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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Musings of a physician in private practice for 24 years, now teaching in a residency program and working as an ob-gyn hospitalist in a large metropolitan hospital.
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The Local MD
Having now been a physician in private practice for twenty-one years, twenty-six days and about an hour and twenty minutes, it occurs to me that I have become what in medical school was often a derogatory term, the local MD.The presentation on rounds often went something like: "This 45 year old Caucasian male was seen last week by his LMD, and diagnosed with a viral upper respiratory infection..." At that point everyone knew that the LMD had missed the diagnosis. Otherwise the poor patient would not have ended up in a tertiary medical center with three consulting specialist, a fellow, a resident and four medical students at his bedside.What we, the medical students, the resident, the fellow and even the attending hospital physicians did not realize is that we would never know John Smith as well as the LMD. We would never speak to his wife using her first name. We would never be able to recall the names of all his children and know where they were in the world. We would never remember his favorite hobby let alone joke with him about it. Nor would we shed a heart felt tear when we gave him the diagnosis of the aggressive small cell carcinoma of the lung that had landed him in our midst and would kill him in less than three months despite our aggressive treatment that was the best medical science has to offer.At that point in my life I was very proud to be even the lowest ranking person on the team that was on the cutting edge of the diagnosis and the treatment of the gravest of conditions that plagued mankind. I felt so very lucky that I was being initiated in to this sacred fraternity. That I would soon be able to write "MD" after my name. I am still proud of my vocation yet I believe there is a wisdom that has only come with those twenty-years of practice.Today I realize what people want most of their physician is that he or she is someone who cares.Yes, we all want "everything medical science has to offer." Yet, what most of patients need is someone who will listen with their heart as well as with their head. Physician eyes are important, not only for seeing signs of disease in the body but for making contact with the patient's eyes where we are often allowed to see into their soul. All of the technology in the world will not replace a warm clasp of the hand or sitting at the bedside to share a few moments of the day along with the test results.So, I have created this blog. In large part it is a place for me to put my feelings. My hope is that at least some of these posts will resonate with others out there. Not just physicians, but others in caregiving vocations and even those for whom we care. If we are not here for each other then why are we here?
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