The cost

Blogging while sleep deprived and a bit pissed off makes for good reading I expect but perhaps you say more than you meant to. I imagine this is the type of thing I’ll re tell on a comfy leather couch in about 20 years (or months depending on how it goes…)

The problem with medicine (says he, with finger pointed and all eyes watching the figure with the air of authority as he gets ready to put the world to rights…) is not neccessairily the medico-legal responsibilty.

Say that I cock up and kill someone, or miss something big or whatever – then there is a certain medico-legal responsibility that I have been negligent or incompetent and should (though not always and occasionally too often) face some kind of disciplinary action.

I figure I get paid for that kind of responsibility. That seems to be the way things work in the world, the more responsibility and education and learning you have the more you get paid. Like a top class economy crippling banker – you bring the world as we know it to an end and you still get your golden handshake…

[Although that is probably a tad unfair on the old bankers – no doubt they were unscrupulous and greedy but they were merely in the position to be so. Yes they’re bastards but I’m pretty sure we all are. Anyhow the dodgy millions they made are what paid the taxes that fund the whole NHS and now that their incomes (and tax revenues) are falling then the NHS will suffer. Anyhow it’s all a tad more complicated than a quick “bastards are bankers” “bankers are bastards” joke allows…]

Legal responsibility is one thing. Moral responsibility is a whole other kettle of fish.

You see that’s were the problem lies. I don’t give too much of a stuff about whether I’m legally responsible for a patient – fine sue me, see if i care. What I do care about is my moral responsibilty to the patient in front of me. Yes I am that self-righteously pious. It has taken years of practice believe me…

They turn up with their woes and sicknesses and it is to me they come. And me with my mythical diagnostic and healing powers, foisted upon me by a legacy of TV shows, movies and dishonest doctors, is the one that that has to give them some kind of answer and dare i say it – final solution to the whole mess. (No nazi killing reference intended…)

Do not get me wrong. I am not grumpy and moaning. I am not saying “why can’t you blood sucking parasites leave me alone and sort your own lives out and crawl into a corner and die as you best see fit”.

I enjoy the job. I enjoy that position. It is one of the highest honour and priviledges to face and speak to these people who are part scared, part hopeful, part accepting of what may lie before them.

It is the moral responsibility that I carry around with me. The simple notion that these people need sorted and that in essence is my job.

It is also what keeps me up till 3am worrying about all these little broken, sickly creatures wandering around out there in the community. It is what makes me come home and be grumpy with my house mates and my family. When you see me staring into space and grumpy and  uncommunicative I’ll either be thinking about Da or about all the patients I carry around with me in my head.

Without a doubt this is part of what makes me (i think) good at my job. It is also a large part of what makes me walk across the car park each day swearing inwardly at myself, the patients and the way we serve them.

While trying not to be too melodramatic – oh why the hell not… –  they come to me like ghosts, or apparitions, their faces, their names, their x-rays their CT scans, their veins and arteries and wounds all their weeping, worried relatives.

I have this uncanny knack of remembering every patient I’ve ever seen. Well not everyone but a scarily high proportion. I go in the cubicle and ask have i met them before then i’ll remember – you were in cubicle 4 two and a half years ago and you’d hurt your wrist and there was no fracture on the x-ray. Which is all very impressive till the patient says “oh yes but i came back a week later and the consultant said it was broken…” Which always takes me down a peg or two but I could do with that.

But i remember them all, the things we got right, the things we got wrong. Each one tells me a story.

I’m not entirely sure if all this psychotic craziness is since Da died or not. Certainly watching one of your own go through it makes you painfully aware of how important all this is. But I think I was like this to start with. Only now more so.

I sometimes I think I have a shelf-life, a period of time that I can pull this off for before it all comes crashing down around me and I end up pulling an into the wild and doing private practice as a dermatologist (awww that’s unfair on dermatologists, sorry…). I hope not.

“a man who has no memory has nothing left to hide… nothing and i like it…”

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February 2009
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