And that was just Saturday

I wanted to start with something less heavy, but this is what's on my mind.

It's the muchness of medicine; the everyday drama and blood and terror and joy. It's the largest and most fundamental part of the transformation into becoming a doctor, and probably a lot of why the "callous doctor" is such a stereotype - and by that, I mean, one with a large kernel of truth.

Because that's how it works: you see every day what most people see well, never. Or once in their lifetimes. Their worst day is your Tuesday. Their best day (if you're in OB - we are lucky enough to get both sides of this particular dime) was hour 19 of your 24 hour shift.

The story I wanted to tell is not even mine. I was working with one of my colleagues, and asked her how her weekend was. Exhausting, she said. She was on call for the day and night, and was juggling a lot of patients, when she got called by a panicking emergency room. A 34 year old mentally retarded woman hadn't known she was pregnant; the question of sexual abuse remained open. She came in with abdominal pain, was miscarrying, and ended up delivering an approximately 12-week fetus on the bed.

My colleague is lovely. Warm, smart, and caring. But her immediate response to this situation was annoyance. Because, in the absence of bleeding or infection, this medical situation is the opposite of its emotional and social one. It's uncomplicated, at least in the immediate setting. It happened, there's not much to be done. Let me go about my work, because there are people upstairs who need me, who are having babies and heart attacks, and threatening to have strokes, and I'm done here.

I know. I know. It sounds terrible. In fact, the situation itself is all melodrama. There's sex, and presumed violence, and blood, and mourning. If this was a novel set in a Southern mansion, this event would be the terrible secret that the family is hiding. This would be the denoument of some awful Lifetime movie. And the doctor was...bored.

There's something about this situation, I think, that represents the difference of culture, of emotional hit between the medical and non-medical person. A difference that is bad, but also good, and I think, ultimately unavoidable. It doesn't have to lead to hardening, but I do think it has to lead to callouses, in the way of all difficult work that needs to be done well.

I said, after hearing this story: Can you imagine what you would have done if you had heard about this patient before you started training? You would have gasped, and wept. You would have had a tremendous emotional reaction, empathy, sympathy, nausea.

Yes, she said. I would have. But I wouldn't have been able to take care of her. And now I can.