IT TAKES PRACTICE
By Aaron W. KempTrafford Publishing
Copyright © 2010 Aaron W. Kemp, MD
All right reserved.ISBN: 978-1-4269-3148-2Chapter One
Before it All
There are probably as many reasons for people to go into medicine as there are people who do so. It's a decision that requires long hours of study-not all of which are very interesting, many kinds of commitments, and, in the thinking of some, investing youth. A valid, true reason is a wish to help the ill or infirm. Some enter medicine out of compassion or pity.
I have known people who truly believed they were called by God Herself to become a physician, just as others are called to become a preacher or a priest. Perhaps I was one of those. Such people don't seem any better or worse than other physicians.
There are other reasons. I observed something interesting-those whose parents were physicians, or people who came from situations where money was never a problem, seem high on the list of fine people and fine doctors. Those who seek to better themselves in some way, seeking admiration, respect, status, position, and money, have strong motivations to succeed. They don't sacrifice much in the long run. They think about security, while those from well-to-do situations aren't so strongly inclined.
The idea that doctors who come from the slums and the poor are more feeling, understanding, or compassionate hasn't been true in my experience. Those who have these positive attributes are very rare, God bless them. Where would medicine be without them?
Just as rich people don't think about money-or, at least, it's not high on their priority list-the real science people are more interested in projects and answering questions, gaining more knowledge and understanding of physical facts, than seeking patients for their own gratification. They were my professors and teachers, and I thank them, but they weren't my inspiration. That's a rather dramatic and true tale.
My family was quite poor. My father worked in construction, logging, and later, on cannery ships, to house and feed his eight children, as well as my grandmother, who lived with us as long as I can remember. During the Depression, they moved from a small town north of Spokane to Seattle. I always felt they never adjusted well to the big city, and they always spoke of home as the place they came from. There wasn't much contentment in our house, and I struggle with that issue to this day. Perhaps I never learned how to be content.
Judy, the last child, had cerebral palsy. Sad and ill, unable to talk, with little control of her functions, she was able to walk on rigid legs, resembling a puppet. She moved around the room, drooling and fretting, twisting her hands and making animal-like sounds. There were frightening, heart-breaking times when she lost her balance and fell, hurting herself terribly if there was no one to catch her. My mother cried frantically, mopping blood from Judy's face, lips, and broken, bent nose.
That added to our difficulties when my father was out of work during Washington's dreary, rainy winter. I never understood why we stayed, but I don't understand why I spent sixty years of my life there, either. The place was like a joke-warm in May spring days, with clear air and singing birds, and the promise of summer to come. Then June came, when it rained steadily until, and often through, the Fourth of July.
In mid-July through August, we had beautiful summer and autumn. Indian summer ran through the middle of October. Then came more overcast and rain. Before I moved to Arizona, it rained for ninety-six days and nights. That might sound like a digression, but I wanted to paint a picture of overcast, dreary skies and being poor and insecure.
My mother was Christian Science to the core. She attended church every Sunday and dragged my siblings and me along when she could catch us. My grandmother was Christian Science, too, but she never left the house. My father didn't say anything about religion, but he demanded respect for my mother's beliefs and faithfully drove her to and from church every Sunday when possible.
Ritchie, my brother, quit high school and joined the Air Force. He came home on furlough when he was twenty-one, and I was thirteen. He'd been working under a car, trying to repair it, when I heard him moan and yell in distress.
I helped drag him from under the car and stumble into the house. He held his stomach in agony, unable to stand up straight, crying out in pain. He reached the bed in the front room and collapsed, curled up and moaning like a wounded animal.
My mother and older sister wrung their hands, fretting hysterically, not knowing what to do except to pray over him in pleading tones. The panic grew, as did Ritchie's pain, until my oldest sister announced she was calling a doctor. My mother didn't protest.
A short time later, though it seemed like hours, we heard a knock at the door. I opened it, and a young man with broad smile, carrying a shiny, new black bag, walked in, radiating confidence, calmness, and purpose.
I followed him, as he was shown to the bed where my brother lay, writhing. He asked a few kind questions, then took out a stethoscope and listened to Ritchie's stomach for a minute. He gently pushed in and released his abdomen, and Ritchie moaned. Putting away his stethoscope, the doctor asked my mother to speak with him in the next room.
"Your son has a ruptured peptic ulcer," he said quietly. "I'll give him morphine now, which will relieve most of the pain, but he needs emergency surgery."
The color drained from my mother's face. Unable to speak, she stared at him, as the air filled with dread and fear.
"He'll be all right," the doctor said. "He'll be all right."
His confidence was reassuring beyond description. Panic dissipated, and fear melted. I was aware of his presence and manner, as well as his understanding of what happened. I saw his assurance, kindness, and, under it all, his knowledge and wisdom. Those things ended the air of chaos and panic that filled our house.
I wanted to be that man someday. I wanted to be like him, someone in control of misfortune, with the power to lighten the load that fear and lack of knowledge brought. I had a purpose at that moment. It was an epiphany that lasted a long time.
His word was good. Ritchie was taken to Madison Army Hospital, where he had surgery. One month later, he was home again, looking pale and drawn. I always remembered my appreciation and gratitude. Even relieving Ritchie's pain with morphine seemed like an act of God Himself. Doctors aren't gods, but I knew then, and I still know, they can be used by Him for great good.
That dramatic moment was how I felt my calling.
I had a 2.0 grade average in high school. I liked drama and speech arts. At the time, that was enough to enable me to enter college, though it takes better than a 3.0 average now. That makes me wonder about late developers, those who find their purpose later in life. Many of them must be left behind, wandering and wondering.
I knew I could succeed, but I had very little encouragement, though what I received was enough, because it came from people I admired and cared for.
I went into college with great resolve. I studied hard. The situation in premed was tense. No one could afford to have a C on anything. It was more pressure than medical school. I applied myself, and, with only three years of college, I was called for an interview in Seattle.
I drove from Pullman to Seattle with an acquaintance who was also being interviewed. It was cold and windy, and the road through Ellensburg Canyon was slick with black ice. We came around a corner, and the car slid until we struck the cables that served as guardrails. We hung there, the front of the car dangling, suspended by cables over a 1,000-foot drop.
We let ourselves out through the back doors, while the car rocked ominously in the wind. Then an odd thing happened. The trunk popped open, and my suitcase was tossed over the cliff, taking my clothes, including the suit I intended to wear for the interview. It was scary, and I became worried about what I'd wear to the interview.
A tow truck pulled us back onto the road. Off we drove, still shaking, to our interviews. When we reached Seattle, I called my brother and asked if I could borrow a suit. He wasn't home, so I spoke with his wife. She was reluctant to loan his clothes, probably thinking I wouldn't return it or might ruin it. She loaned me his old, worn, thin, sports jacket and slacks. They were too big, somewhat ragged, and the zipper on the pants refused to stay closed.
I was the last interview of the day. When I stood to leave and reached for the doorknob, the professor said, "Mr. Kemp?"
"Yes, Sir?"
"Zip up your pants."
I looked down and saw part of my oversized white shirt sticking out. Humiliated, I didn't know what to say.
The professor laughed.
That fall, I began medical school.
Chapter Two
Medical School
125 of us gathered in the large classroom for orientation. The dean had a pile of thick textbooks stacked twenty feet high beside him.
"You will read and know the material in these books as you go through your classes," he said. "The teachers are here to help you retain what's important." He paused for effect. "It's not impossible, though you may think so now. Many, many others have done it before you, but it takes hours of study and dedication."
He was right.
The following day, we began our introduction to gross anatomy lab. We were given little white gowns and a dissecting kit and ushered into a room that reeked of phenal and formaldehyde. Inside were thirty-five pickled bodies on slabs. We divided up, four to a body. Once the plastic drapes were pulled away, we were told, "Skin the chest and abdomen."
My God, I thought. Just like that? I picked up the knife, staring at it. The other three students at my table looked on in abject horror until I forced them to help by pulling the corners of the flaps of skin. After a while, we were able to joke and smile, but it took time.
The next gross lab was two days later, and only 100 students were there. Twenty-five had already flunked out. Maybe a gentler introduction would've made a difference, but I doubted it. Before we finished, we handled and pried apart a brain and washed out intestines in the sink. It wasn't for the fainthearted.
The sink had a large, powerful drain. To my horror, one end of the gut was pulled down strongly. I couldn't hold it, and it kept slipping through my hands until I gripped and twisted. The gut broke, and I fell backward, with the open end splattering nasty contents on the wall, the floor, and the girl beside me. It wasn't a pleasant day.
During our first year, we constantly worried we'd be thrown out. I imagined how they would do it. They would push us down a slide into the street, and, just before we left, our dirty, smelly, disgusting gown would be thrown into our faces.
At the end of the first year, another fifteen people were missing from the course. Some were dismissed in a rather rude fashion.
We were in line alphabetically at the dean's office to receive our second-year assignment package. The young man ahead of me stepped forward and asked for his papers.
"We have no package for you," the dean's secretary said with a sick smile.
That was when he found out he didn't make it. Next in line, I shook when I asked for my papers. She handed them to me, and I thanked her repeatedly until she told me to move along.
The unfortunate one stood nearby with tears on his cheeks, fumbling with his fingers inside his coat pocket. "What will I tell my wife?"
"I don't know," I replied.
The legendary first year passed more quickly than expected. It was difficult, partly because some of the things we learned had no practical purpose to anyone who wanted to be the kind of doctor I did. The information seemed to have very little importance then and still doesn't. That was particularly true of biochemistry, where we had to memorize the Krebs Cycle and regurgitate it on a page. Just knowing its meaning and significance would've been enough.
Physiology was all abut the instructors' research with potassium and sodium pumps in a single cell. We wasted a lot of time smoking drums and redoing experiments that had been done repeatedly before. I remember trying to do an EKF on a turtle heart floating in a saucer of saline.
Neuroanatomy was a difficult subject for me. It was like memorizing the London subway system. Difficult but interesting, it made sense in the long run despite words like Nucleus Ambiguous, Corpus Collosom, and Substania Negra. I can't remember what some of those mean.
The second year, easier in all ways, was also more fun. Finally, our subjects were clinical, about health and disease. The pressure on us was reduced, too. Despite eight-hour pathology tests, it was a fun year. We were given little black bags, all shiny and new, with black pressure cuffs, a stethoscope, tuning forks, pins, and ophthalmoscopes. We listened to each other's hearts, lungs, and abdomens. We looked into each other's ears, eyes, and mouths.
Then one day, we were turned loose on the patients at the County Hospital and VA, where we listened, thumped, felt, looked, and learned. Finally, learning medicine was enjoyable, and people called us Doctor.
Microbiology, parasitology, pathology, psychiatry, and public health information was given to us that year. The dean was right. It was difficult but not impossible. The instructors were kind, helpful, and patient. Classmates became friends. Study groups were social occasions that relieved tension through incessant bitching.
One thing I didn't like about our second year was an introduction to post mortems, or autopsies. I hated them and found them gross and distasteful. I admit I learned a lot from them, not the least of which was I didn't want to become a pathologist. All pathologists lit big, black cigars before opening up a body, as a way to protect themselves from offensive odors, but it didn't help.
All things must be tempered by judgment. I heard and participated in many funny, interesting, and occasionally sad stories, especially from Obstetrics. In medical school, I saw an anencephalic born, which looked like a fish without a skull, because it had no brain. In general, such babies were called "monsters." Unfortunately, the poor creature made a struggling respiratory effort, and the idiotic resident doctor rushed it up to the nursery to be resuscitated.
When the chief of obstetrics heard of it, he fired the resident on the spot for stupidity and inappropriate behavior, as well as a complete lack of judgment.
The hospital board backed him completely, and we were glad. Everything-everything-must be tempered by judgment.
In the third year, we were assigned to various hospitals and wards. I was at the VA Hospital, which had a myriad of pathologies to study and see. We also learned about each other.
One student we nicknamed Ichabod, because he was tall and skinny, with large feet and hands, a bird-like face-(we called his nose a pecker)-and a butt that was too high up.
At the VA, we were given free lunches, and they had good spaghetti. Ichabod ate a lot. The resident in charge told him to put a nasogastric tube down a patient.
Unfortunately, that was immediately after lunch. Ichabod bravely went into the room, but soon, he looked sweaty and ghostly pale. He bent over the hapless man, poking the tube through his nose.
"Ugh, ugh," the patient said.
"Argh!" Ichabod replied, and vomited three pounds of spaghetti over the patient's chest.
Ichabod ran out the door, and no one ever saw him again.
I loved OB. It was exciting and fun, and, for a long time, I thought it was my special calling. The problem with malpractice stopped me and many others. Currently, malpractice insurance costs $125,000 a year, so my decision was correct.
I recently read about a lawsuit for a wrongful life. An obstetrician resuscitated a defective or deformed child that unfortunately lived. In the forties and fifties, oxygen was given to newborns. Though it resulted in blindness, without oxygen, the baby died. Either way, the doctor could be sued. No one but the lawyers win in such cases, who are paid obscene amounts of money.
(Continues...)
Excerpted from IT TAKES PRACTICEby Aaron W. Kemp Copyright © 2010 by Aaron W. Kemp, MD. Excerpted by permission.
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