Introversion, Medical Practice, Guilt and Penance

Anyone who really knows me knows that I am an introvert by nature. And I've been an introvert since long before it was considered cool or intelligent to be an introvert; I remember that awkward phase where my parents thought it was akin to being anti-social (perhaps in the same way some parents used to actively discourage left-handedness in their kids). However, getting older doesn't fully take the awkwardness away, but it feels good coming into one's own, and especially because I finally gained the words to describe myself - Introvert, Melancholic. Eventually, even parents start to understand their own child's quirkiness, so I now have this beautiful statement that defines me:

"....There is wisdom in your silence...Open up..."

This is actually a compounded statement: first part is from what my mother wrote in a birthday card sometime in my early teens; the second is the last set of words my father said to me. So introversion is my gift, and it's also my burden.

Medical practice, on the other hand, is another part of my world. Medicine, and Science in general, fascinated me from early on in my childhood. I was a bit sickly in my childhood, thus I had more interactions with clinicians than your average kid. Those interactions were a real eye-opener because I became familiar with clinicians' "bedside manners"; hence, I run across people I'd love to emulate, and people I'd rather steer clear off (...and that process has never ended).

A third part of this whole equation is my Christian faith. In detail, particularly, I am Roman Catholic. I've been associated with multiple branches of the faith (some more palatable than others), but I always find myself gravitating towards Catholicism. I love the ritual, the sombre ceremony, its stoic nature, its innate silence and room for meditation, and that it's grounded in a long history of tradition. As my temperament goes, Catholicism is the perfect fit. And, like it or not, I bear my personal guilt like a longsuffering Catholic, so it helps that the rite of Penance is there to help set me straight.

All these things collided when I was doing my medical internship. Medical school teaches you a lot of things (allbeit 'book knowledge'), but there are many areas where you are left to adapt on your own. I could write a whole blog entry on "the things that medical school won't teach you" (probably will in future), but off the top of my head here are a few:

1. It can't teach you how to be a 'good' doctor.
2. It won't prepare you to deal with death, nor will it teach you how to break the bad news to relatives.
3. You will, at some point, develop a case of "the giggles" when dealing with patients.
4. You will undoubtedly cause the death of one of your patients.
5. The system can be very antagonistic, so you spend more time massaging your superiors' egos at the expense of patient care.
6. You will sacrifice a great deal in caring for your patients that will never be compensated.
7. A patient's return to good health and "Thank you" will melt your heart, and make your day.
8. You will run across a myriad of people on the streets who will be happy to see you...and you won't even remember who they are.
9. People will drop their guard around you, and ask your advice on a host of intimate medical maladies.
10. D.A.M.A aka Discharging (someone) Against Medical Advice will sometimes be an infinitely pleasurable experience.
11. Don't mess with the nurses!
12. The system will fail you on many an occasion.
13. Contrary to common thinking, it is a team effort that helps save lives.

For my current story, the more sombre points apply. During my stressful Gynaecology rotation, I was faced with a sickly mother who had recently delivered a baby. In the wards, she was newly diagnosed with HIV, and was deteriorating. She (and her husband) needed to be counselled so she could be started on treatment, but the counselors didn't show up; she had developed an emergent surgical condition, but the surgical team never showed up when asked to review her.

In context, this experience took place when all our clinical officer interns had left, and we were seriously overwhelmed with work. Regardless, our superiors merely expected us to step up our output, and get the work done. In the end, we lost this patient. There are few things that will ravage your soul more than a preventable death. I can still clearly remember her name till today. I carried the guilt of that experience like a heavy yoke, and it killed me a little on the inside.

How does one cope with the knowledge that they directly/indirectly caused a patient's death? My hospital didn't exactly foster a mentorship atmosphere, where you could turn to your superiors for advice; the hospital did have a psychiatrist on staff, but I never felt like I could talk to her without being branded as someone with a "depressive episode", with a corresponding entry being placed in my file.
When it comes down to death, there really aren't that many people who you can talk to about it apart from other clinicians; sadly, I never felt like I could share this with my fellow colleagues, not even the ones to whom I was closest.

I was only able to confess it to a priest a whole 1 year and 4 months after it all went down. I love the Sacrament of Penance; I know that God forgives me for my sins when I genuinely ask it, but it also helps to hear it spoken out loud. It goes beyond just the mere realization of being forgiven, and it assures me that I'm healing the schism my actions might have caused the community.

I am still sad that I can't fully correct this situation. I can't change the life of that aggrieved husband and his child. I have no idea what this course of events had on their extended family. The only thing I can do is to practise my vocation in such a way that this never plays out again. I will continue to voice my concern at the poor path the medical field is taking in my country, and I will mentor my subordinates so that they do not make the same mistakes; and, if they do make mistakes, I can be there to offer them the comfort and understanding that I once needed so badly.

God Bless.