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September 8, 2009
CASES
By COLIN FERNANDES, M.D.
As I pondered postgraduate choices in medical school, I divided the medical specialties into joyful ones like
obstetrics (congratulations, it's a healthy baby girl), grim ones like oncology (better get your affairs in order) and
faceless ones like pathology (in which the good or bad news is delivered via an impersonal report).
I recognized I didn't have what it took to be grim. And because I love dealing with people, faceless was out. I
landed in pain medicine by chance, and surprisingly, I've found that it fits in the joyful category: there are few
better feelings than easing a patient's suffering.
Still, after a demoralizing recent constellation of patients, I was left wondering which is worse: informing people
that they are going to die, or that they are likely to spend the rest of their lives in pain.
I've followed one older patient for five years now. He is a lovable gentleman in his 80s with chronic back and leg
pain. Over the years, we've been through successive trials of different medications and treatments -- some of
them quite unconventional. Despite our best efforts, he continues to suffer moderately severe chronic pain.
My patient and his family are habitually early for clinic appointments, always exquisitely polite, forever
compliant with my treatment recommendations. That he is never demanding, only grateful, makes it all the
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