Family medicine, your quintessential primary care doctor, the “I’m going to get a check-up at the doctor’s” doctor. Here’s a snippet of my day as a family medicine student doctor.
It’s 5:15am, another new day, another round. It is supposed to be the most still, quietest part of the day. Despite multiple people telling me I would start drinking coffee in medical school, I’ve defied them. Instead, I down copious amounts of green and black tea in the morning, because despite the silence of the early morning it is my most frantic part of the day, trying to leave early to beat rush hour traffic and trying to remember to brush my teeth. Even the crickets outside and our psychotic dogs know this ungodly hour is best for sleeping, not for gathering up my half-used pocket-sized notebooks and pens and wallet and stethoscope and mints and melted chapstick and skills log and flash drive and phone and cheat sheet drug guide into the pockets of my stubby little white coat (to my readers who are familiar with Harry Potter––you know Hermione’s never-ending purse that is the size of a tiny knapsack and yet it holds books and all that wizardy junk? I covet it tremendously).
Back to the present, it’s about 8:00am; the beginning of clinic. In the past weeks I’ve learned that family medicine not only calls for thorough medical knowledge, but also for emotional stamina. In the past four weeks on my rotation here, I have helped with the care of suicidal patients, newly-pregnant patients (I got to tell a young woman that her pregnancy test was positive!), bulimic, anorexic, and morbidly obese patients, immigrants from all sorts of longitudes and latitudes, and approximately seventy bazillion frustrated diabetic patients. I am not exaggerating when I say that at the very least every other day a patients breaks down in tears during the appointment, sometimes over a recent miscarriage, a boyfriend’s infidelity, or from unrelenting chronic pain. There is no happy median for dealing with emotional issues––if you stay distant and removed, you alienate and discourage the patient; if you come closer and put yourself in their shoes, you will eventually deal with the same emotions yourself. The middle ground of just enough emotional involvement with just enough distance from the patient’s issues is pretty shabby still, in my opinion.
It’s about 2:30pm. I’m back at Glendale Adventist clinic, just returned from lunch. One of the lessons I’ve quickly learned is that if you’re toting around an ethnic last name, like, oh, I dunno, say an Armenian last name, in a location where Armenians tend to congregate and rapidly multiply, it is to your advantage that you SPEAK ARMENIAN FLUENTLY. Please understand that when I write in all caps, this means that I am shouting this advice to you at the top of my voice. Unfortunately, I learned this lesson a few decades too late. Several times a week I am chided for not speaking what apparently Glendaleians consider the language of God, Armenian. The shame and rants and curses (okay, slight hyperbole perhaps) alternate between falling on me and on my dad (the source of these surname issues), if I’m cowardly enough to blame it on him for not teaching me. Thankfully, I usually just bite my tongue for the first few seconds and then lapse into apathy as I am again reminded that I have somehow failed my ancestors as well as my unborn descendants. My appetite for lahmajune and kufta is ever-present, and my backgammon game is improving daily, so I think that makes up somewhat for my lack of Armenianness. But, there is still a twinge of desire to better fit into this unique and tightly knit culture.
It’s 5:00pm, and the day is done, and I’m about to sit in traffic on my way home. L.A.’s smog and random summer humidity actually makes for some of the most beautiful sunsets. The worse the smog, the more brilliant the sky’s last colors. In juxtaposition to the morning, now my rush hour environment is hectic but somehow I am at peace and able to think during the commute home. Today a 50-something year old patient told me that she was ready to die, and was sick and tired with having to deal with the death of immediate family and very close friends, and no longer wanted to closely manage her heart disease. How do I respond to that? Some sort of every-cloud-has-a-silver-lining spiel? Anything at this point would’ve been too cliche, so I did my best to sit back and listen to her talk. Although I said very little, after she finished talking she decided to refill her heart meds and see a counselor. Being naturally introverted, there is always the concern that I come off aloof or snobbish, but in hindsight of today, I realize that being quiet was one of the most impactful parts of my day.
In summary: expect emotional involvement with your patients, learn Armenian, and don’t talk if you don’t have to.
Yummy treats: lahmajune––basically, Armenian pizza. And kufta, Armenian meatballs––super tasty!