Monday, January 18, 2010

eight million stories

In the past, on MLK day, I had nothing very uplifting to say. And I probably don't have anything supremely uplifting to say today either, because med school does chip away at your idealism (especially because, ironically enough, you have to hear SO much of it spewed out all around you, and it more often than not turns out to be nonsense). And also because med school sometimes exhausts you such that you can't muster the energy to be upbeat.

I keep writing about the experiences that I don't actually want to repeat. I gush about surgeons, but I don't want to be one. I can't see myself taking care of children as part of my living, but that's what I did all day today. Perhaps it's when I'm less inclined towards a part of medicine that I spend more time contemplating the colorful personalities and interesting stories that emerge, whereas, when I work in the areas that I feel may be part of my future, I fixate more on self-reflection and doubts. Hopefully, as i become more competent, the balance will shift.

So, today was MLK day. Everyone else working in an outpatient clinic had the day off today, but I began working at a private practice this week, and an overly cautious phone call I made last Friday afternoon bit me in the proverbial rear, as I discovered that the private practice was open.

The phrase private practice brings to mind horrible television shows and posh offices and drug company lunches. I have to admit that I thought that I was probably embarking on a rotation filled with well-insured, well-employed, economically viable patients. And that I was probably going to spend the time with a bunch of doctors who were living a relaxed lifestyle and cashing in the payola. I figured they were working on MLK day because it was about the bottom line.

You know what happens when you assume.

The doctor I was working with today was a wealthy man in Tehran, and, as so many Iranians that I have met, had to start from scratch when he fled to America during the revolution. He had to repeat his residency, and so eager to get started was he that he volunteered to intern for free rather than wait the extra 9 months it would have taken to file an application- he had missed the deadline when he moved here. He had built this practice from the ground up, after having been chief resident at the university hospital. And last year, he had passed it on to a younger pediatrician. He is in the process of weaning his hours down.

We saw all manner of patients today. A few moderately well-off families, but by and large, Medi-Cal patients galore. I forget how spoiled I am to live in this part of the country. In the course of just a morning, I had seen a ridiculously diverse cross-section of the population. And I was very impressed to see that the pediatrician treated them all the same. Whether they had proper insurance or not, whether they came from broken homes or supportive ones, he focused on one thing and one thing alone- their well-being.

I got a text message from a classmate, who was shocked that I had to work today. It said the following (keep in mind it was meant to be taken lightly though):

Wtf? What outpatient clinic racist keeps their office open on MLK day?

Here's the thing. The younger pediatrician who has taken over the clinic? She is- yes, you guessed it- an African-American woman. Her father is a pediatrician as well, and dropped by the clinic in the evening to see the few stragglers left in clinic. Her mother busied herself with finishing up some of the last paperwork. And she, herself, was there, making sure a 14-year old girl with glucosuria was getting a proper diabetes workup, scrubbing down countertops as if it was all part of her job description. She took pride in this work, all of it, from seeing patients to every wire and light in the office.

It struck me as very noble, and I wonder if what I was seeing was not some part of medicine that is slowly dying. Private practices are actually rather rare to come by, especially ones like these, which take Medi-Cal and stay open on holidays. I found out today this clinic stays open on Christmas Eve and New Year's Eve. Also, I found out that the clinic basically breaks even every year.

And here's what else I found out. I'm not sure what I would have done with my day off. I think I probably would have treated it like a vacation day. Maybe I would have studied. Probably I would have baked something. And granted, I am but a medical student, so most of my day entailed looking in baby ear canals, and listening to lungs. But it was probably better than I would have done left to my own devices. And the thing about kids is that idealism is not wasted on them. So little is set in stone for them. So much promise. I suppose it's why I probably ultimately couldn't do pediatrics- I don't think I could bear that sort of responsibility and I definitely don't think I could bear the disappointment when life sent those kids the bad curve balls that life sometimes does. But then, some of them will make it, and defy expectations, and live the dream. I think that's why MLK's dream talked about children. You can see in them so much more clearly the potential for growth, for change. I didn't really do anything noble today, or do anything fitting of the call to service. But I did get to witness both.


karrvakarela said...

I suppose it's why I probably ultimately couldn't do pediatrics- I don't think I could bear that sort of responsibility

I'm wondering if this isn't some sort of left-handed compliment. :)

Seriously though, a lot of it, whether private practice or ER medicine or community outreach is simply about work ethic. I'm not sure whether one environment exclusively inculcates that over another. To a certain extent I think it's something people bring with them, a commitment to the job that extends beyond the mere financial aspects and involves a more embodied and responsible approach to caregiving. You care enough to do a good job and make a difference.

As one of Dr King's predecessors said: Be the change you wish to see in the world.

karrvakarela said...

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