Easy The Hard Way

As I noted in the first El Bloggo, I am a lazy man, but before you condemn me remember:

“Progress isn’t made by early risers. It’s made by lazy men trying to find easier ways to do something.”
-Robert A. Heinlein

In a way laziness is the story of my life. When I was in high school I put in just enough time to learn what I thought necessary to get along the track of life. There were so many things the teachers wanted us to learn. Even in that pre laptop time, I intrinsically knew that 80% of fun filled facts were proven wrong the next day and that most of “the rock-solid facts,” if needed, could be looked up in the Encyclopedia Britannica. My conclusion was that the teachers were trying to poison my mind with drivel and keep me from the important things in life: sleeping, eating, pretty girls (and trying to “cop-a-feel”), watching TV and going to the movies.

What is it that shapes a life? I think a life is ultimately sculpted by a lot of trial and error. Let me explain. In the beginning of childhood you were told to be good. No one actually defined what “good” was, but eventually your parents provided positive and negative reinforcement. Boys doing good things like leaving Mommy and Daddy alone at 5 a.m. got a cookie. Boys doing bad things like giving a little brother a Mohawk so he could be the Indian in Cowboys and Indians got a spanking.

What is it that shapes a life? Is it Einstein’s Theory of Relativity? String theory? Loop Quantum Gravity? Maybe Heisenberg’s Uncertainty Principle? (Well maybe the Uncertainty Principle helps shape a life as it might have helped the disappointment of my early sex life. What is the Uncertainty Principle? LOOK IT UP!)

Doctor Taco was sent into an environment where education was the last thing he got for his parents’ hard earned money. That was Mexico in the ‘70s. But is it so much different in the millennium? Even in the ‘80s as a young man learning medicine in Bed-Sty (LOOK IT UP!) there was a difference between the good boys from the preferred American schools on the surgical team, and the detritus who were the Gringos from Mexico. The Americans came to make rounds with the team of surgeons – a process whereby every surgical patient was examined twice a day before the surgery to show why the patient needed surgery, and then after looking for clues as to healing progress or (“shudder”) early signs of complications. Both sensory loaded processes (look at the patient, touch the patient, listen to the patient, and smell the patient – but don’t let them take off their socks… ER joke!), were an extremely important part of learning how to be a clinical doctor.

We Gringos threw ourselves into these exercises. Our only book learning was what we thought we needed to further explain what we were seeing. Lectures were dutifully dispensed by senior doctors, but very little learning occurred because the surgical team was asleep most of the time. You try staying awake after 36 hours straight in the O.R. or stabilizing a SICU (Surgical Intensive Care Unit) patient.

The Americans shackled to an American educational system were required to sit through innumerable lectures. They read the chapters, studied for the tests and when they were on the surgical ward with the rest of the team, were always in the process of needing to leave early for a lecture. Rarely did they experience the joy of being on the ward; of feeling the bulge of a hernia, the paleness of the conjunctiva due to blood loss, or of seeing a patient go into cardiac arrest from whatever calamity the day had brought. It always seemed that the amount of facts from books and lectures the Americans had to integrate should have made each of them supremely confident that they were going to win the Nobel in Medicine. But that was rarely true. Instead, they were more like the guys who finally got the hottie into bed prepped only with a book explaining where the G-spot is.

So who was the laziest academically: The Americans or the Gringos?
Definitely the Gringos. As a whole we took the easy way out. We lived our lives with joy, learning by living within the context of our patients. Most of us on rotation spent 120 hours a week living our patient’s health problems. Who had time to crack a book, collect data, or prepare learned talks? We lived the high points and low points of Mrs. Schwartz’s amputated diabetic foot. We met her daughters (“I have a beautiful daughter I want you to meet Dr. Taco”) and saw the sugar-laden cake the family snuck in, or the incomprehension family members had with medical instructions. This was our life, along with senior doctors, nurses, attendants,
and even the janitorial staff. The only part of our lives not dedicated to the patients was the occasional locking of the “on-call room” door for the exchange of bodily fluids with a willing nurse (yeah, really TV-esque, but so true to life in the ’70s and ’80s).

The Americans had it much harder. They needed to attend lectures, be quizzed in auditoriums before teachers and their peers, cram for pre-boards, get high scores for good residencies (in nice hospitals in clean and safe suburbs), work up a research paper to present to the American College of Surgeons meetings, kiss the Dean’s ass… Any one of the above tasks not completed was BAD for a career. When the American screwed up he was made to wear a dunce cap and sit in the corner, shunned by the medical system until he served his sentence.

When a Gringo screwed up (screw-ups are part of the educational process and teach the student “not to do that again.” Just try not to kill too many patients in the process), his team was there with support; because when you live a life, you know it is trial and error. Medicine is an art and an inaccurate science.
(Any doctor who tells you otherwise jerks off to pictures in an anatomy book.)

So kids that want to become doctors, remember; live life, enjoy the day and take some time to be lazy. Your patients will be healthier for it.