Scary Movies

One thing I found interesting as I became a doctor was the "distance" I put between my patients and I.  You find yourself in increasingly uncomfortable situations beginning with things like talking about sexual habits with a person you met only 5 minutes ago finally escalating to delivering news to a relative stranger that melanoma has spread throughout their entire body...actually that wasn't the worst, that person took it rather well, which was really surprising.  The saddest experience I can think of was in relation to a 4 year old boy, not much different from my youngest brother (who was also 4 at the time).  I was just starting my new rotation and this was one of those days where you just hang with the attending and they show you the ropes to where you will be working for the next month.  My boss had just gotten the results back on this little guy...he had come in because of increasing fatigue and a high white blood cell count, everybody in medicine knows what you are getting at when you say something like "fatigue, bruising, and a high white blood cell count"...you may not be able to figure out the exact diagnosis from those three words but in a 4 year old boy it's likely something bad and it's most likely leukemia...which was what the lab results confirmed in this case.

I still remember my attending handing me the results on a piece of paper.  I had read results like that many times...in books and in tests...I realized what it meant, but my gut reaction wasn't to pity the child (who I hadn't met yet) it was to look for leukemia (ALL) in the multiple choice bubble sheet on my test (although I knew the answer to the question, I didn't know jack about what that answer actually meant).  I walked in with her and we discussed that we had some results back and we'd like to speak alone with the parents.  As we walked in, the father was sitting in a chair next to his boy's bed.  I immediately made a connection with his son, they were playing video games and as the parents became more engaged with the attending, I distracted this little boy by taking his dad's place at the second video game controller.  We talked about what games were our favorites.  He was a cute kid, with long, blond hair, he looked like a kid that might already be surfing our kicking a soccer ball around with his friends.  He looked like the kind of kid that should have been full of life with a nice sun burn from his last visit to the swimming pool, but I remember how pale he was, how his eyes were sunken in slightly and he had dark rings under his eyes.  When it was time to speak to the parents, the father stated that he should speak with us alone, the mother had recently lost a brother to cancer and he preferred to spare her if there was any bad news.

Moments later, we are in a private room and we tell this very strong, very positive dad that his 4 year old son has leukemia...It was like watching someone take a baseball bat to glass...he just shattered.  He was screaming and crying.  He buried his head in his hands and wouldn't stop shouting, "Oh God NOOO!!!"  I remember how oddly disconnected I was from the whole situation, like I was watching it on TV.  Now when I think of this it makes me tear up a little, but when it was all actually happening I was thinking about the survival probability his son had, thinking that he actually had a really good chance (ALL is pretty curable now days)...I don't know what other doctors do in situations like that, but for me I've realized, as my experience has grown with these horrible moments, that I automatically disconnect myself...honestly I'd say I do that for most of what I do, it allows me to continue acting to help my patient instead of getting bogged down in the emotion of the moment...at least that's what I tell myself...maybe I'm just scared to actually become emotionally connected to my patient at that level...I can't help disconnecting like that, it's just what I've observed that I do. 

It's like when you are watching a scary movie and the screaming girl runs passed the kitchen knives (should have grabbed them for defense) and runs upstairs (should have ran outside and yelled for help)...what they do doesn't make sense to those of us who have watched a billion scary movies, to us they just made the same mistake every scared person makes when being chased by a murderer in a scary movie.  Well I'd venture to guess its the same for doctors, we watch these type of horrible moments all the time and we watch them as if we are watching the TV, not because we are cold, but because we have to cope with it somehow...I couldn't deal with it if I broke down like that dad did every time I saw something that sad - there's just too much of it.  But then you get a doctor who has a sick child or someone in their family gets really sick and suddenly those same docs aren't "watching the scary movie" any more, they are in it...and you'll see them "run up stairs" just like you would...or I would for that matter.

My wife was sent home 27 week pregnant with premature contractions, she's probably going to be fine, she's going back to work tomorrow, but no amount of rationalization is going to calm the jolt we got from this.  My wife and I are both doctors and all it took was a few tiny muscle contractions to put us right into our own little "scary movie". 

My thinking is that if a murderer were chasing me, I would rather have someone calm and collected sitting disconnectedly outside of the situation telling me what to do, rather than having someone running from the murderer with me making the same panic-ed, emotional decisions...but even that is a rationalization.  All I can say is this, when my wife and I have the baby, I won't be delivering.  I want someone calm and collected running the whole show, someone who has done this kinda thing a thousand times (1 million preferably jk). 

Newbie Doc