Uneventful day is not a bad thing

The Sunday Times Dec 20, 2009

By Lee Wei Ling

A Peanuts cartoon caught my attention the other day as I was scanning the newspaper.

As he brings Snoopy a bowl of dog food, Charlie Brown wonders: 'Can you believe it? Another day gone by, and it's supper time again! I don't know where the time goes. You get up in the morning, and you go to bed at night, and another day is gone...'

The next picture shows Snoopy eating his food and thinking: 'Someday I'm going to buy my own can opener.'

For a doctor, an uneventful day is often not a bad thing. It would mean the day had passed without major disasters, but contained sufficient intellectual challenge to make it interesting.

Memorable days on the other hand can mean one among several different happy or tragic scenarios. Of the happy scenarios, there can be no greater joy for a doctor than to know she had helped a patient and brought comfort to his family. Sometimes that knowledge can keep one going even in the face of one's own miserable personal circumstances.

My list for memorable unhappy events that can ruin the day for me as a doctor include the following:

•Being confronted with a patient with a puzzling and serious problem; or a patient whose disease progresses at such a rate that he deteriorates before we can do anything. I am sure many among my peers have had the experience of driving home from work at the end of the day with a sense of unease, still mentally going over our patients' problems.

•Making a mistake in our diagnosis or treatment of a patient, perhaps making a wrong call when we have to make a decision urgently before adequate information is available.

An example was related in an article published in The Straits Times recently. A pathologist, based on the evidence of a frozen section of a specimen taken from the lung, reported cancer; and based on that information, the surgeon removed part of the affected lung. The paraffin section came back a few days later showing that there was no cancer.

Such 'errors' can occur in medical practice when decisions have to be made based on the information available at that moment. Indeed such 'errors' are not really errors but the result of calculated risk.

If there had been indeed cancer, to have closed up the incision and waited for the paraffin section, which would have taken several days to be ready, would have reduced the chances of a good outcome for the patient. Frozen sections can be made ready quickly for the pathologist to review but the details it reveals cannot match that of the paraffin section.

Performing an operation based on the information provided by the frozen section is a calculated risk. The doctor has to balance the possibility that early treatment might be life-saving against the small but real risk of resecting more tissue than necessary.

•Having a patient, especially a young patient, with a fatal disease associated with much pain and suffering, but for whom one can do little more than keep him as comfortable as possible - that is a particularly heart-breaking situation, especially when one has to break the news to the family and sometimes also to the patient.

When breaking such news, I often also warn the family of the futility of consulting Chinese sinseh or spiritual healers, and explain how we - medical professionals as well as the family - can together make the last days of the patient's life as comfortable as possible.

If some of my readers are wondering how doctors can stay sane in a profession that demands compassion and empathy and yet at the same time exposes us to such heart-rending circumstances, I do so as follows: I make myself feel detached from the patient when I am physically separated from the patient and treat the medical issue before me as an intellectual problem requiring a solution.

Over the years, I have found that adopting a similar strategy when I am the patient helps me cope with my own illnesses. I cannot be physically separated from myself, of course, but I have learnt to treat my medical predicaments as problems to be solved. That is certainly preferable to feeling sorry for myself or thinking of myself as a victim of fate.

I have been able to discipline my mind in this fashion at most times, and when I do so, I remain calm in the face of disaster, and not infrequently, I eventually do manage to find a solution to my own medical problems.

There are other events that may make a day memorable in an unpleasant way: For example, a loved one suddenly becoming seriously ill, unlikely to recover. It is difficult to achieve mental detachment under these circumstances. But calm acceptance and the passage of time can take the edge off the sharpness of emotional distress.

Time is indeed a great healer. For example, my mother's stroke on May 12 last year made me feel like my world had been turned upside down. But over the months, I have been able to accept her disabilities and carry on with life as normally as possible, although when I am with her, I still feel a sense of sadness.

A day passed without something memorable is a day passed without a major disaster or triumph. It is not a bad thing not to have too many memorable days.

Dr Lee is the director of the National Neuroscience Institute.