Monday, November 17, 2008
My First Medical Blog Post (classic post)
We tell ourselves the stories about our lives that make it bearable….our better yet magical, mystical.
When my father died unexpectedly, when I was seven, I had no words or stories that made sense. How could I explain how this loving father of three and devoted husband could be taken from this earth so quickly and with so little warning. It was a question that puzzled me throughout childhood.
As I grew older I unconsciously formulated the answer to this question. You see…my father died when I was seven years old. At this age, he was my idol. I wanted to be just like him. I copied his movements, his words, and of course I wanted to be a doctor too. My father was a highly respected oncologist and often treated the sickest people. He had received many accolades as well as the love and respect of his patients.
I figure, if he had lived longer, I may have outgrown this period. Maybe I would have reached an age where we fought more or I might have become disillusioned with him. Maybe I would have changed my mind and wanted to be a sports star or a policeman. Who knows? The point is this idea of being a doctor stuck with me. And it carried me.
It carried me through a learning disability; it carried me through a move. It carried me through successes and failures. It created a confidence that never questioned if…only questioned when.
That story made sense. My father’s death, tragic as it was, made concrete in me the idea of becoming a physician. And by doing this I would carry on the tradition and touch countless lives. From his death would come rebirth and renewal. I would help people….I would save lives. I would turn my sadness into good and beauty.
It almost pains me to read this last line. If I had known then how far this was from the truth………………………………
When I started residency training in July of 1999 I felt relatively confident. After all, this is what I was meant to do! I showed up to work early the first day. As luck would have it, I was on call. What this meant is that my first day of work would last 36 hours with very little sleep. The chief physician brought me to the third year resident who was handing over his patient’s to me. This was his last day of residency. I will never forget the phrase my chief used when introducing him. He said, “This is John, your taking over his patient’s. Today is his last day of residency. He can’t be hurt anymore!” My thoughts raced…what do you mean “can’t be hurt”? Who was hurting him? It took me about year before I understood what this meant.
In the second year of residency you learn what it feels like to be independent. You do a minimum of 2 months in the ICU where you function without direct supervision. Of course, during the day there are ICU attendings and fellows to help but at night you are on your own.
One night early in my ICU month I was faced with a situation that changed my life. One of my patients had severe respiratory problems and required to be placed on a ventilator. He was an elderly man and we weren’t completely sure of what was wrong with him. I paged the anesthesia person on call to help me intubate him in case I had problems and then I got started.
But things went terribly wrong. I couldn’t get the endotracheal tube in! I kept trying but it was useless. Furthermore, the anesthesiologist never came. We paged and paged but he didn’t show up. My anxiety started to rise. As I placed the mask on the patient’s face and delivered life saving breadths, I felt out of control. I could feel the confidence leaving. I struggled for a few minutes and finally another resident was walking by the ICU and came in and helped. After flailing for about 15 minutes we finally got the patient intubated. Within in seconds his blood pressure dropped. We started CPR and injected epinephrine without benefit. The heart monitor went flat…..and within minutes he was gone. I held back the tears and rehashed every moment. Had I moved to fast to intubate him? Had I deprived him of to much oxygen while fumbling to get him on the ventilator? Did I over sedate him? I will never know the answer to any of these questions.
The rest of the night was a blur. I didn’t sleep a wink because I was so busy with my other patients. The man’s wife and family came and went. They didn’t seem to have many questions. It wasn’t till the next morning that the phone calls started to come in.
You see…the family was his new wife and step family, he also had three daughters who were unaware of what had happened. I took three calls that morning. I told three young women over the phone that they lost their father. I listened patiently as all three broke down on the phone. I listened to their moaning and wailing. I remembered what it felt like to lose my father. Each call lasted less then 5 minutes. I never met these women in person. I never spoke to any of them again. Each one of them has left an indelible mark on my soul. I have never experienced grief so pure or innocent. And I will always feel responsible for that grief.
And this is what that resident meant by being “hurt”. If you practice medicine long enough you will make mistakes. You may accidentally hurt people. You will work long hours and deal with the bassist human emotions. At some point you either learn to sublimate, learn to move on, or get crushed. When you say that someone can’t be hurt what you are saying is that they can work 36 hours in a row without sleep, deal with not only the annoyances of hospital life, but also the shear fear and sadness, and still at the drop of a dime make critical decisions involving peoples lives. It also means that you learn how to be hard, learn how not to cry. Your drop your emotions and sentimentality to survive. You change who you are.
When I became a physician I unwittingly made this sacrifice for the possibility of the shear good that I could accomplish. I could deal with the stress, the sadness, even the culpability for people’s lives, as long as there was a pot of gold at the end of the rainbow. I could give up the tenderest side of myself, in order to carry on as a physician and not get squashed by my experiences. During residency there really was no place for tenderness!
So that day, in the ICU, amidst the phone calls and the grief I stood at the abyss. I could either let momentum and sadness carry me down or I could step away. At the time, I thought I was choosing life. At that point I didn’t realize that I was lost and that I wouldn’t feel like myself for many years. In fact, I found myself again October 25th, 2004. The day my son was born……..
The rest of my career has been rather mundane. I left residency and joined an internal medicine practice. My days are straight forward. I cram as many patients into as few hours as possible to stay afloat. The malpractice crises is a constant worry. Malpractice prices go up. Physicians are forced to see more patients in less time to cover overhead. The quality of care goes down. There are more law suits…..and the circular trend continues.
People are less happy with their doctors. I often find my patients to be angry and distrustful before they even meet me. There is a constant barrage of paperwork for what seems to be useless reasons. I am constantly being questioned by insurance companies on why I am ordering certain tests and whether I am making the right decision. I so rarely feel like I am helping people!
Physicians are also changing. Because of the poorer income, decreased respect in the community, and family obligations…..they are becoming less responsible for their patient’s well being. The days of your physician meeting you at the emergency late at night in times of need is gone. Most young physicians believe that after the work day is over….their patients are someone else’s concern.
And I believe I would have been okay with this except my world radically changed on Oct 25th, 2004. When my son was born I became a different person. When I looked into his eyes all the barriers that I had erected since that horrible day in the ICU came down. I had found myself again. After years I could feel the warmth return. I could cry again. I could love again. I didn’t have to protect myself any more.
So why was I staying in medicine? It clearly wasn’t making me happy! Why did I give up an important part of myself for a profession that promised so much and delivered so little? Where had I gone wrong?
And what does this say about the state of healthcare today? I had come into this profession with the hopes of helping humanity. I had trained at some of the top institutions in the world. I had received various awards both for academic rigor as well as patient care. I was considered bright, caring, and hardworking. These are qualities you would suspect would make a great physician. But they don’t! And that is the problem.
The story that I told myself about my life had changed. My father’s death had brought me to a profession which I eventually would not like. As my son was born I would come to this conclusion and leave medicine. I could change in time to teach him what is really important. And change I surely had.
But in my heart of hearts, I really tell myself a whole different story. Maybe I truly was meant to be a physician and help humanity and that it wasn’t me at all but medicine……. medicine that had changed.
Either way I realize it is time to change my way of thinking. Who I am and who I will be was neither a result of my father dyeing nor that horrible night in the ICU. It’s time I stopped looking for a cosmic truth in my father’s death and accepted it for what it was….A sad tragedy that will neither define me nor hold me back. It’s time for me to take responsibility and embrace….
Who I have become.
Posted by Jordan Grumet at 6:02 AM