2 stark contrasting situations from the last week. Of satisfaction versus profound helplessness.

I see a patient for poorly-controlled diabetes. He also tells me of some atypical symptoms, of which I am suspicious for occult coronary artery disease. After all, he is a high-risk patient. Because of bad knees (maybe laziness too?) he tells me he can't exercise, so I send him for a dobutamine stress echo, which is positive for ischemia. I refer him to the cardiologist, and the first cardiology fellow who sees him (who was a bit of a prick) tells it's not his heart, and that it was a false positive test. He suggested the symptoms were caused by 'male menopause' and that I should treat him with topical testosterone. Which needless to say, pisses the hell out of me, when the cardiologist tells me, the endocrinologist, what to do with the freakin' hormones when it's not indicated. Thankfully, with some bugging from my part, his consultant looks over the case and takes the patient to angiography. He sheepishly calls me from the cath lab: "It's severe triple-vessel disease. Dr. P will operate on him tomorrow". My patient undergoes surgery last Monday. He's doing great, and will be discharged today.

"You saved my life, doctor", he tells me (really, it was the cardiac surgeon). He's been introducing me to his clan of family members. It's a great feeling, knowing that you did something right. That your intuition and persistence paid off. The cherry on the icing was hearing that he thought the cardiology fellow was a dick, too.

This, in contrast to what happened to closer to heart, when my mom fell ill so far away from me. They had gone on a trip to Lhasa, Tibet, to take the famous train ride to Chengdu. At that elevation of 3700 m, many in the tour group had some symptoms of acute mountain sickness. Mom, however, developed symptoms to suggest HAPE (high altitude pulmonary edema). When dad called me at work, I felt helpless beyond words, not being able to do anything from so far away, besides giving some directions over the phone, and telling dad to by any means NOT let that stupid hotel doctor treat her with ceftriaxone (idiot was treating as though she had pneumonia. And ceftriaxone, despite us telling him she gets an anaphylactic reaction to penicillin). She got better after getting oxygen, and descending to a lower altitude. They arrived home in Malaysia 3 days ago.

Those who practice away from home know this well. That despite having been put through medical school by your parents, of having the best training or facilities, to not be able to do anything should loved ones fall sick. It's something we fear, something I've talked about with others in the same predicament.

After all, what does it matter anymore even if you make a difference here, when you can't help those closest to you? I catch myself asking that now and then.

It's a dilemma, one I hope not to face again soon. But for now, I'm glad mom and dad are back home in Malaysia and have recovered fully.