Pen V. Stethoscope
I have nearly finished reading ‘The Pen and the Stethoscope’, an anthology of writing by doctors, edited by Leah Kaminsky. The book is approximately half non-fiction and half fiction. I admit that I enjoyed the non-fiction more- there was a predominance of doctors writing about their early experiences as interns and residents. The stories were often familiar to me- a missed diagnosis of leaking AAA, the frustration of continuing intensive care on people who should be allowed to die in peace. But I was thoroughly impressed at how exciting the stories are- these doctors can really write!
I think that the early years of doctoring- internship and residency- provides the richest fodder for writing. In these early years you are most acutely aware of the chasm between your experiences as a doctor and your previous non-medical experiences. You are innocent enough to be properly awed or disgusted by things. The junior doctors are also the ones most often put in ridiculous situations trying to negotiate the ridiculous hospital bureaucracy and advocate for their patients in the under-funded public health care system. Identifying the treatment or test your patient needs is often the easiest part- then comes the frustration of speaking to six different administration staff, four registrars, a pharmacist and a chaplain in order to line it up for them.
For this reason that the only medical show I’ve ever been able to watch is (the early seasons of) Scrubs. It captures this aspect of medical work perfectly. In one episode a patient needs an operation that his health insurance does not cover, and the patient in the next room qualified for the operation but didn’t need it- so they swap the patients temporarily in order to get the first patient’s operation done. This is so close to the truth it’s not funny: for example trying to ‘trade’ with another inpatient team for a spot on the endoscopy list: if you let us take your patient’s spot on the gastroscopy list tomorrow, we’ll insert your patient’s port on the afterhours list tonight…
On my second day of internship, I had an unbelievably quiet afternoon. I was working on the renal team, and we shared a workspace with the neurosurgery team. James, the neurosurgery resident, came into the workroom looking stressed and demanding help from a female doctor. My (male) registrar quickly volunteered me for the task.
As we walked down to the operating theatres together, James explained his problem to me. He had been told- on pain of death- to book his patient for an aneurysm clipping that evening. But operating theatre bookings for the after hours list didn’t open until 4pm, and at exactly 4pm residents from all the surgical specialties- vascular, orthopaedics, plastics, hepatobiliary- would begin ringing the bookings nurse to secure their patient’s spot on the list.
James realized that the only way to ensure his patient got their aneurysm clipped was to be there at 3:58, to ask the nurse in person. “But she hides in the change rooms, Lucy!! You need to find her in there!” He laid out his plan: he would be out in the theatre recovery rooms, “sweeping the area” for the bookings nurse, whist also serially phoning her every 30 seconds. I would ‘stake out’ the female change rooms.
The funniest part about this procedure was that it worked, and James was considered one of the best surgical residents in the hospital. He subsequently got into one the most competitive specialty training programmes in the country.
I think that the early years of doctoring- internship and residency- provides the richest fodder for writing. In these early years you are most acutely aware of the chasm between your experiences as a doctor and your previous non-medical experiences. You are innocent enough to be properly awed or disgusted by things. The junior doctors are also the ones most often put in ridiculous situations trying to negotiate the ridiculous hospital bureaucracy and advocate for their patients in the under-funded public health care system. Identifying the treatment or test your patient needs is often the easiest part- then comes the frustration of speaking to six different administration staff, four registrars, a pharmacist and a chaplain in order to line it up for them.
For this reason that the only medical show I’ve ever been able to watch is (the early seasons of) Scrubs. It captures this aspect of medical work perfectly. In one episode a patient needs an operation that his health insurance does not cover, and the patient in the next room qualified for the operation but didn’t need it- so they swap the patients temporarily in order to get the first patient’s operation done. This is so close to the truth it’s not funny: for example trying to ‘trade’ with another inpatient team for a spot on the endoscopy list: if you let us take your patient’s spot on the gastroscopy list tomorrow, we’ll insert your patient’s port on the afterhours list tonight…
On my second day of internship, I had an unbelievably quiet afternoon. I was working on the renal team, and we shared a workspace with the neurosurgery team. James, the neurosurgery resident, came into the workroom looking stressed and demanding help from a female doctor. My (male) registrar quickly volunteered me for the task.
As we walked down to the operating theatres together, James explained his problem to me. He had been told- on pain of death- to book his patient for an aneurysm clipping that evening. But operating theatre bookings for the after hours list didn’t open until 4pm, and at exactly 4pm residents from all the surgical specialties- vascular, orthopaedics, plastics, hepatobiliary- would begin ringing the bookings nurse to secure their patient’s spot on the list.
James realized that the only way to ensure his patient got their aneurysm clipped was to be there at 3:58, to ask the nurse in person. “But she hides in the change rooms, Lucy!! You need to find her in there!” He laid out his plan: he would be out in the theatre recovery rooms, “sweeping the area” for the bookings nurse, whist also serially phoning her every 30 seconds. I would ‘stake out’ the female change rooms.
The funniest part about this procedure was that it worked, and James was considered one of the best surgical residents in the hospital. He subsequently got into one the most competitive specialty training programmes in the country.
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