FSM a hard day's work

This is my second off-boat experience in Micronesia. The destination is one of the “outer isalnds." The population is 700. No I didn't forget a zero there. We pull in to a crumbling concrete dock next to a beautiful, simple seaside church. Our clinic is again at a school, this one smaller than the last and having only 4 classrooms. My job today is not to be a provider but to work as a military corpsmen. I will take vital signs (blood pressure and pulse) from all the patients seen in the clinic. There is a navy corpsmen Ray working with me. I am actually looking forward to this, as I won’t be under any pressure to make any real decisions about patient care. It will be sort of a break for me.



The day drags on. After checking in what seems like 100 or so patients I check my watch and it is only 9am. Luckily the weather is cooler today and I sweat less. Many of the locals bring me fresh coconuts (which are delicious) and that helps me through. Also local women have prepared lunch for us. I avoid the fish and chicken but try the breadfruit. It looks delicious but it’s not very good. And so I make it through the day, having seen roughly half of the 400 patients that came through the clinic.



It surprised me how good I felt after having put in a hard day’s work. This was in stark contrast to how I felt after many of the days where I worked as a provider seeing patients for their medical complaints. Today I had a straightforward job to do and I did it well. I could see the line of patients waiting and I made it through all of them that were checked in. With each customer I had the sense that they would go on to receive good care from our team of providers. I had time to pause and look around. I took breaks to eat coconuts. I saw the Navy’s band play while the people danced. It was very satisfying.



I can’t help but wonder if this situation parallels the differing stereotypes of people entering medical school and those leaving it. Medical school applicants are characteristically excited, idealistic, motivated to learn, and very much wanting to help and make a difference. Meanwhile many (but by no means all) physicians are callous, weary, and well downright negative about things.



Maybe the work of being a physician is just plain tough. Maybe the long hours and eventually take their toll. That’s probably true, but maybe it’s something else. Maybe when the buck stops
with you and you are the one making the decisions that constitute a person’s healthcare that takes its toll on you in other, subtler ways. It’s a goal of mine to figure out what the subtle ways are so that I can avoid their effects and maintain my naïve premed idealism.



We are advised in med school to try and distance ourselves from our patients. “You can’t take your work home with you” they say. I think the culture of medicine does a pretty good job of making this so. Doctors don’t experience all the pain of their patients. They don’t wait for hours in a clinic for a quick 10-minute visit. They don’t lose sleep at night over the results of an HIV test. Well actually though sometimes they do.



Each patient is a challenge. That premed in you wants to save the day for that patient and give them the best care possible. But that’s tough to do. On the medical side it’s tough to remember all the questions to ask, all the signs to look for, and all the ways to treat it. Then on the practical side you are limited by the resources you have at your disposal and that the patient has access to. In the US, will the insurance company pay for this MRI? In PNG, can we get this woman onto the boat to get an Xray?



--pete