Pretty Little Butcher: Memoirs of a Female Thoracic Surgeon

What makes a good doctor?

What makes a good doctor?

I constantly ask myself this question, from the first day I set foot in the hospital till now, and I still don't have a good answer. When I first started as an intern, I was timid, a nervous wreck, full of useless compassion and a genuine interest in people.

I chatted with the esophageal cancer patient who just underwent a reconstructive surgery. He told me he was a baker before this, and we shared a mutual sense of indignation when people mix up Black Forest gateau and a Classic Chocolate Cake.

"Those are two completely different types of cakes," I said, and he nodded in agreement.

"People mix them up all the time! When I leave this hospital, I'm going to bake a cake for you!"

(I believed him, and when he left he never came back again.)

I chatted with the CEO after he was diagnosed with stage three lung cancer. He was one of the handsomest men I've ever seen in the hospital, and considering that we met when he was in bandages, a hospital gown and lying in the Respiratory Care Center after he just woke up from a lobectomy and had not yet brushed his teeth, I wondered how he looked in a suit. He and his wife told me their love story and about how he had to beat a bunch of doctors in order to win her heart, and I was thinking, hot CEO versus nerdy doctors? I'd choose you any day.

He said his disease woke him from his state of perpetual workaholism, and that he should start focusing more on his health and his family. The next day after the surgery, he was in his ward having a Skype conference while chest tubes were still connected to him.

I genuinely like my patients and I enjoy their stories. A lot of our patients are single veterans, all alone in the world with no family and no visitors. It must be boring lying in a bed all day, I thought as I cleaned their wounds and changed the gauze. I was just an intern with shallow medical knowledge, but I was a decent conversationalist. When they looked like they could use a pair of sympathetic ears, I offered without hesitation. It was one of the few things I could offer, anyway.

What I couldn't offer, and what was perhaps the most important thing they need, is excellent techniques in performing medical procedures. Part of our duty as an intern doctor is to draw blood from their veins everyday. This may seem easy when we practice on one another, because we are young, healthy, fit individuals, and our veins are practically popping through the skin and easy to spot. When it comes to old patients suffering from diabetes, nephropathy, or liver cirrhosis, it's a completely different story. Their veins are an almost invisible thin green line, a tortuous, calcified, brittle green line that can easily break and lead to ecchymosis.

"AllIWantIsYourBlood"---one of my friends changed her username. I could feel her anxiety, because drawing 2ml of fresh blood into a syringe translates into living nightmare.

I had a patient like that. She was a terminal case of pancreatic cancer, and her disease had made her eyes look alarmingly big on her sunken face. Those were kind eyes, however, and the woman was soft-spoken and understanding. She never complained about my clumsiness. Everyone wants "someone with experience", but experiences have to start somewhere, and I'm eternally grateful for the first few patients who allow me to "practice" on them.

When we draw blood, we have to tie a tourniquet around the upper arm tight, so that it blocks the venous return and will in turn engorge the veins and make it easier. This woman was so thin I could wrap it around her arms twice and it still wasn't tight enough. As I was struggling, her husband spoke up.

"Is this really necessary?" There was agitation in his voice, and he was never like that before. You have to be very strong to remain positive all the time in the face of a vicious disease like terminal cancer. "I mean, we have already given up. Why can't we make it easier for her?"

"Don't be like that," the wife stopped him. "She is just doing her job." She turned to me and smiled, telling me it's ok.

I went to talk to the senior resident immediately. "She's about to be transferred to the hospice ward. Do we really have to perform invasive procedure on her everyday? Maybe we can lower the frequency of those blood tests?"

A few days later she was scheduled to be transferred. I went to her and I helped push the bed, and as we move toward the hospice ward I couldn't stop the tears forming in my eyes. We always tell patients that hospice care doesn't equal to waiting to die, it's about giving patients the dignity they deserve and provide a better quality of life, but normal people on their way to recovery don't end up there. You wouldn't be going there unless death is proximate.

I reached out my hand to her impulsively, and her frail fingers curled around mine immediately.

"Please...take care of yourself," I choked out, blinking back tears but was not nearly fast enough.

"I will." She was much stronger than me, my patient. "You are a good doctor. And you are going to be great someday."

As an intern I felt useless. I felt sorry for the patients who got me as their doctor. They don't need my futile tears; they need someone who is confident, collected, trust-worthy, and full of knowledge. Someone who is like the doctor I am now.

I waltz into the hospital rooms and efficiently explain what we are going to do, what other options they have, the risks and possible complications of medical procedures, and I give them details on everything they ask about. I even know what they are going to ask about before they open their mouths.

The first time I inserted a chest tube into a patient, he cursed at me, my parents, my grandparents, and the eighteen generations before me. I probably did a poor job of injecting local anesthesia, although I had tried it on myself first just so I know how it feels and get a hold of the rate I should be pushing it in. Nowadays when I insert one, the patient is smiling from start to finish. I chatted with a college kid as I performed the procedure, although I didn't really have any interest in his life. I just wanted to calm him with a conversation so that I could do my job, and afterwards he told me he didn't feel a thing. Feeling especially charitable, I swung by his ward again before going home to check on him although he was no longer my patient. His face lit up like a blooming flower and he told me how much better he felt just seeing me.

I went home and immediately forgot his name.

I don't know if I have become a better doctor. I'm good at my job when it comes to surgeries, and I have nurses and other doctors asking special favors from me and request that I perform certain procedures so that the patients can "suffer less". In exchange of that, I have lost some of my curiosity, my over-friendliness, and I never cry for patients anymore.

I'm too busy getting to the hospital at six am every morning and stand through the day in the operating room. When I have a minute I re-watch videos of my performances and try to conjure up a paper worthy of publishing in the medical journals. I simply don't have enough time and space in my heart to invest emotionally, and frankly I have seen too much sadness, and the repetitiveness has numbed me.

In the end, I'm glad that we have a team. We need fresh-faced interns who sit beside patients and hold their hands, and we need senior doctors who focus more on providing the medical care they need.

I'm relieved to say I tried my best at both positions, and I hope that is enough.