Saturday, September 13, 2008

Why Medicine?


I think I can confidently speak for the majority of my colleagues in medicine when I say that something like the above summarizes why we did it.

Back in my early twenties I knew full well that, while academically prepared for medical school, I was hardly mentally prepared. I tried my hand at a few other professions, dabbling with the Law and taking the Armed Forces standardized test which screens for their pilot programs. Something in me would not rest, however, unless and until I got my MD.

About five months ago now, at the height of my anger and exhaustion with the ER (as it was in my former hospital), I had an epiphany. This little gal pictured above came into the ER one morning at about 2am. She was a wheezer and was working really hard to breathe. Her mom, a hard-working young woman fighting back tears, was so worried.

Turns out her daughter had been wheezing since birth and, after many visits to the pediatrician, was not getting any better on steroids and nebulized albuterol. Something was amiss. I did the standard ER workup and didn't get any smarter by it, but then two things happened.

First, the mom asked if I could watch her child while she went to the restroom. Hence the picture above. As I held the child I heard that still, small voice that we all hear from time to time saying the following... "Doc, get a picture... this is why you did it... this is why you went into medicine."

Not one to argue with suggestions from above (or, for you nonbelievers, from somewhere deep inside my noggin) I asked one of the nurses to take a picture of me with my patient... this little four-month old girl.

Following the Emergency Medicine axiom of thinking of the worst possible diagnoses and ruling them out I thought this young gal had an obstructive pulmonary process that was more than your simple 'reactive airways disease' or 'asthma' of childhood. And, like any good ER doc ,I did what we all do, I called the Mecca and told them that I thought this kid was sick and needed a more thorough evaluation by the pointy-heads. So, this is what I did.

Not only did the mom break down crying, but she came up and hugged me. "We've been trying to get her there for two months and we keep saying the medicines aren't working but they won't send us."

This is not a ding on my friends in pediatrics, it's simply a different way of approaching patients. This child should have had wheezing from a common source, but she didn't. What she had was a growth (non cancerous) which was encircling her trachea and esophagus and was causing not wheezing, but a combination of wheezing and stridor.

She was cured by a pediatric Cardio-Thoracic surgeon a few days later who took her to the OR and removed the growth. To become qualified to perform this surgery he did at least 8 years of residency and fellowship training (after four years of college and four years of medical school) working, on average, over a hundred hours a week during that time.

I called the Mecca a few times to talk with the mom and she told me that as soon as the little gal came out of the OR the noisy breathing was gone. She was home a few days later and she should do just fine. She will not remember the trip down to the Mecca and all the needles and all the worry.

This is why I did it. These kind of patients are rare, but this little gal let me know, through her wheezes and coughs and the way she rested comfortably on my shouler, that I had been an important part in her young life. The mom's hug let me know too. I thank them.

34 comments:

  1. Great story, thanks for reminding us that sometimes it really is worth it.

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  2. You can't always get what you want...but if you try sometime....you just might find....you get what you need.
    (The Rolling Stones)

    God gave you what you needed at the time. And yes, it is just for this reason we all go into medicine...those small, brief, moments of Nirvana.

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  3. Well done young man, well done!

    Steve

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  4. My baby brother (cousin?) died from inhaling black mold. Too much. They went from ER to ER until...he was admitted and died.

    Fail!

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  5. I just started medical school, and it sounds like we had similar wanderings of interest. Hearing that these sort of moments really do happen at least once in career is going to help justify some of these late nights studying. Thanks.

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  6. Fabulous post. Sometimes the rewards are so few and far between...thanks for the reminder.

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  7. Aw, sweet. The weird thing about this job is that it's not the sick folks who make you sick of it, but all the other rubbish you have to wade through to get to someone who actually really does need you.

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  8. There is nothing like the feel of a half naked baby against your shoulder to make you understand your purpose in life...a job well done. And oh by the way...will you marry me????

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  9. What!?!?! You didn't run this by Chris Johnson M.D.first? Sounds like an inefficient use of Medical Resources to me. Seriously, Good Case, but you know those are Girls Scrubs you're wearing? Just sayin. Please don't tell me you're wearing matching Croks.

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  10. Good job, doc!

    Additionally, I desperately want to start a #16 on your left hand.

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  11. Good catch! I whine and bitch about my job, but I could never think of anything else I'd rather do.

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  12. That is a very moving story. You done good, Doc. Great job.

    And a very tender picture, indeed.

    So how could you leave when there are other patients like that who will need your wisdom? Didn't God put you there for her? Oh, I forgot, reasons 10 through 1. Sigh.

    (That is a very large 4-month-old baby!)

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  13. You're pretty awesome! I wish I knew you personally!

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  14. THIS is a perfect example of why doctors need to listen to moms. Good for you for listening to this mom.

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  15. What a wonderful story.

    My son (now 8) had horrible asthma when he was a baby up until he was about 4. I think I spent more time in the hospital with him than home back then. The wonderful doctors that took care of him in the ER were really amazing people. Just like you. Thank you for sharing and being so kind.

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  16. You are so cool! What a great post - it reminds me of why I went into peds (and medicine for that matter). You really are a white hat cowboy. Oh, BTW, my boys are still wondering when that belly button is going to arrive - they loved you.

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  17. I am sorry, but I am crying. I have two little girls myself (2 & 4) and as a mother it's the worst nightmare when they get sick. And doctors are the only hope when I exhaust every remedy at home. Mom's intuition is powerful! I just want to say that you're an awesome doctor!!!!! And I hope there are more docs like yourself who are willing to help patients with all their knowledge. I'm so glad that the little girl is okay now and I'm happy for her mom. Thank you!!!!!

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  18. It is always the victories that make the pain of the combat worthy. Thanks for being a great care giver.

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  19. As much as I try to remind myself of the times when I help people, the reality is that there's a lot more loser fucks who piss and moan about the service than people who thank me.

    And when people are appreciative of the help, and benefit from it, the up I get from that isn't nearly as good as the downer I get from the miserable fucks who abuse the EMS service.

    I'm not such an optimist.

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  20. Big Doc /Womens Scrubs
    Big Doc /Womens Scrubs

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  21. I was wondering what you all thought of this article.

    It states that ER abusers are not responsible for many of our nations health care problems.

    They're probably full of shit, but why?

    Thanks for your comments

    http://www.slate.com/id/2199645/?GT1=38001

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  22. Well someone woke up on the right side of the bed today. A few more posts like this and I´ll have to look elsewhere for my dose of ER bitching.

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  23. Nice post. I was just trying to remember why I got into this slogging through the nursing home merry-go-round, otherwise known as Internal Medicine rotation.

    I like that your story involved listening and decision making and consulting--just as important as needling chests and intubating. Well done.

    Victoria, the article is pretty spot-on. It's the system, not just the abusers.

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  24. This is such a wonderful post (and photo) that I have linked you on EverythingHealth so everyone can read it! Thanks for being inspired and for being an inspiration!

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  25. Hmm..you had almost convinced me that nursing school was not the way to go and then you had to post this. Guess I'll send in my application.

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  26. Your photo looks like you're a mutant ninja hedgehog doctor, Cool.

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  27. I just realized I never commented on the photo. Seeing a man holding a baby always gets me. Even if the man has a scribbled out face. Awesome picture.

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  28. Wow! What a beautiful story!!!!!

    You were meant to touch each other's lives. All because you held her for a few minutes... and that still small voice. I agree with you about the source of that voice. :)

    You affected them profoundly... because you CARED. You sound like a terrific doc and your patients are blessed to have you.

    What did the pediatrician have to say? I guess he learned a lesson there.

    Mom will never forget you.

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  29. Is that a poop strong bracelet on your wrist?

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  30. This story is amazing, this is the kind of self satisfaction that I've been trying to explain to so many ppl, maybe i should just tell them to read this.. Parents arent so keen on sending me to Med school because of the long working hours and all that studying... thank u..

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