Monday, December 11, 2017

The Whos of Whoville, Pecking Order, and Office Politics as Opposed to Political Office

The attending physician who supervises me is too ill to work, which is extremely rare around here.  What's wrong with him is no business of mine, and, beyond that,  it's best not to ask a whole lot of  personal questions around here, especially since the person about whom I would be asking is one of two people in the entire practice who speak to me, (with the fellow being the other, and the fellow is attending a forum in Chicago), so inquiring as to the nature of the attending ophthalmologist's illness or, for that matter, about anything else,  would be the rough  equivalent of asking my questions to the potted plant next to the office entryway.  I suppose I could ask Siri.  Siri at least wouldn't give me the death gaze.

The  supervision of med school students around here is a chain-of-command sort of thing.  (To be fair, such is the case in all specialty areas, but nowhere else here is it more evident.) You may have heard the expression "Shit runs downhill."  So does the supervision of medical students and their glorified counterparts, the interns and residents. (I won't clump fellows with residents and interns; fellows have been certified in at least one area and therefore worthy of at least a modicum of respect.) An attending physician or surgeon  is on record as being responsible for a med student's oversight and evaluation. Sometimes the attending physician or surgeon has another doctor, called a fellow, gender of the person notwithstanding,  who is certified in at least one specialty and is working to earn certification in an even more narrow field of medical specialization or is fulfilling a fellowship purely for the purpose of picking up additional experience in the field before practicing independently, or, in some cases, is fulfilling the fellowship solely for bragging rights -- for the rightful  entitlement to claim he or she trained under a particular specialist.  The attending physician can lawfully delegate almost any duty to the fellow. The fellow, if there is one, as second in chain of command, can further delegate his responsibilities concerning oversight of med students or of virtually anything else, down to his or her underlings -- the residents and interns. In the field of ophthalmology, the attending specialist or fellow then passes all duties related to the med school student that he or she can lawfully abdicate onto a resident doctor. If there an intern somewhere in the chain of command, the tasks related to supervising the student are then surrendered one rung lower still to him or her. The attending will  lead grand rounds, at which time he or she will ask salient questions in attempt to catch the med student unprepared and to make the person look and feel foolish, and the attending ophthalmologist will be the official author of any and all comments written in the student's formal evaluation, although sometimes said comments have been known to resemble evaluatory comments written by residents and interns  closely to the extent of  seeming to be almost verbatim from residents' or interns' informal evaluations of the student.  It couldn't be, though, that the attending doctor is too lazy to come up with his own original thoughts in evaluating a medical student. It would seem far more likely, I'm sure you would be the first to agree, that it's a simple matter of great minds functioning  in a correlative or consubstantial manner.  Totally. How could anything else be the case?  The bottom line here is that the attending ophthalmologist is still the primary @$$ that seems to require almost constant kissing, but  positing oneself into sufficiently close proximity to the designated @$$ to be kissed is gained by smooching the @$$es of  the underlings who stand between the med student and the God of Ophthalmology, whomever that God might be for a particular med student. The Religion of Medicine is both polytheistic and relative. (Again, it's essentially true of all specialties, but nowhere is it more true than in the specialty of ophthalmology.)

The situation here with regard to this specialty is, then, unique. My particular attending physician has no interns, residents, nor other medical students at this time to supervise. He is here for one academic year only, on loan from another institute of higher learning.  His contract dictates that he is responsible for no interns or residents but will (and does) oversee one fellow, whom he selected from a field of several hundred applicants. I'm not sufficiently knowledgeable in the game of  "Who's Who in the World of Ophthalmology" as produced by Parker Brothers, Milton Bradley,  or whomever else markets board games today, but my attending ophthalmologist would at least seem to be one of the more prominent Whos in Whoville, ranking somewhere between Little Cindy Lou Who and The Mayor.   Yet, paradoxically, he chooses to have as his underlings  one fellow, zero residents, zero interns, and one medical student  every second rotation.  I drew either the long or short straw, depending upon how one views it.

There's no one for me to hide behind in this rotation.  It's just the attending ophthalmologist, the fellow, and moi.  I either know an answer or I don't. Most of the time I do actually have the correct answer, but not always.  At those times when I don't, know, there's an awkward silence as the attending and the fellow look at each other, then back at me. . . except for yesterday, when the fellow admitted, "I don't know the answer to that, either. " The attending ophthalmologist and the fellow broke into loud laughter.  I stared at them unresponsively until the attending said, "You have my permission to laugh, Alexis."  I then laughed along with them.  While it might seem inconsequential to someone who has never played this game, even something so seemingly trivial as laughing along with real doctors, who may very well be laughing at me (as opposed to laughing with me; there's a huge distinction between the two) isn't to be taken for granted.  The topic is addressed even in  The Holy Bible, in the third chapter of The Book of Ecclesiastes. There is a time for everything, and if you want to survive in the world of medicine, you best learn when to laugh along with your superiors at a joke or, conversely, when to suck it up, put on your best poker face, and know that you are the joke.

In any event, both doctors supervising me are away at least for the day. The attending physician appears to be aware that the other doctors in the practice and their staffs are not overwhelmingly fond of me for reasons I have yet to deduce. They're not overwhelming fond of my attending physician or of his fellow, either.  Such should not be a source of consolation to me; I should be a bigger person and should want my attending physician and his fellow (who in this case is not a fellow if one uses gender on which to base the determination) to be liked by those with whom they work. It is, however, a major source of consolation to me. It helps me to feel a whole lot better to know that while, yes, they certainly hate me,  it is not just I whom they hate. And truthfully, I don't think my attending physician gives an opossum's anal orifice whether or not the other doctors in the practice and their wives,  daughters, sisters-in-law, daughters of former missionary companions, and the rest of the motley crew that make up the staff of this practice have any .regard for him. (It does bother the fellow a bit, though; she never says anything about it, or at least not to me, but I can see it in her eyes.)
He just comes in each morning with his coffee (which he needs to pick up from the hospital before coming to the office because God knows there will be no coffee brewing or percolating or whatever it is coffee does to cook itself in the office), greets them all  warmly as though, he, too,  had been one of their missionary companions. (The ophthalmologists in this practice honest-to-goodness became acquainted when they all served in the same mission at the same time.)

My concerns about my supervising practitioner are three-fold.  Numero Uno: I am genuinely concerned about the the man's state of health. He's a kind and decent person who has treated me almost as a colleague from the moment he first was chosen to oversee me.  Numero Dos: If what he has is contagious and is transmitted through airborne means, I've been exposed. I spent most of yesterday in close contact with him. (To any DIRTY-MINDED PEOPLE: my concern for contagion extends only to those illnesses transmitted via shared air and space. I was not boinking or even kissing the guy. He's gay.)  Numero Tres:  If he doesn't get back quickly,  or the fellow doesn't return in a timely fashion, I'll eventually have to be supervised by one of the practice's  blockhead MDs, which would be everyone there holding a medical doctorate other than my attending ophthalmologist and the girl who is his fellow, who is not to be confused with the guy who is his husband (and who is extremely hot, by the way; multiple framed pictures can be found on the walls of his office; if my husband looked like that, I, too,  would plaster his image on every available surface).

The ailing attending ophthalmologist texted me to say that for today I should just hang out in the E.R. and help where I'm needed. He told me which ER physician to whom I technically report today, because if I'm on the job, someone is responsible for my supervision, but that the physician-in-charge would not bother me if I did not bother her.  So far I've stitched boo boos of children and adults, removed a broken Skittle from deep within a child's nasal cavity, held a child while an orthopedist straightened a green stick fracture of  the child's radius and ulna (the two bones of the forearm), assisted in the neurological evaluation of a patient who slipped and hit her head on the concrete sidewalk t her school,  cleansed a wound from a dog bite, and sent a patient off for a CT scan of the abdomen in a case of suspected appendicitis that turned out to be appendicitis, and listened to the complaints of  three urinary calculi sufferers and one likely drug seeker claiming kidney stone pain. I'm pretty sure that dealing with drug seekers will be the aspect of this job that I will hate the most.  I cannot feel someone else's pain. just because a person's symptoms that don't seem to be 100% legitimate to me doesn't mean that the pain isn't real.  On the other hand, if word gets out that a gullible ER doctor will write a prescription for opiates to anyone who can say, spell, or pantomime  hydrocodone,, this ER will become the Haight-Ashbury of the new millennium.  Fortunately for me, I don't yet get to decide which patient gets the good drugs and which patient is handed a piece of paper bearing what the patient considers to be the most offensive expletive in the English language: Ibuprofen.

I do not own this video. To whomever is the rightful owner I express my appreciation for allowing me to have it on my blog for however long you allow it to remain here.

In acknowledgment of the season upon us, I offer a picture of  Little Cindy Lou Who.


  1. Sounds like you had a productive day.

    1. I did. There my not have been a great deal of ophthalmology involved, but I felt satisfied that my day wasn't wasted.

  2. A little of this and a little of that and next thing you know you will have a license.

  3. I'll have a degree in six months and a license in eighteen months. What once seemed so very far away is now within reach.