25 February 2011

Harriet Lane

Emmaline has taken to walking around the house carrying a copy of the Harriet Lane Handbook: a manual for pediatric house officers. She cries when you take it away. She carefully pulls it off the shelf when you ask her to pick out a book. She flips through the graphs of normal hemoglobin values and glomerular filtration rates intently examining the pages and every once and a while exclaiming, "Oh!"

It is adorable, as is her predilection for rearranging the Tupperware in the kitchen cabinets and for offering her milk to the battered Cabbage Patch Kid from my own childhood before taking a sip of her own. When I mentioned this behavior to a friend she laughed and suggested that Emmaline would be far ahead of her classmates when it came time for her to do a residency of her own. I smiled in response but inwardly I balked. Did I want Emmaline to be a doctor?

My own parents never gave my brother or I any indication of what professions they might have dreamed for us when we were young. They managed to be excited about the things we were excited about, even if those passions fizzled and morphed over the course of a few short days or weeks. When I needed to do an experiment for my science class, my mother gave up her record player so that my crop of mung beans could spin continuously next to their motionless control counterparts. When I came home from watching a Star Trek marathon at a friend's house with a phone number to call for information on Space Camp (1-800-63-SPACE), they let me order the brochure and eventually put me on a plane to Alabama even though they could barely afford to do so.

So ultimately I know that Emmaline will choose her own path. Daryl may have a point that being a female plumber or electrician might be a choice niche market and have the added benefit of not requiring the outlay of college tuition on our part. Of course he has a point. But that doesn't stop me from telling him to shut up.

Still, if she chose medicine, would I be one hundred percent not-at-all-conflicted happy about it?

Bob, one of the techs I work with in the ER asked me last week if I like my job. The brief answer is that I do, much of the time. But the real answer is much more complicated.

When I was in college I read ahead for each of my classes. I wrote papers ahead of time in order to be able to edit them at a leisurely pace, to never feel rushed. I went to bed at a reasonable hour so as to be rested and best able to approach my work for the coming day. It felt better to be in control, to not be playing catch up.

Needless to say, I might have been more fun. I might have had more fun. But I had enough. The same was true in medical school. I worked hard. I crashed and burned on a few quizzes early on and I learned quickly what was expected.

And now I work in a job where it is never possible to entirely know what is expected. I'm sure the same is true of any job to some degree. Expectations change, deadlines shift, we have to be adaptable in order to get ahead. But Daryl, when he goes to work and stays late and finishes things early, he gets to revel in that feeling of accomplishment. There is always more work waiting, to be sure, but there are discreet tasks he can check off and pat himself on the back for powering through.

Things don't work that way in the ER. I have no way to pace myself or control my day because I never know what will be coming in the door. Even those doctors who work in offices face the same problem. A patient placed in a fifteen or twenty minute slot on their schedule may either have a few straightforward issues that can be quickly dealt with and then sent satisfied and on their way...or the patient may be a train wreck. A morning's worth of train wrecks means that other patients wait and that doctor, through absolutely no fault of his own, is stuck playing catch up. Did I mention I hate that?

I suppose this is the way things work any time you work with people instead of paper. The trade off is that I sometimes get hugs when I have finished with a patient. I doubt my husband will ever be offered such affections from the patent clerk he hands his applications over to. So yes, I might worry for Emmaline's happiness should she choose to embark upon a career in medicine twenty years from now. She will have sleepless nights on call, days when she feels she will never know enough to do the job well, moments when patients or their families will take their frustrations out on her simply because she is the bearer of bad news. I won't be able to control any of that. But I can be there to pick up the phone when she calls to talk it over. I suppose that will have to be enough.

Unless, of course, she wants to be a plumber.

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