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.
Saturday, October 30, 2010
Saturday, October 23, 2010
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.
“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.
Thursday, October 21, 2010
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.
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.
Thursday, August 12, 2010
Marginal Zone Lymphoma with Recurring Abscess
This past Monday I met a marginal zone lymphoma patient and his wife. He had long grey hair that looked like it had seen better days and suspenders that one might find on the old college professor. The first question he asked after my attending introduced me was “So where are you from?”
Here in Central Illinois, my ethnicity is a conversation starter for the predominantly white population. Thanks to desensitization, my hairs no long bristle at the broaching of this topic.
Quickly understanding the question’s intent, I skipped the “Chicago suburb” formality and answered, “My parents are from Taiwan.”
“Oh.” he says, “The reason why I ask is because 12-14 of my students are Chinese. I teach piano.” And as he said this, his long, sinewy fingers played the invisible Steinway as fluidly as one could imagine possible.
The bulk of the appointment dealt with a persistent abscess that had developed in his right lung unrelated to the cancer. Though his cancer had remitted, this pulmonary lesion periodically forced him out of commission. We talked about the limited nature of antibiotics and the possibility of surgery. Our patient obviously hated how his illness forced him to cancel teaching. He pointed to his suspenders as evidence of the amount of weight he had lost over the last year.
On their way out, I felt compelled to speak with our patient again. I asked him what type of piano he taught. “Classical,” he answered. “I used to teach at universities.” When I asked him where, his wife quickly chimed it “He graduated from Julliard.” Her voice dripped with the kind of pride that remembers a spouse’s greatest moments.
I briefly told them about my musical background, and how I had a piano teacher who passed away from cancer. Before I could explain to him just how much she had meant to me, I had already begun to recall the bittersweet memories of our final lessons together. Even as the couple walked away, I could feel my dry hands chapped from freshman year gymnastics—because it always started with the hands—and those frustrated admonishments for not putting in the necessary practice. I could hear her pleading yet stern hoarse voice telling me that I needed to stop wasting both her and my time. I remember being at my sister’s condo on Michigan Ave. when I found out that she had passed, and I remember attending her funeral at her suburban Lutheran church, my back pressed up against the brick wall in the rear listening to her son uncontrollably weep in the middle of his testimony.
But of course you can’t tell all of this to a patient because life must go on (and lest we forget, the insurance companies will certainly remind us). As we age, we learn to be content with vignettes—if we’re lucky short stories—from each individual that steps through the door. Our fellow man, therefore, gives us snapshots by which we extrapolate the past, and we, in turn, are endowed with a memory through which we begin to move forward in the present.
And for a moment I found myself speechless, wishing that time would stop and let me ponder all of this further. Unfortunately, time halts for no one, and as we began to move on to the next patient of the afternoon, I gave thanks for the people that imbue our lives with meaning
Here in Central Illinois, my ethnicity is a conversation starter for the predominantly white population. Thanks to desensitization, my hairs no long bristle at the broaching of this topic.
Quickly understanding the question’s intent, I skipped the “Chicago suburb” formality and answered, “My parents are from Taiwan.”
“Oh.” he says, “The reason why I ask is because 12-14 of my students are Chinese. I teach piano.” And as he said this, his long, sinewy fingers played the invisible Steinway as fluidly as one could imagine possible.
The bulk of the appointment dealt with a persistent abscess that had developed in his right lung unrelated to the cancer. Though his cancer had remitted, this pulmonary lesion periodically forced him out of commission. We talked about the limited nature of antibiotics and the possibility of surgery. Our patient obviously hated how his illness forced him to cancel teaching. He pointed to his suspenders as evidence of the amount of weight he had lost over the last year.
On their way out, I felt compelled to speak with our patient again. I asked him what type of piano he taught. “Classical,” he answered. “I used to teach at universities.” When I asked him where, his wife quickly chimed it “He graduated from Julliard.” Her voice dripped with the kind of pride that remembers a spouse’s greatest moments.
I briefly told them about my musical background, and how I had a piano teacher who passed away from cancer. Before I could explain to him just how much she had meant to me, I had already begun to recall the bittersweet memories of our final lessons together. Even as the couple walked away, I could feel my dry hands chapped from freshman year gymnastics—because it always started with the hands—and those frustrated admonishments for not putting in the necessary practice. I could hear her pleading yet stern hoarse voice telling me that I needed to stop wasting both her and my time. I remember being at my sister’s condo on Michigan Ave. when I found out that she had passed, and I remember attending her funeral at her suburban Lutheran church, my back pressed up against the brick wall in the rear listening to her son uncontrollably weep in the middle of his testimony.
But of course you can’t tell all of this to a patient because life must go on (and lest we forget, the insurance companies will certainly remind us). As we age, we learn to be content with vignettes—if we’re lucky short stories—from each individual that steps through the door. Our fellow man, therefore, gives us snapshots by which we extrapolate the past, and we, in turn, are endowed with a memory through which we begin to move forward in the present.
And for a moment I found myself speechless, wishing that time would stop and let me ponder all of this further. Unfortunately, time halts for no one, and as we began to move on to the next patient of the afternoon, I gave thanks for the people that imbue our lives with meaning
Thursday, July 22, 2010
the shrink's office
Perhaps the most depressing part about a psychiatrist's office is that it has become a medical McDonald's serving medication. The time constraints compounded by the medical profession's inherent inability to deal with social problems makes this one of the saddest places to visit. Psychiatry has essentially reduced human suffering to the brain because it is much easier to throw medication at the brain than it is to deal with the complexity of people's lives. The most insidious part of all of this is that patients and physicians alike come to believe in the power of medication.
I try not to be so pessimistic about this but this is what psychiatry has become. You can speak of genetic predispositions, chemical imbalances, or even the glory of psycho- and behavior cognitive therapy but in the end, you are still dealing with a spiritual creature. Psychiatry categorizes disorders with nice lists. Meet 5 of 8 of these conditions for 6 months and you have this episode or that personality disorder. People were never meant to be viewed in this manner. But, psychiatry protests and fights back. It tries to defend its validity with more diagnostic criteria, more brain studies, and more drug trials that show "progress." It kicks and screams while its progeny stare back with their flat, constricted, ghost-like affect.
I try not to be so pessimistic about this but this is what psychiatry has become. You can speak of genetic predispositions, chemical imbalances, or even the glory of psycho- and behavior cognitive therapy but in the end, you are still dealing with a spiritual creature. Psychiatry categorizes disorders with nice lists. Meet 5 of 8 of these conditions for 6 months and you have this episode or that personality disorder. People were never meant to be viewed in this manner. But, psychiatry protests and fights back. It tries to defend its validity with more diagnostic criteria, more brain studies, and more drug trials that show "progress." It kicks and screams while its progeny stare back with their flat, constricted, ghost-like affect.
Monday, July 5, 2010
"home"
I went back up to Chicago this past weekend to spend time with other people's families. One of my high school buddies has to move back to the burbs this weekend to take care of his sick mother. Ironically, his dad and two older brothers are all doctors/doctors in training but for various reasons are unable to be home that weekend. So, my friend, the high school English teacher, was ironically the only one that was able to make it home to fulfill his filial duties. I am thankful that I don't need much to be amused and so I have no problem catching up over running errands for his mom, ping-pong wars, and even the obligatory basement poker night with high school acquaintances. In addition to playing many games of rummy with his mom to help keep her mind off her illness, we even have time to scurry downtown to play some ball with his city friends, which turns out to be an excellent opportunity to remind myself of the extent of my physical decline. Yes, it is 90+ and humid but even I can't blame that for the tightness I feel in my hamstrings.
The next stop this weekend was at my college roommate's parent's house in Naperville, IL. The reason why I am here instead of his place in the city is another family matter--his seven year old cousin from India needs baby-sitting. I am able to spend time not only with my college buddy but also get to see his younger brother and girlfriend who are here for the summer. Not that my friend anticipates having children any time soon, but watching him and his girlfriend take turns reprimanding, teaching, and playing with him gives me that eerie feeling of how fast time has flown by--and as if I didn't need any more reminders, my college buddy's younger brother is going to college next year.
Third stop takes me about 15 minutes south to my another friend's parent's place to meet more college-bound siblings and another girlfriend/fiance. Dave's family has always been pretty fun to hang out with, but at this point of the weekend, this theme of family (and the absence of my own) is starting to gnaw at me. It's hard to precisely define the exact feeling, but even if I am the type that is always trying to not get boxed into a specific category or group, growing up these last couple years has precipitated a sense of isolation that has caused me to yearn for familiarity and withdraw from initial discomfort of new experiences.
Last stop is to see my nephew and niece. I find myself almost envying their ability to play all day with few worries. Watching them grow up gives me the ultimate sense that time passes quickly My nephew is beginning to cry when it's time for people to leave. He hugs my leg repeatedly and I have to stop my own tears as I turn to leave to drive back to Peoria. I hate to say it but I'm not enthralled about third year--perhaps this is why weekends like this one are so bittersweet.
The next stop this weekend was at my college roommate's parent's house in Naperville, IL. The reason why I am here instead of his place in the city is another family matter--his seven year old cousin from India needs baby-sitting. I am able to spend time not only with my college buddy but also get to see his younger brother and girlfriend who are here for the summer. Not that my friend anticipates having children any time soon, but watching him and his girlfriend take turns reprimanding, teaching, and playing with him gives me that eerie feeling of how fast time has flown by--and as if I didn't need any more reminders, my college buddy's younger brother is going to college next year.
Third stop takes me about 15 minutes south to my another friend's parent's place to meet more college-bound siblings and another girlfriend/fiance. Dave's family has always been pretty fun to hang out with, but at this point of the weekend, this theme of family (and the absence of my own) is starting to gnaw at me. It's hard to precisely define the exact feeling, but even if I am the type that is always trying to not get boxed into a specific category or group, growing up these last couple years has precipitated a sense of isolation that has caused me to yearn for familiarity and withdraw from initial discomfort of new experiences.
Last stop is to see my nephew and niece. I find myself almost envying their ability to play all day with few worries. Watching them grow up gives me the ultimate sense that time passes quickly My nephew is beginning to cry when it's time for people to leave. He hugs my leg repeatedly and I have to stop my own tears as I turn to leave to drive back to Peoria. I hate to say it but I'm not enthralled about third year--perhaps this is why weekends like this one are so bittersweet.
Monday, June 28, 2010
A book opens itself as much as it is read
As a mentioned in my last post, the phlebotomist at the clinic I spent time at was a memorable character. To me, she was a hidden story tucked away in a room between the kitchen and the area where patients were seen--a quiet yet bubbly woman who waddled in and out to get her blood draws. She would spend her free moments burying herself in a novel or knitting a pillowcases as wedding gifts for friends. Whenever I came by, I would trade pictures of my nephews and niece for her children. She always had stories to tell, beginning them as if they were a continuation of a previous conversation. What always struck me was how surprisingly detailed her succinct stories always seemed. Perhaps it was my vivid imagination that gave pictures to her words--images not drawn from prior experiences but perhaps conjured from a separate life that had merged with a collective conscience.
One story that struck me in particular was one that she shared about her mother when she passed away. She and her sister had decided to live with her mom during those last weeks trying all the while to hold themselves together emotionally. Alcohol was as as abundant as the grief. Mom used to bake pastries and pies all the time for the family, it became a family tradition of sorts. So during those last days, the two daughters baked pies for mom and when alone drank in the melancholy of the moment.
When I hear stories like this, my somber soul insists that somewhere therein lies a serenity that supersedes sadness. I can't quite grasp how this is logically possible, but if sacrifice can surrender to salvation, then something about this must be true.
One story that struck me in particular was one that she shared about her mother when she passed away. She and her sister had decided to live with her mom during those last weeks trying all the while to hold themselves together emotionally. Alcohol was as as abundant as the grief. Mom used to bake pastries and pies all the time for the family, it became a family tradition of sorts. So during those last days, the two daughters baked pies for mom and when alone drank in the melancholy of the moment.
When I hear stories like this, my somber soul insists that somewhere therein lies a serenity that supersedes sadness. I can't quite grasp how this is logically possible, but if sacrifice can surrender to salvation, then something about this must be true.
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