Playing Doctor


The words by now flow off my tongue. “I’m Sarab, the fourth year medical student” comes off in a rhythmic flow without a second thought. My position is comfortable, even simple. I am expected to be there, participate to some degree and occasionally know the right answer- I am after all, a medical student. So, I zone out during rounds, disappear for hours at a time and do my own thing- it’s not like anyone is depending on me. Gotta love play time.

I’ve been playing doctor for quite awhile. The thrill of wearing a white coat has subsided as the white coat has become progressively less white. I’ve been seeing patients, examining them, making plans and presenting for almost two years now and it’s all second nature. I look, think, plan and suggest. Other people watch over it and agree. The scary part is that in 70 days I’ll graduate medical school, and I won’t be able to play at being a doctor anymore. In 126 days, I’ll be a resident in Emergency Medicine.

The complacency and comfort of my current position only adds fear to the change that is to come. In a few short months, I’ll be putting an MD after my name. In a few short months, I won’t be the ignorant medical student- I’ll be the ignorant physician.

My future (hopefully) program chair said it best- the only person who should call you doctor after you graduate medical school is your mother. You learn the basics of medicine in medical school. You learn to practice it in residency. For the first few months of your residency, you’re watched like a hawk as like a newborn foal you start to find your feet, wobbling and falling a few times. You’re watched for your safety and your sanity- the sudden onslaught of responsibility and consequence to your actions can be terrifying. More importantly, you’re watched for the safety of your patients. I’ve been told that until your second year of an EM residency, you’re not really a doctor. I guess my playing days aren’t done yet.

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The Evolution of a Medical Student


At this moment, I’m on the top of medical student evolutionary tree. I’m a fourth year, strutting my stuff in the hospital and casually describing intubating, sticking and poking people. A few days ago, I got to run a book discussion for the new first year medical students.

As I walked into the medical school I walked down memory lane a little. I relived the boring hours of my first years orientation and how little it oriented me to medical school. I relived the shock of my first day of anatomy, and how I was told to “go read” since my group didn’t dissect that day- but I had no idea what to read… I remember how I felt, going from a cocky, confident, relaxed college student who was big fish in his little pond to a medical student who was surrounded by people who were smarter and studied harder. I remember the feelings of inadequacy when I didn’t get an honors grade on an exam, or it seemed that my peers were so much more clued into a concept than I. I remembered feeling like I didn’t belong- that somehow I’d crept into medical school and would be discovered and laughed out.

I recalled how magically in my third year of medical school, when I was seeing actual patients my strengths came out. I could talk to people, get a good history, make a solid differential and decide how to work them up. I could explain in non-medicalese why I thought they needed something and work with them when they didn’t want it. I remember beginning to enjoy going to the hospital, feeling like I was where I could do good work, where my actions and my words meant something. I remember the first time I was called “Doctor” in the hospital and how I meekly responded, I’m just a medical student.

I remembered how in my recent Emergency Medicine rotations, I was being given great autonomy and freedom. I could confidently walk into a room of someone who was sick and make decisions to make them better. I had acquired the skills to take care of people- diagnosis, treatment and decision making. I remembered most recently when I was leaving the room of a woman who had come in with abdominal pain how she had said in parting to me, “Thank you doctor” and I had smiled in return as I walked out not correcting her.

If you told my first year self that I was going to be who I am now in a few short years I’d have reacted in disbelief. At this moment I can scarcely believe that I was once that timid, that new or that scared.

I told the new first years some of this. I doubt they believed me. But maybe in a few years when they’re looking back at their beginnings they will.

Oh, and in terms of advice for you first years, here it is. Watch “Dead Poets Society”. Then you go and carpe the hell out of that diem.

Emergency Medicine from the eyes of a novice

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Having a week of my Emergency Medicine experience under my belt, I’m sure I totally qualify as a veteran.

With my novice eyes-here are some observations and thoughts.

1. ER Docs aren’t your family docs or internists: Just yesterday I saw a lady with a slightly elevated blood pressure who’d been sent in by her visiting nurse because she hadn’t taken her medicine and needed a checkup. Talking to the patient revealed that she needed to follow up with her PCP who she’d not been able to see in a few months, and the nurse had figured that the ER would do that for her. The thing is the ER is a place for emergency care. If you’re having a heart attack, a stroke, delivering your baby, got hit by a baseball bat you need the ER. If you need a checkup and the wait times are too long at your PCP then the ER isn’t the best place for you. Between the traumas, the people with heart attacks and strokes and all the rest you’re not going to get the care you need.

2. Emergency Medicine is based on treating or ruling out emergencies: If you’re entering your EM rotation your attending wants two things from you on the differential- the bad things that could kill you and what it probably is. They’re far more worried about your chest pain being a heart attack and ruling it out before they send you home, consequently what could likely be something benign like a strained muscle can be treated once we’re sure it’s not a heart attack.

3. Not every patient in the ED will have (or needs) a diagnosis: As gratifying as most physicians find it to get an answer they can hang their hats on, the ER is often not the place for it. You’d like to, in an ideal world, figure out what’s going on with a patient but realistically when there’s a 3.5 hour waiting and 40 patients outside in the waiting room with a couple of traumas rolling in and the guy in bed 4 actively seizing you prioritize. That ends up leaving some of the things that need to be worked up on an outpatient basis as just that- waiting to be worked up outpatient. The ER is an incredibly expensive place to receive medical care as is the hospital in general so ED physicians try to judiciously use resources.

4. Sometimes people will hate you: The ER is a busy place, and there are always people you’ll be admitting. Often when you’re admitting someone to a service the resident on staff may be flabbergasted that your history and details didn’t include a more detailed family, social or physical exam- and that’s fair from their perspective. The problem comes, from an ED perspective a lot of those questions and answers won’t change an initial management. Secondly, anyone who’s causing your already busy workload to increase is likely not going to be your favorite person. For that reason, you may have the odd consultant who doesn’t jump for joy each time you call. That’s okay though. As long as the patient ends up being cared for.

5. Emergency Medicine is heavily weighted towards management:  Something I learned the hard way in a simulation session is that EM is a heavy management specialty. The traditional paradigm is for one to get a history, do a physician, collect an assessment and make a plan. In EM- you start with a plan then you keep going. And you modify your plan as you go. It seems rather obvious but if someone is coming in with chest pain that could be a heart attack you don’t want to spend 30 minutes getting a history and physical while the guy is actively losing heart muscle. Obvious it may be- it’s often challenging to make the switch from sitting and talking before you’re touching the patient and doing things to them. That said- 1 week in I’m already beginning to talk to, examine and treat my patients simultaneously.

 

In case you were curious I’m going to go into EM. Aka:

12 medical specialty stereotypes

 

 

 

 

 

 

 

 

 

A Labor of Love

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I stood in the room, gowned and gloved, waiting for the woman to push. There was a thin trickle of sweat running down my back where the bright lights of the delivery room were trained. The baby was just short of the pubic bone, nearly ready to be born.

The mother-to-be had been pushing for hours and was exhausted. We watched the strips that recorded her and her baby’s heartbeats—each time that she pushed, her heart rate spiked to more than 170 beats/min and she closed her eyes and blew the air out of her lungs as we urged her on. “Push. Push. Push.” “Breathe. Breathe. Breathe.” We continued, our implacable rhythm timed to the clockwork contractions of her uterus.

Her exhaustion had caught up with her; I could read the defeat in her eyes as she whispered to her husband, “I can’t do it.” He smiled into her eyes and whispered back quietly, “Yes, you can.” My eyes were transfixed by this private moment between husband and wife, for all intents and purposes alone in a crowded delivery room, oblivious to the five other people standing around.

My hands moved on autopilot, assessing the baby’s position, a job my eyes should have done, as well. I stood there, doing what I was supposed to by habit—this was the fourth delivery that I’d done, after all, and I was a 5-week OB veteran. I stood there watching this moment, this beautiful, private moment, and some of life’s mysteries became clearer.

It was suddenly apparent to me how much I’d given up to be the one bringing this couple’s baby into the world. The fact that I could be welcomed into this intensely intimate moment and thanked after I’d done my job attested to the value of the profession I was joining. But in this moment, I wondered, at what cost?

This couple was a few years older than I. They had been married since they were my age and were having their first child now. They were madly in love, had jobs that fulfilled them, and were bringing their first child into the world.

At that moment, I had one purpose, one raison d’être, one thing I was searching for—that obsession, that passion, was medicine. In pursuit of it, I’d given up my hours, my sleep, my financial future, my social life, and my relationships.

My family was thousands of miles away, rarely seen and always missed. My friends were languishing, with unreturned phone calls and text messages on my phone, forgotten among 14-hour shifts and minutiae that needed to be memorized for each rotation. My love life was challenged by my constant lack of time and impossibly high standards—not to mention my jealous, unforgiving mistress named medicine.

She pushed again, and I snapped back to the here and now. Her son was crowning, and my hands moved automatically. I checked for a cord around his neck, pulling him out of his mother’s womb, one arm at a time. He was born from a warm and safe womb into the cold and lonely world he would now inhabit.

I swaddled him in blankets and placed him on his mother’s chest as his parents stared at him with love, drinking in the sight of his fingers, his toes, his perfect little features. I finished my work quietly. They thanked me warmly as I left the room and ripped off my gown and gloves as I went, their eyes never having left their beautiful baby boy.

I smiled as I left their delivery room, lost in my bittersweet thoughts. I kept walking because my shift had been done 20 minutes ago. I walked to a house filled with books about medicine and the tools necessary for its practice—stethoscope and white coat among them. I walked to an empty house and an empty bed. I was on again in 9 hours.

Ann Intern Med. 2014;160(9):653. doi:10.7326/M13-2673

The Things They Carried: An MS3 Story

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Having just finished my third year here are the things that made my life easier.

1. Comfy shoes: Try walking around the hospital on rounds for >4 hours a day and standing in one place in a pair of uncomfortable dress shoes. I dare you. I can’t even imagine how it would be in heels. Buy yourself some comfy shoes for work. I use rockports when I need to be dressed nice and a good pair of sneakers for when I’m in scrubs. Invest in them- your feet will thank you.

2. UpToDate Mobile: You can signup for an uptodate username and password at any hospital computer and download the mobile app. If you’re not familiar with uptodate it’s the best way to quickly educate yourself about relatively recent guidelines, pathophys, treatment etc. Keep it on your cellphone so you can read whenever you get a second.

3. A stethoscope belt: Stethoscopes can be heavy. Wrapped around my neck it started making me stick my neck out like a turkey. Around Thanksgiving that’s a dangerous thing to look like. A stethoscope holder may not be the most fashionable thing around, but a few days in the hospital will make a sartorial slob out of any fashionista.

4. Snacks: Keep your white coat well stocked with snacks. You may prevent a hypoglycemic coma on Surgery, OB-GYN, and Medicine.

5. A gym membership: You need to stay sane in MS3- it’s busy and you’re going to need things out of medical school you can focus on. For me that was the gym. It was my endorphin rush, my cleanser and my calmer. Do what makes you happy dude.

6. Books: Walk around with the books you might need on your rotation. They’re specific so expect a post to follow later, but a good one year round especially around Step 2 time is USMLE Step 2 Secrets.

7. Reference Guides: Everyone suggests you buy the “Green Book” (used to be Red, now is purple). It’s the Pocket Medicine series and was questionably useful on medicine. Buy it if you’re really keen.

8. A credit card in your ID holder: Your stomach will thank you when you’re in the cafeteria with 10 minutes to eat between OR cases.

9. Pens: Black for the hospital- no blue. And keep your nicer pens on the inside. An attending or resident can snag a pen and “forget” to return it…

10. Fresh socks/Undies/Toothbrush: This one should be self explanatory- but post call- these are amazing.

11. Gum: If like me you’re prone to the sleepies especially after 4-5 back to back OR cases while sitting through a fascinating lecture on the biochemistry of transplant rejection- have gum in your pocket. Or your attending WILL make fun of you.

12. Someone to complain to: We complain. That’s what we do. We complain about our lives, the slights both real and imagined that we endure and the futility of our positions. You need someone to complain to- or lots of someones. So keep friends, significant others, classmates, parents, everyone handy. You’ll need them.

This will be one of the best and worst moments of your lives. My two months on IM was the most educational experience in all of medical school. The year will transform you from a bumbling and eager to please second year into a slightly jaded, somewhat educated, rather arrogant semi-physician.

In fact I’d postulate that the bulk of your learning pre-residency happens in this year. Buckle up. It’s going to be a fun (if slightly bumpy ride!)

 

Third Year: A Survival Guide: In memes

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Third year of medical school is a different beast from anything you’ve had before. You’re going from studying the basic sciences in a laboratory to functioning as a part of a healthcare team. You’re expected to truly learn to begin to be a doctor- and by the end of it you’ll be expected to manage patients to some degree autonomously. It’s a lot of work, a lot of fun, a lot of misery and just a lot- all at once. So with that in mind here is what to expect- #whatshouldwecallmedschool style.

Third Year

(http://whatshouldwecallmedschool.tumblr.com/post/80871300029/medical-school-in-a-nutshell)

This is going to be you much of third year- sprinting around the place, going nuts and basically losing your mind. Live with it and own it.

That said, the biggest thing that worked for me in third year was confidence and trying to get comfortable. Some people and some places have this idea that medical students just sort of stand around like part of the furniture. And there are those who do that!

I’ve found that the people you work with and work for- attendings, residents, interns, nurses and above all the patients appreciate you trying to do things. So when you’re asked a question, answer it with confidence (not a question). Surgeons especially hate that. If you’re not sure, start talking about what you think is going on- typically someone will cut you off if you’re rambling. But if you see someone starting to fall over asleep you should probably stop.

Don’t be afraid to get your hands dirty and do things. In my third year, I’ve delivered babies, opened incisions, stapled heads, done ABGs and placed more Foleys than I would ever want to. The reason I got to do those while some of my colleagues didn’t is that I asked if I could!

Even when you’re on a rotation you’d NEVER ever want to go into- try to learn something.

On a psych interview

What I tried to do (most rotations) was pick one thing or one skill set I’d like to learn that I found interesting, was cool, or could help in me in my future field of choice. And then go out and try to get good at it.

So on OB, I learnt to deliver babies, and do cervical exams. The only way I got to do those is by letting my residents know that I wanted to learn and do those things, and them being nice enough to let me. But still- try!

 

Also, some residents may in general be not the most interested in teaching- that’s the luck of the draw. And that’s okay.

 

 

 

The other thing is prepare to do a good impression of a piece of furniture in some situations.

“This is my medical student”

My favorite is when you’re rounding on a team of 10 people, you all squeeze into a patient’s room and then you’re introduced in an offhand fashion as you have to half sit on the patient’s grandmothers lap.

Though seriously, people don’t really hate medical students. They know we’re learning, that in a year or two, or three we’ll have an MD or a DO after our names and need to take care of them. And most are okay with us learning on them.

It helps if you are comfortable, a little charming, and not totally creepy- a high bar I know.

It’s okay being the wall, but if you’re comfortable introducing yourself do so.

And with that we’re back to confidence. If you want third year to go well, be confident. If you’re not, fake it- till you feel confident and comfortable. The hospital is an alien environment for everyone initially, but if you want to be seen as a better medical student (and one of the most important things for anyone evaluating you is how you interact with those around you)- for two med students with the same thoughts, grades and physical appearances- confidence can make one seem a far better physician to be than the other.

 

As I round off the remainder of my surgery rotation and consequently the last rotation of third year, expect some more gems like the ones above. And if you’re interested in medicine/ in med school/reminiscing about the torture that is med school dive into #whatshouldwecallmedschool. I’ll leave you with a link to one of my favorites.

http://whatshouldwecallmedschool.tumblr.com/post/81984496130/welcome-to-third-year

 

 

 

 

‘I HAVE NEVER VOTED. MAYBE THIS TIME I WILL, FOR THE NEW GENERATION’

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My name is Reba. I think I am 37.

The village I was born in, a few hours out of Kolkata, is one of those places nobody knows about. You don’t come to know about it even when you walk through the middle of it. And it’s for that reason that I have no voter card, no ration card, pretty much nothing. So I have never voted.

I have four children. Three daughters and a son. Today was a difficult day. While cutting vegetables at one of the nine houses I work in as a maid, I cut my hand. A nasty gash. I poured water on it and pressed it with a damp cloth until it stopped bleeding. But by the time I reached the third house of the day, the strong phenyl and acid combination I used to mop the floor had infected my wound. I blinked back tears and carried on. After 13 hours of work, with on 15  minutes for lunch, I got home. Instead of collapsing on my bed, I repeated my actions of the day – wash, sweep, clean, dust, cook. This time I was working for my home, my four children, my husband.

Yes, I can see how a lot of you will look at me as soon as I say I have not voted. My daughters — I’ve educated them, one of them is even doing her Bachelor of Arts from Delhi University — look at me the same way. But you don’t understand. You don’t understand that I don’t live in the same world you live in.

You sit in your rooms, debating whether India ought to take a stand against the Naxalites, typing furiously into your laptops about whether or not the price of petrol is inflated. What you don’t understand is that my bicycle and I really don’t care.

I care about feeding my children, I care about helping them escape this torture I’m living through. I care about being able to smile on my deathbed and consider my life determined solely by the quality of life my children live. And nobody actually helps with that. Not one party.

It all sounds very fancy. It all sounds as if they have these grand schemes to help us, but that’s all they are: schemes. I don’t vote because even though I now have an Aadhar Card. Even though my daughters are educated and smart and talk of how important it is to vote, I’m jaded. I’ve been sidelined, ignored, forgotten by the entire political scene. So much so that I don’t ever remember being part of it.

My daughters say I cannot complain about my politicians if I don’t vote. That I can’t talk about a broken system if I don’t do anything to change it. But to me, voting for the politicians here is as useful as voting in Bangladesh – inconsequential. They make big promises, these big men, but I’m no longer affected.

Perhaps my attitude is defeatist, but you tell me this: what child is born with that attitude? We’re all born clean slates. Take something from that. Look at why I am this way. It’s because of a lifetime of disappointment.

The new generation is full of hope. The new generation is full of fire. And maybe this time I will vote. Maybe I will, not so my life gets better, I have given up all hope for that ever happening. But for the new generation. I pray the politicians won’t turn them into fragile, cynical things. I don’t know whom, I don’t know how, but I’m praying for somebody, and this time maybe I’ll do it with a ballot in my hand.

As told to Saba Sodhi in Noida, Uttar Pradesh. Reba, who requested partial anonymity, spoke in Hindi and Bengali. This interview has been translated, condensed, and edited for clarity.

Photo credit: Vishal Darse

The Other Side


http://www.consultant360.com/articles/other-side

 

An article I wrote that just got published in the Consultant.

 

The Other Side

Citation:

Consultant. 2013;53(8):572

 

“The boast of heraldry, the pomp of pow’r,
And all that beauty, all that wealth e’er gave,
Awaits alike th’inevitable hour.
The paths of glory lead but to the grave.”
                                                               ~ Thomas Gray

The Medical Student

The EMT pushed the gurney into the emergency room, rattling off key information. A 23-year-old male—unrestrained back seat passenger—presents with extensive injuries, lacerations, and head trauma secondary to a MVA. The patient has a weak and thready pulse with shallow respirations and poor response to stimuli. He lost consciousness at the scene and did not regain it en route.

I may not have been there, but I know how the scene in the trauma bay unfolded. Surgeons and ER doctors rushed in, gowning and gloving themselves as they rapidly fired off orders. The patient’s pulse and blood pressure were recorded, an IV was started, and the OR was put on standby. In that instance, my friend was reduced to a set of numbers, readings, injuries and conditions. His life—the person he was and what he meant to those close to him—was simply not relevant.

In the ER, one of the residents was probably crushing my friend’s rib cage as he performed CPR. Another resident was likely putting a trache tube down his throat, cursing as it didn’t go in and digging the Mack laryngoscope in deeper. The person running the trauma was standing at the foot of the bed, calling out for the trauma OR to be prepped and asking the hapless medical student to feel for a femoral pulse. And the medical student was probably in awe, albeit slightly scared, at his first hands-on trauma experience.

When they did a thoracotomy, cutting my friend’s chest wide open in a last desperate attempt to save his life, that same medical student was likely slack-jawed behind his facemask. And when my beautiful friend died, that same medical student probably walked away focused only on what he had just seen, memorizing the procedures and replaying his mistakes. How do I know that he likely didn’t spare a second thought on the patient who just died on the ER table in front of him? Because as a medical student myself, I never did.

The Friends and Family

I first heard about my friend’s death from a mutual friend who lived next door to the grieving parents. I remember reading the text as I was walking home from a party, convinced this was a twisted joke. It took me a long time to process through all the emotions and regrets that follow when you lose a friend of nearly 12 years. I was still in that state of shock when I went to the funeral.

This is not my first time seeing death. In fact, I met my own human cadaver on the first day of medical school. I’ve worked in the ED and seen many patients with severe injuries. I too was amazed the first time I had to slice open a patient’s chest or search for a bullet inside the body of a patient with a gunshot wound.

Yet, as I stood at my friend’s funeral, I found myself questioning my own ethics. As a medical student, the grislier the incoming injury, the more excited I found myself. Was I wrong to objectify my patients in the service of learning? I struggle to bridge the dichotomy: In the ED, traumas were fun and fascinating, but when the tables turned and my friend was the patient, trauma was heart-wrenching. And as I stood at my friend’s funeral and shared stories of our time together, I thought of all the forgotten patients who I treated in the ER. And in that moment, I realized I hated myself and who I had become.

Learning to Compartmentalize

I began to feel like each time I had taken a case, I had systematically ignored the patient a story, a life, and an existence that was so much more than a set of vitals and a 3-line synopsis. I realized that I had left the human element out of my work. In doing this, I had reduced my patients to a series of vitals and a set of conditions to be fixed. And even more so, I remembered them only for the education they gave me—i.e., the first IV I inserted, the first patient I practiced CPR on, etc. It was callous.

But, I also came to the realization that, in those moments in the trauma bay, the meaning of a life has to be secondary to the immediate necessity to save a life. If we can save the body, then we can give the whole person a second chance.

For the doctors who work in trauma day after day, death is another member of the team. It often times is a conscious decision to stay emotionally distant from every person you treat. And, as a medical student, isn’t it good that we look at trauma as exciting, for that is what drives our interest in learning how to diagnose and treat serious cases? In some ways, objectification is a necessary evil to ensure the survival of medical knowledge.

I remember the agony I went through losing my friend and recognize that it is a pain that I cannot tolerate daily. Distancing myself is a way of self-preservation. So, I do not feel guilty when I reduce my patient’s lives to a measly 3 lines. But, I do the best I can to make what is one of the worst moments of his or her life a little more comfortable, a little better. I hope someone did that for my friend.

 

The Goldilocks Conundrum


This was initially meant as a submission to the Gold Foundation. I submitted it to their essay contest on what it means to be a good doctor, on time, but with a blank entry sheet so it was never considered. Clearly, I’m a genius. The title is inspired partially at least by my obsession with the Big Bang Theory. Enjoy!

The Goldilocks Conundrum

When I told people I was going to med school, the first thing I’d hear was “oh, you’ll be a good doctor”. As an idealistic and energetic first year I was flattered every time a standardized patient said that I came across as a good doctor-to-be. Of course, I wasn’t a good doctor- primarily because I wasn’t a doctor. My exposure was to esoteric subjects like biochemistry and physiology- I wasn’t much good to any person in distress. Like my classmates I believed I was going to be a great doctor- all that was missing was clinical knowledge, clinical acumen, and experience.

Now, as a second year med student with almost all of my classroom experiences behind me, I’ve developed a degree of clinical acumen and clinical knowledge. I’m still lacking in detail, and I often mistake horses for zebras- like the time I made a diagnosis of possible Ebola virus in a patient with bloody diarrhea. It turned out to be Salmonella from bad chicken. But, I figure, once I’ve studied up my First Aid and learnt the theory of medicine, I’ll be a good physician. The question remains, who or what is a good physician?

As a naïve newcomer to medicine, I believed a good doctor was someone who not only knew the medicine and the art of diagnosis, but also deeply cared for and was invested in each patient’s prognosis and care. A good physician would put his or her all into a patient, and if the patient didn’t make it, would feel sadness at their loss, yet that physician would get up and do it all over again, a dozen times a day. And at the end of the day, they’d go home and see their loving, caring family and be well adjusted parents and spouses.

Now, I’ve come to believe that image of a good doctor in my mind is flawed. If I’m too invested in my patients, chances are, I’ll become an impaired physician. If that happens, I’ll probably be an alcoholic, or start abusing drugs misbegotten from my own prescription pad in order to forget the people I couldn’t save, the mistakes I made. If I spiral down that path, I’ll likely cause damage the whole way down- to family, friends, and perhaps even patients.

The other path, the one which many doctors take, is detachment. I can choose to look at my patients like bags of organs, with a dysfunction that I can repair or replace. If something fails, if they don’t make it, I can insulate myself enough to not be truly hurt. In this case, I’ll protect myself from self-destructing and perhaps even accrue wealth, prestige and power. The downside is, I won’t be practicing medicine for the reason I went into it. Instead, I’d be functioning as an automaton and a machine- which should be anathema to a physician.

If I were to truly be a good doctor, I’d have to be like Goldilocks. Just right. I can’t be a callous, uncaring person who sees patients as bags of enzymes and organs. Nor can I be completely invested in and care about every patient who sits in my exam room, or haunted by my failures. I need to be able to care about my work, and care for the people who need me, but also be able to let go. I need to be able to separate home from work, and to keep my family safe from my professional demons. I need to be able to go home at night, and let go of the day’s travails and sleep without being haunted. Yet my failures need to inform me, to teach me as a physician, and as a human being.

That’s a nearly impossible standard, especially since we don’t talk about it as a profession. We don’t discuss how to let go- we don’t discuss how in Rudyard Kipling’s words to allow “all men count with you, but none too much”. We are taught everything about medicine, except to express and deal with our feelings. We keep them bottled up inside, unexamined somewhere deep in our psyche. Expressing our doubts, our feelings, our weaknesses is frowned upon, or seen as touchy-feely and weak. So, we repress our feelings and our demons, exorcising them if we must with alcohol and drugs.

A good physician? I’ve seen some of those. I’ve seen physicians who can stand in front of a crowd of medical students and talk about what gives them strength, what keeps them going, their challenges and the pain they’ve felt, and how they got over them. One, a doctor who works in the trenches in the Emergency Room spoke about how every day, he sees people who are terrified, afraid and often having the worst day of their lives. And that his job is to make their worst day a little bit better, a little bit more bearable. He spoke about the cost, about the difficulty of separating work from home, about the losses and failures that haunted him but how every day when he walked into his house and saw his daughter’s eyes, his demons were banished.

The practice of medicine is a truly human profession- flawed, challenging, inspiring and infused with the sadness of mortality and the fear of futility. To practice that art well, may be one of the toughest things in the world. But, if my mentor’s words are true that challenge may also end up being the most fulfilling thing in my life. I’m not a good physician yet, and not just because I’ve not received my MD. I’m still learning, still finding my humanity. That’s a process, a long road I may walk every day of my professional career. So I start my search for the perfect temperature porridge, warm enough to be compassionate, cool enough to remain objective.

Bon appétit.