Sunday, January 8, 2012

Medicine is Killing Doctors

I looked around and didn’t see anyone, so I kept walking.
I stopped and turned around and there about ten car-lengths away from me was a figure dressed in a yellow sweater and blue faded jeans hailing me with his left arm. I looked behind me to make sure it wasn’t for someone else. There was no one behind me. I raised my hand half-heartedly, not knowing, who this person was.

Now before I go revealing his identity, let me take you back a few years. On a bleak winter’s night, I had just gotten into the hospital parking garage and was looking to where, I had parked my car, when I saw my friend, a surgeon lean against the support column. He appeared to be in some distress. I rushed over to him,
“Everything OK?”
“Yeah, I think so?” that did not sound reassuring. Needless to say, I walked him back into the hospital and settled him down in the ER. Called the ER doc and have her evaluate him. His blood pressure was 190/100mm Hg, pulse rate in the 100s and his EKG showed high voltage activity. He was exhibiting all the signs of stress; the reddened face, the slight tremor of his hands, dilated pupils, sweaty palms and all the rest that goes with fight, fright and flight. A little help from his friends and in less then an hour he was back to his normal self. Of course he 
would not stay in the hospital, “God forbid!” as he put it.

The next morning, I met him walking into the hospital deep in thought, for a surgical case. He was back to his calm self, we both mumbled a hello as our paths crossed and off we went onto our respective playing field. That very evening a similar episode happened with another physician friend of mine, only, I was not present but was alerted by the ER doctor.

And then, just like the day turns into night and leaves all its glory to fade through twilight, without any prompts or prior warning both of these friends retired immediately after those episodes. Neither declared the day of the retirement. They just upped and left the workplace. Gone! No farewell parties, no reminiscing, just, gone!

I remember the last time I had seen the surgeon, his face was a veritable topographical delight for furrows and frowns and crows feet. His shoulders were slightly hunched and the eyes sunk into deep orbital havens as if sheltering from the harsh light of reality. He was as I can remember then, around fifty-seven years old and one of the best surgeons in the entire county, if not the state. It was known through the hospital that his hands were “golden.” His success rate was in the stratosphere in surgical circles and his complication rate was non-existent. He was a surgeon’s surgeon. And yet with all that past success and promise of the future, he just left one day and I had not seen him since. I had missed him as a friend and for his expertise.

Now getting back to my story...

The image got larger and larger as the man hailing me came nearer.
“What, you don’t recognize old friends anymore?”
It was him! He looked like a man in his mid forties even though a decade and a half of time had passed by. The frown lines were gone. The eyes sparkled with a sense of self and purpose. The face was weathered, yet  bereft of the deep furrows of yesteryears, from the sun and his shoulders were broad and his spine erect.

“Wow, look at you,” I said, “which plastic surgeon are you hanging out with?” I hugged him and we sat down on the nearby bench. “Golf, a good life, family and grandchildren!” was his answer. We chatted awhile and he told me that he was working in another state, but not as a doctor. We both filled each other’s cup of life with the time spent away in each other’s absence and then he said to me the few words that have been tattooed in my mind. “Medicine was killing me!” I shared with him, the state of all the friends he knew and told him what had happened since he left; we had lost a brace of kinsman to heart attack. Some, I said, have been lucky undergoing coronary stenting of they’re 99% occluded left main descending artery (“The widow-maker”) while other’s less fortunate have died in restaurants or in transit. Majority of the coronary events seemed to have occurred on Monday mornings and most en-route to the hospital. His face seemed to weather the information with some difficulty as memories flooded. Yes, he was lucky. I saw the wisdom of his action settle its weight on him. “Auld Lang Syne” played silently somewhere and a friendship was rekindled.

As physicians we dwell in the world of people stricken with maladies that we try to fix. Much like the watchmaker with his tools fixing the intricate wheels and gears within, only we as physicians deal with animate objects, humans. The complexity of the situation and the constant alertness to detail causes a flow of blood humors that are evoked in a persistent state of agitation. The stress of it all is recorded on the cellular machinery, it gets imprinted into the DNA that fabricates cytokines, modulates immunity and forces all humanly self-protective measures to its knees. Each little bit of a runaway infection, a bleeding blood vessel, a malfunctioning kidney, a confused brain, an intemperate heart with its dissonant sounds and rhythm, the failing liver, the watershed moment of an electrical storm, the clouded vision, the obstructed respiratory passages, the uncontrolled sugars and the unregulated electrolytes, the vanishing blood cells or the Armageddon of the wayward leukemia and cancer cells, chip away at the physician’s inner reserves. And yet not only does he or she bear the brunt of this vocation, there are a multitudes of other externalities that constantly harass and harangue the beleaguered doctor. This then is the vice in the virtuous field of medicine.

Yes! Medicine is killing doctors. 

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