when expectations don’t meet

spending a week in neurosurgery has taught me a couple of things. first, it is very important to wear your helmet or seat belt. secondly, always, ALWAYS take blood pressure control seriously.

finally, i learned that the expectations of patients and their families are very different from doctors’ expectations.

as you would have probably guessed, the majority of patients in the neurosurgical unit either suffered a stroke or were involved in a motorvehicle accident. most of the time they don’t return to their premorbid state. an elderly man who used to ride the motorcycle to the coffee shop to meet his friends in the morning is left bed-bound. the woman whose 2 brothers died of heart disease in their 40s will no longer be able to plait her daughters’ hair.

to the families of those patients, simply getting their loved ones stabilised – off oxygen and drugs that maintain blood pressure, started on feeding through a nasogastric tube – does not constitute recovery. in neurosurgical terms, all they need is nursing care and that means they’re ready to be discharged home.

yesterday, the son of one of my patients waited for me for several hours just so he could ask about his mother’s prognosis. she had a stroke about a month ago and while the surgery to evacuate the clot went successfully, she was bed-ridden and dependent on ryles tube feeding on discharge. he wanted to know why she was discharged eventhough she was unable to walk or care for herself. how can that possibly mean she’s recovered enough to be discharged?

i had a very hard time explaining that what doctors consider as a satisfactory outcome may not meet his expectations. he wanted his mother back the way she was before the stroke. it wasn’t going to happen. her condition might improve a little, but she isn’t likely to walk again, or be able to speak well once more. we discharged her in the condition we felt was the best we could help her achieve, regardless whether that condition was what her family expected or not.

he wasn’t the first. over the last week i’ve had countless family members come up to me and ask what the chances were that their mother, brother, son would walk again. would speak again. would eat, laugh again. i could never tell them. the truth is, even the consultants probably don’t know. to say otherwise would be a lie. i can’t even tell them if their loved ones’ condition will improve.

it was a very tiring week and i am physically exhausted from looking after a large number of patients with heavy needs even if i did share the load with 2 trustworthy colleagues. but more than anything i am emotionally exhausted from having to face my patients’ families, to not be able to tell them when their relatives will recover, to say that i cannot be sure if they’ll ever be the way they used to be.

medicine is so hard.

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5 responses to “when expectations don’t meet

  1. In this aspect, I hope you will always find medicine as hard as you find it now, even many years from now.

    To do so means you will be gaining, for others and yourself. To find it easier in this aspect means – you have lost it, as so many doctors have as the years go by. Maybe they never had it in them, anyway.

  2. i think doctors do find it hard even years down the line, but they either get better at getting around it or they find ways to avoid it. i’ve seen some senior doctors counsel patients and their families very well, saying things in ways i’ve never thought possible. actually i have it easy – i have my inexperience to fall back on. they, on the other hand, have no choice but to be good at handling difficult situations, or they’ll just have to avoid them.

  3. heyyy.. i’m looking to study medicine hopefully sometime in september if all goes well.. and i just remembered a post of yours that caught my attention a few months back but i never left a comment then..
    was a post about how you had to face lifting a lifeless fetus to the medical dish. and i dont know why but that image was always in my head to this day… and so i just wanted to ask what was it that caused the spontaneous abortion?
    and i love reading ur blog πŸ™‚ i love the insights you give as a new doctor, and the insights u gave as a medical student. its not all sugar-ey and overly hopeful, yet hopeful in ur own way πŸ™‚

  4. i don’t actually remember that post! guess will have to dig through the archives. haha. all the best in your journey through medicine. it’s tough and once it starts, it never ends. hope you’re prepared for that. =)

  5. everyday is a new day, everyday a new learning experience. medicine never gets easier. the saying, ignorance is bliss is indeed very true when it comes to medicine. not knowing the risk of the procedure that u are doing, makes u more at ease when u are doing it. it’s never easy explaining to patients family that the patient’s got poor prognosis or is going to die. BUT you will learn to word things better πŸ˜‰ that help? πŸ™‚

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