Tuesday, July 20, 2010

The Heart of the Matter

"It's hard to make that change
When life and love
Turn strange
And old."

Neil Young

Hats off to Dr. Rob at Musings of a Distractible Mind, who muses (of course) on suffering and the ends of medicine. Every now and then it is good to look up toward the remote (and ultimately inaccessible) peak at whose base one labors. To switch metaphors, each morning we march out upon the beach, brooms at the ready, braced to sweep back the tide. Physicians should know their Sisyphus. Heroic? Not usually. Futile? One hopes not. For some it seems to be the worst possible profession, except (a la Churchill) for all of the others.


Anonymous said...

To 'just be there' and watch as death and its pain chariot slowly encroach on an unhelpable life - that's got to be painful.

I hope I never cause someone to 'just be there' for me...

Novalis said...

It occurs to me that one could never communicate an opinion of a "terminal" *psychiatric* prognosis to a patient, due to risk of a self-fulfilling prophecy. There is therefore a certain disingenuousness at the root of the endeavor.

Retriever said...

Liked his post.

Re your comment, Novalis,I understand your concern BUT patients and their families alike are afraid of just that. That a doctor will withhold information or a diagnosis, to spare the patient. The fact is, that tho the MD may be wrong, and has only imperfect knowledge and wisdom, it's the patient's life. They should know what you think the problem and the prognosis are. I say this because when our son was diagnosed with autism, it was after literally years of pussyfooting around by his doctors, all of whom knew what the problem was, but none of whom wanted to be the one to give us the bad news. The worst part about the diagnosis was the knowledge that, had it been delivered sooner, we might have done more, known what we were up against, earlier.

In psychiatry, diagnoses are not usually "terminal" but of stigmatizing, incurable conditions that will profoundly impact a person's career, family life, chances at love, as well as their equilibrium. I can understand not wanting to discourage a person initially, but they'll figure it out eventually, and better to do so with you than despite you.

Novalis said...

Right you are--I didn't mean that one should distort the diagnosis itself or play Pollyanna. I suppose the point is that because prognosis in psychiatry is so much less precise, to put it mildly, than in other disciplines, one may be more inclined to err on the side of optimism rather than pessimism, lest one's passing frustration induce discouragement.