I hate this part of the job

After lunch today it was hard to stay focused on clinic work. My mind was elsewhere, trying to make packing lists and looking forward to my trip to Philadelphia tomorrow.

And then came one of the last patients of the day. A charming 88 year-old woman and her daughter showed up in clinic; the mother, previously healthy, was referred for a cough and shortness of breath–new and progressing over the last two months. Her CT scan was consistent with idiopathic pulmonary fibrosis, and given the rapid progression of symptoms and radiographic findings, her prognosis is poor. This is a disease that doctors cannot successfully treat; in a minority of patients, symptoms are abated for a matter of months to a year. But this lady already had advanced disease…she likely won’t live to see her 89th birthday.

This is the sort of lady you would love to sit down and chat with. Her white hair was bobbed and curled, and she wore a bright green linen pant-suit. Her bright blue eyes complemented her winsome smile.

And she smiled still after receiving the news, though it seemed forced, and her eyes were troubled. Turning to her daughter, she remarked, “I’ve been healthy all these years–how can it be that this silly cough means I’m going to die?”

No tears were shed in clinic today, but even as I write this I have a pit in my stomach, and a renewed appreciation for that necessary–yet blurred–line between giving compassionate care to patients and taking their burdens upon my shoulders; that is, becoming so wrapped up in my patients’ lives that it impairs my decision-making as a physician. And yet I dread and fear the day that I can come home from work and forget about the patient to whom I gave bad news, the patient whom I supported in her suffering.

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