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Hippocratic Oaf: My First Day as a Doctor
Seeing a new patient wheeled into the cardiac care unit, I leapt up from my seat. “Easy,” said the physician next to me. He placed a hand on my shoulder and guided me back into my chair like a trainer gentling an unsteady colt. “Give the nurses a few minutes to do their thing.” He spoke softly and bore a surprising resemblance to a Charles in Charge-era Scott Baio, all black hair and good-natured smiles. “The nurses are going to do a lot more for him tonight than you and I are.” I nodded and eased back into my seat. “Okay,” I said to Baio as I straightened my scrub top. I was anxious. I was excited. I’d just chugged a large iced coffee and could hardly sit still. In medical school, I had moved through  rotations in surgery, neurology, psychiatry, radiology, internal medicine, pediatrics, and finally, obstetrics, where a young Jamaican woman let me deliver her child on my first day. She insisted on giving birth on her hands and knees, her back arched like that of a cat as the baby slowly emerged. An amused midwife later said that I had looked like a nervous quarterback, receiving a snap in slow motion. As graduation approached, choosing a specialty had proved to be difficult. Ultimately I had settled on internal medicine because it was the broadest field, the one that might allow me to feel like a jack-of-all-trades. But tonight was my debut in the big show, a 30-hour shift taking care of critically ill patients and responding effectively to anyone who might roll through the door. “We’ve got a few minutes,” Baio continued, “and I know this is your first night in the hospital. So let’s go over a few things.” “Great!” I replied. Our orientation leaders, a peppy group of second- and third-year residents, had instructed us to exude a demented degree of enthusiasm at all times, which wasn’t difficult now that my blood was more caffeine than hemoglobin. “Just relax,” he said, “and take a look around.” Together we scanned the fluorescent room, an enclosed space the size of a tennis court containing critically ill patients and nurses bustling between them. The perimeter, painted a regrettable shade of yellow, housed the patients in glass cubicles, while the center, where we were sitting, was mission control, filled with chairs, tables, and computers. “It’s just you and me tonight,” Baio said, whipping his stethoscope back and forth around his neck. “And 18 of the sickest patients in the hospital.” Every night an intern and a second-year resident presided over the CCU. Tonight was our turn, as it would be every fourth night for the next month. All of the patients in the unit were on ventilators except one, a large Hispanic man who was riding a stationary bicycle and watching Judge Judy in his room. “These patients are receiving some of the most complex and sophisticated therapies in the world.” Baio reached for a bagel that was sitting on a platter nearby. “Patients get referred to the cardiac-care unit when hope is lost or after something devastating happens. Balloon pumps, ventricular assist devices, transplanted hearts, you name it.” Until a few days ago, I had never set foot in a cardiac-care unit. Nothing about the setup looked terribly familiar. I continued to study the room, trying to decode the symphony of incessant beeps and alarms and wondering what each of them meant. It felt like I was sitting in the middle of a giant equation with infinite variables. “These patients should all be dead,” Baio went on. “Almost every one of them is kept alive by an artificial method. And every day they’re going to try to die on us. But we’re going to keep them alive.” He paused for effect. “And that’s cool.” It was cool. In college, I had studied molecular biophysics and briefly flirted with the idea of going to graduate school in that subject, using my degree to solve the structure of molecules that were too small to be seen under a microscope. But the field lost me when a professor, a young crystallographer, introduced the importance of imaginary numbers in biophysics. Try as I might, I just couldn’t wrap my head around that quixotic concept. I wanted to translate science into something more concrete, more tactile, to seek a profession where I could touch and see and feel. So I changed course and pursued medicine. And thus far, it had seemed like a wise decision. Nothing about this moment with Baio seemed imaginary. Quite the contrary, it felt excessively real. Baio wiped off the bagel crumbs on his scrubs and leaned in close to me. “We have to work as a team. Everything is teamwork. So I need to know what you’re able to do. The more you can do, the more time I have to think about the patients. So rather than listing the shit you can’t do, tell me what you can do.” My mind went blank. Or more accurately, I searched it and found it was blank. “Well …” I glanced at the sedated patient before us. He was on a ventilator and had a half-dozen tubes in his neck, arms, and groin, almost all of which pulsed with medications I’d never heard of. As a medical student, I had been exposed to all sorts of patients. But all of those encounters had involved walking, talking, reasonably well-functioning individuals. Lying there, inert and blanched of all color, the patient before me seemed well beyond the reach of my limited powers. If he needed his appendix out or his face stitched together, I was his man. But intensive cardiac care? The learning curve in medicine was so unforgivably steep. Finally Baio broke the silence. “All right,” he said, “I’ll start. Can you draw blood?” “No.” “Can you put in an IV?” “No.” “Can you put in a nasogastric tube?” “I can try.” “Ha. That’s a no. Ever done a paracentesis?” “I’d love to learn.” He smiled. “Did you actually go to medical school?” Even I had to wonder. If Baio had been asking me to recite pages from a journal article on kidney chemistry or coagulation cascades, I could’ve put on quite a show. But I hadn’t learned much of the practical business of keeping people alive. In fact, I had been allowed to skip the CCU month of my med-school training at Massachusetts General Hospital so I could learn tropical medicine in Indonesia. Who had talked me into that? “I graduated from Harvard earlier this month.” “Oh, I know you went to Haaahvaahd,” Baio said with exaggerated fake reverence. “But do you know how to order medications?” A bright spot. “Some!” I practically beamed. “Do you know how to write a note?” “Yes.” The moment I said it I realized just how paltry a contribution it would seem to him. Baio must have seen my face drop. “That will actually be a big help,” he said. “Examine every patient and write a note on them for the chart. That will save me time. You need to be concise yet precise.” I grabbed my small notebook and scribbled examine everyone/write notes. “And listen,” he said while chewing on the stale bagel, “if I want a sandwich tonight, go to the cafeteria to get me a sandwich. And if I ask for a coffee when you return and give me that sandwich, do you know what you should do?” “Head to Starbucks.” “Correct.” One of the nurses tapped me on the shoulder and asked me to order a blood thinner for a patient, but Baio cut her off. “Dr. McCarthy is not yet a functioning member of society,” he told her before putting in the order himself. I watched over his shoulder as he typed away. After finishing with the order, Baio turned and looked me up and down while grabbing another bagel. “You may be thinking, Why is this guy an asshole?” I shook my head. “Well, I’m not an asshole.” He returned to the computer. “I’m stuck in this enclosed unit for the next 20-something hours. I can’t leave. The only way I can step outside of this unit is if a cardiac arrest is called over the intercom and I have to go bring someone back to life.” “Got it.” “And if that happens, you’re alone in here. It’s just you. All alone. And them,” he said, spinning his hand once around his head. “Now, if you keep me well fed and caffeinated, I will be happy. And if I’m happy, I will feel inspired to teach you a thing or two about how to actually be a doctor.” And that was the truth of it. Baio, one year my senior, would essentially be teaching me how to be a physician. It was hard to believe he had been an intern just last week; the man looked like a sample photo at Supercuts. At Columbia, as at most teaching hospitals, interns were paired with second-year residents to manage between 12 and 18 patients, and were provided with varying levels of supervision by attending, board-certified physicians who met with us every morning at 7:30 to discuss our plans for the day. But the guts of the day, the minute-to-minute, I’d spend hooked to Baio. “I want nothing more than to keep these patients alive,” I offered, perhaps a touch too earnestly. He waved his hand at me. “Yeah, yeah. Just show up on time and bust your ass.” This I could do. It was a philosophy a former baseball coach of mine had sworn by. “Looking at you, I’m thinking two things,” Baio said. “One, you kinda look like someone I know. You both look like big ol’ meatballs.” It was not the first time my admittedly WASP jock appearance had been skewered by a member of the healthcare community. “What’s the other thing?” I asked Baio. He smiled. “You look terrified.” “I am.” “Good. Go examine our new patient.” This article has been excerpted from Matt McCarthy's book The Real Doctor Will See You Shortly: A Physician's First Year. This article was originally published at http://www.theatlantic.com/health/archive/2015/04/hippocratic-oaf-my-first-day-as-a-doctor/390288/Ads from Inoreader:Remove ads • Advertise with Inoreader