In this business, the outcomes don’t always follow the efforts. This is something I remind myself when reminiscing on past patients. I remember when my children were young; I spent an entire Christmas Day desperately trying to stem the hemorrhage of an intoxicated person, ultimately in vain. When I went to discuss the situation with the family, I found an inebriated brother in the waiting room. The irony was deflating, but sadly, indicative of many clinical experiences.
For a decade, I was the chief of gastroenterology at a medical center where I was tasked with policing a department without any of requisite authority to do so. With little to no infrastructure in place, I had to navigate adversarial health policies and workplace politics just so I can provide the quality of care I believe my patients deserve.
What is portrayed on television or on the big screen has very little to do with the day in, day out life of the average physician in the real world.
Do you know why we bother to do this? It’s because we actually make a difference in the lives of our patients, and in turn, they make a difference in our lives. It’s symbiotic, but for an outsider looking in, it’s outright irrational.
My supervising medical resident during my first month of clinical rotations in my third year of medical school was going into gastroenterology. At the time, I thought that was crazy.
In the medical community, gastroenterology represents the purview of streets and sanitation, where you’re exposed to stool, vomit, blood, pus, and all sorts of fluids of disrepute. You get the point. Yet somehow, it’s the field I ended up. And the perspectives of hindsight give me a newfound appreciation for what I do.
After nearly three decades of practicing as a gastroenterologist on the Southwest side of Chicago, I have been fortunate and privileged to have worked with some incredible colleagues and coworkers, and of course, to have taken care of many wonderful patients.
Last week I diagnosed colon cancer in a patient and referred him to a surgeon. The problem is that no one has been able to contact him for the past week. He doesn’t answer his phone nor return any calls. The surgeon, my staff, and I, among other medical personnel, have tried for a week to reach him. Finally today, I reached someone who is familiar with his condition.
Apparently, the police needed to be called three times before in order to contact him. He seems to have a self-destructive affection for firewater – as those in the know call liquor. But before we jump to conclusions, remember that many times, such patients have experienced so much trauma in their lives that this is the only way they have learned to numb the pain. No level of medical training can teach that empathy. That’s something you have to feel firsthand.
I have another patient who I diagnosed with a precancerous condition a couple of years ago and referred him for curative treatment. He underwent one treatment session. Afterwards, he was informed by his insurance plan that he had failed to obtain proper preauthorization for the treatment, so that the entire process wouldn’t be covered. As a result, he would be responsible for the treatment already rendered. Needless to say, he couldn’t afford to continue the treatment process and never finished it.
By the time I saw him again, I had to inform him that he had developed metastatic cancer. When bad things happen to good people, it’s awful. But when you’re the bearer of the bad news, it’s gut wrenching. It’s the most difficult part of my job and it has nothing to do with medicine.
Don’t get me wrong, I truly love what I do. And I would do it all over again. But it’s not for the faint of heart and certainly requires some intestinal fortitude. We all find ways to cope. For me personally, I immerse myself in the world of my patients. It’s somehow soothing to think as they do. Often that entails listening to music that I would never do otherwise. In that vein, I leave you with a song that’s been playing all weekend:
This is how we gastroenterologists roll on the South Side of Chicago. This is how we do it.