The Heart of the Matter

I am doing 2 weeks of cardiology right now. It wouldn’t be my first choice of rotation, but I am paired with a classmate that I really like and we are emotionally supporting each other. Today I was extremely glad she was there with me. We had an emotionally exhausting day.

Our team consists of our staff, a first year resident, Bartycat (my classmate) and me. Yesterday our resident was post call, and today he had something else going on. So it was just Barty and me and the cardiologist. We have about 16 or so patients on the average day, and things are pretty busy. On Monday it took us forever to round (like 9-7:00), and so yesterday and today we were trying to be a little more efficient.

Things are not very organized, to say the least. The cardiologist is a nice enough guy, but he is that stereotypical specialist who is super knowledgeable about their field, but has no clue about anything else. Also, his bedside manner leaves a little something to be desired. So, Bartycat and I are always running around like chickens with our heads cut off, trying to get things done, making sure that people’s constipation gets treated, and that elderly people are not being discharged onto the street at a moment’s notice with no ride home. We are essentially the social committee. I can’t speak for Barty, but I’m pretty okay with that for the next 2 weeks.

Well, today something happened that made me so angry I could barely contain myself. I know I have experienced the occasional conflict with my superiors in the past year and a half, but I don’t think I have ever felt as frustrated as I did today. I was barely able to conceal my rage.

It was a situation where I thought a patient’s best interests were not being respected, and the doctor had already made up his mind about how things should go, and he didn’t even have all of the information. He was ready to diagnose someone with metastatic cancer and stop her medical treatment and he didn’t even frickin’ know what the hell he was talking about.

I could not help myself. I spoke up, and when he didn’t listen, I spoke up again, and again. We were basically arguing in front of everyone (that’s how it felt anyway). Finally, he reluctantly agreed that we could go down to the radiology department and review some imaging studies that had been done in the past, and ask the radiologist what they thought. He did it in a super patronizing way, and I felt like punching his face in, but at least I was getting my way.

I remember one time when I was around 15, I was sitting on the stairs at my parents’ house and just started crying uncontrollably for no reason. It was weird, because I really remember thinking that I had no idea why I was crying but that my prevailing emotion was not one of sadness, rather frustration. I swear today I felt the exact same emotion. There was no way I would cry in front of that guy, but trying to reason with a patronizing brick wall is just about worse than beating your own head repeatedly against said wall, especially when the brick wall has the final say.

In the end, the radiologist agreed that there had been no adequate evidence of metastatic cancer on any previous study. It’s a long story, but there was also a nephrologist involved, and she had been privy to the whole exchange. When I phoned her to let her know that the situation had changed, she told me that she had agreed with me during the discussion/argument. It was a professional courtesy that I really appreciated because she did not need to let me know that she thought I was right, but it really made me feel better about sticking my neck out.

I don’t know yet if this patient has metastic cancer or not, but I feel relieved that she will at least have an MRI which can provide some definitive answers before we charge ahead and make decisions that will have major implications for this woman and her family.

My staff decided to spend the balance of the day educating me on quality of life and health resource issues. He probably wants to fail me, and essentially told me that I am a big bleeding heart (which I imagine must be very disconcerting when you are a cardiologist). He tried on about 7 separate occasions to explain to me the concept of medical futility. I resisted the urge to unleash the fury, and fill him in on everything I know about medical futility, health care resources, and end of life issues.

The day was a mental marathon, but as Bartycat pointed out at the end of it all, we probably had a positive impact on someone’s health care, at least I hope so. It just would be nice not to have to fight those battles.

I love pediatrics and primary care so much. A rotation like this one just drives that home.

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