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an online version of the magazine Spring/Summer 2005
Learning Curve

Onward-Fatigue And All

Dan Munoz
By Dan Munoz, '04

This column wasn't supposed to happen. After two years of writing about the memorable moments in medical school, I felt ready to close the laptop. With residency getting under way in July, this was a natural stopping point, and perhaps a necessary one. How motivated would I be to sit in front of a computer screen as a sleep-deprived resident on the Osler Medical Service, writing about how much I'd rather be sleeping than producing a column? I thought I had a clear answer to that question. I thought I was done.

Then I got thrown a curveball. An event in my family, with an outcome both successful and infuriating, changed my thinking.

I could hear the worry in my aunt's voice. After a week of belly pain, my uncle reluctantly saw his internist, mostly I think to pacify his overworried wife. The news, however, was not good. He had what's called an incarcerated hernia, which essentially meant that a piece of his intestine was wedged into a weak spot in his abdominal wall. That piece of bowel was now trapped. And it wasn't coming out on its own.

So when my uncle went to his doctor on Friday, a surgeon was immediately called. Had blood supply to that piece of bowel been compromised, it would have represented a surgical emergency and my uncle would have gone to the operating room that very same day. But since he was stable, not appearing sick, with a fairly benign physical exam, the surgeon, Dr. L, elected to admit him to the hospital that night and operate the next day.

As most general surgeons will tell you, repairing a hernia non-emergently is a fairly routine and very common surgical procedure. But for a couple in their 50s with no kids and an instinctive fear of illness and distaste for doctors (except for our nephew, they always assured me), there is absolutely nothing routine about it. Just mention the word surgery and everything else is in one ear and out the other. They were petrified.

So when Dr. L came by my uncle's hospital room on Friday night, my aunt had just one question. Would he mind quickly calling her nephew, also a doctor, on her cell phone? Would he mind giving me a quick explanation of the plan, so that I could then answer all of my aunt and uncle's questions?

Dr. L's response shocked her. “That's ridiculous. I'm not calling your nephew. If he's a doctor, he should know what I'm going to be doing tomorrow. I don't have time for this.” So now, add confusion and hurt to the fear that my aunt and uncle arrived with. And she was too worried and anxious to be angry.

I took care of being angry. I could not believe my aunt when she called that night and recounted what happened. It literally would have taken 60 seconds. Sixty seconds for Dr. L to call and tell me the plan. I then could have patiently waded through the sea of questions that my aunt and uncle had, all intended to actually respect Dr. L's time. Instead he dismissed my aunt, insulted me, and unsettled his patient on the night before surgery. I must give him some credit though. He did those three things with remarkable efficiency and an economy of words that would make any English teacher proud.

In some ways, it's the small things that separate competent doctors from great ones. It's in the small acts of heroism that provide comfort to families worried about their loved ones. Thousands of other surgeons could have performed the ultimately successful hernia operation that my uncle underwent. A thoughtful one would have taken the 60 seconds to reassure an anxious patient and a worried loved one.

Dr. Hari Nathan, a friend of mine from medical school, is now a Hopkins surgical intern who probably logs double the hours in a given week that Dr L does. Nevertheless, Hari returned a page of mine from his home on that Saturday morning, ready to answer my questions about the procedure and my aunt's as well. Hari has never met my uncle. And he could have ignored his pager on a rare day off. But he didn't.

We need fewer Dr. L's and more Dr. Nathans. And it doesn't require substantially more effort or more time. It just requires thought. And it requires an elementary ability to empathize.

So why, based on this story, have I decided to keep writing? In a way, this column is a way to reflect on the good and the bad. It's a way for me (and for anyone else out there besides my parents who are reading these words) to think about the things we do right as doctors and the things that we can do better. As a resident, I'm sure I'll look back at situations that I might have handled better, as well as look at colleagues whose styles I might want to emulate or perhaps reject. Putting those thoughts on paper will be a way to step back, however temporarily, from long hours, sleepless nights and the challenge of squeezing laundry, a haircut, grocery shopping and maybe even a nap into that rare day off.

So the learning continues, even though for the first time in my life I'll get a regular paycheck every two weeks. And as long as I keep learning, I want to keep writing.

Even if I occasionally wake up with my head on the keyboard.

 Change of Heart
 Irrepressible Dr. De
 The Heat Is On
 Circling the Dome
 Medical Rounds
 Annals of Hopkins
 Learning Curve
Johns Hopkins Medicine

© The Johns Hopkins University 2005