Why Doctors Should Be English Majors

In early May, I was lucky enough to receive an invitation to see a production of “The Tempest”, by the Hobart Shakespeareans, a fifth grade class led by renowned elementary school teacher Rafe Esquith.  The production was scored, lit, set and acted by inner city ten year olds who, lacking funds for elaborate Elizabethan garb, all wore the same T-shirt emblazoned by an image of William Shakespeare, with the simple slogan “Will Power.”  I wrote about my experience in the blog piece “Such Stuff as Dreams Are Made On.”  Two weeks ago, an op-ed piece by Verlyn Klinkenborg in the New York Times decried “The Decline and Fall of the English Major: http://www.nytimes.com/2013/06/23/opinion/sunday/the-decline-and-fall-of-the-english-major.html?ref=opinionHYPERLINK   As I read it, I reflected on my own experience in medical school and beyond, and I think that Mr. Klinkenborg’s message is one that medical school admissions committees should be hearing loud and clear.

Despite the fact that doctors are faced with increasing mounds of paperwork and decreasing autonomy, medical school admissions are as competitive as ever. All handwringing about the state of the profession aside, young people still desperately want to be doctors.  Students who would vie for a coveted slot in medical school must start their resume building early in their college careers, and must complete with flying colors a standard premedical curriculum which with rare exception has not changed one iota since I applied to medical school in the fall of 1974. Students who major in the basic sciences—biology, chemistry and physics—have an advantage in the race for med school admission because they typically outperform other majors in their MCAT scores and because their majors allow them to get a leg up in scientific research.  In many cases, college students who are science majors apply for medical school with first author publications listed on their curriculum vitae.  And at the end of medical school, students who have taken the time to obtain a dual MD-PhD degree are the ones who are most competitive for those coveted specialties of dermatology, plastic surgery, orthopedic surgery and radiation oncology where the prize at the end of the road is a controllable “lifestyle” combined with high reimbursement.

But even in the rarified world of first author scientific publications in peer reviewed journals, there is that moment of truth, when push comes to shove, and a group of editors must decide whether to publish the paper of one author, or someone else’s.  No matter how brilliant the tables and graphs, in the end that decision will be made on how well the author EXPLAINED the data, how compelling was the argument, and how explicitly the new data informs both the reader and the greater body of work on the subject.  In the end, this is where those former English, and history, and philosophy majors shine, and surpass their basic science background colleagues.  Just ask Dr. Harold Varmus, the current director of the National Cancer Institute, Nobel Laureate, and possessor of both undergraduate and graduate degrees in English from Harvard.

This week I worked with an excellent medical student.  He was bright, personable, and thorough and the patients truly enjoyed speaking with him.  We saw six or seven new patients together, and here is an example of the narrative on the physical exam on one: “ABD: SFT, sMS, NTDR, NABS, NHSM.” Say what?  For the non-MD readers out there, that means that the abdomen was soft and non-tender with no masses, abnormal bowel sounds and no enlargement of the liver or spleen. In this fast paced world of texting messaging and abbreviation, this old English major would like to see her own life history and physical exam written in English, please!   Why does this matter?  Colum McCann said it well in Let the Great World Spin:  “Literature can remind us that not all life is already written down: there are still so many stories to be told.”  Very few doctors will ever win a Nobel Prize.  But all of us should be able to tell a patient’s story, tell it well, and make sure it’s worth listening to.  After all, it could mean the difference between life and death.

You Took Your Dog’s Medicine, REALLY?

I was lecturing to a group of medical students on Tuesday –it was their first introduction to breast cancer and I was determined to make those two hours as exciting as possible.   They had just started their second year, and after the first, spent entirely learning about the “science” of medicine, they were eager to hear something of the “art”.  So when I woke up that day and my elbow was a little sore, I attributed it to a scrape I’d gotten a couple of days before.

By the time the lecture was over, and I went to the car to drive back to my main practice site, that elbow was really bothering me, so I rolled up my sleeve and had a look. “YIKES” and “OMG” do not adequately describe my reaction. What I saw did NOT make me happy.  There was a large red welt where my elbow used to be, and redness extending down towards my forearm.  So what did I do?  I stopped by the house.  Why?  Because I keep a large supply of antibiotics on hand for my dogs–a veritable pharmacy, in fact.  Metronidazole for diarrhea, Keflex for skin infections, Cipro for urinary tract infections, you name it.  I even call in prescriptions for them, as Bartley K9 Fielding, or Dusty K9 Fielding.  Or at least I did, until my pharmacy changed hands and the new pharmacist had moral objections to my practicing veterinary medicine without a license. But that’s another story.

So yes, I went home and took the dogs’ medicine.  I needed to get back to work, in a hurry. I had patients waiting.  I started with Cipro, good for most skin organisms, and off to work I went.  By the time I got home that evening, it was worse, and I sought consultation with my husband, who is also not a veterinarian, but who used to practice medicine.  He pronounced his verdict:  “Add some Keflex starting tonight!”  I was quite certain that I would be better by Wednesday morning.  I wasn’t.

Upon my arrival in the emergency room on Wednesday afternoon with my fever of 102 and my forearm the size of Popeye The Sailorman’s, the nice ER doc sat down to take my history.  He was very earnest.  He diagnosed “cellulitis”, probably staph or strep.  I told him I was a health care worker, a doctor in fact, so that he would understand what I meant when I said that because I did not want to disrupt my schedule or inconvenience my patients, I took the dogs’ medicine.  He was incredulous.  A crowd gathered to see and examine the doctor who took her dogs’ antibiotics, quite unsuccessfully but very determinedly nonetheless, because she didn’t want to take time out to actually go SEE a doctor!

Nearly three days later, I am home from the hospital.  It is always sobering to actually BE a sick person, instead of just taking care of them.  Trying to negotiate my way to the bathroom while sporting an IV pole instead of a Hermes bag as an accessory is a humbling experience.  And Jack Nicholson’s got nothing on me as far as the unintentional “rear exposure” when it comes to those delightful hospital gowns.  I hid deep under the covers and fervently hoped that none of my colleagues would feel like making a visit.  They were smart.  They did what I would have done under the same circumstances—they sent flowers!

The infectious disease consultants, the hospitalist, and the nurses (not to mention the medical students) all had a roaring good laugh retelling the story about the doctor who TOOK HER DOGS MEDICINES!  But I remain unrepentant.  For I know, that in my heart, if I had gone to my primary care doctor on Tuesday, her first response also would have been to give me Keflex or some other oral medication, and not to hook me up to an IV bag full of Vancomycin.  She just wouldn’t have called it dog medicine!

Somehow, I don’t think that this is what was meant in Luke:  4:23 which reads:  “Physician, heal thyself”.  But I probably won’t try it again.