Tuesday, January 24, 2012

The Apple Doesn't Fall Far From The Tree

     I've often wondered what possessed me to become a physician. I detest snot and spit, two viscous bodily fluids which are virtually inescapable in the practice of anesthesiology, the sight and sounds of which I am forced to contend with on a daily basis, but which secretly nauseate me. I don't like living in hospitals or call rooms; they're full of germs and the dim-bright fluorescent lighting gives me a frontal headache. I especially dislike being on call for 24 hours, where I work all day, then have the privilege of staying up all night in the operating room, dealing with non-emergent emergencies, just because it's convenient for the surgeons. The paternalistic hierarchy of power inherent in medicine also poses an issue for me. Given the fact that I have an extreme distrust of establishments of any kind, I have a great deal of difficulty accepting that things can't, won't or shouldn't change within such an artificially-produced system, no matter how irretrievably broken it is, or the notion that I am merely a cog in the wheel. Finally, my name is NOT  "Anesthesia!" I do not have a problem with co-workers calling me by my first name, so call me Doctor or call me Kris, but please don't refer to me in the collective sense, based on my occupation.
     Obviously, I'm over-dramatizing a bit, because I do find caring for patients immensely gratifying. Medical histories aside, I love the way I'm able to learn important, intimate details about my patients in less than ten minutes of face time. We talk about their fears, dreams, and beliefs, what their spouses, kids, and grandbabies are like and what they mean to them, as well as what they'd like to eat when they wake up. It's an opportunity for me to talk to them about smoking cessation, because smokers who decide to quit around the time of a surgical procedure have been shown to have very good success rates. One theory is that general anesthesia "cleans out" the nicotine receptors and decreases the craving for a cigarette. I especially enjoy explaining the process involved in the anesthetic; it gives patients the chance to learn about what's going to happen in the operating room and to ask questions. Prior to undergoing an anesthetic, I think every patient should have a clear idea of how he or she will be monitored intraoperatively, what kinds of tubes will be placed, what we'll do if there's a problem,  and how their post operative pain will be managed, either with pain meds or the nerve block I placed preoperatively. The challenge is finding the words that fit each patient's level of understanding. I like to explain general anesthesia as a therapeutic end-point on the line of consciousness. To illustrate this, I spread my arms out, wiggling my left hand, and I tell the patient, "You are here." My left hand represents his or her current level of awareness, which is usually wide awake and a little nervous. Then, I wiggle my right hand, and say, "This is general anesthesia, and it's very different from being asleep. You and I go to sleep every night, and hopefully, we don't take drugs to do it. It's part of our natural cycle. When you're asleep, you dream, you move around, you wake up when you hear noises; under general anesthesia, you don't do that because we are controlling your level of consciousness with the drugs we give. We're going to take you from here (left hand wiggling) to here (right hand wiggling) in a matter of seconds by giving you medicine through your IV. General anesthesia is a profound state of chemically-mediated unconsciousness or a medically-induced coma, and when the surgery is finished, we stop giving our medicine. The next thing you'll remember is waking up in the recovery room, where a nurse will be with you at all times, and will give you medicine for pain or nausea, if you need it." That's my spiel, and it seems to put my patients at ease.
     I also relish my daily interactions with other physicians (well, most of them), anesthetists, perioperative nurses, scrub techs, and other operating room personnel. My job is stressful, and it's important for me to be able to laugh and decompress while I'm working. So, judging from the length of the above paragraph regarding what I like about being an anesthesiologist, compared to the first one in which I outlined what I dislike, it's fair to assume that I do appreciate most aspects of my profession. That still doesn't answer why I became a physician. I didn't grow up dreaming of following in my psychiatrist father's footsteps, nor did I have a formal calling to medicine. I went from a job in mental health into nursing and worked as a neonatal ICU nurse for seven years before going to medical school. Becoming a physician seemed to be part of a logical, natural progression. It felt right at the time and it just sort of happened, an unexplainable leap of faith where I took my ideas, inspirations, and intuition and ran with them.
     My mom receives a copy of my blog via e-mail every day, and she usually sends me a few of her thoughts regarding each one. She recently read The Beneficial Effects of Roach DNA on the Human Spirit, where I described my entry into motherhood as a physiologic awakening in response to my biological clock, and here again, the pattern repeats itself. I wasn't fond of babysitting, and I didn't seem to possess that nurturing instinct, therefore, I couldn't really picture myself being a mother. She wrote: I agree with you that a biological clock evidently seemed to pop off because you had little interest in kids and babysitting. Even when you called and said you were going to become a nurse, it stunned me momentarily because you never seemd too interested in dealing with sick people.
She's told me many times how I continually surprised her and Dad with my decisions to become a mother, a nurse, and a physician, and I have to admit, it was almost counter-intuitive. I'd always pictured myself as an artist or a chef.    
     Yesterday, I took out the autobiography my father penned in the decade before he died. He has a fascinating, almost unbelievable story, worthy of a book, and I thought it would be fun to have him as a posthumous guest blogger. I was reading about his early years in Poland, and learned that his parents kept a diary of his developmental milestones. It is hard to imagine Dad as a baby or a little boy because I've only known him as my father. Amazingly, this diary survived WWII, a trip to Australia in the hands of my father's old girlfriend, Danuta Dambrowska, and my parents' house fire in 1989. My grandmother, Babcia (BOB cha), recorded that in 1922, my father, Bartek, who was then eight months old, ate a little newspaper which resulted in inflammation of the intestines. She said that he became so ill that she and my grandfather sent their 14 year old son, my uncle Staszek (STAH shek), to fetch the doctor in a distant town, observing how Staszek later became so tired running that the next day he had to go to bed.
     Dad surmised that his parents had been more interested in recording his "intellectual and psychosocial development than the milestones of my physical/physiological progress...as there are many references to my interest in music" as well as his advanced language skills and early use of neologisms, his uncanny ability to recall distant events with great clarity,  and his mathematical dyscalculia, which eventually caused him to fail his apothecary exam in medical school. My grandfather recorded in February of 1927 that six year old Bartek inquired of his mother: Mommy, I know that God created us, but how was He created? Did He create himself? If God is so good, why does he allow people to have terrible diseases?
     Dad observes that "there are no inclinations in the diary that my parents ever dreamt of my becoming a physician or thought I might have nascent qualities of personality that someday could be useful to a doctor. Music and sculpture--yes, but medicine? No way! Except, perhaps, for frequent entries describing my empathy, compassion, and generosity." On this topic, Babcia noted: September 1926--Bartuś is very sensitive to the misfortunes of others. The other day on our way from downtown, we ran into a little boy with his father, returning from the doctor's office because the boy had an inflammation of his eyes. Bartuś took pity, and on the spot, gave him a whole box of candy which I just bought for him. He also promised to say a prayer for the boy. And, indeed in the evening, Bartuś says a prayer, and asks God to restore the health to the boy whom he met in the morning.  She adds: For the poor, Bartuś has a very merciful heart. One day, there came [to the door] a poor man. Bartuś said, "Look, Mommy, this man has such a sad look in his eyes--we should give him something." He was immensely happy when I gave the man some old clothes. Then, he asked, "Why is it that God allows [there to be] so many poor people in the world? God is so good, so why doesn't he give a lot of money to the poor, so they won't have to suffer poverty?"
     Reading through Dad's memoir, it is clear that the apple didn't fall far from the tree. I am very much like my father with regard to the reasons I went into medicine: it is a perfect vehicle for expressing compassion and empathy, similar to the way in which we convey these attributes through our music, paintings and sculptures. We both shared an altruistic desire to help people, to do the right thing, and we followed our hearts to get there.  We were inquisitive, constantly asking "Why" and "How", especially about God, which I believe made us more open-minded and receptive to the experiences of others, while freeing us from a faith-related agenda. Above all, we were both deeply committed to the art of medicine, not just the science of it. In my opinion, most physicians could benefit from developing more introspection, better listening skills, and sensitivity to the misfortunes of others, instead of the regurgitation of data, the narcissism, and the lack of empathy we've unfortunately become infamous for. Who knows? Perhaps artists just make better doctors.
    

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