by Atul Kumar
“Are you in medicine also?”
“Oh, heavens no. I completed my Ph.D. when Peter here was doing his residency in urology, what … some 38 years ago? We married and I got pregnant shortly after I defended my thesis, and I have been a stay at home wife ever since, raising our three kids.”
“One of the most educated moms to have never worked, huh?”
She laughed at the compliment. “Nah, I really only got the degree to keep myself busy because his hours at the hospital were so long. We lived in San Francisco at the time. He was at the SF General Hospital and I was at Cal. We met at UC Berkley, his last year of medical school and my first of undergrad, and got married his first year of residency. Bert Robor and Peter went to medical school together at UCSF.”
“Dr. Robor is one of the best surgeons around for pancreatic cancer.”
“Oh yeah, I’ve known Burt for years. Don’t tell anyone, but Peter performed a prostate biopsy on Bert last year.”
“Has Dr. West been retired for a while?”
“HA. A surgeon retire? We had grand plans of traveling the world and vacationing in luxury, but Peter always said we’d go later. Well, later never came and he was diagnosed with cancer just last month. Our dreams to travel and see the world never came true.” She longingly stared out the window, clearly wondering what life could have been like.
“He’s still working?”
“Well, once he got diagnosed I forced him to retire. He’s been working seven days a week for 34 years. He started a group in Beverly Hills and owns a number of medical buildings and a couple of surgery centers. He was so successful he could have retired a decade ago. I think he just loves to work. He worked so much in fact that our youngest refuses to speak to him, and the other two hardly call him but once a year. I travel to see them and we’re close, but they don’t view Peter as anything other than an absentee father.”
“I had no idea. I figured you’d have the perfect life and family.”
“You are naïve, aren’t you, my dear? I love the man, but he was just never there. Sure I could buy anything I ever wanted and the kids had top notch educations; he even set up a trust fund to pay for the education of his nieces, nephews, and grandkids. But that doesn’t make up for the fact that he was simply never there. I delivered all three children alone; he was at work. I went to all the parent teacher meetings by myself. I was the soccer mom, tutor, chauffeur, basketball coach, bed time story reader, and daddy all wrapped into one. He was just the provider.”
“I had no idea you could be married yet so alone.”
“That’s the life of a surgeon. He always loved the thrill of operating and saving lives. He was happiest when recanting stories of how he was able to completely resect a tumor, or restore urinary function, or correct erectile dysfunction and drastically improve the life of another. I guess I can’t fault him for taking joy in the service of others. I just wish I was able to share some joys with Peter outside of medicine, but the time for that was always later …”
“I’m sure he’s going to be in the 10% and beat this thing.”
She nodded, acknowledging my attempt at empathy and reassurance. We sat in silence for many minutes and when Mrs. West started speaking, she told me about life as a surgeon’s wife. No wonder surgeons had such a high divorce rate, they were never home and opportunities for affairs were plentiful. They also had the perfect excuse to cover up such rendezvous. They could always claim they were on call and a spouse wouldn’t think twice about why they never came home that night.
The kids had some of the best clothes, fastest cars, and coolest toys in high school. College tuition was paid for and money was never an issue, yet they detested their father for not being a dad.
It was unsettling to learn that a surgeon could lead such a successful professional life yet leave much to be desired socially. Stupid me always envisioned a surgeon would be treated like a hero at home.
“My, look at the time, it’s almost 2 a.m. I’m sorry for having kept you so long Raj. It was nice talking to you; I’ve been going through a lot lately. Please don’t take anything I’ve said in a negative light. Medicine is a wonderful career and the opportunity to help others during their time of need is priceless, but everything in moderation and balance is best.”
With that she kissed Dr. West on the forehead and left the room.
I saw Dr. Lanky charting at the nursing station, walking up to him I asked, “How’d that case go?”
“We lost her on the table. Bled out.” He said it so matter-of-factly that you’d think he was discussing the weather.
“That’s all?”
“What else is there? She was a smoker for a zillion years, she had cancer all over the place, she was going to die anyhow, and be miserable during chemo and radiation. At least Parker will never push too hard when he places a chest tube again.”
I was at a loss for words. All I knew was that if I ever needed medical care it’d be through a private practice at a non-teaching hospital where my survival mattered more than somebody else’s learning. It’s no wonder medical trainees call teaching hospitals ‘human wet labs’.
I decided to retire for the night when I heard Lanky’s pager go off. I figured I best stay as I’m sure it was more work headed our way.
“Ra, come with me to the ER, there’s a multiple shooting that’s headed our way in a couple minutes. Three gangbangers apparently arguing over some drugs; one has multiple gunshots to the abdomen, another with a bullet to the chest, and the third with a shot to the arm.”
We ran down the hallway to the trauma elevators. “I’ll do the thoracic case with Dr. Blake; that guy has a chance of making it. The abdominal case is a goner, but he’s still alive, so why don’t you and Parker have at it? If nothing else it’ll be good experience and there’s no possibility of a complication. The arm guy can wait until later to have his bullet removed.”
One look and I could tell that the guy with the abdominal injury was a goner; there was no point in even attempting to operate. His abdomen looked like Swiss cheese with bits of intestine and blood leaking out through several holes. Parker’s rationalization was that the one good thing this guy might do with his life is provide us the opportunity to learn so that we can use that knowledge to help others in the future.
Even with a miracle, what were his chances of survival with an intern and medical student attempting major surgery? Turns out they were zero.
We got him to the OR, opened him up, and fooled around for about 45 minutes. We transfused him with 12 units of O negative blood before his heart finally decided to call it quits. Sure it was a great lesson in anatomy and fascinating to see how much damage four small .22 caliber bullets could do by bouncing around in an abdominal cavity. It definitely wasn’t a great use of hospital OR time or resources. But I guess that’s how surgeons are made. No wonder it costs over two million dollars to train a surgeon.
Parker was elated. He got to clamp the abdominal aorta, remove a spleen, cauterize a liver laceration, and then he even let me put in the staples to close our John Doe … after we pronounced him dead on the table.
I don’t know if it counts as operating after we’ve already declared the body a corpse.
I think all 12 units of blood ended up on our gowns, which were soaked with a combination of intestinal contents and blood. In fact, there was so much blood that it had soaked through my gown, through my scrubs, and onto my boxers. My shoe covers protected my shoes, but my socks were damp from fluids I didn’t want to think about. I was gross, damp, and unhappy.
Despite being more blood soaked than me, Parker was high as a kite. The thrill of operating placed him on cloud nine.
I rushed off to the locker room to shower and decontaminate. It sucked; I didn’t know I was even going to be on call, so I didn’t have a change of clothes. I threw away my socks and boxers; I ended up free balling it in my slacks and wearing my dress shoes barefoot.
I finished showering, just in time to pre-round at 4:30 a
.m. Dr. West was still in la-la land, and our other two post-ops were in the ICU due to delayed extubation and were somebody else’s problem until they arrived on the floor.
Since the gunshot case was going to be a few more hours, the attending excused Lanky so he could round while Blake helped him finish the case. After completing rounds I figured our day was over given the new national rules set forth by the ACGME that mandated residents were not allowed to work over 88 hours per week or over 30 consecutive hours without at least an 8 hour break.
I was wrong.
There were six cases on the schedule for today: two large bowel resections, three gall bladders, and a Nissen fundoplication.
Lanky and Parker somehow had the energy and motivation to stay and assist for those cases. I was sent home after the first case at about noon. They stayed well past 7 p.m. or about 37 hours from when they stepped foot into the hospital the day before. They had only slept about two hours during that time. The kicker is that this is not an atypical day for surgeons in residency; they are often on call every three to four days and extraordinarily busy for most of their five to seven years of training.
I quickly learned that surgeons in training simply don’t honestly report the number of hours they work.
Stats for my first day of surgery: length = 30 hours, patient deaths = 2, pairs of my boxers soiled by somebody else’s bowel material = 1. Only 7 weeks and 5 days to go. A full month on this service and another month somewhere else.
I needed to invest in some more undergarments. That was my final thought before I fell asleep for a short afternoon nap of seven hours.
~~~~
“Good morning Dr. West,” I said as I gently nudged his shoulder. He woke up with that look of haze one gets when they have been on high doses of narcotics.
“Huh. Oh, hi.” His voice was coarse and weak, but it still had an intonation of confidence and authority.
“I’m Raj, I don’t know if you remember me? I spoke with your lovely wife yesterday.”
He was waking up now, and looking around as though seeing his room for the first time. But he quickly remembered where he was and why he was here. “Oh yes, medical student I imagine, short coat. Sorry, I don’t remember you, but Bert had me snowed with narcotics yesterday.”
We shook, and despite having undergone major surgery just yesterday, his grip was firm. “I just wanted to see how you were doing and how your night was.”
“Well, I’m still here, aren’t I? Must mean it was good. Are the pathology results due back today?”
“No, they’re likely going to be back tomorrow. From what I understand your tumor was quite large.”
“Yeah, tell me about it. I just waited and waited until the pain got severe enough to prevent me from operating, so it’s my own fault.” There was no remorse in his voice, clearly a man who took responsibility for his actions. I already liked him; he was honest and affable. Hard to believe he was such a workaholic that his children disowned him. None of the three had come to be with him after such a major operation.
“I heard you recently retired from doctoring?”
“Wait, just a minute there. I am retiring from being a surgeon and the practice of medicine, but I’ll always be a doctor; that’s all I know how to be.”
Ain’t that the truth. But I kept that thought to myself. “I’ll just check your wounds and be back with the team when we round, if that’s okay?”
“Hey, you’re the Doc, I’m all yours.” He winked.
Rounds went well and there were only two long cases with Robor today, so we were free to finish up evening rounds by 8 p.m. I swung by Dr. West’s room to check up on him, and he was flipping through a medical journal.
“I thought you retired?” I asked as I pointed to the journal he was browsing.
“What can I say? Can’t teach an old dog new tricks. I’ve been reading these journals for so many years I don’t know what else to do with my time.”
“Why not travel? Your wife says it’s been something that keeps getting pushed off.”
“Hard when I have 40+ staples that are barely holding me closed and potentially a cancer that’s eating me alive from the inside.”
“Excuses. Suppose the cancer is completely resected with clean margins. The staples will come out in a couple weeks and within a month or two you’ll be good as new, and then what?”
“I like you kid, you don’t bullshit, get right to the point. If the cancer is completely removed, I’ll make you a deal, I’ll do all the things that I said I would but ignored due to work.”
“Ok, shoot.”
“What you talking about?”
“Sorry, I mean fire off the things that you are going to do. I’ll be your scribe. Talk is cheap, but if it’s written I can hold you to it.”
“You’re serious?”
I nodded.
“I like you even more. Ok, let’s go: 1) buy my wife flowers; 2) sit front and center at the NY Philharmonic for which my oldest son plays the violin; 3) first class trip to Europe; 4) an anonymous donation to the battered women’s shelter in New York for which my daughter works. That’s all I got for now.”
“Good start. Seems like you’ve thought this through.” I placed a little box next to each item on the list and taped it up on the mirror next to his sink. Then I took a photo of it with my phone and saved it in case I needed it later.
“In the last couple of days I’ve accepted that I’ve been living life for myself. I’ve been selfish and others have suffered greatly for my behavior.”
“What do you mean?! You’re a hugely successful surgeon; you’ve saved countless lives and helped thousands of others with their problems. That’s not exactly how I’d define selfish. Am I missing something?”
“Sure, I did those things and many more, but not because I cared so much for what I was doing. It made me feel good. When I saved a life or cured a cancer, it was a huge rush and feeling of accomplishment. It made me feel larger than life. It was easy to get addicted to that feeling and forget everything else. I know I was a bad husband and father. I was never a dad. Sure I was respected and rich, but I was no different than your heroin junkie. I was in it for the rush, the feeling of power, and the thrill of success.”
“But you gave all your time to help others during their time of need. I fail to see the selfish nature there.”
“Here, let me put it in perspective. I love to operate, but I don’t like surgery. What I love is that after surgery I get to walk towards a family who has been waiting for me for hours, literally sitting on the edges of their seats with anxiety that is palpable, fearing the worst and desperately hoping for the best. They await my arrival and then I get to break the good news to them. It’s such a rush to tell a family their loved one is cured of a life threatening ailment; it makes your head spin. That empowering feeling became my addiction. Sure the money was good, but it was secondary. I was like a junkie getting paid for obtaining his fix. It was great; for years I earned seven figures. And once you have money, it’s easy to make more. The real estate, surgery centers, medical corporations, and venture capitalism earned me more than my salary. But the money didn’t do it for me; it was being able to play hero that I loved.”
“Your passion for success motivated you to do excellent work.”
“Sure, my outcomes were above average, even exceptional. But it came at the cost of my wife and children. Don’t think I didn’t know it; I was just willing to pay that price to make myself feel good. Not unlike a crack whore or meth head.”
“So, now that you’re done, won’t there be a withdrawal? Alcohol and heroin addicts can die if they quit cold turkey.”
“I might already be dead. My fate is in the pathologist’s read.”
“Fair enough. But as a surgeon, you know to expect the unexpected and always have a Plan B and even C; medicine is all about options. Let’s assume you’re cured … for once you’re on the receiving end of the news instead of delivering it.”
“Well, my wife
has put up with a lot. I think it’s time I let her be selfish. I might even be able to learn how to have fun again.”
“And the kids?”
“Well, one refuses to talk to me. In fact he said I was dead to him almost 15 years ago, so that might be a dead end road. The other two, I’ll have to let them judge me on my actions; they speak much louder than words.”
“I thought you said the donation would be anonymous, she might never know.”
“She’s a bright girl, she’ll figure it out. Went to law school at Duke, got a high powered job at some NY firm, did it for a couple years and quit to work at this shelter. I think deep down inside she does it because she thinks I battered her mother with my absentee lifestyle. Thus, to give back to society she’s helping out battered women who have nowhere else to turn. She helps with counseling, both psychological and legal, even represents them in court, anything to help them get back on their feet.”
“Quite altruistic. You must be proud.”
“You’d think I was, and deep down inside I am, but I never let her know it. I always pushed for her to go the corporate route and try for partnership at a big shot firm where she’d pull in the big bucks. I equated success with financial remuneration and emphasized that too much to my kids.”
“Your son must be doing quite well, playing for the NY Phil. That’s very prestigious.”
“He’s my oldest, very smart and talented kid. He played tennis and got offered a half scholarship to Stanford, but his passion was music. I insisted he attend The Farm and do either pre-medical studies or business and manage a hedge fund. My wife was sympathetic to his passion and was insistent that he attend Juilliard.”
“Not a bad position to be in, choosing between two of the finest schools in America.”
“Again, one would think, but I was so insistent that he not throw his life away as a hippy musician; we got into several fights. Eventually he sided with his Mom and bought a one way ticket to New York. He is much respected for his performance skills and is quite sought after by several professional orchestras. His dream is to become a conductor one day and I think he’ll do it sooner rather than later.”