Compassion, CREST, Cadbury and Coke

Today I got an early mark for good behaviour (that and there's actually no work to do when we have 3 registrars)... it kinda bugs me that I'm getting paid but getting told by my bosses to go home early... I know that shift work means you can do that if it's quiet, but I guess I like to think I have a pretty strong work ethic (despite what you guys might think from my student days... which was not 'work' in my opinion) which means I feel bad about not doing anything all day in the dungeon. I feel like I'm wasting tax payers money by sitting around and leisurely doing stuff. I'd rather work really hard, flat out for 3 hours then knock off at lunch time and save them all some money... maybe it's becasue of who I am... I've always found that when I'm not working very hard I get bored very quickly... in fact that's why I was accelerated at school and skipped a year... because I worked hard and when I ran out of work I had to get more work or I would get restless. But now there's nothing left to study for... I've got no exams this year for the first time in 18 years... maybe I have ADHD and need something to keep my brain occupied... (because believe me, talking to the nurses in the psych ward is not very intellectually stimulating)

Have become addicted to the new 'Coke Zero'... I am ususally very wary of any changes from the original formula invented by Dr John Pemperton in 1896 (although I must say removing cocaine from it was prob a good idea) but for once I am impressed. Not with the bottled from though which tastes like the Coke Methadone (Diet Coke), but I've found that the canned form of Coke Zero is undistinguishable to my palate from the real thing which is great (because I CAN taste the diff between Coke and Pepsi despite what people may say)... so now I have a no suagr alternative to Coke that retains all the flavour of the real product but with no sugar so my HbA1C level wont go up! Yay! (I'm currently working my way thru a 36 can slab at the moment)

Anyway, today (maybe because I was so bored or tired from last night) I was really moved by the plight of one of our patients. Mrs A is this frail 55yr old lady with scleroderma/CREST who weighs only 35 kilos and has psychotic symptoms and depressive symptoms. She can no longer swallow properly and keeps getting pretty sever aspiration pneumonia. We really encouraged her to have a PEG tube put into her stomach for feeding but she really doesn't want it... she says she would rather die and eat Cadbury chocolate (how cute) than be fed by a tube and never taste food again.

To be honest I totally see her point... I would rather die and be eating/tasting food than be fed via a tube indefinitely with a poor quality of life. I've repeatedly stated that I'd rather die young/fat with a smile on my face than old/frail and depressed. It's quite sad to see her get to this stage though at only 55.

It made me kinda get those warm/fuzzy feelings that make you empathise for the patient. It reminds you that you AND your patient are both human beings, made in God's image with dignity and respect.

But then later, we saw another patient, Mrs B who was extremely manic... part of her mania meant she was extremely manipulative... she would corner staff to try and co=oerce them into doing favours for her... and in this case the only way to deal with her is to NOT care... when she burts in to tears we have to ignore them... when she yells and shouts about being kept in, I have to switch off... in this case, part of being a responsible clinician means I must not care in order to care.

To be honest I think I've lost my compassion over the course of med school. One of the main reasons I decided to do med at all was becasue of my grandmother who died a slow protracted death of breast cancer over a decade. I've always kinda been an 'emotionally-aware' person (prob due to having 3 sisters and being subjected to their chick flicks/culture) and I really wanted to 'make a difference' by doing med.

But somehow during med school I noticed that I began to care less and become more cerebral in my dealings with patients. I'm not sure how it happened. Maybe it was a coping mechanism to deal with the flood of emotions that patients throw at you... maybe it was out of laziness on my part to spend time with patients... maybe it was due to peer pressure... but I noticed that the more the course tried to 'teach' us how to 'feel'; the less I felt for them. Ironically I noticed that the more cerebral students actually took on board these lectures and began to at least 'feign' attempts at empathy whilst I became so apathetic towards my patients.

Today thouh I began to feel again... to actually give a damn about what happened to these people... to have compassion on them... just as Jesus would.

And it's scary... cos to get invovled in the mess of people's live isn't easy... it isn't fun.

It means getting your hands dirty and opening yourself up to get hurt and to give up stuff.

But thats exactly what my Lord did. He actually gave a damn about people with a terminal illness (sin)... he actuallygot his hands dirty by coming to earth to fix things and make them right. It wasn't easy... and it cost him his life. But it was worth it.

It's called love.