House of God.

I don't know if it was just because I was post-call on MICU and didn't
sleep 1 minute of 31 hours, if I was feeling guilty about not knowing
what to do with my patients and/or not particularly caring what was
done to them (as long as it was after I left), or maybe because I just
finished re-reading the House of God.... but something about today's
rounds made me pay attention to what was being said.. I don't think
any of it was as horribly intentional as it sounds written out..
because everyone is so jaded and exhausted and drained in the ICU that
I don't believe they can be blamed personally. Actually, in fact both
my attending and resident in particular are brilliant, amazing dudes,
but penultimate assholes, and I just felt the need to share the actual
words... I honestly haven't been able to sleep today without sharing
this. So thanks for the vent. All of these conversations were had with
sarcastic humor. I'm ashamed to say, Everyone laughed.

Before you tell me about anybody, who can we get out of our ICU now
before rounds? What about him, stage 4 lung cancer with mets to the
brain? What is he doing in my ICU on critical census? Send
him to Huntsman, page Heme-onc. It's 10am, time to get up and babysit patients who can't be saved.
That ain't my job. My job is deciding if really sick people can be
saved or not. If not, they go away. If so, I save them. Then they go
away.

Rm8
Attg: Has he taken a crap yet?
Res: Nope, of course not.
Attg: And the surgeons still don't want to do jack but compare the
size of their dicks, am i right?
Res: Yes, sir, that's right.
Attg: OK, here's what. Page GI and tell them we want a hose in each
end and to suck as hard as they can from both sides until something
comes out, then call me. I don't want to hear another damn thing about
this kid until it includes the words "He had ____ amount of stool
output from either his esophagus or anus." Not a word about
anything else, got it? OK, Next.

Rm12
Seriously, what is the endpoint with this, come on man. pull the plug
already. Her brain is pudding. She's in persistent non-convulsive
status. Her demented mom will never understand that, and you know
it.

Rm6 (my pt)
Assessment: 50yo F with altered mental status secondary to watershed
infarcts and encephalopathy, respiratory failure and intubated with
left lower lung collapse, ITP with giant hematoma in her L thigh,
anemia/thrombocytopenia, severe sepsis with persistent fevers,
worsening renal failure with new hyperkalemia, Afib rates in 180s, and
no changes in neuro status in about 1.5 weeks, morbid obesity, diffuse
R-sided skin breakdown with necrotic eschar. Also, no family or
friends have been around to see her."
Plan (by system)......resident interrupts: "She's screwed." And I take
a step back, and realize how true that is...

Rm10
and my favorite... my resident
"Disposition: He's terminal. Hospital day #32. Got a resistant
strawberry fungus growing out of his R eyeball, sinus, and brain. He's
got multiple myeloma status-post failed bone marrow transplant x3.
He's spreading some unknown variety of persistent, resistant Flu all
over this place. He's gonna die, this admission, or else that will be
the true tragedy of this whole ordeal. That's my final
assessment."


So yes, I admit I probably shouldn't have re-read House of God at this
particular point in my life... I read it my first or second year of
medical school and it held some sort of indecipherable and sad
intrigue... relief that I was not that way... or would ever be...I'm
way too naive, hopeful, even optimistic, I thought with relief, to
ever turn out that way. Only just a few years later.... I'm actively
quitting the profession with an utter hopelessness of effort.. drained
and exhausted and bitter.... and i've realized, quite harshly, how
much i have changed... I don't know what made me pick it up again. I
really didn't even like the book the first time. I pretended too, but
it disgusted me. Like the way I read Chuck Palanhuik. A secret
sickness...What a different experience now! I literally felt every
sentence he wrote.

-------------------------------------------------------------------------------------------------------------------------------
Compare above, please, to quotes from the HOG:

...what had happened in the House of God had been fierce, I had been
hurt, bad. For before the House of God, I had loved old people. Now
they were no longer old people, they were gomers, and I did not, could
not, love them anymore.

I struggle to rest, and cannot, and I struggle to love, and cannot for
all I'm leached out, like a man's shirt washed too many times.

I am beginning to relax, to know what I knew before; the peace, the
rainbow of perfection of doing nothing....For the first time in more
than a year, I am at peace, and nothing in the whole world is effort,
and all, for me, is natural, whole, and sound.

Try denial.
Denial?
Yes, a primitive defense. Deny that it exists.

I should have known better than to come to the House. My whole life
had been those goddamn number 2 pencils. You'd think I'd learn.

In internal medicine, there is almost no need to see patients. Almost
all patients are better off unseen.

Gomers are human beings who have lost what goes into being human
beings. They want to die, and we will not let them... They hurt us, we
hurt them.

He was blessed with two traits which were to prove to be so useful to
him in medicine: unawareness of self, and unawareness of others.

But if this is all there is, I can't take it. No way..
Of course you can.. Trash your illusions, and the world will beat a
pathway to your door.

Like so many of us in medicine, Jo was a victim of success.

...I was surprised to hear myself cursing under my breath as I
resuscitated her. 'I wish she would die so I could just go to sleep,'
and I was shocked when I realized that I'd just wished a human being
dead so I could go to sleep...

Our fight was not the violent, howling, barking fight that keeps alive
vestiges of love, but that tired, distant, silent fight where the
fighters are afraid to punch for fear the punch will kill.

...and then, as we approached the Clinic, I felt that sinking feeling
of having to deal with the husbandless hypertensive LOLs in NAD with
their asinine demands for my care, and I groaned...

The main source of illness in this world is the doctor's own illness:
his compulsion to try to cure and his fraudulent belief that he can...
It ain't easy to do nothing... So maybe we do make diagnoses, big
deal. We hardly ever cure.... We cure ourselves, and that's it.

And the delivery of medical care? Farce. There was no glamour in this.
My first patient of the New Year was a five-year-old found in a
clothes dryer, face bloodied. She had been hit by her pregnant mother,
hit over and over with a bludgeon of pantyhose stuffed with shards of
broken glass... How could I survive?

He would not recover and yet I could keep him alive for a long time....