After a year of clinical rotations, I am still not absolutely certain what particular field of medicine I want to enter. However, I do know that there are fields that I would not want to touch with a ten foot pole:
-Surgery – No thanks. Although I enjoyed cutting in to people and the simplicity of surgery itself, it’s just not for me. My ego is fine how it is and does not need that extra boost of being able to say, excuse me, I’m a surgeon. Especially for the price of living a life of 5am mornings and despicable attendings.
-OB/GYN – No thanks. While I appreciate that there is a field for female doctors to think that they are surgeons, I would rather not subject my manhood to the catty girls club that entails OB/GYN.
-Anesthesiology – No thanks. I don’t understand why some of my best friends desire this field. They say it has lots of procedures and it’s fun, but all I see is intubations, lumbar punctures, and being the surgeon’s servant. I’m pretty sure it’s mainly the money and shift work that entices them.
-Pathology – No thanks. I’m not one for looking into microscopes in small dark rooms with little human contact.
-Radiology – No Thanks. Again, I’m just not a fan of small dark rooms with little human interaction. The most you ever say to the patient is, ‘please remain still.’
And then there is emergency medicine. The residents in this field are stereotyped as the cowboys of medicine. This allegory is often true; the residents are thrown in situations in which the right decision has to be made quickly. Do we intubate this asthmatic with a rising pCO2 or not, do we spinal tap this obtunded child with fever and nuchal rigidity or not, do we place a chest tube in this 60 y/o man with acute CHF exacerbation who’s oxygen saturation is 80% due to refractory pulmonary edema.
The problem that I have with emergency medicine is not the field itself; rather, it is the type of patients that you have to deal with which deters my interest in the field. Everybody knows this patient, even if you haven’t done a rotation in the ER. She’s the one that doesn’t have health insurance and thinks the ER is a primary care doctor that she can get prenatal care from when she doesn’t have an OB/GYN doc. Or the non-compliant male that continually returns to the ER in respiratory distress because he refuses to quit smoking, but it doesn’t really matter anyway because his 80-pack/year smoking history has already signed his obituary.
The patient that really tickled my nerves was a man that appeared to be the age of 35 years old. He was an alcoholic, and openly admitted to it. As well, he openly admitted to being an ex-heroin addict currently taking methadone. He was actually a really nice guy and we ended up bonding because he genuinely seemed like he wanted to stop drinking. My brother is an alcoholic so I shared some of my thoughts and ideas as well as related to him. The patient has been unable to maintain a job for months because his life has been swallowed by alcohol and he can’t live with out it, much like my brother. I felt like I was having an impact on this patient as I shared some of my stories with him and he shared his thoughts and troubles with me.
He was brought to the ER with the two large police officers standing on the opposite side of the gurney (who did not deny any of his story). He was being booked for what I originally had assumed was for drinking in public or some other alcohol related charge and didn’t ask any further questions about it. While the patient was at the police station, he had a seizure, this being the reason why he presents to me in the ER. He stated that he had been drinking two pints of blueberry bourbon every day for the past two months. The seizure was due to withdrawal from alcohol. The patient stated that this was not out of the ordinary and that he previously had seizures before when he stopped drinking cold turkey. So I do the normal history and physical, investigating for any other potential cause of the seizure (cranial nerves were intact, no motor or sensory deficits, negative cerebellar signs, no obvious metabolic disorder).
It was not until later on when the patient was giving a urine sample in the bathroom that the police officers spoke up to ask if I knew why he was being booked. I assume the one officer asked in such an inquisitive manner because I was being nice to the patient rather than treating him like a drug addict or criminal. The officer continues to explain that he is an ex-heroin addict that is now on methadone (which I had already gathered). The important part of this is that since he does not have a job and has no means of income, the government steps in and pays for his methadone. The money that pays for his methadone essentially comes from the police officers, you, me and everybody else who pays taxes. Now the officer gets to the reason why the patient was being booked. He states, “we caught him earlier on the street trying to sell.”
Dumbly confused as to why this was significant I pause, then ask, “sell what?” A thought crosses my mind that perhaps I was missing some kind of cop jargon and the patient was actually selling his body on the street for money.
The officer replies, “methadone.”
As I walked away, I wondered why the cop felt it significant to tell me this, then I began to realize. The patient was receiving methadone from the government, which you and I are paying for. He is then selling the methadone, which is essentially money from your pocket and mine, and using it to support his disgusting habit of two a day pints of blueberry bourbon. Unfortunately, it doesn’t end there. Since he was brought to the ER for having a seizure secondary to alcohol withdrawal, he is wasting even more taxpayer’s money by being in a hospital and wasting the time of the staff and the expenses required to run labs and tests to make certain that he is medically cleared to go to jail.
I find that I am unable to cognitively deal with this type of blatant abuse of a system and still try to say that I am happy with my job. I know that I’m just turning a blind eye by choosing a different specialty, but it’s what my mind must do in order to keep my sanity. If you have any better suggestions, then feel free to comment.