Dr. Give-A-Crap

I'm on vascular surgery this month which brings with it a whole new patient set. These patients aren't adorable kids like in the world of peds surg and they aren't misfortunate like the burn patients. Well, sometimes the burn patients are a little stupid. I mean, really what kind of person burns trash with gasoline? Gasoline doesn't burn, it explodes. But, I digress. The vascular patients are a whole new breed.

For those of you that aren't a hundred percent sure what vascular surgery is allow me to explain before I delve into the patients. It will make things a little easier. According to wikipedia, vascular surgery is a specialty of surgery in which diseases of the vascular system, or arteries and veins, are managed by medical therapy, minimally-invasive catheter procedures, and surgical reconstruction. The long and short of it is that we make blood go where it no longer wants to go.

Well that's weird, you say. Why does the blood not want to go there? Well, if you were to spend your entire life scarfing down cheeseburgers and smoking, not to mention mismanaging your diabetes and ignoring your hypertension, your blood vessels are going to give up. And, can you blame them? I mean, I'm not going to pretend like I'm the picture of health or anything. But, I make some attempt to prevent what is definitely a preventable disease. Atherosclerosis, diabetic neuropathy, gangrene are not diseases which just strike down the undeserving. You have to actively work to have these things happen to you.

And, the end result of most of these diseases are amputations. And if you're a good vascular surgeon you won't just take the leg. You'll be as sparing as you can each time you operate. You'll take the big toe, and the the others, then you'll take the rest of the longs bones in the foot, then you'll go below the knee, then above the knee and then finally you'll take the nub that's left and disconnect it from the hip. This is a process that takes years. And it's depressing to watch. It's even more depressing for the patient.

I want to feel bad for them. I try and feel bad for them. But most of them make it so hard. And it's not because they are bitter and angry. I get that, hell I would be too. But because they don't change their ways. Fine, you lived life hard for the first 40 or so years. But then your toe falls off. Shouldn't that be enough of a wake up call to quit smoking? To take your anti-hypertensives? To put down the remote and go for a walk? How about simply measuring your blood glucose? But, for some reason they don't. And that is what frustrates me.

Of course there are vascular patient who did not bring it on themselves. We get patients with rare genetic disorders whose blood clots when it shouldn't. We get people who for some unknown reason have an aneurysm in their aorta you could drive an 18-wheeler through. But, the majority of them aren't just simply unlucky. They are people who never bothered to take care of themselves. And when you decide to go into a profession the respects life above all else people who don't respect their own make you angry.

So, this past week has been hard for me. And when people ask me why I look so run down I can't give this long and convoluted answer. It makes me sound so judgmental. So, instead I talk about the long hours, how sick the patients are, how tedious the surgeries are, how long our census is. But, deep down it's because I can not feel bad for my patients. I don't not feel sympathy for them. Empathy, yes, but not sympathy. And, for me, that makes my job feel nearly impossible.

There are a lot of trite and cliched reasons that people give for wanting to become a doctor. I sometimes wonder what the real reason is. I've bullshitted my way through answering that question so many times I'm no longer certain. And looking back to the girl that made this choice in grade school I know she had no idea what she was getting herself into. And it's not the long nights, the endless hours, the unfortunate tragedies that I was naive to. It's the helplessness that you feel when you realize that no matter what you do this person is not going to change and they are going to lose their leg.

And this isn't just with vascular surgery. Yes, it's more apparent here. But what about the frequent flyer in the trauma bay? The guy you see two or three times a year for getting drunk and crashing into something? Every time you patch him up, set his leg, transfuse him, sew up his holes. And each time you send him out you know it's only a matter of time before he is back there. Or the smoker with COPD? You know that no matter how bad it gets she's going to keep smoking. And how about the 400 pound guy who comes in for a gastric bypass, which fails because he literally ate till his stomach exploded. What do you with these patients?

It takes a toll on you.

As I was writing this I kept thinking about a myriad of scrubs episodes in which Dr. Cox expresses these same emotions. The link to one of these rants is embedded in the title of this blog. He says that he knows he's supposed to be "Dr. Give-A-Crap" but that he can't be in certain situations. That's how I feel. I feel badly that a patient is losing their leg, I do. But, a part of me is angry at them for bringing it on themselves.

I don't know if I'm ever going to reconcile these emotions within myself. But for right now I'm glad that I'm angry at these patients because it means I'm not yet so jaded that I've actually lost the ability to give a crap. And that is not the kind of doctor I want to be.