Tuesday, February 22, 2005


{Disclaimer: This is not remotely funny}

Bleep. Bleepity-bleep, Bleep.

Yesterday, a very nice person came in to see me in the office with a mundane, innocent seeming concern. Over a couple of hours and several tests later, it became clear why he was having the symptoms and also why he was having some other symptoms that later came to light. And the answer is bad, my friends, very, very bad. It may turn out to have a good ending but at this point we just don't know much more than the bad.

In my work, bad news is not a stranger. You never get used to it and it never gets easy but you learn how to deal with it for yourself so you can help your patient try to deal with it. The focus has to be entirely on them, not on your issues. Sometimes, though, there are extenuating circumstances and we all have our Achilles heels. Mine happens to be kids. I can take the truly horrible when it comes to adults. I don't like it, I shed tears and get very angry at the unfairness but when it comes to hurting kids, it is as though a line that should be inviolate is crossed and it pierces to the well-armored center of me.

I often get asked why I don't see children, why I went into internal medicine rather than peds or family medicine. I always say it was for 3 reasons. First, I could never see the teeny-tiny ear drums to assess the teeny-tiny ear infections. Second, I loved dealing with the kids, but the parents, sheesh. Third (and the real reason), I can't stand it when kids are sick. Kids should never have anything bad happen to them. Ever. Add to it the fact that I would be incarcerated for 1st degree murder the first time I came across a case of child abuse, well, it just was best that I stick to the adults.

So yesterday happened. The patient was an adult but has a kid the age of one of my kids. And now the child will have to deal with some really horrible stuff happening to his family. And that just should never happen.

Once again, I am reminded that life is not fair and very horrible things happen to very nice people and that includes kids.

And once again, I am reminded how things change with becoming a parent. Previously, I really didn't understand someone choosing an almost certainly futile, yet very painful and debilitating course of treatment in the face of terminal illness. I have never feared death and I still don't. I fear disability and senility. I fear severe, unrelenting pain. But not death.

With the birth of my son, however, everything shifted instantly. I now must live until my kids are grown and can fend for themselves. I would now choose the path of painful, minimally hopeful interventions even if it only prolonged things for a few months, because those few months may make a mountain of difference to my kiddos.

Death is now the unaffordable luxury.



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