Series, The Doctor's View

The Doctor’s View: Dousing The Fire

HeaderBy Denise Kavuma, Uganda:

I dream about my patients a lot. It's not of my doing though and in fact if I had any choice in the matter, I'd really much rather not have any reminders of most of the patients I meet, except for the new knowledge learned in treating a condition. Yes, I am one of those despicable people who don't like being around others. It has always seemed to me like some cruel twist of fate that I should have social anxiety and yet have a career that requires me to see numerous people in a day and be nice to them. In a way, if you squint your eyes just right, I'm sure you can see why I don't want to remember the hundreds of faces I see every day.

Of course, tell this to a client who comes in expecting that their unique experience with you somehow found enough space for you to remember their face, if not the name, and they'll pout like a child. Often enough I have to hold back the exasperated explanation that I've never been good at remembering faces, names, or roads and with all the new information I have to keep up with considering medicine's unending discoveries, I barely have enough space to remember how many cups of coffee I've had in a day, let alone which UTI patient you are. To quote M. Bison: “for you, the day Bison graced your village was the most important day of your life. But for me, it was Tuesday.”

With all that in mind, think then, how odd it is that I dream about these same people and I can always pinpoint who they are in my dreams, never guessing which patient is which. A case happened last year in which a childless lady came in with a ruptured ectopic pregnancy, her second one unfortunately. Years before that, she'd had a procedure done to deal with some blockage in her fallopian tubes and had hoped that she'd finally get pregnant and deliver. Unfortunately, her first pregnancy had ended up being a ruptured ectopic and the right tube was cut. Hoping that the remaining tube would still deliver her from her misery – which works for many people, mind you – she went ahead and tried to conceive again. Some time at the beginning of the year, she sustained burn wounds and spent a good number of weeks in the hospital before she was discharged, only to come back for a routine checkup later on to find that her pregnancy was in the left tube and had just then ruptured. So I had to cut her left tube as well.

Oddly, I'd been the primary doctor working on her for all 3 of her unfortunate experiences in the hospital and each time, I still needed to be reminded of her previous experiences with me. Callous, yes, but you see, that very afternoon I had a fitful nap during which I kept seeing myself operating her abdomen, looking at the muscles but never quite going on to the suture the rectus sheath closed. It was frustrating to say the least and now, her experience is ingrained in my mind. I'd like to be the nice person here and say that I remember her because her story touched something in me but that would be a lie. I've never really wanted children and any urge I've had to have a baby always played along the lines of me stealing one or adopting one to fill my loneliness and for nothing more. Whatever portion of my soul the maternal instinct is meant to occupy is filled instead with a love for burgers and the nearly insatiable need to keep writing. I could take a week to count all the ways I see no need for children and it still won't be enough. So, on top of me having compassion fatigue even in my daily life, I couldn't empathize with her need for children.

I remember her story though, because some part of my brain stored her and then proceeded to torture me for an hour or so with images of me staring in her abdomen. I'd say the same for all those children that die in my arms as I am doing CPR, for the woman whose anencephalic baby tore apart in my hands, and for the mentally ill patient who was doused in petrol and burned alive by some hooligans. I can't afford to get emotionally involved with my patients anymore and at this point, I'm not sure that I could even if I tried. Rest assured though that even if I don't remember the faces and names, I do remember something and that's rather monumental in my world.

Often enough, I look politely at traffic accident and assault victims as I take relevant information from them but the 'sorry' and 'you poor thing' statements are always voiced by the nurses, not me. Not every doctor is as closed off as I am and some can handle being open and generous without breaking down. The rest of us have learned the hard way that you get burned when you get too close to the fire and we are very flammable. So I stay a safe distance away; my job is to control the fire so that people don't die in it, not to protect the house.

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