Thirteen Doctors

Folks liked last week’s Thirteen so much (Thirteen Patients), I thought it would be fun to do one from the other side of the exam table. Without further ado,

Thirteen Doctors: The Good, the Bad, and the Ugly

sorry for the length . . .

1. Most of my med school profs have blurred to mush in my memory, but not all. I remember dearly one anatomy prof who waxed poetic over that most wondrous of muscles, the sphincter ani.

“Some anatomists seem to think the human hand is of miraculous design,” he said, “but can the hand hold a combination of solid, liquid, and gas, and pass only the gas?”

(This fellowly narrowly beat my microbiology prof for the #1 slot. The latter fellow once put up a slide of a cholera bucket with the caption, “Other people’s feces are our bread and butter.”)

2. I never dreamed I would want to be a surgeon, but the chief resident on my first general surgery rotation, a big-hearted (and big-bodied) Italian, made me realize surgeons weren’t necessarily dickwads. He was kind, patient, and caring.

The “caring” part became evident when he lost a patient on the table. My beta readers will recognize this story: it was literally the first case I ever scrubbed on, and the patient bled to death before my eyes.

This was no fault of the chief’s, by the way. If anything, the attending physician should have been blamed for poor judgment. But the chief felt responsibility for his patient’s death. As bad as I felt (shocked would be the understatement of the decade), he took it far worse.

3. Karen’s first neurologist. Don’t get me wrong, we love the guy. He helped her get through the worst years of her illness, and he did more to improve her situation than her other doctors combined.

But.

To his students, he once said, “Don’t ever forget that when you are speaking to a neurology patient, you are talking to a diseased brain.”

My corollary for patients: “Don’t ever forget that when you are speaking to a doctor, you are talking to a poorly socialized human being.”

4. The patient, an exceptionally anemic Jehovah’s Witness, was losing blood from an unresectable cancer. An operation would likely stop the bleeding and buy him some extra time, perhaps a month or two, maybe more. He wanted that extra time, but he wouldn’t grant his surgeon permission to transfuse him if the need arose.

The surgeon, an attending physician, knew he could help the guy and wanted to operate. The hospital’s lawyers instructed him not to transfuse the patient intraoperatively, even if it meant the patient would die on the table. The patient, his family, the lawyers, and the hospital administrators were all lined up on the side of NO transfusion. The surgeon went forward with the planned procedure, with no consent for transfusion and with the patient’s explicit instruction not to transfuse.

Going in, he told his residents, “To hell with it. We’re not letting him die in there. If he needs blood, I’m giving him blood.”

They lucked out — he didn’t need the blood.

5. The chairman of my department divided ENT cancer surgeons into whittlers and hackers. He considered himself a whittler, but one of our other attendings was most definitely a hacker.

“Hacker” is not necessarily a bad thing. The idea is to widely resect the cancer in order to give the patient a lower chance of recurrence. A bigger operation means more risk and more post-op disability, however.

Philosophically and clinically, I’m more of a whittler . . . but in the OR, if I had my choice of attendings, I chose Dr. Hacker every time. Our other bosses would abandon us for a cub scout meeting or a dinner date, but if Dr. Hacker committed to you, he would stay with us for the duration of the case.

That counts for one hell of a lot. I never minded setting aside my philosophical differences.

6. One evening, I got into a casual conversation with one of my chiefs. “You live over on Fremont?” he said. “Whereabouts?”

“Dark little apartment complex just a few blocks up from Huntington.”

“Just a few blocks? Really? We live just a few blocks up from Huntington, too.”

“Yeah, we’re in that complex immediately north of those cottages. You know the one with the wild child?”

His expression shifted. This wasn’t a casual conversation anymore. “Wild child?”

“Some infant,” I said, feeling faintly queasy. “Screams constantly, day and night?”

“That’s my wild child,” he said.

7. She was cute. CUTE. Natalie Portman cute, that’s how cute she was, and yet she drove me crazy.

And her husband, too.

She was my senior resident, and one night, we were taking in-house call together. She sent her whipped husband out for pizza. She asked me what I liked.

“Pepperoni.”

“Ach. Pepperoni. Fred and I HATE pepperoni. Here’s what we should do: Fred, get us a large vegetarian and a medium pepperoni –”

“Get me a small,” I said. “That’s all I ever manage to finish.”

“Good. A large vegetarian and a small pepperoni, okay?”
Half hour later, Fred showed up with a large vegetarian and a small pepperoni. He and I finished the small pepperoni pizza in two minutes, after which we looked with sad, sad eyes at the vegetarian pizza.

Sybil stared back at us. Finally, “Fred. I don’t understand. You HATE pepperoni.”

“No, Sybil,” said Fred. “YOU hate pepperoni.”

I don’t know why, but I really do love that story.

8. Karen’s doctor at USC, a rheumatologist (she hated every LA neurologist she ever met, and she met a few), came close to accusing her of Munchausen syndrome.

She wasn’t the least bit dismayed; she had the MRI scans at home to prove her point. She decided she would bring the scans along with her on her next appointment. She would show him the proof and rip him a new one.

She put the scans up on the light box and geared up for the rip-him-a-new-one phase of this doctor-patient visit.

“Damn,” he said. “You’re right. I’m really sorry I doubted you.”

Which left her nearly speechless. “Oh, um. It’s okay,” was all she managed.

Moral of the story: if you’re a doctor and you’re wrong, APOLOGIZE.

He became one of her favorite doctors, by the way.

9. Midway through residency, we acquired a new attending physician, a hacker who would make Dr. Hacker look like Dr. Whittler. She had recently trained in the relatively new technique of microvascular free flaps — borrowing large blocks of tissue from one area of the body to fill holes in another part.

Oh, how I hated free flaps. Someday, I will devote a whole blog entry to the horror of my free flap experience.

Nice enough woman, and a very good doctor, too (she watched her inpatients like a hawk, regardless of whether they were County or private patients), but it was hard not to hate the person who caused me so much loss of sleep. My record, I think, was one 72-hour interval with three hours of sleep. Try it some time — hate becomes the common coin of thought. You’ll start hating inanimate objects.

By the time I became a chief, she was my favorite attending. Go figure.

10. Sometimes, our pediatric ENT attending seemed little more than a mass of idiosyncrasies. When he was nervous, which was often, he would whistle atonally below his breath, and his usual assemblage of physical tics grew in amplitude. The man’s hands were never still.

He taught us well and he took good care of the kids, but we, in turn, had to take good care of him. Each of us in turn briefed our juniors on how to “handle” Dr. H. We learned to both love and dread our Peds rotation — love it for the kids, and for the fact the work load was appreciably lighter, but dread it because of Dr. H.

And yet, when he retired, I missed him, and I wasn’t alone.

11. Speaking of junior residents, it’s hard to select only one for this list, but I’m going to pick Dr. A. Irrepressible, that’s a good word for Dr. A. One story will have to serve:

We went down to the ER together to evaluate a patient who had been shot in the throat. I let Dr. A scope the guy while I reviewed the chart and tried to coordinate O.R. plans with the ER doc, General Surgery, and Neurosurgery. I was deep in the logistics when Dr. A bellowed, “WELL HELLO DR. HOFFMAN! I SEE YOU!!”

He had threaded the fiberoptic scope through the patient’s nose, throat, and neck wound, and he was peeking at me through the eyepiece.

I rolled my eyes, muttered jackass, and got back to work.

I know you’ve been waiting for The Bad and The Ugly, right? Here goes.

12. She had sort of a Sandra Bernhard thing going for her, this anesthesia resident: big girl, big tattoos, harsh makeup, loud voice. But that’s where the comparison ends — I like Sandra Bernhard.

She hated children. Hated them. Hated them the way the witches hate kids in Roald Dahl’s The Witches. It got so bad, we wrote a letter, one department to another, requesting that she never be allowed to give anesthesia to our pediatric patients.

Case in point: a four-year-old boy pointed to her anesthesia machine and said, “What’s that?” She replied, “That’s the big fat oven where I roast kids who ask me too many questions.”

I can’t make up stuff like that.

13. I’ve saved up Dr. M for last. He was my chief when I was an R2. I can’t think of anyone more paradoxical than Dr. M — by turns charming, wrathful, funny, loathesome. The man had serious anger management issues.

My two favorite Dr. M-isms:

Once, while changing a patient’s neck dressing on work rounds, I jostled her nasogastric tube and she winced. “Don’t do that,” he said. “It hurts her.”

I did it again by accident. He screamed at me — and screaming is not an exaggeration, and yes, this was in front of the patient — “Do that one more time and I’ll bust your fucking nose.”

Other screwups were met with, “Do that again and I’ll tear off your head and shit down your neck,” and “I’m going to rip off your arm and beat you to a pulp with it.”

But just when I thought I had his number, knew he was the biggest jerk in the universe and was, indeed, his own worst punishment . . . he would change. Become warm, caring, friendly, concerned. I would start liking him and then I would hate myself for liking him.

What a psycho. I hope he either (A) got counseling, or (B) never bred. The thought of him treating a girlfriend or wife that way makes me ill.

***

Yeah, there are probably lots more out there in the ugly/bad category. I haven’t even mentioned my cardiothoracic fellow, the guy who labelled me with the nickname “Doogie,” the guy who had to take out his divorce woes on every intern and junior resident who came under his thumb. Nor have I mentioned the plastic surgeon, now deceased, whose hands shook every morning until he had his first drink. Or another plastic surgeon who liked tying up nurses with Kerlix gauze.

Homely dude, that one. How can you be an ugly cosmetic surgeon? I don’t understand it.

And it pisses me off to no end that in training, no nurse ever asked me to tie her up in Kerlix.

I never get lucky. Never.

Leave your comment below, and I will (shall? who knows!) link you below.

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D.