I came across the plaintive tale of a young OB/GYN physician, Dr. W, who decided to bail out of practice after less than a decade. She gave several reasons: falling asleep while driving home and wrecking her car; missing out on birthdays and weddings; sticking herself with a needle while drawing blood from the umbilical cord of an HIV positive patient and felling like crap while taking prophylactic antiretroviral drugs. Worst of all, she discovered health care wasn’t what she thought it was when she started residency, and that physicians are “only pawn in game of life,” albeit very well-paid pawns.

I can hear the ghosts of the old timers saying, “See, we told you women had no place in medicine!” I can also hear the voices of the women with whom I went through medical school four decades ago yelling, “Shut the fuck up! Do you have any idea what we had to endure so that no one now thinks twice about women in health care?”

Being a physician isn’t a nine to five job unless you’re a dermatologist. Obstetrics is a grueling, physically demanding profession and four years of residency should have made that intuitively obvious. Babies arrive at all hours. So do emergencies like ectopic pregnancies and twisted ovaries. Someone has to take care of those patients and sometimes we must go above and beyond the call of duty in the name of patient care.  Good labor nurses frequently stay past the end of their shifts to follow through on pending deliveries.

My first post-residency job was in rural Michigan with a former fellow resident. We did every other night call which turned into solo call when one of us took vacation. Two years later I joined three ob/gyns at a staff-model HMO, doing call every fourth night and every fourth weekend. I did 250 deliveries a year, four years in a row. Sometimes it was so exhausting – I didn’t know my own name after doing thirteen deliveries one weekend – but it was nowhere near as bad as residency.

Those of us who’ve been in this biz for a while aren’t oblivious to the dangers of sleep deprivation. The Institutes of Medicine, the Joint Commission, and even The American College of Obstetricians and Gynecologists (ACOG) recognize the problem. But you made one choice when you entered residency and another choice when you started practice. There’s a middle ground between working yourself into an early grave and quitting altogether. You just have to find it.

I’m a hospitalist in a town with about forty OB/GYN physicians, mostly women, in groups of six to ten. Most of them are mothers; one of them has six kids! They take call a few times a month. Yeah, sometimes staying up all night gets old, but they are making far more money than I could ever fathom and it’s hard to walk away from those golden handcuffs. Working part-time is one possibility but you can’t expect a full-time salary.

Dr. W. said, “no one wants to hear a doctor complaining about their job.” No shit, Sherlock. What makes you think physicians are the only people who work odd hours, miss out on family events and suffer from sleep deprivation? Municipal workers where I live (the Midwest) stay out all night plowing and salting snow-covered roads in the winter. Many sales reps spend a lot of time driving or flying to clients and living out of suitcases. Store managers are the first to get called in if there’s trouble – a fire, a water main break, a burglary – and they fill in on the floor when someone doesn’t show up for work. My brother-in-law calls his Asian-Pacific vendors in the dead of night because that is when they are doing business. Many of those people make a lot less money than you, but it’s part of the job and they don’t whine about it.

I had joint custody of three kids and worked full time. I picked them up from daycare and/or school, cooked dinner, bathed them and read them stories before tucking them in. I made them breakfast the next morning before getting them dressed and dropping them off. I did laundry, housekeeping and grocery shopping with no help. I missed some things, but my life was far easier than someone on active duty spending fifteen months in a war zone, just hoping to come home alive.

(c) Can Stock Photo / zabelin

I’ve never worried about acquiring HIV from a needlestick because the chances are about 3 in 1000. I don’t double-glove when I do surgery because I can stick a needle through two pairs of gloves just as easily as one. I worried more about acquiring influenza from women who came to my OB Emergency Department hawking up hairballs this past flu season.

Health care started changing in the 1970s, not the mid-aughts of the 21^st century. I came of age between the Great White Fathers who could do no wrong (and who had easy access to amphetamines, so they could function like superhuman gods), and the employed physicians of today who ceded autonomy for financial security and lost both. Administrators, insurance companies and the government started telling us what to do in the mid-1980s when the money got tight. Capitation, diagnosis-related groups (DRGs), relative value units (RVUs), and the overly complicated ICD-9 coding system (now the hilariously overly complicated ICD-10 system) made unending paperwork an integral part of practice. Medical coding and billing is a multibillion-dollar industry.

I left the rat race over twenty years ago, largely because I got tired of the people who signed my paycheck lying to me. I became a locum tenens physician and traveled around the country. I made a quarter of what I could have made in private practice, but I could just do my job, get paid and go home. No meetings. No hospital politics. No turf wars. If the situation became untenable, I could give thirty days’ notice and walk, something I did only twice. And, I didn’t have to pay a $150,000 tail for liability insurance.

What troubles me now is seeing a generation of physicians for whom practice appears to be just a job to endure until they make enough money to retire. I can honestly say that for me medicine was a calling (I was thirteen when I decided to go to medical school). Now I’m just praying for a quick and painless death in lieu of spending my golden years beholden to some baby doctor who doesn’t listen, can’t think and is just going through the motions.

Crying Girl: (c) Can Stock Photo / jirousova

Doctors make lousy patients.

I spent half the summer extolling the virtues of adequate hydration to pregnant woman whose urine specimens were as dark as Granny’s sweet tea, but then ignored my own advice.

Every August our church holds an outdoor mass at a local farm and family activity center owned by one of our parishioners. Several of us arrived early to move picnic tables and set up stands for hot dogs, drinks and dessert. The guys hauled out the four rusty barbecue grills made from steel drum halves and filled them with charcoal. The farm donated several dozen ears of corn which we soaked in Rubbermaid garbage cans half full of water.

We soaked the charcoal with lighter fluid and lit the grills about a half hour before Mass. If the coals didn’t seem hot enough, someone would squirt more fluid onto them, creating a fireball.

“Hey, I heard you’re not supposed to do that.” *wink wink, nudge nudge* Another shot of fluid and another fireball.

We loaded the grills with corn just as Mass started, turning the ears with gloved fingers as they roasted. I had my trusty grill tongs, one in each hand, and my heat-resistant gloves, which last year I discovered don’t work when wet. The heat became so intense none of us could stand close for very long.

The sun was hot and the sweat slithered down my neck. My arms started feeling heavy after about forty-five minutes and I knew I should probably drink some water. I trudged over to the table our family had commandeered and sucked down the rest of my McDonald’s iced tea from a large Styrofoam cup.

Now, I travel a lot for my work and often miss church functions. I didn’t want to seem like a slacker so I refilled my cup with water and headed back to the grills. Everyone else congregated around the covered wooden corn stand, sucking down bottled water. One would have thought that was an obvious sign from God: “Get out of the sun, dummy!”

I was staring at the grills, watching the corn husks charring, the heat blasting my face, when the world faded to black, and I felt the ground sneak up behind me. I imagined the cup was a stationary pole and grabbed for it as I went down, crushing it in my fingers. I thought This is going to hurt…and you’re going to look really stupid.

I grazed my shoulder on the antique plow surrounded by flowers, hit the grass and decided this was as good a time as any for a nap…

I heard voices which sounded far away.

“Hey, are you OK? What happened?”

“I think Jimmy must have pushed him.” There were a few chuckles but their concern was evident.

“He’s pretty warm. Someone get some water and pour it on his head and cool him off.”

“Do you think we should call 911?”

A small crowd had gathered. I still had my eyes closed when someone doused me with a couple of bottles of cold water. It felt good but I was still pretty toasty and asked for another bottle which I poured on my chest. A woman’s voice above my head asked, “Does anyone here know his medical history?”

By this time Peg had arrived and said, “I’m his wife.”

The other voice persisted, “Does anyone know if he has a heart condition?”

“I’M HIS WIFE!”

Lady if you don’t back off Peg is going to hurt you. Don’t poke the bear!

I opened my eyes and was looking up The Voice’s blouse. She was leaning over me, holding a tablecloth for shade. I said, “I’m still pretty hot.”

Someone handed me an open bottle which I poured onto my chest. I reached out for another one and lowered it to my mouth, I took a few deep gulps but then, momentarily forgetting I was flat on my back, lifted the bottle straight up and waterboarded myself. I struggled to turn on my side to drain my nose.

“What’s happening? Is he having a seizure?” The Voice again.

No, you idiot. I’m drowning.

I rolled to my side, snorted a few times and lay back. The Voice said, “His breathing is labored.”

“No, I’m not in labor.” This got a chuckle from everyone who knew me, but she didn’t and said, “He’s delirious.”

“Do you think we should call 911? Do you have insurance?”

Peg said, “Yeah, we have crappy church insurance,” which is true. Every year the premiums go up along with the deductibles and co-pays while the coverage gets more stingy.

“No, I’m fine. I’m just hot and a little dehydrated. Let me sit up for a few minutes and I’ll be OK.” I mentally imagined the cost of an ambulance ride and an emergency room visit; the dial in my head was running faster than a gas pump set for five bucks a gallon.

I heard a familiar voice at my feet. “I’m a personal trainer and my sister is a lab tech! We need to get his legs above his head.” She grabbed my feet and started lifting.

Oh God, no. That is the LAST thing I need.

Peg said, “Don’t do that; he has a bad back and you’ll hurt him.”

Listen to the lady and get your hands off me.

She persisted despite my wife’s objections and I foresaw another rumble.

Peg said, “Put something under his knees if you want but don’t lift his legs up.” One of the guys grabbed a couple of empty charcoal bags and chucked them under me. The personal trainer dropped my legs but tried another well-meaning but ridiculous intervention.

“I’m going to put a couple of bottles of water inside your groin. That will help cool you off.”

You gonna do WHAT??? Jesus, just leave me the fuck alone!

“We really should call 911.”

I knew I wasn’t going to win, but I didn’t want to give in and muttered, “Let Peg decide.”

She gave the OK and later told me, “I did it because if I said no they would have thought, ‘Gee, what a heartless bitch; she won’t call an ambulance for her poor husband.’ You’re a physician and I play one on TV but they aren’t going to listen to either one of us.”

So the call went out and about five minutes later the local ambulance and fire truck pull into the grounds. I’ve never understood why a fire truck always comes along since there’s nothing burning.

One of the paramedics asks how I’m feeling and The Voice says, “He’s cold and clammy.”

No shit. I’ve had four bottles of ice water poured on me.

Peg intervened, gave them a brief history, and I crawled onto the gurney. I’ve ridden in the back of an ambulance with a patient but I’ve never been the one being transported. Once inside they started asking me the usual questions: name; medical illnesses; allergies and any medications.

“Ranitidine; enalapril; aspirin; antihistamine and something for my prostate. It’s…uh…that blue one.” I couldn’t remember the name; maybe this was more serious than I thought.

“Ok, we’re going to start an IV, put some pads on you and do an EKG and check your blood sugar.”

They took their time, for which I was grateful because there’s nothing worse than trying to start an IV on someone with collapsed veins in a moving ambulance that rides like a 4X4 over railroad ties. We finally started moving and I watched the picnic grounds recede out the back window which reminded me of riding in the rear-facing third row seat of a 1960s-era station wagon.

The firemen,  having nothing better to do on a Sunday afternoon,  stayed around for another hour, feasting on roasted corn, sampling the desserts and socializing with the crowd. There’s much to be said for small-town life.

Peg arrived at the hospital long before the ambulance left and asked about me at the emergency room reception desk.

“We don’t have anyone here by that name.”

“Are you sure? I watched the paramedics put him in the ambulance.”

“Oh, wait. We had a call about a man who collapsed at a picnic. The ambulance should be here shortly.”

While she was waiting a man dressed in pajamas and carrying an old-time doctor’s bag walked up to the desk and said, “I’m Doctor Moore and I’m here to check into the hotel.” A woman behind him said, “No, I’m his sister and he’s here to see the psychiatrist.”

Just another day in the emergency department.

The ambulance pulled into the bay about ten minutes later. They pulled the gurney out and I shook hands with the paramedics before they wheeled me into an ER room. The nurse gave me a gown, asked me the same questions and said, “The doctor will be in shortly.” She hung a new IV bag before she left.

Someone brought Peg to my room; her sister showed up a few minutes later. They caught up on what happened after I left; I wondered where my barbecue tongs and gloves were.

The ER doc, a Denis Leary clone, came in a few minutes later and cut his spiel short when he found out I was a fellow physician. He ordered blood work and a 12-lead EKG, even though the one in the ambulance was normal, because there are protocols to follow and asses to cover. I’ve done the same even though I often think it’s a colossal waste of money.

Lab and EKG techs came and went. I dozed; they talked.

Then the woman who gets the insurance information entered. She may seem a humble employee, but she is the Most Important Person in the hospital since the hospital doesn’t get paid without her efforts. One would think the administrative suite would treat her like royalty, but to them she’s just another FTE, an interchangeable cog in the machinery.

My sister-in-law looked at the woman, paused for several seconds and said, “You look familiar.”

“So do you.”

“Do you go to Our Lady of Perpetual Trepidation?”

“Yes, I do.”

Suddenly it was Old Home Week and they chatted while I snoozed on the cart.

I was ignored for the next two hours.  The nurse was staring at the computer screen when Peg went to tell her my IV bag was almost out. About 30 minutes later I needed to go the bathroom. Peg went back to the desk, found the nurse reading a book and the doctor futzing on the computer.

“My husband needs to use the bathroom. Do you have his labs back so we can get out of here?”

The ER doc came in after my potty break. My labs and EKG were normal – big surprise. He asked if I had a primary physician and I just snorted. (I told you doctors made lousy patients). We talked about ER patients and how he had to work another 20 years before he could retire. We finally left with instructions to make a follow up appointment with the primary care physician on call that day, something I had no intention of doing.

It’s probably just as well. Peg did some online research and discovered he was a Family Practice doc with three judgments and a state reprimand in only 11 years of practice. But that’s a story for another blog post.

A woman called the church office on Monday.

“I heard Peg talking about taking her husband to the emergency room and she seemed really worried about the cost. Do you think we should start a GoFundMe page for them?” Our insurance may not be the best, but it is far better than being uninsured

I got the tab a week later:

Ambulance ride: $1047
ER visit:    $5681
ER Physician charge: $651
Humiliating yourself in front of a crowd: Priceless!

Physicians don’t listen for shit, even when the patient is another physician.

I spent two hours in my own ER after doing a Cesarean section in a hot operating room. I was sweating like a pig and starting to get shaky, even though I’d had breakfast a few hours earlier. Thinking my blood sugar was plummeting, I wandered out to the nurse’s station and asked for a sugared pop (which tastes like pure syrup when one is used to diet).

Joy, a nurse with a very kind soul, thought I looked like crap and took my blood pressure. She got a panicked look in her eyes because my diastolic was 108. I’ve been on medication for about 12 years and my pressures are usually fairly normal at home. She took it again suggested I go down to the Emergency Room.

I said, “I feel fine. How about I go lay down for a few minutes?”

“So we can find you dead in the call room? How about the ER?”

I objected again so she grabbed the guy who’d done anesthesia for my Cesarean. He listened to my heart, looked at my blood pressure readings and said, “You really should go to the ER. I know the doc down there and I’ll give him a call.”

I relented. “OK, I’ll just mosey on down there.”

The nurses all said, “NO! We’ll get you a wheelchair and take you down. And if you don’t behave, we’ll call Denise to do a one-on-one with you.” Denise is another nurse and doesn’t take crap from anyone! I thought I’d be safer in the ER.

They wheeled me out of the unit, into the elevator and down a very long hallway to an ER bed. The ER nurse had me change into one of those idiotic gowns, then hooked me up to a monitor and a blood pressure cuff. She asked me the usual questions: Did I have any chest pain? Was I taking any medicine? Did I have a history of hypertension? Heart disease?

The ER doctor came and I repeated the same information, adding I was taking medication for my blood pressure; that I couldn’t take it at night with the drug that helped me pee because my blood pressure would plummet and I’d fall on my face; that I wasn’t diabetic but that I’d had a can of sugared pop shortly before coming down.

He listened to my heart and lungs, ordered an EKG, a chest X-ray, and blood work and told me he’d return when all the results were back. Standard ER protocol. I figured all the results would be normal.

The nurse started an IV and drew a few tubes of blood. Then someone from Imaging (the X-ray Department to anyone my age) snapped a chest x-ray. She apologized for the cassette being cold, but it felt really good on my back. I thought about the good old days when x-ray departments had 55 gallon drums of discarded films. Now everything is digital and viewed on a computer screen.

A Cardiopulmonary tech did an EKG, which read normal sinus rhythm—big surprise. Yes, the EKG machine reads the strip and makes comments. After that Dave from Respiratory Therapy came by with an albuterol solution because my lungs were a little tight.

“Have you ever done a nebulizer treatment,” he asked.

“Yeah. I have Symbicort—“

“That’s not a nebulizer med.”

Dammit, let me finish my sentence. “—albuterol inhaler and albuterol solution for my nebulizer.”

“So, you know how to use it?”

Yeah, it’s like taking hits off a bong but I’m not about to tell YOU that.

I laid on the gurney, pondering what my wife would say when I told her I’d been in the ER as a patient. I’d left my personal cell phone upstairs in my locker so I couldn’t call her, which was probably just as well.

The ER physician came in about 90 minutes later. All the results were normal, except for my non-fasting blood sugar of 174, which was not a big surprise after ingesting 39 grams of pure sugar. My blood pressure had returned to more normal levels. He told me to take it easy the rest of the day.

All was fine until I got the discharge paperwork which the following diagnoses:

• Acute generalized weakness
• Near syncope (fainting)
• Chronic diabetes
• Uncontrolled hypertension

WTF??? I didn’t have “generalized weakness” and I didn’t come anywhere near fainting. I’m not a chronic diabetic. I’ve checked my glucose levels frequently at home and if anything I’m prone to hypoglycemia if I don’t eat for several hours. (My record low was 54). My blood pressure came down to normal after lounging on the gurney for two hours. One makes a diagnosis of hypertension with several blood pressure readings over several days, not a couple of hours. If I had to guess, I think he assumed “fat Hispanic guy; must be diabetic, hypertensive, non-compliant and a walking heart attack waiting to happen.”

The next day I had the nurses at the office check my blood pressures, which were normal every day. I bought a glucometer and poked my fingers five to eight times a day, dutifully recording what I’d eaten and when along with my blood sugars, all in a nice Excel spreadsheet. My fasting blood sugars were just a bit high (101-103), but they normalized when I had a protein snack before bedtime.

Patients have complained to me that their doctors didn’t listen to them. Well, they are probably right more often than not, and for that I am truly sorry.  And now I understand.

Photo Credit: Canstock Photo