It feels just like the other day when me and a bunch of my colleagues were being oriented as college freshers. Orientation meant observing, asking and helping out wherever it was one happened to be placed but one had to eventually graduate from being a hand person to an actual doer. The one month was meant to prepare us for what it was that we were getting ourselves into. I remember one very good friend of mine who used to faint away at the sight and smell from a very bad wound in the male surgical ward. But he has gone on to make a world class anaesthiologist!
Observing was the best part for most of us, the more aggressive and daring were however able to establish their competencies early enough during this period. My very good friend C developed a particular affinity for maternity and went on to be a small authority on matters obsgyn in our class..
Overall everybody was able to pick some small trick or the other from the people we had to work under. Well if you had to be mentored by guys like Dr. O, you had no choice. O was a specialist surgeon. He provided my very first up close experience with a consultant, that department happening to be my first placement. Pompous in style, he was known to make it clear to you that his knowledge well ran deep indeed. He gave instructions concisely, precisely and eloquently in a style that was only his. Known to be a bit too laid back in the wider scheme of things, he ingrained in most of us the idea of a doctor's (especially surgeons) self worth as being well superior to the other medical professions. He was eccentric just as he was a genial being at heart. One day during a tiresome operation (I can't recall what) he happened to cut himself through the gloves and to the utter shock and disbelief of his assistants went on unperturbed to the completion of the procedure. All pleas to change gloves fell on deaf ears. Now that patient happened to be HIV positive. Did he then deserve what befell him? For he succumbed to the very same HIV some years later. But had he taken precautions would the world be less one good surgeon?
We were also acquainted with a certain Dr. OO. A physician who actually believed that books treat patients. His customer care relations was a phenomenal disaster and it's why his private private practice was not only a case study on how not to run a private practice but how not to relate with people. It was hard to believe he had not heard of or purposely disregarded a very simple Second Law of Medicine which stated thus; that patients did not care how much you know but only want to know how much you care. Lacking in that universal element called empathy he only made a good ward round and lecture hall academic doctor but a bad actual doctor.
Then came internship. I remember vividly what a lovely mess our morning meetings used to be. The Med Sup who happened to be a consultant surgeon himself was always in a state of war with about everybody else. His most frequent combatant was one old general practitioner. Now this old good fellow was Russian trained and had lumbered on his practice and was coming to the sunset without the honor of a specialty. He was the most agreeable chap you would ever encounter but all this changed the moment Med Sup picked his unending wars with him. Then Good Old Fellow in a supreme defense to his ego could go hard at him. It always ended with one calling the other medieval, archaic and the other 'a surgeon and no doctor'.
The points of conflict were as varied as they were baffling; why do you still give frusemide in this day and age? Why can't you get your anatomy right? You are not going to patronize how I deal with my patients! And so forth and on. My own reading of things then was that the one was a poor master of logic whereas the other was a poor defender of his position. Just a small dose of modesty could take one far. These roles however kept swiftly changing from one to the other in the course of the many encounters they had.
It was clear Good Old Fellow could not stand the, ''I am a consultant you know'' attitude that Med Sup wielded mercilessly.
Then there was Dr. W! Now this guy was and still is a joke! If doctors have occasionally been accused of some unfounded queerness in character and personality then W is probably one of the reasons. He was the obstetrician gynecologist. He hardly attended any meetings with the rest of the team. He came late, most of the time drunk and he owed no one an explanation nor apology. Did he himself keep his appointments? He was known to engage in some out-of-nowhere banter that was discomfiting to some patients of his. Many were the times that a junior doctor was called in to go handle his clinic. I can not for sure say if 'The 48 Laws of Power' was the only book he read but the number of times he carried this book along with him are infinite. He believed himself to be the master but I believe his patients were the real masters for they made their displeasure known and eventually he had to be let go.
Good Old Fellow might have been in err but he had a point all the same. How many times have you had a physician say, ''I will now send you to Dr. D the diabetologist!'' Or a pediatrician proudly quip, ''I am not a physician!"
And so it was that after some reluctance I took the mother to a colleague friend of mine (who based abroad) to the resident physician of one of the high end treatment facilities in the country. With reluctance because I have come to understand how these people think and work and I wanted a different physician but they prevailed, for some reason to be seen shortly. The old lady in question has been hypertensive for close to a decade now. The blood pressures had however been under remarkable control. For some time she had also been on anti failure regimen. Then she developed a progressive swelling of the feet and weakness in the hip to the point that she could hardly move without support. Many tests done and nothing. The case was clearly confounding. Now this is where the Big Hospital Physician comes in; he was actually for the longest time the personal physician to the lady in question till around two years before when she chose a nearer (and cheaper) alternative. Much of what she had been on was however retained.
We fix the day and make all other arrangements me being engaged in some other businesses then. The day comes. Old Lady is one of those witty mamas off the old mold. I am more than adequately cracked up all the way to the hospital. Man, is she not a dose of talent, is she not therapy! Sometimes when I have only purposed to briefly check on her I have found myself spending an hour or two laughing and drinking off her ever flowing cup of wit, humor and reason. She will wait at the height of your mirth then whisper something in your ear, "I can see you want that lady but be forewarned, she will lick you dry!" Blessed with such a magnanimous heart it was heart rending that her physical heart was actually failing her.
The reception here is world class and so Mr Physician better be good too.
Appointment or new? New.
General doctor or Consultant? Consultant physician.
Okay, this way.
We find ourselves waiting in line at the physician's offices after the usual routines of registration and booking. Old Lady's turn comes and in she goes. One of those remarkable characteristics of good doctors is their uncanny ability to remember their patients. And so despite the bubbling queue outside about three minutes are spent in cheerful banter between the two; for old times sake. We then settle down into serious business and I state the details of the case. He carefully reviews her medications and asks and asks again one or two issues. Then he sits back in his chair and ponderously stares into the air. We (me and Old lady's son) let him do a thorough physical examination as we wait outside.
So doc how is she? I ask him when when we are re-admitted.
Damn I don't know! She seems to be on optimal therapy but I can't explain her weakness and edema.
Me: It's why we brought her back!
He: But you expect too much from me my friend.
Me: you are the physician! okay then, course of action?
He: (after some brief engrossment) let her do a chest xray.
Me: chest xray! but how useful is that? I believe it will only show an enlarged heart..
He: let us start there, it might show us more..
Me: what about her weakness and hip? Is not an MRI indicated?
He: let me see what the chest xray reveals first then we can do the others later.
Me: (out of sheer respect) okay doc.
We return with the chest xray film about an hour later. It shows us nothing much and so the physician at an apparent loss on how to proceed says this: she will continue with her current medication and i will prescribe some medicine(prescribes) that you will try to get outside since the hospital stock is run out. Then within two weeks kindly let me know(gives me business card) how she is doing.
What an epic underwhelment. But as leave the consultation I console myself with that Ralph Waldo Emerson; every man I meet is my superior in some way, of that I try to learn from him. In my case it's comforting that even the best of them get caught in quicksands.
All the renowned pharmacies in K had never stocked the mysterious magical elixir and so we end up right where we began, only about 15k less loaded than when we walked in that magnificent reception. When you grow up strive to be a consultant in something or the other..
We were also acquainted with a certain Dr. OO. A physician who actually believed that books treat patients. His customer care relations was a phenomenal disaster and it's why his private private practice was not only a case study on how not to run a private practice but how not to relate with people. It was hard to believe he had not heard of or purposely disregarded a very simple Second Law of Medicine which stated thus; that patients did not care how much you know but only want to know how much you care. Lacking in that universal element called empathy he only made a good ward round and lecture hall academic doctor but a bad actual doctor.
Then came internship. I remember vividly what a lovely mess our morning meetings used to be. The Med Sup who happened to be a consultant surgeon himself was always in a state of war with about everybody else. His most frequent combatant was one old general practitioner. Now this old good fellow was Russian trained and had lumbered on his practice and was coming to the sunset without the honor of a specialty. He was the most agreeable chap you would ever encounter but all this changed the moment Med Sup picked his unending wars with him. Then Good Old Fellow in a supreme defense to his ego could go hard at him. It always ended with one calling the other medieval, archaic and the other 'a surgeon and no doctor'.
The points of conflict were as varied as they were baffling; why do you still give frusemide in this day and age? Why can't you get your anatomy right? You are not going to patronize how I deal with my patients! And so forth and on. My own reading of things then was that the one was a poor master of logic whereas the other was a poor defender of his position. Just a small dose of modesty could take one far. These roles however kept swiftly changing from one to the other in the course of the many encounters they had.
It was clear Good Old Fellow could not stand the, ''I am a consultant you know'' attitude that Med Sup wielded mercilessly.
Then there was Dr. W! Now this guy was and still is a joke! If doctors have occasionally been accused of some unfounded queerness in character and personality then W is probably one of the reasons. He was the obstetrician gynecologist. He hardly attended any meetings with the rest of the team. He came late, most of the time drunk and he owed no one an explanation nor apology. Did he himself keep his appointments? He was known to engage in some out-of-nowhere banter that was discomfiting to some patients of his. Many were the times that a junior doctor was called in to go handle his clinic. I can not for sure say if 'The 48 Laws of Power' was the only book he read but the number of times he carried this book along with him are infinite. He believed himself to be the master but I believe his patients were the real masters for they made their displeasure known and eventually he had to be let go.
Good Old Fellow might have been in err but he had a point all the same. How many times have you had a physician say, ''I will now send you to Dr. D the diabetologist!'' Or a pediatrician proudly quip, ''I am not a physician!"
And so it was that after some reluctance I took the mother to a colleague friend of mine (who based abroad) to the resident physician of one of the high end treatment facilities in the country. With reluctance because I have come to understand how these people think and work and I wanted a different physician but they prevailed, for some reason to be seen shortly. The old lady in question has been hypertensive for close to a decade now. The blood pressures had however been under remarkable control. For some time she had also been on anti failure regimen. Then she developed a progressive swelling of the feet and weakness in the hip to the point that she could hardly move without support. Many tests done and nothing. The case was clearly confounding. Now this is where the Big Hospital Physician comes in; he was actually for the longest time the personal physician to the lady in question till around two years before when she chose a nearer (and cheaper) alternative. Much of what she had been on was however retained.
We fix the day and make all other arrangements me being engaged in some other businesses then. The day comes. Old Lady is one of those witty mamas off the old mold. I am more than adequately cracked up all the way to the hospital. Man, is she not a dose of talent, is she not therapy! Sometimes when I have only purposed to briefly check on her I have found myself spending an hour or two laughing and drinking off her ever flowing cup of wit, humor and reason. She will wait at the height of your mirth then whisper something in your ear, "I can see you want that lady but be forewarned, she will lick you dry!" Blessed with such a magnanimous heart it was heart rending that her physical heart was actually failing her.
The reception here is world class and so Mr Physician better be good too.
Appointment or new? New.
General doctor or Consultant? Consultant physician.
Okay, this way.
We find ourselves waiting in line at the physician's offices after the usual routines of registration and booking. Old Lady's turn comes and in she goes. One of those remarkable characteristics of good doctors is their uncanny ability to remember their patients. And so despite the bubbling queue outside about three minutes are spent in cheerful banter between the two; for old times sake. We then settle down into serious business and I state the details of the case. He carefully reviews her medications and asks and asks again one or two issues. Then he sits back in his chair and ponderously stares into the air. We (me and Old lady's son) let him do a thorough physical examination as we wait outside.
So doc how is she? I ask him when when we are re-admitted.
Damn I don't know! She seems to be on optimal therapy but I can't explain her weakness and edema.
Me: It's why we brought her back!
He: But you expect too much from me my friend.
Me: you are the physician! okay then, course of action?
He: (after some brief engrossment) let her do a chest xray.
Me: chest xray! but how useful is that? I believe it will only show an enlarged heart..
He: let us start there, it might show us more..
Me: what about her weakness and hip? Is not an MRI indicated?
He: let me see what the chest xray reveals first then we can do the others later.
Me: (out of sheer respect) okay doc.
We return with the chest xray film about an hour later. It shows us nothing much and so the physician at an apparent loss on how to proceed says this: she will continue with her current medication and i will prescribe some medicine(prescribes) that you will try to get outside since the hospital stock is run out. Then within two weeks kindly let me know(gives me business card) how she is doing.
What an epic underwhelment. But as leave the consultation I console myself with that Ralph Waldo Emerson; every man I meet is my superior in some way, of that I try to learn from him. In my case it's comforting that even the best of them get caught in quicksands.
All the renowned pharmacies in K had never stocked the mysterious magical elixir and so we end up right where we began, only about 15k less loaded than when we walked in that magnificent reception. When you grow up strive to be a consultant in something or the other..
No comments:
Post a Comment