Desensitised
I.II.II
DESENSITISED
It was during my time in neuro that I realised I was not the same person I had been at the start. I never thought I could end up so jaded, so robotic, so heartless. At one point, I found myself almost intolerant and oblivious to other people’s woes.
It comes with the job, most people would say. And I agree. But it doesn’t have to necessarily be the case. Before I started, I swore to myself I’d remain the compassionate and involved type. I’d be Izzie, not Cristina – despite how much I love her. Then I started working, and I managed to keep it up – for a hot damn second. You see, when you have so much on your plate, the emotional component of being a doctor starts to lose importance. When you have to attend to fifteen calls at any given time, it becomes a matter of prioritising. A patient’s state of mind is inconsequential compared to another who’s physically decompensating. Someone’s loneliness and depression can wait, flash pulmonary oedema can’t. Also, there isn’t much I can do if a patient doesn’t like hospital food (save for me giving them my lunch – that’s also served by the same hospital). That, unfortunately, is the harsh reality.
Little by little, I started to realise how natural it is to become desensitised. The first time I told Mr Chill I’d take him out on a ride around the hospital, I felt awful about having to rain-check it so I could wolf down a sandwich instead. The first time I told Mrs Fire I’d sit down for a chat, I felt guilty as hell when I decided to head home after a long day of work. But the guilt soon wore away as I tried my best to keep up with everything else. I had to prioritise my own health and well-being too. Otherwise, I’d be spreading myself too thin. Providing holistic patient care, I quickly realised, comes at a great personal cost.
But as I figured, the few times I did go the extra mile, it filled me with a sense of satisfaction and happiness unlike any other. I felt as if I had done right by my patient, that I had done a good job, that medicine isn’t all about treating the disease. Would that offset missing a meal, spending extra hours at the hospital, and neglecting myself though?
I remember one night shift where everything seemed to go wrong. I was on CPR duty – meaning I’d be the junior doctor responsible for carrying the CPR pager and tending to any cardiac arrests that arose.
The first call hit me hard. I literally ran to the ward where a bunch of nurses were huddled around a patient – one doing chest compressions, while the rest either stood idly by or panicked. I took a good look at the patient – a man in his seventies, white and unmoving, vomit splashing from his mouth with every hump. Without thinking much, I stepped in and took the lead. It was my first ever CPR, yet somehow I felt confident.
I followed the ABCDE approach to the dot – inserted an iGel, started high-flow oxygen via a non-rebreather mask, secured venous access, drew blood, started fluids, and gave adrenaline, all while the nurse kept up compressions. Still, the patient showed no signs of life. But we kept at it. By the time the CPR team assembled, I handed over to the anaesthetist who would continue leading.
I have to admit that despite all the chaos, I couldn’t help but feel proud as hell. I had followed protocol under extreme stress. “What’s next?” I asked as I handed over the venous blood gases (VBG) report. “Nothing, he’s been down too long… Time of death 18:06.” he said. I looked at him blankly, my mouth wide open. “All that for nothing?!” I wanted to yell, but I bit my tongue. “What the hell was the point?!” I remember thinking. Why did I put in so much time and effort – not to mention use so many expensive resources – if we were just gonna call it?
Needless to say, with the nature of our job, I didn’t have much time to ponder. A few hours later, my CPR pager went off again. The second I arrived, I was faced with a yellow corpse. God only knew how long the patient had been dead. Turns out, the nurses had misplaced the Do Not Resuscitate (DNR) order and called the resus team just in case. He was DNR after all.
Then another call. This patient was pale and lifeless, but everyone seemed on top of their game. A nurse had secured the airway and started oxygen therapy, another did compressions, and a fellow house officer inserted an IV line. I was practically redundant. As I stood there, staring at this middle-aged man seemingly in the prime of his life, I hoped their efforts wouldn’t be in vain. I stepped in, switched with the nurse, and continued compressions while instructing them to get adrenaline – all the while screaming in my head, “Come on! You have to do this! You have to fight!” The anaesthetist and senior doctor showed up, and we kept at it for forty minutes. With every passing cycle, the patient’s odds plummeted, as did my hopes. And there it was – my third “time of death” of the night. It was no less sickening than the first, especially given the patient’s age.
And that’s how the rest of the night went. After two more failed CPRs, the initial shock gave way to resignation, futility, and then indifference. This was part of the job. Survival rates for in-hospital cardiac arrests vary from 20 to 40% – and even then, their long-term outcome is abysmal. The odds are stacked against them. Yet somehow, out of five CPRs, I had a staggering 100% mortality rate – despite adhering to guidelines.
I didn’t feel guilty so much as helpless. Right there and then, another scene from Grey’s Anatomy flashed in front of my eyes as Dr Bailey’s lesson to George rang in my head:
-
-
-
Dr Bailey: If they’re dead or dying when they come through those doors, you hump and hump hard, why?
-
Dr O’Malley: So we can tell their family that we did everything we could.
-
-
To do the best we can – that’s all that matters. We aren’t gods. We can’t do it all. But we can damn well give our best. And that’s what I took from this experience. I wouldn’t be able to do it all. But what matters is being there for my patients whenever, if at all, possible.
The lonely and depressed patient I didn’t have time to chat with? He could have spiralled and harmed himself. I could have referred him to a psychologist if I didn’t have the time to speak to him myself. The patient dissatisfied with hospital food? That could have devolved into malnutrition, becoming yet another medical problem. I could have spoken to the carers or the catering team to make arrangements. And if I didn’t have time to do any of that myself, I could always delegate.
Because these things do matter. It’s not just about treating physical ailments. I knew that from the start, but somehow, I had become desensitised. I swore I’d try harder.