Sometimes we have to hurt patients to "help" them. About half of the people I did ultrasounds on today were in pain when I scanned them, and my scan caused them distress. A tattooed black man who had just been shot in the chest and I had to press the probe into his tensing muscles to get a subxiphoid view. A young white woman who had just had knee surgery and gripped the bedrails, shaking, while I glided the probe up and down her leg and all around her knee to look for clots. A gray-haired old lady who had been backed over and then run over by a car who cried out when I swept the probe over her bladder.
There was also an old man slowly oozing blood from his rectum, heart rate increasing, pressure dropping, and yelling and flailing in pain from a finicky peripheral IV insertion, working himself up into a panic attack, hyperventilating. He begged us not to do it. He said he'd rather die than get stuck again. I knew he meant it but didn't mean it. I knew he was not himself. Pain makes us not ourselves. It makes us not our best selves. And my voice slid into the loud, firm tone that makes me sound more American than I really am, that's not me in real life, but is me in doctor life, and talked him down. That voice cares, but it also doesn't.
"I know this is hard, but you're losing a lot of blood and we really need you to have this IV, all right? We have your best interests in mind here, okay?"
He nods, incoherently. His eyes seem teary and I'm embarrassed for him and he's embarrassed for himself.
Their pain makes you detach.
At first, you're a novice, and you try not to press hard. And then you realize that it's better to press hard and get your image and get it over with than to torture them with a light touch. It's better to just rip off the bandaid in one fell swoop.
You don't want to cause them pain. You don't want to cause anyone pain. That's not why you entered this profession. But you are causing them pain. Even if it's with the intention of helping heal them, whatever that means in modern biomedicine, you are causing them pain.
So the easiest thing to do is detach. I pay attention to your pain but I also don't. I pay attention to my job and getting my job done. If there is someone else in the room--a nurse, a tech, a student, another doctor--who can console you, I'm not going to use my energy to do it, I'll just let them handle it. I'm just going to focus on my job.
And now I feel your humanity, but only in an abstract sense. I'm still present to you. But I'm present to you the patient, not you the person.
The old man got transferred to the trauma bay soon after his pressures tanked. I walked by and I thought his eyes were closed. He looked asleep. But he waved to me.
"Hi there," I said.
"Hi there," he responded.
