The Human Race: Take It or Leave It?

so i was having a discussion the other day with a group of friends on whether human nature is fundamentally good or bad. there are easy and hard arguments for both. i've always inclined toward glass half-full when it comes to people as a species, and am of the opinion that, although we certainly can do horrible things, one-on-one, we basically don't have ill will toward others and will show some kindness when put to the test. but this week has been a test of my faith in human beans. and in my own humanity.

in my own small world i'm still all tra-la happy joy joy over my new job. but it's been nuts to the wall busy at the hospital where i'm finishing up my final preceptorship rotation. completely insanely busy. like i can't believe i'm doing all this work for free- busy. and it's getting frustrating that i can't write my own orders, can't make decisions on my own. i feel like a puppet where i'm pulling my own strings but someone else is getting all the glory and laughs. and internal medicine is so tedious in many ways. i write the same note on virtually every patient we have, since they all seem to be in with renal/cardiac failure. and it's kind of a cluster-badword working with all the consultants...

like "did so-and-so order the transfusion? i don't know-what did he say? can you read his note?" absolutely not. ever. "did so-and-so show up yet and make a decision on what to do about ambulation/diet? well, his resident came by and they said...." absolutely nothing. ever. "did so-and-so remember that putting the 400lb patient on a 1500 calorie /day diet (when he's used to eating, probably, 4,000/day) but not adjusting his massive amounts of insulin might put him into a coma?" not so much. like i said in an earlier post, doing internal medicine is like being the ring leader. but it's a lot to juggle. and it's getting pretty old.

so i've been crabby about that. and also, patients and their families can be very frustrating. much of health care is about customer service...but that can be challenging when there are impatient 'customers' bitching about every little thing. it seems some people have no idea that they're not the only patient in the hospital and that sometimes their priorities and that of the rest of the world don't match. every once in a while i'll come across a patient/family member who thinks that shouting/whining/threatening is the best way to make sure you remember they exist. it usually has the opposite effect.

and news this week (i check cnn.com every morning for a pick me up w/ my coffee) has been devastating to my people-are-good theory. examples of horrible, twisted murders- 16 and 17 year old kids beating to death a Mexican immigrant, several pregnant military women killed by baby daddies and the revelation that some 40% of women in the US military have been sexually assaulted while in the service, the anthrax killer scientist's suicide, the list goes on and on. awful things people are capable of. it can be so disheartening. and maybe these incidences and, of course, the larger scale human tragedies we've seen across history, trump the small anecdotal evidence i've collected to prove that people are good.

but i still have to stick by the astonishing human spirit i see in patients. for all the pain and fear and anger people experience while suffering in the hospital, most are amazingly generous and kind. patients who haven't gotten to take as much of a sip of water in a week and are being fed through their noses, those in unfathomable pain, those getting zero answers and only more tests, tests, tests, some who are in the process of dying....they will still smile and laugh with me. will still reach out to their family members and worry about their needs. they'll even worry about their roommate or the patient down the hall that they hear crying out.

and we had a patient recently in the ICU who was in terrible shape- on the ventilator, being dialyzed, jaundiced, swollen all over, every system shutting down...and her wonderful husband kept coming in every day, not just holding her hand and talking to her in her non responsive state, but also teasing the nurses, bringing cookies to the staff...he somehow still built people up while going through this most awful situation. and you can tell they've impacted others-- apparently she and her husband (married 64 years, he proudly told me- he called her his "princess") had for years gone to mcdonald's every morning for senior coffee. when the staff there noticed that she wasn't coming in with him, they asked about her...and mcdonald's sent a HUGE bouquet of beautiful flowers up to the hospital for her. you can't tell me they're trying to keep their reliable $0.60/day customers happy- that's just kindness. love to virtual strangers. goodness.

i found that really touching. and for that example and many others, i'm not changing my theory that people are loving and good. i don't know how we effect change so that people won't do awful things...it's pretty apparent that we humans all have the capability to be awesome or awful....other than to show them kindness and grace and hope they figure it out. when i'm angry and fed up with whiny patients or devastated by the stories in the news, i try to remember that i can only control my own interactions with people and hope that how i do will effect the world at large. i've certainly seen examples of how to be humble, gracious, and thankful from my patients, and i'm really trying. if you have any ideas on how to go about any of this, let me know.

so that's where i stand and what i've been thinking about these last few days. sorry i'm kind of a downer today.

"there are good people and bad people in this world....the ones who start the fires and the ones who put them out." - meryl streep as 'aunt josephine' in "lemony snicket's a series of unfortunate events"

"people are bastard-coated bastards with bastard filling!"- dr. bob kelso, "scrubs"