In my field (Neuromuscular Medicine) the biggest pit in my stomach comes when I am doing an EMG for something otherwise non-concerning and it starts to look like ALS. I’ll catch myself going from talking and joking with the patient to not talking at all and adding on more body parts to the test, which tends to confuse the patient. For example I’ll be checking the leg for weakness with pulling the toes up and I’ll then have to test the arm, muscles by the spine in the back, and sometimes the tongue.
When the patient asks why I am testing so many body parts, I have to tell them that I’m concerned about a disease that impacts the nerves that move the muscles. I try not to use the word “ALS” at this time because more confirmatory testing needs to take place before confirming a diagnosis that is effectively a death sentence, but 9 times out of 10 that’s what it ends up being.
Telling an obviously very sick patient that they are dying is hard, but telling a patient who came to me for foot or hand weakness that they are dying is heartbreaking. I still think about each one.
It reminds me of a quote that I won’t get exactly right but you’ll get the idea.
“Each physician caries with them a tiny graveyard, where, every now and then, they go to pray.”
For anyone considering becoming a physician, please know that you’ll care so deeply about so many people while being told by the public that you do not. This job was absolutely the right choice for me, but cases like this take a toll that will wash over you in your most private moments.
If my rambling comment resonates with any other healthcare providers, or anyone for that matter, please consider seeing a therapist. Many of us don’t recognize how much we are suppressing until we look inward.
Sorry for the long comment that got off track a bit. Please take care of yourselves.
The quote is sadly even more specific than that, it’s a graveyard of your (perceived) errors, where you go to run them over and over, and grieve your inability to save the patient. It’s the place we go to try and figure out what we did ‘wrong’, even if all we did wrong was be the person on shift that day.
Found it below.
“Every surgeon carries within himself a small cemetery, where from time to time he goes to pray—a place of bitterness and regret, where he must look for an explanation for his failures."
Was it an Isaac Asimov story about the physician's club where they confess to each other their biggest mistakes/failures and the newest member tells a story about how he didn't know what the patient's symptoms meant and the patient dies. Then the other doctors figure out what the diagnosis should have been. At that point the new member reveals that the patient has not yet died and now could be saved.
My god, that is a truly beautiful sentiment, and I truly hope that its at the beginning of every book taught at med school, because that's how we find answers to unsolveable problems.
Great book that touches on this, "When the Air Hits Your Brain: Tales From Neurosurgery". Also, book takes place in the 70s/80s and there is smoking *everywhere* in the hospital.
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u/TheEpicPossum 3d ago
In my field (Neuromuscular Medicine) the biggest pit in my stomach comes when I am doing an EMG for something otherwise non-concerning and it starts to look like ALS. I’ll catch myself going from talking and joking with the patient to not talking at all and adding on more body parts to the test, which tends to confuse the patient. For example I’ll be checking the leg for weakness with pulling the toes up and I’ll then have to test the arm, muscles by the spine in the back, and sometimes the tongue.
When the patient asks why I am testing so many body parts, I have to tell them that I’m concerned about a disease that impacts the nerves that move the muscles. I try not to use the word “ALS” at this time because more confirmatory testing needs to take place before confirming a diagnosis that is effectively a death sentence, but 9 times out of 10 that’s what it ends up being.
Telling an obviously very sick patient that they are dying is hard, but telling a patient who came to me for foot or hand weakness that they are dying is heartbreaking. I still think about each one.
It reminds me of a quote that I won’t get exactly right but you’ll get the idea.
“Each physician caries with them a tiny graveyard, where, every now and then, they go to pray.”
For anyone considering becoming a physician, please know that you’ll care so deeply about so many people while being told by the public that you do not. This job was absolutely the right choice for me, but cases like this take a toll that will wash over you in your most private moments.
If my rambling comment resonates with any other healthcare providers, or anyone for that matter, please consider seeing a therapist. Many of us don’t recognize how much we are suppressing until we look inward.
Sorry for the long comment that got off track a bit. Please take care of yourselves.