Trying to write this week is almost absurd, but maybe that's the best time to write. And when you have so many other things you should be, writing feels like an indulgence that it doesn't always otherwise.
I wanted to play Welcome to the Jungle to the new interns today, who were shadowing the outgoing interns-- this is a new thing, by the way. No more throw-them-in-the-water-see-if-they-can-swim, which makes people of my generation cantankerous about the good old days, but honestly, though that trauma made me put on my big-girl pantalones, it didn't make me a better doctor. Anyway, given this new kinder, gentler entry to the world of doctoring, I, of course, did not play Welcome to the Jungle. Never mind that most of them would not have recognized the song.
The outgoing interns, seasoned after a year of being on the lowest rung of the ladder, sailed through rounds. I've only been working with them for a few days, but they're a good bunch of them. One, in particular, has the most righteous indignation that reminds me that I really should try to get out of the way of her generation. They channel their rage sometimes with such absolute focus. This intern, H, she's got a reputation for having a temper. The first day I served as her attending, she dropped a curse word in the work room right in front of me without the slightest pause. She is unapologetically herself, and I'm torn between high-fiving her or making her my role model.
H defended her rage, when one of the men in the room (of-f***ing-course) said she was angry, pointing out that her rage wasn't focused on slights against her. It was always, always on behalf of the patient. And the thing is, it's true. A few months ago, a patient of hers was dying. Not an uncommon occurrence on the Hematology Oncology service, unfortunately. But H was trying to take good care of her patient, and so she felt that this patient's family, his parents in particular, should be notified that he was dying.
Well, it turned out H taught me something with this story. Even though I've been doing this for a while, I had no idea that patients who are also prisoners are under something called a total-blackout. This means, no communication about their whereabouts or their wellbeing to the outside world. I'd somehow never taken care of a prisoner that was dying of a terminal illness, so I was not aware that this total-blackout applied under any and all conditions.
Here's the thing. Many an intern would be pissed, and many an intern would go home despondent. Many an intern would wonder why they didn't go into Dermatology, and many an intern would tell themselves they should pick a specialty that didn't involve so much doom and gloom. But this intern, she got mad. She got Good and Mad, and she channeled her anger with zero f***'s to give. The guards taking care of the prisoner told her that their hands were tied. It was policy, nothing to be done. They said they understood the man was dying and they felt badly but it was out of their hands. H could have said the same thing. Many interns would have. But not her. She was still angry, and she demanded to speak to the guard's superior. She escalated and escalated until she was speaking to the hospital head of security.
She went head to head with him, and she did not back down. He once again reiterated the policy, and she would not take no for an answer. She said, "we are treating him like an animal." And the head of security tried to get offended and said that it wasn't fair to characterize their behavior in this way. To which H responded, "then stop treating him like an animal." And impressively, this woman on the lowest rung in the ladder at the hospital prevailed, and she called the patient's parents, who got to say goodbye to their son.
She told me of all of this because, when the man in the room had told her she was angry, I said, "rage can be a good thing." I'd also muttered offhandedly about our entire healthcare system being broken during rounds, when we spent 15 minutes talking about MediCal sending a letter to our severely immunocompromised patient with acute leukemia that his antibiotics were not covered by them and that he had the option to go to court to appeal (!!!WTF?!?!!!). She'd seen my rage, and offered up her own.
But she did something else. First of all, everyone complains about the trainees nowadays, and I understand that too. They don't work as hard, they aren't willing to sacrifice their personal lives for patient care, and they simply refuse to do some things. But they are a direct response to a phenomenon described probably most aptly in this recent NYT article - the system is grinding down physicians, chewing and spitting them out. Forcing us to fight unwinnable battles, work unworkable hours, while also telling us the problem is that we don't have wellness training. Medicine is no longer glamorous, and no longer does it even feel like a noble profession because so often our hands are tied by bureaucracy and insurance companies and government policies.
The thing is, the new generation of physician trainees, a sect of them are very much in the f*** you quadrant that's occupied by the likes of AOC. They are not having it. H was not having it. And she realized something that people of my generation have long since forgotten. She had the truth on her side. She had doing-the-right-thing on her side. My generation is so jaded about the thanklessness of doing the right thing, we've lost the ability to be brave in many situations, or we've just become discouraged from failing to change things. But H and her crew, they could change things, for the better.
Or. See, that's the thing. They could change things, or the system might break them. I remember how valiantly I fought battles when I was an intern. Nowadays, I am angry and I try to change things, but it's not with that same passionate righteousness, it's not with the hope that I'm going to change things. I have this horrible I'm going to speak my mind so that I'm on record but I know I have no power to actually get anyone to listen attitude about things, this horrible screaming into the void feeling. Will these interns become me some day?
I hope not though. I know that's the party line to millennials and the generation younger than them. That they feel these things so strongly now, but wait until you're older, you'll be the same as the rest of us. But I don't know. They seem like a different breed, and if I'm going to put my faith in anything-why not put it in them?
I wanted to play Welcome to the Jungle to the new interns today, who were shadowing the outgoing interns-- this is a new thing, by the way. No more throw-them-in-the-water-see-if-they-can-swim, which makes people of my generation cantankerous about the good old days, but honestly, though that trauma made me put on my big-girl pantalones, it didn't make me a better doctor. Anyway, given this new kinder, gentler entry to the world of doctoring, I, of course, did not play Welcome to the Jungle. Never mind that most of them would not have recognized the song.
The outgoing interns, seasoned after a year of being on the lowest rung of the ladder, sailed through rounds. I've only been working with them for a few days, but they're a good bunch of them. One, in particular, has the most righteous indignation that reminds me that I really should try to get out of the way of her generation. They channel their rage sometimes with such absolute focus. This intern, H, she's got a reputation for having a temper. The first day I served as her attending, she dropped a curse word in the work room right in front of me without the slightest pause. She is unapologetically herself, and I'm torn between high-fiving her or making her my role model.
H defended her rage, when one of the men in the room (of-f***ing-course) said she was angry, pointing out that her rage wasn't focused on slights against her. It was always, always on behalf of the patient. And the thing is, it's true. A few months ago, a patient of hers was dying. Not an uncommon occurrence on the Hematology Oncology service, unfortunately. But H was trying to take good care of her patient, and so she felt that this patient's family, his parents in particular, should be notified that he was dying.
Well, it turned out H taught me something with this story. Even though I've been doing this for a while, I had no idea that patients who are also prisoners are under something called a total-blackout. This means, no communication about their whereabouts or their wellbeing to the outside world. I'd somehow never taken care of a prisoner that was dying of a terminal illness, so I was not aware that this total-blackout applied under any and all conditions.
Here's the thing. Many an intern would be pissed, and many an intern would go home despondent. Many an intern would wonder why they didn't go into Dermatology, and many an intern would tell themselves they should pick a specialty that didn't involve so much doom and gloom. But this intern, she got mad. She got Good and Mad, and she channeled her anger with zero f***'s to give. The guards taking care of the prisoner told her that their hands were tied. It was policy, nothing to be done. They said they understood the man was dying and they felt badly but it was out of their hands. H could have said the same thing. Many interns would have. But not her. She was still angry, and she demanded to speak to the guard's superior. She escalated and escalated until she was speaking to the hospital head of security.
She went head to head with him, and she did not back down. He once again reiterated the policy, and she would not take no for an answer. She said, "we are treating him like an animal." And the head of security tried to get offended and said that it wasn't fair to characterize their behavior in this way. To which H responded, "then stop treating him like an animal." And impressively, this woman on the lowest rung in the ladder at the hospital prevailed, and she called the patient's parents, who got to say goodbye to their son.
She told me of all of this because, when the man in the room had told her she was angry, I said, "rage can be a good thing." I'd also muttered offhandedly about our entire healthcare system being broken during rounds, when we spent 15 minutes talking about MediCal sending a letter to our severely immunocompromised patient with acute leukemia that his antibiotics were not covered by them and that he had the option to go to court to appeal (!!!WTF?!?!!!). She'd seen my rage, and offered up her own.
But she did something else. First of all, everyone complains about the trainees nowadays, and I understand that too. They don't work as hard, they aren't willing to sacrifice their personal lives for patient care, and they simply refuse to do some things. But they are a direct response to a phenomenon described probably most aptly in this recent NYT article - the system is grinding down physicians, chewing and spitting them out. Forcing us to fight unwinnable battles, work unworkable hours, while also telling us the problem is that we don't have wellness training. Medicine is no longer glamorous, and no longer does it even feel like a noble profession because so often our hands are tied by bureaucracy and insurance companies and government policies.
The thing is, the new generation of physician trainees, a sect of them are very much in the f*** you quadrant that's occupied by the likes of AOC. They are not having it. H was not having it. And she realized something that people of my generation have long since forgotten. She had the truth on her side. She had doing-the-right-thing on her side. My generation is so jaded about the thanklessness of doing the right thing, we've lost the ability to be brave in many situations, or we've just become discouraged from failing to change things. But H and her crew, they could change things, for the better.
Or. See, that's the thing. They could change things, or the system might break them. I remember how valiantly I fought battles when I was an intern. Nowadays, I am angry and I try to change things, but it's not with that same passionate righteousness, it's not with the hope that I'm going to change things. I have this horrible I'm going to speak my mind so that I'm on record but I know I have no power to actually get anyone to listen attitude about things, this horrible screaming into the void feeling. Will these interns become me some day?
I hope not though. I know that's the party line to millennials and the generation younger than them. That they feel these things so strongly now, but wait until you're older, you'll be the same as the rest of us. But I don't know. They seem like a different breed, and if I'm going to put my faith in anything-why not put it in them?
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