Posts Tagged ‘medical school graduation’

Admit ignorance: practice it, get good at it.

March 13, 2017

If you don’t know a yes from a no,

And if you can’t tell the fast from the slow

Listen up, please,

For I can do it with ease,

Just say out loud, “I don’t know.”

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I went back to adventures in temporary positions until they have an Electronic Medical Record (EMR) system I can get along with. Assignments in Nome, Alaska, rural Iowa, and suburban Pennsylvania stretched into fall 2015. Since last winter I’ve worked in Alaska and western Nebraska, and taken time to deal with my wife’s (benign) brain tumor. After a moose hunt in Canada, and short jobs in western Iowa and Alaska, I am working in Clarinda, Iowa. Any identifiable patient information has been included with permission.

Over the weekend I observed the anniversary of my graduation from medical school. I remember the night well; I went out to the Chinese restaurant in East Lansing (at that time, there was one) with my father and my brother.  My fortune cookie said, “You will have great power over women.  Use it wisely.”

Before and after I have heard many commencement speakers, but the only one I remember was the one from March 11, 1979. “When you get up in the morning,” he said, “First thing, look in the mirror and say, ‘I don’t know.’  Practice it.  Get good at it.”  I remember a good deal more of that speech, but that particular commandment came to my mind this morning.

The patient came in for follow-up of cough. He had had all the right treatments before he got to me, but he wasn’t getting better.  I repeated the chest x-ray and didn’t see pneumonia.  Antibiotics, steroids, breathing treatments helped but not nearly enough, and he felt worn out from the cough bothering his sleep.  I said, “I don’t know what’s wrong, but, clearly, something is wrong.  And I know exactly what to do when I don’t know what to do, and that’s to send you to someone who knows more than I do.  Because I’m the world’s final authority on nothing.”  We were lucky to get him a follow-up appointment with the pulmonologist in a week.

But at the end of the visit I told him about my medical school commencement speaker, and how good I’d gotten at saying, “I don’t know.” And then I asked permission to write about him in my blog.  “I won’t say name of course, or age, or gender, but…”

“Doc,” he said, “You can tell ‘em my name is ### and I’m ## years old and I’m ### for all I care. Especially if it’ll teach other doctors to admit when they don’t know.”

I can hope.

An awful lot has changed in medicine since 1979. We don’t use penicillin for pneumonia any more, and rarely do we bring out the digitalis.  But doctors still have to admit when they don’t know.  It’s one of the rules of the game.




Memories of March 11. 1979

March 14, 2014

Three decades ago I did walk
How fast move the hands of the clock!
My life rearranged
As a man I was changed
And I remember the speaker’s fine talk.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, sold my share of a private practice, and, honoring a 1-year non-compete clause, went to have adventures in Alaska, Nebraska, Iowa, and New Zealand. I returned to take a part-time position with a Community Health Center, now down to 40 hours a week from 54. Right now I’m in Petersburg, Alaska, on a 1 month working vacation.

The anniversary of my medical school graduation arrived with snow and rain in southeast Alaska.

March 11, 1979 remains a date burned into my personal calendar. I had hitchiked back from Montana, my 4th move in 5 months. I stayed with friends in Saginaw and East Lansing the few days till graduation.

My father and brother flew out from Denver.

The graduation speaker did an effective job; I still remember what he said: There aren’t very many true emergencies. Write down what you need to know for each one on 3×5 cards and carry them around till memorized. Every morning, first thing, look in the mirror and say, “I don’t know.” Get good at it. Medicine is a jealous mistress with a cruel embrace.

He spoke for about 20 minutes. His exact words probably reside somewhere in the archives, but I carry the most important parts in my memory.

Michigan State at that time and to this day keeps the med students in East Lansing for the two preclinical years; after that the College of Human Medicine sends the students off to the five clinical campuses around the state. Those clinicals years constitute the crucible that makes a doctor. We saw people born and die; we delivered babies. We received praise and verbal abuse. We listened to attending physicians expound wisdom and acclaim outright lies. And for our last year, most of us travelled.

We lost track of each other. Some slowed their program from four to five years, some longer. Some dropped out. For the next three years we focused on our post graduate training, and for the next thirty years we focused on our careers.

But most of us walked across the stage that cold and snowy night in East Lansing.

I almost didn’t.

While I stood in line I started to panic. I had been a student for 24 years at that point, and without a school and a program, I had no identity. With only two classmates ahead of me, I turned to my one time roomate, who, fortunately, came right behind me alphabetically. “I can’t do this,” I said, “I’m a student. I don’t know how to be anything else.”

He said, “Be quiet. Turn around and graduate.” Which I did.

In that short walk across the stage I underwent a metamorphosis. I walked off the stage gripping a faux parchment (not the diploma; they had handed me a note that promised my diploma would be mailed to me), a changed man. The change, of course, had built over the three years of premed and the four years of medical school, but those few steps brought me past the tipping point.

Yes, I had lost an identity and in doing so acquired another.

My classmates and I milled around in euphoria and then we prepared to leave.

My father and brother and I went out to the Chinese restaurant afterwards. My fortune cookie said, “You will have great power over women. Use it wisely.”

The problems of time: crossing the equator, avoiding jet lag, caffeine as an ally, and not celebrating March 11.

March 12, 2011

I messed with my internal clock,

With the advice and support of my doc.

     One late night so fine

    We crossed the Date Line,

And went for an evening walk.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  On sabbatical to avoid burnout, while my non-compete clause ticks away I’m having adventures, visiting family and friends, and working in out-of-the-way places.  Just back from a six-week assignment in Barrow, Alaska, the northernmost point in the United States, we’re now in New Zealand.

I didn’t celebrate March 11 this year.

I graduated from medical school on March 11, 1979, and every year the day evokes vivid, euphoric memories, the savor of the occasion lingering with me from the time I awaken till I fall asleep.  I remember the day, and the night that followed, well.  My brother, my father (also a physician) and I went out for Chinese afterwards; my fortune cookie said, “You will have great power over women.  Use it wisely.”

But I didn’t mark the occasion this year because I crossed the International Date Line from March 10 directly to March 12.  Most of the people on the airplane remained fast asleep, but I kept looking up at my TV screen from my Droid/Kindle book.  I watched the icon of the plane cross the line on the map at a 30 degree angle, skipping March 11 without even a feeling of turbulence.

New Zealand has one time zone and two islands. Six o’clock Sunday afternoon in Sioux City happens at the same time as Monday noon in Wellington.  The summer here ends when Iowa’s spring begins; the Vernal Equinox at home corresponds with the New Zealand Autumnal Equinox. 

An eighteen hour time difference boils down to a six-hour time difference for the sake of calculating jet lag.  In the Los Angeles airport we drank Pepsi, ate chocolate, and played Scrabble so we wouldn’t fall asleep once the plane took off.  With consultation and prescription from our doctor, we took eight milligrams of Rozerem (a prescription version of melatonin) and ten milligrams of zalpeplon (a four-hour sleeping pill) eight hours before we anticipated the dawn at our destination.  Shortly prior to our early morning landing we each ingested two hundred milligrams of Provigil (a stay-awake pill for shift workers and jet laggers).

Once we’d overcome the SNAFU at Immigration and cleared Customs, we trudged two kilometers from International to Domestic terminals in Auckland.  The flight from Auckland at the north end of the North Island to Wellington at the south end of the North Island went boring well. 

We fought the natural urge to nap after we showered at the hotel.

Nor did we sleep till after we’d eaten and exercised and the sun had gone down.  By that time we’d wandered around downtown Wellington.

I didn’t have my March 11th celebration this year, and I didn’t miss it.  If all works well, I won’t be jet-lagged when I meet with the New Zealand Medical Counsel tomorrow.