The enemy

As medical students, we are often idealistic, thinking of how many ways we can help a patient, and wanting to help or save every patient we ever see. I remember being somewhat appalled at how some of the fellow interns of residents treat patients. They were rushed, and didn't spend time with patients, always having one foot out the door, or cutting patients off while they spoke. I remember thinking, "I will never do that to a patient. I'll always give the patient my time and respect they deserve, because they are the one with the illness and need the sympathy, empathy, and healing..."

But as an intern or resident, we are often tired and overworked, and our patience can run thin. Yep, we are all guilty of it. Every one of us has come to the point where we view the patient as "the enemy." If you spend 20 minutes talking with the patient, you realize your to-do list expanded from 5 to 15 items. You were just paged something like 8 times and need to return these calls. And you always have too many patients...patients are the source of work, the ones who complain, the ones who bring you more paperwork and requests for laxatives at 3 am. And your patience is simply lost when a patient is narcotic-seeking and giving you attitude for not giving them their oxycodone.

You enter residency bright eyed and bushy tailed, ready to learn and save the world. Ready to be there for your patients 24-7. But we get tired and jaded, and we forget that naivete, that idealism and desire to do good and mean well. And the patient becomes the enemy.

I admit, I got that way myself. I think there were classmates of mine who were worse, and then some who always cared for the patient no matter how crappy their day went. I fell in the middle. I felt that overall, I wanted to care about and care for everyone, but some days it was a damn challenge. Some days I just wanted to forget that certain patients didn't exist and walk pass their room, so they couldn't pester me for more narcotics.

It is standard procedure to ask patients when they are admitted about their "code status" or "advance directives." This means, we ask patients that, if in the case that their heart stops or their lungs fail, would they wants us to perform CPR or place the patient on a breathing machine? Some, but a minority, of patients have already thought about this ahead of time. Most patients, however, have never thought about it. And at my most jaded or most frustrating of days, I remember asking this to patients bluntly, as if I'd be better off if they said "no, don't bring me back," and then I woulnd't have to worry about bringing them back. If they died, they died, and that was one less patient for me to "care for."

I now look back, and I can't believe that I thought these thoughts. These are human beings, and I can't believe I even had the thought run across my mind that if a patient died, I'd be better off. Have I forgotten what it means to be a physician? Or to be a person who cares? Or to put myself in the place of a patient and understand what it is to be in a thin, half-gown laying in a hospital, always being awoken, poked, sent off to tests and scans often without even advance notice, having catheters put in my urethra, and all the while sick with whatever disease they've got?

The funny part is, every one of us interns has likely had those thoughts. Thats how grueling this process is, and how low one can get. The good news is, once we become better at our job - better at being an intern - we are able to step back and start looking at our intern year with some perspective. And we realize we're in a dark place, where no one outside our profession could possibly understand. And when things start getting easier for us, we stop being jaded, and we start caring again. We remember that these patients are human beings, they have loved ones, and we need to do everything we can to care for and protect them. The meaning behind being a doctor in training returns. The thirst to learn returns. And the work is still there, but flows easier, and you realize that the nightmares of residency really are true; you've lost the naivete, but gained the perspective of the dark side and climbed out of it.