Don't become a doctor #6 - Laughing at the pain of others

Recently, my friend West Coast and I were getting a laugh at patient care. He's got a patient who's 400 pounds. We couldn't help but get a few laughs at this patient's expense.

But the thing is, in medicine, we use a lot of dark humor. We laugh a lot at the pain of others, both the patients and our colleagues. The proof in the pudding? Scutmonkey. The author has comics about her horrible med school experiences, and me and WC were falling out of our chairs laughing at it.

In med school, one med student, Handwriting, he was an idiot, but everyone loved him because of his amazing handwriting. One day, we were having a bioethics discussion about delivering bad news, and our prof mentioned that a lot of times we'll use euphemisms for death in the hospital. "Like celestial discharge?" one med student chimed in. Instantly, we were coming up with a ton of such euphemisms: transfer to the pathology service, basement admission (the morgue is usually in the basement), organ donor (motorcyclists who don't wear helmets), ICU cuisine (tube feeding), M&M rounds (my rounds on vascular surgery, where patients died like flies).

Handwriting, he was appalled. His gut reaction: "Well, we shouldn't make fun of these situations. It's wrong." We were all silent, not shamed but outraged. How can we NOT make fun of this? What's the alternative? Go home and cry our eyes out every day?

I had another med school colleague who did just that. I'd see her in the hospital when she was off service, but she was visiting her patients, sometimes for weeks. At first, I thought it was noble to be so attached to her patients. Then I realized that there was no way I could do it. It was like self-inflicted torture.

There was a nice episode of Scrubs that I really liked, and I'm sure I've quoted it before, but the episode was about how they were making fun of the patients in the hospital, and Dr. Cox had this to say:

Lemme guess, you're off to another funeral. ... Turn around. Turn around. You see Dr. Wen in there? He's explaining to that family that something went wrong and that the patient died. He's gonna tell them what happened, he's gonna say he's sorry and then he's going back to work. Do you think anybody else in that room is going back to work today? That is why we distance ourselves, that is why we make jokes. We don't do it because it's fun, we do it so we can get by and sometimes because it's fun. But mostly its the gettin' by thing.

If you find yourself like Handwriting, offended at the thought of laughing at the pain of others, you'd best avoid medicine entirely.

I & D

In my life, I'm so used to being the underdog. I'm so accustomed to being disadvantaged. I'm so used to people thinking less of me, whether it was because they were wealthier than me, or that I was Asian, or that I wasn't Asian enough. I was too short or too fat or something. And I've spent my life proving them wrong. I won awards, I took the hardest classes, I smashed every standardized test, I kicked the shit out of the MCAT, I got into med school, and on graduation day at medical school, a funny thing happened.

You'd think that graduation should be a happy time, but I was scared witless. Walking into the auditorium, I couldn't imagine a greater feeling of panic. I had nothing left to prove. I had no one holding me down.

And it was scary, because I realized then and there that one of the greatest motivating factors I've had in my life is proving other people wrong about me. Nothing made me feel more wonderful than the biting envy of Asian parents who had scoffed at me before now grinding their teeth knowing I was in med school, and their first born was cleaning dishes for $5/hr.

And without anyone holding me down, I felt a little empty, and it was hard to feel the drive to succeed anymore. I'm doing fine now, but there are two things that I've never been able to let go: my low self-esteem, and my bitter resentment.

After so many years and years of being told that I was less, I can't help but believe it. And I didn't see it before, but I do now, and sometimes it tears me up. I'm a doctor, dammit! I've gone to school for 8 years, hold a bachelor's degree and MD, have a job, and I'm damn good at it too. But when I look in the mirror, I can't help but see something less. And now, I can see it in my life, and it burns me that I can treat myself so horribly, that despite what I've done, in my heart I really believe all the doubters. And that just fuels my resentment.

There's so much resentment in my heart, from secretaries and paper pushers to God Himself. I've spent so long stoking that resentment, and now, I don't want to let it go. Why should I? I've been treated like shit in my life by more people than I care to remember. I've suffered. They haven't earned my forgiveness.

My friend West Coast (I don't know when I decided to give everyone nicknames, but hey, what the hell), he's very wise sometimes. "No one's paying you to carry that around." He gave me a book. The book is about forgiveness. I'm supposed to forgive people: God, my father, all those shitty little prep school bastards. I don't want to. Why should I? I don't want to grow as a person anymore. I've done that enough.

The one true thing about personal growth is that it is exceptionally painful and arduous. It is like lancing a boil. If you've never incised and drained an abscess, have fun. The area is sore and indurated, actively inflamed. The scalpel blade, although so tiny and so sharp, hurts like a branding iron. Then, you have to squeeze the pus out, and it's enough to make a grown man wimper to watch. And 3 days later, it's better and life moves on.

My resentment hasn't come to a head yet. Maybe when it does, my life will come crashing around me, but for now, I'll let it fester. And I'll read the book, and see if maybe there's hope for me yet.

You f***ing Democrats

Now with Alito on the court, and the growing possibility of a heavily religiously conservative (this new shit version of the Republican party, not traditional conservatism) Supreme Court, states are lining up to chip away at Roe v. Wade, and in the case of South Dakota, attack it with a shotgun. This is, more or less, ridiculous. I can't think of anything more appalling than the current trend of this country to make everyone conform to Christianity's view of things, or at least fundamental Christian beliefs.

So I'll say it right now to make things clear. I am Catholic, and a seriously practicing one at that. I abhor the entire idea of abortion, to the point where we had a patient that needed an abortion for medical reasons and all my friends tiptoed around me because they thought I'd be offended. I think it's morally reprehensible. But since when is that a reason for something to be illegal? There are lots of things that are horrible and legal. Abortion's not exceptional in that sense.

Last I checked, more than a ton of Supreme Court rulings have consistently found abortion to be protected. It is legal. And I may not like it or even approve of it, but if it's law, and if the Constitution of the United States is behind it, then I'll be damned if I sit quietly while some jerks piss all over it.

The most appalling thing to me is that we're doing nothing to prevent abortions. This is no better than the war on drugs. It doesn't address causes. We have kids out there who honest to God don't know to use condoms. They come to me, and I have to be the one to break the bad news that those sores, that's Herpes, and that nausea and vomiting in the morning, that's being knocked up. Please! This is criminal! And you know that with these ass backwards, fundamentalist, sanctimonious super-Christians, it's only a matter of time before they try to outlaw what I can tell a patient.

Listen up, there's a difference between religion and politics. There's a reason for the separation between church and state, and maybe if we were a majority other than Christianity, you'd understand why. At it stands right now, we're moving closer and closer to Theocracy, and I blame the Democrats.

That's right, you heard me, the Democrats. You motherfuckers let this happen. You watched halfwit after halfwit being elected by the Republicans, and you barely put up a fight. And now, we've got a fucking moron for president who'd sign a law requiring chastity belts if it was passed by Congress. And what did the Democratic Party do? You sat on your hands and put up for scrutiny the most ideologically vacant candidates possible. You lost all your vision. You let the Republicans become the Christian party, as if Christianity has a political party.

And you have the FUCKING GALL to talk about Hillary in 2008. If this thing in 2008 ends up Frist vs Hillary, I promise you that I am voting for ANY third party candidate I can find, because that would be proof enough to me that both major political parties are completely useless.

And if I should wake up on the first Wednesday after the first Tuesday in November 2008 to find out about President Frist, I will grab every representative of the Democratic Party I can find and beat them for letting their party go to shit and letting another Republican moron run our country further into religious zealotry.

Don't get me wrong, I've got nothing against the Democrat voter. My beef is with the politicians running the party who've let us all down.

And as for the Republican Party, you're not getting off easy here. I have never been so ashamed IN MY LIFE as I am about the fact that I've voted Republican. I wish my friends had beat me within an inch of my life on voting day so that I couldn't have made such a tremendously stupid decision. At least then, I could sleep at night knowing I didn't vote for you asswipes.

Don't become a doctor #5 - Thou shalt not opine

One of my colleagues asked me to write him a script for Augmentin a while back, which I did without a second thought. A week later, I found out he was in the hospital with a serious infection, and that the Amox/Clav I wrote was pissing on a forest fire. I was kicking myself all day.

Once you're a doctor, you'll find that people will continually ask for your professional opinion, which is fine when they're your patients and you've examined them and can best determine their plan of care. But it's very dangerous if that opinion is given out casually. The danger is that you could completely miss the mark, like I did with my Augmentin, or risk being completely wrong, like good old Dr Frist on the subject of Terri Schiavo.

Senator Frist had proclaimed her not to be in a persistent vegetative state, based on the 1 minute video we have all seen. Now, Senator Hatch or Biden or Kennedy or Clinton or any other senator could have said the same thing, but with Frist, he's a doctor. That's his professional opinion. That's not rhetoric. That's diagnosis. I don't know how he can still call himself a doctor, because he should've known better.

Most of the time, it's not such an overt display. We will make an offhand comment or some remark, and that carries amazing weight. It determines what shampoo someone will buy or whether to eat more broccoli, or most notably, whether to sue another doctor.

The numbers show that one of the most powerful factors in patients bringing malpractice litigation forward is doctor B telling the patient that doctor A was wrong. This is simply irresponsible. People think that when we say that we should refrain from these comments, we are trying to protect our own (which is a legitimate reason in and of itself, but certainly morally questionable). I disagree. The simple fact of the matter is that you weren't there. You didn't see what doctor A saw. You can't put yourself in his shoes.

Honestly, I think that a lot of people go into medicine because they have this vision of the rabbi rather than the healer. What I mean is that in the Jewish community, a rabbi is a teacher and a scholar. People come to him and ask his advice or knowledge. He offers a piece of scriptural wisdom to support his point.

The same cannot be done in medicine because it's dangerous. We don't have the authority of God to fall back on when we have bad outcomes. I seldom if ever give out free medical advice, even to family, because I am professionally liable for that advice, and my conclusions bear serious weight, but are based on limited data. Your professional opinion is not something to just throw around or wear on your sleeve. Unless you want to sell your soul to some foot cream company.

So if you want to go into medicine for the admiration and having people seek your opinion, please reconsider. It's a dangerous game.

BTW - I'm still on vacation.

A rare book review: Lynne Truss's "Talk to the Hand"

Recently, I've just finished the book Talk to the Hand by Lynne Truss, famed author of Eats, Shoots & Leaves. That book took a hard line, zero tolerance approach to punctuation. It was a charming read, which I found especially enjoyable because I have strong punctuation-related opinions as well.

But reading through her latest opus, I have to admit I find it rather pedantic. It's a continual complaint about what's horrible in society and the possible causes. I had hoped for dry British wit, but instead, it's a laundry list of annoyances, with poorly supported evidence.

The resounding comment in my mind, as I read through this thing, was, "Why does it bother her so much anyway?" On TV, there is a series of commercials where there will be a bunch of people staring at a piece of litter, and finally someone else walks by, picks it up, and puts it in the garbage. That is my reply to this book.

I've written far too much on manners and etiquette, and I won't force any more of that on you, but I will leave off with a comment. Most women say that they want to be treated like a lady. I think that these days, chivalry and gentlemanly arts are on the decline thanks to the feminist movement and a variety of social factors. That's the world we live in. However, we are all not above some common courtesy. And if you are a lady and wish to be treated like one, then please remember as well that most men wish to be treated like a gentleman. We could all use better manners.

By the way, I'm still on vacation.