The End is Only the Beginning

 

I'm doing family medicine at Michael Reese hospital these days, my last rotation as a medical student.  I graduate at the end of May and then start my internal medicine residency in Milwaukee in July, God willing.  While finishing medical school will be the end of formal schooling, it really is only the beginning of the intensive training process that occurs during residency.  I'm somewhat nervous about the transition, both because it is the next level of patient care and because I'll be in a new city, but I'm also looking forward to the chance to do what I've always wanted to do.  It's strange to think the moment is at hand...

 

Michael Reese is an interesting hospital.  In the past, it was a major academic center, producing physicians like Dr. Milzer who helped design an effective vaccine for polio and Drs. Pick and Lagendorf, who helped develop the EKG.  There are other big names as well, but, unfortunately, the hospital lost much of its luster when it was taken over by a for-profit hospital chain. They failed to transform Michael Reese into a profitable hospital, a model that seems inappropriate anyway for the patient population Michael Reesee serves.  They are now owned in part by Doctors Community Healthcare Corporation which partners with physicians to run the hospital.  Apparently, they have made some progress and still maintain a residency program in internal medicine.

 

The weird thing is how underutilized the hospital is, with entire floors abandoned and empty.  You can walk through and see patient rooms that haven't been used in years, where the only activity is the dust settling down on countertops and window sills.  The family medicine clinic that I'm at takes up an entire floor though we clearly do not need so much space.  One of the other med students told me that it used to be a wing of the hospital and that our exam rooms actually used to be inpatient rooms.  If they were patient rooms in the past, the rooms were likely a little snug...  

 

The physicians at Michael Reese, however, are doing a real service to the community by seeing largely uninsured patients and taking care of them.  And I'm sure the residents see more than enough interesting cases, as many patients have advanced stages of various diseases like diabetes, high blood pressure and the like.  

 

The frustrating part about working with a low-income population are the patients who simply refuse to take care of themselves.  I saw one patient, a woman in her late 40s/early 50s, who weighed over 300 pounds, total cholesterol over 300 (over 200 is bad), and blood pressure above 160/90 (called stage 2 hypertension).  She was prescribed a variety of medicines to help control her blood pressure and cholesterol but only takes one of the medicines, at half the dose prescribed.  This, despite the fact that Medicaid covers the expenses for all her medicines.  On top of all that, she smokes.  I talked to her for a while about the serious implications of her illnesses (heart attack and stroke) and tried to encourage her to take her medicines, but I have a feeling she is out there somewhere having a cigarette and eating one too many items off the dollar menu... sigh...  

 

There are, of course, many patients that do a great job of adhering to their medicines and following up with doctor visits, and those are the patients that make you feel like you're doing some good, that the struggle is worth the effort.  We certainly cannot force people to do what we think is best for them, no matter how sincere our intentions, and developing the patience and discipline to understand that is a lifelong challenge.  At least, for the likes of me...

 

On that, adieu