Saturday, June 12, 2004

not to be all serious or anything, but...

Just in case you haven't been following, this is a conversation that has been taking place in the comments section. I decided to share it here because I actually think it brings up an interesting topic for discussion, and I thank Gogoli for starting it off:

you are a peds doc yet you never mention having any kids, nor how great it is to work with them, nor saving their lives. it kinda gives me the notion that docs are just becoming ducks for the money and prestige only...which is true for the majority of the time.

-- Gogoli

* * *

That is one way to look at it, I suppose. Another way to look at it is that as a doctor, there are patient confidentiality issues that I have to be very aware of, and for that reason, I actually try to tell very few stories about specific patients. The last thing a parent wants is for me to be blabbing about their kid's medical care on the internet. In addition, my whole life thankfully does not revolve around my job and career, which is why that's not all that I talk about.

Finally, medicine (particuarly Pediatrics) is probably the last field you'd want to go into if you were "in it for the money." Trust me on this one.

-- Michelle
* * *

do you enjoy what you do?
-- Gogoli

* * *

(In answer, I wrote this response, but it was too long to put in the comments section, so here it is out on the main page)

Much of the time I do like what I do, but sometimes I don't. And that's just the unvarnished truth of it. I don't know any doctor or resident or nurse who loves what they do 100% of the time, or are thinking unflaggingly and selflessly about their patients 100% of the time. To paraphrase a great and learned doctor (Doctor J, aka Julius Irving), being a professional is doing what you love to do every day, even on the days that you don't feel like doing it.

True, medicine is a vocation, it's a calling, but let's be honest, it's also a day-to-day job. Let's not elevate the practice of medicine to mythical proportions, here. Ideally, we would all find our ideal careers at the interface of what we love to do and what we do best. I think I've managed to get pretty close, but that doesn't mean that I go skipping in to work every morning with a giant smile on my face or some charged sense of purpose. It's still real life, after all.

We can't expect superhuman things from our doctors, and as doctors, we can't expect the extraordinary from ourselves all the time. We get tired, hungry, irritable, stressed. We miss our families and friends, miss the quiet time for ourselves, and can resent the hospital for the long hours we have to work that take us away from the other things that we love. How could we not?

Yes, medicine is a noble profession. Yes, it's about something that's bigger than oneself. Yes, the bond between patient and doctor is a sacred trust, and all that lofty stuff they tell you in med school. But it's still your life. It's not dirty or unethical for doctors to want to be well-compensated for their work, or to think about their own interests or those of their loved ones. That's just how it is. As long as we go in every day, do our jobs, care for and about our patients to the best of our abilities without allowing outside concerns to affect our work, then we're doing a pretty good job.

-- Michelle
* * *

I hope no one thinks I'm slamming anyone here by putting up that exchange, because it's not meant that way, and again, I thank Gogoli for bringing up the topic. It's an interesting one, this question of "How to be a doctor, but a real life person as well." I've thought about it a lot, but the nuances escaped me until I started thinking in earnest two years ago about what kind of medicine I wanted to practice, and the life I wanted to have while doing it. There's a lot to think about, and I think most of us still wrestle with that question every day.

However, speaking of outside lives, I just met up with Sara And Company last night out at Yabby's in Williamsburg. She's in town from L.A. for Pavani's wedding, and it was good to see her, because, you know, she lives far away and such. There was a sizeable outdoor seating area at the bar, and given that the young artsy intelligentsia have taken root in Williamsburg over the past 5 or so years, we were sitting in a maelstrom of cigarette smoke. Since the indoor smoking ban in New York a year and a half ago, I haven't come home from a night out with my hair and clothes smelling like smoke, but I was reeking last night. If I were a comic book character, I would have had all those wavy lines emanating from my being, trailing behind me wherever I walked.

I have to start keeping in better touch with my friends. It's just ridiculous how bad I've been at this. I'm going to e-mail Sara when she gets back to L.A., and we will start a mighty electronic exchange the likes of which this world has never seen.

Currently reading: McSweeny's Quarterly, 13th ed. I love it, but it's a little hard to read because it's heavy and hard to hold up for prolonged periods of time.

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  2. May I send you a digital copy of my novel, Reluctant Intern, to read and possibly review on your blog?


    Addison Wolfe never wanted to be a physician. He wants to be an astronaut. NASA turned down his application, forcing him to seek employment as a doctor. The problem with obtaining a physician's license is the need to complete an internship to acquire one. Wolfe finds himself in an undesirable rotating internship in a very busy public hospital. Inexplicably, the Director of Medical Education seems to have developed an instantaneous dislike of him and the remainder of the internship class. Another mystery is why an attractive female physician expresses a romantic interest in him on the first day of internship.

    “The absolute worst time to go to a teaching hospital as a patient is the month of July. Recent medical school graduates, known as doctors, start their real training on July first. They don’t know anything. They don’t get any sleep. They are underpaid and overworked. Their stress is at catastrophic levels. Is it any wonder they make mistakes?” – Anonymous

    “In local news today,” the reporter said, “state and federal authorities are in the process of taking into custody the entire intern class at University Hospital in Jacksonville. Officials cited the number of deaths attributed to this class as the reason. It seems that wrong doses of medications, inappropriate surgeries, failure to diagnose lethal conditions, and other mistakes have led to hundreds of deaths….”

    “The overdose?” Wolfe asked.
    “Yes,” Dr. Rubel replied, “that will be her legal cause of death, of course. The real cause of death was the autopsy. Barbiturate overdose, followed by refrigeration outside and then here in pathology, slowed her metabolism down. She was actually alive when they started the autopsy. The flexing of her limbs when the saw touched her brain happened because of nerve conduction, brain to extremities. But it was too late; we cannot put her back together. A hard lesson for those poor boys to learn. You, too, gentlemen. It is also true for those who are clinically dead from exposure or drowning. Remember this: a patient is never dead until he is warm and dead. Don’t forget that!”

    The senior resident started his description, “EMS responded to a report of a cardiac arrest at 1:07 a.m. in Junior’s Topless Bar, on East Bay Street….”
    Figueroa again jumped to his feet. “What is this, a bad joke?” he asked. “Two EMTs walk into a bar…. Let’s be reasonable, guys. The most likely reason for needing a paramedic in a bar at 1 a.m. is a knifing or a gun shot wound, not a heart attack.”
    The autopsy and x-rays were condemning. The thirty-nine year old, black male had no history of heart disease. No medical history of any kind. He did have a bullet entrance wound to the back of his head with no exit, bullet still in his brain.

    The patient was a massively obese woman who complained of a headache. The intern knew only that she was complaining of a headache and had requested aspirin. Extremely busy, and assuming the nurse would let him know if it were not a good idea to give the patient aspirin, he quickly flipped to the order page and signed the order that had been written by the nurse. Figueroa asked the intern if he had talked with the patient. No. Had he examined the patient? No. Had he even skimmed the chart? He had not. He asked if he knew what allergies the patient had. The intern did not know. At the time he approved the order for aspirin, did he realize the patient was on warfarin, another clotting inhibitor? No. Did he know that aspirin also inhibited platelets and clot formation? Yes. Did he know the patient had a history of blood clots? No. Did he suppose that a blood clot in someone's brain, or a ruptured berry aneurysm in the same area might cause headaches? Yes, he knew that. The autopsy pictures revealed stenosed carotid arteries, two small clots in the patient's brain, and massive bleeding from a ruptured berry aneurysm.