Reflecting After a Sad Day...

So practicing for a bit in New Zealand has been eye-opening, horrifying, and refreshing all at once. There is such a vast difference, micro-cosmically speaking, in the medical culture, but also in the culture as a whole. I think that, particularly, coming from large, urban health centers on the East Coast of the US (with such giants in the world as Harvard nearby) has made this transition somewhat dramatic for us. The levels of what are possible, and, even more so, what is expected, are just light-years apart.
We have found the people of New Zealand to be exquisitely pleasant after dealing with, not just patients, but often people in general, in the US. It may just be a small town vs big city phenomenon, or perhaps just us being taken out of the Eastern seaboard where we settled into the relatively cool and distant culture that never quite fit us. But the base level of civility is wonderfully refreshing here. Oh sure...there are certain problems endemic to small towns: a fair bit of drunken brawling, gossiping, etc..., but, generally speaking, we find ourselves somewhat overwhelmed by the friendliness here, sometime even annoyed by it, as we've become so jaded to nice people.
The way that this culture spills over into medical practice has also been nice to see. It's so rare to meet a patient in the US...or at least it seem so...that has pain anything less than a 10 on a scale of 1 to 10; quite often the scale is misunderstood to go on upward from 11 to millions out of 10. And the perception, reasonably or not, is that this pain should be gone. Always. In fact, the US consumes >90% of the worlds hydromorphone supply (roughly 7-8x the potency of morphine). Everyone is always in pain, which may be true...but it wears you out to constantly be dealing with it...it taxes ones compassion. Here, you witness grown men trying to hold back tears after they've had horrible accidents, and their pain is 6 of 10. It really invokes a soft spot in your heart and actually increases the capacity for care to see what is clearly under-reporting. It's just so refreshing to treat pain knowing that there isn't an attempt to get a high off the treatment.
Along with this less ambiguous feeling about treating people, there is just so much more gratitude for what is done, even if it doesn't solve everything. There seems to be an almost baseline assumption that, of course, the doctor is trying their best to help. And that makes all the difference in the world. That, perhaps, is the most gratifying thing. Even in day to day relationships, this seems important. What good relationship doesn't start with the assumption of best intentions? Medicine in the US seems, not always but often, much more antagonistic, and, to quote Radiohead, "It wears me out." I pulled someone's fingernail off that would likely never grow back, and stitched the remaining stump of a finger back together, to try and avoid infection. In the US, there would have been constant second guessing, demeaning comments, and demands to see a specialist who only deals with the fingernail of that finger and hand (granted, I wouldn't have been pulling off fingernails in the US). Instead, I was thanked...and profusely.
The gratitude even extends to when nothing can be done beside making someone comfortable. I love end-of-life care. It is often a wonderful and beautiful thing. But particularly, I think, in large, advanced, urban centers there is this misconception that people are not suppose to eventual die. And if you're the bearer of information that there isn't a cure or a solution or whatever, there is an immediate distrust, and quite often...an unrealistic expectations that the 90 year old, demented patient with no functional organs left should be kept alive on life support because "they're a fighter", which most people are, even though no one would think to torture their pet dog in that way. There seems to a more realistic understanding of life here...that it eventually ends, but that that can still be done in the best way possible...that there is pain, and sometimes it doesn't go away entirely, but you can still do things with your life...that yes, there might be something more that could possible be done, but it's not likely to do good, so you don't have to choose to do it.
It can be horribly frustrating here when you have a healthy 80 year old that should be able to have a surgery that would make the next 10 or 15 years of their life better and no one will do it no matter how much you yell at them. Even more so, it's frustrating when you see younger people hurting or dying because there isn't a specialist available, because there just aren't enough of them, or you can't get them to one on-time for such stupid reasons as the roads a snowed over and the ambulances and helicopters are running. But by and large, it is refreshing to see that people can get on with life even when a doctor didn't make everything better for them...and even still find gratitude for what that doctor did do.