Tuesday, March 27, 2012

because I never was cool

One of the other interns is also interested in Oncology, and we were talking about how who people are sometimes makes more of a lasting impression on us. She thinks it is because we appreciate how fleeting everything can be. I'm not entirely convinced. I've certainly met plenty of oncologists, I am sad to say, who refer to patients as "the lady with ALK-positive NSCLC that didn't entirely respond to crizotinib" or the like.

Probably it's just a subset of all physicians who process patients as people instead of diagnoses and conditions. I tend to remember a face and a name first, their diagnoses second, which to some, would make me a peculiar and maybe not-very-good physician. To which I respond with a resounding and unapologetic 'oh well.'

When I was a medical student, I was much more quiet and reserved than I am now (not that I am now bursting with fruit flavor). I was acutely aware of being judged and evaluated by everyone around me, and moreover very frustrated with the notion that I was not contributing much to the overall mechanics of the team on which I was supposedly working. My solution was often to give in to the ancillary nature of the role and become invisible. It comes rather easily to me.

So, having stayed at the same institution for residency, I am never much surprised when I am not remembered. It comes in handy, most of the times, because the senior residents and attendings have no recollection of my bumbling incompetence from those previous days. Last week, on a lark, I told one of the senior residents that I remembered very clearly taking my very first board exam, and seeing her at the test center. I remembered because that's how I remember things- people, conversations. I remember because she was taking her third board exam, and had told me not to be nervous. When I had wryly remarked that it seemed these tests never ended, she had bemusedly replied that they didn't end, but that the stakes became lower and you stopped studying for them over time.

She, of course, did not remember any of this, at all, and looked at me as if I was some strange stalker for remembering.

Last month, I was at a conference at one of the hospitals that we rotate through, and an elderly oncologist sat down at the table, engaged in discussion with all of the interns and residents and medical students. I wanted to talk to him afterward but he was surrounded like a rock star after a show. I remembered him too. As a medical student, he used to gather all of us into his office once a week in the early morning. Often, he brought us pastries and coffee. Every week, he went through cases from the New England Journal with us. I was facing a time of great self-doubt during that period, and I remembered that those sessions made me remember to go back to what you cherish when things are rough. I still go back and read cases when I am having a rough day. When I am frustrated with residency, I sometimes sit down with a cancer journal and read those articles, because they're of more interest to me than diabetes and COPD management (no offense intended).

That particular oncologist had always struck me as someone who thought of people as people, not diagnoses, despite his fondness for reading through cases and explaining to us how to think through symptoms to come to a diagnosis. But there he was, surrounded by a swarm of medical students trying to improve their marks undoubtedly and a few interns who had not quite shaken their gunner tendencies. I assumed he didn't remember me anyway.

Last week, I checked my mailbox at the department office, something I only get to do about once a month because of my schedule. In it was a card from the old oncologist. His note read:

Internship is more than 2/3 over. Seems hard to believe it has been that long since you were a medical student here (September 2009). Good to see you doing so well last week.

Now, mind you, he may well send these notes out to every intern who passes through. He may have looked this up in my file. The card may have meant nothing altogether. I get that. It reminds me of a conversation I once had with a friend Y when he was visiting from NY. We were talking about how people were nicer in SF, but were more sincere in NY. He said, "I don't care anymore if they're lying- just be nice to me!" I think, as an intern, that's how you feel after a while. Who cares if it is all an act? It's an act of kindness not malice, so that sort of tomfoolery- well, go right ahead.

It's also one of those things I file away. Because I remember people, and I'm already seeing how much medical students appreciate it when you remember their names, acknowledge them in the hallways, ask them how they're doing. It sounds stupid and like basic social skills, but it's shocking how that sloughs away in many folks during residency. I keep trying to hold onto pieces of me, and this is one of those pieces I want to keep close.


On a lighter note, a patient came into the clinic yesterday to have his abscess repacked. He pulled out his iPhone and showed me a day-by-day documentation of the wound. I said appreciatively, "Wow, so you've been keeping a very careful eye on it?"

He waved this off and said, "No, I have a buddy who's squeamish, so I send him a picture every day to gross him out!"

Boys will be boys. Even when they're 40.

1 comment:

Maitri said...

Thinking out loud:

But medicine requires one to be simultaneously caring and emotionally sterile, doesn't it? And as humans who are pattern recognizers first, emotional second and problem solvers third, it's gotta be hard not to read subjective somethings into a person (and his or her name, looks, physique, etc.) first before treating their all-too-real objective symptoms. Especially when it's cancer.

Not saying the same thing doesn't happen in my profession. It's hard to be a geologist (probabilistic/descriptive/art brain) and geophysicist (deterministic/math brain) simultaneously.