Super Medicine
At the Texas Medical Center doctors can rebuild your heart, give you new limbs, treat your cancer, save your children from affliction, and maybe even bring you back from the dead.
(Page 7 of 12)
He picked up a microphone. “Are you squeezing that bag good? Are you doing CPR?” He turned and resumed a conversation he was having with a friend about the sorry lot of a fire department employee whose fate it is to be an emergency medical technician. “And all the guys back at the fire station call you a gut-scooper. That’s the worst part. They say you wouldn’t make a pimple on a fireman’s ass.” He picked up the microphone again. “Keep somebody on that boy all the time, goddammit. Get that second line started.” He turned around again. “He’s dead. He’s a goner. I guarantee it.”
Indeed he was. Ten minutes later the ambulance pulled up and the driver and technician rolled the man in, pumping furiously on his chest. He went straight into one of the emergency ward’s two trauma rooms, where the residents and nurses lifted him up onto the table. Because the man had been shot in the back, there was no sign of his injury except that his abdomen was bloated from internal bleeding. A big, gray-haired black man in his fifties, he looked perfectly at peace lying there in his roomy striped boxer shorts. The third-year surgical resident, Dr. Joseph Perlman, felt his pulse and shook his head. “Nothing,” he said. “He’s DOA.”
“No, he’s not,” said one of the emergency room nurses. “He’s an ER death. If you bring ‘em in here and then pronounce ‘em, that’s supposed to be an ER death.”
“He’s DOA,” said Perlman, but when he looked at the nurse he saw a look of total bureaucratic rigidity on her face. “Okay, he’s an ER death. If that makes you happy, fine.”
“It doesn’t make me happy, but that’s what it is,” said the nurse. Somebody wheeled the dead man out and attached a tag to his big toe. The next day’s paper said he was Alfred Prescott, shot by robbers who had broken into his house, Houston’s 434th homicide victim of 1978.
By now the emergency room was jammed with patients — victims of stabbings, gunshot wounds, auto accidents. At about two in the morning, a young Mexican American named Valiente walked into the emergency room, his shirt soaked with blood. The residents led him into one of the trauma rooms and cut away his clothes to reveal a body completely covered with elaborate, beautiful tattoos. Somebody had stabbed him in a pool hall on Lyons Avenue.
Perlman gave him a local anesthetic, cut open his wound a little, and poked a gloved finger inside it. Valiente, naked, in pain, in a room full of strange people, with tubes in his arm and his penis, looked on in horror. “Hey, doc,” he said to Perlman, “do I get a chance? I need odds, man, odds.”
“The odds of your dying are real slim,” Perlman said, “but the odds you’ll need an operation are real good.”
A few minutes later another Mexican American walked in, also suffering from a stab wound, also tattooed front and back: Valiente’s brother-in-law, Evaristo. “Where’d you get those tattoos, Evaristo?” one of the nurses asked him. He rose up a little with great effort and muttered, “In college,” smirked, and sank back, exhausted, onto the table.
As the two brothers lay waiting for x-rays, another stabbing victim came in, all the way from Jacinto City, in one of the city’s ambulances. The ambulance driver followed him into the trauma room, a worried look on his face. “Um, listen, man,” the driver said to the young man, who was writhing in pain on the table, “since you’re not a resident of Jacinto City the ride’s gonna cost you thirty bucks. You want to pay now or you want me to bill you?”
With what seemed to be the last of his strength, the young man grunted, “Bill me.”
The ambulance driver shrugged apologetically and said to the assembled doctors and nurses, “I’m required to ask that.”
“One thing you have to remember,” said one of the residents, under his breath. “The zoo does not end at Hermann Park.”
That night, from 11 p.m. to 7 a.m., the emergency room saw 89 patients. Forty-two had some kind of trauma or extreme injury — 12 aggravated assaults, 12 auto accidents, 5 gunshot wounds, 9 stabbings, 3 drug overdoes, and 1 cardiac arrest. In the morning, 20 of the 89 went upstairs to the wards, admitted as patients. Two went downstairs to the county morgue, which is in Ben Taub’s basement.
If you’re not a doctor, it’s likely that you’ve never spent any time in a place like Ben Taub; that you’ve never saved someone’s life or watched someone die; that you haven’t spent years working on your feet all night as a matter of routine. Doctors are different. They are true professionals. They have genuine expertise. They train longer than anyone else. They can produce results more dramatically beneficial than anyone else, and they confront more of the side of life that most people prefer not to think about. No wonder they’re immodest and impatient with the minor concerns of most of us. They live more apart from the rest of society than other professionals, in a world with its own rules and a strong impulse toward continuity and self-preservation.
The differentness starts early. Most doctors will say they decided on medicine before adolescence, perhaps because of a trip to the hospital or the influence of an admired relative or neighbor who was a doctor. Medicine often runs in families. In any case, it’s very difficult to become a doctor if you don’t know that’s what you want to do by the end of your freshman or sophomore year in college, because the pre-med requirements are so heavy and medical school is so difficult to get into. And to decide to go pre-med is to begin the lifelong segregation from the nonmedical world. “We were all a little different in college,” says a surgeon at the medical center. “We were the kids with thick glasses. We didn’t go to football games. We didn’t go skiing.” Senior residents — having had four years of medical school and at least three of additional training — often go through a phase where they think, “My God, my old friends who aren’t doctors are out in the world, doing things, making money, and I’ve hardly been outside a hospital in years.”
During all that time, doctors are learning how hospitals and the human body work. They often come to think of social problems as insoluble, but they know they can help one person who comes to them sick. Their minds don’t run so much toward thinking about controlling costs, about health in general, or about how society works as toward making people well, one by one.
Besides patients and medicine, what the interns and residents at Ben Taub think about is how tired they are, how much more time they have to spend there, and how to avoid living this way forever. They swap horror stories and try to decide what to do with their lives as doctors — what specialty to enter and what kind of medicine to practice.
None of their options involve real financial risk or hardship. It’s virtually impossible to be a doctor and not make at least four to five times the median family income, and the chances of losing one’s livelihood are infinitesimal once the proper credentials are attained. But there are still important differences among the careers doctors can have.
There is government practice, which means working for a salary on a hospital staff. The hours are regular and there are no office or malpractice insurance worries. The pay is low for a doctor but high for a government employee — a fifty-year-old Army doctor makes about $45,000 a year. Because there is little chance to make great medical breakthroughs or to have continuing relationships with patients, the prestige is not very high.
There is academic medicine, which seems much more appealing to most residents than private practice. The private doctors that a bright young resident sees seem to him to lead dull professional lives. They seem to deal with the same simple diseases over and over while sending their really interesting cases on to specialists, to be behind on the latest medical developments, to be making no contribution to the advancement of human knowledge, and to be faced with terrible financial temptations to perform unnecessary procedures and to book patients for needless stays at the hospital. “There’s a subtle pressure over at the Medical Center,” grumbles one private Houston doctor. “Only if you stay in academic work will you be doing something important. If you open an office, you’re wasting your time.” Like a government doctor, an academic doctor makes less than most doctors and more than most professors. An assistant professor at M.D. Anderson starts at $24,000; a full professor there makes perhaps $60,000; and a senior professor at Baylor as much as $70,000. And medical school professors who are in clinical fields—surgery, for instance—split their fees with their schools according to complex, closely guarded formulas, thus making much more than professors in nonclinical fields like anatomy or cell biology.
In private practice, the money is much better. A well-established private practitioner in Houston has no trouble at all making a six-figure income. One young doctor in his last year of training as an oncologist told me that if he went with a private clinic he would make $50,000 the first year and $80,000 to $100,000 the second. A private radiologist in Houston can make from $200,000 to $300,000 a year. Denton Cooley is said to make well into seven figures. According to its 1977 federal income tax return, St. Luke’s Hospital that year paid their pathologists, Lind, Milam & Associates, $1,849,979. Out of this, of course, must come insurance premiums and overhead. Besides money, the advantages of private practice are personal contact with a loyal flock of patients over the years and less competitiveness than in academia.
My Library
