Friday, February 6, 2009

Could I get a little Zen here?

My kids have a book I love. It's called Zen Shorts, and it's just that: a series of short stories, each with a Zen message. (Note: we are not particularly religious in general and completely non-Buddhist, in case that matters to anyone.) One of these short stories includes a well-known parable from Zen Buddhism. It goes like this. A young monk and an elderly monk are walking along. They encounter a high-class woman stuck at one side of a big mud pit fretting about how she will get across. The elder monk picks her up, carries her across, and gently puts her down on the other side. She is quite unpleasant to both of them, complaining all the while, and never says a word of thanks. The elder monk walks on silently as he did before. The younger monk ruminates on what happened for the remainder of the afternoon as the two monks continue their journey, marveling at how the woman could be so rude and disrespectful and asking why the elder monk didn't just put her down. Finally the elder monk says, "I put her down hours ago. Why are you still carrying her?"

My kids love the book, so we read the story often, and I have a Eureka! moment every time. THAT is how I want to be, like the elder monk. I have to cultivate this Zen thing. No, wait, I know, even better: maybe I'll even BECOME A BUDDHIST!!!

But the sad reality is that I am SOOOO not Zen. I am the young monk. No...worse. I am the anti-Buddha.

I have an extraordinarily hard time letting anything and anyone go. I have a lifelong tendency to accumulate clutter in my house and office--not DSM-qualified hoarding or anything, but real clutter--and in my mind. The sad fact of life as an oncologist is that yes, there are many people we save, and yes, we've come a long way, especially in breast cancer which is my specialty, compared to 10 or 20 years ago, but we still lose a lot of people. I remember the name of every single patient who has ever died in my care--all of them, even my patients in the ICU as an intern--and, in most cases, the names of their spouse and kids and various random facts about them, too. I don't know if this is because I doubt myself and wonder whether I could or should have done something differently that might have saved them. Or if I actually have too much empathy for patients and families. Or if that's even possible. All I know is that I take every death very much to heart. And, as an oncologist, if you're still carrying patients long after you should have put them down, you are in for real trouble.

Although I suspect that most of the readers of this blog are in fields other than oncology where death is fortunately not a regular occurrence, I wonder if and how you put patients down once you have done your job of carrying them across. When you have made mistakes, do you let them go? If you have lost patients, can you put it behind you? And if so, how do you do it? I know we don't have a doctor-patient relationship, but, please, can someone prescribe me a little Zen?

6 comments:

  1. I might not as many deaths as you, but I carry patients for years, through marriages, divorces, children, new cars, new jobs, and of course, some deaths. Many have taken up permanent residence in my brain. These ghosts (many of whom don't belong to people who are dead yet) become old friends. I make peace with the angry ones and the ones I fumbled a bit. I smile when the memory of a beloved old friend pops up. And no, they don't talk to me or compel me to do anything more interesting than make room for more. It's the big-hearted part of the job. Zen would be good, but I'm not wired for that.

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  2. It's interesting. I think most of the public would interpret your inability to let the deaths of your patients go as being a "good" person, a "caring" person, or a "good" doctor.

    "Letting things go" is drawing a line between your own sanity and the right amount of caring. I'm not sure anyone gets the balance completely right.

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  3. As a PM&R doc, death is something I fortunately very rarely have to deal with these days. Most people don't die of patellofemoral syndrome, thankfully.

    On the rehab end, I lost only one patient since finishing my internship. It wasn't my fault, that much I'm sure of, but I still think about it all the time. I still think about several of the patients who died on me in the ICU, the ones I got to know rather than the ones who coded and died within hours of coming to me.

    But even though I don't deal with death much, I do make mistakes at work from time to time. And boy do I ruminate on those, even though none of them have had any consequences.

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  4. I need some Zen, too, this morning after wrestling a couple of sick patients to be able to look in their ears. We had a teenager in our practice die suddenly this week, and it leaves us all shaking and scratching our heads and wondering what we could have done differently. The reality is that we've seen this kiddo one time, and he was a very healthy teen then. The human part of me wants to accept responsibiilty for a lot more than I am actually responsible for. Death of a patient always teaches me some lesson - whether it is "go love on your own kids some extra", or "you did everything humanly (underlined in bold!)possible to help that patient". I've also learned more from my mistakes than from successes - so while they are painful, they have a silver lining. Gonna go buy that book for my boys now! Thanks!

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  5. I think that we all to some extent carry those patients with us. Whether you remember everything about the patient (name, family etc) or just learn and grow from those patients, they become a part of the physician we are currently. I think the problem would be if you didn't learn or if the patient you are "carrying" gets in the way of caring for the current patients, then it is a problem.

    Rx: Zen
    1 helping
    Take PRN

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  6. Zen Ties is awesome also! As a geriatrician, lots of my patients have died. I remember all of them well. I think it easier to think of " a life well lived" for some of my patients, but it really doesn't always make it easier. I worry about the patient who died while I was on maternity leave, the ones whom I never figured out what was really wrong, the one who left a single, devoted son....
    keeping them in your heart and learning from them and remembering them keeps their spirit alive.
    i am sure you are a great doctor.

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