The Pain, The Pain

I've been thinking recently that being a parent is making me a better doctor, and in this week's Grand Rounds, (http://emeritus.blogspot.com/2004/12/grand-rounds-12-welcome-to-12th.html), a post at The Cheerful Oncologist echoes my thoughts somewhat.

For me and most of my cohort at medical school, life has been comparatively easy. I enjoyed the benefits of a stable home growing up, "child-centered" parents, a safe community, and an excellent quality of education. I had the privileges of a very expensive education and then medical school. All of this was not without its hard work and sacrifices, but mostly in comparison to my classmates along the way who worked less hard, studied "easier" things where there aren't necessarily right and wrong answers to find or avoid, and who went straight into the workforce at age 21-23 without all of the exams and overnight calls.

Now I have a little girl, who is the light of my life, and even the slightest threat to her well-being, emotional or physical, causes me to become nearly paralyzed with a gnawing, tearing, chest-pain.

And yesterday after I operated on a very nice 70-ish woman (for benign reasons), I went to tell her middle-aged sons that Everything Is Going To Be OK, and I could see their palpable relief, and appreciate it in a new way. I got to be the agent of destiny that showed up with good news.

All of this makes me more sympathetic. Not that I was unsympathetic before, but now I can really empathize with the stress and fear that come with medical hardship in a way that I don't really think I did before.

Unnecessary C-Sections and VBAC

Just a short post on this, since I think it has been done to death elsewhere. I love how in these articles about vaginal birth after caesarean they talk about how many "unnecessary" c-sections are performed. Um...exactly how do the reporters, critics, insurance companies, and other rock throwers know that these c-sections were "unnecessary?" Somehow I doubt they were sitting there for six hours reading a vaguely non-reassuring fetal heart tracing and examining a woman whose cervix is dilating but edematous, and who is screaming every 2-4 minutes at the top of her lungs because the epidural isn't working that well.

As usual, after the fact, everyone's an expert in what should have been done, but there really aren't that many people who are actually willing to put their minds and hands into service just to be judged the day after that what they were doing wasn't really necessary.

My final note on this: the women who are outraged that they are being denied the "right" to VBAC can solve this problem in many ways (most obviously, by finding a doctor and a hospital that is willing to make a blanket guarantee that they will permit a VBAC- good luck) - I think the best way would be for them to learn how to deliver babies. Then they could all give each other whatever rights they think they deserve, and sue each other when they have bad outcomes.

You can't handle the truth

Via Luskin's www.poorandstupid.com, I was directed to a Times of London piece by an author named Janen Ganesh (http://www.timesonline.co.uk/article/0,,3284-1371830,00.html), in which he remarks upon the negative treatment of the US Armed Forces by the media. The Jack Nicholson monologue from the film A Few Good Men ("You can't handle the truth!") is referenced.

I've always said that along with my co-blogger, I'm one of the only people in America who watches that film and roots for the Nicholson character. My experiences as a doctor have generally strengthened this view.

Nicholson is doing a difficult and stressful job, a vital job, protecting American lives. He describes the rigorous training and discipline needed to execute his responsibilities. There is little margin for error. Most people don't really want to know the bloody details about the pain and suffering that he and his colleagues are going through ("Ever put your life in another man's hands, or ask him to put his in yours?"). If they're doing their jobs right, the general public won't want to know about it. ("Deep down in a place you don't talk about at parties, you want me on that wall...you need me on that wall.")

Of course, the minute something goes "wrong," someone dies, some outcome that is not anticipated comes to pass, suddenly everyone and their uncle is howling all over the place, "How could this happen?" and "What has been going on here!?" and is more than willing to judge in retrospect what ought to have been done.

Sound familiar?

As Nicholson says in the film, (I'm paraphrasing I think): "I'd rather that you just said 'Thank You,' and be on your way."

My frustration as a physician with the way my work is analyzed and judged retrospectively mostly by people who aren't capable of doing it themselves is one thing, but to put it in perspective, the military has to do all of that stuff, plus people are trying to KILL them while they do it.

(I'll just say "Thank You" and be on my way.)