FIFTH PATHWAY

First an oldie but goodie.  When Jack (physician assistant) worked for me, we would have fun.  He brought out the child in me and we played to the audience/patients.  Somedays, especially when we had long waits, the audience would get feisty.  To lighten the mood and ease our distress ourselves, we might put a bogus chart on the intake wall.

Nurse (too busy to realize what was going on):  “Jack….Jack…..Jack Meehof.  I guess he’s not here.”  When everyone stopped laughing, she would get the next patient.  Invariably, the mood would change for the better. Now, on to my journey.

As medical students in Mexico, we had the option of spending our fourth year of medical school in Mexico or in the states.  My Uncle Oscar was the head pharmacist at Portsmouth General Hospital and convinced the hospital administrator to take the responsibility for providing me with the clinical rotations I would need. In Portsmouth, I found two extraordinary mentors.

The hospital administrator dumped me on two, old, head nurses.  They were amazing.  Their skill sets and knowledge base was as good as most docs I had ever worked with.  What they said was law. No doc dared mess with them.  They taught me medicine from the nurses’ point of view.  I ended up being a major supporter of the nursing staff.  I understand how handling bedpans, cleaning patients’ rumps, assisting with urinals, passing meds and a host of other bedside duties affected them while acting on doctors’ orders, monitoring vital signs and trying to appease self-absorbed A-hole MDs.  Bedside nursing is difficult.  It is also crucial for both the patient and medical staff’s wellbeing. Without the help of nurses, nothing would get done and people would die; yet, they are often taken for granted and even belittled by docs and by patients.

In the office as well as in the hospital, I retained my nurses’ skill set including rooming and discharging patients, as well as cleaning up after myself.  In my surgical suite, I disposed of my own sharps in order to reduce the chance that my nurse would prick or stab herself.  New hires and hospital nurses were amazed that a doc would pick up after himself. I think all med students should do at least a month’s rotation with an old school RN.

Portsmouth Naval Hospital was next door to Portsmouth General and I was able to access their classes and seminars.  I sure was lucky to get a high draft number.  My “Milo” character could never tolerate their rules and regulations.  The one tolerable thing was the officer’s mess.  For $3 I got a 10-ounce prime rib, twice stuffed potatoes, salad, drink and dessert. I also got berated daily for not being in a proper dress uniform.  The look on the officer’s face when they found out I was non-military was precious.

More important than a great education, PGH brought me home, to Norfolk  and my parents’ home.  Simultaneously to my moving back, Renee moved back to Norfolk from Chicago.  I had dated Renee’s sister off and on, had fallen for Renee’s mother so one of the first things I did was visit Cynthia (Renee and Dale’s mom).  To make a long story short, I asked Renee out hoping to make Dale, her younger sister, jealous.  Little did I know that, within the year, I would marry Renee and live happily ever after! (I get a few brownie points here.)

By offering to provide my fourth year of training, the hospital administrator, nurses, and docs not only built a sound foundation on which to grow my practice but introduced me to my future wife as well. 

I’ve told the following story multiple times.  It is so important I will tell it again.  There was an ancient, retired doc who wanted to teach.  The medical hierarchy believed that his knowledge was so old as to no longer be relevant so they would not let him teach.  They did allow him to eat lunch with me and other students that rotated through.  His mentoring skills had been honed over 50 years and his ancient knowledge base was incredibly useful.  I used many of the things he taught during my years in practice. In his world, doctors had been placed on pedestals.  He told me that, to be effective, you had to get off the pedestal and stand with your patient.  He brought humor into everything and was the reason my office demeanor was what it was (I don’t know how to describe it).

I learned to listen to my elders and assess for myself, the knowledge they offered.  In some cases, old is much better than new.  I would love to teach but now I’m the ancient one; and the authorities definitely don’t want the knowledge I possess in the hands of new docs.  Towards the end of my practice, I realized how powerful a tool the computer had become. Simultaneously, I realized that I was becoming increasingly dependent on the computer and that no data existed showing any improvement in patient care and outcomes.  If not careful, I would become an excellent typist and a middle of the road doc.  Unfortunately, the electronic medical record has become ubiquitous and is enslaving medical personnel around the world.

I fervently believe that, to improve medical care, we need a purge, much like the purge we use for a colonoscopy; only instead of getting rid of excrement, we need a big dump full of computer programs.  In Shem’s book, “Man’s 4^th Best Hospital,” the doc does an excellent job taking care of the patient’s problems only to hear the patient say, “Doc, you sure are a good typist.” More on the invasion of computers and the destruction of the medicine I knew it in the near future.

Here’s your joke for the day:

The crowd was tense with excitement as the final three Samurais faced off.

After a long day of competing, it was the final round of competition to find who was indeed the master swordsman.

In a final challenge, the three men had to show their prowess and concentration by slicing the finest of targets, a mere fly.

The first Samurai steps up to the stage and a fly is released.

Bzzzzzzzzzz Bzzzzzzzzz ‘Zing’

With extreme precision, the Samurai slices the fly in half; the crowd erupts.

The second Samurai fearlessly steps up on stage and another fly is released.

Bzzzzzzzzz Bzzzz ‘Zing Zing!’

With two cuts of his sword, the second Samurai cuts the fly into not two but four pieces.

‘Amazing!’ Screams the crowd. Such a feat has never been seen before.

The quiet descends for a final time in the stadium as the third Samurai calmly steps on stage; the tension is paramount as the fly is released.

Bzzzzzz bzzzzzzz ‘zing!’ Bzzzzzz bzzzzz

With the swing of the sword, the fly simply flies off, seemingly free from its fate.

The crowd is dejected.  One man can’t help but disappointedly ask, ‘Is that it? You couldn’t even kill it!’

The third Samurai raises his finger, “Ah, yes, he may live but that fly shall have no children’. In an alternate, less politically correct version, the third Samurai is Jewish and he says, “Circumcision is not meant to be lethal.