Tuesday, August 28, 2007

manners and mortality

Moving on now from the delicate topic of religion and faith........ (funny how this is a topic that is almost considered taboo. I see plenty of posts about peoples' sex lives, but rarely writings about spirituality. It's as if discussing religion is way more impolite than discussing favourite sexual positions. Odd.)

I spent last night tossing and turning and dreaming of giant livers, glistening and distorted. I dreamt of masked surgeons. I dreamt of the lady I saw yesterday - the lady who sobbed in my room, as I informed her that her CT scan showed a cancer growing on her liver.

To be brutally honest, I'm not sure why I am so disturbed. I have met Diane* only twice now (usually she sees another doctor at the surgery where I work). She is not someone others warm to ..... the receptionists moan about her being an 'awful woman'. As I called her in to my room yesterday, I asked her if her husband was coming in with her, and she spat out "No! I don't want him anywhere near me. He's useless." Howard sat a mere six feet away. He quickly grabbed a newspaper, and studied it fiercely.

I ushered Diane to a chair in my room, closed the door, and sat down. I told her gently and simply, "The scan shows you have a cancer growing in your liver." I passed tissues as she cried. With her permission, I called her husband in. As he tried to comfort her, she swatted his hand away and told him to 'Shut up, Howard!'.

When I have to break very bad news in my job (which, thankfully, is rare), I often feel quite emotional. I have to steel myself and blink more than usual. I am inclined to get very attached to my patients, so to tell one of my regular patients that they have a life-threatening condition always twists me up inside. But with Diane, I felt concerned yet calm. I let her cry awhile, while I stayed dry-eyed. When her sobbing abated, I quietly explained that I had made an appointment for her to see a surgeon. I passed more tissues, and answered her questions as best I could. An hour later, I drove home thinking of this unhappy, grumpy woman, who was now devastated, bewildered, terrified.

When I was younger and more self-absorbed (yes, more!), I had no affection for 'difficult' people, and outright disliked patients who were rude or irritable or demanding. I took their impolite behaviour as a personal affront. I bewailed their lack of manners; their failure to show me the appreciation and respect I felt I deserved. Why was this person so angry and annoying, when I was being so helpful and nice?! Yes, folks, I thought it was all about me.

These days, patients can still rub me up the wrong way, but I hardly ever get in a stew. It has dawned upon me that sometimes a person is 'awful' because awful things have happened to them; because they have been treated awfully by others; because they did not have the intrinsic resilience to survive what life has thrown at them. I may still find their behaviour offensive, but I don't take offence. More than that, I develop a strange sort of fondness for some of these perpetual pouters. One of my patients stridently refuses medication for her depression, continues to smoke like a chimney despite her diabetes, tells me she wishes her husband would die, and complains that I haven't helped her sleeping problem one iota. Yet she keeps coming back, and I care about her; I want the best for her. I believe I understand her.

Today, though, my thoughts keep returning to Diane. She faces a huge battle with this nasty ball of malevolence growing inside her. From what I can tell, her emotional reserves are low. Her medical history means that any surgery carries higher risks. If she survives the surgery, her fight may not be over, because the scan showed there has been spread beyond the liver. This woman who defeated another cancer, over a decade ago, now must face up to a malignancy once more. I doubt that Diane will have much support, because I suspect she has alienated many friends and family. Misery loves company, but no-one wants to come visit.

I do not know what exists beyond our lives on Earth, but just in case this is IT, I'm living my life as well as I can. I love my life. But what of Diane? What does she think of the life she has lived? Does she feel satisfied with any part of her life?

Was she frightened last night, as she lay stiffly beside the husband she shuns? I'm certain she was scared.

Scared, and utterly alone.

*As usual, names and other medical details changed to protect patient privacy


Motherkitty said...

What a sad, sorry woman. And, poor husband. Can you imagine the lashing he receives every day and still has the stamina and determination to remain with this unhappy wife? I'm sorry for her troubles and I'm sorry for her upcoming battle, the outcome of which remains dismal.

I would like my own physician to be as caring as you are. Love your beautiful attitude and patience.

thisisme said...

Thanks :)

What a lonely woman. I'm really sad for her. And sad too, for her husband. What a sad way to live, and to fight to live.

susan said...

Can't your front office screen these patients better, only nice happy ones?

I am sure she is in a better mood after getting a dose of jelly!

Take care, and keep on taking care of everyone else.

Redneck Mommy said...

Diane sounds much like my mother. So sad.

Yet, there is time for Diane still. Every day is a new day and she doesn't have to chose to be miserable or act miserable even if miserable things have happened to her.

Life is nothing a series of choices. And sometimes the only choices you have are how you choose to behave.

My very best wishes to that lady. I hope she finds happiness and health.

And thank you for reminding me (again) why I choose not to go med school.

Val said...

I am so glad there are people in the world who can handle and comfort patients in such a difficult situation. Do you realise how special you are?

mackeydoodle said...

To be honest, I feel sorry for people like Diane.
What a sad way to spend your life.

meggie said...

Perhaps Diane behaves as she does, because it is the only way she knows how to be. It seems some people are too 'guilty' to allow themselves to be happy, -ever.
Some part of her must still care for her life. How nice you were to her, how gentle.

John Cowart said...

"Sometimes a person is 'awful' because awful things have happened to them; because they have been treated awfully by others; because they did not have the intrinsic resilience to survive what life has thrown at them".

You have certainly hit the nail on the head with that observation!

Diane is lucky to have your compassion and medical skill on her side as she faces this cancer. I hope the awfulness of the situation draw her and her husband closer.

TUFFENUF said...

I am sad for your patient who can't even muster up a kind face for strangers! I am always disapointed with people who have a crappy attitude. Is is a conscious effort to act like an assclown? I don't know, I have seen people with everything going against them who still have a great attitude. I hope I can rise to the occasion to "keep smiling" even in the face of adversity.

freefalling said...

Sorry Jelly, this one is just too hard for me at the moment.

How about a nice photo of a dinosaur eating a doll again?!

Puss-in-Boots said...

Poor Diane has built so many walls around her that no-one can see the real person...the one she is too scared to show.

Sad story, Jelly, but oh so common. You are a very compassionate person.

Alice said...

Just when we think it's safe to get all complacent again, you go and prick our consciences and stir our compassion.

Thank you for yours, Jelly.

Heather said...

As medical professionals, I think this is one of the challenges we face daily -- caring for those who are difficult to care about.

I agree with T. Sometimes the only choice we have is the choice of how to behave. Your patient may well learn to play well with others once the gravity of her diagnosis sets in.

You're a good person, Jelly. This is why we are friends.

shellyC said...

I just hope Diane has experienced real happiness and love at some point in her life.

You really are a very special person and Doctor Jelly!!

Sharon said...

So sad. Sometimes it is difficult for me to remember that those who need compassion the most act like they deserve it the least.

freefalling said...

I've come back again - you've had me thinking.
There's doctors and then there's doctors.
Some are good to go to, to get a script filled and that's about it, but then there are the ones you really need to reach out and cling to, like a life preserver.
What does that feel like?
Do you feel overwhelmed by the burden of your patients' ills?
It must be difficult not for it to seep into your pores.
I used to have a wonderful doctor, so caring, so empathetic, but it burnt him out and now he does other stuff.
10 years on I have found another.
(But he has alopecia, so I'm a bit worried about how he's going!)

I take my hat off to you (as I did to my gazanias earlier in the week!). You do an incredibly difficult job - and I'm not talking about all that medical stuff, I'm talking about stuff of the heart and soul

Mimi said...

You have one hell of a job Jelly. I would have a really hard time not sobbing too. What a great attitude you have about such lonely and sad people.


fifi said...

hello dear girl, have been thinking about this post ever since I read it. People can be so alone.

You so remind me of my well-loved gp, who i have had since I was 18. She is my age, and so gentle and clever.
She sent me off to a specialist last year. On the referral letter she had written "do not alarm: easily terrified".
The specialist looked over the top of the page and said.."you don't look the frightened type!", at which I replied
"she knows me better than you'd think!"

and best of all, it was nothing.

She knows I'm frightened of myself.

yes, there are doctors and there are doctors.

Kerri said...

You have that rare ability to verbalize the various emotional aspects of a situation so beautifully Jelly. You can pull us right into the story.
You're learning well to deal with the complexities of people...and how lucky your patients are to have such a compassionate and caring doctor.
Diane's story is very sad. It's awful to contemplate what some people must endure.
I'm smiling about your opening paragraph. Yes, it is funny how discussing religion seems to be taboo.
Now where do you find these posts about other peoples' sex lives, huh? LOL

Sandy said...

You are wise beyond your years Jelly.

Anonymous said...

I feel more for her husband who obviously loves her or wouldn't still be by her side.