Thursday, January 20, 2011

Culture Club.

"Do you really want to hurt me?
Do you really want to make me cry?
Do you really want to hurt me?
Do you really want to make me cry?"

~ Culture Club

When I was a resident, we weren't always so professional. In fact, oftentimes, we were downright unprofessional. I mean, we cared about our patients and did everything to keep them alive. But back then, pre-duty hours reform, we worked obscenely heinous hours. And on top of that, the whole "professionalism" and "humanism" movement hadn't quite hit yet. Every now and then, I remember some of the things I heard, said, or to which I didn't object--and I cringe. No--first, I shudder, and then I totally cringe.

Today, I am reflecting on knowing better and doing better.

There was a middle school kid who was emergently rushed into our Pediatric Intensive Care Unit during my PICU rotation as a second year Med/Peds resident. My team that month consisted of a third year Pediatrics senior resident, who took call with me. There was one other junior/senior team, and a nurse practitioner there that month, too. Supervising us all was our attending and a Pediatric Intensive Care Fellow.

This particular day, my team was the one on call, so we admitted that seventh grade boy.

What I remember is that he had deliberately drank a few swallows of Liquid Drano because he was mad at his mother. It unfortunately liquified his esophagus, and nearly killed him. It remains one of the most awful things I have ever seen in clinical practice.

My upper level and I cared for that child all month long. And he was so, so sick. Reconstructive surgeries. Setbacks. Total parenteral nutrition. Back to the OR. Infections. Adhesions. Back to the OR. It was terrible.

But now that I am older, I remember some other parts of that month and those times. If I close my eyes, I can even feel the culture we were in back then . . . .sigh. . . .and it wasn't always good. Humor was our pressure release valve, and we released pressure a lot that month.

Me as a second year, but this classmate, Ron C., is NOT the resident in the story!
After seeing and caring for that young man for so many days, we somehow lost our sensitivity chip. Completely. I wish I could say that I was the one who objected and that I could tell this story not as a "we" but as a "they". . . .but I can't.

It started with my senior resident. He had already been asked to be chief resident, and was considered a golden boy. I worshiped this guy, and everyone else on our team, including the attending and the fellow, thought he'd hung the moon. We were rounding one day. . . on like hospital day ten or something. . . and I can hear it like it was yesterday. We stopped in front of his room and my resident said,

"And now, for 'The Gutless Wonder.'"

My real, true recollection? Everyone laughed. Including our attending. Including me.

"No guts, no glory," my attending replied. Then he added, "Literally."

Everyone howled. Me included.

The fellow snickered and said, "Guess he won't be swallowing his pride for trying to get even with his mom!"

Bwwwahhhh haaaa!

I actually remember thinking it was cool that our attending could loosen up and poke fun with us. I thought he was the cat's pajamas for being so easygoing that he'd join in all of our (making) fun. Every day it was something new. And even he was in on it.

"How is Mr. Esophagush?" he asked one morning. Yes, the attending.

More laughter.

Every time I think of that month, I want to hang my head. How could we have been talking that way about someone who was literally on the brink of death? How could we stand in front of his mother, the mother who trusted us so much, and still say such things in her absence? How could our leaders have been talking that way?

It was terrible.

All month long, if a patient stayed with us long enough, at some point they became fair game for "witty" team jokes. Another one I continue to feel ashamed of:

"Are you down with hearing about our Downs baby?" my senior would ask each day.

(Insert collective laughter here--especially from the attending which, to a resident physician, is equivalent to high praise from a parent to a child.)


Every single day, this is how he preceded his discussion of this sweet, sweet infant girl on our service who was hospitalized with congenital heart disease as a complication of Down Syndrome. And although I can't remember if I LOL'ed as second year in 1997 or simply looked amused--what I know for sure is that I didn't protest. At all. Not even internally I didn't protest. Even as an intern without a big voice, I could have screamed at the top of my lungs on the inside.

But I never did.

Shame on me. Even in 1997, shame on me . . . . . and shame on us all.

But especially our role models. Now that I am allegedly one myself, I bristle every time I imagine myself as that attending.

That was then, yes. But it was still foul. Real, real foul. . . . .even in 1990's pre-duty hours reform, it was foul. And it's foul to this day.

"Give me time. . . . .to realize my crime. . . ."   

~ Culture Club

Today I am reflecting on the power of culture. More than that, I am reflecting on the power of role models as drivers of the culture in our learning climates. I am so happy to be a clinician educator in an era that promotes feeling and acknowledging that being tired and overworked is no excuse for being unprofessional. I'd like to think that our culture has evolved to something more empathic than walking up to the bedside of a twelve year old with a chemically decimated esophagus and who is fighting for his life, closing the door so his mom can't hear and saying, "Gutcheck!" (Bah-dump-bump!)

What about now?

Do tired learners and faculty still lose their manners? I'd say, yes. Call me naive, but I'd say it's not as bad, though. At least now we are practicing in times where you wouldn't seem like a martian for raising a red flag when someone does take a complete detour from professional behavior.

Knowing better. . . . .

Referring to somebody's beloved child or loved one as "a Downs baby" is beyond offensive. It's hurtful and rude. Furthermore, many don't even realize that the proper term is "Down Syndrome" -- named for the late physician John Langdon Down--and even saying "Downs" with an 's' is not cool.

I now know for sure that just referring to the child by their name works just fine, thank you very much.

Sigh. To every single one of those patients. . . . I deeply apologize. I know it's over a decade late, but I do. I really do.

Nowadays, my "fun" references to my patients are things more like "F.P." for favorite patient or something like that. And while I do like having that relaxed camaraderie with my own students and residents just like my PICU attending did with us, now I know enough to not try to achieve it at my patient's expense.


"When you know better, you do better."

~ Maya Angelou

Do better, man.


  1. The take home message from this post is "When you know better, you do better". I'm so glad you are the role model for the young doctors now. They will "know better" much sooner. Powerful piece, Grady Doc.

  2. Oh I hear ya on this one! Unfortunately, I've been part of "those" rounds as well. Your story reminded me of one attending, when I was still on nursing orientation. In the middle of rounds, while we were discussing an unconscious patient with a poor prognosis, the attending came up to her (7yo), with a smile "knocked" on her head and said, "anybody home yet?" as everyone proceeded to laugh. Since then she has recovered but I sincerely hope, she doesn't have any recollection of this embarrassment on our part.

  3. Forgiving ourselves is such a hard thing to do. Doing it publicly- even harder. Thank you for sharing.

  4. You are such a talented writer, not to mention doctor. I so appreciate your insightful words. I get happy when I see a new post from you :o)

  5. Thank you for these heartfelt and poignant reminders. I will be returning to this post as I go through the clinical years, then residency and beyond.


"Tell me something good. . . tell me that you like it, yeah." ~ Chaka Khan

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