Scott A. Rivkees - Resident On Call: A Doctors Reflections on His First Years at Mass General

Resident On Call

Resident On Call

A Doctors Reflections on His First Years at Mass General

Scott A. Rivkees, MD

Copyright 2014 by Scott A. Rivkees, MD

ALL RIGHTS RESERVED. No part of this book may be reproduced or transmitted in any form by any means, electronic or mechanical, including photocopying and recording, or by any information storage and retrieval system, except as may be expressly permitted in writing from the publisher. Requests for permission should be addressed to Globe Pequot Press, Attn: Rights and Permissions Department, PO Box 480, Guilford, CT 06437.

Lyons Press is an imprint of Globe Pequot Press.

Project editor: Meredith Dias

Layout artist: Melissa Evarts

Library of Congress Cataloging-in-Publication Data

Rivkees, Scott A.

Resident on call : a doctors reflections on his first years at Mass General / Scott A. Rivkees.

pages cm

eISBN 978-1-4930-0828-5

1. Rivkees, Scott A. 2. Massachusetts General Hospital. 3. Residents (Medicine)United StatesBiography. 4. Residents (Medicine)Training ofUnited States. I. Title. II. Title: Doctors reflections on his first years at Mass General.

R154.R445A3 2014

610.92dc23

[B]

2013050234

These stories are based on real events. Some of these stories are described as they occurred; others are compilations of a series of real events; and others are what we imagined happened or hoped to occur. They have been modified to protect the identities and confidentiality of the individuals discussed.

This work is for Jack, Hans, Marco, Don, Steve, and Pete, who shaped my medical soul and are my eternal and special friends, even though some have passed. Most of all, this book is for the living and departed whose care was entrusted to mea special privilege for which I am indebtedand for my family, Tina, Mike, and Ben, who tolerated a life in medicine that perpetually pulled me from home.

Contents

Introduction

Reflections on the Charles

I have been at Yale for fourteen years, a professor of pediatrics at the Yale School of Medicine. I am sitting at my fake woodtop desk on a gray fall Saturday as Hurricane Irene is about to hit New Haven. I am looking out my window at an ugly tan brick research building as the rain begins. I am just about to ink a letter of offer that will make me the chairman of pediatrics at a major university.

As I grip a blue pen, I look up from my desk at a picture that has always hung in front of where I sit. It is a faded color photograph taken at a special symposium held in honor of the retiring chief of pediatric endocrinology at Massachusetts General Hospital in Boston.

I look at that picture and see good friends, some dead, some retired, some still in Boston and at Harvard, but mostly I see friends who have moved on to other universities. I close my eyes and hear the voices and laughter. I hear their admonitions and encouragement. I look at these individualsthe souls who shaped me as a physician and person.

As I am about to sign this letter of offer with joy, I know it is not I who should be holding the pen but rather they. I am their surrogate, their trainee, who over eleven yearsthree as a resident, three as a fellow, and five as a young faculty membersoaked in decades of their collective wisdom, brilliance, kind nature, discovery, good humor, and friendship.

It is their soul in my hand more than mine. It is their song to me that says, We have met our obligation to you. You now meet your obligation to the next generation.

While I think of the venerable individuals who trained me to become a physician, I think of my Boston soul mates, my fellow interns and residents in training who, like me, entered the demanding, electric, driving world of Boston and Harvard Medicine, where we struggled in earnest to become doctors. There we also struggled to cast our lives beyond the clean hospital walls. We fought the emotional exhaustion of providing complex care while brutally sleep deprived. We fought the despair following the death of our charges and encounters with child abuse. We struggled to set our identity and autonomy in a nondemocratic system of a medical apprenticeship.

And among all the wretched tribulations and stress, we found a way to see and make humor in it all. Perhaps this was because the amusement made the serious moments and tragedies fade, making our days of training, which would be otherwise unbearable, some of the greatest days of our lives.

This reflection is a memoir of the special days, the special circumstances, and the special people who made me and my young colleagues the physicians we are. Like all reflections that go back many years, some are fuzzy, some are bigger, and some are smaller than reality. Some reflections may be the outcomes and tales we were hoping for rather than what happened. Some reflections are of the grand stories told in a basement cafeteria as we huddled around plastic-top tables during our late evening meals, when we ducked out of the wards for twenty minutes of peer socialization. We chose to believe these stories were real, knowing they were perhaps not.

But these are my reflections from a special dimension in my mind, emblazoned during a special time of my lifealong the Charles River in Boston at Massachusetts General Hospital, which we affectionately and mockingly called Mans Greatest Hospital.

In this reflection, I first see myself as a young medical school graduate with an inferiority complex about having gone to a state school and now swimming against a sea of Harvard and Ivy League alumni. I see my good friend for life, Wags, who entered Mans Greatest Hospital to train in surgery and who by chance I roomed with in a rodent-infested apartment, chasing companionship and dodging heartache during our precious time off. I see Fenway Park, the Cape, and the bars in town, our essence of sanity in an insane world of disease. I see how we pondered the difficult cases and navigated a way to learn among one-upping overachievers.

I see how we prevailed over the exhaustion, the mistakes, the deaths, and the threats of disease and persons. I see how the long days and nights of training stacked on top of one another, giving us needed confidence to care for precious lives and futures.

I see the occasional arrogance of youtha consequence of our rapid promotion from student to doctor without having lived much in betweenthat could make us seem cavalier, cold, and uncaring. But this was unintentional and would be later reined in by wisdom and age.

As I reflect, I see there was no one time, neither after a tragic code nor after a case of meningitis cared for, that would make us step back and say, Now, Im a doctor. Our training never done, humbled by our perpetual inadequacy, we were made doctor only by the salutations of those who addressed us as such.

And in a flat reflection on the Charles River, I see the green beginning of my time in Bostonthe compass for my career that started like the first arc swing of a pendulum clock, the timekeeper that started the first day I pulled onto Storrow Drive.

But the emptiness of the reflection of the day I drove out of Boston for the last time, more than a decade later, the day the pendulum stopped, lingers more. That was the day I took one last over-the-shoulder glance at a reflection on the Charles, wondering if the wink I saw in the ripples of the river was real. Or was it just a duck?

First Glimpse

We were the lucky ones, the chosen ones, the overachieversall with the social delays wrought by too many years of schooling. We came to train at Mans Greatest Hospital, entering with fear and doubt and with often nervous, sometimes hopeful imagining of the days ahead that would in the end turn out to be far from reality.