Questions That Patients Never Ask:
- Where did you go to college?
- What did you study in college?
- What were your MCAT scores?
- Did you graduate from college with honors?
- Where did you go to medical school?
- Were you in AOA (the honor society in medicine)?
- Did you match at your first choice for residency?
Questions That (Some) Patients Ask:
- Where are you going for vacation?
- What did you do for Valentine’s Day?
- How many other patients have you treated with X condition?
- What’s your first name?
- How much money do you make?
- How old are you?
- Are you old enough to be a doctor?
- Do you like your job?
- How do you do this day after day, year after year?
- Where’d you get those pants?
Questions That (Some) Attendings Ask:
- Where did you go to college?
- What did you study in college?
- What were your MCAT scores?
- Did you graduate from college with honors?
- Where did you go to medical school?
- Were you in AOA (the honor society in medicine)?
- Did you match at your first choice for residency?
Questions That (Some) Nurses Ask:
- Are you single?
- Do you have a boyfriend?
- When are you going to get a boyfriend?
- Have you gone on any dates recently?
- When are you graduating?
- Are you going to work here after you graduate?
- Why not?
Questions That Medical Students Ask:
- Where did you go to medical school?
- How did you choose to go into X specialty?
- Why did you choose to come to this residency program?
- What books should I get for this rotation?
- Is there anything else I can help you with (… so you can let me go home…)?
Questions That Hospital Operators Rarely Ask:
- Before I page this physician for you, can you tell me who you are?
- How do you spell that last name?
Questions That Residents Always Ask:
- Where are the bathrooms?
- Where is the cafeteria?
- Where is the call room?
- How do I get into the call room?
19 Feb 2008 | 6 comments.
The Great Lie?
Edwin Leap, MD, believes that physicians are unhappy because they believe in the great lie:
What was it? What was the lie and when did doctors learn it? The lie was this: ‘if you become a doctor, your profession of medicine will be all you need for happiness and fulfillment.’ In short, physicians learned to validate themselves by way of a profession.
He reminds us that medicine is, at the end of the day, simply a job, not a “reason for being.”
Graham Walker, soon to be MD, believes that the younger generation of physicians do not believe the lie:
We knew we wouldn’t make the most money (or at least, we should have known this); we knew that medicine was time-consuming, but we chose it anyway.
Graham later comments:
Look at the fields that are incredibly popular today: they either make a lot of money, offer a good lifestyle, or both…. We want to have free time outside of our careers. We want to have families and relationships. Sure, we’re ready to make sacrifices, but we weren’t told a lie–or maybe we just never believed it.
The thing about medicine, like many things, is that you don’t really know what it’s like until you actually work as a physician. No one really knows what it’s like to work thirty-hour days until you actually work thirty-hour days. No one really knows what it is like to witness a patient die until you actually see that first patient die. No one really knows the feelings of incompetence, fear, and frustration of an intern until you’re an intern. No one really knows just how much paperwork there is until you’re the one who has to fill it out.
And, of course, no one really knows what it is like to help someone get better—whatever that may mean—until you’re the one doing it. No one really knows what it is like to sit with someone who is dying and offer comfort when that is the most desired course of action. No one really knows what it is like to have ongoing relationships with people and play a significant role in the optimization of their health until you see them healthy (if not healthier), year after year.
Edwin Leap writes of a former expectation that medicine would provide everything—financially, emotionally, cognitively, socially, etc.—for the physician.
Graham Walker writes of a current expectation that medicine can provide some things, but not all things, for the physician. He expresses confidence that we have the time and capacity to find satisfaction elsewhere.
Both expectations continue to compete—if not clash—in the current practice of medicine. There are still those physicians who insist that medicine is a life calling and express disapproval for the younger generation of physicians who seek well-rounded lives. Some of these physicians are the supervising attendings for the younger generation.
The work in medicine can be consuming. Though most of us soon learn that humans often heal in spite of, not because of, our efforts, patient and physician can collude in the belief that the physician is actively “doing” something to help the patient feel better (again, whatever that may mean). Physicians, for the most part, are nice people—they think and worry about their patients. Sometimes, that consideration morphs into guilt and though we may “want to have free time” and “families and relationships”, we find ourselves pulled into the belief that we are squandering our skills and potential if we are not tending to our patients (through direct patient care, reading, studying, etc.) as much as we can.
There are a lot of interns (and residents) out there who are working many, many hours per week who berate themselves for not reading “enough”. “Enough” is always more than what the intern is currently able to read.
And though it is true that medicine is a just a job, the job description of a physician often means different things to different people. There may be misalignment of expectations between patient (”the doctor will fix me”; “the doctor is a quack”) and physician (”there’s nothing I can do to help this person”; “this person won’t follow recommendations that will probably improve his health!”). Merriam-Webster defines medicine as
the science and art dealing with the maintenance of health and the prevention, alleviation, or cure of disease
That’s a really vague definition. It encompasses many different things.
Furthermore, when people ask doctors what they do for a living, how many physicians say, “I work as a doctor”? Medicine can overwhelm our identities, which is why most physicians say, “I am a doctor.” (Indeed, that may just be semantics, but the words we use reflect the thoughts we have.)
I mean no condescension or disrespect to Graham when I write that it is challenging to achieve all the things you want in your life while working as a physician. The population that enters medicine tends to be full of ambitious types who do boast a variety of interests. As trainees, at least, it is difficult to balance all of these pursuits. Because of the amount of time physicians in training spend at work, other interests—hobbies, relationships, etc.—can easily fall by the wayside. Sometimes, we purposely choose to direct our energies towards our non-doctorly lives to re-establish equilibrium… only to sense (later) that we are letting our patients (and ourselves!) down because of the shift in our priorities.
The point of equilibrium constantly moves.
Maybe the lie for the younger generation of physicians is that you can work and play.
We shall see.
18 Feb 2008 | 8 comments.
The Orchid.
Sprawled across the table were the heads and arms of tired men: Their foreheads rested on their forearms in an effort to limit the amount of grey light that trickled into their eyes through the windows. Styrofoam cups half full of cold coffee dotted the table like chess pieces in the midst of a game. The men who were awake were slouching in the plastic chairs, appearing about thirty pounds heavier due to the multiple shirts and jackets on their bodies. Their tired, red eyes cast a cursory glance over passing individuals. They frowned.
In the corner, a group of three women engaged in asymmetrical conversation: An overweight woman wearing a faded white tee-shirt splattered with stains resembling coffee and ketchup pontificated to a young lady with pigtails, acne, and several missing teeth. The third woman, a brunette with glasses that occupied half of her face, occasionally looked up from her newspaper to nod at the orator.
The women afford greater protection within the homeless shelter if they remain in groups.
The floor, though freshly mopped, did not appear clean. The soles of those within the shelter had tracked in the grunge and frustration of the city streets. The Seattle cloud cover prevented any beams of sunlight to illuminate the space. The walls were a drab hue of institutional beige and discolored from years of abuse from overstuffed bags, heavy shoulders, and disgruntled fists. The fluorescent lights overhead drained any remaining color from the space and harshly illuminated the emptiness within.
People stared listlessly at the walls, waiting for the time to pass.
On a table sat a white orchid. It captured the attention of everyone who walked past. They all slowed down, mesmerized with the flower’s audacious presence and silent beauty.
The slender plant gracefully arched forward from a small plastic pot. From its green-brown stems bloomed soft white flowers, each petal reminiscent of a rising full moon. The blossoms looked out in all directions, like the curious eyes of young children examining the world.
Everyone looked away. Such innocence did not belong there.
16 Feb 2008 | 3 comments.
Connections.
Eric died the weekend after we graduated from high school.
I didn’t know him that well. He and I had known each other since seventh grade. His distinguishing feature was his height; he towered over his male peers as a freshman and was well over six feet tall at graduation. He surfed. He had dirty blonde hair. At some point, he dated the most popular girl in school (before she was deemed the most sexually promiscuous girl in school). He didn’t say much, though when he did, people laughed at his cynical humor.
He looked handsome in his royal blue graduation cap and gown on Friday afternoon.
I heard that, on Sunday morning, Eric simply didn’t wake up. He was 18 years old and slated to attend a respectable university in California.
Right when we were all about to manifest the platitudes contained within the high school commencement speeches, he died. Now he only lives in our faded memories.
Sometime in elementary school, a teacher asked the class to produce an “about me” book, which included pages about our respective pasts, presents, and futures.
I recall tearing off the perforated edges from the paper from the dot matrix printer and inserting the page about my future into the book. I had it all planned out: I was going to attend Stanford University for my undergraduate degree, obtain my medical degree from some other uppity school, and become a family practice physician (or maybe internist; the distinctions weren’t clear to me then) somewhere in California. My past, present, and future would all be in the Golden State.
My life has totally not gone according to plan—and not that I’m complaining. Yes, I attended medical school and am now a physician; this much is true. However, had someone told me when I was 21 years of age (the oldest I ever projected myself; I never thought, “What will I be doing when I’m 30 years old? 45? 60?”) that, in the future, I’d leave California, end up in Seattle, become a psychiatrist (!), swing dance, publish my writing online to an audience of hundreds (!!), take up running, develop an identity as a teacher, meet and befriend amazing people, and relocate to New York City (!!!), amongst many, many other things—I’d laugh in disbelief.
I’ve led a remarkable life. I don’t say that out of vanity. I am grateful for and incredulous at the numerous opportunities and fantastic individuals that have entered and shaped my life. I am very fortunate.
I recently sent out a note to those of my friends who run in Seattle, inviting them to join me in running my first 5K race in April.
A dancer—a guy I enjoy dancing with—zapped back a response, expressing interest in the event. In addition to informing me that he “run[s] 5Ks in [his] sleep” (I certainly don’t!), he noted my absence at the weekly dance.
That was nice.
The connections that we make and share with people are what enrich our existences and imbue our lives with meaning. This is why I remember Eric and my elementary school teachers (especially my fourth-grade teacher, who is one of the best teachers I ever had). This is why my dear friends from the past and I continue to chase each other down, regardless of our peripatetic ways. This is why we want our friends and family to visit us should we be in the hospital, instead of our brokers and accountants.
This is why I feel deeply sad about leaving Seattle.
15 Feb 2008 | 1 comment.
Seen and Heard.
>> The hospital operator announced four codes in the span of forty-five minutes. This means that in less than one hour, four people were actively dying and, to use the passive voice, assistance was requested to help prevent the irreversible.
Four codes in forty-five minutes is impressive. There is only one “code team” in the hospital and though not all members of the team are necessarily required in a code, each code can last anywhere from ten minutes to over an hour. Thus, four codes taxes the code team system.
The first code was in the lobby of the hospital. (Not a good place for a code.)
The second was on a medical ward of the hospital.
The third was on the same medical ward, but seven rooms down.
The fourth was in one of the intensive care units.
The operator sounded non-plussed by the third code.
>> In the cafeteria, a woman was carrying a tray that held what looked like a grilled cheese sandwich (mmm…). As she passed by the shelf of cookies, her walking speed decreased and her eyes surveyed the confections. Turning away, she resolutely murmured, “I do not need one of those.”
>> A female physician, long white coat ballooning open, stealthily crossed a hallway and entered a restroom. The door was clearly marked “MEN”. This classification did not phase her. Before the door closed completely behind her, however, she suddenly lurched backwards and re-opened the door. She was grimacing.
>> Two people were guiding an empty gurney out of an elevator. The gurney did not initially clear the elevator doors. The two people attempted to steer the bed out again, this time with success. After making a wide left turn, they guided the bed to turn right into the main hallway. The right side of the gurney then bonked into the corner. They backed up the bed again and completed the turn. Like an obstinate shopping cart, the gurney began to veer left, despite their best efforts to maintain a straight path. The bed then banged into the left wall of the hallway. To compensate for the bed’s deviant tendencies, they purposely oversteered the bed to the right. The bed then collided into the right wall.
>> Written on the ER board: “Drumstick versus eye.” It was unclear if the eye injury was due to a stick used with percussion instruments or a poultry leg.
13 Feb 2008 | 1 comment.