picking up the thread: is it worth it?

first i must note that my beloved mac is finally back in my possession. i might not let it out of my sight again--that was one long tough week without it! i must thank the mac geniuses--they replaced both my fans, gratis. now the only periodic odd noise i hear is the sound of my cat, biddle, growling at the fed-ups man. did i mention that my cat thinks she's a dog? ;-)

....

i've spent a considerable amount of time lately pondering my pursuit of higher education. i'm not questioning the thirst for knowledge itself, mind you, but the actual paying-of-tuition / sitting-in-classes / eventually-getting-degree part of this whole journey to become a physician. choosing to delay my education for another year has left me feeling a bit depressed. this year, when (if?) i start medical school again, i'll be 30. i know chronological age is essentially meaningless (unless you're an actuary), but for some reason, i feel odd about this fact of turning 30. it's a petty thing, really--i'm experiencing that "always on the outside looking in on other's lives" syndrome that accompanies one of those life moments when everyone i come into contact with seems to have something that i want, yet lack. you know these people: they have the mcjob or the mchouse or the mcpartner or the mcbaby or the mcdog or...the real clincher for me these days...the mchealth. some people i come into contact with even have all of these things, including the mchappiness. i guess they got all the mcluck, too, eh?

the envy i feel probably stems most from having too much time to think. but recently, i realized that i'm not the only one gnawing on these feelings and issues, particularly as they relate to medical school and the sacrifice it entails. this is where i catch onto the thread--dr_panda_bear asked the question first, as far as i can tell, and dr_urostream mentioned it next--and so i might as well audibly voice the question that ricochets through the head of every med student as they hit yet another bump in the road: is it worth it?

it's a heavy question. one might think, based upon my recent "toad list" post where i ranted about some of the worst physicians on record, that i have a negative view of the medical profession. the truth is the opposite: i tend (to a fault?) to see the positive first. i'm a bit of an idealist in this way...and a tad gullible, i suspect, too. it's been difficult for me to answer questions posed to me about medical school and whether it's worth all the time/effort/energy/money/sacrifice/stress/etc. the other bloggers do a great job of addressing the issues in their posts--i wish i could write so cogently and analytically in response to the question.

....

when i ponder the question as to whether or not it's worth it for me to continue medical school, a certain experience comes to mind--the one that confirmed my convictions about being called to this career path. the story, i believe, speaks for itself:

when i first became interested in a career in medicine, one of my physicians, fertile_doc, hired me to work as the slave in his office for the summer. i spent most of my first few weeks on the job culling the thirty years of medical records and journals that were beginning to eat up all the storage space in the office. toward the end of the summer, though, i began doing more clerical work and having some interaction with patients.

the office was chronically busy, particularly on mornings when the ultrasound technician was present, as the majority of fertile_doc's practice surrounded treating couples with infertility issues and ultrasound plays a key role in this process. on one such morning, we were running a tad late. the waiting room was crowded and the staff was bustling about, trying to get all the phones answered, labs drawn, and insurance forms organized. i'd been assigned to "man the window," checking in patients and making sure charts made it to the appropriate spots on the racks for triage. and i was at the point where i was beginning to feel truly frazzled....

in the midst of this, someone knocked on the window. i groaned silently to myself; i'd thought all the morning's patients had been checked in already. what now? i was prepared to give my memorized, automaton directions to the bathroom, insurance policies, etc. i feared i'd strangle a drug rep if they appeared in the midst of our busiest hours. but i opened the window and was quite puzzled by what i saw. an elderly woman sat in a wheelchair with her husband standing behind her. they were definitely not the sort of people who'd show up for infertility treatment and i wondered as to whether they'd wandered into the wrong office. this was a situation that was going to require me to think. carefully.

"does fertile_doc work here?" the woman asked.
"uh...yes." i replied, still feeling puzzled.
"is fertile_doc here now?"
"yes" i replied. "do you have an appointment?"
"no" she said, "but i would like to speak to him."
"I'd be happy to schedule an appointment for you."
the woman looked at me--my confusion was no doubt clear by this point--and then struggled to pull herself up out of the wheelchair until she was standing. now eye-to-eye with me, she said:
"twenty-four years ago, fertile_doc detected my breast cancer during a routine exam. i survived because he discovered it early. i'm here because i would like to thank him."
she then carefully lowered herself back down into the wheelchair.

a few minutes later, i watched as this woman thanked fertile_doc for
what he'd done. most physicians i'd known treated breast exams as a perfunctory part of the physical examination. it's another one of those areas in which technology (in this case, mammography) often replaces good hands-on examination in medicine. but fertile_doc always took this portion of the exam seriously, taking time to really look and feel for lumps and changes in breast tissue. now i knew why he did so. it was a profound lesson.

as i watched this frail woman give fertile_doc a hug, i discovered something even more profound: fertile_doc had given this woman more time--time to be with her children, her husband, her loved ones...time to live. with one small, attentive act in the midst of an everyday job, fertile_doc made a huge difference in this woman's life.

it was in that moment, watching this interaction unfold, that i realized that there was nothing more meaningful i could do with my life than follow a career that had the potential to give even one person an extra minute, day, month, year, of quality life.

is anything worth more than that opportunity?

....

the answer for me, to the question "is it worth it?" is a simple resounding yes. in spite of all the bullsh!t that surrounds medicine these days, I believe it is a privilege to become a physician.

....

to all those physicians who have taken care of me, my loved ones, and even (especially?) the homeless jane & john does on the street: thank you for choosing to make the sacrifice, to dive in, & serve by example to show students that the pursuit of medicine is, indeed, worth it.

the difficulties of being the patient in the doctor-patient relationship

a few days ago, i had what i thought was a good idea. i thought that, after all that i'd been through recently, it would probably be a good idea for me to go see mr_dr_do and see if we could come up with a plan for my healthcare that would maximize the possibility of me being at least somewhat healthy by the time i return to school in august. what was not a good idea: scheduling this appointment for the day after i'd gone *splat.*

i started getting anxious about the appointment last night. that was my first indication that something was wrong. i tried to think about it--why am i feeling anxious? but i really couldn't put my finger on a precise cause. i thought some of it had to do with my embarrassment over having to leave school, another part to do with the fact that i was feeling just emotionally vulnerable enough that i was afraid i would cry (why it bothers me to cry in front of doctors, i really don't know--but it really bothers me), and some to do with the fact that, ever since i was a little, little kid and experienced some GI problems, i have absolutely detested talking about my bathroom habits. to anyone. you can tell me all about yours, just don't ask me about mine. it's an odd quirk for a doctor-to-be, but at least i know where my quirks lie.

needless to say, i didn't get much sleep last night. this was okay, because i was reading a really good book (the sunday list of dreams, by kris radish) and relishing it because it's been so long since i've had a chance to read a non-science text. but it also meant that i was tired today--more tired than usual--which just means that i was all the more vulnerable by the time i arrived for my appointment. this was not a good thing.

mr_dr_do's office is quite nice. it's the only primary care office i've ever been in where i didn't feel like i was one cow in a herd of cattle. everything is simple, efficient, and, aside from the argument i'd probably get from the lady who answers the phone over this one, it's actually quiet. this is a relief for me, as i hate being stuck in waiting rooms that feel like airport gate areas, with tv's blaring, tons of general noise, and, invariably, carpet patterns that make me dizzy. so, again, when i go to mr_dr_do's office, i really have nothing to be anxious about: i'm not overwhelmed by his office and i like having him as my doctor. but today, i was anxious.

it didn't help that the assistant who retrieved me from the waiting room was not in a good mood. and here's where i run into something i don't understand about certain medical offices: what is the deal with the assistants? she took my vitals (grudgingly), then asked me why i was here to see the doctor today. now, i get that one of the most important parts of the medical record is the chief complaint (cc for short), but seldom do i feel like talking to these people, given that the physician always proceeds to enter the room and ask me the same damn set of questions. what's the point? i really, really don't know. so...i was hoping (i must be delusional) that by giving this chick (<--i don't ordinarily use this term, but anyone who dyes their hair with blond streaks and has funny patterns on fake manicured nails fits the description too well for me not to use it) my letter of withdrawal from school, i (a) wouldn't have to talk to her for much longer, and (b) between that and my cc, should've been enough information to give the doctor a clue as to why i'd appeared for this appointment. i'm not sure, though, that she actually wrote anything down. the chick soon disappeared, and i was left alone to indulge in my book. here is where the experience begins to get even more problematic. the book itself is basically about a mom who finds out that her estranged daughter has opened an adult toy store in ny to provide women with options for obtaining and maintaining sexual health. so the part i was reading was describing one of the new employee's feelings about his first day on the job. he was astounded by the number of women who came in--particularly about their ages and the fact that so many were not sexually satisfied. i went to a women's college for my undergraduate degree, so i'm pretty opinionated about this subject. i didn't start off at this college, but rather at a catholic institution, at which they didn't even sell condoms on campus (in spite of the fact that 80% of the student body was engaging in random hook-ups every weekend). i transferred out of there after my first year and entered a totally different universe. i learned that women who are educated talk about things like birth control, masturbation, toys, fetishes, body-types, etc. you couldn't go to this school without learning about these things, and, i think, by the time most women graduate, they're pretty damn liberal about this stuff. (yes, even the republican women.) so, i was getting a little homesick as i was reading this book. i miss being in a place where sexuality is celebrated instead of suppressed. and i feel odd about the fact that i've landed in a medical school where they're still rather, well, in the dark about some of these things. it bugs me, in particular, because i want to encourage women to be more in touch with their bodies and know that liking sex doesn't make you a slut. not to mention that it is a woman's right to have an orgasm. but that's just my opinion....

anyway, it was an odd thing to be reading/feeling when the doctor walked in the door. i was relieved that he didn't have the hot 3rd year med student with him this time--i don't think i could have tolerated being outnumbered by that much testosterone/eye candy just then. it was also one of those times when i felt oddly ambivalent about seeing a male doctor. and this is something i still don't understand. most of my doctors are male. my main specialist in my hometown, who has handled the majority of my healthcare up until now, is male. he's seen it all, so to speak, and i don't have any problem with that. but i was struck, when i saw mrs_dr_do the week before, at the different type of energy she brought to the patient encounter. there was something comforting about knowing she's experienced being a woman and knows what it feels like to be in this type of body, and somehow that was expressed in the way she touched me. not to mention she didn't make a big fuss over things like listening to my heart under my shirt like physicians are supposed to do. nothing makes me quite so frustrated as knowing that a physician is taking a shortcut because he's too embarrassed to put the stethoscope under my shirt. i had a surgeon do that recently, before surgery, and i was stunned. there was an assistant in the room--it wasn't like i was going to claim being molested or something. but there's the rub--in today's pc, litigious society, doctors are coerced into taking shortcuts during exams. it's not only nuts, but it has the unfortunate effect causing me to dislike my breasts even more--they're always in the way. i know, intellectually, i "shouldn't" feel this way, but sometimes i feel like it's just another thing that makes an excuse for discrimination. then again, maybe this anger i have is more about the fact that i haven't had anyone around to enjoy them in a long time. did i mention that i miss having a boyfriend? <--odd thing for a feminist to say, isn't it? but i digress.

it was pretty clear to me, from the outset of this appointment, that i was not well-prepared to be there. one of the most profound difficulties i have as a patient is knowing how much information to provide a physician with, and how detailed i should be. it seems that i either haven't been paying enough attention (how often have you been taking x for your nausea? i dunno....), which frustrates the doctor, or i've been paying too much attention (here's the list of everything i've taken, experienced, etc), and get that you-must-have-ocd look. where's the balance? i still don't know. and i'm supposed to be on the professional side of this spectrum now. ha! as if that makes a difference! so, i wasn't prepared. and given the fact that the past ten days have been like a roller-coaster, i didn't know how to answer his questions. i felt myself starting to get frustrated, which wasn't a good thing, because i was already worried that i was going to burst into tears. which brings me to another difficulty of being a patient--communication. mr_dr_do said "i heard you were feeling better," and i looked at him, completely puzzled. "my wife told me," he pointed out. i didn't realize until later, after the appointment, that what i'd said to mrs_dr_do is that i'd been feeling better up until the time i landed in the er with the severe pain, but somehow that came across as i was better in general. given that i was (am?) still a bit freaked by that episode of pain, i don't know what to say about this.

and here we have another point: my desire to please people. especially with my male doctors, who seem to be more goal-oriented, i can see that they really, really, really want to hear that i'm feeling better. and i understand that, because i really, really, really want to stop feeling like crap. but i don't know what to say when everything remains uncertain. am i glad i'm only taking 1 of the nausea pills a day versus 3? yes. but it still sucks to be nauseated and i hate the fact that i have to take the medication at all. mr_dr_do caught this ("are you taking fewer because you're feeling better or because you're tired of taking them?" my answer: "both."), and that's one of the things i like about him--he picks up on such subtleties, unlike most PCPs I've encountered who may have been equally astute (I'm not entirely sure), but certainly never took the time to listen to me long enough to catch these nuances. And these are important nuances in the life of a patient. believe me.

but i so badly wanted to be able to tell him that i was feeling better that it hurt me not to be able to do so. i always end up in the doctor's office thinking, "please, please don't hate me for being a complicated case." sometimes i even go so far as to withhold information that i want to discuss with the doctor because it's clear that s/he is getting frustrated with me. the problem with this perspective, as well, is that i often run into another problem, the one i call the fascinoma syndrome. this is when my symptoms/disease process becomes so interesting to the doctor that s/he gets so caught up in my case as to forget that I'm a human with a life and not a lab rat. *sigh* i cannot even begin to describe the complications that arise from that type of doctor-patient encounter.

the odd part about today's encounter is that it took mr_dr_do a while to realize that part of the reason i was there is that i'd left school because of the medical problems and my anxiety about them. i did end up sharing some of my concerns about all this, but i don't think i was quite clear about how i felt. then again, what the hell does my emotional state have to do with my gut? everything. and nothing.

the other odd thing about being a patient is that for the patient, each encounter with the doctor is significant. i get almost hyper vigilant when i see a physician, in that i find myself latching on to their words and expressions so that i can sort out what happened later, when i'm less overwhelmed. this means that i'm a lot more aware of the encounter than usual; whereas, for them, I'm one of a steady stream of patients they've seen that day, barely distinguishable from the rest. So, i was a little surprised that mr_dr_do thought that i was younger than i am (this also made me a tad insecure: do i seem that immature when i'm here? is it my anxiety that makes me seem young? note that i think these things instead of, hmm...might it be that i don't look like i'm almost 30? why can't i think of the positive possibilities first?!?!?), that he'd forgotten i was an english major in college, and that he hadn't realized that i'm not one of the students who has come to medical school straight from college. he seemed a bit surprised to learn that i've had a long work history in healthcare, particularly in management. too bad i didn't get to tell him some of the crazy stories about managing odd groups of super intelligent doctors with not-so-great personal skills. those stories are unforgettable.

so, what makes a patient unforgettable? and why do we, as patients, care so much about what the doctor recalls about our personal lives? is it because the medicine impacts upon these lives? or are we merely making a mad cry for attention? or could it be both? i really don't know.

there was more to the encounter today--a lot more--but i won't ramble on about all the details. i think my point has been made. being a patient? it sucks. being the doctor? well, i guess i'll find that one out soon enough.

what i do know is that i left mr_dr_do's office today feeling out of sorts and confused. once again, i made it to the car before i started crying...but i'm not even sure why i cried. nothing bad had happened. i did get some help. so why did i feel so odd about the encounter?

maybe i'm just tired of being the difficult patient.

time for change!

first, i decided it was time to change my blog template. the dots were starting to drive me crazy. alas, my attempts to find some really neat artistic template failed when i realized that i was spending too much time tweaking and not enough time studying. so, for now, my html alterations on font, plus a different blogger template, will have to suffice.

but, when i titled this post "time for change," i wasn't thinking primarily about the template, or the impending daylight savings time debacle (does anyone know *why* we still do this? does it stem from hubris? i need my hour, dagnabit!). no, my thoughts were of a more radical sort: thoughts that call for alteration of our conventions.

my problem, at present, has to do with the conventions of being a woman in medical school. more specifically, my problem has to do with american definitions of "modesty," particularly in clinical settings. it's been insulting enough to be a female patient, one who gets asked to don a paper gown for every examination. does anybody really think that wrapping myself in paper preserves my modesty or my dignity? the darn things are practically translucent! not to mention they slide off with the slightest movement, rendering one nearly or totally naked in spite of the paper. but i digress. this week's problem isn't about being a patient, it's about the insult of being a female medical student.

****disclaimer: if you're the sort of person who cannot cope with precise anatomical descriptions of the human body, you might want to skip this post.****

that said, medical students, as i may have mentioned previously, learn the art of physical examination by practicing on one another. we do this in a large room, with a handful of physician instructors who wander around and monitor/amend our progress. it should, for all intents and purposes, be a very professional learning environment...right? wrong. first off, let me mention that the school chased off the only female physician instructor for our clinical exam class. (don't even get me started on how i feel about that--she was, after all, our best lecturer and really the only female role model here within an age range to which we could relate--i could vent for hours about my anger over her absence.) so, now, our clinical examination class (we call it ce for short) is led entirely by a staff of male physicians, most of whom are retired from clinical practice and/or getting there. don't get me wrong--some of these guys are brilliant and it's a privilege to get to learn from people who have been in practice for a number of years (i.e. 30+). since it's one of the anatomists/deans that refers to me (and every other woman in the class) as "honey," i can even say i have comparatively good rapport with these men.

however, on tuesday, our ce lab covered the cardiac exam. the night before, we got an email from one of the primary instructors, reminding us to wear our omm (osteopathic manipulative medicine) attire. this consists of shorts or sweatpants and a t-shirt. for the women, it also means we have to wear a sports bra. (the professor's email blithely mentioned that this piece of the attire was optional for the men.) supposedly, we have to wear sports bras to "preserve modesty" when doing the exam. whatever....

the cardiac exam requires that we remove our shirts, which is no big deal since we do it every week for our omm class anyway. however, in order to properly perform a cardiac exam (at least in the thorough manner in which we're taught to do it--i've never actually seen a physician perform each and every one of the components of the entire physical exam in a real clinical setting), we have to palpate the chest for the pmi (the pmi is the point of maximum impulse; it's about a 1cm spot on the chest where you can feel the heart beat up against the sternum/breastbone). when the physician instructor demonstrated this technique to the class, he (of course) chose some young chiseled man as his specimen. in order to find the pmi, the professor noted, we should find the level of the nipple line and move slightly inferior (below) that. any of you who are female readers should already begin to see the problem here. but did the professor mention it? no.

so, he instructs us to begin practicing on each other. several of the female students and i began working on each other. we quickly noticed a big problem: breasts. first off, when breasts are bound up in a tight-fitting sports bra, they don't move a whole lot. you can't really separate them, lift them, or otherwise get them out of the way without getting bound up and/or stuck in the elastic of the fabric. so, we tried to feel for the pmi around them. no luck. we tried to find the pmi on ourselves (so as not to have to molest our lab partners); again, no luck. at the 4th and 5th intercostal spaces (the areas between the fourth and fifth ribs), there is, in many of us, simply too much tissue to get anywhere near the breastbone. we were stumped. so, we did what any normal group of students would do: we called over one of our professors to ask for help.

the professor, upon hearing our question, turned bright red. by this point in the day (we'd had 5 hours of lecture already), i was too tired to censor myself, so i said, "haven't you seen like a million breasts in clinical practice? what's the big deal?" he stammered a bit and then said that it's different when it comes to students. what's different? i thought, my breasts? but fortunately, i bit my tongue before the questions came out of my mouth. essentially, we got no answer from him as to how to perform the exam properly. we were only given the impression that, in a room full of 80 students and a dozen faculty, the men were still afraid that someone would claim inappropriate behavior if they demonstrated on us.

after class, a bunch of us gathered and began talking about the experience. now i, having been a women's college graduate, really have no problem with breasts. (they're breasts, people! i wanted to shout. parts are parts!) in fact, as a medical student, after having seen cadavers and the like, i really don't have a problem with any body parts. but i also recognize that i am not everyone. some of my closest friends here are muslim. as such, they cannot remove their t-shirts in lab because we're in a co-ed lab. i asked one of them why the school did not offer her a separate lab session; apparently, one of the other medical schools kicked a muslim student out of school because she requested this. (can they do that?!?!? isn't that against our civil rights or something?!?!?)

is it 1950 again?

needless to say, i am angry. part of me wants to go to the next lab braless, but i have a feeling that'd give half the old guys heart attacks, and then i'd actually have to *use* the new cpr skills i just learned and...well...i'm not ready for that. i did end up emailing one of the professors and asking him to address the issue at the next session, but he hasn't replied to my message. am i surprised? no.

so, what is a girl to do? you might ask. for starters, never call a female over the age of 18 a girl. or honey for that matter. as for my solution? i scraped up my pennies and joined now.