The Cheerful Oncologist's Little Book of Rules: Number 5

Once upon a time I was caring for a nice man who was dying in a simply awful way from a cancer that seemed to revel in the act of slowly grinding his body into dust. In order to relieve his suffering the hospital staff gave him narcotics and sedatives intravenously. My job was to make sure that the doses were adequate. I had promised him and his family that we would do everything in our power to keep him free from pain. This is the kind of promise that, like a father walking in at the last minute to his daughter's school play, needs to be kept.

Apparently one of the nurses didn't get the memo about "we" meaning all of his caregivers. The family complained to me that this nurse was making excuses about why she couldn't give my patient any more medicine during an episode of pain. She told them that he was already receiving the maximum allowed by the orders and that she couldn't go any higher.

I pity the fool who never bothered to learn the art of equanimity when encountering such temptations as a professional caregiver reeking of disregard and stupidity. Losing one's temper is a lost cause in this situation. I know, because I was once such a fool, but then discovered this little piece of advice:

RULE NUMBER 6. A DOCTOR CANNOT BE MERCIFUL AND ANGRY AT THE SAME TIME.

I rewrote the orders for comfort meds so that the staff would have plenty of room to increase the dose at any time, spoke to the patient's family, made sure that the nurses knew to call me if necessary, and left.

My footsteps echoed down the hallway in perfect rhythm like a metronome, each one shattering the morning into fragments of glorious, incandescent spleen.