A Medical Economics Web Exclusive

That's what a doctor does

Facing burnout as a third-year resident, this doctor learned the meaning of healing from his patients.

By James Dom Dera, MD
Family Physician/Fairlawn, OH

"Third year residents aren't supposed to work this hard," I would mumble to myself, getting up in the middle of the night to see a patient. "And I'm chief resident. Can't somebody else do it?"

Thoughts like these often floated through my head during my family practice residency. It wasn't that I didn't enjoy my work. My clinical skills were getting sharper by the day, and the work was gratifying, almost nurturing. But as the months went by, I found myself seeing more and more patients, rounding more often, and working every other weekend. Administrative responsibilities and political power plays were grinding down my spirit. I was getting burned out–and worried. "If residency is this hard to handle," I thought, "what am I going to do in the real world?"

One cold, windy day in January, I managed to sneak away for lunch at a Chinese restaurant with some other residents. Just as we sat down to eat, my pager went off. Reluctantly glancing at it, I recognized the numbers scrolling across the screen: the emergency room. I called and got a quick history: 95-year-old female with bilateral pneumonia. I drove back to the hospital.

I made my way to the ED, saw the patient, and talked with the family. Our conversation was not about IV fluids, antibiotics, or blood tests, but about the big picture. What does it mean to have pneumonia at 95? What is the long-term prognosis? What will a few days in bed do to the strength of an already frail lady? Will she be able to go back home and live by herself as she'd been doing for the past 50 years?

I helped the relatives form a plan of action, and the patient agreed with it: Antibiotics, oxygen, and IV fluids would be used, but nothing else. No heroic measures.

Unfortunately, the pneumonia didn't respond to therapy, and a decision was made to stop everything and transfer the patient to a nursing home. She died about a week later, comfortably, with her whole family at the bedside. The relatives mourned their loss, but felt relieved that it was over and that she'd died peacefully, without pain.

Still, my feeling of burnout continued. It was now the dead of winter. My only glimpses of daylight were through the tiny windows of a hospital room during my daily rounds. But this went beyond the despair that comes with Ohio winters. I was tired and didn't enjoy being a resident.

A few months later, I received a phone call about a middle-aged patient. He had metastatic small-cell lung cancer, which had spread to his brain. Despite radiation and chemotherapy, he'd gotten worse. The end was near. I found it easy to speak some of the same words I'd spoken earlier to the relatives of the old woman with pneumonia. We talked about the relief of pain, the process of dying, and what would happen next. I felt satisfied knowing that I was helping those around me. What I really needed, though, was some help for myself.

A few weeks later, that man lost his battle with cancer in a hospice facility, with his family at the bedside. Death claimed the man. But it could not claim their memories. They mourned their loss, but celebrated his ultimate victory over cancer. He was now cancer-free in their hearts, and in that way he survived.

Several months later, I graduated from residency and got my first "real" job in medicine. Shortly after assuming this position, I examined a pleasant older gentleman for some back pain. As I was getting ready to leave the room, he said, "Oh, doc, I just want you to know that I probably won't get these X-rays done any time soon. My 16-year-old granddaughter has leukemia and is in the intensive care unit, and she's not going to live much longer. I'm really worried about her. Do you think it's okay if I wait?"

Tears began to form in my eyes. This man didn't care about his own pain–he was just worried about his granddaughter and wanted some guidance. So I closed the door and we talked. He told me about her, about his own fears, about how much he loved her. And I shared with him the details of the lady with pneumonia and the man with lung cancer, their deaths, their families' grief–and more importantly, their families' survival afterward.

Driving home that night, all my frustrations with life and medicine just melted away. You see, that lady with the pneumonia was my grandma. And that man with the lung cancer was my brother-in-law and the best man at my wedding.

I'd done my job as a family physician, treating everyone around me medically, socially, and spiritually. But until then, I'd had the wrong attitude: I'd been focusing on all the negative things and the traumatic events in my life, forgetting how wonderful it is to be a physician and to be alive.

After speaking with my patient that day, I realized I wasn't alone in this. There are others who have much worse situations than mine–much worse than I could ever imagine. But because of my own experiences, I can help them through their hard times. That's what a doctor does, after all.

My grandma and my brother-in-law will never again see the leaves change, or eat in a fine restaurant, or tell someone "I love you." I still can. And I treasure that now. I'm a new person and a new physician. I have the most wonderful job in the world, and I enjoy waking up every day and going to work.

James Dera. That's what a doctor does.

Medical Economics

Apr. 25, 2003;80.