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HOUSE CALLS: 'Greener Pastures'

Kennebec Journal Staff

A surgeon sat sipping coffee in the operating room lounge of a metropolitan hospital. Mask around her neck, cap still covering her red hair, she shifted her weary body to gaze out the smog-stained windows. She lifted her legs to the chair adjacent and watched the street-wise pigeons nesting under the eaves of the hospital roof, losing herself in thought. Was she wasting her time here? Was all this just a colossal squander? Was this the way her life was meant to be: a 60-hour week, week after week, diverting the flow of blood around the dietary excesses of another? Was she really happy with these huge sums of money, earning more than she could ever hope to have the time to spend? Must she endure this peculiar kind of boredom, performing what had now become, for her, a simple surgical procedure? Shouldn't she instead be in the trenches, using her surgical skills to help those who really had need of them?

How remote she seemed from the ideals of first-year of medical school. She pictured herself in her dream of a more meaningful life, in a busy emergency department somewhere, anywhere, where she could really practice her art.

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A surgeon leaned far back in his swivel chair, utterly exhausted. Incompleted records lay strewn all about his charting desk, and his half-finished coffee, his fifth cup, stood next to him. More patients were entering through the automatic doors every minute. He summoned the strength to continue. He half-turned to watch the house-staff and nurses hurrying about. He saw two nurses help another wretch to the suturing room, a disheveled drunk with soiled clothes and a jagged scalp laceration. For the ten-thousandth time he would find a frightened medical student, sit him on a stool and guide shaking hands through the mechanics of interrupted mattress sutures.

Was this what it was all about? Was this a proper use of his talents, of all those years of training? Was he forever doomed to knit the scalps and prod the bellies of the indigent, patching here and there, so they could abuse themselves all over again? What had happened to the glamour of the moment, the electric excitement of the emergency department? Why did he feel cheated, as though he were letting someone down? Might he not be far better off, and doing far more good, out on the front lines? In rural America he could deliver his gifts, his surgical skills, to real people, in proper, God-intended fashion. Wasn't it time for a change? He gazed out of the hospital windows, at the lines of traffic dragging by in the rain, and dreamed of life as a surgeon in some country hospital, wherever it was he was needed.

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Two layers of subcutaneous Dexon, then the subcuticulars, and she would be done. Another gallbladder out. The surgeon glanced at the OR clock and continued suturing. She thought of her packed office, of the waiting patients for whom she was already late. More gallbladders to remove, together with assorted moles and wens, a diverticular colon or two, and always the spastic bowels -- far too many of those. Five major cases today. A chance to cut is a chance to cure. Sure. Another late day, another late supper, her kids already in bed, her journals unread and the glossy magazines and unopened novels taunting her. A too-quiet husband withdrawn.

She finished her case, dictated the note and went out into the courtyard of the small country hospital. Her patients could wait. She watched the jays at the feeder and thought of her college roommate in Dahomey. Shouldn't she pack up, bag and baggage, move her family and settle there? Wouldn't that be the place to practice surgery, to deliver medicine to those who really needed her skills? She could teach again, and teach those eager to learn. That would be the greatest good for the greatest number. That would be doctoring as it is meant to be. Wasn't that the real meaning of the Oath, to practice medicine in a place like Dahomey? How could there be any meaning in this endless procession of patient visits with their endless lists of minor complaints? Shouldn't she be going where she was needed?

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The doctor sat at the makeshift table, partially shielded by a staked tarp from the hot Niger sun. Before him stretched the long line of Kanuri children, waiting for their sulfonamide drops. Both he and his nurse knew they would run out of drops more quickly than they would ever run out of children with trachoma. The doctor waited for the next child to be brought to the tent. Absentmindedly, he watched a hammerkop wade in the shallows of the muddy stream. Tomorrow he would be in Loga, and after that, Madaoua, and Agadez, and then the long, long trek to Chirfa. And always, he would pray that politics had not intercepted his medicines, preventing him from treating at least some of these children.

But what of malaria, and of trypanosomiasis? What of leishmaniasis? Who would treat those?

Here he was, spending sixteen hours a day either treating, or travelling to treat, these children with trachoma. The arrival of a case of sulfonamides was a major miracle here. How could he ever find proper medicines for the rampant infectious diseases he saw everywhere. How little he had to work with! There he would see a child with appendicitis, long for his scalpel and some decent anesthesia, and know that that child would die. And here, a child with Burkitt's, so simple to cure in other places, so doomed to die here in Niger.

He recalled his residency days in the great American hospital. The facilities! The equipment! The technologies available to guide the doctor in treatment! Even if he had a microscope! A microscope could tell him which patient had vivax and which falciparum. And in America he would have at his fingertips a whole host of drugs to treat them.

Was his trachoma-fight simply an exercise in futility? Wasn't trachoma, after all, more a social problem, a political problem better left to the politicians? What business had he, a doctor, travelling the length and breadth of this scorched country, treating the same children year after year, children who, out of ignorance, reinfected themselves? Would he not be better off in a Western hospital where he could be a proper doctor? Wouldn't that be a happy time! How lucky were those doctors there. How lucky!

This story is from Bedside: The Art of Medicine by Michael A. LaCombe,

published by University of Maine Press.

Michael A. LaCombe is a cardiologist at MaineGeneral Medical Center. E-mail questions to: housecalls@mainegeneral.org