exactly the same.

But that being said, I don't have direct familial experience with 99.999% of the fatal diseases out there. That patient with CHF who's on death's door, surrounded by a dozen teary-eyed children? I'm pretty dispassionate -- empathetic, sure, but the empathy comes from a very distinct part of me. Cancer? I was pretty amazed at how squarely that one hit me between the eyes. I did fine during the call (and I think the patient's overall state of non-urgency helped a lot) but I spent some time reflecting on my feelings during the drive back to the station. (Every hospital is a minimum of 20-30 minutes drive.) 

20 years ago, before my grandparents all died and my parents had cancer, practicing was largely without emotional burdens because distancing myself from my patients was simple. The worst thump I got (apart from a 4 month old baby who died of SIDS) was performing CPR on a patient who was 1 year younger than I was at the time. Even then, the kid had played his cards pretty recklessly (he got lit up on booze and thought a high-speed motorcycle ride was a prudent decision) so I had that working in my favour.

I think moving forward I will remain "fine" but it's something that made me think about personal vulnerability. This was a reminder to remain on guard against dancing too close to the flame without appropriate protection in place. A lot more of my patients are going to look more like people I know.

November 2014

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