What a hectic past couple of weeks. April-May: Boards, boards and more boards; May; say goodbye to class of 2012 and preliminary hello to class of 2015 (I hope). And now, off to a completely new campus, with new classmates, new professors, a new way of thinking. Go North (Engineering Campus), Young Man!
That pretty much sums up things since my last post. All of a sudden in late March, I gave my last computer based medical school exam at the Learning Resource Center. As always for me, I submitted my test sometime after 11:30 pm on Sunday… Then it was off to study for boards. I saw only three of my friends during the course of that time. After having gone through a freakout and postponed the test, we all went our separate ways. And I feel like I didn’t even get to say goodbye! Board study days were eternal, but looking back it all went by in a flash. And before I knew it, my class moved on to their third year of school, the start of clinical clerkships, and me; well I went off in a completely different direction.
The end of second year marks the MD/PhD student’s transition from medical school and lecture halls to something completely different. Some go off to molecular biology wet labs, others go to do theoretical work in neuroscience, biochemistry, even biophysics. And then there’s me, off to start my mechanical engineering PhD. Although I had worked in the department before, and knew the advisors under whom I would be spending the next four odd years of my life, the transition, however premeditated, left me utterly disoriented. All of a sudden the schedule and expectations changed. There are journal clubs and seminars to attend; weekly progress reports and milestones in a proposed research project to complete. … assuming that first, one actually has a viable research project in mind, which I want to say I do, but really that’s just wishful thinking. This is a jumble of loose ends jotted down, I know, but really, this is how I feel. I haven’t gotten my bearings yet. I see ex classmates, friends at the gym or around town, and it is so strange not to be having the same experiences they are. I don’t necessarily wish I was back with them per se, after all this is what I signed up to do, but I feel like I left my class without closure. Like all of a sudden I am not a medstudent anymore but a grad student in engineering. Really? It’s over? Just like that?
Dr. L has always appealed to me both as a person and as a physician. Perhaps what stands out most about her is her frankness. Though she carries all the traits of an excellently trained doctor; professionalism, a keen eye to detail and a passion to mentor and teach others, she has a way of seeming so down to earth, of “keeping things real” so to speak. I have been aware of her demeanor from our interactions and by shadowing her a handful of times in the Veteran’s Affairs Hospital in Ann Arbor. And it is on the wards where her character truly connects with those whom she serves.
The typical VA patient, as I have experienced him, is an exercise in patience, noncompliance and general stubborness. Most of the vets I have seen alongisde Dr. L are old, somewhat disgruntled and their bodies have seen better days. Their minds have too; they have been through so much, Korea, Vietnam, the first Gulf War, to name a few of the conflicts that have popped up in our general conversations. Thus it is self-explanatory that they are jaded, and don’t see a reason to maintain and upkeep their already traumatized bodies. The stereotypical patient smokes, (more than just tobacco), drinks a lot more than they report and have a diet rich in ketones and saturated fats. Many are diabetics too. But most of all, they have become weary of authority. They do not like being bossed around and told what to do anymore, by a woman nonetheless. Consequently, they can be sarcastic and testy in their raport with physicians. And so, the VA becomes a battleground of frustration, a challenge of whose nerves will outlast the other’s.
Yet, this is where Dr. L’s “people-skills” prevail. With a bit of dry humour, a touch of sarcasm and a tone of playful overbearingness, not too serious but just enough to get the message across without seeming condescending or annoying, she reproaches the patient for being non-compliant, for waiting so long to do something about that digit that turned black and blue three weeks ago, for continuing to smoke despite having emphysema, and a slew of other irregularities that would otherwise drive physicians crazy. It seems that most patients are surprised by this attitude; indeed, other doctors are not as clever at hiding their frutstrations. As a result, many seem to drop their guard, and focus more on what the doctor is saying, rather than coming up with a clever rebuttal. Moreover, it would be wrong to say that Dr. L is not frustrated by what she sees. Many times, after visiting with a patient, she returns to the on-call room to vent. And vent she does. But she still keeps that attitude to herself, away from the patient’s eyes and ears.
Dr. L does not treat all patients this way. There are those for whom she instinctively knows that her usual approach may not work. And at those times, she can be persuasive, humble, quiet. In fact, she is very good at reading her patient and tailoring her approach accordingly. She is able to do this quickly, in the first one or two minutes of the encounter. I initially thought that she was so good at it because her patients were recurrent visits, but the same hapenned when I shadowed her last time in the VA Emergency Room.
That day, Dr. L and I saw an old gentleman who had been in a car accident the year before, and whom was mostly bed ridden. He was married, and his wife just had double knee replacement surgery, rendering her immobile as well. The only person available to take care of this couple was their working daughter, who had moved back in with them and who looked clearly overwhelmed. The gentleman had come in because of discomfort in his legs and feet. He had suffered from bedsores on his abdomen and sores on his soles, which to her credit, the daughter had done her best to ensure they would heal. Yet, the significant discomfort in the feet persisted. Upon removing the patient’s shoes and socks to examine the feet, the reason for the discomfort came clearly into the light. Indeed the sores were healing well. But the patient’s toenails were large, thick, yellowed, and curling back on themselves, poking into his toes. The sight was stomache turning, and the first question that came into my mind, after my stomache had settled, was how the daughter, who took such good care of the healing sores by massage and applying ointment, could let the nails get into such a horribly twisted mess.
But Dr. L did not even flinch. She said: “Let’s see how we can best take care of this.” There was no scolding of anyone, no questions asked about the kind of care the daughter was giving her father. Instead Dr. L went to Dermatology, got a pair of clippers, came back, got on her knees and proceeded to gently cut each toe nail, one by one. This was not a necessary action for her to perform. She could have asked the daughter to cut his nails, or asked a nurse who was more flexible than she, to assist her, while she would see another patient. But that did not happen. Instead, Dr. L took the time to make sure her patient’s nails were trimmed, and that he was in no pain afterwards. The impact of this gesture had nothing to do with applying state of the art resources to solve the problem or an elegant new method of treatment. Instead, the impact on all of us came from Dr. L’s humility. There was no hesitation when she procured the clippers and proceeded to cut each nail one by one, no smirking from the sight (and stench) of the feet. The solution she brought to the table was simple, silent, gentle, yet extremely profound.
Dr. L’s versatility and flexibility in her approach to patient care is what makes her a great doctor. And in this instance, in her own gentle way, she put her reproaches aside and proceeded to go above and beyond what was expected of her. Actually, now that I think about it, she did reproach the daughter for not cutting her father’s toenails. But she did so by example; not with words but with a simple, non-demeaning demonstration that even those toenails could be cut. There was no mention of the toenail trimming for the rest of the visit. Rather, Dr. L praised the daughter for keeping the sores clean and for taking care of her ailing parents. Before they left, she suggested that they get in touch with social services, so that they can offer additional resources for care, in case she should get overwhelmed. The suggestion was made in a friendly, non-accusatory manner, and I think that the way it was delivered made it highly likely that the daughter would do all in her power to comply with her father’s need for care from now on.