Saturday, March 31, 2018

Practicing To Be a Practicing Physician, and Watching Vintage Judge Alex Cases on YouTube

For anyone who doesn't know and actually cares, I'm technically in school -- medical school, to be more precise -- but I'm beyond the classroom phase of my education other than the occasional seminar, which even licensed physicians are required to sit through on occasion.  My education now consists of on-the-job training with close supervision and a liberal amount of critiquing.  I actually perform some patient procedures, but I don't have the power to determine any treatment or course of action for a patient. I have to go through all the motions as though I'm qualified to make those life-or-death decisions, but in the end, someone smarter and more powerful than I is there to confirm or to overrule any decision I make.  Even though I'm mere months away from graduation, I have no more power than I had a year ago because each clerkship rotation is in a different area of medicine, and each one is new to me. 

The nice thing about my current rotation -- radiology --  is that much of the work is done behind the scenes. If I make an incredibly stupid error, I'm corrected in relative privacy rather than right in front of a patient and his or her relatives. I don't make tons of incredibly stupid errors, but the possibility of my doing so does exist. It's much less stressful to know that, should my diagnosis be laughably off the mark, the audience of witnesses will be very small.  It is a consolation, however minuscule. This year, for the most part I have only to worry about making a fool of myself, though there are exceptions.  The stakes, however,  will be higher next year, and even more so the following year, when I'll be  in the actual position of potentially killing someone with my screw-ups.  Even this year there's the possibility of doing considerable damage if I bungle a procedure, but the program does everything it possibly can to provide a safety net. They do this for the good of the patients and not for the preservation of my honor and peace of mind. Where my fellow med students and I are concerned, if the system could give us more responsibility with less support, they would do so, as we would learn more quickly (and the hospitals would get more free labor), but patient well-being has to come first.

Teaching hospitals face a difficult balancing act. Prospective physicians have to learn to perform the procedures they will need to perform once they are licensed. A medical school or hospital cannot simply wait until a physician is licensed, then expect him or her to know how do do all the things he or she will need to be able to do without any actual hands-on experience. They do what they can to give us simulated practice. We performed our first incisions on cadavers. We do computer simulations. We also have access to remarkably life-like dummies that give us the opportunity to perform many invasive procedures on them before we get our hands on their genuine living and breathing counterparts. 

At some point, however, all of us have to take the plunge and perform procedures of all sorts on live humans. It's frightening for us, and it would really be frightening for them if they knew it was our first time at the procedure, but of course they never know that. Sometimes they don't even know it's the student who is performing the procedure. I certainly wouldn't want to know if I were they. 

The first time I did a lumbar puncture, I very nearly passed out. I had to stop right after the initial puncture. A nurse held the needle in place; the supervising physician would have taken over if necessary for patient safety, but she chose to treat the situation as if it would have been treated had I been the actual physician and not merely a student, so she allowed the nurse to hold the needle for the fifteen seconds or so that it to me to stabilize myself. I sat and put my head down until the light-headedness left me, then continued without a hitch. 

I don't think anyone would argue with the idea that it is at patient expense that medical students master the procedures that comprise their jobs, but if we didn't learn them, everyone would suffer. We at least have the benefit of the dummies for practice. A couple of generations ago, once everything that could be done on a cadaver had been done, it was on to real live patients with no in- between. One couldn't have paid me enough to be a patient in a teaching hospital back in the day. It's treacherous enough now.

After a long week (I was officially on duty for eighty-two hours in the hospital this week; I was physically present for considerably more hours), I needed a diversion. For that diversion, I went to YouTube and found a few vintage Judge Alex cases. Those old classic episodes were the perfect venue for unwinding after a difficult work week. One case in particular -- Bidwell versus Hale -- was quite a hoot. Megan Bidwell, a lesbian (not that there is anything wrong with being a lesbian; it's merely worth noting that an avowed lesbian would unintentionally conceive a love child after the personal and public confirmation of coming out. Her reason for it was that she was drunk; it would take a whole lot more than mere alcohol to compel me to do anything that could possibly lead to the conception of a baby with Mr. Hale, and I'm heterosexual), was suing the father of her child, David Hale, over charges made on a joint credit card. The case would have been mundane to the point of boredom were it not for the litigants and their companions (with the exception of the plaintiff's companion, Kathryn Moore, who appeared normal as far as I could tell and was smart enough to say essentially nothing), who looked to me like haphazardly constructed puppets. When they spoke, they gave me the strong impression (which I really hope was a false impression) that they were the products of consanguineous relationships. I'm speaking of serious dueling banjos here. Again, because I do not wish to be sued, I must clarify that this is nothing more than an impression I had. I have no evidence whatsoever to support the proposition that any of the people featured in this case were the products of brother-sister or even aunt-nephew relationships. They merely appeared to be such.

Ms. Bidwell described for the audience and for all of us in TV Land how she made it to her child's gestational age of twenty-three weeks without knowing she was pregnant. This is far from any sort of record; you may have caught an episode or two of TLC's I Didn't Know I Was Pregnant, where women show up in emergency rooms with acute abdominal distress, only to be told that they're in labor.  Perhaps I should be less judgmental, but I don't quite understand how any sound-of-mind woman with cognitive function approaching the normal range could make it much past the first trimester of pregnancy without harboring at least a suspicion that she might possibly be, as the French would put it,  enceinte.  Ms. Bidwell next complained that, upon discerning an "awkward feeling in [her] belly" that he (it's not entirely clear, but I assumed the male pronoun was in reference to Mr. Hale) wouldn't "take me to any doctor or anything to find out if I was pregnant." Why would she have needed someone else to take her to a doctor to find out if she was pregnant? Did she lack the capability to seek medical care for herself? And while I'm the one of the last people who would disesteem the importance of medical care by professionals, home pregnancy tests are available at almost every pharmacy or supermarket. The bottom line for me is that if I were incapable of acquiring medical care without the assistance of such a a numbskull as David Hale, I would give up and consider myself as good as dead at the first sign of a medical emergency.

Megan Bidwell and her comparatively normal-appearing significant other, Kathryn Moore

Defendant David Hale spoke with an impediment I have no idea how to describe. Judge Alex made reference early in the episode to dental work Hale had done recently as being the alleged cause of his speech anomaly. I obviously have no idea what was done to the defendant's mouth or what he sounded like before the dental procedure.  Dental work notwithstanding, he's an odd duck, though not nearly so odd as was and presumably still is his wife/witness.  She was easily the most bizarre character featured on that particular day, and would quite possibly find a place in Judge Alex's Top Ten Most Idiosyncratic Litigants if such a list were to be compiled. She reminded me very much -- in speech and mannerisms --  of some of my cousins' cousins' cousins in Oklahoma, minus the heavy Oklahoma drawl.

David Hale and his bride and would-be P.I., Angela Brown

At some point during the case, when David Hale's bride of one month, Angela Brown (whose boobs appeared to droop at least three-quarters of the way to Antarctica; I'm not meaning to be catty in saying this, because she at least has boobs, but in all sincerity, I don't know if she went bra-less in attempt to seduce Judge Alex, or if she was wearing a bra, yet gravity still had such a potent impact on her anatomy), was telling a rather convoluted story of how she had attempted to conduct her own investigation of her then-future husband by contacting Ms. Bidwell through Facebook, bailiff Mason Burroughs failed to contain his laughter. He turned his back to the litigants and to the gallery of the courtroom as he wiped his eyes and at one point snorted. Judge Alex eventually lost composure as well. The audience laughed throughout the entire fiasco. Then the litigants and witnesses began to laugh. I had the strongest of urges to walk through my television screen to tell the litigants and witnesses, "They're not laughing WITH you, morons [and morons may very well have been a literal if not euphemistic term of address for the individuals featured in this case]. They're laughing AT you. There IS a difference." 

I suspect one of the reasons Mason laughed so boisterously was because white people on the program made more thorough fools of themselves than had any of the black litigants. I wouldn't accuse black people in general of behaving any more outlandishly than white people do. In real life, uncivilized behavior is something on which no single ethnic group holds anything resembling a monopoly. On TV court shows, however, the producers somehow find more people of African-American ethnicity that they are able to persuade [with money or with whatever it is that producers of court TV shows use to entice people to appear on their programs] to air their grievances in ways more emotive and flamboyant than are typical of the Caucasian litigants. This case, however, belied that entire premise.

In attempting to check these people out,  I googled their names. Ms. Bidwell was charged with assault and battery in May of 2017. Her mugshot was reprinted in a Virginia publication entitled Gotcha!. Gotcha! is a weekly periodical from Richmond, Virginia, which is comprised solely  [except for the obligatory advertisements; God alone knows who or what would choose to advertise in such a rag] of mugshots. How does such a publication have a large enough circulation to be sufficiently profitable to remain in print? Seriously, who buys this shit? I might possibly purchase a single issue if someone I knew was included in it, though I certainly wouldn't subscribe. Maybe that's the point. Perhaps many of the residents of western Virginia know so very many people who are arrested that to them, reading Gotcha! is like thumbing through a high school yearbook or family photo album. Perhaps it's the closest thing to a high school yearbook or family photo album that some of the readers will ever own.

Megan Bidwell's mugshot (photo credit - Gotcha!)

Here is a link to the episode for your viewing pleasure.

Saturday, March 10, 2018

Thank God I'm Not Married to Medicine

One side effect of having in excess of an entire month off is that I have had the opportunity to watch at least one TV program that I previously didn't know existed. Married to Medicine is a reality program on the Bravo network featuring  women who are MDs and women who are married to MDs or who are MDs married to MDs. A slight twist on the premise of the show is that all of the regulars on the show are African-American. 

I've been supervised by and have worked with African -American women who are doctors and nurses, and none of them conduct themselves as do the women on this program, at least at work. I'd be willing to bet a month's mortgage payment on the condo in which I reside (my parents, not I, make the payment) that they don't act that way when they're off the job, either.  The women on this program are only half a millimeter more civilized than the Real Wives of the various upscale communities, and most of these women have earned doctorates in medicine. Call me prejudiced (not racially in this case) but I expect more of medical doctors than what I have seen of these women. A few of them are merely married to doctors as opposed to being physicians themselves, but I would assume that even they have attained some post-high-school formal education. Maybe some of the women are osteopathic physicians. That's another of my prejudices; I hold osteopathic physicians to a lower standard than I hold MDs.

Doctors are not inherently perfect people. If the producers of a reality show came to me and asked me to help them locate  a given number of doctors who are unrefined, classless, and generally jerks, I wouldn't have any trouble accommodating the producers. I would be hard-pressed, however, even if I had access to my entire medical school community including all its students and professors, as well as every intern, resident, and attending physician working at any hospital affiliated with the medical school, to come up with six women of any race or creed who were as lacking in decorum as are the women featured on Married to Medicine. I would assume such is also the case with the spouses of those with  whom and under whom I work, though I don't know most of them well enough to state definitively that such is the case.

My guess is that participation in reality programs such as Married to Medicine is a highly lucrative second career. Money will persuade some people -- even ones whose level of education and presumed level of intelligence should exclude them from possession of the lack of judgment usually associated with agreeing to air one's shortcomings on TV.  Physicians are typically well-compensated enough that they wouldn't ordinarily be tempted by the lures offered by the production staffs of reality TV programs. Nonetheless, there are those among us for whom no salary is sufficient to support the lifestyle they have adopted.  Professional athletes are prime examples of this phenomenon. At least once a week I come across a hyper-linked story on present or past professional athletes who earned seven-figure salaries yet who are now either broke or bankrupt. 

While the incomes earned by most physicians are, at least in the short term, dwarfed by the incomes of professional athletes, the IQs of most professional athletes are, for the most part,  dwarfed by those who have successfully completed medical school. (Obviously not all professional athletes are of sub-average or even of average  intelligence. David Robinson of the U.S. Naval Academy and later of the NBA is often the first name to come to mind in any discussion of intelligent athletes. His son Corey is said to be similarly athletically and intellectually gifted.) While obviously not all professional athletes are dullards, and while there are obvious exceptions to this rule, the average college or professional athlete would not gain acceptance into an MD medical school program (perhaps many of them would be admitted to  osteopathic medical schools;I really don't know) if he or she were measured by the same standards as are other candidates for admission. 

It's conceivable that some or even most of those who agreed to participate in Married to Medicine did so because of financial difficulties and the need to moonlight for extra income.  I possess still another prejudice -- this one in terms of the intelligence, common sense, or self-control of anyone who cannot live comfortable on the salary typically  earned by a physician.  We all need to learn to live within our means. While I feel genuine  sympathy for those trying to remain financially solvent while working at minimum wage jobs, I don't feel all that sorry for doctors who cannot make ends meet. While sometimes divorce with its resulting family support/child support payments could cause a physician to have to scale back his or her lifestyle, a reasonable person can support a family on a physician's salary. In some cases with the Married to Medicine cast, they're living on not merely one but two physicians' salaries.  Even if  circumstances have caused a reduction in earnings of a doctor, the salary of a physician in the U.S. is still a living wage. Perhaps the physician's family can no longer afford a full-time house-keeper. Perhaps the number of and the expense of family vacations needs to be drastically cut, or maybe the number of restaurant meals a family eats needs to be reduced, and possibly an expensive home needs to be sold in favor of a more modest home in a more affordable area. Still, unless a physician's circumstances are highly unusual (perhaps a man fathered twenty children by eighteen different women and is required to provide financial support for all of them, or perhaps a woman married such a man; stupidity in regard to how one lives his or her life is not without consequences), adjustments can be made so that one can live with his or her spouse and/or family within one's means. It's feasible to make necessary adjustments to one's lifestyle in order to subsist on the fruits of one's labors rather than selling one's dignity in order to remain financially solvent.

Then again, perhaps it's not just money as a motivating factor where some of those featured in such reality programming are concerned. Among us are those who relish the prospect of celebrity for themselves even if the end result more closely resembles infamy than actual fame.  I don't understand it, and, for the most part, many of the people who have signed on for the lack of privacy that accompanies  participation in reality television probably don't fully comprehend just what it is that they're signing on for when they agree to allow their lives to be broadcast into living rooms across the nation.  I've yet to see anyone who has agreed to long-term participation in reality TV emerge unscathed. A very few families with large numbers of multiples allowed themselves and their offspring to be filmed for just a few segments, then took the money for whatever they needed it and went almost immediately back into obscurity. Those families appear to have beaten the system.  For the most part, however, if there's not something bizarre or at least highly quirky about at least one member of a family, the networks producing reality shows have no use for a family. Airing a person's or family's weirdness on national television isn't much more beneficial to the person's or family's overall well-being than airing the person's or family's soiled underwear would be.

With regard to  Married to Medicine, I take exception to the use of African-American physicians and their spouses in the program.  I should make it perfectly clear that I am in no way jealous or covetous of those who were selected to appear in this program, and no amount of money could persuade me to trade places with them. While presumably no one was compelled by any sort of force or extortion to participate in this project, I don't think it's a coincidence that African-American couples were chosen to participate in this program or these programs (there may have been a spin-off in a different location than the original; my schedule doesn't allow for me to follow any TV series, so I really don't know). Those of African-American heritage are often a bit more flamboyant or colorful (seriously, no pun was intended here) and perhaps more interesting than are their non-African-American counterparts. A reality show featuring my parents and their white and Asian physician acquaintances wouldn't hold the attention of many viewers for long. It seems almost as though Bravo scoured medical communities all over the nation for the loudest and most ostentatious physician families they could find.  It's probably not a coincidence that the couples chosen for this project have been African-American.  Those who participated are adults and as such legally entitled to make their own decisions regarding participation in such a project, but still, to me it reeks of exploitation.  

As a future physician, this program is an embarrassment to me. If I were an African-American prospective physician, it would be an even greater embarrassment to me.