Thursday, December 30, 2010

Calling Rampart

Growing up, I wanted to be an astronaut, a United States Senator, and a doctor, preferably all at the same time. As fate would have it, the chance to be the latter came first. I was a senior at Shawnee Mission East High School just over the state line from Kansas City, Missouri, and there was a new and innovative medical school on the Show-Me side that took you in after high school and six years later sent you back out with a medical degree. And during my interviews I was asked the inevitable questions of, "Why do you want to be a doctor?'' The problem was that I didn’t have answer, and still don’t. It’s not like I was impacted as a child by some friendly family physician that came to my bedside, nor was my life saved by the swift intervention of a skillful surgeon. I was not born into a medical family. The only things I ever remembered (or at least haven’t suppressed) about going to the doctor's office were shots, being bribed to get shots with butter cookies, and reassurance that yes, someday he will hit puberty (it did happen, and last week was a life-changing experience, to be sure). About the best I could do was recall drawing arteries and veins on a Valentine’s Day heart, causing the girl across the street to say she'd never play with me again, and absorbing all the reproductive details in the Better Homes and Gardens Baby Book the adoption agency sent home with my brother. So I gave the admissions folks the honest answer, "I really don't know. It's just something I've always thought I should do.” The answer, no matter how truthful, provoked frowns all around, and I was sure it was time to pack up the bags and head to the closest state university with a drinking age of 18 willing to give me some scholarship cash. (I did have some standards.)

(Frankly, I also had crap answers to other questions the interviewers would ask. One of them, a female psychologist, would have you tell a story about something that happened, and then say “Tell me more.” On several occasions I had to say “There isn’t any more. The story’s done,” which seemed to displease her. A second interviewer, who was an older African-American pediatrician, asked if I ever had any experience being a minority. The only thing I could think of to say was, “Does being a Jew in Kansas count?” Apparently it did.)

So how did I get into medical school? Truth be told, I have no idea. I‘m not sure I would have taken me. Nonetheless, the official reason would be that they saw my potential as not only a physician, but as a person, and wanted to help me fulfill my destiny. To this day I’m convinced that the real reason was simply dumb luck. The University of Missouri-Kansas City School of Medicine was designed to turn out primary care doctors for Missouri, and it had always taken exclusively Missouri residents. However, there was a small, never used clause somewhere in the Admissions Manual that said every year, they could take up to four kids from the Kansas side of the metropolitan area. (Kansas City, Missouri and Kansas City, Kansas, are just across the Missouri River from one another; the Kansas suburbs of KC are separated off from the main city by a two-lane street called State Line Road. When Kansas was a dry state, the police used to sit just over the Kansas side, watch cars with Kansas plates go into liquor stores on the Missouri side, and bust the drivers when they came back into the Sunflower Realm.) The year I applied, the daughter of one of the Vice-Chancellors of the University, who happened to attend high school in Kansas, also wanted to go to medical school. So the clause was dusted off for her, and a few other Jayhawkers were let in for show. They sent me a letter of acceptance, I called my parents who were on vacation in the Caribbean (the message they got from the hotel operator was “Mr. Howard’s in the hospital”), and a mere thirty years later I’m writing about it all.

I have the same difficulty in describing why I chose emergency medicine as a specialty. It just seemed like something I was always supposed to do. Now, with over twenty years of practice under my belt, I can think of a number of reasons I stay in it (and a few more to get out, but until I can convince my son that trade school would make him happier than a four-year college and a graduate degree, I’m still at work.) The truth is I still don't know why I do this, except it makes me happier than anything else in clinical medicine. I suppose that happiness is the only reason you should do anything for a living, and it probably doesn't matter if you know why you're happy or not.

But since there’s a requirement that everyone has to have an anecdote about why they chose to do what they do, here’s mine:

I remember watching the show “Emergency!” when I was eight or nine years old. “Emergency!” was about a group of LA County paramedics who saved lives and stamped out disease. Their medical base was the fictional Rampart General Hospital. Rampart is the only hospital I’ve ever known that was staffed 24 hours a day, 365 days a year, with two physicians (Kelly Brackett, MD FACS and Joe Early, MD FACS) and a single nurse (Dixie McCall, RN), complete with starched white cap and dress. (The nurse, I mean.)

I can remember not being terribly interested in the paramedics. Roy DeSoto was a boring guy, and Johnny Gage was always chasing girls. Who has much use for that when you’re eight? My girl issues back then consisted of making sure I had the requisite shots against cooties. But the doctors really impressed me, mostly because of the initials after their name besides the usual MD. At the time, I though the more letters you have, the cooler you are. I didn't know that FACS meant fellow of the American College of Surgeons, which in turn means you allowed yourself to have the personality sucked out of you during five to seven years of surgical training in exchange for the ability to rummage around someone’s innards, and that you then get to pay a large chunk of money in dues each year for continued use of the letters. And there was no way to know they were surgeons, for they weren’t ostensibly arrogant and could occasionally relate to patients and admit mistakes. But I knew that someday I wanted lots of initials after my name.

I think that the drive to work in the ED was solidified the day that Kelly and Joe saved a goat. For some reason that escapes my memory, Johnny and Roy had brought a goat to the hospital. I suppose the goat was dying of some dread goat thing, and needed immediate goat surgery to save its bleating little life. So they've put the goat under, and Kelly has his hands somewhere within the goat's entrails, and Joe is about to administer some sort of goat drug to do some sort of goat thing when suddenly Kelly has what can only be described as a veterinary version of an LSD flashback. "Wait!” he cries to Joe, who is busily keeping the goat asleep with anesthetic gases and chewed up tin cans and soothing goat noises and such. "Don't give that drug!” Whereupon Joe replies calmly, holding up an uncapped syringe, "Don't worry Kelly. I just remembered my animal physiology."

That was it for me. I can save people and goats, too. If the people didn't make it, I could still have food. And in retrospect, I got my initials. I became a Fellow of the American College of Emergency Physicians, or FACEP. That is, until I got tired of paying over $700 each year for the initials that nobody asked about, and when I realized they were best pronounced in a rhyme with “duck up.”

So with all this being said, what’s the main reason people go into, or stay, in emergency medicine? I think the bottom line is that emergency medicine is fun. We have the wildest stories, the closest sense of family, the highest highs and the lowest lows, the most food per capita of anyone in the hospital, and more laughs per hour than an episode of “Scrubs.” It’s like being in a perpetual amusement park. Sure, you spend a lot of time waiting in line for the fun, but the ride at the end of the queue is worth it. The risk of barfing when it gets too fast or twisted adds excitement and mystery. And always stay away from the deep fried Pepsi.

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