Under the Magnifying Glass

I remember my first week of college.  I remember sitting at a stop light with my new room mate, Kyle.  As we sat there a green light turned in the perpendicular street and cars slowly started to march across our path, as they made an arching left turn, driving down the opposite way we had came. He asked me if I ever "just watched the faces in the cars as they passed by" wondering who they were, what they were doing...what they were going to do.  That memory sticks in my head, a person I considered a relative stranger making such a randomly honest statement to me, it caught me off guard, I lied stating I hadn't ever put much thought into it.  When he had said that, I thought he was weird...and I thought was weird for secretly doing the same thing, but I was young, and as time went on I realized it's one of those taboo things we, people in general, don't exactly "talk" about, after all, it's not always so "benign" to quickly place a person under your magnifying glass.

A very naive 6 year old says, "Are you pregnant?" to a store clerk as his mother checks out at walmart...the mother blushes and begins to check out faster...the store clerk is not pregnant.

A white supremacist screams racial slurs as an African American carries her back pack into a desegregated school for the first time.

The truth is making quick decisions and judgments off of very little is what we all do, it's a survival instinct that is as burned into us as much as the instinct of a bird flying south for the winter.  The truth is most of the time it is very useful helping us navigate this social world we are all apart of, but in the rare instances when it doesn't work, you end up as the example of the word "moron" in some doctor's blog ;P

In training to be a doctor, that magnifying glass isn't "gifted" to you, it simply adds a couple more powers of vision for you to see through.  Before school you see a sickly man pushing a cart down the isle of a supermarket.  You look at the man, you see his disheveled appearance, you look at the large amount of booze he has in his cart and you know what's got him that way.  After medical school you look at a similar sickly man, you realize he is jaundiced, you think he probably has liver failure, you glance at his shopping cart expecting booze...but it has toilet paper and cereal in it, (laughably) you STILL immediately think, "alcoholic". 

However, as I'm going through residency I'm discovering how it's tempering my judgments.  How in meeting patient after patient and getting to know the most intimate details about them, that nothing is as simple as the magnifying glass makes it seem.  The alcoholic sometimes has a VERY good reason for being that way, even if his lifestyle is an unsavory one.  You start to see that the mother who hit the child isn't always a monster, sometimes she's just a very stressed out woman in a bad situation, that was pushed and pushed 'till she snapped.  More and more, I'm coming to the realization that this "magnifying glass" was never meant to be used all by itself, that's why when our teachers were sharpening our vision in medical school they were also teaching us to talk to our patients...to empathize with them...otherwise we run the risk of focusing that glass too much in one place and that can be a very dangerous thing.

Newbie Doc

Clouds

One of the things that has really helped me through medical school and now residency is my childhood on the farm. It was a place of uncharacteristic freedom as well as unending responsibility. From an early age my brothers and I were expected to get up before the sun did and do the chores, though I'm sure by my father's and my grandfather's standards we would be considered highly spoiled, yet our "spoiled" is a far cry from what I see roll into my clinic these days. I remember times when Jason (my brother) and I would return home from school. As we sat around the house, watching TV, playing video games, and (in Jason's case) playing basketball, the radio would sound off and it would be our father. He would be needing our help with something, although now I'm sure the task would seem trivial, to two young boys wanting nothing more than to play it was something to be feared and hated. Upon hearing the radio, "Jake. Jason. Ya got a copy." We would often share a quick moment of recognition, our eyes would narrow, thinking the same thing, we would both bolt for the bathroom...you see if you could lock yourself in the bathroom, you could say that you were busy, if you were busy, the other would have to answer the radio, and if only one of us was needed for work (which would be the one that answered the radio), the other would get to stay home, free from work and worry.

Recounting that story, it always seems to make me smile. As the years went by and our responsibility increased that knee-jerk reflex to work was slowly trained out of us and somewhere in there we gained our father's ability to simply get the job done. It seems like such a simple thing to say it - if a job needs done, better get to it. Yet, everyday I see a large number of my co-workers which can't manage a task without an inordinate amount of complaining and foul attitude. In that respect, a few are still much like 7 year olds, hiding from the call of responsibility.

In medicine, there are residents that get marked as "dark clouds". These are the residents that seem to always get the complicated patients, they are forever stuck with more patients than others, and should it come to a competition in "horror stories" they have the market cornered. There are also those residents which are known as "white clouds", for which only good things happen. It seems that these "white clouds" are constantly getting patients that turn the corner, they join services that seem blessed by God himself, and even when things turn a bit "stormy", somehow things seem to work out. I can't speak for other white clouds, but in my experience I'm less of a white cloud for the work I get and more so because I don't complain. I've had horrible nights and dark days during this residency, some of which I have shared on here, but even when it's rough, I make an effort to contain it, to keep it from spreading to the people I work with. Not to say that I haven't learned that there is a place and time to ask for help...because there definitely is...but life on the farm with my father taught me that there is a grind to life and it is made worse if one of the cogs in the machine is a squeaky one.

For the longest time I really did believe in these "clouds". It really did seem like my dark counterparts were amazingly unlucky. One rough night on call I was working with a fellow "lucky" senior resident, Sam. We went into call with a low load of patients and went on to gain the maximum amount of patients we could admit that night, we capped out. It was a long and sleepless night and at the end of it we sat with 20 minutes of spare time before the morning residents arrived and checkout would begin.

- at 6am all of the day residents arrive and you hand over their patients to them, telling them if any issues or problems occurred overnight..you then go back to work taking care of your patients until 12pm, when you get to checkout and leave -

I don't remember the whole conversation specifically just a quick exchange that left me thinking. Sam was saying how he and another senior residents were really annoyed with a particular co-worker who never seemed to stop complaining. I reminded him that in her defense, she was a dark cloud. To which he replied, "I can never tell if they are dark clouds because they are unlucky or they are dark clouds because they complain so much." And I realized that I couldn't either.

It's not my intention to come down on those of the "stormy" disposition, but lucky or unlucky, you still have a choice in how you present yourself to the world and in my experience it can have a very positive or negative effect on not only yourself, but also those around you.

Newbie Doc