What do i want?

Yesterday something cracked.
I hopped in the car at 545 am to leave Milwaukee, got stuck in traffic in madison and ended up late to our 7 am cath conference. I walked into that old dark room in the va hospital, lights were out as they were showing an angiogram of an unknown patient on the projector. I sat down, pulled out my notebook. For some unknown reason I started to actually remove my veil of anonymity that morning, and actually started to listen to the words coming out of these doctors mouths. There was so much bantering on who was right who was wrong, what % of mortality they could expect, no! this %, no! that %, well according to the Euro Score they say this!! NO!! I have been in that cath lab for 30 years!! I KNOW BEST!! no! I know best!! Well then you do the cath, no you do it, ok i will stent that artery! WHy would you DO THAT? this is right. They went on and on about who woudl do that procedure, why that man didnt deserve to undergo surgery because of x,y,z ... I sat there, getting more and more disgusted. Hearing people crack jokes about someone else's life and suffering is not my idea of funny.

Then after walking out the conference after they had finally stopped talking I went back to my desk, and became entirely overwhelmed with emotion. What has happened to medicine? What has happened to respect? What if that man was sitting in that room? What if their family were there? Do we treat everyone as a money making incentive? A possible risk to our perfect surgical outcome score? Do we ever consider that the people were discussing at 630 am are really REAL Human beings, with lives and families, and feelings? We talk about what we think they do... sit around, smoke cigarettes, eat junk. But in reality these are real people with stories, children, grandchildren.

Medicine has changed. I generally feel that people enter it for the right reasons, well some people. Other people truly get into medicine for money, power, prestige. A precious amount really love medicine, love helping people, want to change lives, save lives--- some are idealists, altruists. But as you stay there, in the world of a festering, broken health care system you are slowly changed, at a rate that you do not notice at first, at such a slow rate that you could almost feel like a frog in a pot of water heated ever so slowly. One day you will wake up and realize that your soul is gone, your spirit is crushed, the water is boiling around you. You will wake up to find that your eyes and lips are sewn shut. You will wake up screaming. How has this happened?? How can I look back one year, and realize that it is already happening to me? Does it only happen to the people that actually do care in the beginning, the nurses, PA,NPs and doctors that enter for the right reasons, and are confronted day in and day out with profit, insurance restrictions, malpractice insurance, law suits, angry patients, violence, demands, death, life, dying, sickness. What happens if every single day it is your job to shut up and listen to others complain, listen to superiors order you around? What happens when you are not appreciated for doing the best job you can possible do, when it is never enough, when you will never swim to the top to catch your breath? What happens when youa re so overworked, that your brain cannot function anymore- when sleep is the only thing that your body aches for? What happens to your relationships then? What happens to your spirit, your soul, the bright spot in your heart that yearns for happiness. What happens to your family, your husband, your children? Do they know you? Do you know you? Do you lose track of who you really are? What happens when you are so humbled and pummeled by tragedy death and dying that you can no longer live?

When is it time to get out? When is it time to get up brush yourself off and try to walk away while you still can? I love medicine, I love helping others, I love my patients. But THAT is not all that medicine is. It is also the endless hours of paperwork, the scut work, the politics, the drama, the never ending suffering. People will die, people will suffer, you cannot help everyone, you cannot help those that do not want help. You will need to sit back and at the end of the day be able to physically and emotionally leave it behind. If you cannot do that... you will eventually see parts of yoru soul chipped away. There is too much suffering for one person to take responsibility for. Can I accept the medical system as it is? Can I afford to stay in it? Can my life, my loves, my family afford that sacrifice? Or can I change it? How will I change it? Not as a PA. For as great as our profession is, and our education is. You will always be considered part way there, never at the destination, but always half way done. You will be a physician EXTENDER. A mid-level practitioner. And as great as the actual job is. you will never be taken seriously enough to make great change. You will be respected by some, scoffed by others. You will be constantly fighting for your title. And so do I need to go back to medical school? Will I consider that now? At first I thought so. Just go back to school get yoru MD or DO and make some real change, and now I am not so sure.

Medical school is so much more than dedication and time. It is also a great sacrifice, if you want to be great. It will mean taking on 250, 000 dollars of debt, 8-12 - 16 years of intense HARD work, long long days, shorter nights. Fewer hours with family, almost no time for babies. It will be countless tests, mind numbing work, endless memorization. It will also mean getting in line, removing your name, your identity , and becoming the med student again, or the resident who sits at a desk and gets the crumbiest work of all. You get loaded down like a pack mule with all the shit work for years. You get paid less than minimum wage work 80 + hours a week, and for what? In the end you will need to work longer hours for less money. You might get lucky and be in a specialty and then you can work a little less, but not always. It will mean a lifetime of on call, weekends missed. Now, this might sound glorious to some. But I no longer want glory, power or prestige.

What do I want?