November 2, 2007

The Problem With One Specific Female Doctor

This is a true story that's going to offend you, I'm telling you that up front. 

This is how it goes: the pediatrics attending was attractive, no two ways about it.  That's probably not what she wanted you to notice about her but that's the way things go, you have no control over first impressions and even less over second and third impressions.  Hold tight to your identity, I sometimes say, because no one else is buying it.

In her defense, if defense is actually needed, she tried to downplay her looks. Hair in a ponytail; glasses on, long dress, white labcoat, modest shoes, little makeup, but as is the problem with some women who don't know the game, all this had the opposite effect.  You may get to choose an identity, but you can't pretend to be someone else.

She's talking to the parents of a 4 year old girl.  The kid needed an MRI because an ultrasound maybe showed something... "I'm pretty sure it is nothing, but just in case."

Well, just in case isn't just just in case, since it involves sedating to unconsciousness a four year old while her parents look on, visibly anxious, invisibly terrified.  The little girl blinks, shakes her head, eyes drift simultaneously north and southwest before she jerks herself alert-- she looks at her parents who gave her the juice and for a devastating, guilty moment the parents think that she thinks that they are trying to kill her.  And then she's down.  All this, for "nothing."

Sometimes, when a pediatrics attending at a major university hospital says "nothing," what she actually means is "partial anomalous pulmonary venous connection" which, I'll admit, to the untrained ear sounds like two different things, but praise God they are exactly the same.

"Even if that's it," she reassures them before the MRI, "it's one of the more common congenital heart defects, and it's usually associated with another, also pretty common, heart defect, called an atrial septal defect.  That's a hole in the septum between the left and right atria."  Again, reassuringly.

The father looks at her blankly.  "You're saying she could have two heart defects?"

"Well, no, they're both part of the same syndrome. "

"You're really going to have to dumb this down for me, I'm sorry."

She repeats herself.   Just slower.

"The surgery will attempt to patch the defect in the septum and redirect the pulmonary vein to the left atrium." 

"I don't follow you."

She tries to use simpler words, but in an attempt to maintain the formalism of medicine, she dumbs down the easy words.  "Defect-- it's the hole in the septum."  Obviously, this isn't what he needed clarified, because she then adds,  "redirect-- reattach."

"I still don't understand.  There's a hole in her heart?"

"Let me draw it for you."  And there, look, she draws for him an excellent drawing of the heart and vessels, with arrows showing blood flow; then scratches out part and redraws, showing what is normal and what she is worried it could be.  It's obvious it's different, anyone could see the pathology.

"But this artery is smaller--?"

"No, that's a vein, but it's ok because after the repair..."  She is frustrated, it couldn't be any clearer, what the hell is wrong with these people? 

Meanwhile I am watching in amazement.  She won't tell them what they need to know.   She wants to tell them facts, not realities.  I see her, she is pretty, really beautiful.  Distractingly pretty.   What does she look like without glasses?  Without clothes?   And then I think, why am I thinking this?  I'm a dog, I know it, but this is different, the thought "she is pretty" appears like a puzzle, a code, it means something else...

I gently lean over and say, "but what's the relevance to the girl?  What does that anomaly actually do to her?" 

The father nods, yeah, yeah, exactly-- but the attending looks at me in hostile shock.  Then her expression softens, I actually see her create and discharge the thought, "oh, he's just a psychiatrist."  She thinks I'm retarded, I know, she thinks I don't know any cardiology at all because I'm a psychiatrist, it never even occurs to her that I may be asking on behalf of the parents, because it never even occurs to her that she's not explaining herself well.   So she tells all of us, in pretend surprise relief, "oh, it just means a left to right shunt, sometimes they're asymptomatic, maybe sometimes pulmonary infections..."  Pause, staring.  "Shunt. Blood gets diverted."

After the surgery, can she run, play, swim? Hold her breath?  "Oh, sure, there's normal oxygenation."  What if she gets into a car accident, is she any more likely to rupture a reattached vessel?   Is she more prone to heart attacks in later years?  "No, no, she'll have the same risk factors for heart disease as anyone else."  She can't say it, she can't say, "no the kid will be normal" because it's not technically exactly accurate, she's a doctor, and she's careful, she's precise.  

And there are the lawyers, of course.  She always thought it was nothing, that there was no chance it was PAPVC, but the risks of sedating an otherwise asymptomatic 4 year old girl through an expensive test and putting the parents through a week of anxious hell certainly are outweighed by the risk of lawyers, right?

I notice how pretty she is again:  a secret message.  And I realize that I am seeing her as particularly attractive because she is trying not to be defined that way.   She is overcompensating with words, and since no one can understand her they are left only with what they see-- the very thing she was trying to mask.   The result is she is incomprehensible except as attractive: "...and you can tell she's really hot underneath all that..."  Take a highly technical paper and black magic marker out one sentence, people will spend more time trying to look through the magic marker than they will trying to understand the technical paper.  And if they manage to figure out the redacted sentence, it will be assume to be a proxy for the entire paper, even if it isn't.

You can't judge a book by its cover.  But if no one understands the book, they will judge it by the cover, if they bother to at all.  And if the cover is confusing also, well, forget it.

These parents need her to be real, but she can't be real, her whole professional demeanor is based on the suppression of real.

And that's the problem with this one, single, particular female doctor.  I'm not saying this is something that I've observed in other female doctors or that it doesn't happen to male doctors.  If you want to make generalizations based on this story, well, that's your own lookout.