Friday, June 15, 2007

Death as a ritual gone awry

Another passage in "Final Exam" strikes me as interesting.
During undergrad I volunteered for a hospice, so maybe I notice issues related to death and palliative medicine more than others. I've learned to see death as a natural part of life. Obviously when someone close to you dies, it's ok to feel a sense of loss and sadness, but I guess I also feel like it is bound to happen eventually and dwelling on it too long is what makes it ugly.
In regards to death, Dr. Chen says, "Along the way, we learn not only to avoid but also to define death as the result of errors, imperfect technique, and poor judgment. Death is no longer a natural event but a ritual gone awry."
I am comfortable with myself and how I see the world, but it does still make me feel better to see that although some may see my views as a little cold and unfeeling they could be much worse. Rather that seeing death as a natural part of life I could see it as some failed intervention aimed at life. To me at least, this seems worse. I hope that in the future I can refrain from blaming myself or treatments for the deaths of all my patients (though unfortunately and invariably, some deaths will be directly related to the treatment provided) and remember that death is an inevitable part of life, one that will come with or without my interventions.

Introductions are in Order

Working in medicine, one often encounters moments when it is necessary to suppress their human side. When you are a doctor, human is"other" - subject matter. In medical school we actually have to teach students how to interact with their patients. We're taught specific phrases to use to show our empathy: "that must be hard for you" becomes a scripted response to any kind of pain. Some may argue that when a person signs up for 4+ years or rigorous post-graduate study only to head straight into a career where it has become a luxury to be limited to eighty hours a week this person is perhaps not the most social or empathetic kind of person to begin with, but I argue that many go into medicine for the "right" reasons, then somehow the education, the rigors, the pure intensity of it all changes who we are and distracts us from or original intentions.
I picked up a random book off the shelf at the library because even though my life is saturated with medicine, I still can't get enough. It is entitled "Final Exam" by Pauline W. Chen and actually mentions some of these issues for which I created this blog to begin with.
In talking about the medical students' rite of passage, the anatomy dissection she states: "To complete the initiation rite successfully, however, we need to learn to separate our emotional self from our scientific self; we must view this dead human body not as "one of us" but as "one of them," a medical case to be understood but not embraced... it required suppressing the fundamental and very human fear of death."
I'm forced to agree.
So this is me, trying to have a dual life as both Human and Doctor.