just some things on my mind today

(These are the experiences, opinions and views of the author only and may not reflect those of the majority.)

Just yesterday, I was handed a book on the history of surgical pathology, and in it were some autobiographical notes by one of the prominent founders of the field. And as I was reading about his experiences in medical school and his training beyond, I grew excited. Medicine back then was fun. We are, by the way, in the first half of the twentieth century. I began to compare my education with his and must admit that I am bitterly disappointed. I began to think, what is it that I really learned in medical school? I learned how to read a book and ace a test. I learned how to get up really early and function, albeit maybe not well, in a sleep-deprived state. I learned how to be ignored and treated like I was invisible and be okay with that. I learned how to write a detailed note on a patient, often copied from the previous day with minor changes in vital signs, etc. I learned how to follow directions, obediantly and submissively. I learned how to go through the motions of doing a physical examination on a patient. From an outside observer (the person grading me), it appeared that I knew what I was doing, but I was never taught (with few exceptions) the significance of going through these motions. I learned how to order tests, lots of them and was taught that tests will give you answers. I learned how to wade through massive charts to find information. I learned how to dress, act and talk like a professional, how to wear a short white coat stuffed with books and penlights and papers on which I had scribbled notes, heavy on my shoulders, weighing down my spirit. I learned how to please people, what I had to do to get a good grade and how to make patients happy (usually). I learned how to not get sued. I learned how to say, "Hi, my name is Dr. ____," which may not sound that difficult, but is. I learned a lot. So what am I complaining about? I didn't learn the most important thing (at least to me), that which the prominent early twentieth century physician spoke of in his training, and that is the art of medicine, how to truly examine a patient and solve a problem and think and ask questions. Yes, I learned medicine from books, but not from my patients, with the exception of my short experience in Africa, and yes, I am bitter. I think we can do better. I think we should do better. My experiences in clinical medicine are a major reason why I have chosen to leave it. In pathology, there may not be living, breathing patients, but at least I can still do real medicine. Had I gone to medical school 100 years ago things may have been different, but today this is the best I can do.

desiderata

Go placidly amid the noise and the haste, and remember what peace there may be in silence. As far as possible without surrender be on good terms with all persons. Speak your truth quietly and clearly; and listen to others, even the dull and ignorant; they too have their story. Avoid loud and aggressive persons; they are vexatious to the spirit. If you compare yourself with others, you may become vain and bitter; for always there will be greater and lesser persons than yourself. Enjoy your achievements as well as your plans. Keep interested in your own career, however humble; it is a real possession in the changing fortunes of time. Exercise caution in your business affairs; for the world is full of trickery. But let this not blind you to what virtue there is; many persons strive for high ideals; and everywhere life is full of heroism. Be yourself. Especially do not feign affection. Neither be cynical about love; for in the face of all aridity and disenchantment it is as perennial as the grass. Take kindly the counsel of the years, gracefully surrendering the things of youth. Nurture strength of spirit to shield you in sudden misfortune. But do not distress yourself with imaginings. Many fears are born of fatigue and loneliness. Beyond a wholesome discipline, be gentle with yourself. You are a child of the universe no less than the trees and the stars; you have a right to be here. And whether or not it is clear to you, no doubt the universe is unfolding as it should. Therefore be at peace with God, whatever you conceive Him to be. And whatever your labors and aspirations, in the noisy confusion of life keep peace with your soul. With all its sham, drudgery and broken dreams, it is still a beautiful world. Be cheerful. Strive to be happy. --by Max Ehrmann (1927)

quitters sometimes do win

The sun is once again shining, after months of darkness. I quit the first real job I've ever had. The etiologies were varied and complicated and many. It wasn't an easy decision. My gut had been telling me to quit since the day I started, but my head was reminding me I wasn't a quitter and I had worked exceedingly hard to put myself in this position. Many people would die to be where I was.

I was running along the Cherry Creek one evening when I finally let myself quit. I felt as though an elephant had been lifted off my shoulders. I could once again run fast and free. Many people have called me stupid. These are the people who choose security over passion; the people who are content with mediocrity, who are afraid of uncertainty and change. I am not.

I quit, if for no other reason, than on principle alone. I don't believe people should be treated the way a surgical intern is and continuing to submit myself to their torture methods is only condoning the process and allowing it to perpetuate. Cheers to happiness, health, freedom and sunshine. I'm back.

intern absurdity

I went to four years of medical school to tell people when they can eat. It's not rocket science. I'll even let you in on the secret so you don't have to go through the four years of hell, ahm I mean school, and $180,000 debt part. If a patient is farting and pooping it means his or her guts have woken up enough after surgery so that he or she can eat, hopefully without puking. That's it.

I am essentially a glorified secretary in a long white coat with MD on my name tag. I wander the hospital halls like a zombie, making phone calls, answering pages, writing notes, typing orders, dictating discharge summaries. I'm not really sure why they call it medicine because it's really only about 2.7% medicine, 97.3% crap. And I'm not so into the crap. I want to actually have to think. I want to apply the physiology I learned in school. I want to see it in action. I want to see that I've made a difference in someone's life. Thus far I have been so sleep-deprived and depressed that I don't think I've seen anything.

For those of you considering a medical career, consider this your fair warning...it's not what everyone on the outside thinks.

identity theft

I've been waiting my entire life to fit in and now that I finally do, I'm not so sure I like it. I can no longer tell someone I ran the Boston and expect them to look at me like I'm some sort of god, or better yet, say "what's that?" Instead I get, "Oh, what year? Yeah, that was my 11th Boston. The weather really sucked that year, didn't it? Hey, I'm doing this 50-mile trail run race this weekend...interested?" I no longer get looks of awe and "are you crazy" when I tell someone I went mountain biking for two hours in a hail storm yesterday. Instead I get, "Yeah, yesterday, I did this 12 hour adventure race and then, after grabbing a quick bite to eat, went out and rode for 3 hours in the moonlight with a few of my buddies."

On my way home after a long hike in Rocky Mountain National Park with my cousins yesterday, I decided to stop in Boulder to see if I could still sign up for the Bolder Boulder, a 10K running road race on Memorial Day and the largest of its kind in the nation. As I drove around town for 20 minutes looking for a place to park (which I never found), I was appalled at what I saw: 10 year-olds riding $2000 miniature road bikes to the candy store; every third car with a bike on the roof; beautifully sculpted bodies walking down the street in their chacos; people riding bikes everywhere you turn--serious racers out for their training rides, commuters, dads pulling their kids in buggies... Hey, wait a minute...that's my gig. You can't do that. The more I saw, the angrier I got and I finally had to leave without signing up for the race. Let them have their stupid race. I don't need 40,000 Sarah clones to run with. I can run my own 6.2 miles wherever I want.

I am officially, no longer, crazy Sarah. I am now completely ordinary, below average Sarah. Congratulations. You got what you wanted.

loss for words

I made it home. And I am already depressed.

Today was my first day back in the hospital and I am convinced that there is something seriously wrong with the way we practice medicine here. I never saw it before. I guess because that's all I ever knew. It took me over two hours to wade through the patient assigned to me's charts (yes, multiple--there's the nurses paper chart, the other paper chart, the computer program where you can access all the labs, x-rays, etc, the computer program where you can access the patient's past medical records that have been scanned in, the computer program where you can print a progress note for the patient and yet a different computer program where you can print the changeover sheet.) The patient is taking no fewer than 20 different medications and 10 additional prn (as needed) meds. She has been taken care of by probably 20 different doctors and at least as many different nurses. She has pneumonia and acute respiratory distress syndrome and congestive heart failure and chronic obstructive pulmonary disease and morbid obesity and obstructive sleep apnea and hypertension and acid reflux and pseudotumor and osteoarthritis and a brain aneurysm and bipolar disorder and chronic lower back pain and cellulitis of her right calf and a few other things not worth mentioning. A fancy machine is breathing for her and she is now developing bed sores. She has a tube in her nose that goes down to her stomach so she can receive liquified nasty tasting calories. Her potassium was a little low yesterday so we put some extra potassium in her feeds today. We give her a little of this, go up a little on the dosage of that, and continuing tweaking until she is just "perfect." We will continue to tweak her to perfection until she dies, likely right here in her ICU bed.

Yes, patients in Africa die too. But not like that.

Are we really doing what's best for our patients? Doing "no harm?" Somehow I don't think so.

oh, africa

Africa is kind of like medical school in that it is nearly impossible to describe to anyone who hasn't experienced it. After you've been here for a while, you eventually go from saying why, why, why to why not? Why wouldn't there be a man chasing a goat that is darting back and forth in the street, on your way to work? Why wouldn't there be a live chicken in the front seat of your taxi? Why wouldn't there be a man selling perfume out of a crate on the back of his bicycle at the hospital? Why wouldn't the bovie stop working in the middle of a mastectomy or flies be landing on the sterile field? Why wouldn't there be a viper in Dr. Daniel's house last night, "attacking my son"? (His wife killed it because he is afraid of snakes. Oh, by the way, I live right next to him in a duplex sort of thing. Good thing they have antivenom here at the hospital.) Why wouldn't our landrover get stuck in deep sand and we all have to get out and push for 50 meters? After a while, it somehow all just starts to become normal. You fall into the rhythm of craziness, and just have to say "Oh, Africa" and continue on with your day.