Teflon

Sunday, August 23, 2009

The patient goes into a long train of profanities, hoping to portray the amount of agony he has been endured since his failed back surgery three years ago.

I wish I could say that I learned some new words and phrases. But I've heard everything variation on the theme from other patients.

He suddenly falls silent and looks at me, probably realizing for the first time that I am half his age and female.

"Sorry. I didn't mean to offend you."

I reassure him that he didn't. That I understand how frustrating his condition is and how discouraging it can be to have dealt with it for so long before finally getting a referral to our clinic.

When I come back with my attending to have the patient sign the consent for the procedure we hope will ease his pain, he launches into the same stream of profanity, only to apologize again.

My attending disregards it with a casual wave of his hand.

"Don't worry. We're all Teflon-coated here."

Maybe that's true. And maybe that's the problem.

Our training teaches us to be accepting and empathetic. Yet our training also teaches us that we can't become too involved. I used to think that this was harsh. Of course I want to be involved! my newly trained self would shout. But quickly, we learn that we can't.

I can shrug off a patient's accusations or crudeness or flat out rudeness and act like a professional. I can provide the best possible care without prejudice or criticism. I treat IV drug users and parole violators and moms on meth with the same carefully thought out decision making process I use for university professors and preschool teachers and stay at home parents. I can Teflon-coat myself to be immune to the emotional and, occasionally, moral onslaught that occurs daily.

But like most things in medicine, this non-stick coating is a two edged sword. Yes, we can treat your cancer, but you will be sick and weak and bald. Yes, we can treat your pain but you may end up addicted to the drugs we prescribe. Yes, we can fix your problem but it will take you weeks, maybe months to recover from the surgery and you will always, always, have the scar.

Self-protection is no different.

The rudeness and insults an unhappy drug-seeking patient hurl at me as she storms out of the exam room do not bother me.

But neither does telling a patient that their diabetes had completely ruined their kidneys and we need to start talking about dialysis.

I can stand by the bedside while we, as a team, tell sobbing parents that their teenage son will not wake up again. I don't make a sound as we tell a young mom that her once cooing, crawling, smiling baby has had a stroke and will not do any of those things again.

Let me take that back.

Yes, it bothers me. It all does.

I have hunched on the floor behind the coat rack of the locker room and sobbed. I have escaped to stair wells to break down. I have walked away from yelling patients shaken.

But we must not be involved.

We can be empathetic, yes. I can sit with a patient while they take it all in. I can answer their questions. I can occassional provide answers, and hopefully, comfort and reassurance.

But I can't be involved.

The amount of hurt and grief and anger that spins past me everyday is enough to grab me, take me under and never let me surface again.

But I must surface. I must go home everyday where I am greeted by the sound of little running feet and happy blue eyes.

And so I'll take it. I'll take my Teflon-coating, the good with the bad.