October More Voices: Tough Calls

Dear Pulse readers:

When I was about twenty years old and living in New York, I wandered into a men’s clothing store on Canal Street. There, an army jacket caught my eye. I liked it right away. It was stylish–in a counterculture-rebel sort of way–and I decided to try it on.

It fit perfectly.

The only problem was, it cost more than I wanted to spend.

I was caught in a bind.

Having been raised by two frugal parents, one who’d lived through the Great Depression in New York and one who’d lived through World War II in Europe, I was brought up to value thrift above almost everything else. My mom would walk four blocks to save three cents on a gallon of milk. In my dad’s business, he reused carbon paper until you could see through it.

Thrift was part of my DNA.

Still, I really did like this jacket.

I tried it on again. I put it back on its hanger. I perused some other jackets, but kept returning to this one.

I tried it on once more, checking myself out in the mirror. This was the dude I wanted to be.

I looked at the price.

I put it back.

A middle-aged, world-weary salesman, who’d been eyeing me for quite a while, finally had had enough.

He approached me and offered this assessment:

“You’re going to have a lot of trouble in life.”

Years later, when I started doing inpatient medicine as an attending physician, I would remember that salesman. My team of residents would confront me with challenging decisions on a daily basis–sometimes on a minute-to-minute basis.

“Should we change the antibiotic? It doesn’t seem to be working, but the patient has only been on it for two days.”

“We told the patient they’d be going home, but now their potassium is abnormal. Can they still go?”

“This patient with a substance-abuse history says his pain is getting worse, and he’s been asking for a narcotic since he arrived. Can we give it?”

“The CT says there’s something suspicious in the liver. They suggest an MRI. The patient wants to leave, but he’s also confused. Should we keep him against his will and make him get the MRI?”

“We could use a neuro consult on this patient, but if we ask neuro to see them, they’re going to demand a spinal tap, which none of us wants to do. Should we still call the consult?”

It was like this, day in, day out. I found it exhausting.

“You’re going to have a lot of trouble in life….”

Actually, in life I was doing okay with some pretty big decisions–marriage, career, having children.

And in my outpatient practice, making decisions gradually got easier. When it was a flip of the coin–and oftentimes when it wasn’t–I’d ask patients which option they preferred. We had time to try out one way or another. I’d see them back, and we could correct course if need be.

But whenever I was on inpatient service, with the need to make decisions fast, I felt like my twenty-year-old self in front of that army jacket, which is why I dreaded being on service.

And that is why, a few years ago, I was delighted to let go of inpatient medicine and leave those tough calls to colleagues who didn’t seem so bothered by them.

October’s More Voices theme is Tough Calls. What about you? What’s your experience of tough calls, and how did you handle them?

Share your story using this More Voices Submission Form. For more details, visit More Voices FAQs. And have a look at last month’s theme, Bedside Manner.

Remember, your health-related story should be 40-400 words. And no poetry, please.

We look forward to hearing from you!

With warm regards,

Paul Gross
Editor