Medicine Archives - Page 5 of 26 - Man, Medicine, and Mike

I read a twitter post this week about a doctor leaving medicine. A lot of people seem disillusioned and discouraged.

My mind went back to Dr. O.

I was 19 years old and thrilled to have a job in the emergency department (ED) at a small hospital near my parent’s home. They hired me as an ED technician. I would get patients from the waiting room, bring them to a bed in the treatment areas, get their vital signs, and take a brief history from them. I would also help do whatever they needed me to do.

I loved it. While college was SN1/SN2 reactions, derivatives/integrals, and memorization of botany classifications, this was real life. I was on the front lines. I got to talk to patients. I was able to touch them, hear their stories, and see their illnesses and injuries. It seemed there was a never-ending stream of interesting things that I saw. I started to gain story after story in my secret internal library.

I made friends with the other people working there. While we were often very busy, other times the ED would be quiet. In those times I could talk and listen and learn from them. Even now I think of all of them as good friends though I have not seen them in over 35 years.

I liked Dr. O, but he was tired and discouraged. He did his absolute best to talk me out of going to medical school. In the quiet times he would sit me down, “You don’t understand. If there is ANYTHING and I mean anything else that you like, do it instead.” “Do you like engineering, or computers? Do that. Do NOT go into medicine.” “You do not understand. Do not become a doctor.”

I don’t know all the details of his life. I don’t know why he was so discouraged. I tried to talk with him, but I was young, and he seemed to be talking from a position of experience and knowledge. I explained that I really loved what I was doing and that what I really wanted to do was medicine. I repeatedly tried to explain myself. But I was quiet and reserved and I don’t think I could communicate it very well. I know that he couldn’t or wouldn’t hear me. I was young and naïve, and he felt that I was making a mistake.

It was awful when I heard that he was gone. The story was that he set up a neat and clean anesthetic type setup for himself. He ended his life. Even now my stomach turns as I think about it.

I don’t know all the details. Depression and death by suicide are always complicated. Depression is such a horrible illness. I am not going to try to explain away his life and experiences and what happened to him. I just don’t have enough information to do so.

But reading the twitter post this week and sensing discouragement in so many people, my mind went back to Dr. O and our dialogues in the ED.

I am about his age now. There are indeed days when it is easy to get discouraged. Sometimes I look at the long rounding list, another full day of clinic patients, or a huge Epic inbox and it is just drudgery and work. Back then it was paper charts. I can remember the stacks of them in front of Dr. O waiting for his dictations. He always seemed to get behind on his dictations.

It is easy for me to get anxious at work. I hate getting behind. Today I looked at my list of patients. I saw one who was very complicated. I saw the name of another who has persistent symptoms despite my best efforts. I clicked to the Epic inbox. Already multiple patient calls and messages.

Sigh. A lot to do. Work.

It is tempting to envy the engineer, the banker, or the computer science person. “If there is ANYTHING else you are interested in…” His words echo back in my brain even now 35+ years later.

It all seems to be worse now.

COVID has created a lot of casualties. So many people have died. Beyond that so many people seem angry and not able to talk and understand each other. How odd that this battle that I thought might unify us has only served to divide people. Healthcare workers are burning out. People are leaving healthcare. Many are dreaming of being “engineers, or bankers, or…” I am hearing Dr. O’s voice on an increasingly frequent basis.

Young me (let’s label as YM or young Mike) calls out in my memory. Old me (let’s label as M for Mike or Me) and YM start to talk. M wants to be cynical, burned out, and envious of others. YM cries out, “I couldn’t help Dr O see it. I still feel it. M – will you hear me and understand?”

YM continues. “I just couldn’t understand it. Dr. O had so much that I wanted and dreamed of and yet he couldn’t see it or appreciate it. He made 20x what I made per hour. He had money and a nice car. He had knowledge. He would call out orders of labs, tests, and things that I had no idea what they were. He was smart. He would prescribe treatments. He would suture wounds. He had knowledge and he was able to use the knowledge to help people. He had people – real people – who needed his help, and every single day he was able to use science and his knowledge of science to help them. Many (most) of them (not all of them but many of them) were very appreciative.”

M begins to remember. YM has his attention now.

YM continues, “It was so exciting to see the patients and all of their problems. I looked forward to every shift. I was young and didn’t know very much. I couldn’t help as much as the RNs or Dr. O or the other doctors. They could do a lot more. But I could get the patients settled, get things for the doctors and nurses and help to hold or position or move the patients. I was happy to just be a part of it all.”

“It was so meaningful. It was real life. It was working on the front lines. It was not sitting in the background. I was a part of all of it. I loved it so much that I gave up every other Friday night and every other Sunday to be there for it. I got paid, but honestly, I didn’t do it for the money.”

M is now very interested. YM seems to possess some extraordinary wisdom. M seems to worry that he has forgotten it. M encourages YM to keep talking.

M: “Tell me more. Why did you not listen to Dr. O? Why were you so determined to go into medicine? If you could have a chance to talk to him again, what would you want to say?”

YM: “Medicine is so cool. It is just such an amazing combination of science and getting to use science and knowledge for good.”

M: “But people seem to not respect science anymore. Just look at the news and internet and the antivax movement.”

YM: “That is not really true. Look at your clinic schedule today. You have a full list of people who are eager for you to use science, your knowledge, and your experience to help them. Do you ever have patients tell you, ‘thank you’ or express gratitude?”

M: “Well, yes I do. But not everyone gets better. Look at my list today. I have got all of these patients to see. I worry that I won’t be able to help them. I worry about not keeping up. It is another full day in clinic with people bringing their problems to me and expecting me to have answers.”

YM: “I would LOVE that. Look at you. You really don’t get it do you? You have years of training and experience. You always seem to come up with ideas about what to do. I know you worry about it, but you do a great job. Your patients love you. I would absolutely love to live today in your shoes. I SO want to be you.”

M: “You are me – or you have gotten to be me. And you are right. I am not sure why I seem to forget. I do really enjoy what I do. I am going to give myself permission to really enjoy today at work. I am going to be sure to feel the excitement and the pleasure of using my training, my experience and science to truly help people.”

A pause.

M: “Thank you. This has been helpful. Can we talk again if or when I need it?”

YM: “Of course. Anytime. And thanks for listening.”

Another pause.

YM: “I wish I could have helped Dr. O to listen.”

M: “I think he had a lot more going on in his life than just his discouragement with medicine.”

YM: “You are probably right. But why is it that people so often only see what is missing rather than what is good?”

M: “You mean, seeing the partly empty cup rather than partly full cup?”

YM: “Yup. 1/10 empty rather than 9/10 full from what I can see.”

M (laughing): “I think you are right!”

I went to the office. I fell behind a few times. I walked out of an exam room half an hour behind. I clicked my Epic inbox. Six new patient calls, 2 patient messages, 8 result notes. It would have been easy to start getting frustrated. But this is who I am. This is what I do. This is my privilege. I kept going. For the next patient I had answers. It was gratifying to be able to help them. The one after that thanked me. She was feeling so much better.

It was a good day.

My patient was a reconsult in the ICU. This was a patient my colleagues had seen the prior week. They had provided input and then signed off (left his care to the Intensivist). He had a complex combination of health problems including heart failure. The ICU team called us to come back and provide further input.

There was not a lot for me to add. I dutifully reviewed his chart and his imaging studies in depth. I then went in to talk with and examine him. He was in his 80s. He had recently suffered a stroke. His speech was slow. He was not completely oriented, but he still tried to maintain his dignity and his identity. His wife and daughter were there and were almost too attentive. They anxiously participated in my history and exam of the patient. They seemed to hang on my every word. I didn’t have a lot to add to his care. I thought of making a quick exit from the room and moving on with my day.

And then I didn’t.

Something happened that changed the whole scene and honestly changed my whole day.

I looked again at my patient, and then at his wife and daughter, and the whole scene in the room. It made me think of my Dad. In that instant, I thought about my father, his times of illness and his times in the hospital. How would it change how I viewed things if the man in the bed were my father? In order to understand I decided to (in a sense) pretend he was my father. Not fully pretend – but just enough to look at him and try to picture my patient like I would have looked if it were my Dad in the hospital bed.

This changed things A LOT. Suddenly there was more to the man who was in front of me in the hospital bed. I could see beyond. I could imagine what he was like before age and illness had changed him. I looked into his eyes and then turned to look at how his wife and daughter looked at him. It was then that I truly could understand. They didn’t see an elderly frail, weak man with so many medical problems. In their eyes I saw reflected a younger, stronger man. I saw someone who worked hard. I saw a solid secure person who was the one that they leaned and relied on.

As a child, I remember being amazed at my Dad. He could do or handle anything. I would struggle to lift the bushel crates of apples (about 50 pounds). My Dad could stack two bushel crates together and then lift both of them over his head. He would do this so that he could stack them in the cold storage higher than any of the rest of us.

My mind drifted to more memories of my Dad. I thought of him navigating the small little forklift around moving boxes of apples in tight areas. He had to wrap a pull rope on the engine to get it started. If it wouldn’t start, he could fix it. He was confident. He could fix anything or do anything that he needed to do. If it needed to be done, he would just do it. I remembered listening to him talk with my grandfather. Together they would work through complex decisions about running the farm.

I thought of him as a high school teacher. He was always calm and always in control. He never seemed to get flustered. He loved to laugh and would get a twinkle in his eye at times. He was a solid reliable figure in the school. Everyone loved and respected him.

My Dad passed away last November. His cancer had aged and weakened him before he died. But when I think of him, I don’t remember that stuff. Instead, I remember him as the strong and robust man who could do anything.

I looked once again into the eyes of my patient’s wife and daughter. The scene was so different than what I initially saw when I first walked into the room. Their facial expressions, their attentiveness, and their questions now all made sense. They could see so much more than what was obvious. I looked back at my patient, and I slowed down. There was indeed so much more there. I suddenly didn’t want to leave the room. My long list of patients and work yet to do didn’t matter as much. We talked more. As we did, I learned more about him. He was truly frail and not able to tell me much, but he didn’t need to. The four of us could now somehow together see a much more full and complex understanding of who he was.

When I left his room, I was honored that I was allowed to be a part of his medical care. I felt better. I’m not exactly sure why. I think part of it was a feeling that what I was doing was important. I had purpose. The person I was taking care of was important.

I decided that it was good what I did in my mind that day. I resolved that I should do it more. Who is the person beyond the hospital and before the illness? What is their world like? What was their world before?

Since that day I have continued my game. I refuse to just see who they are in the hospital bed. Instead, I pretend they are people who have been important to me. Let me be clear. I don’t assume that they are the same as my family or friend that I remember. But if they were, how would I want a doctor to see them, to talk to them, and to care for them? In this thinking of the depth and complexity of my family or friend, I am able to push myself to see more.

Today I was consulted on an 89-year-old with heart failure. She was hunched over and asleep when I went into the room. I woke her to talk with her and examine her. She was small and frail. She had a prominent kyphotic (bent over) deformity of her spine. She was confused. She didn’t provide a lot of information to me.

I paused a minute. I imagined my grandmother. My grandmother was a strong farm woman in her day. I thought of all that she was and meant to me and my family. I stopped. I pretended that this patient was my grandmother. This changed the entire scene for me. Suddenly there was a lot more going on. My patient was complex with a long life and lots of details to her past. It would be amazing if I could somehow learn more of who she was. I was determined to do the best that I could to help her just like I would have wanted others to do for my grandmother.

And so, sometimes I pretend they are my father.

Share this:

Share this: