Death

I know I've brought up death countless times, over the previous posts. I also know that I've talked about it at length with friends who wonder how, as doctors, we're able to deal with death so casually. I guess this is a post that'll help maybe clear up the misconceptions or at least give people an idea of how we deal or rather, process death in the health industry.

Bear in mind this is all going to be coming from an unclear mindset. No drafts and second drafts will be made, so there is a possibility I might veer off topic, and if I do that, then I apologize.

The first time we're exposed to death is in the morgue during our anatomy lessons. This happens in the first year, within the first week of education. I remember that clearly but not vividly. The class is usually divided up to 20 people to one corpse (specimen is always the preferred word) and we're shown muscles, nerves, arteries and veins. That first class is always interesting. You're always able to differentiate the students into two, those that will stay the course and those that finally realize they have no business being a doctor. You're able to differentiate through attitude. There are those that are unfazed, those that are interested, and those that just freak the fuck out. The professors explaining on the specimens are usually relentless in the fact that they will try to gross you out as much as possible. I've seen girls faint. I've seen boys puke. I remember thinking how cruel those professors were sometimes with the more queasy students. I probably didn't realize how necessary this 'reality slap' was until much later when I became an intern. I realized that they do it because they know for a fact, that if you can't stomach a preserved corpse, drained of all its blood, then there can possibly be no way for you to handle what will come later.

The specimens were drained of humanity. They were more like the preserved mummies you see at the museum than they were actually human beings. Still, that was probably my first time seeing a dead person in front of me.

Much later when you become an intern. That's when you truly witness death. There is a difference between seeing a dead body and seeing a person die before your eyes. I actually don't remember the first time I saw a person die. I do remember the first person I performed CPR on though. I don't particularly remember which round it was in, but I remember being ridiculously anxious over the arrest. The nurses had shouted out that there was an arrest and I ran to start performing CPR. I remember being very anxious and nervous. This was it. There was a chance that, through some maneuevers and medication, this patient might very well survive. It was ----exciting.  I also remember the nonchalant behavior of the residents. It was more a chore to them. They had this air of  "Oh, here we go again." rather than "I hope this patient survives." I was very upset by the demeanor. After all, why become a doctor at all, if that's the attitude that'll prevail.

In retrospect, I realized my naivete.

I remember asking my senior resident about it. All he told me was

"You'll understand later."

He was right. I did understand later.

Arrests aren't portrayed very well on television. On TV shows, when someone arrests, there's a chance they come back at 100 percent ; that all that's necessary is bringing back that base line to a normal heart rhythm and suddenly everything will be okay again. That's a very rare thing. It might be true in trauma cases and sudden arrests but usually when a patient arrests in the hospital, it's because his or her body is giving out. Sure, you can do CPR and give them some adrenaline and they'll come back, but that only means that most likely, they're going to arrest again within a few hours. We call these patients Post Arrest patients. When you're looking for an ICU spot for these patients because obviously when they come back they need to be ventilated mechanically (something you don't see in the TV shows either) the resident in charge of the ICU will very rarely ever admit them. That's because they're hopeless. It's a harsh reality, but it's also the truth. When you're in charge of an ICU, selecting a hopeful patient over a hopeless patient is always the priority. The question usually asked is "Will his stay in the ICU actually improve his condition or just be a place for him to die in?"

It's a difficult question. It's also totally lost on patients' families.After all, they'd just been told that his heart stopped and now it's back. As far as they're concerned, there's still hope.

I hate false hope. I understand the need for it. Doesn't mean I still can't hate it.

I remember the first death that mattered though. That didn't happen until I became a resident. It was during my second or third month and I was on call in the ward. There was a kid, who had something called Fallot's Tetralogy (which was a congenital heart disease). It's not the worst cardiac disease a kid can have here, and there's a surgery that can correct it completely (given that they fulfill the criteria for it). This kid however, did not fulfill the criteria for the surgery (her brain was damaged, which was a complication for neglected Fallot patients and so her brain was basically mush which meant that even doing the surgery wouldn't bring her back to 100 percent). I remember always sitting down with the mother trying to explain to her, in the nicest way possible, that there was no hope.

That sucked.

Anyways, the kid had arrested during a shift and so, I nonchalantly started doing all the necessary things we do when a patient arrests. It didn't work. She didn't come back. The mother was out buying diapers so she came a few minutes right after we called the time of death. I remember telling her. She wore the niqab, so all I could see were her sad watery eyes. She was angry. She was angry that she wasn't around. She was angry with me. She was angry with the surgeons. She was angry at God.  She kept shouting that she should have been there. I told her there was nothing she could do. She told me it wasn't about that. She said,

"I just wish I could have spent those final minutes with her."

Yeah.

I say this story because during the CPR and during the arrest, I felt nothing. There was no empathy. If anything, I was glad. This was by all means a hopeless patient and it was time for her to no longer be in pain.

That all changes when you see the reactions of the parents.

I'd mentioned in a previous post that that's why I hated the good parents. That is why I hate them. That empathy you feel, it doesn't help in making you a better doctor. It's just a burden that comes with the job.


I think the issue is how routine it gets to be, and that's exactly the thing. Death, to alot of people, is something that's witnessed in the most trying of times. It's an event. But for us, it's no longer this catastrophic event. It's just something that happens that we deal with.

I think I hate that it's no longer this event though. I remember once I was sitting with friends (not doctors) and I had a shift the next day. I remember calling up the doctor who was on call that day and asking him how the ICU was.

"So how's the ICU?"
"It's alright, Patient A is dying though so good luck delivering the news to the parents tomorrow."
"Oh man, is there no way she's going to die with you tonight?"
"Doubt it. But tomorrow definitely."
"God damnit. Fine, but I hope she dies with you."

My friends were flabbergasted. All they could think about was how harsh and cruel I seemed to be. It didn't help that we were both laughing about it as we were talking about it. Keep in mind, I'm censoring how cruel these conversations can be. Jokes are usually made about how the on call doctor should just kill the patient now and things like that.

It is cruel.

But only if you're not a doctor, and it's not because we have the notion of being superior to non doctors.

It's because we have to cope.

Otherwise, we'd all just kill ourselves.

Why I Can No Longer Stand Egypt's Health Industry.

I hate that a lot of the patients I see are dying or on the verge of death. I hate that parents aren't educated or well informed enough to notice catastrophic symptoms and signs in their kids. I hate that usually, it's too late by the time they come to the hospital.

I hate that sometimes, a patient will come in, and there won't be place to admit them. I hate the way I feel every single time I tell the parents of a sick kid to go on a wild goose chase looking for an incubator or an ICU bed. I hate how hopeless I feel, and how hopeful they feel when I tell them.

I hate it when a kid dies, and I know something could have been done to prevent his or her death. I hate having to tell the parents, "It's all part of God's plan."

I hate seeing fathers treat their wives and kids like shit when it's visiting hours. I hate having to hear fathers go on about how it's time for the mother to come back home because he can't handle the house. I especially hate hearing the phrase "You said he was going to die anyways right? Well, we might as well go back home and care for our other children." I hate it because sometimes, it's a true and real thing.

I hate that sometimes surgeries are rushed or delayed not depending on the patient's health but more so on the whims of the surgeon. I hate that the bureaucracy can sometimes be so maddening, that all that's left for a distressed parent, is to cry in a corridor making sure his wife doesn't see him.

I hate the good parents. The parents that are supportive, understanding and completely and genuinely polite. I hate giving them bad news. I hate them for letting me sympathize with them so badly.

I hate having to see parents lie to the older kids. Telling them they're going to be okay when it's clear they're not going to be. I hate the false hope instilled sometimes, in the child's bright and fleeting eyes.

I hate seeing a mother give birth to her 8th baby. I hate having been part of her bringing this baby to the world, who will most likely grow up impoverished and resentful.

I hate the way the system works. I hate how it jades you and hardens your heart. I hate that I no longer treat death with the same respect it eternally deserves.

I hate the older professors, most of them having abandoned the public teaching hospital that taught them so much, all in search of greener pastures. I hate that the system forced them to resort to thinking like that.

I hate walking down the street adjacent to my hospital. I hate having to accidentally bump into a parent I haven't seen in ages and having them tell me how their son or daughter died a month or two after they left the ward due to some chronic illness they were having. I hate the looks they sometimes give me, with good reason.

I guess what I hate the most is how helpless I sometimes feel when I go back home, lie down in bed and close my eyes.

The Public Sector vs The Private Sector (Or How I Grew Up To Be a Dickhead Doctor)

Okay, I'm about to go on a rant and ignore the fact that I haven't posted here for over a year so bear with me here.

Now you all know how much I bitch about the public health system here in Egypt. It's a mess. Facilities are minimal and the load is heavy, but despite that I like to think that sometimes we do good work. It's not the BEST work, but at least I can go home and sleep at night without having any ghosts of dead children wallowing and wailing over my sleepy carcass.

I've recently started to work in the private sector, specifically a post operative ICU. That means I work in an ICU that receives kids that just had major surgeries and it's my job to manage their recovery and make sure they, you know, don't die.

I had all these thoughts about how much better the private sector was going to be. After all, why wouldn't it? Better equipment, better facilities and better yet, there should be a lesser load (as in number of patients)

I was wrong. I was horribly wrong.

I mentioned previously how being a doctor, you sort of have to kill off the part of you that really sympathizes with patients, not all of it mind you, but just a little bit so you're able to function without any preconceived emotions clouding your judgement. Working in the private sector, I've realized that you have to kill off ALL of it.

Let me explain why using my favorite method of analysis: bullet points!

• In the public sector, the problem is always that there's no money and too many patients. So what happens in post operative ICUs is that there is a limit to two things, the number of patients you can have in the ICU, and the number of surgeries you can have in one day. The first one is self explanatory. If there are 20 beds with 20 ventilators, you can't have 21 patients. The second point means that there's only a finite number of surgeries a day because the surgeon working in the public sector isn't getting paid shit. That means that after he's done with his surgery he'll have to go work in the private sector to make his money. It has its cons for sure, for example there's a never ending list of patients, but that can also be a good thing.
  
  For example, say a child has chest infection or a fever and he was scheduled for surgery today. In the public sector, that child's surgery gets rescheduled and another patient ends up getting the surgery. When the sick child eventually gets better, he'll have the operation. It doesn't matter for the surgeon because he knows he's going to work 2 cases a day. It doesn't matter which cases he works so long as he works them.
  
  Now let's imagine this scenario in the private sector. Let's say a child has a surgery scheduled for today but he's got a chest infection. FUCK THAT SHIT, let's cut him open anyways. Why? Because there's a finite number of patients and the surgeon gets paid handsomely for each surgery. He has incentive to perform the surgery, fuck all consequences because at the end of the day, he's going back home with a big fat stinking check devoid of humanity. Now let's say we have 4 beds left but there are 6 operations scheduled for today. In the public sector, the ICU is closed until the beds get empty again, whether through death or recovery. Not true in the private sector. Something called 'overbedding' happens where there are more patients than there are beds. I do not need to explain what this means because obviously, you can understand how horrible a situation like this is. Why doesn't one of the surgeons cancel his surgery you might ask? Well, why would Surgeon A cancel his surgery when Surgeon B is working his and gets paid? Fuck that shit, I'm going to do the operation myself and we'll see what happens. After all, I get paid for the surgery, not for the welfare of the child afterwards.
  
  This game I call "Penis Envy Surgery Chicken" needs to stop. It doesn't though. Because like I said, money.

• This one is going to suck ass at explaining but here we go. Okay, so let's say the kid had his surgery and complications happened, whether in the ICU or during the operation itself. In the public sector, we cut no corners in explaining how bad the prognosis of the kid is. Sometimes, doctors are extra harsh in dealing out this information. If the parents dare complain or put the blame on someone, they are constantly reminded that the operation was a costly endeavor and that they should thank God that their kid was at least given the chance of a life free of any problems, even if it didn't pan out so well.
  
  The way doctors look at their work in the public sector, it's sort of like a 'charity'. I'm not getting paid for shit and you already signed away any legal rights you might have had with our iron clad 'pre-surgery' contract. Sorry your kid's going to die madame, but those are the ropes, EVEN if the surgeon or the ICU doctor (intensivist) made a huge mistake. You aren't worried about consequences because as far as you're concerned, no legal action will ever be taken so there's no need to pad out the horrible news.
  
  Now the private sector, that's different. The patient is 'entitled'. He's paid money to have the surgery. He gets his say in what's happening. So what do the doctors do? We pad the truth so much it becomes a downright lie. Things like "Oh he's got some secretions in his lung but he'll respond to the antibiotics we hope" are said instead of "Well, he's got pneumonia and we're not sure the antibiotics are working." Why do we lie? Because the truth means more questions. "Why did he get pneumonia?" "Why is hygiene piss poor?" "What do you mean the operation didn't work out as planned?" The more questions asked, the more likely it'll be evident that somewhere down the line, something could have happened to prevent the child from deteriorating.
  
  So we lie, and my God does it takes its toll on the soul. 

• But at least we've got the facilities in the private sector right? Right? Also not true. In the public sector, we are funded through two mechanisms: Government money and donations by people. Most of the money goes directly into providing whatever facilities because money is scarce and because no one, thankfully from what I've seen so far, is going to steal from donations (which is where most of the supplies and medication comes from) Now who funds in the private sector? Hospital managers and owners. People. Not institutions. And they're trying to make as much buck as they can. So corners are once again cut. Why buy new ventilators when we've got perfectly ancient but functioning ventilators. Monitors aren't working? Come on, do you REALLY need to monitor a patient's fucking vitals? I'm exaggerating a little bit but that's the truth. All the hospital managers care about is getting by with the least amount of money invested into the hospital so that they can make a fatter profit. Paychecks are sometimes delayed or handed out in increments. Nurses are especially fucked in this scenario (at least in the hospital I work in). 

Okay, so 3 massive bullet points, but you get my point. All this, gives the doctors a sense of superiority and grandiosity that feeds their ego and turns them into dickheads. In summary:

You are getting paid handsomely, for half-assing medical care, with no worry whatsoever of any legal or ethical (because that dies out early on) consequences.

Fuck.


PS: Obviously, I'm focusing on the horrible here. At the end of the day, the private sector does ensure a better survival rate but there are different reasons for that which I'll one day explain in a different post that'll have a somewhat brighter view. 

A Matter of perspective

Okay so I stumbled upon a few notes I had written back in 2009 that have absolutely nothing to do with medicine but I decided to share anyways.

This first one is called "A Matter of Perspective"

Enjoy.

"Hey, sorry I'm late. The traffic was just ridiculous today? Did you see the car accident on the bridge?"
"Hey, no, no I didn't. Listen we need to talk."
"I know, you scared me on the phone. Is everything alright?"
"Before we talk, promise me you won't get angry. Promise you'll keep your composure."
"I don't understand. What's the problem?"
"Just promise."
"No, you're obviously going to say something that's going to aggravate me. I'm not going to promise you anything. Now spill it. What's wrong?"
"I don't know how to say this… You've obviously noticed there's been distance between us lately."
"I have, I remember clearly you excusing yourself on account of stress at work. I obviously knew you were lying and would tell me eventually what's wrong when you were ready. Guess that time is now then."
"Why do you always have to assume I was lying?"
"Well, clearly, it wasn't an assumption. You're just about to prove my point right now aren't you?"
"I hate when you do that. I hate your "holier than thou" attitude and your assumptions. Work has been really stressful. It's the end of the fiscal year and we've got so much paperwork. Obviously, you wouldn't understand seeing as how you're always on top of everything."
"You're diverging again. Just tell me what's wrong already."
"This is exactly what I want to talk about."
"What are you talking about?"
"This, this little argument right now. I love you. You know I love you, but I can't just keep taking this abuse from you."
"Abuse?"
"Mental abuse yes. You're always thinking you're one step ahead of the rest of us. Always trying to prove your point and win your little debates just to satisfy that ego of yours."
"So you're saying it's my fault that everyone we meet is an idiot and I shouldn't even bother to speak my mind just so the idiots can feel at ease? What the hell is this really about?"
"See, there you go again. I'm presenting you with a fact. But you're not even willing to listen to me, because in your mind you've already made the decision that I'm trying to hide the real problem from you. You think everyone has a personal vendetta and everyone thinks in layers. Sometimes what you see is what you get."
"Are you serious?"
"I'm dead serious. This isn't a joke. Please wipe that smirk off your face."
"Wait, wait, wait. Let me just get this straight. You're breaking up with me because I think for myself and speak my mind? You're breaking up with me because I don’t go with the flow?"
"I never said I was breaking up with you. Why are you even suggesting that?"
"Obviously, you're hinting at it."
"Stop claiming you know me inside out! No. There's no hidden implication here. I'm telling you how I feel. I'm being honest here."

"No you're not. You're trying to break up with me, but you don't want to say it. You want to piss me off and get me riled up and angry at you. You want me to see that there's no other solution. Clearly, you knew how I'd react to this and clearly you realized that I'd see no other solution. I mean after all, I do think 5 steps ahead, don't I?
"No, that's not it all. Why is it always extremes with you? I'm telling you because I'm hoping you might find a solution to this mess."
"You're lying. And I can't tolerate this any longer. Here's the money for the coffee. Goodbye and have a nice life."
"So that's it. It's as simple as that? You're breaking up with me?."
"Spare me your drama. It's what you wanted. Just once, just once, be honest about yourself. Take care of yourself and know that I still loved you even with all your flaws. Never once did I want to change you."

And he left.
And she cried and talked to her friends about it. They called him an asshole.
And he was angry and talked to his friends about it. They called her a slut.
And that was the end of that.
It's all a matter of perspective in the end . Was she the paragon of virtue and him the renegade?
Or was it the other way around?

Why the Health Care System in Cairo is Doomed.

Well it's not exactly one reason. There are a number of reasons the public health sector in Egypt is entirely flawed and not up to par with any golden set of standards imposed on it by even the saddest of developing countries.

Lack of finance, lack of resources, lack of decentralization. These are all very valid points.

But let's focus on one that can be changed but won't ever change due to how the health care system works.
I'll call it the Circle of Residency.

Now bear with me because I'm about to compress a lifetime of a medical student in a few measly sentences.

First off, let's consider the student that just got accepted into medical school. Let's even assume he actually wanted to go to med school and wasn't forced to fulfill his parents' failed dreams of success. He's ecstatic, he's hopeful but most importantly he knows he wants to be a doctor to benefit society. He makes an oath to himself, swearing to study hard and become a success despite the poor teaching conditions in most of the public universities here.

He finally finishes those 6 years, still wide eyed and full of hope. He guarantees a good enough grade to work in the hospital with a guaranteed teaching position.

Then he starts his internship, and that's when things start to turn sour. He witnesses the corruption, the poor ethical standards, the abysmal working conditions of the resident. He starts to realize that maybe, just maybe, life isn't going to be that easy. He's still set on making a change though. He brushes off all the horrible attitudes the residents take and tells himself he will not be THAT resident. He finds a field he's comfortable with and decides to spend all his free time there, soaking up and absorbing all sorts of information to prepare him for when he becomes a resident.

The year ends and he finds out he was 2 marks away from getting that field he wanted.
So he settles.
For a field that that he wasn't so in love with in the first place.

No matter though, his heart will not be broken, his spirits uncrushed, he moves on! He goes into the field wholeheartedly, anticipating all the excitement. After all, he's a resident now. Now is when actual professors will give him advice on management and treatment and he'll finally notice how much of a difference he makes.

Until the professors never really show up. And he's forced to make decisions based on his minimal experience and then he unintentionally harms a patient because he was forced to make a gut decision due to the fact that there was no one there to guide him.

His mind begins to jade.

And when the professors actually show up, they don't offer guidance or help. They ostracize and demean the poor resident. They put him in harsher conditions not offering him even the tiniest bit of solace or gratitude.

He soldiers on.
He tells himself, "It's alright. I'm going to be an Assistant Lecturer in 4 years. Then I won't be the one getting shit from the professors. Not only that, but I'll show them. I'll show them how it's supposed to be done. I'll teach the new residents. I'll be there all the time and guide them and make my hospital a better place."

The man falls in love with a girl. They get engaged and soon to be married. Just as soon as he finishes his residency.

He succeeds and gets his Master degree thus ensuring his position as assistant lecturer.
It can only go uphill from now, he thinks to himself.
He gets married, his wife gets pregnant and he's there teaching the new residents and enjoying his life.
Then he realizes the money isn't enough. That he needs to work in the private sector.

"It's only a few days a week. I can manage. I can do both."
But then those days become weeks.
The new residents call him on the phone, asking for the guidance but he's too busy. A month passes and he finally shows up and sees the department in a mess.
He shouts at the residents for their poor management skills. He tells them how he barely made these mistakes when he was a resident.

He forgets how hard it was.


Eventually as time goes by, he becomes exactly what he hated, and the cycle repeats itself.
Believe me when I say, that I haven't even begun to shed light on what happens to residents in public hospitals. Believe me when I say, I totally understand why we become jaded, cynical and just not the greatest of human beings.

It still doesn't make it right though. 

Copts

So we were sitting the Emergency ward me and a few other residents (one of whom is a Muslim non veiled girl because yes, they've become a ridiculously rare breed in the public sector) and we had two patients that needed an incubator. One let's call Mohammed, the other let's call Peter.

They both needed to get operations done and they were both in pretty bad shape.

Now, amazingly enough, we actually had an empty incubator available. Fucking fantastic, only until you realize I used the singular version of the word. Thankfully, it wasn't our choice; the ICU surgical resident (who gets to decide) decided to choose Peter (for actual medical reasons, he had a somewhat better prognosis), and we had to somehow explain to Mohammed's parents that Peter was going in and Mohammed wasn't.

They didn't take it too nicely.

Here's what they said and forgive me if it's not word for word:

"Well OF COURSE you're going to pick the Christian kid. This is what happens all the time everywhere. We get treaded on while the Copts get all the special treatment. It's not fair."

This was of course directed to my non-veiled colleague.

My Muslim non-veiled colleague.

Let's break this down and go over that sentence again.

Mohammed's mother,

1- Assumed the doctor was a Christian and so gave preferential treatment. This is fine. I'll forgive her for that. I've seen it happen before and I don't really mind it. I've never seen it during a critical call though. Just silly shit like donations and stuff.

2- ACTUALLY fucking said, "This is what happens all the time".  Here. In Egypt.

In a Muslim Brotherhood run Egypt.....
......During the aftermath of what was possibly the worst year Copts have had to endure when it comes to death.

3- Further reassured her point by saying "It's not fair"

Fucking Copts. Seriously you guys, aren't you all going to die already? Your 10% is totally putting a damper on the 90%.

Rest assured, I explained the situation to her, not calmly of course.
I told her why Peter was chosen. I had a beard. She had to listen to me.
And all was well (until he arrested and died but that's not the point).

You might be wondering, "Well, doc, it DOES happen! I've seen Christians give other Christians preferential treatment or whatever"

You probably have, and that's your fault. Majorities have to to tend the minorities and let's face it, we haven't been a pleasant majority now have we.

Everytime you wonder why some Christians give other Christians preferential treatment, remember the last time you said something along the lines of
"Oh man, it's a shame he's a Copt."

It's our fault for putting them in that particular situation, and if anyone needs to start a peaceful (and non hateful) coexistence, it should be the majority.

Funny end to this story: The resident (non veiled) came up to me and said, "How do I prove to them I'm a Muslim?"

I told her to tell them the Shahada (There is no God but Allah) so that they'd think they converted her out of shame.

She didn't.

Some people can be such spoilsports sometimes.

I'm Sorry.

After almost 6 months of being a resident, this is the one thing that's still pretty difficult to deal with: Telling the father or mother of a child that their kid is either terminal, hopeless, or just not going to be their same old son or daughter anymore.

 It's an emotional rollercoaster that's always different with each family. There's no routine to how it works or what you're supposed to do. I'm sure abroad there's a whole system or class teaching you how to deal this particular piece of information out but here, it's just an afterthought.

Which sort of sucks.

It's gotten to a point where I jump at the possibility of delivering bad news to families because I feel I'm the only one equipped with the ability to emotionally convey bad news and at the same time, share the emotional fuckage the family experiences. I don't think I'm better than my colleagues at it. I just think that they've been at this longer than I have, and that they've reached a certain jaded level of consciousness I'm not sure I'm ever going to get to... or want to at least.

It's also a whole lot harder to do than say, telling the family their kid died. There's a finality to death. But with terminal illness or affection, I always feel like I'm damning them to both feel the loss of their child profoundly but also hope that maybe, through some sort of God given miracle, their kid will be the 0.0005 percent that miraculously becomes okay.

And man, do they stick to that hope. Because after all, "God is almighty and works in mysterious ways."
I sometimes thank God that I don't have to deal with atheists and agnostics. It becomes a whole lot easier to accept when the doctor says something like "Well, God is here and this is what He wanted to happen so who are we to judge."

And I feel like a prick every single time I say that because it works every.single.time.

So yay for Egypt not having any atheists.

Another one that's always harsh is "Was there anything that could have been done to prevent this? Was it my fault doctor? Was I too late? Did I do something wrong?"

I pride myself in honesty, but goddamnit does that become a whole lot harder when I say, a single shot of Vitamin K could have saved their newborn from having intracranial hemorrhage and subsequent brain atrophy for the rest of their life.

And I tell them that. But I also tell them it's never their fault (unless it's aspiration pneumonia, ESPECIALLY after I've told them not to fucking breastfeed their kid but that's a whole other story entirely).

After all, ignorance is rather rampant here as you might have sussed out from my previous blogposts.

I have a few stories about a few of these moments and I might or might not share all of them here but here's one that really did a number on me.

We had a 10 year old girl who got admitted into the hospital for having pancytopenia (all blood cells, including Red , white and platelets are decreased) Now, there are alot of causes for pancytopenia but we usually screen out leukemia first by doing a bone marrow aspirate and sometimes biopsy. So we managed to book her aspirate a few days later and I remember going upstairs to the labs to pick up her report.

She had leukemia.

I'm not going to lie. I felt nothing reading the paper at first. To me, this was just another girl who had cancer and we were going to tell her parents that and then she was going to go on to the Cancer Hospital and get her treatment and then maybe get better, or maybe not.

Pretty standard stuff.

But then I bumped into her father, who had been waiting for hours outside the lab for the test results.

"Did the results come out Doc?"

His eyes were wide open, full of worry and anxiety.

"Yes, let's sit down first."

So we sat on the bench in the hallway.

"Well, your daughter, she has leukemia."

"You mean cancer?"

"Yes."

Then and there he just broke down in tears, as if crushed by this immense weight. Not as if. He was, and there I was, sitting next to a crying middle aged man who just found out his 10 year old girl had cancer.

I felt like shit.

I felt like shit because I felt nothing a few seconds prior to seeing him, and now here I was, just emotionally syncing with him and feeling every ounce of sadness seep out of him.

That's a lie, because obviously I couldn't even experience a fraction of what he was feeling, and even that small fraction was already too much for me.

"It's not the end of the world. It's tough. It's going to be very tough, but I've seen kids with leukemia go into remission and get better and move on with their lives and become healthy individuals."

"So you're saying she's going to be alright?"

I fucking hate that question.

".......... Listen. We're all going to do our best here. You're going to do what you can and the doctors are going to do what they can, and well, the rest we can leave to God. Okay?"

He was still crying.

So I hugged him.

Might have not been the by the book thing to do. Might have not even been the right thing to do.

But there we were; two sad men sitting on a bench trying to get through life's hurdles.

And boy are those hurdles high for some people.