The full circle

Almost anyone who knows me knows that I went to college to teach English and coach tennis. Those were the two areas of high school where I was moderately successful. I say this because in a high school class of 720 students there are some very high achievers. Fifteen of us grew up to be physicians. There is a least one federal court judge, several lower level judges, and about a dozen attorneys. Many of my classmates are teachers at various levels. In fact 82% of us finished at least 4 years of college and earned a degree. This is from a public high school in the western part of the state. College was expected and most of us found a way to go.

I did not begin my college career believing I had what it takes to get into, let alone finish medical school, so I just thought I would teach. Teaching looked like a good life and I had plenty of role models after 12 years of elementary through high school education. Yet, when I switched majors, earned a degree in biology with a minor in chemistry, applied to medical school and was rejected, I was shocked at what a difficult job teaching high school chemistry happened to be.

For just over 9 months, I read and re-read the chemistry text books. I organized class notes, prepared lectures, made pre-lab quizzes, and graded papers. Even more challenging, I dealt with the behavior of students who were 4 to 6 years younger than myself. "How did the world go downhill in such a short period of time," I often wondered. When I was a student we were never like these students. Or were we? I do vaguely remember the reason I had such a keen interest in college chemistry was because I learned none in high school. Was it me or was it the teacher?

At any rate, just before Christmas of that fateful year as a high school chemistry teacher, when I learned I had been accepted in to medical school, I wept. I cried not for the fact that on my second try I had been admitted into this elite institution to study for a different profession. I cried because the first 4 and one half months of teaching had exhausted me. Now realizing I would not have to continue teaching high school chemistry, I thought I could make it through the rest of the school year.

With this background, you can imagine my chagrin when I receive the residency program's teaching award for this past year. While I was overwhelmed at the thought that twenty residents voted to give this award to me, I was truly overcome when I received a standing ovation from the guests at the graduation dinner. The icing on the cake of this honor was having one of the just graduated residents tell me, "You were just the right amount of hands on and let me do it myself. I felt like I was doing it my way but you know what I was doing and you were close enough that I could call you if I got into trouble."

The past year, removed some thirty-three years from my first year teaching experience, has been an incredible joy. What I have gained from working with and teaching these young physicians as they move toward their goal of becoming obstetrician-gynecologists has more than compensated for anything I lost leaving my private practice. I feel as if I have come the full circle, arriving at a place much like the one where I began. And I realize that having traveled here, the journey has made me appreciate it so much more.

A story

Yesterday, while I was wondering around the grocery store in a post call stupor, my pager went off. Every patient I had seen on morning rounds was stable but there were a new group of residents on duty, so I quickly dialed an unfamiliar number.

"Pathology, Erin speaking," said the chipper voice at the other end. When I identified myself saying I had been paged, she replied, "Yes, Dr. P wants to speak with you."

A very formal Dr. P now on the other end of the line says, "Do you remember a woman you saw in the emergency room on the 28th, M.C.?"

I could remember no such person. "Did she have a D and C or an ectopic?" I asked.

"I can't tell," Dr. P answered. "All I have on the pathology slip is products of conception."

"I know I did NOT admit her to the hospital. What night was this again?" I have been on call 3 of the last seven days. Actually, it has been 4 of the last nine so everything has run together. The name is Hispanic and one night the theme was 'I am very sick and I do not speak English.'

We determined she was in the emergency room on the 28th but never seen by me or one of the OB-Gyn residents. The patient was given my name to follow up but I had yet to have a call from her. Not necessarily a bad thing since it had only been three days but I had to get to a computer and see what phone numbers I could find for this lady who might have a molar pregnancy.

A molar pregnancy is where no fetus develops and only placental tissue grows. This tissue can even spread to other organs such as the lungs and the brain. Patients can get very sick, bleed a great deal, even die if they don't receive appropriate treatment including at times chemotherapy.

Later, at home, I get on my computer and find the patient information. Reading through the emergency physician's notes I see where he saw her and referred her to me. Looking at her patient information I see that she does not have a social security number. She is an undocumented alien.

There is a home number, a work number, and a husband's name and work number. I call the home number first. A man answers. Identifying myself I ask to speak to the patient. He hangs up. Not, "Sorry, you have the wrong number." Just click.

When I can the work number and ask for the woman, I am told I can only leave a message, which I do. Finally calling the husband's work number I speak to him. He understands English but tells me he is not allowed to talk at work and hangs up.

Sure enough, the woman leaves a message on my voice mail from the cell phone of a co-worker who speaks English. I am able to call back and talk with her and make arrangements for the woman to be seen. Is this a HIPAA (Health Insurance Portability and Accountability Act) violation? I doubt it but I worry a bit that I have divulged all this information over the phone to a total stranger.

I am also very upset that the emergency room seems to take no responsibility for the follow up. I understand the task of follow up is over whelming. Even in private practice, where patient want their test results and call daily until the results return, people fall through the cracks. Here I feel as if I am sitting on something bigger than the Grand Canyon with very few resources.

I don't know what the answers are to health care access or to people who are in this country illegally. I do know where these two issues intersect it is extremely difficult to get anything done.

"Happy new year!"

These were the words of the recovery room nurse as I put the finishing touches on orders for a post operative patient at 00:05 or 5 minutes past midnight this morning. Looking at the clock, I sighed, "Well, it is July 1st." Her come back was "Happy new year!"

Yes, it is the first day of the post graduate training year. There are brand new interns, who are also known as first years, signifying their PGY 1 or post graduate training year 1 status. A quote from my past when the PGY 1 designation was just beginning is "They can call us anything they want, we are still working our butts off." This is true. I just did not know it would get worse my second year. I also did not realize the terror I some times felt when I was on call late at night was nothing like the terror I some times feel now when I realize I am truly IT. Yes, I have colleagues I can consult but the responsibility is all mine.

So, at 07:00 there they were in front of the board, new interns. The old interns were now PGY 2s or second years. They sounded as if they had learned a great deal in the last 365 days. The computer was down for an extended period of time and the electronic medical record was a mess as a result but we muddled through the change of shift and as I left an intern was recording the first set of orders which would be signed with a MD following her name.