Gratitude

I think one of the fundamental desires of humans is to be appreciated. They want to do things that are important, they want to make an impact on other people, and they want acknowledgement for their efforts. I suspect ER doctors are no different, and many of them (including me) probably went into medicine to satisfy this desire.
Sometimes however, you don’t want to be thanked.
One such time was a few years ago, when I had a man in his early 60′s present to the ER with fevers, rash, and feeling crummy for a couple weeks. His symptoms were not adding up to a typical infection, so I ran some tests. Turns out he had acute leukemia. This was obviously terrible news, and I had to deliver it. The man was typically upset, but took the news with great composure. He then asked if he could go home.
I said, “No, you’ve got to be admitted for treatment, and you’ll probably be in the hospital for quite a while.” He needed induction chemotherapy, and he was going to have a tough time. He really didn’t want to be admitted to the hospital, because it turns out, he had cancelled his health insurance last year. He couldn’t afford the premiums anymore. He was hoping to make it to age 65, and get Medicare benefits, before he had any serious health problems. As the wheels were turning in his head, I came to realize that I had given him several pieces of bad news all at once. He was very ill, he could die, he was going to have a long and difficult hospital course, and he was going to lose all his money.
I checked on him several more times before he was admitted, and each time, he expressed his sincere appreciation and gratitude to me.
I wanted to say “For what? So I could give you the worst news of your life?”
Sometimes feeling appreciated is a shallow goal.