Flux

I've been using this word to describe my life at the moment. I like the picture that conjures up in my mind of coloured dyes mixing in a liquid medium, or watching the continuous fragrant wisp of smoke that rises from a burning incense stick. Suddenly glimpsing the state of molecules as they really are - moving, twisting, dancing to an invisible momentum.

It's kind of not a good thing, or a bad thing. My ego grasps and the habitual anxiety ensues, and then after a while I wonder, why? Voices talk over each other in my head: "I need to know!" "But why do you need to know?" "Everything in its own time." "Are you sure?" I can't decide, and give in.

Sometimes I think about what I do in a day, and shake my head. Sitting on my couch now in the new rental with a wonderful view, I can't decide whether to count my blessings, or to somehow make changes to my life. An emotional day it had been today, and it comes back to the final of a series of conversations with one of my patients at the very beginning of the day. Sometimes small events like that just sets the tone for the whole day.

It was meant to be a bit of a chat to convince the patient to go home, even though we have brought him into hospital for a week to investigate a new cancer that was found. An elderly man, living alone, drinks out of boredom, and physically separated from his daughters.

The previous days I had urged him to tell his daughters of the diagnosis on the telephone, even though we don't know what the prognosis holds out for him in the future, and whether any treatments the specialists offer would help him or make him feel more ill than he does now. I'd been the bystander in the conversations that my seniors had had with him. They talk about what they can do, what they can offer.

But he is a smart and rational man. He askes the important things: how much longer will I have? will I feel more sick? if we can't cure it then what if it comes back again in six months and we have to go through the whole thing again? He goes on further, he says life isn't great, and he knows his body is failing. He is not a stranger to the hospitals and hears a great deal of stories and experiences from his fellow room mates.

My seniors side-step the questions. They talk again about what the specialists can offer potentially, holding out false hope. The patient turns to me and says, what do you think, doctor? I answer diplomatically, "I think you should make the choice that would give you the best quality of life." He hears me and relents. We shift focus onto the minor details to help him manage better at home, before the specialist appointment in a week's time.

Today he asks me the same questions. I tell him honestly I have no answers. He sighs a little, and says I seem to be the only one who understands where he's coming from. I nod, silently cursing the hypocrisy of professionalism and the provision of false hope. He goes on to tell me he will go home, wash his sheets and buy apple pie from the supermarket, with lots of cream, and bless his cotton socks, asks for my permission to drink a couple of light beers. I agree, and he says, alright I will go home, but I'm better looked after here. I nod, sigh and give the same old poor excuse of an imperfect public health system in an imperfect world.

I have learnt to be candid with my patients. Afterall, they are real people with real problems, and it easily gets drowned out. Sometimes, the reality is cruel. And sometimes, I don't know if my pessimism should serve me better or worse as a clinician, or as a human being.