realitycheck(dot)ie

Irish doctor with too many thoughts, too little time and a blog that's supposed to check in on reality.

Saturday, March 11, 2006

Diseased, Demented, Depressed – Medicine and Politics

NHS Blog Doctor links to an article written by the Rt Hon Lord David Owen, CH, former British Foreign Secretary and doctor who discusses the health of most of the major players of later 20th century politics – based in part on his meetings with them.
It’s a really fascinating article.
In light of the breaking news of Milosevic’s death from natural causes, it is interesting to note that both his parents committed suicide.
The interface between medicine and politics is a complex one – medical ethics are thorny political issues and our health service the bane of the government’s existence but a more intricate medical conundrum arises when the head of State gets sick. Owen’s article catalogues the many dilemmas faced by the personal physicans of Presidents Woodrow Wilson, Mitterrand, Paul Deschanel (who once received the British Ambassador stark naked save only his decorations) and many others. Personally, I would much rather be involved in political life as a politician than as a doctor to a politician. I can say quite definitely that I won’t be either!

Another superb medically related post is from Maria at intueri on her reaction to a patient who was very embarrassed by his suicidal intentions. She thought – “That’s it? All the energy in my body flew to my face to prevent a smile from creeping across my lips. I was simultaneously amused and horrified.”.
She continues – “The faces of all the people I had ever interviewed for suicidal ideation shuffled through my mind—how many were there? One hundred? Two hundred? As if flipping through a deck of cards, my mind’s eye caught a glimpse of each face: the Queen holding the single flower of love that her betrothed had spurned; the Joker with his belled cap who was tortured by laughter and taunts that no one else could hear; the King who had attempted to thrust a sword into his head….
Then there were those who had told me that they wanted to kill themselves with hopes of securing a warm hospital bed away from the cold, rainy night. And those who wept salty tears while desiring the chilly embrace of death as the molecules of liquor circulated through their inebriated brains—how quickly their death wishes evaporated along with the alcohol.
What has my occupation done to me that I do not feel any distress with his confession?”

I was always afraid that I would burst out laughing at some of the more colourful stories heard from people with psychotic symptoms. I am continually amazed how being the “doctor” part of the doctor-patient relationship gives me a control that I simply would not have if I was talking to them on the street.
Last week one woman told me that the suds in her washing machine were been stolen by her neighbours, and she had attempted several times to get proof of this by trying to force them to take photos of their washing machine. While I am smiling as I type this, I remained serious and simply said, in my best psychiatrist voice, “and how did that make you feel?”
More distressing than the temptation to laugh, is the cynicism that you somehow lick of the hospital floors. (a bit of an infection control issue, too).
A friend of mine was talking to a patient who was sexually abused as a child. She described how she simply continued questioning her about sleep patterns and her appetite. It was only when she left that she realised the enormity of what that woman, who is forever scarred by her childhood, had told her, a complete stranger. And she just kept going, ticking off the boxes for a diagnosis.

As our lives as medical students seems precariously close to ending (shit – I still know nothing!), maybe we are gradually gaining the clothing that real grown-up doctors wear under their white coats – a professional veneer of Teflon emotional switch-off. This is probably a good thing or we’d never get through the day.
We seem to be told at least once an hour, that we will kill someone as doctors – not if we kill someone, but when.
Most of us are horrified by this revelation. A shiver runs up and down by intestines every time I hear this.
One of the girls in the class, who ticks all the stereotypical “surgeon” characteristics (cut open, take out, sew up, say bye-bye) finds our regular mass hysteria irritating – “of course, we’re going to kill people; let’s just hope we don’t get caught and sued”.
My prospective involvement in someone else’s death induces a desire to pray hysterically on my knees – but her callous attitude makes me want to pray that I never am treated by her. And the thing is, she’s actually quite a nice girl – and will probably get top of the class.
I’m happy to settle for a bare pass in my degree, and an appreciation for humanity in my life.
(Praying it’s honours though!)

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