During a 35 year career, a surgeon lives through many experiences that impacts on his character, emotional state, beliefs and values. So it is not surprising, that during my own career as a general surgeon, I have witnessed the unfolding of life from the womb to the tomb. This included encounters with people from all walks of life. In particular, I have witnessed behavior not befitting the dignity of human kind to the utmost reaches of morality, kindness and love. I choose to remember the latter kinds of interactions I have had the good fortune of being part of during my career.
As doctors, we are privileged to be part of people's most private life experiences. Whether it is the joy of placing a newborn baby on the belly of a tearful mother, or the deepest sorrow of a parent following the tragic news about the death of a child, one cannot help but be moved and forever changed.
I have never become accustomed or comfortable about delivering bad news. Unfortunately, I have chosen a profession that by its very nature causes injury before the healing nature of the craft can be appreciated. Whether it is treating a trauma patient, or excising a cancerous tumor, surgeons inflict pain and injury, before they reap the fruits of their labor and earn the gratitude and trust of their patients.
One of my favorite utterances has always been: "A chance to cut is a chance to cure" much to the chagrin and rebuke of my medical colleagues who merely "push pills" and never actually cure a disease, as is the case with diabetes or high blood pressure. When I remove an inflamed appendix, the patient has forever been cured of appendicitis. Unfortunately as surgeons, we have to live with the consequences of our actions. I have never had a patient who liked me a day or two after a hemorrhoidectomy when going to the bathroom can only be compared to passing a broken bottle with the wide end first. Fortunately, there are also positive experiences which more than make up for the negative ones. It's hard to find a more grateful patient than one who has lost two hundred pounds as a result of your efforts, and is now able to live life the way it was intended, unencumbered by morbid obesity.
I was fortunate during my career in surgery to be involved in the types of surgical procedures that resulted in making patients feel better and live longer lives. As a result, among the greeting cards during the holiday season and throughout the year, I was privileged to receive gifts and letters of thanks from patients who were eager to share their gratitude for what I have done for them. I keep a folder filled with such letters. When I am disheartened or depressed about the medical profession, I pull out this folder and read through a few of these faded cards and letters that have accumulated there during the past 35 years.
I found myself in such a state of mind the other day. I needed a picker upper. Maybe it's the holiday blahs or SAD, [Seasonal Affective Disorder] from years of living in Cleveland, Ohio. As I sorted through the dozens of letters, I ran across a letter, that I had read many times before. Unlike most of the other letters, this one was extra special. It was a letter of gratitude for something "I didn't do" or "Couldn't do", which just reminded me of my fallibility and humility as a surgeon. It is reflective of the imperfect nature of our surgical skills and the strength of the human spirit when everything else fails. It is so touching that I am compelled to share it with others. The amazing story of this wonderful human being, the wife of a physician, began months before she died. To the best of my recollection, she suffered from a rare tumor involving most of her small intestines. Her husband entrusted me with her care and on two previous occasions, I was fortunate enough to repair a high grade bowel obstruction by partial resections and bypasses of the obstructions, knowing all along that my best efforts will ultimately be unsuccessful in the long run because of the relentless growth of this nasty malignancy. When I was confronted with yet another one of her high grade obstructions, I felt compelled to operate in an effort to relive her of the agony of the painful obstruction. To my dismay and great disappointment, I was unable to relieve the obstruction. Rarely during my surgical career did I find myself in such a predicament. There was absolutely no possible way I could relieve this patient's obstruction without causing her immediate death. Dejected and defeated, I had to confront this wonderful patient and her loving husband with the tragic news of my failure to help. In my humble opinion, she was doomed to a painful death from a bowel obstruction and an indwelling plastic tube in her stomach for the remainder of her short life, merely to keep her from constant vomiting. With a courage that I have never witnessed before, they accepted their fate. I have purposefully omitted names and dates to protect their privacy in the letter that follows:
Dear Dr. Schreiber
--------
"Now that it's all over, I would like to take this opportunity on behalf of my three sons, ----, ---- and --- and myself to thank you from the bottom of our hearts for all the help, care and kindness you showed to my dearest wife -----, during her recent illness.
She expired on the ---------- after 22 days of hospitalization for intestinal obstruction. We decided not to have surgery and so we got Hospice involved and took the approach to just make her comfortable. She suffered tremendously, she had gross tense ascites[fluid in the belly]; severe pain and was on continuous N-G Suction for all her 22 days. Unfortunately, she was of clear mind+ knew everything that was happening. I have seen many people die [as a physician] but I do believe that my wife was one of the bravest.
In spite of her being so ill, in so much pain+ respiratory difficulties, she welcomed all visitors and always found something to say to them which would comfort them. She was at total peace with her maker.
She reminded me many times not to forget to thank you for all you did for us. She had the utmost faith in you + your demeanor, + your caring and compassionate ways will always be an inspiration to me.
I tell my big son -------- that if he ever becomes a doctor [he has become one since]he must be like Dr. Schreiber.
------- was very taken up by your kind, gentle way you listened to her; your efficiency and of course your sterling surgical skills. When you told her nothing more could be done, it broke her heart, but she recovered and told me that she believed you implicitly and never doubted your judgment. From then, she started trying to cope with the finality of her dying.
In her dying days her strength of character, her inner peace was an inspiration to all she touched and in our final prayer with our pastor, she prayed that God will make more 'Christian' doctors like you, Dr. Schreiber.
I miss my wife so very much- It's a very sad life without her and obviously I have not adjusted. Hopefully time will heal.
God bless you Dr. Schreiber and your staff. You are one of a Kind.
Sincerely;
------------------- [M.D.]
Humility is not generally attributed to surgeons. I must admit to a touch of this character deficiency during the early years of my career before I realized my own shortcomings as well as that of my craft. Practicing surgery in a society where 'dying is not an option' is not easy. It becomes increasingly difficult to admit to defeat and inadequacy lest you expose yourself to criticism from competitive colleagues, with much less morals and values.The experiences of dealing with hopelessly ill patients whose expectations you cannot fulfill, leave you wondering. Was it all worth it? After re-reading the letter above several times in the past years, I always come to the same conclusion.......YES IT WAS.
No comments:
Post a Comment