The OSBID Service

I always expected sadness in medicine to come in the form of unexpected morbidity and mortality. Someone under my direct, active care expiring despite the best efforts of the team I am a part of. I have thankfully not experienced it so far this year, but have certainly in the past and so I can say, too, from experience that it is heartbreaking.

But only momentarily. It is the shock more than the event which brings about the feelings. Sad things happen all the time in medicine, it is often only when they catch you off guard that you feel them, however. Like a bullet to a flack jacketed frame, I am stunned briefly, but otherwise unhurt. For a short while I am without breath, but I recover and aside from some mild bruising am no worse for the wear.

I also always appreciated, I feel, the subtle, grinding effects of disease on clinicians. Sick, sad, hurting, angry, and confused patients and families get underneath the armor to slowly wear you down. It is not the only side of medicine -- there is an equal share of pleasant patient interactions to reward and rejuvenate -- but it is a significant side nonetheless.

What I did not expect, and what I did not prepare for in all this, was gratitude. Not thankfulness for refilling someone's prescriptions or a vigorous hand shake for treating grandpa's chancroid or a even kind word from someone who's pain was heavily medicated, but gratitude undeserved and a smile in spite of pain.

Working on the Infectious Disease (ID) service at Brooks Army Medical Center (BAMC), now more commonly unofficially known as the Orthopedic Surgery and Burn Infectious Disease service because of all the war wounded, I experienced such kindness in spite of loss on a somewhat regular basis. Most of our patients were amputees with infected stumps or burn victims with infected everything. Victims of IED blasts, RPGs, and mortar attacks. Many times, unfortunately, despite our best efforts and the collective intelligence of what I believe to be some of the smartest infectious disease doctors in the nation, things didn't get better. Antibiotics these days can only do so much. But even the completely recovered were still, well, amputees and burn victims. Young men and women whose lives would be forever different for the worse. It is possible to still live a happy and fulfilling life injured as they were, but chances are certainly not in their favor. Everyone knows this, I know this, they know it, and when they then thank me for doing a little to make life suck a little less, well, I don't know what to do.

This was worst when I could see through their ruse. Frequently I would see my patients in the cafeteria -- no frowns were on their faces but their shoulders were often enough sagging from emotional fatigue -- and we would bump into each other. Recognizing that, hey, it's me, your physician!, they would briefly, magically transform themselves and on their face would be a generous smile and a pleasant hello. Perhaps we'd exchange a few pleasantries even. If we didn't run into each other, however, if they remained anonymous, their grief and distant eyes remained. I'd see them tired enter and tired leave. It is not that I think they were being insincere or just polite -- truly their motivations are unimportant here -- but rather, simply, I was able to see them with their shields down as well. I saw the disease taking its toll. Being strong means you take the pain not that it isn't there, but it is often easy to interpret things the other way for those not enduring it.

So it is this combination: seeing them freely hurting and seeing them graciously smiling that gets me. It is one of the few experiences during the day that get me out of the hustle of paper work and data collection and actually make me stop to feel what I am doing. It is not that I do not care for or about my patients otherwise -- I certainly do -- it is just that the intellectual practice of medicine often detaches you in the process. I am on the Cardiac Care Unit (CCU) service now and people are dying but it is not the same. I will briefly shed a few tears for some of the lost in the unit, but I have so far only been deeply moved by the the patients I've taken care of while on ID. Unexpected.

So that was sad. Anyone watch Wipeout?! What a great and entirely terrible show.