Friday, February 22, 2013

Day 251 - survivor guilt, the internet

Not much to report on today. I had an interesting conversation with one of my doctor friends about survivor guilt and a mutual doctor friend who died a few years ago from pancreatic cancer. I felt somewhat guilty back when I was completely healthy and he was dying, but I feel more guilty now that I have a cancer that has responded well to treatment and he has died. I think the more like you the person is, the more acutely you feel the survivor guilt. This is probably not an original observation, but it is new to me.
A related phenomenon is that sometimes when I hear a patient's story, I think, "Holy buckets! What fabulous problems I have! I'm so glad I have my cute little problems and not some one else's huge difficult problems." I know this is a pretty universal reaction for a lot of us.
I don't think I've had survivor's guilt with a patient although I have had "I love my problems" with fellow doctors. I wonder if health care providers feel survivor's guilt with patients or if the way we separate ourselves from our patients keeps us from that. And what about when the patient we're separated from is, themself, a doctor? I have only taken care of one doctor patient who had something really bad happen to him medically, but it was a disease I cannot get so the opportunity to relate closely myself was not really there. I do not have survivor guilt feelings about him.
In other musings, I have been wondering about the differences between opioids recently. It is fairly common for people to have a different side effect to beneficial effect ratio for different opioids. It seems, however, that dilaudid and demerol are the two opioids that people with a preference generally feel work best. I wonder if my anecdotal observation is true or not and I really wonder why this might be. Dialudid and morphine are both primarily mu agonists. Perhaps dilaudid is more avid to mu2 receptor subtypes which wikipedia tells me mediates euphoria. Or perhaps not.
Although I lived half of my life without wikipedia and the internet, I cannot remember what it was like to lack them. Remember when we had to go to the library to look stuff up? Remember when you had to call up your cousin who was good with trivia if you wondered what the capitol of Nairobi was? The Berkeley public library used to offer a service where you could call a reference librarian up and they would look things up for you so you could find out whether or not Jordan and Egypt share a border without having to leave your house. I had never heard of any other town that offered that service and I'm sure none offer it now.
In completely unrelated news, no nightmares last night. Phew.
For me, for tomorrow, I will hope for a continued absence of anxiety dreams. For you, an interesting question and the means to answer it.

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