This room is fabulous. I am sprawled across a king-sized fourposter bed laden with so many pillows it is several feet shorter; a CD of piano music is playing on the tiny CD player provided; through the open door beyond me is a private bath containing a two-person Jacuzzi tub. I was personally instructed on how to work the light switches and the occasionally-sticky back door lock. And I got to see all the beautiful Christmas decorations. The walls are the colour of the bedroom my Angel and I shared until our apartment was done. There is a book on the writing-desk with little notes and words of thanks from previous guests in the room. This is, O Best Beloved, the way I like to go on brief vacations. It transports one.
And this week has been one of frustration, from which I am delighted to be transported. I will tell some stories, to pass the time, perhaps...
I came in Monday and spent the day in clinic. It might have been Monday when I saw the young woman - composed, put-together, with a young daughter who seemed quite well-behaved. She was having spotting. I asked a lot of questions, and she answered them without any real discomfort. I felt her use of the word "gross" to describe her dark-brown vaginal discharge was appropriate; I think it's gross to be oozing fluid too. I asked if she had any pain with the discharge. "No," she answered me, offhandedly. "My hootie don't hurt none." I almost fell over laughing right there. This was the first interjection of slang into an otherwise rational conversation, and the particular word she used...I don't know. Does everyone but me have pet names for their genitalia?
Tuesday was my day to miss deliveries. J paged me. She paged me to ask if I wanted to get in and help with one of her women in labor. The young woman in question was 5 cm dilated at 0800 when J paged me. We planned to go over around 0930 or 1000 to meet her and let me pick up following her care. At 0920 J was paged. "Well, great," she says, giving me an amused look. "She's complete and wants to push. Shall we go see?"
The first thing out of this woman's mouth after I was introduced to her was "Dr. R is still going to deliver my baby, isn't she?" Not much to do but agree. I stood back and watched an absolutely perfect delivery - good effort, about 5-10 minutes of pushing, seven-pound boy who slid out without a single skid mark to show for it. It was beautiful. J apologised profusely. Very profusely. "I wanted to let you do the whole thing!" I understand.
"Just one delivery? That's no good." They found a patient (the only other patient on the board) in labor and called over. Nine cm, no, it's too late for her to come in.
"We have an induction Thursday." I'm interviewing Thursday. A long way away. It simply wasn't my day. But I did get to use the skin blades to do shave biopsies of an old man's back moles. I got to examine lots of people with sinusitis and I got to meet a positively charming veterinary assistant whose ex-husband had, not so long ago, kicked her in the face and broken her nose.
I met an English teacher with panic disorder who sat and talked with me for a long time. We agreed that his "two drinks" a night were more like four or five shots of Scotch, and that he would try cutting it down to two shots and see how he did. He spoke to me openly, and when my staffing physician came in he looked at him and nodded. "She'll do very well." I hope so. I very much hope so.
There are a lot of women in the Medicaid prenatal clinic, which is where I spent my morning. I gave good news (baby looks great, there's a heartbeat, see you in four weeks, let's schedule an ultrasound and find out if it's a boy or girl) and worrisome news (I can't find a heartbeat, let's schedule an ultrasound and make sure your baby's still alive). I talked about drinking more water and about prenatal screening. I waved some paperwork from a transfer patient at staff. "Why are they screening a black woman with no history of cystic fibrosis in her family for CF?" CF, mind, is largely a disease of white people. Caucasians have a 1/29 carrier rate. "To waste her money," came the dry answer. I was intimidated by this man, when I first came to clinic. Now I see he is like my father-in-law and he is not only harmless but rather funny in a dry sort of way. And he mumbles, just like my father-in-law.
The more time I spend at this program the more I wonder whether this might not be the right place for me. I don't know. I can't decide. Everywhere I look there's a great program and good opportunities.
Next year, O Best Beloved. Next year I will be a doctor. I will be able to introduce myself as Dr. Nykki or Dr. B without feeling like an imposter, though they have begun to introduce me as that already. I see the subtleties of respect in people's eyes - strangers, like the man at Auto Zone who replaced my windshield wiper blades so that I could see in the rain - when he asked why I travelled so much (I had to ask what town I was in) and I told him I was a medical student, it was there.
Is it something so very special to be a doctor? It doesn't necessarily feel like something special. It feels like the cumulative weight of centuries of tradition and learning settling uncomfortably onto shoulders shored up by two scant years of medical experience and braced with two years of book-learning I barely remember already. It feels like knowing that next June or July or August, when there is a code in the middle of the night, they will be looking to me as a man or a woman or (havens forfend) a child is trying to die in front of my face and they will expect my hands to carry the slim chance of life out to its fullest. It feels like standing in an airport in an unfamiliar city and staring, fascinated, at the AED sign above my head. I spent ten minutes in Boston staring at a sign that read "AED - for trained medical personnel use only" and thinking my God, that means me because I have a little card in my wallet that says I am ACLS certified, I can use an Automatic Electrical Defibrillator and I have not even seen one out of the bag in over a year. If someone were to fall over in the middle of the airport I have a card in my wallet that says I know what to do.
(And my Angel, bless his heart, laughed softly as I poured out my angst to him, and reminded me that when I was taking classes and knew precisely what to do [I did it, after all, on a mannequin, alone without prompting, to get my certification] I told him that a trained monkey could read the pictures and listen to the voice on the AED and operate it. I have faith that even now I am more competent than a trained monkey.)
Doctor. It carries with it images of healing and love and devotion and babies smiling for their first pictures. It carries with it words like "Malpractice" and "Credentialling" and "Hospital Privileges". It is scented with alcohol hand scrub and the tang of Betadine soap, rubbed on soft-bristled disposable brushes into the cracks of hands that crack with too much washing. It is soft as newborn swaddling and crisp and crackling like paper surgical gowns. It is blue and white - Doctor will always be blue and white to me, scrubs and the envy of long white coats - and it is the fresh, brilliant red of blood. It is the look on my high school math teacher's face when I told him that I had delivered a baby with my own two hands. It is the tongue-lashings of an attending when I failed to check a CT scan result.
When I was very young, I played Emergency Room with my Barbie dolls and a bottle of red nail polish. The accident was serious - it took most of the bottle. All the Barbie dolls survived, although their skin was dulled by the acetone employed to clean up their injuries. They all survived.
Doctor. It means that I have given my most sacred word to devote myself to the art of healing. It means that there are things we cannot cure and there are things we should not cure. It means that patients will die and that I will, sometimes, let them die when heroic measures remain that could be taken. It means that I pray every single day that I will have, as it says in that old prayer, the serenity to accept the things that are, the courage to do what must be done, and the wisdom, above all, to discern the difference.
There is not a cure for every illness. There are cancers that will eat one from the inside and devour life within weeks. There are children cast from the womb before their bodies can support the rigors of life. There are aneurysms that burst in an instant and send the mind in flight from the body. There are things that we cannot cure.
But we can always heal. There are always ways and places to heal. And O, Best Beloved, above all - that is what Doctor means.