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.