There is no crying in medicine!

While there have been many changes in the training of doctors in the last 30 years, there are a few things that never will. No matter how you slice it, becoming a doctor means sacrificing a lot of free time in your twenties. So, our capacity to whine about this is pretty much intact from the 1970's. In fact, doctors carry this as a badge of courage. We wallow in our work ethic. We love to rub EVERYONE'S face in how tough we are; repeated nights on call harden us to suffering, clearing our thoughts and separate us from the trials of our patients. We can remain cool, calm, collected ... and distant. More recently, though, this is changing. We are supposed engage more deeply with our patients and their families. Okay. For those who want the distant doctor, we must be ready to be that doctor, too. This hard for many of my kind. This episode has to do with this issue.

As as resident physician, I dealt a lot with the"old-school" doctors, but the medical students who I was assigned to look after and teach were "new-school" - touchy, sensitive, and soft. One day, one of my medical students whom I will call "Flower" was assigned to take care of a lovely elderly woman (lets call her "Granny" because I have no imagination) with a urinary tract infection who had a sweet personality and lovely family. Anyone who knows anything about medicine knows it never ends well for people like this. Well, Granny's kidneys begin to fail unexpectedly, and over the course of about 2 days, to everyone's surprise, Granny goes from knitting blankets to, well, you get the rest. Anyway, Flower spends those last 2 hours of Granny's life with her family, praying with them, crying with them, etc. Afterward, she is a runny nose, sniffling, hot mess. She used most of the tissues paper on the floor. She tried, but just couldn't pull it together. So, I suggest that she just collect her stuff and take the rest of the day off, not to worry - the rest of us will be here tomorrow. She hugged me, and then carried her puffy-eyed self home. This scene is observed by one of the older "attending" physicians who looks like a Jeremy Piven's much older, much geekier, and MUCH more nearsighted brother. Anyway, he is looking at me with disgust, muttering under his breath.

"What?" I ask him.

"What was with her?" I explain about our tender Flower.

"She shouldn't be crying. That person wasn't in her family. It scares the patients." I have no response to this, so he continues, "There is no crying in the hospital." I am still silent, as this is starting to remind of Tom Hanks' rant in A League of Their Own. "No CRYING!" he exclaims.

"Um, okay." I say. I realize I should be vehemently defending Flower, but I kind of agree with Bizarro-Piven. Families look to us for strength, and while we can share in their sadness, I suspect that when we grieve with them, we are really taking the opportunity to relive our own losses.

Really not the venue.

But, the downside of this is we are often walled in. I never get choked up in the hospital, yet weep when I see commercials for the ASPCA. Should we be like Flower? Should we be more like Bizarro-Piven? The middle ground is the achievement of a truly grounded, even person. How many doctors do you know who meet that description? Me, neither.

Welcome to the House of Dog

Let me first say this blog has nothing to do with dogs. I am not selling, buying, or processing anything for canines. There is no symbolism here; I am not that smart, and anyway, everything I write about really happened, or is happening. You can't make this shit up.

The name of this blog is merely a reference to the infamous book penned by "Samuel Shem" (aka Samuel Bergman, The House of God. I read this book as I prepared to apply to medical school - actually, I was commanded to read it by my peers. "If you want to apply to medical school, you HAVE to read it!" Reading it reminded me of reading Jane Austen. I thought it was amusing, but it felt so tethered in the 1970's, that I considered it a period piece. Nearly 15 years later, I am a practicing physician. I did an internal medicine residency, heard the terms "turfing," "wall," and "sieve." In learning to speak "medical," I learned not just the real names for muscles and how to improve someone's potassium, but the slang terms listed in Shem's book. So that part of Shem's novel checks out. What I found so dated in his book was the silly personal lives of the characters. Who has sex in a supply closet or a call room? Nasty.

Flash forward to the late 1990's-current. ER, which began as a respectable show, suddenly had helicopters landing on people. Grey's Anatomy had more sex in the hospital than gall bladders removed. House? People began to request "Dr. House" to see them when I can't explain EXACTLY why they passed out. We are not Hollywood. We are limited people, working for you, at some of the worst moments of your life. We can be uneven, some days when we have the Midas touch, other days when we have shit finger. But, most of use have no idea what else we would possibly do it we weren't your doctors.

All of these are real stories. Welcome to our world.