So you wanna be a doctor

When I was an intern, I had a patient who, after extensive workup, had a simple fecal impaction. He was in need of manual disimpaction, which has to rank up there as one of the most humiliating jobs imaginable.

The matter of actually disimpacting someone isn't so bad. It's relatively simple. It's figuring out who's going to do it. And to be fair, I could've told the nurse to do it. Surgery was on board: I could've had the surgery residents do it. But I had some time in the afternoon, so I did it. I didn't get much, but a little rectal stimulation and some judicious enema use, and voila, one working colon.

And everyone around me asked me the same question: why did I do it, when I could've just dumped the work on someone else? It would've been quite easy for me to call surgery and say, "This is your domain. Do your worst." Or I could've told the nurse to do it. Wouldn't have made any friends, but wouldn't have had to do something that I'd rather forget. And honestly, I couldn't believe the attitude.

Y'know, I'm a doctor, and I'm taking care of patients, and they're my patients. They're my responsibility, and at some point in time, someone has to say that the line stops here, period. It's like heparin dosing. I track the PTT's, because while it's someone else's job to monitor that stuff, it's my name on the chart. It's my care.

Whenever I meet pre-meds, I try my best to discourage them, not because I am cynical or spiteful. It's because people go into medicine and don't have a clue what that means. They think it means sipping scotch neat at the country club and talking about how to improve your short game, or picking out which BMW to buy. Even worse, people go into medicine thinking that it's all about saving people or comforting the dying.

If you want to save people or comfort the dying, be a priest. Seriously. It's a better use of your time. Medicine is about dealing with shit. It's pulling stool from a grown man's rectum, or losing sleep at night trying to remember if you ordered a CT scan, or arguing with an HMO about getting a patient's MRI covered. It's messy work, and no amount of BMW's or scotch or people in the community kissing my ass is ever going to make it worthwhile.

The reason to go into medicine is because you love it. It's because seeing sick people and helping them deal with their illness is something that you enjoy doing. You can sit in a radiology suite, sip coffee all day in scrubs, earn $250k a year, and still hate your life. MD after your name won't fix that.

I knew I was in the right line of work when I had a patient of mine in the hospital, and I can't stand this patient in the clinic. One of my chronic pain med patients. But the patient needed surgery, so I stopped by, and we chatted for a while, and I realized that as much as I don't like taking care of this patient, it's my responsibility. If not me, then who?

When you are faced with the most unappealing jobs in life, like trying to manually disimpact someone, and can still go home and add up the day and come up in the black, you know you're there, because any number of people I know in medicine would've endlessly complained about such humiliating work, and I would not let one of those people take care of me.