Confronting the Internal Issue

So why have I not said a word about medicine lately. I am sure you are wondering this. Or maybe I flatter myself here. But well, let's confront the hard, cold truth here. Which is that I am not particularly enjoying it these days. In fact, sometimes I resent it. I am glad to be learning a whole lot of stuff, of course. It's the pressure-cooker I can't stand. That is what I am in right now, veritably. Believe me -Internal Medicine is no picnic. And I would know, because I actually did go for a lovely picnic this past summery long weekend in Montreal. We ate delicious avacado, havarti, sliced turkey, tomato, lettuce and dijon-mayo with salt and pepper sandwiches. And there was bocconcini, baby tomato and pesto salad. And later that weekend, my semi-salty chocolate chunk cookies. And Internal Medicine is galaxies away from that.

If I had to describe Internal in one word it would be this: a drag. But actually soul-sucking, opposite of joie-de-vivre, let's watch really sick, really old people who are too far gone to actually help -let's watch them get sicker, be in more pain, deal with more side effects, happily acquire C. difficile and VRE until their bodies and spirits and minds waste away, wrangle their friends and families haggard, give up with one last moan and at last, die. Now, you might be wondering how on Earth I could utter these words and yet be so infatuated with Palliative Care. That is because in Palliative, the goal is not "one last damn fight" to manage or control or cure the pathology. It is to manage pain, to make patients comfortable in their last days so that they can attend to more important material and spiritual concerns before leaving this world. The goal is the patient, not the collection of systems that happen to find themselves in a single human body. Bleak, you say? My friends, you ain't seen bleak until you've lived Internal.

And maybe that's life's ironic metaphor. That anything Internal is really an Inferno, which, if you're not careful, will burn you up and leave behind nothing but smoke and ash. Now really, this is not to say that the doctors in Internal Med are not good doctors. As a darling friend would say, "Au contraire mon frère!". They are some of the best doctors, hands-down. They are bright, compassionate, award-worthy, have one hell of a memory, boundless energy and the ones I have met really love what they do -really, exemplary physicians, no question. But it's the culture of Internal that is soul-sucking, the know-it-all, we're-so-busy-and-important and frankly reductionist 2D-attitude that rubs up so hard against me. I don't know. Perhaps I'm being unfair. Perhaps these guys have all read Kuhn's The Structure of Scientific Revolutions and Kleinman's What Really Matters and Andrea Tone's Medicating Modern America and enjoy reading fiction on occasion.

Just, well, my imagination feels so... stunted. Not because they don't think out of the box -believe me, if anyone has to think outside the box, it's these guys. But... there's... I just have a general feeling that there is a missing-the-forest-for-the-trees here. There ain't no space for no existential crisis. Nobody has the room to break themselves open and re-make themselves whole. And I can't quite touch the tangible problem here, except that I feel like my favourite part of me and what will make me the good kind of doctor that I want to be, kind of dies a little every day in there. Like someone rubbing margarine all over your windows... I mean, you can't see anymore! Really see. Because the science of the medicine is extremely important, absolutely 1000% necessary (and I plan on doing my 1000% best in learning it, I swear), but so wholly and fully insufficient. There is no way anyone is seeing the whole picture when the body is just an ammalgamation of systems. The whole is greater than the parts. And when it comes down to it, even Internal cannot explain the whole -they'll just call it 'autoimmune' instead. Sometimes they'll say 'idiopathic' (as in "we're idiots on this one"). They'll diagnose your COPD, your CAD, your CHF, your RA, your pancreatitis, your anemia... but when it comes to managing the whole picture and the person that actually manages to get them all (these poor patients, yes, they exist)... it's a sad deal. And it's suffering and wasting away and then a long (or short), painful death.

Yes, all areas of medicine deal with suffering and pain and death. But there's something about this baby that just saps my energy to negative 10,000. Really. I don't know what it is. But it makes me miss Anaesthesia like nobody's business. Okay. So there you have it. I think I'd most likely rather be a surgeon than an internist any day. But who knows -I have yet to do my ICM surgery rotation.