Do you know what your patients are thinking?
Sometimes when I see a GP, I find that they know what I would like to say, before I have said it. Which is not at all surprising when you consider how many consultations a GP might oversee. They have that skill.
I often don’t know what my patients are thinking. I can say ‘hello my name is’ and ‘I am just going to examine your chest’. I can do this for days. I can touch their flesh and pull back their eyelids and press my finger on to their sternum for three seconds to watch their skin slowly fill with colour again.
I could talk to them for all of the days they remain where I work, intubated and on a ventilator and I still will not know what it is that is on their mind, if there is anything at all.
The Copenhagen theory floated that an object in a physical system can exist in all of its possible forms until observation forces it into just one of these states. My parents always taught me that it is what is on the inside that counts. So, for many of my patients then, ‘what counts’ remains a mystery until they ‘wake up’.
How can I know what they are?
Schrödinger said that Copenhagen theory was flawed. He told us about a cat in a box with a Geiger counter, hammer, poison and some radioactive material. The radioactive material had a 50/50 chance of triggering the Geiger counter and if it was triggered, the poison would be smashed and the cat would be dead. The other ‘if’ was that the cat was alive.
Unless you opened the box, the cat was both dead, and alive.
I stand beside a patient who is about my age, I place my hand on his wrist and it is warm, but without a pulse. The arterial line does not have a waveform. I place my stethoscope on his chest and I cannot hear clear heart sounds. His chest moves up and down with the ventilator and there are large cannulas taking blood out into the machine next to me, running it through an oxygenator and pumping it back in.
His heart doesn’t work. It had stopped some days ago and you could say that he died, but a team pushed on his chest until the machine was ready and you could say that resuscitation failed, because he remained in a non-perfusing rhythm, but then there was this machine and some pacing wires.
I look at the consultant and ask, ‘so we just wait?’
And he says ‘yes, we wait for his heart to beat again’.
Schrödinger didn’t really think that his cat could be both dead and alive. He knew that the Copenhagen theory couldn’t possible hold for large organisms, because how can a large organism ever be simultaneously dead and alive?
I stare now at Schrödinger’s patient; dead or alive?
It has been five days when I look up at the cardiac monitor, tracing a heart rate of 100 beats per minute. Sinus rhythm; a heartbeat that is his own. I place my stethoscope onto his chest and a hear clear and familiar lub dub, lub dub, lub dub.
I am, I am, I am.
By the Secret Doctor
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