Wednesday, December 30, 2015

War(d) Buddies

I love movies and have always been inspired by the stories and characters. I should claim to be more guided by the great works of literature and religion, but that would not be true. War buddy movies have been a popular genre for decades and I was always drawn to the emotional bonding between the characters, especially when the bullets were flying and the situation seemed hopeless. The emerging friendships always seemed to transcend the predicament. Despite the dangers, I usually felt a desire to be embroiled in the same trenched warfare.

Many years ago, after a tumultuous year as an intern in Internal Medicine, where I had no help, few friends and many bad outcomes, I traveled from New York back to Florida to begin my Neurology residency. The transition from being an intern in one discipline, where I eventually gained some level of competency, to a resident in another, where I had forgotten the little I had learned as a med student, was a point of great concern. To make this monumental move from a Friday in New York to the following Monday in Florida was an additional challenge. The two hour plane ticket and the twenty four hour train ticket were identical in price. I chose the latter, feeling the geographic perspective would some how mitigate the professional chasm. With nothing to do on the train and no one to talk to, I manage to read the entire textbook Stupor and Coma by the famous Cornell neurologists Plum and Poser. This was somewhat helpful, but I still had a long way to go. I felt like one of our soldiers must have felt on the eve of D-Day heading towards Normandy. When the residency started, no one was actually shooting, but there were many potential causalities and metaphoric mine fields to negotiate. I needed a buddy.

Each in-patient Neurology Service in Gainesville was set up with two residents. The attending physicians provided some help at one of the hospitals and very little help at the other. Each resident rotated the duties of speaking to the referring physicians and arranging admissions, which generally involved arduous follow up care on these complicated patients. There was a finite amount of  work and the split was somewhat arbitrary. We had very little exposure to benign outpatient cases. We dealt almost exclusively with the very sick. Several residents in my program were famous for shirking their responsibilities and adding to their partner's workload.

I got along fairly well with everyone and even tolerated the few who did not pull their share of the weight. I did developed a very special relationship with a fellow resident named Ed, who started the same year as I did. We had completed our Internal Medicine training at separate locations and had never met, but found ourselves thrown together for the three year stint. We worked together on the wards many months throughout our stay in Gainesville. When this occurred, each of us tried to do 55% of the work. I always had the feeling, (as I expect he did) we had each other's back. We rounded together every morning on all the patients and took great care to go over each patient's physical findings and imaging studies, consistently providing constructive advice to one another. Though appreciative of specific advice he gave me, the fact I knew he was also " on the case" was critically important as it ameliorated the lonely, scary feeling of accepting total responsibility. I loved him for that. This was my first real 'Ward' buddy.

Now, thirty five years later, in my medical school faculty teaching duties with the first and second year students in basic sciences, I am encouraged to introduce some clinical issues to help the students grasp the subject matter. Often I find myself saying:
          "My friend the Eye doctor says.." or
          " My friend, the Sleep doctor says..".
Not surprisingly, these two guys are my main cycling partners. When not in the office and on our long rides we have plenty of time to share ideas and stories. Though neither has taught at our medical school, both are now well known there. The Sleep doc, Chuck, is also my 'sous chef ' when cooking pizza in the backyard. Since leaving our Neurology group ten years ago, he has built a very successful Sleep practice. I wish him continued professional success of course, but if at some point in the future there was a major technology breakthrough obviating the need for docs in the sleep world, I would not be too disappointed. I am confident I could talk him into joining me at the hospital. He always did like the intense stuff. We could then finish it out as we started, making rounds every morning with a good friend we totally trust, going over each other's cases in a meaningful and constructive manner, then off to do the individual consults. Just like in the movies.

I have come to see life as a set of concentric circles. The outside circle is the classic dust to dust for which I am prepared. Within that circle is the fetal position as an infant to the fetal position as a demented old person, which we all fear, Within that circle, potentially another, just as natural and for me, most desirable: 'Ward' buddies working together on intense cases at the beginning of our residencies, to 'War(d)' buddies decades later. In the same war. Just old soldiers.

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