Welcome to Doc's Page

Aaaahhhhh, the end of the workday. I hope. My day started with rounds 12 hrs ago, and, if all goes well, is now done for the day. I've poured a glass of my favorite adult beverage, and am going to sit and relax for a little while before attacking the mail and a dozen other chores around the house.
But let me introduce myself. I am a General Surgeon, living and working in a small community in the Midwest. While that may seem a little vague, so it must be if I am to do with this blog what I intend, which is to tell the tales of my life and work (mostly work), some sad, some maddening, some comical, I must maintain a certain degree of anonymity so as to avoid a dredded breach of confidentiality and a certain HIPPA violation. (More about HIPPA later) I'm quite certainly going to wind up on some political soapboxes along the way. The opinions expressed here are quite certainly my own, please feel free to disagree at any time. It's a well known fact in the medical community that if you want two opinions, ask two doctors. You'll get them.
More importantly, though, is a desire to journal the life of a surgeon, and the factors that shape us and our work, the issues that drive us nuts, the things that we really want to say, but don't, because you'll get pissed off at us and walk out of our office. I certainly want to highlight some of the absurdities that the lawyers, politicians, beaurocrats, and insurance companies have propagated upon the unknowing public, much to the expense of the public, both in money and in health. I also want to try to show you all just what is involved in being a doctor today--for instance, the fact that my pager just went off, even though I'm not on call tonight. Most people today have an impression of medicine derived from one part Marcus Welby, 3 parts "ER", 4 parts "Grey's Anatomy," and 5 parts "House". Second page in 5 min. Hang on a second.
OK, I'm back. Well let's see. I vaguely remember Ol Doc Welby, saintly, always there, all knowing. What a great age that was. Oh, and that was also before Medicaid and lawyers. Truly a golden age, but alas, now gone.
ER. ER hit the airways the year I started Med School. Every Friday morning, my classmates and I would sit around and analyze the previous night's adventures, compare them to our cases and studies, and unaminously assign last night's disease du jour to one of our patients. It was haled as "gritty," and "realistic", and in those early days, I guess it was. But I haven't watched it in years, and what little I've heard of it certainly doesn't impress me as real.
Grey's Anatomy. Have never seen it, haven't ever seen anything that suggested it was worth wasting an hour of my time. What little I have heard and seen of it, screams "soap opera!" And, hey, hospitals make for great soap operas.
House. Another show I've never seen a full episode of, and what I have seen was probably sitting in a surgeon's lounge, waiting to start a late evening Appendectomy. Pertinent observations-- Ooops, hang on, another page. OK, observations. 1) House is an arrogant, pushy ass, and would be kicked out of any current day hospital as a "disruptive physician," a label that would just about end his medical career, no matter how good he is. 2) House has managed to get miracle, just developed cures from drawing board to patient in a single episode. That's damn good, considering it takes the standard pharmaceutical company a company several million dollars and several years to do the same thing.
What does this all mean? That people really have no clue about what a doctor's life really is. And that's what I'm going to try to show. OK, I'm back just took another page, and a phone call from another doctor, to discuss a patient with no good answers. As a matter of fact, this is a great case to open a discussion of a doctor's life.
Ms. Green (no, not her real name), is a 90 year old lady. She's pleasantly demented, which medically savvy people will recognize as meaning, "she's clueless, but she doesn't cuss, spit, or try to hurt you." She was admitted several days ago with nausea and abdominal pain. The cat scan done at the time suggested that she has some intestines that are not getting enough blood, and are almost dead, or are getting no blood, and are dead. From a clinical perspective, she certainly doesn't look that sick. But by the book, she probably should be operated on, to determine if this really is the case, and, if so, to remove the dead gut. But here's the glich. She won't survive the operation. Oh, sure, I'll get her off the table, and into the ICU, but she won't leave the hospital alive. Now, she's just had another cat scan, and it shows a slightly less pretty picture. So the question is, what should I do when the family says, "save her. do everything. spare nothing." Am I doing Ms. Green any favors? I certainly don't think so. Am I practicing "responsible" medicine, trying to make the most effective use of your taxpayer's dollar? I don't think so, either. I know what I'm going to do, I can only pray that the family agrees with that course, and I don't wind up doing CPR on a 90 yr old lady who will not leave the hospital alive.
OK, I'm going to get to those chores and mail I mentioned about an hour ago. Next installment (if I remember): How I got here, or, the breaking of a starry eyed intern.