Realities

We rotate at several different hospitals here. Besides the VA hospital, which is like every other VA hospital in the country, the university operates two hospitals, one downtown and the other in La Jolla. I've spent most of my time working at the downtown hospital, and I've come to realize that that experience has really influenced my view of health and illness. The downtown hospital is effectively the county hospital in San Diego. They tend to care for the uninsured population, those on Medicare and Medicaid, the undocumented population. There are a lot of people who haven't spent a great deal of time focusing on their own health. As a result, they tend to be chronically ill. I see these people, and can't help but think how far apart our life experiences have been. I can't possibly understand where they are coming from or how difficult their lives have been, but it's easy for me to distance myself from their problems because it is impossible for me to imagine being in their situations. Somehow, that makes me feel protected, that their problems will never be mine. I feel safe.

For the last month I have been working at the other hospital, and realize I am not safe. In the last month we have admitted three physicians to our service. Two have newly diagnosed metastatic cancer. Another seems to have found himself in situation he no longer has control over. We've admitted a former math professor, who we discharged to hospice. A chemistry professor, who is still holding out hope for a cure, but it's not likely to happen. We had a diplomat who died a quick and unexpected death. People who were active and presumably healthy 3 weeks ago, show up in the emergency department and their lives are changed forever. It's sobering. I've always felt safe from illness, as though there is something about my socioeconomic status, my education, the fact that I'm a doctor! Something about that that should protect me from illness, from cancer, from death. But as these patients prove, it doesn't (and given my reluctance to ever actually go to a doctor, I suppose that being a doctor doesn't really provide any protection at all).

I don't know that this last month has really changed my life in anyway. I'm still going to speed when I drive on the freeway. I'm still going to eat pie for breakfast on occasion. I will drink my glass of wine at night and I suppose if any bars allowed smoking anymore, I would still inhale second-hand smoke. It just makes me realize how tenuous life can really be, and that you need to make the most of it. Maybe it will make me procrastinate less? Maybe I will finally go to the doctor and get this lump on my leg looked at? Or maybe I will just keep doing what I'm doing, but with a little more compassion, as I realize I'm really not that far removed from the people I care for.