Gold Plated Mercedes

I spent today in surgery. 95% of this time was anus-related. When my preceptor left for clinic and handed me off to another surgeon, he looked at her next case on the board and said with a smile, "Oh, this can be your butt day!"

Among the lower GI tract things I saw was a colonoscopy preceding another operation. It was the first time that I've experienced the amazingness of all that gas they pump in you coming back out again. W.O.W. My wife and her brother on their worst days combined could not rival those amazing sounds. The human body does not cease to amaze.

But I digress. As the title suggests, what was most on my mind today was this other aspect of life in surgery: money and prestige. The dear safety-net hospital where I'm spending my third year is not exactly a hotbed of stereotypical egomaniac fancy-car surgeons. The attendings are by and large nice, even if their unanticipated questions can be scary, and with few exceptions actually seem to realize that they treat human beings rather than body parts.

But our residents are not from the dear little hospital. Indeed they are not. Now we've had nice residents, residents who like to teach, residents who send you home when they can. And we've had grouchy residents, apathetic residents, residents who say nasty things about patients or the medicine team. But before today I hadn't hung out with a cares more about money than people resident.

His reputation preceded him, having told my classmates that a gold-plated Mereceds was in his future. Needless to say, I went in with some trepidation, but I was still thoroughly dumbstruck. First I was put off when he returned from a consult saying "that patient was being an idiot so I had to put a nasogastric tube in him." Which is not only crappy and dehumanizing, it doesn't even make sense. Then, while closing up after a gall bladder surgery, he started telling me how he's really not sure what kind of surgeon he wants to be yet.

Him: I mean, realistically, you have to think of the money. The way things are going, you have to go into something you can count on. Really plastics is the only thing that makes sense.

I try to figure out what to say to him. Something like, "I'm pretty sure that all full-time surgeons are wealthy by any reasonable measure," might have been appropriate.

Him: But I really value being the best, and the best surgeons are really the transplant surgeons.

This sounded somewhat better to me... I mean even if he doesn't care too much about patients, I appreciate that he cares about doing a good job. But, of course, before I could say anything...

Him: But you know, different kinds of people need transplants. There's just no money in it, you end up having to take care of all these people without insurance and poor people.

So much for medicine being a service profession. This is when I was wishing that thinking, suturing, and speaking weren't so hard to do all at once.

Him: Or I could do GI. It's just a one-year fellowship so I could be making money right away. But you have to be on call. Really nothing makes as much sense as plastics. Even if Obama screws up health care more and reimbursement falls off, you can just do more cosmetic cases.

At this point I was in full-on medical anthropologist mode, taking mental notes on how not to be. Plus it was about his third nonsensical Obama dig of the morning, but in the moment I was more fascinated (car-wreck style) than pissed.

I'm not sure what bothers me more, that he seems to be more interested in money than patient care, or that he's so blatant about it. It's been said time and again, that going into medicine for money just doesn't make sense. Getting into a to business program is a much better return on investment by far. That knowledge just serves to piss me off further that people take up room in medical schools and competitive training programs when their end goal could be better served elsewhere and their spot could be filled by someone who wants to make peoples' lives better. When you have that value set, money over people, becoming a doctor strikes me as a cover. You can be an ass, but still get some social cred for doing good.

Not to mention that the idea of wanting a gold-plated Mercedes is totally outside my understanding of reality. I am more effected by the consumer culture than I would like to be, but I can still recognize that money and stuff won't actually buy me contentment. Money doesn't buy happiness, we know this. It seems like someone steeped in the culture of evidence-based medicine ought to delve into some sociology research and reexamine life choices.

Visiting

Through an incredible giftfromthegods type fluke, four of my outpatient clinic preceptors are on vacation this week, leaving holes in my schedule that even our incredible schedule populating program coordinator couldn't fill completely. What this means is that not only am I left with very few items on my "to-do right now" list, but also when an elderly patient I was on the phone with asked "couldn't you just come over?" I actually could.

For the people who know me and don't think of me as "shy," it might surprise you to learn that there are some things that indeed I am shy about. Visiting an old person in chronic pain at their apartment isn't exactly in my comfort zone. But much like cold calls to hospitals I've never seen and patients I've only met for 10 minutes, I'm trying to build a new comfort zone.

She lives in one of the many high-rises for older folks in the area, a drab construction with a surprisingly difficult to find front door. I managed to navigate the elevator conversation and complicated door-knocker situation. She steered her walker to the door to let me in, smiled to see me, and launched into a description of her current symptoms. She's feisty, but trapped in a cycle of chronic pain, with ever elusive solution. We talked for an hour, mostly restating the same problems differently. We made sure she had the right phone numbers to call for appointments and I cut some of her pills in half. In the end, we left with the same conclusions as the previous conversations we've had over the past two weeks. But if her resolve has moved only by inches, my ease of stepping across bounds I never saw before is growing by miles.

When I was a girl scout, I absolutely dreaded cookie drop off. Once the mountain was piled in our living room, it meant I had to call everyone I had sold cookies to, even my parents' co-workers, to tell them they were ready to be delivered. I can still feel the sense of cold foreboding that would fill my belly as my mother complacently handed me the phone. But these days my to-do list is increasingly filled by "call..." at first these were suggestions from others, but now I've found how easy it is to say "how about if I just call That One Clinic and find out what they think the plan is..." or whatever it may be. And it's not hard anymore.

For some people, it's over-stepping social bounds like touching others' naked bodies that really jar the ingrained sense of normal. For others it's asking deeply personal questions, talking about death or even just poop. We all have barriers in taking on this doctorish role. Today made me realize how much having assumed this new role has given me this space where pushing past my own fears is so much easier.