Читать книгу Confessions of a Park Avenue Plastic Surgeon - Cap Lesesne - Страница 10

Focus and drive.

It’s hard to find two words that describe better what it takes to become a successful surgeon.

Focus and drive.

It’s what defined my last two years of college. I took all the premed courses I didn’t take my first two years.

Senior year, I also managed to find the time, somehow, to fall in love for the first time. Victoria was a sophomore from New York City. Smart, intellectually curious, five feet eight, brunette, nicknamed Tory. We biked and played tennis. Our time together was always sweet. I knew that someday I wanted to be married, have kids, probably lots of them – not at all surprising for someone who came from a big family, and who has mostly happy childhood memories.

On graduation day, Tory was there. Life was perfect. But even greater joy lay just ahead.

The challenge of medical school.

It was at Duke Medical School that I learned how to be a doctor.

Sounds dumb, right? You go to medical school to learn how to be a doctor.

Except it doesn’t always, or even often, work that way. Yes, of course medical school teaches you, in class and in clinical rotations, a basic fund of knowledge. Some concept of disease. Some concept of the treatment of disease. Medicines.

But to be a doctor, to really know how to care for patients rather than how to deal with them – that deep understanding may not happen at medical school. For me, I was fortunate already to have had a taste of it, by witnessing Dad’s devotion and sense of rightness. The simple message of his coming home late so often – when I knew how much he loved his family – taught me that you can’t ever turn off your responsibility to your patients. Ironically enough, his not being around – which had been the greatest deterrent when I was younger to my even considering a medical career – now revisited me as an important lesson to help prepare me for the difficulty, the relentlessness, of what I was about to embark on.

But as much as my father taught me, it was mostly secondhand observation: watching him through the car window as he made another house call; seeing him once every few months at the hospital; feeling his absence at home. (Later on, he became – and remains today, even in retirement – an even greater professional influence. Recently I phoned him with an immunology question that had stumped me. Dad knew the answer. It’s pretty great having a man with a half century of medical experience always on call.)

My mentor at Duke, Dr. David Sabiston, taught me how to conduct myself, every day, as a healer of people. Like my father, he was devoted to his patients, worked hard, and stayed disciplined. But it was Dr. Sabiston’s interaction with other doctors that was a revelation. I’ve never seen a superstar doctor – or any doctor, in fact – act so respectfully toward medical students, the indentured servants of our profession. If we med students did something wrong – and we were always doing something wrong – Dr. Sabiston would never admonish us publicly.

Yet he was stern. Each week during my rotation, one of us had to review a case history of a patient and present it to the doctor, other med students, and some of the residents. The chief resident would prep us a bit, but mostly it was up to us to bone up on everything, to be armed to answer all questions about the history and management of the patient’s disease. The presentations were made in one of the medical school libraries, a wood-paneled room decorated by photographs of previous chief residents, all of whom had obviously thrived at this kind of thing. The prize for a good presentation might be a phone call on your behalf, your final year of medical school – Dr. Sabiston calling the head of the medical residency program of your dreams and praising you to the stars. If you didn’t do well? Let’s not even consider that. Maybe surgery is not right for you. I was so nervous each time I presented to him, my knees actually knocked. I was grateful my lab coat covered the spectacle.

It was Dr. Sabiston who taught me probably the single most useful principle in my doctoring arsenal:

Do not treat without a diagnosis.

Again – sounds dumb, right? How could you treat without a diagnosis?

But the caution is more nuanced than that. It demands that, before you attempt to be a healer, you remember that first you’re a scientist.

Sort out the problem. Think it through. Do not treat without a diagnosis.

You’d think every doctor would have learned this last tenet – or, if not, would have intuited it himself. But no. This fundamental notion (perhaps the doctor’s equivalent to the lawyer’s mantra to provide one’s client with the best possible defense) is ignored and abused and forgotten by more doctors and hospitals than you want to know about. A few years ago, I got a call from a patient whose eyelids I’d lifted a year before. “This has nothing to do with plastic surgery, but I trust you,” he said, his voice shaky. “I have prostate cancer.” He then mentioned the name of a renowned New York-area hospital and said that they wanted to remove his prostate.

“How did they find the cancer?” I asked.

“Blood test,” he said.

I hesitated a second. “Any tissue sample?”

“No, but a blood test.”

“They’re going to take out your prostate and possibly leave you incontinent without a tissue sample to verify that you have cancer?”

“See?” he said. “This is why I called.”

He went back to the doctor and insisted a tissue sample be taken.

It was negative.

This happens all too frequently. A physician starts treating without having the proper diagnosis and ultimately injures, rather than helps, the patient. It’s particularly infuriating because it’s often so avoidable and delays real diagnosis.

Why does this happen? Are these doctors lazy? Intellectually undisciplined? I don’t know. But every patient is entitled to a clear explanation of what is happening to him or her, why, how it’s being treated, and why alternative treatments were rejected in favor of the one being followed. It’s your body and your life, not to mention your peace of mind. Don’t be afraid to ask for the explanation. If you still don’t understand after it’s been explained to you, then ask again, or ask more pointed questions. If your doctor can’t explain clearly what’s going on, then he or she doesn’t understand the situation well enough. Get a new doctor.

In the end, Dr. Sabiston taught me only one thing, really. How to be a doctor.

I requested pediatrics as my first rotation.

Since Duke is a major cancer referral hospital – meaning it receives many of the most “complex” (read terminal) cases, largely from the southeastern United States – I saw dozens of children afflicted with cancer, some in infancy. Most of them suffered from leukemia or lymphoma. It’s a sad euphemism but, in this role, Duke was termed a “tertiary medical center.”

At the end of my first month in pediatrics, for whatever karmic reason, we received an unusually large influx of terminally ill children in a very short time – six in one week.

Of those, can you guess how many of them died by the following week?

Two?

One?

Four?

All of them. I saw every single one die.

When the sixth and last of those children died, I remember walking out of the hospital into the summer evening and taking a seat on the steps. I was more than just depressed. I was stunned, almost in shock, from what I’d just seen. I was literally dizzy with grief.

I couldn’t see how I might spend the rest of my life witnessing the deaths of so many children; I simply couldn’t. Of course, I could be a pediatrician and not work at a children’s hospital that specialized in cancer. (It should be noted that, thanks to medical advances in the last generation, certain childhood cancers, particularly leukemia, have become far more treatable, at Duke and elsewhere. Duke was then and remains today one of the world’s top pediatric cancer clinics.)

But it also seemed like running away. It seemed an acknowledgment that I could go only so far, no further. And that bothered me.

Bothered me? It destroyed me.

I was surrounded by Southern pine and dogwood, but the trees that evening smelled like death. Everything did. Everything around me was dying. And everyone. I managed a bitter smile thinking that, from the moment I’d arrived on campus, death was lurking. On the first day of sign-up, I stepped up to the registrar and said brightly, “I’m here to enroll!”

The lady behind the desk looked up at me, quizzical and pained. “Have you heard? The King is dead.”

“What?” I asked.

“Elvis died,” said the registrar. “The King is dead.”

What is wrong with me? I wondered now, sitting on the steps of Duke University Hospital.

I’m a doctor who can’t handle death? Does this mean I’ll make a rotten doctor, no matter which kind of medicine I go into?

What else is therefor me to do?

Sadly, there was then, and remains now, a great need for young doctors to work in children’s cancer hospitals. But there was just no way I would be one of the courageous men and women to do it.

My feeling of desolation, sitting alone on those steps, did not make me a rotten person, or even mean I would not succeed in medicine. I think I understood that. But it depressed me to think I didn’t have it in me to be the doctor I’d hoped I could be.