Practicing Medicine

My father, who was a physician, a specialist in pulmonary medicine with a long career, used to always remind any who listened that “There’s a reason they call it practicing medicine”. Well, I can certainly understand that reason, since I’ve seen a few practitioners, some good, some maybe not so much.

The first one, of course, was my Dad, part of that “greatest generation”, an individual who rose from a working-class background (his mother had been a nurse; his father was an engineer on steam-engine trains hauling coal over mountains) to finish medical school just in time to be drafted into the Army, soon to be sent over to Europe; he landed on Normandy Beach the day after D-Day and went about practicing wartime medicine. 

Having survived all that, when he returned Stateside to his young bride, a former switchboard operator and stenographer, and an infant me, whom he sired before shipping overseas, he signed on with the Veterans Administration (VA) and, over time, rose through the ranks. He resisted becoming the general hospital administrator until shortly before retiring (knowing it would boost his pension later) because he wanted to always maintain patient contact, to be practicing medicine.

As far as I knew, he was a decent practitioner; all I normally saw of him was in the off-hours, which were mostly evenings and weekends. He spent a lot of time, many evenings, consulting medical books and reading the latest journals. He used to say it was how he kept current on how it’s done, but he always then emphasized that any techniques had to be practiced to be perfected, and he thought that is what doctors, particularly surgeons, should keep on doing.

The next doctor I remember was our family doctor, an elegantly dressed gentleman with a white brush mustache and a courtly manner. He employed a matronly nurse, one who always wore a starched white uniform and held me close while the doctor gave me the usual childhood vaccinations. He even made house calls if I was sick; fortunately, I rarely was so as a child; all I really remember of him and his practice was his quiet manner and his matronly nurse.

As I grew older, I basically only went to a doctor when something was the matter, a bad cold or an injury. Handball led me to most of those, since knees are not really designed for lateral motion, and ice packs and Ace bandages only mask the symptoms of deeper injuries. Finally, when I had abused one knee enough that it needed extensive repair (and this was before outpatient microsurgery), I got to know a doctor (I’ve now forgotten his name) who went in and rebuilt it, pretty much from the bone up; the result has developed arthritis (as he predicted), but has held up pretty well for over forty years, so I guess he knew what he was doing.

He was a tall, burly guy; I saw him once or twice before he carved me up, dressed first in a suit, a dress shirt with no tie, and slacks, then scrubs before the big event, and finally casual wear during post-op checkups a couple of times afterward; all I know about him later was that he went on to be the chief orthopedic surgeon at a fairly prestigious Midwestern hospital, so I am choosing to assume from that ascent that he knew what he was doing when he practiced his thing on me.

As I’ve gotten older and contracted more of the usual abuses life throws at all of us, I’ve had to get to know a few more of these people. There’s my Primary Care Physician (PCP) through a Health Maintenance Organization (HMO; the acronyms required in dealing with all this become a language in itself, one I sometimes understand, although I don’t speak it very well). He’s maybe a decade younger than me, has a somewhat sardonic attitude about life similar to mine, and wears nice ties designed by Jerry Garcia. He’s also a computer nerd, involved with the HMO’s internal Internet system and website design, so he’s not practicing medicine much these days, except virtually (his reality stand-in is a Physician’s Assistant, or PA), but he’s my gateway to other specialists there.

One of them is my rheumatologist, who isn’t technically a doctor at all, but a Nurse Practitioner (NP); she’s the one who seems to stay most on top of things (those things being my health and well-being), so I’ve come to trust her the most of all these practitioners I’ve encountered so far. She’s a ferret for information through tests and X-rays, my squawk box parrot of communication to any other practitioners involved, and a bulldog about seeing I get the healthcare help I need. She’s the one who pushes my PCP to stay on his toes, to send me to other necessary specialists.

These specialists now include several people, all of whom want to examine my innards, my heart and lungs and arteries, yada yada. So now there’s forming a new bunch of cardiologists, vascular surgeons, anesthesiologists, and other practitioners, probably sitting in the gallery of a potential operating theater set to run the standing room only (SRO) production of Carving on Me. Right. I suppose I’ve watched too many episodes of Gray’s Anatomy.

Sigh. I’ve already been through a “battery” of tests (another urban guerilla gang of acronyms). I’ve had just about every test that begins with the letter E and ends with a G, except EGG, and that one I’d have to cook for myself. And the test batteries aren’t expired yet; I still have to go through several more. They involve IVs and Day-Glo highlighter, and they come with hefty copays. It’s the beginning of going down that medical rabbit hole, the one called “circling the drain.”

There’s a polysyllabic name rooted in Latin, a language nobody except doctors speaks any more, for whatever I’ve got, but, back in my Grandpa’s day, it was called “hardening of the arteries”. 

My paternal grandfather is (or was) my namesake, right down to the middle name. He was the steam-engine engineer who retired, sat in a sturdy wooden rocking chair by his dining room window, and rocked, much like he had done while sitting in the padded metal seat of his locomotive; in the last few years of his life, the hardening in his arteries made him forgetful, and, when we visited him, he would ask me the same five questions frequently in the course of a single afternoon. “How’s school going, Tommy?” He died when I was ten years old and he was seventy-five.

That’s the bad news. The good news is that I’ve already outlived him. Maybe it’s because all the intervening activity by so many practitioners means that now medicine has advanced, maybe the practitioners have gotten better at what they can do, and maybe the hospitals are better now than they were then. Yeah, right.

So now it’s reached the point where I’m going to have to go to the local one, and have my neck sliced open on one side (I asked for a two-fer, but they won’t do that) so the head surgeon can (please) gently slit one of the arteries to my brain and scrape a good chunk of the accumulating plaque out of it, hoping all the while that he doesn’t break off a piece that shoots into my brain and kills me. Jeez. No pressure, on him or me. But without the surgery there’s a good chance I could keel over in mid-sentence as I’m typing this.

At least the place where the surgery will be done seems to be a decent hospital. It’s that place downtown (names are being withheld to protect me, the truly innocent here), a giant ring around a four-story atrium, one filled with rock ledges and a waterfall, a music platform built on a ledge, and lots of wide hallways and open acoustics. In better days, a friend and I used to play guitar together on that ledge. The natural delay was wonderful. Would that I could invoke it now to delay this surgery, but I doubt that’s the case.

Have I mentioned that the plaque needs to be scraped away during our current plague? The hospitals are once again getting overcrowded with the local citizenry who insist on trying to get back to something approaching the normal of a year ago, so that’s just about everybody (including me). In addition, there’s currently a nurses’ strike at the hospital (the issue: overwhelming patient loads), so there’s a good chance now that my surgical team attendants could be partially made up of itinerant nurses, medical gypsies willing to travel for work and who don’t really care about a picket line or maybe a patient. In some circles they are called “scabs”: a wonderfully appropriate medical term (the cover over an injury) adopted to strikebreaking personnel.

In addition, there are complications. Because I have rheumatoid arthritis, my NP specialist says that, if it has crept into the sections of my spine up in my neck, when the anesthesiologist tilts my head to insert a breathing tube, the movement could kill me instantly. (One of the reasons I trust her is because she is as morbid and careful as me.) She subjected me to some X-rays, and called to tell me that I look good (medically speaking, anyway), but she is going to send a note to the head surgeon, just to cover that base and probably her ass. I hope all the gypsies get the memo.

It’s not that I hate hospitals, although, like anyone, I hate the thought of being a patient in one. After all, hospitals are where you go to get sick and die, sometimes in that order. And I also know some of how I feel is due to having been associated with a couple of those facilities. Unfortunately, because of those associations, I’ve seen how they really work.

The first hospital I got to know much about was the VA complex, several yellow-brick buildings connected by covered access tunnels that could serve as fallout shelters, should the mushroom-cloud need arise; this is where my Dad worked for all my life while I was at home. Once in a while I saw him there (but never while he was going about his professional practitioner duties), but for the most part I came to the complex as part of a motley crew of teenage do-good volunteers who played wheelchair basketball with a group of paraplegics, war veterans who had suffered paralyzations and/or amputations as part of their sacrifice to our country’s various military involvements in successive international affairs. Along the way, I got a good look at how the medical staff, especially the inevitably lower-class and lower-paid underlings, protected, neglected, misused or abused the resident patients. It wasn’t always a pretty sight.

Then it was eventually off to my own active duty, drafted and assigned through no volition or ambition of my own into a military hospital unit, a pretty big deal in the Mekong River delta of Vietnam, part of my country’s military-industrial complex’s effort to “win the hearts and minds of the people”, people we were allegedly helping to determine their own political future while simultaneously protecting and destroying their rice paddies and rubber plantations, helping by engaging their “enemy”, often their own local neighbors, butchering and maiming them and such other citizenry as might fall victim to being the collateral damage of our efforts. It was complicated, and I worked in sort of an upgraded M*A*S*H unit, one without the comedy. I may have been only a medic, but I saw a lot, and I saw how things work.

For my part, I worked nights (I volunteered to do so because that was when most of the action outside that I wished to avoid occurred), and I was happy the wards I was assigned to were made of steel Quonset-hut style bunkers atop thick concrete foundations designed to withstand mortar attacks. Here I got to practice doing things I didn’t like to do, but it was better than being outside, doing other things I disliked doing even more.

Because the members of my unit had been together for a while and shipped over to ‘Nam together, we knew each other pretty well; we each knew who among us was a decent practitioner of whatever specialty we performed, and who had their practice affected by being uncaring and/or barely competent to begin with, and/or who was drunk or stoned most of the time. We each did the alleged best we could, but obviously some of us were better at that than others. 

And to use a pidgin phrase from the time, over there then and over here now might be the “same-same”.

Later, discharged from my military obligation and returned to ordinary citizenhood, I became familiar with hospital routine once again when I needed to enter one to have my knee rebuilt, due to my own repetitive abuse of it. I spent a couple of weeks there while convalescing from the reconstruction, and I witnessed the same sort of competency or lack thereof exhibited by the various staff members in attendance. Once again, I was made aware of how each individual’s ability is affected by their own attitudes and habits. And while it’s nice to know how things work, it’s not always a good idea to know why they do or don’t, as the case may be.

The hospital where I’ll have all this vascular surgery done is allegedly the same one where I had my knee surgery done about forty years ago, but it’s now in a different physical location, that four-story atrium, and I’m sure the current cast of characters there now is completely different from those in attendance all those years ago. Yet I’m also sure much of how any medical service delivered by them is dependent on the same human traits and foibles - competence, practice, attentiveness, and attitude - they’ve always been dependent upon.

I’ve only just met the surgeon who will handle all this, a slim young man of probably Italian descent about my daughter’s age. Of course I’ve read the professional summary sheet about his medical training, pedigree, and surgical philosophy, but I don’t yet “know” him. I think I need to ask him to tell me something about himself as a human being, his “story”, so I can begin to make some judgments about him and how he might go about practicing medicine.

Then again, maybe I really don’t want to know. Maybe I’m better off not knowing. After all, ignorance is supposed to be bliss. Since this is going to involve slicing open my neck and slitting my throat, naturally I’m a bit scared about all this, and I can use all the bliss I can get these days.

All I really need to know is that the people involved know what they are doing, and they have practiced doing it for a while before they get around to doing it on me. I need to know that they are confident about their abilities, competent when it comes to performing them, that they have been practicing the techniques required for what they are asked to do, that they are attentive to what they are doing, and that they have a conscientious attitude toward doing those things.

I just need to know that their practice won’t send me into the eternal bliss that could come through malpractice.