Let's Try Again in 2013

OK, so this blog has been dormant for nine months; the time it takes to make a baby. So, maybe the way to look at this is that I've been doing something else that takes just as long and am ready to start anew.

Today I read an interesting comment on a Nephrology blog. The subspecialty of Neprhology is the least popular of all the subspecialties of Internal Medicine at this time. I am not surprised by this statistic although the hypothetical reasons don't make sense to me.

Difficult and challenging classwork during medical school on fluid, electrolytes, acid-base disturbances and the study of glomerulonephritis is cited as the major reason why young physicians in training don't select Nephrology for their professional life. Hmmmm.

I remember sitting in renal physiology lectures in UTMSH back in the late seventies and being totally confused because of two things:

1. the poor quality of the teaching in general, and

2. a particularly horrid clinician who  delivered the "real world" of Nephrology lectures. He ruled the classroom with a "Gestapo-like" approach. In his opinion, we students were appalling unprepared, dumb, and hopeless. I was terrified that Dr. N would call on me as he was wont to do; so terrified that I'd often leave class so as to avoid even the smallest chance of ridicule. He was a horse's ass (hole).

And yet, although I understood little of renal physiology, a spark of interest remained and bloomed much later when under the watchful and supportive influence of mentors in the field. This made all the difference for me.

The reason I attribute to the decline in interest in this field we call Nephrology in the "modern era" is what students witness as the nitty gritty real, everyday practice of the Nephrologist.. The work is hard; labor intensive and never ending. Furthermore, when kidneys don't work, the whole body suffers head to toe. Ultimately nothing works well aside from the liver which for some reason hangs on to a relative immunity unless....unless, we're talking about a particularly thorny problem of hepato-renal diseases and then, absolutely NOTHING in the body works well or at all.

We patch things up the best we can. We do as little or as much as we can, depending on the day and time and the end result is usually the same. The diseases often benefit from benign neglect, a term that I've learned to embrace the further along I am on this doctoring path. If you simply leave things along, resist the notion that doctoring requires action, many times things improve on their own.

We cure little, hopelessly little. We stand by and watch ravages of disease march along at variable pace. And for this we come to work every day and do the very best we can.

It takes a certain person to consider that this field gives back enough to balance the feelings of helplessness in the midst of a super storm.

Bravery?

I finally learned what not to say to my patient who is battling a chronic illness whether it be cancer, recurrent strokes, kidney failure on dialysis, diabetes with endless complications or anything remotely similar.

Never (ever) say: "You're so brave." in response to their hardships, struggles, and the seeming courage they show making it through each day.

Guilty of this faux pas on an embarrassingly frequent number of occasions, a light bulb finally went off in my head. Uniformly I've received the same response from my patients to my perceived encouraging and complimentary statement. I've been told nicely by some and with exasperation by others something on the order of "Brave? I had no choice in the matter." In other words, trying to pin the word brave on someone fighting for their life is likely neither reassuring nor endearing. In fact, many who've heard these words come out of my mouth probably say to themselves, "Doc just doesn't get it.".

I suppose I'll never really know how annoying my comment, however innocent, feels since I don't walk in their shoes. What I learned was to hold back on this reflexive comment and instead, listen more deeply, respond with the squeeze of my hand on theirs and say less. For this, I'm grateful.