Friday, April 9, 2010

Role models

I am very tired today. No, I was not up all night and I have not been terribly busy today, so I find myself drawn to reflecting here. I have been at this new job almost 14 months now. I am less tired than I was in private practice. I have days where I have a great deal of energy - usually my days off.

I am, however, constantly bothered by thoughts that I am becoming lazy. This afternoon I gave a great deal of thought to taking a nap. I have worked hard not to sleep during the day. I am constantly thinking of ways to be more organized, to get some writing done. I have several projects, one of which is this blog, that I wish to keep up.

It is difficult to write about events after the fact. While I have a vivid recollection of what I saw and heard for days or weeks, the emotions surrounding these events are less intense the following day. It is that emotion which can propel my words across the page. I was incensed today when a general surgeon refused to see a patient with free air in her abdomen (a surgical emergency) until I, the gynecologist had seen the patient for her total vaginal prolapse which has been present for years. She is in surgery as I write this. Consulting me and insisting I see the patient preoperative was a way to buy time. Time for what, lunch? The only reasonable answer I could come up with when I ask myself this question would be time for this 75 year old woman to die.

Free air in the abdomen on an abdominal X-ray means that her bowel has ruptured. It could be from an ulcer or cancer but there is no way around the problem short of making an incision, finding the hole, fixing it, and treating the cause. That is a question any third year medical student on her surgery rotation can answer. Of course this woman is in poor health, she has multiple medical problems, including heart disease and diabetes, and her family is extremely dysfunctional. The scene in the emergency room was one straight out of ... well, it was probably straight out of "ER."

I certainly hope I played my role better than most of the doctors on "ER" or even most of the doctors in this major medical center. I guess today my true job is to be a role model, especially since I am easily the oldest physician seeing this patient. I delivered the general surgeon's kids, which maybe the biggest reason he was willing to listen to me and take this woman to surgery sooner rather than later. I hope my residents and his remember this woman when they are in practice at Elsewhere General in a few years.
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