Doing the Awful Thing

When I graduated from NP school, I had two jobs to pick from.  One offered to me in an elevator on the fly one evening as I headed to the ER for one of my last RN shifts, and the other a formal interview and vetting process.  Me, being me, went with the on the fly offer and hoped for the best.  It happened to be in neurosurgery with a doc I had done some stroke research with and was regarded as the greatest local surgeon of that time.  He was an iconic member of the medical community and the most well respected guy around.  I suppose that's why the late night elevator offer seemed perfectly reasonable.  Besides, I kinda knew the guy so that made it easier out of the gate.

I would start my eight years there with no idea what I was doing.  Dr. B patiently took me under his wing and taught me just about all there was to know about the nervous system and the various pathologies that existed under the realm of surgery.  There were disc herniations and brain tumors.  Hydrocephalus and traumatic bleeds.  As for me?  I grew to love every minute.  There is a certain order to the body's wiring that clicked perfectly with my fairly linear brain.  Besides, I had a mentor that had a love for fast cars, which went perfectly with his work life which was pedal to the metal, 100mph at all times.  Coming from an ER background, and a self proclaimed adrenaline junkie, this suited me just fine.

Over time we developed sort of a dance we did.  On surgery days, I handled the office, hospital rounds, and the ER, and he would catch up with me between cases to handle pressing things.  Those calls always went the same way.  I gave him the rundown of the day, and ultimately would present cases waiting in the ER.  Early on I tried so hard to be prepared, ready to answer any question, preferring not to get stumped by the master.  I had my facts straight, like "62 year old male anticoagulated on plavix with a right sided subdural hematoma with 4mm of shift...."

Oh yes.  I had this.  That is until he would stop me,"Amy...."

"Yes?"

He would ask,"Did you do that awful thing?"

"Um..."

He would then ever so gently say,"Go look at the patient."

I learned early on that he had been trained in an era there was no CT scan, no MRI, no fancy lasers or 3D imaging.  There was him and a patient.  Period.  He would teach me that your patient will always tell you what is wrong with them if you ask enough questions and do the right neurological exam.  The only reason to get imaging is to confirm what you already know. As he would say,"we don't treat films, we treat people."

I would come to learn that very often the patient did not look anything like the scan.  They were talking when they shouldn't be or unconscious when the studies did not necessarily support that and the studies we had were not capturing the problem.  I would also come to learn that his practice style was unique in an age where limitless imaging was available at our finger tips.  I would see other physicians ordering bunches of tests.  I asked him one time why they would do that.  He said this,"It's like this Amy.  If you fire a rifle into a tree full of birds, eventually you are going to hit something."  In other words, searching for a diagnosis without really listening to your patient.

I have been thinking a lot about this lately.  How many times do we look at our own health and get so desperate for an answer that we get wrapped up in the diet plan, the number on the scale, how fast our mile time is, counting macros and a million other measurements? I am wondering what would happen if we put down the proverbial rifle, walked away from the tree full of birds and did that awful thing of really spending time asking ourselves the hard questions to see where the root of our health failures lives.  Is it late night snacking?  Is it relying on past failures to hold us back from trying one more time?  Is it not trusting ourselves to be successful?  or a support system that really isn't all that supportive?  Only by working through these things are we able to systematically take control and figure out which of those birds in the tree it truly will take to make the changes lasting.

I have come to learn that Dr. B was right on a lot of things.  Nineteen years later I can honestly say he made me the provider I am today, and taught me a lot about life.  I was proud to call him mentor and friend.  Dr. B passed away today, leaving a hole in the hearts of thousands of patients and colleagues, not to mention his family.  Thank you for all that you taught me, RIP old friend, and I hope I continue to do you proud.  Don't forget to always drive fast and stay in your lane as the best is truly yet to come.