Tue, May 07, 2002 08:53AM -0600

Despite the fact that I'm still in finals season, on the verge of studying-for-the-boards season, I've been doing a lot of non-medical-textbook reading lately. Still, there is some convergence. The last few novels I've read have been infused with medical terminology and medical apocrypha--Choke and Survivor by Chuck Palahniuk, House of God by Samuel Shem. (As a side effect, I can't seem to go more than 30 minutes without my conversations degenerating into a clinical vignette.)

But I've been finding doctors more often than I'd expect in various novels and short stories. And I wonder if these authors are a good representation of the public opinion. I have yet to come across a Marcus Welby-like portrayal of a physician in any of the recent things I've read. Most of the time, the typical physician is depicted as emotionally-stunted, narrow-minded, pathologically overachieving, paternalistic, out of touch with the outside world--to sum it up, an asshole. Either they're being disgustingly judgemental or they're trying to achieve distinction in the medical hierarchy at the cost of their patients or they simply refuse to listen to other people because obviously they're more educated and should know best. The most benign caricature I've seen is of a doctor who is naieve and well-meaning but utterly ineffectual.

Now, you might think that with me entering this particular profession, I might feel a little defensive about these descriptions, and maybe deep down I'm a little dismayed. (After all, they say that on average a physician gets sued for malpractice at least once.) But on the other hand, I know my dad, and I know his own feelings about his colleagues. I've worked for a doctor briefly, too. I've read Ferdinand Louis Celine, with his sharp deprecation of his own profession. And I know my classmates. At this point in my education, it's not surprising at all.

Yesterday marked the last of the "Big 3" second-year subjects. (The Big 3 consist of Pathology, Microbiology, and Pharmacology.) As my friends in the allied health care professions chide me, I probably have not learned anything practical. Ultimately, all I really know are some buzzwords and their key associations. None of it is really going to prepare me for when I actually start taking care of patients. Ironically, the last two exams--Preventive Medicine and Introduction to Clinical Medicine--probably contain the most relevant information for clerkships, and yet somehow, they are considered lower priority than the Big 3. Then again, perhaps it is rightly so. You really can't expect to understand any of this stuff until you're really doing it. You can't understand what a boggy prostate feels like until you've actually felt one, I suppose.

And yet there are those who consider academic distinction the only point of this exercise. On one hand, it's sick, sad, and demented in a rather existentialist way. On the other hand, I still have to compete with these people and keep them from pushing my head under C level, so to speak.

Now, I could easily turn into one of these people, concerned about nothing but grades, about getting that sweet internship I want, about landing that kickass fellowship. Not to brag or anything, but I think I have what it takes to be a socially-inept, inconsiderate, self-centered cutthroat pure academician, up to a certain degree at least. (This is what we affectionately call a "gunner.") But then I end up asking myself "Why?" I think I learned long ago that the ladder to "success" is always painted with the blood of the bodies that fell from higher up, that what happens is that you'll never make it to the top, you just eventually decide that a particular rung is as high as you want to go, and if that's the case, why don't I just rest up right where I am now and just "think outside of the box" and "go orthogonal." (Like Willy Wonka's elevator that goes sideways, too.) While being a physician is a huge responsibility, to the point of being considered a vocation, to the point where this identity will follow you even when you aren't wearing your white coat, this is still not who I am. It's all about separation of spheres. In the same way that you aren't what you own, you aren't what you do, either.

So, yeah, I feel a mixture of pity and loathing for my misguided comrades. Pity, because to a certain extent, they have become nothing but biological machines. Loathing, because they can certainly make my life a living hell for a long time.

Yes, I know, this opens up the abyss a little more. If I keep thinking about this for more than five more minutes, I'll start to question why I'm even doing this.


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