Lies and Regrets

Her heart barely works anymore.

That’s not to say she isn’t clinging to the life she has left. A ferocious tenor pervades her spirit.

It’s unmistakable. For so long, she’d held onto her health, youth, and virility.

And then she got sick – she had a few heart attacks.

I asked her if she’d smoked. She told me no. I asked about drugs. She said no.
She, I think, lied to me.

She was ashamed and afraid of her mortality – a fear that having your heart literally give out on you tends to impart – a shame that comes with succumbing to an addiction that causes your heart to literally give out on you…

Her husband shot me a question:

“Why is it that doctors come in here, and they ask if you smoke, and tell you not to smoke…”

“yes??”

“and you go outside and you see half of em smoking?”

“It’s not right…I can’t tell you…I just know it’s not right…”

From Axe to Anxious or the Story of Two Pills and $12

A few years ago…well almost a decade ago now

I was stuck…in a tiny little tube…I was having trouble breathing, sweaty, struggling to move, on my side, bogged down and completely unable to even wriggle forward or backwards…again, I was stuck.

Lt. Green, the salt-fried truck officer yanked me out of the 6 foot long, 13″ square “confined space” tube and quietly shamed me for not being able to overcome such a tiny little obstacle…literally.

He intimated that men whose gut formed pannuses (what is the plural of pannus anways?) that overlapped their thighs could make it through that tube. He marveled – if the fat-bodies could hump their way through it, but I couldn’t – I bristled. I put my mask back on and I flew through that damned tube – I wormed through like a champ.

Fast forward nine years.

My back, which has hurt for the better part of a half-decade, is starting to hurt for more than just a day at a time. I’m always aware of it, the pain much worse now, is at times barely manageable. It’s likely soft-tissue damage and so the obvious thing to do in order to look at the soft-tissues – is to do an MRI.

An MRI is a test where the area to be imaged, in placed in the center of a huge magnet – basically you find yourself in the middle of a tube, while what sounds like a jackhammer thumps and tumbles all around your body. There is about 2″ of clearance all the way around you. It’s a tight fit – at least for me it was…

And it’s been a terrifying fit too. For some reason being on the table on my back, being in the magnet – unable to put my hands up to my eyes or anywhere near my face, over my chest, nothing – is unabashedly terrifying. It conjures up images of some of my most incredible fears – being buried alive. For that reason I’d rather be cremated than anything else – I have no desires to be buried.

I had gone from axe-swinging to anxious. I’d lost the fire in my belly. At least that’s how it’s seemed. I’d love to be able to tell you I finished the test – completely under my own willpower – but in a shockingly powerful way, my brain told ME ,that I wasn’t getting in that tube. At least not headfirst. I wondered if I could jump in the tube feet first. I wondered if I could be knocked out cold with a horse-dose of sedatives.

I’ve thought about losing weight – even going as far as making a bet with a fellow classmate who is entirely too skinny to want to lose weight – to make the tube a less claustrophobic and intimidating place to spend an hour of my time.

I’ve thought about zoning out – pretending I’m in outer space, and that I have to lie perfectly still in order to stay in my oxygen bubble – but that there was ultimately nothing that would keep me calmly lodged in the narrow little tube.

Damn. My doctor prescribed me some sedatives.

The tranquilizers by the way – two pills total, cost me and my insurance company $11.99. They were almost wholly ineffective to boot. I couldn’t help but think that it was why people didn’t go to their doctor – so that he could tell them to buy two expensive ass pills that gave them funky side effects and didn’t really do much to help them feel any better.

So now tangentially, as I’m getting my medication filled – I’m wondering if the exorbitant prices of drugs is one of the driving reasons behind the health disparities that we see in America. I’m wondering if it’s one of the driving reasons behind the amount of chronic disease we see in America – and I’m wondering if it’s the reason that we see people end up completely noncompliant with the regimens that doctors prescribe their patients.

The two pills never even touched the anxiety, the crushing feeling that prompted me to feel like I was suffocating even though I had just drawn in a deep breath of “fresh” air. My stomach tightened and I was having crushing palpitations. Physiologically, I was fighting for my life – my heart fluttering wildly, pupils dilating, and me shaking uncontrollably. I belched and passed gas for a solid ten minutes after the attempt. I walked out in the cool night angry, frustrated with myself and more importantly my head for fearing death in a way I’d always hoped I was immune to.

On tranquilizers, 20 minutes after the procedure had short-circuited a second time due to my overactive limbic system – my pulse was a solid twenty beats a minute above its’ normal. I still felt nauseous. The fight or flight response was still kicked into gear. I wondered what it might be like for those who had random panic attacks when they went about their daily life – doing things like going to the doctor, dentist, post-office. Going to school or the aquarium. At home with relatives, out at a grocery store. On an airplane.

I reflected on the last flight I was on – with a woman who seemed a little edgy and as it turned out she was – fairly afraid of flying – especially through turbulence. Her body language betrayed the shitstorm of fear that was flying through her mind. Her hands clutched out in vain for some sort of safety bar – but then she realized it would’ve been attached to the very airplane she thought was crashing.

A friend of mine summed it up quite succinctly and nicely – “when you are starting to panic, there is a duality in the logic you use to attempt to calm yourself down – you are able to tell yourself that nothing is wrong, and that you are perfectly safe, because there is nothing threatening or harmful happening…but then you realize that even if nothing threatening or harmful is going on – and you feel the way you do, something MUST be wrong, and now you don’t know WHAT it is.”

His understanding made me both laugh, and comforted me.

Now I’m confronting my own mortality. I’ve put on some years, and I’ve begun to learn about all of the myriad ways people can not only die – but degrade and die. I’ve also become much more aware of my place in the world and the world itself. This world is a terrifying and sickening place.

And so naturally, I’ve become more fearful, more anxious in general – and I’m wondering if its’ natural manifestation is via my irrational expression of fears. I’m wondering if I’m doomed to a semi-decrepit body that hurts but isn’t diseased enough to warrant much treatment.

I fear that inattention and slow decline exquisitely. More than ever before I realize the potency and happiness of youth. And I’m very glad I blew all of my money and did as much as I could when I was young. I’m glad I was mostly single – I’m glad I came out of my early twenties and late teens without children or hard committments to anyone other than myself.

But now I have to make sure that in this next few decades, I can learn to live in a fearless manner. They are there – I just need to ignore them. That’s a strength that I’m going to have to develop. As you grow older – the monsters under your bed don’t go away – they just change clothes and get jobs as attorneys or politicians. Or creditors. Or police.

I can’t help but wonder how people feel when they go to the doctor. Do they think they have a crushing super-debilitating illness? Do they feel like its’ going to be a pop-fly illness? Or is it going to be a chronic slog through misery?

Are their physicians going to make it any better? Can their physicians make it any better? How are they going to deal with it? Are their physicians going to even attempt to protect them from their own vulnerabilities and insecurities? Their unique neuroses?

My doctor did. A healthy dose of razzing followed. But he went on and sent me to a physiatrist even though he knows they are going to look at him like he’s not doing his best for not getting me into an MRI. But he did his best – both for the specialist I’m going to see, but also – and ultimately more importantly – for me.

Hard work

So, I’m effectively cut off from the Internet and going through computer withdrawals.

I’m typing this from my iPhone. Thank God for my iPhone.

My post today is about hardwork. The kind that makes other people say – dude that’s insanity, slow down just a bit. It’s my style – excitedly working on getting myself somewhere – diet coke in hand, charging hard through the thickets of work that interect themselves into my day. I’m by nature a bipolar person when it comes to work. I either want to – or I don’t. Spring is the time when I want to the least and fall is probably when I’m at my best… At least that’s my thought…

I recently decided to claim my rightful place in a top-notch residency. I’m smart enough for it…now I just have to work hard enough for it…

Three days outside of Facebook and while I sadly miss it – I’m on the way to making up for it with a vengeance…I can do this all day and night long.

I have two more weeks to be here…I’ve gotta make them count like there’s no tomorrow…because while that statement is a stretch – there is some truth in it…we aren’t measured in life by what we’re GOING to do. Or what we plan to do…We’re measured in life by what we’ve done.

That basically sums up this entire post. I’m not going to fight to get back west. I’m FIGHTING to go back west.

Nuff said, it’s time for a self-imposed drill school

Discipline is my friend…Discipline is my friend…

Blinded Professionalism

It’s funny, reading in the NYTimes today – business schools are scratching their heads. They want to figure out exactly where they went wrong. The economic collapse has left them wondering what’s next – and why exactly their proteges and products didn’t see it coming and couldn’t steer their respective ships – read: companies – away from the brink of the financial abyss that opened up on Wall St.

I can’t help but draw analogies to the current state of medical education and medicine. We send people to medical school for 4 entire years and expect them to come out competent physicians. But anyone who knows anything about medicine knows that you don’t want to be anywhere near a hospital on July 1st. Why?

It’s the day all of the recent medical graduates start their internships and residencies. And they are brand spanking new.

Beyond the basics of figuring out what they are doing organizationally – these graduates are developing their chops, diagnostically and treatment wise.

But isn’t that what they were supposed to do in medical school? Aren’t they supposed to know how to diagnose and treat – from day one? Isn’t this a time for familiarity with the intricate details?

Well, what’s funny – is that brand new doctors are a little bit like puppies. They are familiar with how to sniff, scratch, and suckle. They’ve got the tools they need – they’re just blind for a few weeks. A friend of mine – whose halfway through the first year of her surgical internship – put it best:

“I’m nowhere near the retard I was in July.”

Odd thing to hear a doctor say.

What it would naturally prompt one to question is – what exactly are student physicians learning?

Well it seems a whole lot of minutiae – with no framework of where to put it. And very little repetition. There’s a worthless statistic floating out there that says factoids must be repeated seven times before they stick in long-term memory. Over the four years that medical school consumes of a doctors life – they may hear the obscure, extremely important “trivia” four or five times…but it may not stick.

There is good reason for the minutiae – unfortunately, many medical schools (mine included) do not utilize technology to reinforce the important little lessons, nor cement them in the memory of young physicians by providing the rationale for knowing the facts.

Another shocking quote we heard on day one of medical school: “You’ll forget 50% of what you learn within a year of learning it…of the 50% that you remember, half of that will be wrong in 10-15 years.”
Well why teach it in the first place then?

There’s a quote in the article above where Warren Bennis, a professor of management says business schools suffer from “an overemphasis on the rigor and an underemphasis on relevance.” He goes on to say, “Business schools have forgotten that they are a professional school.”

He could be talking about medical schools…

Caught in the imperfections…

It was a good thing he passed out when he did.

If he’d made it home, he likely would have died right there – his red blood cells bursting under the burden that his white blood cells were putting them under.

If he’d been somewhere private, his bizarre behavior and drunken, stuporous gait wouldn’t have been noticed.

He says he fell. EMS says he was taking his clothes off in the snow, screaming obscenities, and running through rush hour traffic. They brought him in, and an ER intern, groping in the dark for a diagnosis – blindly ordered almost every single test they could think of…they did the medical version of “throwing the book” at somebody…

Turns out, this guy had a rare blood disorder – Thrombotic Thrombocytopenic Purpura – one that strikes about 4 to 6 OUT OF A MILLION per year. If undiagnosed, it’s fatal 95% of the time. If undiagnosed, a patient can die in days…sometimes hours…

When we saw him, he was weak – the only thing he remembered was the vivid dreams and hallucinations he had while he was still being stabilized and was restrained – and still unclear on the majority of the details of his illness… He thought he had been in the hospital for five days – he’d been there closer to twenty.

Our resident told us that it was a lucky thing that he was diagnosed. Our resident told us the reason he was diagnosed was because the ER intern ordered a “shotgun panel”. A shotgun panel is a group of blood tests done when a physician doesn’t know what’s going on and in trying to figure out what’s going on, tests for just about everything.

Our patient got caught in the cracks, and it saved his life.

What’s funny, is that those same exact cracks – shotgun panels, intern physicians without the benefit of a more experienced, and present attending physician – are what cost the medical system a TON of money every year, and are threatening to swallow the rest of the US economy.

I spoke with a friend in law school, and asked what their thoughts on medical malpractice lawsuits were – their answer was that pressure due to lawsuits was getting physicians to practice defensive medicine, which is a “good thing” – sort of like defensive driving.

But to many physicians, defensive medicine is anathema. It is what swallows hospitals whole – physicians so afraid of making mistakes and being sued, that they subject patients to painful, unnecessary testing. MRIs when CTs could suffice. CT scans when an x-ray would do. Blood work, DNA testing, biopsies. Medical testing makes up one of the largest expenditures in the US. Defensive medicine, in the purview of many docs, means you don’t know what’s going on – and you aren’t going about the best way of treating the patient.

Sometimes, that’s an acceptable position – unintelligible or non-communicative patients, green doctors (a.k.a. interns /slave labor), exceedingly rare medical conditions – from an academic standpoint…it’s almost understandable given the conditions. But from a legal standpoint, there is no excuse for not knowing – even though the practice of medicine is akin to reading a half written science textbook with beer goggles on…

So there is this large disconnect – the financial pressures of malpractice lawsuit driven behavior (defensive medicine) does not connect up with the medical systems aims and goals. It also does not connect with the medical reality of patients that do not faithfully follow textbook patterns of disease. It also does not connect with the scientific reality that our state of knowledge is woeful at best.

One of the first things that was said to us when we started school was “Half of what you are going to learn is wrong – the problem is, we don’t know what half…” It’s like living by a constantly changing bible that you are expected to have memorized… So until we get a medical system that asserts its’ right to be make mistakes without being penalized monetarily, until we get a legal system that can differentiate between simple professional mistakes or mis-communications and mistakes that extend into the realm of criminal negligence or manslaughter, and until we figure out a way to check increasing medical test costs – we won’t have universal health care, and unfortunately, since prevention is the best medicine – we’ll continue to get sicker as a nation.

But for now, for people like my patient today – the response to the cracks in our broken system were ultimately what saved his life…

We owe it to her…

To get the diagnosis right

I have to wonder about how much money we’ve already spent trying to diagnose and treat her.

I have to wonder about how much money we’ve gone through being wrong…How much less would it cost to get her diagnosed correctly the first time.

Why is it, that testing and screening cost what they do?

Shouldn’t they – by virtue of the fact that they are the most emphasized aspect of medicine – be the cheapest aspect of medical costs? It seems like there is an artificially constricted supply. Where is the cost efficiency in laboratory medicine?

I got a bill the other day for a “radiographic procedure”…

It was $800 and because I have good insurance I only had to pay a $25 co-pay. Others aren’t so lucky.

Why exactly, does it cost $800?

Why exactly, is medicine as an industry forcing individuals into bankruptcy.

I’d submit that twenty years from now this will all be looked at as short-term greed that prevented progress, both in terms of medicine and research. I’d like my children to be proud of my contributions to medicine – both from a fiscal as well as a humanitarian standpoint.

From what I’ve been able to gather – being a doctor means juggling three separate, related, yet at times antagonistic professions.

First, you must be a healer – you must cater to your patients to a certain extent. You cannot just ignore your patients complaints and questions. And you must question your patients – interrogate them really. Many patients don’t seem to understand that the more questions a doctor is asking you, the more personal the questions, the more unrelenting, the more critical and suspicious the doctor is of what you tell them – the more they are actually trying to figure out what is happening. The more a physician can dig into their patients while conveying that they care, the better patients tend to think of a doctor, regardless of what they cost… Most patients only see this side of medicine. They don’t see the other two aspects.

Second, a physician must be a policy advocate/expert. It’s not enough, professionally, to just diagnose and treat their patients, they need to advocate for systemic change to make sure that the medical industry (it makes me cringe to call it that, even though that’s EXACTLY what it is) is improving in terms of the value it offers its’ patients. The medical industry should be doing EVERYTHING it can to make sure that not a single patient goes uninsured and therefore untreated. The medical industry should be doing everything is can to make sure that the price of medications don’t force people into untenable decisions about the relative value of heat or food. The medical industry should be doing everything it can do to ensure people are exercising.

Third, a physician is expected, at least in academia to contribute to the state of the art. The physician is supposed to add knowledge, and share it with the rest of the profession. Physicians are expected to practice constantly and add the knowledge they gain through case reports, clinical studies, and if they are so inclined, through basic science research.

But we OWE it to the people who’ve entrusted us with the unique privileges that we have to actually figure out what is wrong with people and to help them, sooner than later.

I’m all for being a physician, but the system that i’m going to be practicing in is already broken and I hope, for my sake, and for the sake of my future patients it gets fixed before too much longer.

Ma’am he’s already dead

She was sitting in the corner reading her bible.

We shuffled in, all of us, and because our resident told us that she was afraid of infection, we all made a show of scrubbing our hands with antiseptic lotion before even entering the room.

He was lying there, intubated. He would cough occasionally, the alarms on the respirator would go off occasionally, and then he would settle back down. He had a few IVs, and the site of the tube was in through the front of his neck. She didn’t want us to touch him out of fear that he wouldn’t be able to fight his infection any longer. Out of fear that he might die prematurely.

He already had.

About 8 years prior, he was a vibrant young man. He was popular. He was also into drugs. And about 8 years ago, almost to the date he overdosed. He slipped into respiratory arrest first, his brain no longer interested in breathing. Almost as if he’d forgotten how to breathe. From there he slipped into cardiac arrest before it was discovered that he’d overdosed. He’d been in cardiac arrest for a short time – 5 to 8 minutes before he was discovered and before CPR was started.

He recovered a rhythm on the way to the hospital. He was later able to breathe on his own. He hasn’t walked or talked since that day. He lives in a nursing home nowadays where they feed him pureed food because he cannot chew. He cannot write or use either of his hands. They rest near his clavicles because of the spasticity that his massive brain damage caused. He has no meaningful motor function. He also does not respond to verbal questions or commands. He cannot make eye contact, nor can he even control which direction his eyes point . About the only things he can do are breathe and swallow.

A few days ago he was discovered coughing wildly, and sweating profusely. His caretaker got him admitted to the hospital where he was put on a trial of antibiotics and eventually intubated and put on a respirator for a florid case of pneumonia. As the infection finally started to clear up, his doctors tried to wean him off of the respirator. It didn’t work. So they moved his intubation site to his neck, to alleviate the stress on his respiratory system of having all of the oral secretions make their way down (apparently you make 1 liter of saliva every day).

So now he lies there, helpless, unproductive, comfortable.

And it made me angry.

It made me angry that he had figuratively blown his brains out. Insurance is what pays for his nursing home care. Those costs are passed onto me in the form of higher premiums. It made me angry that because he is in the position he is, friends of mine at the opposite end of the spectrum are unable to afford medical care. You see, some of his care is charity care – but the fact remains that there are others who have problems that I feel more sympathetic to.

I was angry that I felt like I could judge the value and quality of his “life” in such black and white terms. It didn’t seem gray to me at all – he’d done it to himself, and now he was stuck in a place where he wasn’t at all able to help society in any manner. 150 years ago we thought that black people were 3/5ths human beings. What are we wrong about today? Consciousness?

I found myself confused. I found myself angry and hoping that our patient was somehow getting more out of the encounter than he appeared to be. I was hoping that he had some form of consciousness that was overall a positive experience. I was hoping that he was perhaps in a state of consciousness similar to the one that neonates are when they are in the womb, or immediately after birth. Part of me hoped that he was still high – floating blissfully through the rest of his state and society sponsored life.

I just hoped that it was worth it. I couldn’t reconcile what would be better or worse – to allow his physical body to pass on, and utilize the resources for people who are alive and awake who can continue to exchange with the rest of the world – OR to let him lie there comfortable until the time when he does finally die and use those much needed resources to help this young man.

He was a young man when he died – only 21. He’s now 29.

The person who made the decision to keep him from passing away is his mother. She would have no talk of “allowing nature to take its’ course” when the pneumonia made a respirator the only course of action capable of keeping him alive physically. Deeply religious, she sat quietly, clutching her rosary beads, reading her bible the entire time we were there. Our resident told us that she’s been praying for twenty minutes every hour every day to make sure he doesn’t die.

All I could think was: Ma’am, he’s already dead.

Her Gentle, Trusting Soul

She addled onto the elevator after me, brushing by as she reached to press the floor button.  Recently I’ve tried to be much less judgemental about those who take the elevator up only a floor – replacing my thoughts of their conspiracy to slow me down with explanations involving arthitic hips and inflexible knees.  It was easy not to dislike her however.  She seemed like a patient.  And hopefully I seemed like a doctor to her.  Even though I was wearing baggy brown linen pants and a brown polo – an outfit that screamed RESEARCHER – she looked at me trustingly and divulged her entire encounter with medicine today.  She told me about how she was on a liquid diet until tomorrow when she was to have an “outpatient surgery”.  She told me how far she had trekked from 72nd St all the way to the hospital’s main entrance on 68th.  She told me how she had just finished some Jello and was on her way home but still felt a bit weak…. I asked her how she was getting home and she said “Suwbay”.  I knew she had a walk ahead of her, and her slow ambulating, gently lifting each foot barely off of the floor just didn’t seem to mesh with the speed of the rest of the world.  She was still weak, and I told her as she got off the elevator:

“I want you to make sure you eat some more food so you won’t feel so weak…sit down and eat more Jello…drink more  liquids.”

I realized I felt protective of her.  As if she was my patient.  In an era where there is so little distrust of doctors.  In an era where there is so much disillusionment with our broken medical system, it was nice to see a patient, and feel like a doctor.  Even if it meant only prescribing her some more juice and Jello.  Even if it only meant telling her to take care of herself.  It felt good to take care of her.  If only all medicine could be as altruistic…

I wonder if African Americans

tend to be less healthy due to a founder effect – really a founder legacy that had to do with slavery.

This isn’t an anti-slavery post – well, actually it is…

Slavery was a brutal event in history that lasted, at a minimum 100 years.

During slavery, the people who managed to survive were worked incredibly hard physically.

In order to work as hard as they did, and still survive long enough to procreate and actually maintain a pregnancy while heavily engaged in manual labor, their serum chemistries would have had to be resistant to
the effects of the work – things like their blood glucose levels, lipid levels would have had to be higher in general to supply the energy necessary to maintain positive or even neutral energy balances.

The people who didn’t survive were likely the ones whose blood glucose and lipid levels were genetically lower that those of the others.  So they likely died without passing on their genes to offspring.

Fast forward a hundred years and change and suddenly our society is such that it no longer requires the strenous manual labor that was a normal thing even 100 years prior.  In addition, the energy density of food has increased substantially in the last 50 years.

In addition, advertising for tobacco products has been found to be consistently higher in African-American neighborhoods and magazines than in White neighborhoods and magazines according to a study presented in the scholarly journal Public Health Reports by University of Pittsburgh School of Medicine researcher Brian Primack.

It all makes me wonder how much of our history is going to affect our children’s health in the long term.  As much as I don’t want to suffer from heart disease, cancer, diabetes, and other stress related diseases and syndromes such as depression, I certainly don’t want my children to do the same.

How to solve that idea…hmm…another post I think…

So I tried

to have breakfast this morning – it worked somewhat.  Unfortunately both lectures I attended were complete wastes of time and effort.  Both were also pretty boring which made it somewhat difficult for me to seriously pay attention.

But that said, it was the worst case scenario, and I still feel like I did a great job of staying awake.  There is something I’m realizing about the grades and much of the frustration that is coming out of studying here right now.  Your grades on a quiz aren’t directly correlated to how much studying you do.  Nor are they proportional from quiz to quiz.  It depends on what exactly you study, and when you start studying.  Now, if you start studying the “memorization” topics sooner, then you will do just fine on those questions.  The concept questions you have to understand sometime before the quiz, whether its’ 15 minutes or 5 days before.  But you could put 45-50 hours into studying for the quizzes and it doesn’t necessarily matter.  You might barely pass.  And conversely you could cram the night before and you could rock the quiz, scoring well ahead of the pack.  It really just depends on the quiz.

And that is what is frustrating.

There doesn’t seem to be a strong incentive to study and KNOW/UNDERSTAND the important things.  The quizzes represent very little to the students other than random slices of information that may or may not have been covered in the book.

Rarely – well, never actually – are we given explanations to the quiz answers.  Just the answer.  Our quizzes are never returned.  The information is important right now, it will be heavily represented on the boards because it forms the basis of most of the pathology that can go right or wrong.  But the fact of the matter is, we need to have this information mastered, but the quizzes encourage us to NOT master the material, rather they encourage memorization of selected facts that have no basis in reason, and therefore aren’t even permanently reasonable to memorize.

People deserve doctors who actually know what they are doing.  I’ve heard entirely way too many brand new residents say that medical school was a joke and didn’t really teach them what they needed to know – and on top of it, the only reason it was stressful was the hours that you had to work to pass the quizzes.

Why such discontent from a group of highly motivated, self-selected people?  Why such disdain for the educational foundations that the medical establishment has promoted and developed for decades?

Does the discontent carry on into practice?

It seems like it may.  Today the New York Times carried a story about physicians who are completely dissatisfied with the non-clinical aspects of being a physician.  Aggravated by issues such as billing, insurance, paperwork, etc… many physicians are moving to cut insurance companies out of their bottom lines.

To be honest I’m almost considering the exact same policy when I practice, but I’m not sure if I can do that.  Not realistically, not as a surgeon.  Working at an academic hospital.

I heard today that attending spine surgeons can start at 750K per year.  It made me gasp.  The possibility for excellent compensation and great hours definitely looms out there.  I just have to find it.

Perhaps the growing job dissatisfaction and disillusionment of medicine is partially responsible for the divorce rate that hovers around 33% for surgeons.  What is funny is that psychiatrists tend to divorce at about 51%.

All these facts swirling around in my head make me wonder what I’m doing here sometimes.  In general I would like to ensure that I have some days that tend to be long, and other days that are short and easy.  I would be fine with working three 24 hour shifts a week including trauma call.  That would put me at 72 hours a week, but with 4 whole days to spend with family.

It’s interesting to think about the possibilities.  All I ever wanted was to be content.  I’m going to have to figure out a way to manufacture contentment in the context of school and almost irresponsible lecture quality.  I’m realizing that I will have to TEACH MYSELF medicine.  I’m not sure how that makes me feel about the doctors that I’ve seen in the past.

Medical school is amazing in its’ ability to prompt long-lasting, deep seated anxiety.  I’m going to be just fine.  The investment I’m making in myself will pay lasting dividends.  I’m just hoping I get to engage in something that I actually like.  Because right now that doesn’t feel assured.

Then again this is the real world where nothing is…