It was a busy Monday morning. I had half a dozen kids scheduled to see me for vaccine advice, but by the end of the morning I had seen or coordinated care for more than twice that number. One little boy had an appointment to get a polio vaccine to help protect him from the new epidemic in the country. But he wasn’t looking great when I saw him. His breathing was fast and he was putting in too much effort to move the air in his lungs just a little. His oxygen was okay, but I didn’t like the effort it was taking for him to get there. He only had a fever for one day, but I didn’t like how fast his heard was beating. I noticed some wheezes so I gave him a breathing treatment, which opened up his lungs but then increased the wheezing I could hear in both of his lungs now. The chest x-ray showed a diffuse pneumonia and the full blood count was consistent with a bacterial infection. So I gave him the strongest antibiotics we had, gave the family a pulse oximeter to check his oxygen, and sent our clinic’s pediatrician a thorough note about the case. I told the family that they could go home if they agreed to monitor him closely and bring him in the next day for a checkup. I wished I could do more, and questioned whether I had not been cautious enough when I let them go home.
I hope that I treat every patient equally, but I will admit that it is hard for me when the patient is also my friend. Greg and I work closely with this child’s grandparents in bringing training to communities. Greg attends Bible Study with the father and I get hair advice from the mother. It’s an honor that I’m their doctor, and I think I do the best I can, but sometimes it is hard when I wish I could do more, when the outcome is not what I hope it would be from the start.
This happens over and over. My great friend who I walk with each week has an endocrine condition which isn’t the easiest to treat in this context. The lady at the front desk has hard-to-control diabetes, but lifestyle advice results in low sugars and medications result in side effects. One of my dear friends has a lapse of terrible back pain but I feel uncomfortable giving her stronger medications due to the other meds she is taking.
I’ll admit it, I want to be the one who heals, I want to be the one who saves. When I end an encounter and I don’t feel like I have reached the outcome I wanted for a patient, or especially for someone I’ve grown to care for, it’s difficult. I know all the right words and theories, but I carry the pressure on my shoulders nonetheless. I know that’s not sustainable, I know that is how doctors and missionaries burn out. And I think it’s healthy for me that I’m not in the hospital every day these days, it gives me a chance to let go and let my capable colleagues take over. It’s not always easy to realize that I don’t have control and that I can’t direct most medical outcomes, but it’s a good discipline to remind myself and others.