Kind Of Blue

**MORE NAVEL GAZING**

There was a pall over the Department today; not the usual end of nights lull that you see in weary faces across the country, as people realise the night is at an end, and they can step, blinking into the day. Not the almost palpable sense of loss when something has just gone bad, but somewhere in between. The feeling that something has been and gone, and we haven't quite decided how to feel about it yet. Except that we don't feel good about it.

Working as part of a team, in extremis, or close to it, is an interesting experience. It is bonding and team building in a way that corporate events will never understand, let alone capture; actually, I suspect there is always another level of jeopardy in which one can find oneself, which you just can't under stand if you weren't there, man. Shared experience binds us powerfully, especially if there is hazard, even if that hazard is at someone else's expense. You discover a lot about your own mettle when everything goes a bit runny. I have rarely felt closer to my colleagues than when we are trying to pull the fat from the fire. Maybe that says a lot about my ability to form relationships...

But it can be extraordinarily disheartening when all your efforts are for naught.

As Physicians, I suspect many of us adopt a moral compact whereby we take on the responsibility for identifying the truly sick, and trying to divert the course of their illness; if we are 'good' enough, or experienced enough, we may even expect to be able to do this. Or perhaps we tolerate failure to do so less. We become, willingly or otherwise, more sensitive, but less specific, But I wonder if we still harbour the belief that, when confronted with the really sick, we will recognise them. For if not, if we cannot make that difference, what does all the rest count for?

To be fair, I can't, obviously, speak for my colleagues. But I suspect most of us know that the obviously sick patient is just that: obvious. And so identifying them, treating them is not where we like to think our skill lies. Our grasp on the art of medicine depends on us being able to reliably identify the patient who looks well, but isn't.

Unfortunately, no matter how good one is, sometimes this just isn't possible. Sometimes, it's true, they slip through the net because mistakes were made. These are usually multi-factorial, systematic. But sometimes a disease follows a course so aggressive that it eludes us. It is a sobering reminder of our own frailties.

When this happens, especially if the result is a bad outcome, there is often an agony of soul searching. Do not weep for us, gentle reader, because it is usually worse for the patient, but we must subject ourselves to harsh criticism to see what, if anything, could have been done differently.

In this way we learn; but sometimes, there is nothing more we could have offered.

We might feel relief: I did everything 'right'. But we don't feel good about it.