I work in a field where I am constantly faced with moral dilemmas. None is more difficult to reconcile than the one I encountered recently, and that I deal with on an almost daily basis.

Being a physician, I am trained to solve problems.

That is who I am, at my core – a really great puzzler, decoder, riddle solver. I pick up a chart in my Emergency Department, scan the initial triage notes and vital signs along with the chief complaint and past medical history of the patient. This gives me the first few pieces – the corners of the puzzle. I can set my game, plan my approach. Walking in the room, my first impression of the patient before me gives me more clues. I ask questions to further elucidate the nature of the person’s visit to the hospital, and choose different lines of questioning to take me to the heart of the matter. I’m like a detective, using information I gather to help me formulate the next set of queries.

Laying of hands comes next; I use my senses (sixth included) to, at this point, confirm or deny the conclusions I have started to develop. I look, listen, smell, feel and sense what the illness is. Then using the tools at my disposal – labs, imaging, electrocardiogram – I try to place the final puzzle pieces.

Finally, I can step back and hopefully see what the answer is.

Sometimes (and more and more often the more experienced I become), the answer is clear very quickly. Sometimes, it sits in the shadows of my mind, furtively hiding and moving, appearing and disappearing, not quite showing itself until the final pieces are placed.

The other day I had such a case.

I have struggled, since my time as an ambulance medic in Israel, to reconcile the two competing natures in me as a physician: one, the pursuer of answers – searching, excited, drawn in by the hunt, relishing the chase. The other, the human – apprehensive, empathetic, hurting inside for the patient before me because I know what is hurting them.

Working through a diagnosis gives me a rush, tickles my senses, it’s like an addiction – and it’s probably this that makes me a good emergency doc. I sniff out the sickness, and I tackle it head on. I don’t give up. I dig and dig until it opens itself to me like a treasure chest. And I am relieved, happy, excited to share the findings – but then, my humanity kicks in and I realize how horrible these very same treasures, answers, pieces I have found, really are. The gold nuggets of discovery are disease, sickness, trauma, pain.

Th other day, I had to tell my patient and her son that the relatively benign (to her) constellation of symptoms she described to me meant she had a tumour both in her chest and in her brain.

 

She will die.

 

And me, I am the one who dug for buried treasure.

I solved the puzzle.

I won the game.

I am the messenger.

I am the physician.

But I am also human, and being so, I am disgusted with myself.

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