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What Does It Mean to Do Enough? A Reflection by Darren Nguyen

For the book review that inspired this piece click here.

As future doctors, some of us will be dealing with death all the time. In many cases, we would help our patients cheat death. “Not today!” we tell death in the face. But no matter how many times we save patients from death, they will die. Specialties such as intensive care, critical care, hospice, and emergency medicine (something I will consider) all deal with death on a daily basis. This is the reality for those doctors: your patients will die, but the essential question is “did I do enough?”.

What does it mean to do “enough”? Is there a medical definition of “enough”? Does it mean if I give my cancer stricken patient 500mg of anti-cancer drugs, surgery, chemotherapy, and immunotherapy and my patient still dies, then I tell the patients’ family that I, medically, did “enough” in the treatment of their loved one but “it was not sufficient”? No reasonable, or morally sound, doctor would ever say that.

So how would you tell a patient’s loved ones that you did all you could to save their loved one but could not? Knowing how to break the news to them is one thing but telling yourself you did enough is another. The guilt, shame, and regret of having someone die on your watch is enough to break some people. Just thinking about every tiny mistake you made and every second wasted is just too much for some people. Part of being doctor is not just having the knowledge to know what to do but also having the confidence in yourself to carry out your duty.

Sometimes I wonder to myself, am I strong enough to be a doctor? I don’t know. I struggle a lot and sometimes I overcome and sometimes I do not. I often get lazy and lose focus on what really matters. I fall for distractions a lot. Whenever work is due next week I would do it a day or two before because Warframe does not play itself! Most importantly, I often complain to my friends and family that school is hard. While I think school is hard, I do not give up on it. I do work hard every day to get the grades I want and improve myself as a person. When I become a ER doctor (possibly), I will look at my undergraduate years and think “I am an idiot for thinking that writing a synthesis reaction for (2R,3S)-1,2-Dihydroxybutanioc acid is difficult!” while thinking of a treatment strategy for a patient with septic-shock.

However, it is important that a doctor should not bear all the responsibility in the world. Intensive care doctors work in teams with nurses and other doctors as well. The coalition of healthcare providers will all share responsibility whenever a patient dies. No individual healthcare practitioner should be blamed for the death of a patient. From my perspective, doctors are the leaders of this coalition and, as a result, will bear much responsibility. So whenever a patient dies, a doctor should know that he/she is not the only one carrying the burden. There are others who will share that same burden as well. Sharing the weight of that burden will strengthen the team and provide the motivation needed to improve themselves.

In essence, being a doctor is more than giving medical advice, prescribing drugs, and performing therapy on patients. A doctor is not just a nice person who knows how to make someone feel better. As a person interested in intensive care, being a doctor means taking responsibility and being strong. People will depend on me. They place their trust and lives in my hand. If I break it, then is it my fault?

Final word: I apologize for sounding very pessimistic and dark in the second part of the last analysis, but I felt it was relevant to the topic. When Joe loses his daughter after fighting so hard, he starts to question whether he did “enough.” I wanted to explore what it means to do “enough” and give my thoughts on the question. Here’s my definition of enough: every reasonable medical option you thought is necessary. Simple, right? If my patient dies and I provided every reasonable medical option available, then I did enough. Modern medicine cannot perform miracles, and its limitations are not justification for self-guilt. Another factor to consider is health insurance. Not everyone has health insurance and the cost of medicinal care rises every year. Doctors should not economic decisions for the family, if a doctor believes a $10,000 chemotherapy treatment is necessary for the survival of the patient, then the family and patient should make that decision. If they refuse the treatment because it is too expensive, then the doctor should figure out a cheaper alternative. I would tell myself that every treatment, every drug allowed that dying patient to be with his/her loved ones a little longer so they can say their goodbyes. I will tell the family that I did all I could to save their loved ones, and I would do my best to comfort their sorrow and tell them that their loved one’s last moments were peaceful. Every death I will encounter will weigh heavy on my heart and my soul; however, it will provide the motivation I need to look at a dying patient and say “We are in this together, here’s my plan.” Of course I will adjust that plan should the situation demand it.

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