Tuesday, September 14, 2010

Treat For America

My first month on in-house surgery is coming to a close this weekend, and I can honestly say that I will miss it. It has been tough, of course, being Q3 and so on (and Q2 this week, to make up for getting Labor Day weekend to spend with my sister), but overall I really did enjoy things. It's nice to write focused notes, and speak quickly and succinctly, and justify not hitting the gym because I run around so much. My residents this past month have really looked out for me, and I've been able to throw in a few central lines without too much difficulty. Hopefully when I re-start surgery again in December at an outside rotation, I'll be able to hold my own.

I'm not sure my residents all feel the same way in terms of nostalgia for surgery at my hospital. Without saying too much to identify my medical center, it is an old, small community hospital in the NYC area. I have rotated at a lot of not-so-well funded hospitals in NY, and this is probably the least funded of all. At our hospital, it is often difficult to find very basic supplies, especially in the middle of the night. Shortages of medications or fluids are common, and interns often stash blood-drawing supplies in their pockets at night because the nurses' stations are never re-stocked for the evening. In summer, we have our fair share of mosquitoes and other buggies, and humidity shoots through the roof. The call room I was using had a massive hole in the wall leading to outside, with no insect screen or boarding up, for several weeks.

Small discomforts aside, there seems to be an undercurrent of deeper unhappiness amongst residents that our hospital at times seems ill-equipped to handle some patient complications. This feeling is more pronounced in the surgery residents, because we do more invasive interventions and cannot always optimize the outcomes to the standard we would like. Some residents have taken the position that if we cannot manage care at the same standard as bigger academic name-brand facilities, then we should not attempt such procedures in-house. Added to that, of course, is the general feeling of uneasiness that all residents feel when they realize just how little the patients truly know about the goings-on of inter-department politics, inexperience of residents, complications of procedures, and alternative options for care.

Somehow, I have managed not to share too much in this same experience, although I find that chipping away slowly. Last night, I had to spend 40 minutes hunting for 2 blood culture bottles so that I could find out of my acutely feverish patient had a bacterial infection post-operatively. It was time I could have spent writing better notes on my patients or spending more time checking on them (or sleeping...), and it didn't feel too good knowing that I got the last set in the hospital when we presumably have many other patients who may also be running fevers. The resident I was on with is one of the main people who quietly voices his opinion regarding our inability to provide gold-standard care at all times, and by the end of the night, I found myself getting more annoyed with my hospital's precarious financial state.

I called my sister, who is flying out tonight back to London, to basically complain for a few minutes about how I got slammed last night and how there was so much to be done, and how my hospital is disappointingly unable to provide all care for our patients. I was surprised when she (not a doctor) laughed at me, and reminded me that medicine is not equal-opportunity, no matter how much we try to make it so. "The fact is, richer hospitals exist in richer areas because you have richer taxpayers, and vice versa. Poorer people receive lesser care because the people in their areas don't have insurance and can't fund their hospitals as much. It's really that simple." She went on to remind me that American schools are often in a similar situation, but young college graduates apply in droves for the prestigious Teach For America program. "Of course it's not the best education for kids, that's the point. You're investing your time to make a bad situation better. You don't complain once you get there that there isn't enough paper or textbooks or parental support. It's a poor school. Duh."

The final note she left me on was the reminder that other family members we had who are also doctors perhaps would not be able to work under the same conditions and thrive. "Are you kidding me? They would just get frustrated that labs aren't done on time, and that not everything is on the computer, and miss the whole point of working somewhere needy. You, unlike them, can do this, you're built for it." And she's right. One day, many eons from now, I will be stronger for having worked at a rough-around-the-edges hospital, and when everyone flails because the expensive wound-vacuum system is malfunctioning and the patient is dripping bile from his fistula, I'll know how to jerry-rig the damn system, old-school.

So, I've decided to look at my program as like a 5-year volunteer course instead of a regular old job. Treat For America, it is.

1 comment:

  1. My school is in Australia, so I'm guessing not the same school you went to!

    It's interesting to see your insight into 'real medicine' - I'm currently enjoying the student's rose coloured glasses, where I don't have to worry about what things cost. Generally speaking, the Australian system is more equal-opportunity than the US system (though of course still far from perfect), and I can't say I'm not glad about that.

    What's your next rotation after surgery finishes?