post: the second; getting started.

Disclaimer

The following tales and perseverations are my attempt to document my life and experiences as a a hired medical goon (ie, Resident Physician) at university hospital some where east of the MIssissippi. Some of what is to come may seem callous or inappropriate, depending who you ask, for someone in the medical field whose job is to care for the sick and dying; but like so many other situations in life, one does what one has to in order to survive. When your job is of the ilk that, every day when you arrive, there is a decent chance that one of your projects (I use that term for the sake of comparison to other jobs , not in the pejorative sense…at least, not yet) has died overnight and moreover, there is an equally good chance that another person will shuffle of this mortal coil during the day, it becomes difficult—even dangerous—to form emotional attachments to those in your care.

In fact, one needs to develop coping mechanisms, and quickly, in order not to curl-up into the fetal position and cry the day away. For me, the coping mechanism is humor and my day is suffused with a constant stream (both internal and external) of witty, though perhaps inappropriate, observations and one-liners without which I would almost certainly be reduced to a quivering mass of flesh and hair by the preponderance of misery, suffering, and social injustices by which I find myself surrounded on a daily basis.

Think long and hard about the conditions in which I work before you pass judgment—I see drug addicts, rapists, child abusers, teachers, nuns, cops; I see people that remind me of my mother, of the kid who beat me up in high school, of two brothers I met at summer camp. I had a patient with severe COPD (chronic lung disease) who an hour after being extubated had her daughter bring crack to the ICU so the two of them could smoke together; in the next room was a 64 year old man dying rapidly from leukemia who reminded me a great deal of my father, who died of that very same disease.

Medicine is unlike nearly any other profession—not only in the magnanimity of saving lives but also because doctors deal heavily in a trade of materials and subjects that most of society goes out of it’s way to avoid thinking about or discussing: body fluids—urine, feces, pus from every orifice and organ on the body; odors—rotten flesh, unwashed feet; chronic pain, terminal illness, end-of-life decision making, and of course, that appointment we all have with the Grim Reaper. Add to that the myriad social injustices of the day, violence, addiction, deception, etc; If that is not enough, there will always be the sweet old ladies that remind us of those we love, who have likely committed no serious transgressions against anyone, who still die horrid, painful deaths, sometimes—literally—right in front of you.

This continues, daily, for the duration of Residency—4 years in my case, and anywhere from 3-6—during which time you are chronically sleep-deprived, working for what comes close to minimum wage because of the number on hours you work, in what in most cases is a socially isolating environment because 1), you hardly see anyone besides other physicians, 2) as hackneyed a notion as it has become, it is tremendously difficult for those not in the medical profession to fully appreciate and understand the enormity of what the average resident sees and does on any given day, and 3) in many cases, including my own, due to the vagaries of The Match, many residents, as they start their career, find themselves in new cities, far from home without friends or a true social support structure aside from their co-residents who, by the way, also suffer from all the aforementioned tribulations. So if, at times, my words and thoughts seem cold, uncaring, bizarre, or even outright mean, try to remember the words that my father—in what was an unexpected display of paternal affection and guidance—uttered to me as he lay in a hospice bed hours before he died: “Never judge a person until you have walked a few miles in their shoes…not just one mile, but several.” That was the last thing that he ever said to me, and to this day, I cannot decide if those are poignant or pathetic last words…probably some of both. What didn’t occur to me until much later was the fact that these were somewhat ironic last words from a man who was fairly stern and unyielding is his own judgments and words; he once told me that if I did not get accepted to college, I could not continue to live at home.