Since I started this year, I have stuck dozens of needles into dozens of my patients. I have torn tape off skin so tender that my patients cried despite being loaded up on painkillers. I have used a vacuum-powered sponge to rip dead tissue out of my patients' open wounds.
I have sat patients up in bed when they told me that sitting up caused them the worst pain they could imagine. I have asked patients to walk when they told me they hadn't stood up in a week because standing hurt so badly. I have pushed on patients' stomachs right after they had abdominal surgery, just to see how much they hurt.
I have gawked-with my eyes wide open and my jaw on the floor-at my patients' bizarre physical deformities. I have tightly wrapped a patient's swollen penis in gauze to try to push the fluid out. I have performed a pelvic exam. (Guys, ask your girlfriends about that one.)
And I have even turned off my patients' televisions when they were trying to watch "American Idol."
Alex, you're a real a-hole. How could you possibly do all that?
It's not like I did it without being told to do it.
That's what Goebbels said.
And anyway, I always said I was sorry.
Tell it to the judge, buddy.
Let me explain. They say the most important rule of being a doctor is "First, do no harm."
(Everyone thinks that sentence is part of the Hippocratic Oath. It's not. But you know what is? "In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or with men, be they free or slaves." In other news, the Hippocratic Oath wasn't written by Hippocrates, and Santa Claus doesn't really exist.)
But doctors do plenty of harm. Really, being a doctor is all about balancing the harm that you do to your patients with the harm that disease is going to do to them if you don't harm them first. (Boy, I wish I had written that sentence on my med school application.)
In fact, one of the major things I feel like I'm learning this year is how to do the necessary harm to my patients without sweating too much, crying and/or quitting.
For instance, on my current rotation at the VA Hospital (quick, tell all your WWII-veteran grandfathers not to get sick for the next month), I'm doing a lot of blood draws for various tests. Of course, I understand that sticking a patient to draw some blood for bacterial cultures is less harmful than potentially allowing them to die from an infection.
But when it comes time to actually stick them with the needle-or more accurately, when they groan in pain from being stuck by the needle-I wish that I didn't have to do it. And of course, I'm still learning, so sometimes I have to stick them twice just to successfully get blood. (In fact, I've started taking two needles into the room.)
Still, there's a sense in which hurting my patients actually makes me feel closer to them. Sure I hurt them, but I'm only doing it because I want to help them. And when I'm spending an hour drawing blood because I've had to try four times, I get to ask them about their grandkids and wives. And since they know I'll probably be there for a while, they know they have a captive audience. Good times all around!
At least that's what I tell myself when I try to sleep at night.
Alex Fanaroff, Trinity '07, is a second-year medical student. His column runs every other Thursday.
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