Just finished a rotation in Rheumatology, a specialty of internal medicine that treats diseases related to inflammation of the joints and soft tissues. I saw my share of rheumatoid arthritis, gout, and Lupus. I also got to take care of patients with more rare diseases such as scleroderma, Sjogrens, and vasculitis (inflammation of the blood vessels). I had already done a rotation in rheumatology as a medical student, but this one was different because it was in the hospital, rather than in an outpatient clinic. Translation: most of these patients were really sick, if not from their rheumatological disease, then from other failing organs.
What often comes with inflammation, unfortunately for the patient, is a lot of pain. Sometimes the pain was easy to treat, by giving the patient a short course of steroids to decrease the inflammation, or by injecting steroids into an inflamed joint. Other times the pain was more elusive and difficult to treat, as in cases of muscle pain in fibromyalgia, or the abdominal pain with intestinal ischemia (lack of blood flow) with vasculitis.
There was also a tremendous amount of emotional pain, both for the patient and their families. A young man with scleroderma, a disease which was hardening his skin, esophagus, kidneys, heart, and lungs. He was so ill, and lost so much weight, his young children were too scared initially to enter the hospital room because they didn’t recognize their father. And his wife, strong and trying to fight the disease side by side with her husband, while knowing he probably would not live long as the disease destroyed his internal organs.
Another patient we took care of was so complicated, even a roomful of doctors could not figure out her diagnosis (and hence the treatment to stop her kidney’s from failing). We had the internal medicine team involved, the nephrologist (kidney doctor), the urologist, the pathologist, and us, the rheumatology team. We got to know this patient’s family well, since she was in the hospital many weeks. One day when I came in, the patient was sleeping, and the daughter burst into tears, asking me (the lowly intern, the least experienced off all the doctors involved in her care) if her mother was dying. What could I say? I sat down next to the daughter, listened to her cry, and told her what I did know, and that combined, we were all doing our very best to take care of her mother.
There was another patient I took care of who had a vasculitis that affected the blood vessels in his lungs. He was an older man, but prior to his diagnosis this past summer, was very physically active, mowing his lawn, taking care of his yard like any other healthy retired gentleman. Ever since his diagnosis however, his breathing slowly worsened, landing him in our hospital with a bad case of pneumonia. We were treating the infection with antibiotics, and continuing to treat his vasculitis with steroids, but he just wasn’t getting better. Every day I could see that his will to live was melting away. His family and I tried to encourage him to eat, to give his body the nutrients it needed to heal. I talked to him and his family one afternoon, and then returned the next morning to discover he had died.
I was stunned. I was initially upset at him and his family for deciding to give up, to stop the antibiotics and the oxygen, to let his lung infection take its course. It was so easy for me to pass this judgement. I was thinking, but we just figured out exactly which bacteria was growing in his lungs, and which antibiotic was the best to kill it. They didn’t give the medicine enough time to work! But who am I to make this decision for the patient, or to pass judgement. I did not have to live for the last 6 months with shortness of breath. I did not have to spend weeks in the hospital (he was at another hospital for 2 weeks, not getting better, before being transferred to ours). I could not understand his experience, and so I finally had to let go of my disappointment, accepting the man was just tired of continually struggling to breath.
There is no comparison between the suffering of my patients and my own aches and pains of this residency. But I cannot deny the impact of my training on my own life, on my relationship to my family, and on my own health. I can’t deny that there are days when I groan: when the alarm goes off early, when the pain in my own belly from gastritis distracts me from my work, and when the ache in my shoulders from a heavy white coat (pockets filled with tools and books) gives me a tension headache. What do I do? Get up, turn the alarm off, take some medicine for my stomach, take off my white coat for awhile, and try to remember why I choose this path in the first place.
Because I love people. I love their stories. I love the challenge of trying to figure out what’s wrong with a patient. I love learning new things. I love the emotional connection that occurs with patients and their families. Yes, it is about love, and this reminder dulls the aches and pains.