"he took the midnight train...
...goin' anywhere."
Michigan Central Station.
This past week was spent on the OB/GYN's Ambulatory/Outpatient Service.
A distinctly different take and approach on the Medicine I've been exposed to up until now.
Naturally that means a different brand -- a different set of glasses to look through.
This is Life. This is Strife...and as always the chance to appreciate all the things that make us Human are Rife.
crate --
}Papanicolaou Stain ('Pap Smear')
Infamous.
Almost undoubtedly more-so for all the Women out there. (And thank you for going through so much.)
It was encouraging that almost every Patient that came through our Outpatient Clinic received a Pap Smear, if warranted, whether it was the primary reason for their visit or otherwise. By warranted I mean according to currently accepted guidelines which is generally anyone 21+ of age and every 3 years thereafter (other considerations notwithstanding).
[and with that...any of you that are 21+ and have not had one in the past 3 years I strongly urge you to schedule an appointment with your Primary Care and/or OB/GYN.]
But Why?
Only because it is up there as one of the most successful Crates within Preventive Medicine in recent history. A relatively simple and straightforward exam/procedure has led to a significant decrease in the incidence of Cervical Cancer.
Needless Procedures, Costs, Worry, Tears, and Death -- all avoided. Definition of Medicine.
There are the Crates we are looking for.
(Note: mild Star Wars reference)
"just a small town girl. living in a lonely world."
I can only imagine what the experience is like despite the Pap Smear being described as relatively "quick and easy" -- which is to say I have no idea at all what it's like and never will know. Nonetheless, I've had the privilege of conducting a number of Pap Smears under the ever-watchful eye of my Attending Physician and always tried my best to have Patient's interests and concerns at the forefront of my mind.
You are in a compromising and vulnerable position. The table might be cold or the room might be stiflingly hot (like it is now) or maybe everything is just hot/cold/cray at the same time. For a good amount of time you have no clear vision of what is going on. This is the definition of trust if there ever was one. Not to mention for those that have not had a Pap Smear in some time -- there is a possibility that the results are not favorable.
Maybe I'm blowing it out of proportion. Maybe any Female readers are rolling their eyes right about now. 'Get over it buddy', to me, 'it's no big deal at all'...and if so, then I'm glad. Either way, I refuse to be pompous enough to think I know exactly what my Patient's feel or need -- I can only offer suggestions and, hopefully someday, expert and evidence-based advice.
But, again, I have no idea and I'm sure everyone's experience is different. At least for me I'd like to err on the side of considering Pap Smear's a big deal to my patients. If it's big to you then I am reassured in continuing to do everything in my power to make the experience seamless. If it's insignificant then brush me off and I'll be just as equally happy to report on your continued good health every 3 years -- no harm done.
Win, win.
Either way this is the de facto Crate of Annual Exams, Outpatient Care, and run-of-the-mill Women's Health. A quality shipment if you ask me -- and props to the manufacturer Dr. Georgios Papanicolaou.
"some will win. some will lose.
some were born to sing the blues."
hippo --
}In the world of Google, Dr. Oz, and 'Consumer Medicine' the Physician is still a Physician....and they are still the one's to turn to when all is not well.
For the most part, I finally got a taste of what it's like within the quintessential 'Doctor's Office' -- from a medical student perspective at the very least. Imminently more predictable than Inpatient hospital services and in many ways, that much more intimate as well.
The vast majority of Patients we saw this past week were coming for their Annual Exam -- to recharge batteries of reassurance and defuse any ticking time bombs, imagined or real, that can often pervade minds and hearts.
It was a gratifying experience as a whole to see the incomparable expressions of relief and happiness when the Attending would explain the benign nature of a Bartholin Cyst or the paucity of worrisome calcifications within the Breast tissue.
So many Patient's place an immeasurable amount of trust in their Physicians. Each day I was reminded why exactly I was giving away more than a decade of my life towards this Profession and why I am incurring hundreds of thousands of dollars in debt to do so.
If First we Do No Harm...
She was not having a good day. It wasn't just a bad hair day or a coffee stain on white pants day. It was a just found out about a growing mass in the uterus day. This Patient was no damsel in distress by any means -- she knew more than I did about the course of a rapidly growing Uterine Fibroid and the wide range of options available including Ablation and Hysterectomy to name a few.
As usual and appropriate my Attending walked her through the costs and considerations associated with our findings and her options. Modern Medicine. In Modern fashion she would question and contradict and make full use of her WebMD app throughout the consultation. In discussion with the senior Resident the conclusion was made that a Hysterectomy would grant the best chance of success with the lowest risk of complications.
But those are scary...and she didn't want one...and she let us know.
What can my Attending do but suggest and suggest and fight the Patriarchal urge to heal?
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For the most part, I finally got a taste of what it's like within the quintessential 'Doctor's Office' -- from a medical student perspective at the very least. Imminently more predictable than Inpatient hospital services and in many ways, that much more intimate as well.
The vast majority of Patients we saw this past week were coming for their Annual Exam -- to recharge batteries of reassurance and defuse any ticking time bombs, imagined or real, that can often pervade minds and hearts.
It was a gratifying experience as a whole to see the incomparable expressions of relief and happiness when the Attending would explain the benign nature of a Bartholin Cyst or the paucity of worrisome calcifications within the Breast tissue.
When the Doctor says it will be 'OK' it carries so much more weight.
Heavy Hippo Weight.
So many Patient's place an immeasurable amount of trust in their Physicians. Each day I was reminded why exactly I was giving away more than a decade of my life towards this Profession and why I am incurring hundreds of thousands of dollars in debt to do so.
If First we Do No Harm...
...then I submit that Second we don't take our Role and Calling for Granted.
There have been questionable Physicians I am sure. And undoubtedly there have been, unfortunately, some (frankly) bad Physicians. Yet, the reputation of Physicians as healers and counselors endures and has been such for the past two thousand years or so. It is a heavy mantle to carry. Hippo Heavy to be exact.
-------
The days of Patriarchal Medicine are gone. In fact, we as medical students are trained and encouraged to stay away from that form of Medicine -- one that has been in place for the larger part of the past century. Physicians no longer tell you, flat out, what is best for you and no longer give out commands that must be obeyed for 'your own good'.
Modern Medicine is a partnership where the Physician and Patient enter into a mutual pact which is, for better or worse, an end product of our consumer society. It's a good thing in my opinion. Coming to a health decision as a team makes for more confident and compliant Patients. Ultimately, it reinforces further the trust and bond that Patients already inherently feel with their Physician.
But sometimes it feels good to have a Patriarch...to have something solid to lean on when we are dizzy with life's twists and our usual sound reason is nowhere to be found. More than anything this week, I realized just how unspoken and powerful a Physician's evidence-based words of Hope can be.
-------
I mean...she had an iPhone 5 -- what do you expect?
As usual and appropriate my Attending walked her through the costs and considerations associated with our findings and her options. Modern Medicine. In Modern fashion she would question and contradict and make full use of her WebMD app throughout the consultation. In discussion with the senior Resident the conclusion was made that a Hysterectomy would grant the best chance of success with the lowest risk of complications.
But those are scary...and she didn't want one...and she let us know.
What can my Attending do but suggest and suggest and fight the Patriarchal urge to heal?
"payin' anything to roll the dice.
just one more time."
She desperately wanted my Attending to express an opinion...it was blatant. She wanted him to step outside of the evidence for just a microsecond and into the zone that the Scientist in all of us tries to suppress for the sake of Objectivity. It felt like the exam room itself would burst into a tsunami of frustration-flavored tears.
-------
Patient: "I don't want a Hysterectomy, what is best for me?"
Physician: "A Hysterectomy for the treatment and removal of Uterine Fibroids has a high success rate."
Patient: "But is it best for me? What if I don't want one?"
Physician: "Based on your symptoms, your other co-morbidities,
and the Ultrasound it has the highest likelihood for a good outcome."
Patient: "But is it for me!? What do I do?"
It took everything I had to stay silent and not overstep my bounds.
Then finally...
Patient: "Doctor, if I do this then..."
Physician: "Ms. ____, all my knowledge and experience tells me that this will afford you the best outcome...and though I can not afford any guarantees this is the best available option and................
everything will be OK."
Everything will be ok.
That's all she wanted. At times, maybe that's all any of us ever really want.
Modern Medicine is a new thing, but the Art of Medicine is something that has been painstakingly honed for thousands of years. I am humbled and honored to find the Hippos exhibited by all healers, past and present.
You can't fit this Hippo in a Crate.
}}Sometimes Endings are really Beginnings. (Actually they always are).
I realize this is a gargantuan entry already, but I can not avoid the Hippo in the room -- that of my city's recent bankruptcy filing.
I love Detroit.
"Streetlight people. Living just to find Emotion."
I also couldn't help but notice the parallel with my Patient experience this week. Detroit's recent history has been frustrating -- has been full of opinions and risk assessments and uncertainty. No one has been able to Diagnose the Motor City's problems let alone find any kind of efficacious Treatment.
When I heard news of the Bankruptcy filing it seemed like the surrender of Mr. Orr and Governor Snyder. I was prematurely and immaturely defensive. I even felt a little betrayed.
There must be other options right?
What is best for Detroit? Doctor? Anyone?
But when my Attending "surrendered" and told the Patient she would be OK it helped me frame the recent actions of our politicians. There are no guarantees -- they made it clear. All things equal this is the option that may have the best outcome.
And, in the End, I firmly believe that Everything will be ok.
As far as cities go Detroit might be the sickest Patient there is but that only means it can make the greatest recovery and return to prominence over any other city in history. Hippos are tougher than you might think. Motown Hippos are even tougher. Ain't no mountain high enough.
"working hard to get my fill.
everybody wants a thrill."
"don't stop believin'"
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