Being A Doctor

Doctor! 
There’s an emergency!

And immediately your brain has to switch from sleep mode to permutations. You immediately feel the adrenaline rush. Your heart beats faster, your palms sweaty. In that brief journey to the emergency room, you’ve made a million calculations and speculations of what could be the problem.

You step into the emergency room door and the first sight that hits you cancels one arm of your analysis and activates the other arm. If they’re screaming in pain, that’s good news. At least that means the lungs and heart, the biggest players, are functioning.

You’re still tensed but you have to keep your cool so you remain in control of the situation or at least appear to be. Patient relatives interpret that as being uncaring, but they don’t realize this detachment is necessary for the rest of the team. You panic, the other members of the team panic and that will lead to mistakes.

Does this person require initial resuscitation or can they make it through your interrogation? This can be the line between life and death.

From initial assessment you start asking questions, probing for likelihoods. You’re compressing the past minimum 7+ years of study into 10 minutes, trying to find out what, how, where?

They wonder why you’re wasting time asking so many questions, you reassure them and get them to calm down. You ask all your questions, you narrowed the possibilities from a thousand to a hundred to ten to five to three, sometimes to one if you get a clincher.

Then you start calculating which investigations to choose from a barrage that will be relevant, less harmful and financially prudent. 

In our environment, sometimes financial constraints are a major bottleneck. You can’t do the needed tests because the patient can’t afford it, so you go back to your calculations. Out of these 3 possibilities, which is the more likely considering environment, age, duration, predominant symptoms and other sets of information.

You finally settle for one or two, then you enter into the area of treatment. Which options do I have? If they require antibiotics, which class out of the different classes? Which particular drug in this class? Considering age and other individual factor, other drugs the person is on that wouldn’t lead to an interaction between different drugs. You’re compressing minimum 18 months of study into that 1 minute.

And so in a few minutes, your ability to think, reason and recall information becomes the dividing line between life and death, and you have to do all that while showing the right facial expression according to patient condition. You do all that in 5, 10, 20, 30 cycles depending on how many patients you see that day, and somehow manage to remain sane.

Then you get home, and just as you’re beginning to fall asleep after a hard day’s job, a thought hits you: you forgot to ask one pertinent question for that other patient! And so your heart starts racing, because you know a yes or no holds dire consequences. You try to reach your colleague on call but can’t find any free hand to help you check. So you try to calm yourself down, reassuring yourself that the patient will still be alive by tomorrow when you get to work.

Most lucky days, you meet patient still alive the next day. Some bad days, you don’t. And so for a long time, maybe days or years later, the memory nags at you, you keep wondering if they died because you didn’t ask that one question or if they’d have died anyway even if you had.

Anyway, you go ahead to fill the death certificate. Unfortunately you cannot mourn, you have no time to process what just happened because the other patient waiting for you has fully recovered and is excited to go home. And so like a zombie you walk to their bedside, smile and write your discharge notes. Of course you have to show some excitement in the process because you’re also happy for them. 

That’s one hell of a life. Will strongly not recommend. 

Dr. Kanichi.