Blue Collars, Blue Scrubs
The neurosurgeons have learned to give their expertise, their skill, their time, but they cannot, they will not, give themselves. They donāt allow themselves to get too high with their successes or too low with their failures. They canāt let a tragedy from six days, six months, or six years ago affect them. It is not prudent. It is not efficient. It is not professional.
A lot of doctors think circumcisions are unnecessary. The only reason most fathers want their sons circumcised is because they are circumcised. So here I am with a scalpel in my hand, about to do a horribly painful, possibly unnecessary procedure on an unanesthetized fellow human being who just happens to be a defenseless little baby. I feel like I am violating ten parts of the Hippocratic oath at the same time.
. Med students are not allowed to be passive observers. The patients know we are med students. They know we, presumably, arenāt struggling with any addictions, but Dr. Hester tells us that it is unfair to ask the patients to open up in front of us if we donāt open up in front of them. By opening up, he doesnāt mean we are to make up some BS story about our rampant heroin use but to share our feelings and our impressions. When it is my turn, I tell Jeannine how impressed I am with her struggle. I tell her Iām glad she seems to be getting her life back on track.
I have a hard time reconciling the role of pain in giving birth. One of our charges as physicians is to relieve suffering. Since giving birth is a painful process, isnāt it our responsibility to get rid of the pain? If so, we arenāt doing a very good job. It seems that almost every delivery I witness is accompanied by at least some degree of paināoccasionally a great deal of pain. And yet, when it is all over, the mothers seem to feel it was all worth it. It makes me wonder if pain is always such a bad thing.
Iām learning that life isnāt always fair. In fact, Iām not just learning it; Iām having it rammed down my throat every day. Everywhere I turn in medicine I see unfairness: guys dying of heart attacks, women dying of breast cancer, kids dying in car crashes.
do we feel sorry for the human condition in which all organs will ultimately fail? Or, in the final analysis, are we really just feeling sorry for ourselves, seeing in the suffering of others a reflection of our own mortality and demise? None of these questions has to be answered. None of them even has to be asked. A kid can become a med student and a med student can become a doctor without ever considering these questions. But I donāt want to become that kind of doctor. I want to ask questions and seek answers, but more than anything, I want to be a doctor, and the obstacle in my path tonight is not understanding the paradox of healing; it is understanding the blood supply to the liver. I turn my back to the row of cadavers stretching away into the darkness, bend my head over Jimmyās abdomen, and peer into the right upper quadrant. I have work to do.
Dr. Pomeroy and I develop an unusual relationship. He very quickly sees that I am not going to scrape and bow to him like his residents do. Our exchanges in the OR take on a pattern. Dr. Pomeroy attempts to embarrass Collins by showing everyone how dumb he is. The problem is that Collins wonāt play along. I make it clear that when a surgeon who has been in practice for thirty years tries to make himself look good by making a medical student look bad it is the questioner, not the questioned, who should be embarrassed. We are doing a thoracotomy on a sixteen-month-old when Dr. Pomeroy, without looking up, says, āDescribe for us, Collins, the microvascularity of the embryonic thymus.ā To which I immediately reply, āI am not familiar with the microvascularity of the embryonic thymus, sir, but Iām sure you are.ā āOf course I am,ā Pomeroy says. āDonāt they teach medical students anything at Loyola?ā āYes, sir. They do.ā He slams the hemostat back on the Mayo stand and says, āCollins, you might just be the dumbest medical student I have ever had.ā āI would ask you, sir, to consider the possibility that your annoyance is leading you to speak in hyperbole.ā
At times it seems I know so little, and yet I realize I am already better trained than most doctors in previous generations. I would be scared to death to do itābut in a pinch, I could remove someoneās appendix. In a pinch, I could do a tracheotomy. And I could deliver a baby and run a code and manage diabetic ketoacidosis.
Iām taking inorganic chem and physics not because I want to but because I have to. Not every doctor wants to be a scientist. Some of us just want to take care of sick people. I canāt help thinking that medicine is more closely aligned to the humanities than to the sciences.
They accomplished a miracle. They not only rid Mrs. Armour of her headaches; they also removed the threat of the vessels bursting and killing her. It is a remarkable achievement, but the neurosurgeons seem oblivious to it all. They have a job. The job requires skill. The job does not require emotional involvement. They do the job. They do not get involved. Surgery was a success? Thatās nice. Next.
