Milestones: The Worst One of All.

Lost my first patient (well, first as an MD) on Wednesday. Didn’t really want to talk about it, but I figured I should at least acknowledge.

We live in such fragile, temporary shelters.

Milestones: Te Conozco, Bacalao

Dear Fiancee Of My Dying Patient,

To be honest, this is not REALLY a milestone. Patients and family members threaten me all the time, with everything from reporting me to my superiors, to lawsuits, to actual bodily harm. Some people even threaten me as if it’s a joke, when they’re uncomfortable with a medical situation. Dealing with being threatened is normal for me. It’s practically a part of my job description.

But since this is the first time this has happened since I got the degree, I may as well mark the occasion.

Ma’am, your fiance has stage four lung cancer and end-stage AIDS. He is dying. And though we’ve told you this many times, I understand that you haven’t yet accepted it. It’s a tragic, impossible thing to have to figure out how to accept.

I know that you do not know that you’re grieving. I know that you’re trying to exert power in a situation in which you feel powerless.

When you go and speak to the chief of medicine tomorrow about my refusal to flip your fiance’s medication schedule twelve hours so he gets his morning meds at night and his night meds in the morning, I hope it helps you take another step through the stages of grief that will allow you to face the end with grace and dignity together.

I know this demand is an expression of your need to participate in your fiance’s care and have some power over a horrible situation.

But let’s be clear. You’re not going to have my job for refusing.

You are a family member, and therefore your needs are important to me ONLY if all of my patients’ needs have been adequately dealt with first. If they haven’t, there’s only so much time I’m willing to spend on you. I’m sorry if that makes you angry. But my time is limited, and it belongs to my patients.

I am more than happy to be your bad guy. I’m everybody’s bad guy. Just look in popular media. The doctor is ALWAYS the bad guy.

People never think twice about threatening the bad guy.

It. Happens. All. The. Time.

If you don’t believe me, consider this:

I have been a ward doctor for ten days.

Ma’am, I wish you the best. I’ll see you tomorrow.

And I’m very good at smiling at you.

Love,

Dr. Grasshopper

(Posted with trepidation.)

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