The call.

"Doctor, the medical examiner is on  the phone for you."

Words you never want to hear. Especially on a Monday morning. After being in practice for the last 12 years, I've gotten many calls I'd rather not. These calls are never fun. They mean someone has died, either at home or in unclear circumstances. It usually means that the medical examiner either needs me to sign a death certificate or provide insight on the medical problems of the deceased.

It also means I've lost a patient. This elicits a whole host of emotions. You feel sad for the family. Sad for the loss of the patient. Sometimes you feel sad because the patient was someone you liked, enjoyed, bonded with, a "favorite".  Sometimes there's relief. You know that patient was suffering and very sick. and you know that is finally over for them.

Sometimes there is shock because it was unexpected. Unfortunately this can lead to guilt. Sometimes as a physician there are patients that no matter how hard we try, we just can't establish a relationship with. You can't relate to them. Or frankly, there are patients that are just plain annoying. Either because of their refusing to follow our advice or because they are just plain an unpleasant person to be around. You find yourself wondering if there was something more you could have done or said. Some other way to break through to the patient.

And then there's the shame because on some level you are relieved that you won't have to have yet another visit with that patient that is confrontational or just plain ignores what we say.  This is usually followed by a smidgen of fear. Medical examiner=patient death=possibility of a law suit. It may seem crass or mean, but these calls always include a little fear for me. Did I do something wrong? Did I miss something? Did I document all those times I told her to take her insulin and see the specialist and she refused?  Did I prescribe the right meds? Did I try hard enough? Did I make a mistake?

It's a fear we live with everyday as physicians. And to be honest a fear that drives many of our actions. It is a fear that is healthy in some ways. We have to remember that the decisions we make have huge consequences. We have to be careful and thoughtful and educated. But, we can't let that fear be paralyzing. We can't be so afraid of making a mistake that we do nothing. Sometimes this is much worse.

Twice this week I've gotten that call. Twice too many. Luckily it's not a call I get often. And whether I like it or not, these calls won't be the last. One was a patient that was too young. It was sad, but not surprising. We tell patients that if you don't take your medicine or follow advice you will die, but I don't think they always believe us.

The other patient was old and it wasn't a surprise. But, I had just seen her last week. She seemed good, getting better, on the mend. She had a fall and with her blood thinners this resulted in a fatal injury. I was sad to see her go. And I am ashamed to admit that I was glad that I was not the one managing that blood thinner.  I was relieved that I don't have to sign the death certificate since the death included a trauma.  But, so sad that she seemed better the last time we met. Is there something I could have done differently?

It's OK to work through these feelings. We have to. We're human and we have to let ourselves feel. In my opinion good doctors are in touch with how they feel and this helps us relate more to our patients. We can't be robots. We can't be super-human either.

I joked with the guy on the phone letting him know that I liked him fine, but I'd rather not hear from him. And then I felt bad. Can't be any easier to be on the other end of that call, can it?  But that is life. We do the best we can. And sooner or later we will all be the subject of one of those calls.  Until then, I'll keep striving to be the best physician I can be. The best mommy. The best wife. The best me.

Of course all that doesn't mean I won't cringe when I hear, "Doctor the medical examiner is on the phone."

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I wrote this post a few weeks ago, long before my cousin died this week. I hadn't posted it yet as I had written it and then didn't know if I wanted to. I stumbled across it today and was struck that this week I'm experiencing that call from the family side and not the medical side. Waiting on the death certificate and cause of death and all that.  Understanding how the system works helps at least a little.   I ate dinner last night, but realized just about an hour ago that I ate nothing yet today. I had a couple of cheese sticks. I'm trying not to give in to the cravings and the old crutches of food, particularly sodas. I made myself drink some water this morning. I am trying. I will not give up.

I realized today that it was exactly one year ago today that I started this life change.  I started logging my food and such.  In that time I've lost about 55 pounds (assuming I haven't gained any the last few days. I have not weighed and really can't face doing that yet.).  I started blogging 9 months ago. It was the best thing I've done for my health. No joking. Stumbling across this blog world where I have support and can find inspiration and ideas and recipes has helped so much. Of course I had to do the work of diet and exercise.

In the wake of what's happened this week, I have been struggling. I have not worked out. I didn't go to TKD. I am honestly too tired and I haven't slept. But......I will. I will get back to balance with exercise and diet. I will move forward toward my goals. I will get through this terrible time.  I am stronger now than I've ever been, mentally and physically.  I will not quit.