Wednesday, July 1, 2009

Thoughts on Doctors

Yesterday, the an advisory committee to the FDA recommended for the removal of Vicodin and Percocet from sale in the United States due to the acetaminophen (Tylenol) component. Acetaminophen overdoses are directly related to acute liver failure, and long-term use is linked to other liver issues.

At the Emergency Department, we are not unfamiliar with overdoses on a variety of issues, acetaminophen included. We are not also unfamiliar with people pleading -- pleading -- for painkillers, usually vicodin or percocet. See, they are relatively inexpensive and innocuous as compared to the more powerful ones like dilaudid or fentanyl. Why we don't see more people begging for morphine tablets escapes me, but I have no doubt it's due to the sheer obivousness of morphine in comparison.

Which brings me to my point...

As we are speaking, right now, a new class of doctors is arriving in Cincinnati for their very first shifts as MD's. Sure, they've had their time in clinical rotations, but today they begin the arduous process of doctorin' up people, and they will get to learn the lessons and make the decisions that so many have before them. They will get to learn the difference between a grimace of real pain and the grimace of a needy 20 year old dislocating his shoulder regularly for the sole purpose of obtaining pain medication. They will get to hear the crazy tales -- the STD check who brings both his pregnant baby mama and his pregnant girlfriend in to get tested -- and they will become familiar with our frequent fliers.

At the same time, a class of doctors is leaving. I have fought with these doctors and become friends with them. I have learned to like them, and I've learned to hate them. Though my job does not near approximate the nurses roles, and my judgment on who is good and who is bad is slightly skewed to who refers to me the most, I have a pretty good and I am sad to see them go. But it also reinforces a sharp divide within the hospital.

We are a team together, working towards health, working towards homeostasis. However, as doctors move from R-1 (first years) to R-2 (second years), or as the R-4's leave, or as the R-1's enter, the doctors are still the doctors in a class in and amidst themselves. They know each other best. And the nurses know each other best. And the other services are so dwindled and separated out as to not be able to say that we really know each other. Thus, these new doctors will learn from all of us, and we will learn from them. They will take with them, as they move onto bigger and better things, the memories of our combined efforts. They will remember the patients we diagnosed together, and the crazy patients we held down together.

But they will move on, confident in their ability to cure. For my part, I will be part of "this cool program we had during my internship;" and the nurses will likely fall into one general lump of people known simply as "the nurses at my last job," individual faces and names forgotten and left behind. (See, when a nurse leaves, it is known, and we say good-bye a little and hug but there are a lot of them and they pass on; when someone lower leaves, it is not known and likely forgotten more often than it is remembered.)

I guess I'm just a little sad this morning, seeing work friends depart and realizing that they were never, perhaps, my friends. I was just part of their learning experience.

In the next month, I will teach the newbies about HIV and sexual health. They will look to me for answers about behaviors they had never heard about, and they will ask me questions about my program, my experience, and some snippet of neat information they missed over the newswire. Or, they will use me -- well, all of us in the Emergency Department -- to supplement their knowledge and to carry out their great and wonderful work, and we will support them. We will help them become better doctors.

Then, on their final day years later, they will look at me over their guitars and say, "I'm just ready to get the fuck out of here," and forget to say good-bye when they go and never acknowledge the part we all played in making them, them.

And I wonder who I will say good-bye to, and who will guide me, much like these doctors in a class all their own did for each other.

In a weaker moment, I might say that I just want to be remembered, that I want to matter in some way. I wonder, for those doctors already gone, if I did.

1 comment:

mdeals said...

Overdoses direct related to acute liver failure and long-term use is linked to other liver issues. painkillers such a eeeeeeee