Racing through the rain as the sky opened up,
I felt a thrill from the resulting wetness seeping through my sweater. I didn’t plan for rain today, but should have expected it given the last few weeks.
I sat, drying out as I listened to the sounds of a four year old playing piano, and thought about drugs.
Yes, drugs. The current environment is full of drugs of all kinds right now-
drugs to make you better, live longer, improve your mood, your skin, your heart, your joints.
Drugs that will kill you,
drugs that have a double edged sword of Damocles dangling over those who so desperately use them.
We are taught primum non nocere- first, do no harm.
But how are we supposed to achieve that,
given the narrow therapeutic window for so many of these drugs?
Drugs that have the equal potential to harm, even as they do the very thing they are intended to.
Harm that is known, weighed, and sometimes accepted as a necessary evil.
The lowest dose, the shortest course by the most appropriate route.
Taper and stop if at all possible.
It’s a daily balancing act, following patients, symptoms, labs, appearance.
Deciding when it’s time to quit or switch, if the course has succeeded or failed.
Some days, I find it hard to make a decision. Some days, I wish someone else had the responsibility and that I could sell fishing licences at Canadian Tire again.
Some days I wonder if I learned anything in school and if maybe they changed the rules when I wasn’t looking.
Well, they have changed the rules since I was in school-
the joy and sorrow of getting older in medicine is that, while you gain practical knowledge, learn about how people actually work, the field continually advances,
Changing and growing.
Half of what you will learn in medical school is wrong, we just don’t know which half
This was the first thing I learned.
It’s the one thing I’m sure is still true,
although much of what else I’ve learned is not.
Please, be patient. We are human and are learning and growing too. We do our daily best, and have good days and bad days.
Our targets keep moving, and we try to continually follow them, modifying treatments to the best outcome possible for our patients.
We worry. We wonder. We care. We never have enough time to do everything we wish we could.
And sometimes when we sit with wet sweaters at our children’s activities,
We wish we knew for sure we were doing the right thing
