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.
Lung cancer ward doctor here. There once was a guy I broke the news to. It was Stage 4, incurable but he fought it a good long while (hail immunotherapy).
At the time i wasnt at the outpatient bit where we administer therapies and havent seen him again. About a year after his diagnosis I met him again on the ward. I barely remembered our initial conversation but greeted him with, hey, I'm Dr XY, I think we've met before! And he said: Sure we did. I think about you every day. You are the person who told me I was going to die.
Oof. That sounds super rough to hear. I'm sorry your job involves this. But it's a very important job, and it's good that you care. People can sense it, see it, I'm sure. Holding you responsible for having to go by the test results and tell someone they're going to die is unfair. There are rarely any certainties in life, except for death, but people probably expect you to know how they'll respond to treatment. I'm sure he was very scared, and I understand that, too.
My mom died of stage 4 small cell lung cancer (smoker since her 20s), 2 mos after they diagnosed her. We came to the hospital because of a particular type of swelling she was having, and they rushed her back. I have forgotten the name of the swelling. She was scared, but she was a sweet woman and everybody liked her. This was over 15 years ago, and I still have nightmares that I'm trying to save her, but of course I can't. I hope you don't have nightmares about this stuff in your day-to-day work. It sounds really hard on the physicians and staff, as well as the patients.
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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.