The Bubble Boy

He showed up to his first day of perinatology not sure of what to expect. He was typing notes at a work station when his eyes met those of the attending to which he was assigned for the week.

"Are you with us this week?"
He nodded his head.
"Come along, then," the doctor said gesturing in a somewhat inviting somewhat melodramatic fashion.

And so, just like Jesus called his disciples, the slightly bewildered med student pended his note and followed his attending for the morning rounds. They were soon joined by a resident, a couple nurses, and a nursing graduate student. The rounds started off as benign as any other. Patients were seen, pleasantries were exchanged, and they moved on to the next room. Rounds went quickly with little explanation of the problems and little discussion. This was expected from this attending so the medical student thought nothing of it.

Throughout the day, the attending talked with pretty much everyone in his path. He treated patients kindly, cracked dry jokes from time to time, and went out of his way to try to make sure the nursing student would be able to do the things she needed to do for her schooling.

To the medical student, he said very little, and there was no harm in this in and of itself, but when a group of them would be in a room shooting the breeze waiting for the next patient, it became evident that the attending had very little to say to the medical student. The student in the short white coat thought this to be rather strange for someone who was so cordial to everyone else, and wondered if he had done something to offend the doctor, but could not think of a single interaction that had lasted long enough to even warrant taking offense.

And this continued throughout the rest of the week. The MS3 became increasingly annoyed with the indifference, and found his attending's behavior, in some ways, to be childish. He became annoyed with the whole system of large universities making heaping sums off indebted students for a training that often exposed them to "volunteer" faculty who simply didn't care to teach And, of course, much of these loans were government-sponsored. In some ways, it was a circle of futility. No one person could be singled out and yet everyone was at fault.

and so the week dragged on. Patients were followed, discharged, and admitted. It was a daily grind on the floors with nurses, physicians, even maintenance people, scurrying about, and somewhere, amid the routine of the hospital machine, a single medical student found himself lost within a world of progress notes, shelf exams, and meaningless rounds that went on as if that short white coat was but a ghost of the imagination.

Matthew 26:6-13

And it came to pass that a doctor was on duty at the charity clinic sitting in the office talking with her colleagues when they were interrupted by a nurse

“Doctor, there is a patient here to see you.”
“Oh?”
“Yes, she is in the front right now.”

So the resident left the room and came back several minutes later bearing a fruit basket and a bag of cupcakes.

“Look, the patient I delivered a week ago remembered my birthday and came by with these. Aren’t they beautiful? I feel bad because these are so nice and she shouldn’t have spent money on me like this.”
“Aww, how sweet,” another one of her fellow physicians commented.
“Yeah, and she also had brought me cake and cookies when I delivered her in the hospital. She really shouldn’t have.”
“That’s a nice gesture indeed,” their attending remarked, “Those fruit baskets are really expensive. She probably shouldn’t have even bothered.”

This last physician said this because he knew that this patient had a couple of other children to support and received monthly public aid checks--the same checks that paid for her expensive new cell phone, cigarettes, and the oral contraceptives that enabled her to carouse around with whomever, whenever. Such purchases often left the patient unable to pay her cell phone bill, which prevented the physicians from being able to contact her and follow up during her prenatal care. This was troublesome because her baby had a condition that needed consistent monitoring to ensure that it did not get worse. Of course, all of this was made possible by taxing other economically-burdened citizens who were struggling to make ends meet on a daily basis.

One of the nurses came in to the room.

“Wasn’t she sweet? She even brought cupcakes for the nursing staff. You know, it’s people like this that really uplift our spirits because so many of the people in this clinic just aren’t very grateful.”

And all of them could agree on this. Gratitude was a scarce commodity in the charity clinic. One would think that those without any health insurance would be extremely grateful for the services they received at no cost, but the reality of this situation was that many of them were non-compliant, refused to make lifestyle changes, and would simply come back with a sense of entitlement that would make even the most sympathetic health care provider shudder.

Despite this sobering reality, this was still a day to celebrate and be thankful. The doctor asked one of her colleagues if she wanted to split a cupcake and the other happily obliged.

The efficiency of social medicine

Yesterday I spent time at the free clinic that the ob-gyn residents run for indigenous patients. The last patient we saw that day was a post-menopausal elderly woman who presented with chronic cystocele and rectocele issues. This patient had already had significant spinal surgeries in the past and was wary of the complications involved in the post-surgical healing process. My resident showed a remarkable amount of tact over discussing the option of surgery. From a physician point of view, it's easy to take such delicate matters lightly when discussing patient options. It would be nice to believe that the decision is a simple yes or no decision or as medical people like to put it, "a matter of doing what's best for you," but the cost of surgery is more than a financial one; it is also an emotional and social one as well. Several times over the interview, my resident repeated herself to the patient regarding treatment options and quality of life issues. On one hand, this took more time, but on the other hand, I believe it also played a role in helping the patient make her decision. In the end, the patient still had to weigh her options.

Today, I went to see an ophthalmologist in town to discuss possible cataract surgery. The group here in town has a cushy facility that is a stark contrast to the clinic I spent time in the day before. The place was packed with the elderly. Having had to deal with congenital cataracts growing up, this was an all too familiar setting.

Somewhere in the large waiting room, an elderly lady voice asked a nurse,"Excuse me ma'm. Did they forget about me?"

As I ran through the litany of eye exams--the measurements, the letter charts, the dilation drops--I became increasingly impatient over the whole process. These were the things I had gone through my entire life, but over the past couple years, my failing eye sight had become a bit of sore topic whenever it came up among my classmates who really never understood quite what I was going through. "You really should get those checked out," they would say, or "I think you need glasses or something." These were the words of future physicians of the future. Beware of such "sympathies."

The ophthalmologist was a middle-aged male physician. A brief greeting without the handshake tipped me off that he might have been in a hurry, and as the interview progressed it became even more apparent that he was probably thinking more about the long line of people in the waiting room. He took a look at my eyes and asked me the purpose of this meeting. i told him my concerns and he presented with the surgical options. Somewhere in the conversation, the "doing what's best for you" cliche came out. When I had concerns about scheduling and financing, he referred me to his nurses. When I asked him about recent studies over new lens implants, he said they were "very good." As the conversation progressed, I began to feel hurried in my questions and concerns and increasingly irritated as well. I found myself repeating similar concerns because I sensed a growing anxiety within myself, but the hurried doctor sensed none of this. The interview ended with him getting up before me and having his nurse guide me out the door.

The moment a physician begins to feel or act hurried, regardless of how behind he or she is, you lose the essence of what it means to be a physician. What you essentially tell a patient through your body language or lack of explanation is that your time and comfort is more important than their well-being. Emotions are messy; they are, by definition, inefficient. They do not fit in your 15 minute blocks that a physician constructs in his or her schedule. I have little sympathy for doctors that take on heavy schedules to make more money at the cost of quality of patient interaction, especially in a private practice setting.

Driving home, I realized two things. One, I was going to find another one of his partners to do the surgery. Two, if I ever became a physician, I hoped that I would never conduct myself in such a manner. I understand stress makes people do things they might not normally do, but the doctor left a sour taste in my mouth. It's encounters such as the one I had today that make me even more cynical about the medical profession. Fortunately, for every doc like this one, I have had the chance to be with others, such as the ob-gyn resident, who demonstrate the ideals that I struggle to hold to as I continue in my medical training.