Some Days It is Worth It

Some days this strange life in medicine seems worth it. Sometimes it is not all in one day, but you look back over a week and piece a few moments together and they add up to about a day. However you reach that sum, those are good moments. Although this sounds like war story, it is more of a reflection at the end....

This last week I had a 39 year old male as a patient with chest pain. Thirty-nine! I will be 39 years old in ONE MONTH! Most guys that are 39, almost all guys, that have chest pain have anxiety, reflux, a muscle strain, whatever.... too young for some of the scary stuff usually. (by the way, the photo is NOT his ECG, just one I found online and it happened to have the right caption, whaddya know...) Still, the more we worked him up... negative ECG, negative cardiac enzymes.... still..... something seemed to tug at my scrubs and say, "this isn't adding up". So we have the chest pain service come down and work him up... they say, "WHAT!? The guy is 39 without any real obvious risk factors....Okay, we will stress test him because his story does sound suspicious...." Later that day the doc comes down and says, "Take a look at this." He shows me an ECG from 2 minutes AFTER the stress test.... "Yeah, the stress test seemed to go fine even though he did have some chest pain while on the treadmill.... his ECG was normal, no problem. Then for some odd reason I got one more ECG while he was resting and there it was.... flipped T waves!"

This was a few days ago. Today he comes down and says, "Remember that guy you were suspicious of and we found the flipped T-waves...? Well he went in to the cath lab and turns out he had an 80% occlusion of his LAD (often called the "widowmaker" artery). He just has a double bypass and is doing well now." . . . We both have a big smile on our face.

Yes .... that is a lot of jargon, but what this boils down to in the real world is this - Some guy is 39 and thinks he has acid reflux and ignores it... still, it gets worse and he takes more Tums. Then, one day when he is 43 he is walking up the stairs at home one morning, clutches his chest and his heart stops dead right there! Everyone is surprised and sad and he is gone when they find him at the bottom of the stairs ... but not this guy! Days like that make you feel that this is all good.... you are learning AND you are helping and saving peoples lives, or at least adding a few years.

Today I had a very sad case.... A lady with probable pancreatic cancer with mets to the liver. This is not the kind of thing that gets better... The story was not going to turn out as well for her I realized. She was sweet and in pain and between episodes of retching and vomiting and crying she would have moments of peace without the pain. In these moments she would say "thank you" and smile and was a shy, happy person. Her family loved her and they had tears in their eyes while having to sit by and watch this happen to someone they loved so much. I gave her a lot of hydromorphone (a powerful narcotic painkiller) and I gave her lots of anti-emetics to stop the vomiting & nausea that came in waves.... lots .... finally she was able to rest without the pain and vomiting but I knew it was only temporary. Despite NOT being able ot fix the larger problem I was touched and happy that I was there to care for her and her family, to make this easier in some small way despite how overpowering the heartbreak was for the man that said, "I just love her so much..... and this is so hard. I don't know how to do this." In the moments of peace that she had she knew she was loved and that is why she smiled and said thank you and was truly happy still. I was lucky to be allowed to help them. I had worked hard for that chance.

These sorts of days make it all worth while and I need to write them down so that I can come back and read these posts on the nights that are not wirth while. The nights when I am tired from sleep deprivation... the nights when I seem to do everything wrong.... the days when I stumble on my presentations and feel like I am 2 steps behind everyone else and the nurses are frustrated with me for not knowing the right things and the days when my central lines fail and the days when I don't know which antibiotic is best and the days when I feel my personal life is falling apart and I see other parts of me withering away from neglect. Those days I hate medicine and I want to give up and I sometimes even regret my decisions to take this path....

Then I have days like these and I decide that all in all, it is still a good trade.