Road Trip 2: Chicago


My daughter’s the third generation

She’s had enough education

     To make a diagnosis

     Infer a prognosis

And legally prescribe medication

My father did two years of medical school at University of Missouri and transferred to Harvard.  His Barnes internship gave him one day a month off.  He finished residency in Pittsburgh, and when I was six we landed in Denver for his American Heart Fellowship; he went into cardiology. 

I wrestled with my career choice for years but, unlike my father, I didn’t battle racist admissions policies. Family practice internship and residency meant a mere 100 hours per week.

My daughter, Jesse, a third generation physician, didn’t hesitate to choose medicine.  She had to learn a great deal more during her med school years than either her father or grandfather.  Halfway through residency now, in theory her work week stops at 80 hours (reality differs).

I stopped to see her in Chicago to visit her after an easy day’s drive.

She looks good; she carries herself with confidence and personal strength.  We had a great time talking about cases and patients and the meaning of medicine in the larger scheme of things. 

Nostalgia can lead one to a quagmire; in medicine it risks a journey to a swamp at a toxic waste dump.  Medical care now beats any medical care of the past.  Even if the hours look shorter, medical education get more difficult every year because every year the body of knowledge expands.

I hope but can’t prove that doctors who work sustainable hours will function as doctors more years than ones who don’t.

Society, the world, and medicine have changed since my father carried his microscope into the histology lab in 1948.  I had that microscope refurbished in 1975.  A fun toy, but microscopy skills add little to a practicing physician’s ability to take care of patients. 

We talked about cases and the front-line reality of life.  Every disease carries a human cost and the impact ripples outwards from the patient to the family and the workplace and the society.

She told me about syphilis’s resurgence in Chicago.  I told her how it always started with a chancre (a soft ulcer at the site of infection) when I began med school, but ten years later it rarely did.  She talked about her disappointment at the delivery she had attended the day before, when the breech presentation necessitated C-section.  I observed that when I started private practice in ’87 we sometimes delivered breech babies vaginally (and got some pretty beat-up babies) but by 1989 we’d stopped.

If medical office paperwork doesn’t flow functionally, it will flow dysfunctionally, I told her; this I have learned on my walkabout.  

Her ten-doctor office runs with one nurse and five Medical Assistants, which amazed me.

We went out to eat with her boyfriend (also a Family Practice resident); over Pad Thai and sashimi I got to tell stories about bring up my daughters, liberally sprinkled with observations about thyroid disease and vitamin D.  I watched vigilance exact its toll while he ate, and his OB patient labored; he kept waiting for his beeper to go off.

Doctors will always pay a price for being doctors, tradeoffs are inevitable.

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