Time to Move on...

I'm more or less set on going to Iowa next year, and the three following. The question is, where do I plan on going afterwards, for medical school? The University of Iowa has an excellent medical program, one of the top in the nation as a matter of fact. But there lies one problem in all of this: I don't know how long I can take it here in Iowa. I'm not from here, and while I've lived here for pretty much most of my life, I hold no loyalty to this place. In fact, ever since I came here I've been waiting to leave. Snow? Below zero temperatures? No Beach? No. This place really is not for me. Which is why I'm glad I picked the profession I did.

Wherever there are human beings, there are bound to be doctors. The job is not tied to a specific geographic location like say an oil driller or a corn planter might be. Likewise, it allows for easy permanent settlement. An established doctor in a community has arguably some of the best job security you can get. He is simply too invaluable to let go. It's such a blessing to be a doctor because of the sheer amount of options you are given at your fingertips. One of those options I would instantly pursue would be moving down somewhere south. If I was a doctor today, I would probably head somewhere like Atlanta or southern Florida. I'm a big city type, and it's no big secret that that region is a hot spot for retirees. Or, in other words, an area with an ENORMOUS demand for doctors. But before I think about where I want to settle once I am a doctor, there is still the big question of medical school. There are very fine programs across the United States, and I certainly would not like to tie myself strictly to Iowa.

There are some really nice medical programs on both of the coasts, including Stanford on the west and Boston College in New England. Hell, even a college in Chicago or something. All of those places would be really nice to attend, and surely a change from Cedar Rapids or Iowa City. Maybe, sometime really down the road, if everything plays out like it should, I’ll come back and do something nice for the community, because of course I can not forget about the place that aided me in becoming an actual doctor.

Man vs. Machine

In economics, structural unemployment is defined as the unemployment that occurs when there is an imbalance between skilled workers seeking employment and the labor market. Or in other words, when their skills are no longer needed. This happens all the time, throughout human history. Take for example, telephone operators like the ones you see in the movies way back in the day. With the invention of wireless and cellular telephones, those individuals became structurally unemployed. With the alarmingly quick increase in technological advancements it's no big secret that there are some positions that are being passed on from human to machine.

No variety of work is exempt from this truth. Air Force pilot? Unmanned aircrafts. Ford assembly line worker? Robot arms. Doctor? Who knows? And that's what I want to find out. Are those who work in the medical field facing competition, albeit how slight it may be, from machinery? Will there come a time that a collection of metal parts wired to a circuit board are able to do the same task that someone who spent more than half the life they've lived learning how to do? Most would argue against that. They'll say that nothing can beat the sheer instinct and gut that a real human being has. That no matter how advanced healthcare might get, it can not ever function without a certified, old school DOCTOR there on the scene making sure it all works.

Some people however, might be strong advocates of this. Surely it would bring the costs associated with healthcare down, considering the lack of doctor requiring a six or seven figure salary. And a programmed robot just doesn't mess up... a doctor who has been operating on patients for thirty years and can slice open someone with his eyes closed is still human, and might cause accidental injury. If a machine breaks, you take it out back and throw it into the dumpster, but an old man is going to ask for a pension. I don't doubt that there are very nice perks associated with using machinery instead of human beings to do some tasks. Especially the dangerous, meticulous tasks that medical professionals are asked to do.

But could they really find a machine that can sit down with a family and explain to them that their father has only a few weeks left? Could they create an inanimate object capable of sitting down with a patient and discussing how their day went, and how they've been feeling over the past few months? Of course not. Like no other profession I think, doctors are sometimes almost required to have a human side. You're dealing with sick people and their families. I sure as hell would not be interested in taking my sick grandparent to a humanless operating table. In a field that is very sensitive to human feelings, I think it's just overall a bad idea to install a cold piece of metal to take the place of the doctor that people trust with their lives.

Types of Doctors

I haven't thought much about what I want to specialize in after Medical School, throughout this post I will explore a few paths that at least sound reasonable to me. I know though, that I don't want to pursue any type of surgery, I'd rather stick to something less patient oriented. I think the coolest part about medicine is its sheer complexity and vastness. If you look at say a football team, lots of people have no realization of how many people are actually on the staff; they assume its merely the players, and at most a few coaches. When in fact most NFL team rosters are upwards of 60 people: players, head coaches, position coaches, managers... you get the point. Or a better example might be the crew involved in making a movie, those dozens and dozens of names scrolling through the credits all had something to do with creating the final product, even though they don't see as much glamor and are generally hidden from public view. Similar is the case of hospitals and all of the personnel they employ.

Ideally, I would like to have a career that both incorporates my medical knowledge and skills, as well as any other skills I have and like to use, such as working with technology. I looked around for a bit and discovered this. Radiology seemed like a pretty appropriate field, although they are physicians, they primarily deal with technology in various ways: CT scans, x- rays, MRIs, etc. A little farther down in the article, clearly stated was that 13 years of post high school education and training and required in order to get a shot at becoming a successful radiologist... meaning I'll be 31 before I officially start working........ That's kindergarten through senior year all over again. So I don't know, I'll keep looking around maybe I'll find something a little more reasonable than this.

A Day in the Life of Dr. A, vs. a day in My Life

Becoming a doctor is no easy task... everyone knows that. But for most, it stops there. They never bother to think about what it's like after they become one. This could be for many reasons, but perhaps the most important one is that they are never around any one in the field, making the whole thing seem very alien to them. Personally, I know a handful of doctors, friends, parents of friends, etc. and recently I've been getting curious about how they live their day to day life. The daily life of a high schooler and that of a medial professional are quite different.

So I made a quick comparison of both of our days, starting from when we first get up in the morning. Dr. A wakes up promptly at 5 AM, every single day, no matter what. As for me, I usually get up sometime around 8 or so, considering I don't have to be anywhere until 9. He's in the hospital by 6 AM, where he is promptly greeted by a series of appointments, checkups, trips between the two hospitals here in Cedar Rapids as well as the private clinic he works for. Enjoying a lunch break is a rarity for him he says; sometimes he's holed up inside the hospital for so long he couldn't tell you the time of day it is outside. Me on the other hand, I'm at school from around 9 until 3, with one of those hours strictly devoted to lifting weights in the gym, not exactly a class per Se... I also partake in a lunch break every day, no matter what. He may get home as early as 6 in the afternoon, but there really is no telling how late his work might keep him.

One weekend out of every month, he is on call. This means that anytime during the day or night that weekend, he can be called into work. His beeper can go off during dinner, the Super Bowl, or at 3 AM in mid December; it doesn't matter, if it goes off, he has to race to work. Sometimes he says, it might go off 5 minutes after he gets home from an 8 hour hospital session he just finished. I work one day on the weekends, and I'll be damned if I ever answer the phone if I see a call from anyone related to work trying to get a hold of me. If I wasn't scheduled to work that day, it's close to impossible to get me to come in.

All that is fine though, during the summer I was working two jobs everyday, usually up to 16 hours a day, about 4 days a week. So I know I'm capable of those long hours into the night, the real question here though is: am I prepared to do that for the rest of my life? I would like to continue on with my hobbies once I grow older as well, and I think that becoming a doctor might get in the way of that. Once Dr. A gets home, he's done for the day. No real hobbies or anything like that, just from work to bed, everyday. And by far, the biggest thing I'm not liking here is the whole being "on call" thing. I wouldn't be able to do anything, because at any given time, I know I might get called into work. I'd be like the guy in class without his homework done afraid that the teacher might call on him to explain something from the assignment.

.45%

I just finished Better: A Surgeon's Notes on Performance the other day, and I can easily say it is one of the best books I have ever read. All three sections of the book were masterful; every chapter had a catch to it that made it seem better than any other one before it. What I found to be my favorite part about this book was how Dr. Gawande could take something that seemed so irrelevant and meaningless to any higher purpose and show you just how vital it was. Every anecdote he mentioned took the points he was trying to make and turned them into very real life situations that anyone in the medical field will have to deal with, no matter what you think.

There were times in this book, especially near the end, where it felt like he was talking to me specifically.

For instance, one of the chapters found in the third section, the ingenuity one, was discussing the lethal disease Cystic Fibrosis and how America is dealing with it. Cystic Fibrosis is something that you are born with, and because of the genetics, you can never know if you will get it. It's what's called a recessive gene, which means that the only way you could inherit it is if both of your parents had it and they passed it on to you. This makes it very much more complicated because then most people never find out until the disease has matured in the body. One of the strongest symptoms of it is the accumulation of mucous inside of the lungs, making it increasingly hard to breathe. Until eventually, it kills you. People who find themselves inflicted with this also find themselves in a daily struggle against it. They must endure, at least twice a day, physical pain as someone bangs on their chest and various points across their body trying to force the mucous out of their mouths. Regular doctor appointments, something that would already annoy most people, are something they also have to participate in for the rest of their lives. Along with various medications, etc.

The average lifespan of someone born with CF was about thirty some years. Recently however, this number has gone up because of the aggressive new treatment methods that have spread across the United States. Which is where I go back to what I was saying earlier about Dr. Gawande talking to me. In one clinic where CF is treated, Gawande interviewed on of the doctors, he'd been there for decades, and in the last ten years, not a single victim of CF has died. The oldest patient they had at the time was over sixty years of age. What was his trick, was what Gawande was curious about. The doctor explained how the well being of a patient could be analysed by seeing the percent at which their lungs functioned: 80, 100, 110 (if the person's lung was functioning better than that of someone without CF). In one instance, there was a patient who's lungs were at 99.5%. That didn't cut it for this man, and he continued vigorously treating this patient until lung functionality was 99.95%. 99.5%...99.95%... if I were in his shoes, you better bet that I would have stopped at the former number, and been very proud of myself. But in fact, in order to be successful in medicine, a doctor always has to try until there is absolutely nothing more he can do.

When it comes down to those fractions of percents, .45%, when it comes down to staying up until the wee hours of the morning to deal with a patient, or working double time over the weekends, that is the difference it takes to be a good doctor.

Some People Would Call This Beautiful...

Here is a short video I found on YouTube of a woman delivering her child through a Caesarean Section. I have never seen something like this before and was actually quite surprised to find soemthing this gorey on YouTube. Everyone sitting around me just flipped out after seeing this video, but personally I can't see why people are so scared of it. I wouldn't go as far as other people and call it "beautiful" or anything like that, but it's definelty interesting how medicine has progressed thus far. I just read a chapter in Better where Dr. Gawande just talked about this very same thing.

In order for something like this to go smoothly, without any fatal accidents, so much has to go right. Gawande discussed some stories where women were in labor for absurd amounts of time, like 39 hours and crazy things like that. C Section births are almost always used as a last resort, because of the fact that its a full blown surgery where the doctor literally cuts the woman's abdomen open, and usually because women are just too scared to do it.

Like nothing else in human history, human birth has existed ever since the dawn of time obviously, and those in charge of seeing it through have always been pressured to make it work better. Child and maternal fatalities at one point were a common thing, most women would die because of infections, being in labor for too long, etc. And lots of infants would die from injuries they recieved during the labor process itself. In the medical community one was regarded as sort of a savior if he or she was to discover a new technique or invent some sort of contraption that would aid in the process, such as "forceps", or basically tongs used to pull the kid out if it's somehow wedged inside the mother and can't get out.

By far though, the Cesarean section is one of the strangest operations I have seen.

A Couple Things to Think About...

You can not turn on the television and flip to any news channel without at least seeing something related to the current healthcare system of the United States. It is the single most discussed issue in politics right now... and with President Obama's recent signing of the Bill into law, everyone from Bill O to high school teachers feel their obligation to tell everyone exactly what they think about it. And until now, I have not seen a professional in the field of medicine discuss their feelings about it. I've had light conversations with doctors before, and the handful that I spoke to were all in complete favor of "universal healthcare." I have a few questions of my own though... what exactly does this healthcare bill mean for this field of work today, and down the road; how will salaries be affected, if they are? What exactly do doctors think they owe the public, if anything at all? Is there a line to be drawn between politics and medicine, and who decides?

The first place I decided to look for answers was in my book, Better. Of course, Dr. Gawande had much light to shed on a couple of these questions, under his "doing right" virtue. He himself briefly mentioned his stance on the issue, with the generic "universal healthcare for all" response, note however, that this book was published sometime in 2007, quite before the current debates. Regardless, he had a chapter, "What Doctors Owe," where he discussed the issue of malpractice lawsuits. He heavily explored the touchy subject of whether or not doctors actually owe anything to society. He spoke with a few other men in the field, who told him that a doctor was simply "a business man, nothing more, nothing less." That he was comparable to an accountant, or an electrician. He provided service in exchange for pay. The idea that doctors are burdened with some sort of extra, moral obligation to society sounded outlandish to this man.

In a time where some medical procedures cost upwards of tens of thousands of dollars, has doctoring been reduced to a business transaction, devoid of any humanity? Why does it cost so much? Is this simply those in charge jacking up the price tag simply because they can? Frequently, I mention the importance I place on the money I will make in the future. From the looks of it, I seem similar to the doctor Gawande interviewed, careless about the human side of the work, and I do not want to be that way. I made my decision to enter this field originally simply because I wanted to help society in anyway I could, if I was solely chasing the money, I guarantee you there are ways that I could earn bigger paychecks, but I do not want to pursue in those routes.

So, assuming this bill lasts into the future (this is a pretty big assumption considering the intense opposition) and serious restructuring of this sector of the economy is undertaken, what does this mean for doctors in particular? I've heard almost two, almost polar opposite, answers to this question, dependent on the political view of the answerer. I've heard that this may increase the number of people insured, which in turn would increase the demand for doctors. I've also heard that the new insurance policies are going to drastically reduce physicians' salaries because they directly benefit from high insurance costs... I can't really tell you who I believe. If the latter is the case, I will find myself having to choose between money and the other reasons I choose to pursue medicine.

Just a couple things to think about...

Road to Riches

Automatically one of the first things anyone pairs with becoming a doctor is the grueling process of med school that comes before it, and all of what that entails. While the average four year college student could land himself a career as early as around age 22 or 23, a doctor may not until around age 30... This is because of all the preparation required before one is to operate on people and attempt to rid of them of disease and wounds.

The first step, after high school, is attending a four year college and picking a field to pursue as a Major. Now, this could be anything. Anything from subjects like Biology and Chemistry, all the way to something like World Religions or Studio Art. So long as he or she takes the MCAT (Medical College Administration Test), and takes it's prerequisite courses, a package usually called "pre-med." Taken from About.com, here is a general list of the courses needed for Pre-med.

• 2 years of biology
• 1 year of physics
• 1 year of English
• 2 years of chemistry
• 1 year of calculus

Of course, depending on other variables (AP coursework, major, etc) some of these courses could be crossed off the list or at least not require the amount of time currently listed.

So, after those four years, completing my Major coursework, passing the MCAT, the next step is Medical School itself. Again, this is almost always a four year program, this is where a student begins taking more field-specific coursework. Different courses include: neurology, radiology, biochemistry, pathology, etc. Medical school is also designed to give med students their first experience in a hospital environment.

After completing those four years, one has earned him or herself the title Doctor of Medicine, or M.D. At this point, they are what's usually called a general pediatrician. If say you want to specialize into a particular type of doctor (cardiologist, anesthesiologist, etc), you enter into a period of residency, or supervised medical training. This can last anywhere from one year to seven. From what I've read, this is the most grueling part of the entire thing. It is not uncommon for medical residents to work eighty hour work weeks making just above minimum wage... there have been recorded instances of straight 30 hour shifts, and things of that nature. Upon completion of residency, the student is hired into a hospital and is now officially a doctor as we know it.

Diligence: The "Mop Up" of Polio

The next installment in the diligence virtue of this book is a story about the efforts of the World Health Organization (WHO) to eradicate the nasty and virulent disease Polio off the face of the earth. Polio is a highly infectious disease that primarily attacks children under the age of five- about eighty percent of all cases are in this category. It's symptoms are mild at first, lulling victims into thinking they've merely attracted a flu or something of that variety. Then the major symptoms kick in: total paralysis of the limbs and abdominal muscles. In some severe cases the pathogen will target the part of the brain that controls fundamental tasks such as breathing and consuming food. There is a vaccine for this... but the issue here is actually getting the vaccines to the families that need it.

Dr. Gawande retells his experience in India, following Dr. Pankaj as he oversees a massive undertaking: providing immunization to around 4.2 million children in a particular region in India. The amount of preparation required in order for something like this to not be a complete failure is massive, the WHO found success with this endeavor in the Americas... but in the much less modernized and informed parts of India, it's much harder. More than half of the men in some areas are illiterate, as well as more than 3/4s of all women. Between keeping the vaccines fresh and usable in the blistering heat of the desert, the team faced a lot of difficulty getting some of parents to comply. They weren't convinced of what these men were really trying to do, especially considering a lot of children hadn't yet even come into contact with Polio, so the parents saw no need.

Gawande takes great time to explain the inefficiencies of the bureaucratic setup of the WHO. When he and Dr. Pankaj stopped to meet with a doctor that had been stationed to oversee the nearby operations of around 34 thousand children, they found out he was understaffed, lacking enough medicine to go around, and did not have the means of getting the vaccine to everyone in the particular region. He repeatedly mentions past times when people tried to eradicate disease off the face of planet (malaria, hookworms, etc) and failed miserably.

Diligence is necessary in situations like this he argues, when you're trying to get a handful of doctors to cure an entire country of a disease that plagues tens of millions of small children. This is merely a magnified view of what happens inside the hospital on a daily basis.

Diligence: The Importance of Washing Hands

I am merely through the introduction of this book, and I have amassed a vast new wealth of knowledge about the field of medicine. Atul Gawande, the author of this book, focuses on a few main virtues that anyone thinking about being a doctor needs to have: diligence, "doing right", and ingenuity. He looks at each one separately and gives stories of when these each of these was needed.

The first of these stories is simply on the issue of washing hands. Of course, it is necessary for anyone coming into contact with humans to wash their hands... but as Dr. Gawande points out in this twenty page chapter, it's not so simple. He cites alarming statistics of how many people die each year due to negligence from doctors and nurses in the operating room. And even after hearing these numbers, medical personnel are still very uncommitted to the simple, yet crucial act. His hospital has been adorned with laminated signs posting the threats of infectious, contagious bacteria found on peoples' hands, as well as medical instruments. Sinks have been installed in every corner, along with sanitary glove dispensers, gowns, etc. But even with all of these drastic measures, diligence is not being exhibited by doctors and nurses enough to drive down the number of infection-caused deaths in hospitals across America.

Many organizations have launched multi million dollar foundations to try and spread awareness of the importance of washing hands in hospitals... but Gawande is skeptical at best, or maybe it's just exasperation I think. He mentions the story of an ancient doctor living in Vienna, who tried to figure out why exactly newborns who were born at the hospital were around twenty percent more likely to die because of infections as opposed to the one percent chance of dying if they were born at home. The only variable in this situation were the doctors, whom he deemed the culprits. He began preaching the importance of sterilization and hand washing but was faced with offended doctors and a team of nurses revolting against his new ideals. He was quickly labeled as a lunatic and dismissed from the hospital. Gawande thinks this guy was on the right track... maybe it does take someone insanely obsessed with this issue to get people to follow it.

The Book I Chose

The House of God is the book I'm going to be basing this blog off of mostly from now on. This book follows a handful of medical student interns during their journey through the self proclaimed "Best Medical School" abbreviated BMS throughout the rest of the book. This book takes place in the 1970s, so at times it might seem a little dated.

A lot of times this book strays quite far away from the main plot and follows the main character's life outside of the med school. In these scenes, it is not uncommon to find yourself reading detailed descriptions of his adulterous relationships with fellow interns, or his experimentation with various substances. I don't know if this is trying to say that this is really what med school does to you, or what exactly... I'm not far enough into the book to figure out exactly how all of this ties in together.

UPDATE: As of sometime over Spring Break, I am no longer reading The House of God for this assignment, I have switched to a different title altogether. The appropriately titled new book, Better, seems like it will in fact be better. In almost every way. This book is nonfiction as opposed to the former's lack thereof. This book was designed with the new medical student as the primary audience... the surgeon general who wrote this book is trying to give inside information on the workings of a hospital and how exactly being a doctor will affect your life. Discussing these two titles with someone who had read them both, I was strongly urged to run away from The House of God before it was too late and being reading Better: A Surgeon's Notes on Performance.

Why I Chose this Profession

When in elementary school I would get asked what I wanted to be when I grew up, I was never one of those kids that immediately shouted "fireman" or "cop" or anything like that. My decision to become a doctor came about not because I saw anything particularly "cool in them, but only because I felt like if I could become one, than I was obligated to. In short, I felt like I needed to enter a profession in which I was doing something for people that would save their lives or somehow help them.

With this criteria, there were a handful of job opportunities out there. But I started to look heavily into the medical field, because it fascinated me the most. The way the doctors ran around the hospital in their white coats, working into late hours of the night, always busy with something or other, gave them this profound sense of prestige. It seems far from a job that was anything close to monotonous or boring. At the time I didn't particularly care, but they made BANK too, something that as I grew older, I would value more and more.

So when I started high school, I figured it would be an ideal time to start messing around with some classes that could be similar to what I would see later on if I followed through with medical school. I found myself doing exceptionally well in these courses, and it seemed as if all the roads were in fact leading to Rome. I saw very little input from people around me either opposing or supporting this decision, it was mostly made on my own from what I've seen.

Hopefully after finishing the book I am currently reading for this new project, I will have a much better understanding of the medical field, from the point of view of a student, which is quite a rarity. All of the doctors I'd spoken with until now have been in their late forties or something like that, and told me it was preposterous to consider any other profession. They didn't give me an answer I wanted, they were comparable to grizzled, Vietnam War generals who saw the world differently than everyone else; they had become so engrossed in their work, it had become synonymous with their everyday life. I need someone who can still relate to me somehow, and give me some insight on what it takes to become a doctor, and what it's like after becoming one.