Talk about a tough crowd: on making a dying man laugh

I haven't posted in the past few days because i have been relatively depressed by medicine in general. I have found my niche, so things are getting better, but it still tends to NOT be how I want to spend my days. I miss the lab so much more than I ever thought I would. A few of the recent things that have happened in my last 4 weeks. I have spent the last 2 weeks in the ICU at Memorial Sloan Kettering Cancer Center, the 2 before that in the Coronary Care Unit (CCU) in NY Presbyterian.

In the CCU, we "round" for 5 hours each morning. This is where you walk around to each room with the housestaff (Residents) and the Attending (older doc thats in charge). One morning on presenting my patient I said "he had a thrombus (clot) in his (specific vessel) so they went in and removed the occlusion". My attending is crazy. She was like "woa woa woa, they removed an occlusion? How do you remove an event???" I reply, "like i said, the occlusion was a thrombus, they removed the thrombus" "RIGHT, they removed the thrombus, ...." on and on she went.

As busy and stressed as drs are I cannot imagine this helps, especially as we know stress, fatigue, etc leads to many errors.

Rounds today is this intimidating time when everyone tries to shine and the attending picks at whomever they can. I actually don't mind it - I often just laugh at the attending. BUT, I do not think this is good for patient care - but people don't seem to care so much about that it seems. As one prominent physician that trained at Harvard told me "at rounds it was a feeding frenzy - you came ready to knock anyone down you could and show your stuff - if a little patient care came out of it, fine, but that certainly wasn't the goal."

In the ICU, I had an attending correct me for giving him the Ventilation settings NOT in the order he wanted. This is more humorous when you consider that I was giving the info in the order that the last person I was with wanted it in. I just laughed and said, "ok, what order do you want?" And he said about 8 things more quickly than I could write them down, when it was obvious i was trying to write it down. The point wasn't to do it that way, I learned, it was to lightly haze me. Patient care? Not so sure that is high on the list.

Actually, things have gone quite well. I guess I am giving you only recaps of the things that bother me. In reality, I have had some AMAZING residents take me under their wing and help train me. Both of my last 2 weeks I had a patient mainly to myself. Both pts will die sooner rather than later, which it turns out is where I excel. My gift so far has been talking to families about diseases and what they mean, particularly with an eye on death.

Turns out I love nothing more than making a dying man laugh or explaining to a spouse what a disease means and putting all the articles on treatment I read the night before in context of the patient. My lab interests fuel my interactions with patients. Particularly, I find that as much as I want to leave medicine and go into comedy or some other public speaking avenue where i can tell jokes on stage, I have found nothing more fulfilling than making a dying man laugh.

I'll close with this, about my patient with incurable and untreatable stage 4 (spread everywhere) esophageal cancer:
I watched as people came in and out of his room, the psychiatrist, the family, the cancer team. All with the same looks, all with the same news. Time to be comfortable, we cannot treat you - you are too sick. Any chemo would kill you. We are sad the family says. Can't you fight more the wife says? Can you help him suffer less the mother of the man says to me. In and out of the room they go, he sits there, stoic. I talk to him often. In fact, I am in there with every team that comes in, and unlike the docs from different teams bouncing in and out on to different rooms or lunch, i began to feel the dreary mood in the room. He never has the luxury of escaping it. I share with him that my grandpa was a merchant marine like he was. He smiles politely and says nothing. I let him be for days.

After some days, many with intense talks of death and DNR orders, I walk in to update him. "Matthew," he says. "Yeah?"

"What did they find on the spit - the test where they had me spit up stuff?"

"Oh, nothing really. They found bugs, but its the usual bugs that live in your mouth"

I realized immediately that explaining this concept was probably fruitless- I should have just said "they found nothing" rather than try and explain they found normal oral flora which means nothing.

"Bugs???" He said wide eyed.

"NO no" I said, "you know how those yogurt commercials talk about how its for the good bacteria of your gut?"

"yeah" he said.

"Well they found some of the good bugs like that - so you have no infection...think of this way, from mouth to butt, you got bugs, and that's what we all have, its normal."

He just broke up laughing, the first time I had seen him laugh. I cannot explain the feeling.

"From mouth to butt, I have bugs, eh?" He says and then laughs more.

"I like that, you're funny man," he says.

I wasn't sure why it was so funny, but I just laughed with him.

I've made big groups of people laugh at me while on stage, or college classes laugh as i taught, or my family laugh at the dinner table. But none of these compared to the feeling I got from making a dying man laugh. It is all worth it, it turns out. For that one laugh. My grandfather died years ago from esophageal cancer. My mom wanted me to travel up there with my dad so I could keep the mood upbeat, be funny, lighten the atmosphere some in the tough times. I'm not sure I did anything particularly special on that trip, but it opened my eyes to how my gifts could help the dying.

We all die, there's no reason to be in a bad mood as it approaches.