Robert S. Rosson, MD
Copyright (C) 2002 Robert S. Rosson. All rights reserved.
I remember when I first realized I was hooked. It was 1999 and I had been a practicing gastroenterologist for 36 years. I came out of the ERCP room and caught a glimpse of myself in a mirror. Haggard and bleary-eyed, I was covered with a mixture of blood and bile. My shoulders sagged under the weight of the lead apron. “How did I get myself into this mess?” I wondered. My Mother and my psychiatrist probably knew the answer; my wife had her suspicions.
Oh, it had been thrilling at first! The G.I. bleeders, at 2 a.m., vomiting blood and enveloped in the unmistakable fragrance of melena, were a formidable challenge. Depending on what we found, we buzzed, banded, or injected with noxious chemicals. We took credit for stopping the bleeding although we knew most G.I. bleeding stopped on its own. ERCP was stimulating and worthwhile, even when one had to wait to get started while the endoscopist ahead of you took 2 hours and used 4 cannulas, 3 wires, 2 stents and still failed to get the stone out. And of course colonoscopies were always a joy; endless cavernous tunnels full of diverticula occasionally revealed a polyp to attack.
There also were the inevitable complications to rob one of sleep. The perforations, bleeds, pancreatitis and others left one looking over his shoulder for the next 2 years for the process server.
You might say I did it for the money, but that is blatantly untrue. With the squeeze on reimbursements by Medicare and the HMO’s, it was clear that one could make more by grinding patients out in the office. It was more of a silent, sneaky addiction that crept up on me forcing me to do more and more procedures at the expense of my health, sanity and personal life.
I decided to try to taper, to withdraw slowly. For the next 2 years, I cut back my hours, went off emergency call and gave up ERCP. The attempt failed. With the advent of screening colonoscopy for everyone, I found myself doing more than ever and liking them less. Finally I decided to go “cold turkey”. I retired from active practice and limited my professional activities to seeing GI consultations one morning a week and teaching medical students a second morning.
I am now a new person, freed at last from the curse of endoscopy. I have time for my family and for new non-medical pursuits. I spend an hour with my new patients, taking a thorough history and doing a complete physical examination. I realize now that this is what I enjoyed most about medical practice through the years. I welcome the chance to find out about a patient’s family, work and interests. I have rediscovered the fact that a good history makes most endoscopy, laboratory tests and imaging studies unnecessary, or at best confirmatory.
I know that I shall always be at risk to relapse. I am starting an organization called “Endanon” and invite all similarly afflicted souls to join. Meanwhile I am pleased and relieved to be out of the closet and able to tell my story.
Published originally in the Yale Journal for Humanities in Medicine on November 19, 2002.
No comments:
Post a Comment