Healer’s Choice
Michael Costello
Healer’s Choice
Copyright © 2014 by Michael Costello.
All rights reserved. No part of this book may be used or reproduced in any manner without written permission except in the case of brief quotations embodied in critical articles or reviews.
This is a work of fiction. All of the characters and events portrayed in this novel, while entirely plausible and medically intended to be possible, are not real.
To those young people who would be healers—students of medicine, nursing, physical therapy, chiropractic and pharmacy. To those would seek to teach them. To those who love them as family and those who fall in love with them.
Contents
Chapter 1
Chapter 2
Chapter 3
Chapter 4
Chapter 5
Chapter 6
Chapter 7
Chapter 8
Chapter 9
Chapter 10
Chapter 11
Chapter 12
Chapter 13
Chapter 14
Chapter 15
Chapter 16
Chapter 17
Chapter 18
Chapter 19
Chapter 20
Chapter 21
Chapter 22
Chapter 23
Chapter 24
Chapter 25
Chapter 26
Chapter 27
Chapter 28
Chapter 29
Chapter 30
Chapter 31
Chapter 32
Chapter 33
Chapter 34
Chapter 35
Chapter 36
Chapter 37
Chapter 38
Chapter 39
Chapter 40
Chapter 41
Chapter 42
Chapter 43
Chapter 44
Chapter 45
Chapter 46
Chapter 47
Chapter 48
Chapter 49
Chapter 50
Notes and Acknowledgements
“In large part, we are teachers precisely because we remember what it was like to be a student. Someone inspired us. Someone influenced us. Or someone hurt us. And we’ve channeled that joy (or pain) into our own unique philosophies on life and learning and we’re always looking for an opportunity to share them—with each other, our students, parents, or in our communities.”
―Tucker Elliot
Chapter 1
My abuela always told me that gambling was risky and that by engaging in it there might be unforeseen life-altering consequences.
I’m not sure about the risky part but she couldn’t have been more right about the consequences.
My name is Carlos Ramon Sanchez y Vega and here is my story:
Abuela’s warning was the farthest thing from my mind as three of my fellow students and I took a rare break at the start of our fourth year of medical school. Poker was a great way to relax because you could play for thirty minutes or three hours, you couldn’t lose much money (twenty five cents maximum bet and no more than three raises per card) and we spent much of the time discussing erudite intellectual matters like girls, sports and…did I mention girls?
It would not be an exaggeration to say that this poker group featured some of the stud members of our class at Midcentral State University College of Medicine. At my left, Tyler Fitzhugh Simmons IV came from a long line of high-profile doctors. I think there are actual cave paintings with one of his ancient blond-haired blue-eyed ancestors performing a Paleolithic surgical procedure and driving the primitive equivalent of a Lexus. Tyler went to Yale and had Hopkins medical school in his sights but he became infatuated with a very hot classmate and his grades slipped quite a bit. He was waitlisted initially at Midcentral but finally got the call and spent every waking moment since convincing everyone that he was a Simmons, by God, and he was going to be the best neurosurgeon since Ben Carson.
At my right sat Gomedalu Adeyei. “Gomey” was from Africa and was barely visible behind the enormous stack of quarters that he seemed to amass at every game. He absorbed information like one of those infomercial sponge mops but more importantly could apply everything he learned so quickly that I think the professors stayed up late at night trying to stump him—and rarely succeeded. At well over six feet tall with studiously handsome features, Gomey was enormously popular, was elected class president and eventually wanted to do transplant surgery.
Across the table was Courtney Schwartz. Courtney did undergrad at Amherst and expected to go to one of the big gun medical schools like U Penn in her home state, but her dad died after a long and very expensive illness and the funds dried up so she wound up at Midcentral to avoid deep debt. As with so many women I had met in medicine, she was very attractive but didn’t want to let you know it. Courtney had perfected the art of wearing the least flattering glasses, clothing and make-up possible and even adopted postures and expressions which continuously broadcast the message, “I am a serious professional, boys, get any other thought completely out of your heads.” At this, she had considerable success. In her academic work, she was a laser beam. Courtney was the nuts and bolts blood-and-guts type in the group and she was bound and determined to be an orthopedic surgeon specializing in joint replacement.
It was Courtney who, after raising the bet on what appeared at best three of a kind, asked the big question, “So, Vega, what rotations have you planned for this year?”
“Schwartz, you need to learn to bluff better,” I chided her as I called her raise. “Actually, I am doing Neurosurg at Mayo, Emergency Medicine at Georgetown, Plastic Surgery at Hopkins, Orthopedics here at Midcentral and Trauma at Metro Health.”
Tyler called her bet, then reminded me with undisguised sarcasm, “Hey Vega, don’t forget about the highlight of your fourth year, the best two months of your life, Excitement City…”
“Oh grow up, Simmons, it’s called Family and Community Medicine and in case you forgot, it’s a requirement for graduation at our fair university so we all have to complete it”.
Gomey folded his cards which meant he probably had a straight flush but just didn’t want to show off. “I have heard there is one preceptor for that rotation who isn’t a complete waste of time…”
“Oh sure,” I interrupted, “I’ve heard about that guy…what’s his name? Greco? Isn’t he retired and or more likely fossilized yet?”
Schwartz showed her cards, “You’re all calling me---can anyone beat four jacks? Actually, Greco is still precepting and I’ve heard he’s decent. Why don’t you sign up for his rotation, Vega? Or are you afraid you might get too tempted by wiping runny noses and holding old ladies’ hands for the rest of your career when he talks you into taking over his practice in family medicine?”
I only had a ten high straight in my hand. So not only was this woman taking my very valuable loose change, she was questioning my honor. There was no way some small-town rinky-dink family doc was going to talk me out of my dream of a career in something heroic like trauma surgery. I could still remember the day I decided to be a doctor. I was volunteering at my local hospital and one of the oncologists who knew my Dad offered to let me “shadow” him for a day. We saw one little girl who was finally turning the corner after a number of rounds of really nasty chemotherapy for her leukemia. She had seen so many doctors and nurses that she didn’t know who was who. She looked up at me from her bed and said, “Are you the doctor who saved my life?” As I blinked back tears, I told her I wasn’t, but I vowed then and there that someday, I would be someone who could.
But I didn’t know any heroes in the nose-wiping business.
“Okay Schwartz. I accept yo
ur challenge. I will call Greco tomorrow. And on Match Day you will all eat my dust when I accept a position at a more prestigious residency than any of you clowns could even dream about—and no hand-holding will be involved!”
Chapter 2
And so it was that at the start of my fourth year of med school, I found myself driving into the foothills of central Maryland to a small city to spend two months with Albert Greco, M.D. Dr. Greco was sixty-five years old and my hastily compiled brief dossier (based on interviews from students who worked with him previously) was as follows: Reasonably smart guy who knows something about all facets of medicine but can’t (or won’t) use electronic medical records. Went to Swarthmore undergrad graduating summa cum laude, got his M.D. from Midcentral State U Med School, did family practice internship and residency then served in the Army for a few years and then practiced family medicine ever since in the same town.
Now as I pulled into the parking lot of his modest office, I was figuring the old guy was probably something in the early Pleistocene period, but by now my knowledge base should pretty much allow me to academically run circles around him. I mean, how could he possibly keep up with even the basics of internal medicine, pediatrics, gynecology, orthopedics, dermatology and geriatrics much less the more in-depth specialties like cardiology, infectious diseases and so on?
Unfortunately, my first day had a rough start. As I finished navigating my way to his office, my attention was glued to my GPS instead of the ancient Honda Civic in his parking lot and sure enough I rear-ended the vehicle. Fortunately, I was only going about 3 MPH and the damage to both cars was minimal. I was more embarrassed than anything else to have started the day with a collision with one of the doctor’s patients. All I could think of was, “wouldn’t it have been awful if I had hit one of the doctor’s cars?” But of course a physician’s ride would be a BMW or Infiniti or something, right? The car I hit was clearly owned by someone of more modest means.
At that point, I saw the driver was a distinguished older gentleman who seemed neither impoverished nor wealthy and was plainly dressed and not the slightest bit intimidating. I started to chuckle to myself as I realized there was nothing to worry about. I had a simple fender-bender with a nice senior citizen who did not seem prone to road rage. What possible consequences could this simple lapse in concentration have?
The driver of the car got out and was remarkably calm. We exchanged insurance information and everything was going well until with a start and a sinking feeling I recognized the name on the insurance card:
Albert J. Greco, M.D.
Chapter 3
I waited in Dr. Greco’s office while he made us both a cup of coffee. I was convinced that my promising career in medicine was coming to a premature and humiliating end. He returned with the file from my first 3 years of school and studied it intently.
“It says here that you have top grades in every course and rotation since you got to Midcentral,” he noted, “Good thing they don’t have a driver’s education rotation,” he added with a twinkle in his eye.
“Uh, yes sir, I placed out of that,” I tried to joke back.
“Well, this rotation is a little different than what you’ve had up until now. I don’t expect to convince you to choose family medicine as a career. I do expect you to learn how to diagnose and treat patients with your eyes and ears and hands as much as with lab tests and CT scans. I also expect you to learn that gaining a patient’s trust is as powerful a tool in healing as any medicine or surgery. I expect you to respect a patient’s choices even when they wouldn’t be the ones you would make. Finally, I want you to learn that it isn’t what you don’t know that can trip you up in medicine, but what you don’t know that you don’t know”.
Wow. “Okay, Sir, I can handle that,” I ventured.
“Great”, he replied, “here’s our schedule. At 6:30 AM we meet at the newborn nursery at Memorial Hospital to see any babies. By 7:30 AM we arrive back here at the office to review morning lab and imaging results like xrays, CT scans, ultrasounds and so on. At 8:30 AM the first patient arrives. You will see some patients with me in the beginning. Once you see how our office operates, you will interview and examine some patients then present them to me and tell me what you think is wrong and what you propose in terms of testing and treatment. We eat lunch from 12:30 to 1:30PM although much of that time will be spent reviewing phone messages that have accumulated while we were seeing patients. From 1:30PM until 4:30PM we will continue to see patients. From 4:30PM until about 6PM we will review the afternoon phone messages, labs and xrays etc. All patients will be advised that you are a doctor-in-training and asked if they mind seeing a student doctor under my supervision. Any questions?”
“No sir”, I replied.
“Alright then,” Dr. Greco said approvingly. “Here is your ID card for the rotation. You will notice it has the same photo as your med school ID and is labeled ‘Dr. Vega Physician in Training’. I have lots of students that come through here and my patients know what that means. You will be addressed as ‘Dr. Vega’ because I want you to understand that you are a part of the team and not just an observer. Is that clear?”
“Absolutely.”
“Good. Now that the ‘bumper cars’ and introductory portions of the rotation are completed, let’s go over to the hospital to check on the newborn nursery, shall we?”
As I felt a hot red blush creep over my face yet again I wondered if I was ever going to get to live that that down…
Chapter 4
On the short drive to Memorial Hospital, Dr. Greco showed me some of the highlights of the town I would call home for the next two months. The old main street featured bustling sidewalks filled with restaurants and shops. The Civil War era town hall and even older historical buildings in the town center were nicely preserved. I was impressed with how vibrant and alive everything was. I was not so impressed with the less-than-historic Honda Civic he owned. How could this prosperous physician drive such a hunk of junk?
We parked in the garage and headed directly into the newborn nursery. Dr. Greco had explained that over time he had turned over the care of most of his hospitalized patients to specialists called hospitalists who spent 100% of their time doing inpatient care—a national trend in all but the most rural areas. He continued to see patients in the newborn nursery in order to not lose his skills with younger patients. As for me, I had done a required pediatric rotation as a third year medical student but our experience was very high-tech and therefore was centered on the neonatal intensive care unit where the babies were very sick or premature. I think I examined one or two normal newborns for about five minutes before being hustled off to a 500 gram infant that I could barely recognize for all the monitors, tubes and IV’s attached to it.
I was very relieved to have what I anticipated would be an idyllic experience with a normal newborn and his or her mother. I expected to walk into a pink wallpapered hospital room filled with flowers and balloons overseen by a proud beaming mother holding a sleeping peaceful infant with harp music in the background watched over by an ecstatic father maniacally snapping an endless series of photographs.
Well, that didn’t exactly happen.
We were greeted by a very no-nonsense nurse with a furrowed brow who said in a concerned voice, “Dr. Greco, you’re going to have to have a word with Mr. and Mrs. Katz. They are not adjusting well, if you know what I mean.
We entered the exam room after reviewing the records, scrubbing and gowning to see a red faced newborn at full screaming volume and two terrified parents.
Dr. Greco strode into the room and said, “Hello Mr. and Mrs. Katz. So good to see you again. This is student Doctor Vega. Congratulations on your new addition. What is her name?”
“Dr. Greco, I am so glad you’re here,” Mrs. Katz literally sobbed, “her name is Elizabeth and I am afraid I am a complete failure as a parent on the very first night!”
“Oh, Mrs. Katz, I’m sure it isn’t as bad as it seems. What makes y
ou feel that way?”
“Well, Elizabeth is our first, as you know. I have gone to all the classes and read all the books. I am absolutely determined to breast-feed. And yet she was up all night crying because she is so miserable and hungry and not getting anything. Look at her!”
I had to admit that was one angry-looking newborn. However, even with as little experience as I had, my inner voice was telling me that she wasn’t really suffering either.
Dr. Greco walked over to the bassinet and did the first of what I would later call “Greco Scans”. It was as if he was observing and processing a thousand different pieces of data just by intently looking at a patient for about 10 seconds. I had the sense he had concluded that this was not an ill infant.
Then, he casually picked up the child in a way I had never seen before. He scooped her up first in the usual way but then draped her over his right arm with her chin cupped in his palm and her cheek bones supported by his thumb and index fingers. She was literally lying over his forearm on her tummy with her legs and feet pointed toward the crook of his elbow. Dr. Greco completed the effect by gently rubbing her back with his left hand.
He was carrying her like a football.
And she had stopped crying completely. Elizabeth had her eyes wide open and was about as awake, content and alert as a newborn can be.
Everyone in the room relaxed, especially Mr. and Mrs. Katz.
“Mrs. Katz,” he said softly, “babies are designed to get absolutely nothing by mouth until your milk comes in, no matter what people tell you. She was crying as a signal to get you to nurse her again. The more you nurse—to a point—the faster your milk will come in. You should nurse her as the nurses instruct on each side. In between times, she can suck on the pacifier and be rocked and held and comforted in the way I just showed you or other ways until the next feeding in two hours. Is it possible that you won’t produce enough milk or that there will be some other barrier to breast feeding? Sure. But the great majority of the time, if you just nurse frequently and have faith in the process, you will be successful. Elizabeth is a fully mature healthy newborn.”
“But what if I can’t do it? What if I give up and feed her…dare I say it…FORMULA?”
“Then Elizabeth will grow and develop into a wonderful woman and you will feed her formula but it will remain our little secret.”