Death of an Ordinary Family Doc

Death of an Ordinary Family Doc

I had an interesting and traumatizing experience last night that again shook my core and reaffirmed my belief that when the layers fall away, I am ultimately a scared and unprepared coward in the realm of primary care medicine...

I've had that realization many times in the past...

I think it is rooted in the fact that, as Family Physicians, we are in a unique position in which we are expected to know something about everything in medicine, to do everything possible for anyone, and to utilize resources in such a way as to do this in the most cost-effective manner to reduce healthcare costs while educating people with a pretense or hope that this will enable some sense of personal responsibility... And we should perform this task without personal consideration of constraints limited by our own effort, time, or level of frustration.

A Daunting Task.

However, I do not mean to suggest that it is impossible to accomplish this task well. In fact, I have had the opportunity on countless occasions to work with and for family physicians that are meeting all of the outlined objectives listed above.

I believe, in order to accomplish this task in a satisfactory manner, the Family Doc must have an element of "extraordinary" that I feel I am distinctly and absolutely lacking.

The elements of "extraordinary" that I am referring to are numerous and vary widely from person to person, but many paths of extraordinary can carve the path to being an excellent family physician.

The first extraordinary quality is that we need people *willing* to provide primary care, a thankless and under appreciated profession, and few people are willing to do it. You can learn how to be a good primary care doctor. You have to listen and become the ultimate utilizer of resources. These are learned skills.

Other extraordinary qualities that good family doctors must have in order to be good must include, in some extraordinary quantity or combination of quantities, the following: intelligence, work ethic, commitment to social justice or humanistic values, a selfless willingness to sacrifice many other facets of their own life, courage to do the right thing under all circumstances, and finally and most importantly, an unfathomable sense of priority and level of comfort with the quantity and gravity of tasks required of them day after day after day.

Last night, I delivered a baby. I was on call at the hospital, and a fellow resident sacrificed his evening to cover me so that I could go to this delivery at 11pm. This baby was large, and the delivery was complicated by a shoulder dystocia. I couldn't get the baby out. My attending, who was one of the CHC family docs, was able to deliver the infant after three of the longest minutes I have ever experienced. Next, the delivery was complicated by a retained placenta followed by a manual extraction.. this is a particularly horrific experience. My arm was inside this woman's uterus up to my elbow, warm blood flowing up to my armpit, while I was still experiencing the sweating and shaking muscle fatigue from the shoulder dystocia that I was unable to release.. and I realized after about five minutes in a cold and exhausted stupor that I was not going to be able to get her placenta out.. My attending, this CHC doc, extracted the placenta. Finally, I repaired a borderline 3rd degree laceration.. My first. The type of laceration after which when you finish repairing it, you have to ensure that the rectum is intact so that the patient doesn't form a vaginorectal fistula...

I looked up at my patient, a wonderfully sweet and patient woman who immigrated from Mexico with her husband and son with the wish for something better than her life had been.. She speaks absolutely no English, but has put up with me as her physician throughout her pregnancy despite my painfully limited Spanish skills. She locked eyes with me after this traumatic experience, her baby girl had been rushed out to the nursery after a resuscitation, and smiled. She whispered, "Cansada?," And I sudden realized with shame that this woman was asking me if I was tired.

After the initial shock of the question sunk in, I thought in my mind, "Yes, I'm exhausted, burnt out, just spent three hours doing this delivery while a resident that should be home sleeping is covering medicine for me, and now I have to go back to the hospital to deal with a crashing septic 97 yo woman as soon as possible... and I can't remember when my last day off was or when the next is.."

That's what I was thinking, but I wanted to say, "NO! Don't worry about me! Think about yourself, that scary and traumatizing experience, and the health of your newborn baby! For me, this night is just another night, one of hundreds similar, but you just had your second baby and first daughter..."

But I didn't say that, because my spanish is limited enough that this would have been harder to describe than it was worth. So I simply said, "no," smiled, and held her hand.

I looked over at the CHC doc. He was sitting on a chair next to her husband, explaining to him in perfect Spanish everything that had just happened. The same CHC doctor who was the direct reason that everything was going to be OK.

Afterward, the CHC doc and I were sitting down next to one another, decompressing and charting, and he told me that the delivery was one of the worst shoulder dystocias he'd ever had and I was "lucky" to have that experience before "I am out on my own."

I realized (again, in a countless reminder) that I absolutely do not have the "extraordinary" quality that this CHC doctor has..

I am hopelessly flawed and absolutely ordinary, not worthy of this job, and even if I was I ultimately would not want to do it.

Because as I whine that I am working an incessant amount, he is working harder than I ever want to work 10 years into his career, for a salary that I would be making had a gotten a job right out of college, and he is doing this job because he believes that what he is doing is improving this world.

I was bitter to be there at that ungodly hour on a Saturday night, embarrassed that I was unable to do what was required of me when the situation called, ashamed that this unfortunate woman was worried about me in her moment of hardship, and frustrated that I insist on caring for people that I cannot even communicate with on a level as basic as their own language..

All I could think was, "someone capable should have been caring for her, someone who can communicate with her, and someone who cares about her." I would never be able to forgive myself if that patient would have had a bad outcome because I shouldn't have been caring for her in the first place..

My point is, there are family docs out there who can rise to the occasion. The one I did this delivery with was one of them, but there are many. However, I am either unwilling or incapable of sacrificing myself to the extent required to meet that objective. I have nothing left to give after working this much. I have no desire to learn more. And in the end, I don't really care all that much. I just want to be freed from this burden and perform a job that is reasonable and attainable.