Thursday, January 24, 2008
In response to a post from long ago, about death, I recently received the following (in part) comment:
"July '03, I was dying in a hospital bed at the moment my doctor came in to check on me. I saw his face and I knew in that moment that if I let go, he would blame himself for the rest of his life--when it absolutely wasn't his fault. I saw in his face how deeply he cared about me, and I knew I couldn't do that to him....he needed me to live so much, and I needed so much for him not to be in pain for the rest of his life over my death, that that gave me the strength and will to live, gave me the emotion to hang on that I needed, pulled me through that horrendous night."
The more I think about it, the more amazing I find those words to be. I've been there. Much as I always tried to establish a relationship of trust and caring, much as I believe in the value of attitude in recovery from surgery (the writer had not, in fact, had an operation, as she told me in a later email; in addition, the doctor was not even the one treating her at that moment), I'd never have thought of it in exactly those terms. Living because of one's relationship to one's doctor. I'm still not sure how to process it. But it has made me think, once again, about the concept of "saving a life." What does it mean, really, and what are the relationships? Isn't it, at some level, hyperbole?
In one sense, perhaps every operation could be considered life-saving: fix a hernia, prevent strangulation and the death that can sometimes follow it. More clearly, doing a curative operation for, say, colon cancer, pretty inarguably fends off certain demise. Having done thousands of cancer operations, I guess I could say I've saved that many lives. But if there's anything at all to the term, in my mind the concept of saving a life suggests something most immediate. Rescuing someone from a fatal condition, right now, right here, with no time to lose. I've written about a few of those: here, here, and here. Oh yeah: and here.
I've been thanked directly for saving a patient's life. I've gotten cards, annually, on the anniversary of the event. When writing a check at some store or another, my wife (she has control of the checkbook) has been told, "Oh, Dr. Schwab is your husband? He saved my life." It makes me feel weird. I happened to be there at the right time, is all. And I'd learned enough to manage the situation. Whatever else it might be, it's not as heroic as the term -- saving a life -- suggests. There is, of course, another side to the coin. If I can save a life, what is it when I fail to do so?
When thanked for saving a life I always felt uncomfortable, and mumbled something to decompress the situation; to shorten the distance between us; to get us back on equal footing. One human being ought not be in that position with another, so it seems to me. Not a doctor, anyway. And yet, when being unable to save a life (as I described here), I've often felt so bad as to want never to pick up a knife again. And in those rare cases when I've wondered if I had erred... well, it's unspeakable. So maybe my attitude that it's less a big deal than it would seem is tied to my desire not to bear the burden of the opposite; even though I do.
Or maybe it's about "heroism." I've saved lives, whatever that means, but I'm no hero. (I also allow adequate spacing when driving on the freeway, and I've slammed on my brakes when someone made a stupid move.) First of all, the term is so over-used nowadays as to be nearly meaningless. Doctors don't risk their own lives (well, I've operated on lots of people with AIDS and hepatitis C); we don't run into burning buildings, or jump into rivers. Sometimes it falls into our laps to do a thing for which we've been trained, about which we've learned a few more things after training, and we do it successfully, when the chips are down. It alters the trajectory of another's life. I don't know why, but I just don't feel right about referring to it as life-saving. It puts me on a different level from my patients, and I never felt that way. Plus, if my commenter's words are true, it might even be the other way around.