Thursday, January 24, 2008

Life Saver

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.


rlbates said...

Thanks to your commentor for sharing Dr Sid. Thanks to you for passing it on to the rest of us.

Anonymous said...

I was thinking of that concept the other day. Reading something else on the internet, I wondered about the boundary where a life is saved and where it is not in medicine. Your eloquence in this post was wonderful and perfectly described the patient/doctor relationship and the humanity of physicians.

Anonymous said...

Thankyou for sharing that.
I've felt the same way towards a surgeon and I know they felt the same way back.
Even though things went wrong when they were in charge that they were ultimately responsible for.

It's a strange sort of a relationship. I worry that it can even be a bit dangerous. I downplayed my pain and fear so as not to hurt the surgeon's feelings...

I worked really hard to recover, and my motivation was a great deal driven by my wanting to allay my surgeon's self-blame.

So there you go. If things go wrong, it isn't all bad.

gay CME guy said...

It's good to see you back, Sid. I'm a bit behind. I'll catch up on your postings.

Lynn Price said...

Sorry, Sid, I know what you're saying and all, but docs save lives through the merits of their training. You're just going to have to man up about the praise when it comes your way. As uncomfortable as it may make you on several levels, people need to be able to thank their docs when they have been given a second chance.

SeaSpray said...

Wow...powerful post on many levels! Also moving comment by that woman...another wow!

I can relate in that I was picturing my urodoc and could imagine him being upset if something happened to me on his watch. It hurts for me to even think of it and I would also never want him to carry around such a burden.

How did that other post get past me? Also excellent. (So glad you are back!) Happy Hospitalist recently did a post about dealing with dying patients. No matter must be so difficult.

I have said it docs see so many patients but we see you...just you getting us through something. We come to trust you to believe in you and speaking for myself...I felt an invisible safety net of sorts just knowing that urodoc and others were on top of things but also because of the compassion that was so much a part of their care. I have always felt very taken care of in that practice and the compassion IS a big part of it. Doctors show their compassionate caring in various ways. Each DR/pt relationship is unique I am sure.

Maybe it is a lot to put on one human being but because we trust you with our secrets and we nervously surrender our bodies with trust and hopefulness that you will facilitate healing and sometimes we even have a connection beyond the medical...just an understanding, a knowing. It's unspoken but it is there when there is a good doctor/pt connection. You are our heroes! You rescue us from awful things sometimes. How could we not see you that way? And you know what? I like knowing there is someone like that looking after me when necessary. It's all part of the confidence package.

You docs matter to your patients and so any extra kindness, show of compassion extended to your pts and families validates their worth in your eyes and fosters encouragement where needed or additional comfort in empathizing/sympathizing with the dying. Don't worry what you feel like in these situations because your presence speaks volumes. A hug, a compassionate all matters and people remember for a long time.

I wrote a short post today about inspiration and how even doing the simplest of things can make such a positive difference in all of our lives. And the person doing these good deeds can't help but to be influenced by the good that is going out from them to others.

You may not be running into a burning building or be getting shot at in a war zone, but you SAVE LIVES and that IS monumental! Obviously some docs are more dedicated than others and I don't think every doc is a hero but there are the ones that shine and in my opinion based on all the things you have are one of them.

To me...the heroic docs are the ones that are in the trenches with you, don't bail but stay with you to the end regardless of outcome.

I have said this before here...but regarding the pts that do die despite heroic was their time. Just like when you expect a pt to die and they don't. it wasn't there time.

I can imagine you guys fight really hard in the OR sometimes...the battle between life and death. Sounds like hero territory to me. :)

Sorry long and feel like not articulating my thoughts very well tonight. Ha! I may have blogger's remorse when I come back in the morning!

Also looking forward to your interview with Dr A!

And it was very interesting to read what one commenter said about absorbing feelings from others in the room while she was in a coma.

Anonymous said...

I apologize, I didn't check your blog the last few days. I did, however, get my copy of your book in the mail, sit down, and read it cover to cover today (I just finished). Well done.

One misunderstanding--yes, that was my own doctor, although we didn't know each other well yet at the time; his partner, my former doctor, had recently moved away.

And that comment was not hyperbole. That was absolutely the reality of the situation to me. It would have been so much easier to have let go and stopped fighting to keep breathing. SO much easier. But for his sake, I could not.