Turning Tables – Treating Physicians

Today, one of the other residents and I had an interesting conversation.

Somehow, the topic of treating physicians came up.  And it is something that terrifies us both.  And not just for the reasons you might think.

I will confess, treating other health care people is always nerve wracking because you worry even more about saying something wrong or stupid because you always wonder if they are secretly judging your skills.

But the bigger thing is that when we see them, they are being faced with a cancer diagnosis.  And for some reason, most physicians and nurses get the bad ones and all the complications.   And that is horrible for anyone.

The issue is, they know too much.  Sometimes, having some uncertainty is a good thing.  But, when you have cared for people with the same thing.  When you understand the odds and get the treatments, it is a whole other level.  You know the worst case scenarios.  All of them. Sometimes the unknown bits of the known are the worst.  Especially when your whole world gets turned upside down.

That is the hard part.  The anxiety, the sadness, the anger and guilt.  The fact that sometimes, the person who knows too much coming in can’t be easily comforted.  That the numbers that scare everyone have too much meaning.

It also forces us to face our own mortality.

We both agreed that given we work in Oncology and given the odds in the world today, we will both one day have cancer.  And we will probably die from it.   Those are simply real odds.  And the “comedy” that is life.

And we know this and accept it.  In fact, we laugh about it in an uncomfortable kind of way.  Sure, I might have a heart attack or an accident, but it is more likely I get dementia or die of cancer… Or both.

Really, it is something I accept.  But, it is still something that is terrifying. And maybe that won’t happen.  Maybe I’ll just die in my sleep in old age.

Either way the reality of seeing people who dedicate their lives to healing others broken, afraid and unwell is terrifying.  They are “one of us” who became “one of them.  It is just too real sometimes.  Too close to home.

I just want to fix the hurt.  I want to prevent the hurt.  I want to be out of a job (kind of).

But I can’t.  So, we do the best we can.  With every person.  Because one day the tables will turn in one way or another.

My flu shot soapbox

Please allow me to pull up my soap box…

It is time for what is becoming my annual flu shot rant (see here and here for previous).

I got my flu shot this week.

Unless you are allergic to it or have another medical indication to not get it, you should too.

I mean, we are all running around terrified of Ebola and really, afraid of getting sick in general.  But, most of us are too chicken (or cocky or ill informed or paranoid) to get a simple measure that prevents a common and potentially deadly illness.  It is simple, it does not make you sick and the risks are really low (you can actually get some similar complications at random or from a bout of the flu).

Just to point out some facts… You can get the flu shot if you are pregnant.  This came up at work the other day.  It is not contraindicated.  It is advised (I know, there is limited data on fetal risk because the population data does not suggest an issue, but if there was a giant issue, they wouldn’t be doling it out to pregnant women… That is bad PR and asking for a lawsuit).  You can also get the flu shot while on most cancer treatments if you time it based on the advice of your doctor (ao came up at work)ls.  It is free in a bunch of workplaces and also if you have a chronic condition that puts you at risk if you were to get the flu.

Last year, I had, at one point, 3 people in ICU on ventilators (aka life support) with the flu.  The FLU.  And they were all in their 40s-60s.  Not old people.  Not necessarily people who were sickly before.  Crappy luck.  Bad strains.  None of them had received flu shots.  They all survived.  Not everyone is that lucky…  I also had a patient I cared for on an oncology related service die from complications related to the flu during their cancer treatment.

I have watched people die or nearly die from the flu.  I don’t want to watch more.

I know the vaccine isn’t perfect. Sure, there are years where they miss the mark in picking the viruses, but they still do confer some immunity and other years they are spot on.  I know people don’t trust doctors because apparently we have been brain washed.  And there is limited research on each specific year’s vaccine (because they are basically similar with different strains).   But, I like to hedge my bets.  It is simple, quick, easy and has more evidence behind it than most of the stuff seen on talk shows.

Don’t kill my patients.  Don’t kill my family.  Get the shot, it is extremely unlikely to make things worse and it probably will make things better.

Rant over.  I’ll step down again for now.

 

How Did That Happen?: How I Survive Breaking Bad News

It is due time for another How Did That Happen? post. This one is How I Survive Breaking Bad News. Not how to break bad news. That gets covered all over the place. I’m talking about the facing people later, living the rest of your life kind of survival.stethoscopes1

This one is a result of my week of breaking bad news. I know, I am an oncology resident. More days than not, I break bad news. I tell people about pathology reports they don’t want to hear about. I tell them they have cancer (not always for the first time, but sometimes for the first time they really process it). I tell them their cancer is back. That it isn’t curable. That they need treatments they didn’t want. That they are going to die… Soon.

Breaking bad news is tough. So tough it is its own section in many med school communication classes. So tough most people do a crappy job of it because they are scared.

I’m a weirdo. I don’t love breaking bad news, but I like to do it. Because I believe people have the right to know the truth. And to hear it in such a way it is understood and compassionate.

This week has been especially bad newsy. From clinic to call to pediatric brain tumor clinic, I have delivered or been in on delivering all kinds of crumminess. It wears on a person.

  • It is okay to cry. Seriously. Sometimes, stuff is really tough and you just have to let it out. I’m not saying sob on the shoulder of the person you are talking to, but it is okay to shed some tears then or later.
  • It is okay to be angry or disappointed or relieved. Emotions are good.
  • I’m going to sound cliché, but reflect on it. Sometimes, you say stuff that is stupid or comes off the wrong way and other times it goes well. Actually think back on it, even if it is tough and then learn from it and move on. I tend to really stew on things, so this is something I’m working on.
  • Find the rays of hope. This is also helpful when delivering and discussing the news, but I really mean it is important for me too.   Sometimes, I start to feel like I am the grim reaper or that life is a miserable existence. It is good to find the bright sides, like how fortunate I am, how that person will have a good outcome or good days or whatever. Just something positive.
  • Count your own blessings. If I get really discouraged, I find it helpful to think of how fortunate I am despite the bad in the world.
  • Talk about it. Confidentiality is important to maintain, but there is nothing wrong with discussing it with co-workers involved in the case, or even just your thoughts around it without disclosing details with a friend or family member.
  • Have an outlet. I sing and dance like a fool. Or exercise. Or write. Just something not work that helps get some of that badness out.
  • Do something happy. I like ice cream. Or spending time with friends. Or music. Or books.
  • Mix it up. This isn’t always an option. But, I love that my job involves lots of time on the computer doing technical stuff or research, not just difficult conversations. I also love that there are really good positive things mixed with the difficult in clinics.
  • My faith is super helpful to me at those times too.

What are your bad news survival tips?