Very bad karma

Life was hard as the dirt-poor son of a poor dirt-farmer in Southern Maryland in the 60's. To this day I remember the humiliation of Farmers' Market on Saturdays, seeing all the displays of neatly stacked corn and tomatoes as we sat trying to sell our dirt.

"Why would anyone want to buy that stuff?" the other farmers would say, laughing derisively at our wheelbarrow. "Anyone can dig that up in their own backyard!"

That was a long time ago and I admit that the recollection may not have been seared into my memory with total accuracy. It's true, though, that when I graduated from college I didn't have a pre-Carter-inflation nickel to my name.

Rather than take out a loan and graduate from medical school $80,000 in debt, I applied for a military scholarship. Everyone hated the military in the 70's, and getting a full ride to medical school courtesy of the Armed Forces was easy.

After medical school the Service owned my as-of-that-time unchapped hide. Part of the arrangement was that I could do as much of my post-graduate training in the Service as I wanted without incurring more "payback" time. I did all of my training (internship, residency, and fellowship) while in uniform.

I'm proud of my training. Some of the very brightest and best doctors I've ever known were also the progeny of dirt-farmers, drawn to the military by the lure of scholarship money.

That made it insufferable when we were led to the back of the academic bus as second-class citizens and third-class doctors by the civilian training programs. I remember the humiliation of sitting in a conference at the nearby medical school (the same school that was drilling Savary dilators into peoples' chests), decked out in uniform, listening to the audience yukking it up as the Distinguished Speaker recalled his own Army days:

"My title was MD, USA which some thought meant 'medical doctor, US Army', but which I knew meant 'Many Died, U Shall Also'."

Pretty funny if you ask me.

Adversity makes us better people, or as a famous philosopher once said, "That which does not kill me only postpones the inevitable." I studied my hide off and scored in the 96th percentile in both my internal medicine and gastroenterology boards. One of my colleagues scored even higher. Screw 'em if they thought we were nitwits.

All doctors have ugly memories of their training, often centering around the ER. ER's in the military were particularly ugly. We could not charge anything for anyone coming to the ER for any reason, so there was no incentive whatsoever for people not to use it for even the most trivial of illnesses. The result was that you'd have 100 folks checking in, only one of whom needed to be there. Would you be able to figure out who he was?

One busy night at the ER, a harried intern and his attending were dealing as best they could with the onslaught. A little boy had cut his lip and was raising five sorts of Cain, screaming and crying and otherwise very loudly expressing his unhappiness with the situation.

"Let's go ahead and sedate him until we can take a few minutes to sew him back up" said the attending. "Give him some Phenergan and Demerol."

Someone with a higher level of training than internship would have realized that the attending meant for the medications to be given IM, which would be slowly absorbed into the bloodstream, rather than IV, which would reach full effect very quickly. The intern didn't realize it and gave the meds IV. As the doctors were scurrying around, the little lad was placed on a comfortable bed in the corner where he stopped breathing. It was probably twenty minutes later that he was found dead by one of the nurses.

The first I heard about this case was when I read about it in the papers. The case was quickly and quietly settled out of court for large sums of money from the government, as well it should. If you are a military physician you can't be sued, only the government that employs you. The intern won't ever have to list this on his applications for malpractice insurance.

I probably didn't sleep for three or four days after reading about this. At the time I had two beautiful daughters at about the same age. It was beyond comprehension trying to imagine the shock, the loss, the anger and grief and misery that such an occurrence would have caused a parent.

It was also beyond comprehension trying to imagine what life was like for that poor intern. In my training I had some less than stellar moments, although nothing that came close to this level of error or consequence. With any of my own blunders I would lapse into a depression, wondering each morning why I should even go into work, fearing for anyone unlucky enough to fall into my clutches. Unless the hapless physician received electroconvulsive therapy or is heavily medicated, I can tell you that not a day goes by when he thinks about the little child under his care dying in the corner of the ER thirty years ago, his parents out in the waiting room ready to take him home, his lip all sown up, stopping at the Baskin-Robbins on the way as a reward for being such a good little boy.