Tuesday, June 12, 2012

Why I Chose Family Medicine: Part 2

    One day I was sitting quietly in the surgeon’s break room.  I was on my Orthopedic Surgery rotation and we were between cases.  Medical students on rotation are the lowest of the low in a hospital, invisible unless they make mistakes.  Compounding my irrelevance was the fact of being female;  even worse, I was blatantly pregnant.
     All of the Orthopedic Surgeons in the department were male.  They were gigantic, big-boned men, and loomed even larger because they had the bloated self-images that characterized the surgical profession at that time.  Surgeons were forgiven their narcissism because it was understood that it must take an enormous ego for a feeling person to be able to amputate a patient’s leg; or take a beating heart out of the chest cavity; or use a hacksaw to remove the upper femur, drive a hip prosthesis into the marrow, and glue it in.  The orthopedic surgery suite emanated odors of sawdust, plastic, and epoxy, which sometimes made me feel nauseated, so I was drinking a cup of warm, weak tea from a styrofoam cup.
     What might esteemed surgeons say to a pregnant medical student drinking tea in the corner of the break room, hunched over Harrison’s pocket manual studying instructions for administering post-surgical IV antibiotics and fluids to a patient in the recovery room?  For these orders would be my responsibility and I didn’t want to make a mistake. I was lucky, really, to be able to stand by, scrubbed and robed, watching them perform their heroic and life-saving deeds.  It was considered a privilege by medical students when a surgeon asked the student to hand over a particular instrument, or to staple the wound shut.  
     The surgeons did not speak to me at all, nor did I interrupt their lively conversation, since I had developed a reputation in my last rotation for impertinent questions and did not want to annoy these physicians who with an offhand comment to the course director could ruin my career.
     They were exchanging anecdotes about their activities over the weekend and giving one another ideas for ways to spend the upcoming holiday.  Each story seemed to improve in humor and grandiosity upon the last.  There were hunting tales and ski stories, twelve-point deer, near-catastrophes on the slopes, trips in motor boats, faster and more expensive sports cars.  There were occasional offhand references to wives and children who seemed to form, as in regal portraits, the neutral backdrop for their lives.   
     One surgeon said that his wife’s sister had come to visit with three young children in tow.  One of the children had a peculiar rash and, naturally, the women asked this surgeon--a doctor after all--to check it out, fully expecting that he would know how to proceed.
     “I looked at the kid’s skin and, hell, I didn’t know what he had!  Who knows rashes?” he said, laughing royally.  “So I said to my wife, take him to a regular doctor--so that’s what they did.  Geez!  You know what he had?  Chicken pox!  Ha-ha-ha-ha-ha!”  Everyone chuckled along with him.
     But I felt embarrassed.  How could you call yourself a doctor and not recognize chicken pox?  How could you face your relatives, who had reason to expect that any doctor could diagnose such a common condition?  What else didn’t these surgeons know?  How to diagnose a cold?  What to do for a stomach virus?  When a patient might have a brain tumor?
     I understood then that I wanted the broadest education possible so that I could help people everywhere, meet any common request, point out skin cancers to people in line at the grocery store, recognize and intervene in an emergency.
     I also knew that my head would not be able to support the ballast necessary to participate in these surgery break room repartees.  Nor could I bear the absence of meaningful conversation about the patients themselves, who had just fallen under the knife, whose lives, were I a surgeon, I would have at the edge of time. 
     During the rest of my training years I made sure to learn as much as possible from every specialty.  I wanted to be able to make a correct diagnosis with limited information, and I wanted to recognize chicken pox, or measles, or malaria--whatever might show up at my door.  
     If I should need a hip replacement, the Orthopedic Surgeons can take the stage and garner applause for their powerful skills.  I’ll be backstage immunizing their children and treating their stomach aches and rashes.  

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