February 2018
The hospital system’s new clinic building opened last year, and it is the pride of the organization as it boasts some of the most innovative technology. But when I come to work, I sometimes get the sense of walking into a hotel lobby rather than a place that delivers health care.
This is no more evident than when I hear a baby grand piano play as I enter the building. The music itself is not unusual. Volunteers and patients at other places I rotated often played instruments in the hall to create a therapeutic milieu—an important contribution to breaking up the monotony of the fluorescent hospital ambiance. But this was different.
The piano sits in the middle of the lobby, roped off at all sides. On the piano bench, a sign warns all passersby not to touch. And then, importantly, the piano plays itself. It strikes me as the very symbol of the disconnectedness of the healthcare system—an instrument of healing that completely lacks the human touch.
As a physician in training, I need to learn how to make my patients partners in their own care. I try to listen actively to their complaints, to work together with them to arrive at a treatment plan, and to engage each one in a thoughtful informed-consent process. Good medical care is a duet—if not a symphony—and it’s certainly not mechanized.
But when patients walk into the building, they are conditioned to be consumers of medical services. We will play music for you—don’t touch. We will do medicine to you—don’t engage. I love music, but music, like medicine, should have a human touch.
March 2018
Deep in the midst of a TKA operation, the conversation switched to a high-tech computer program. My attending asked me if I was familiar with it.
“Who me? I replied. “No way. I’m a Luddite.”
My attending stared at me blankly.
“You know, a Luddite.”
He continued his blank stare before finally stating, “No, I don’t know.”
“A Luddite. A person who is opposed to new technology. It comes from the English textile workers who destroyed machinery in the 19th century because they were afraid that skilled workers would be replaced by machines.”
The sound of the saw whirring blocked out our conversation for a moment before I uttered out a phrase I immediately regretted. “Come on, everyone knows that.”
The attending raised an eyebrow. He turned to the scrub tech. “Do you know what a Luddite is?” She shook her head no. He turned to the circulator, “Do you know what a Luddite is?”
“Nope!” the circulator replied.
The attending turned to me and dryly responded, “See, not everyone knows what a Luddite is.”
The next day, I was in clinic with the same attending. At every opportunity, he stopped various team members in clinic: other attendings, medical assistants, and nurses.
“Do you know what a Luddite is?” he asked. To a person, they did not. The attending smirked at me a smile of full satisfaction. He was right.
I thought back on my path that led me to orthopaedics. It was not the typical path. I had spent my undergraduate years indulging in a liberal arts education, devouring all the literature and history I could get my hands on, interests I enjoy to this day. Most of my friends know the definition of “luddite”, but perhaps in this world of orthopaedics, I am too different. Maybe I do not belong.
A few weeks later, I met the same attending after early morning rounds to update him on his patients and discuss their care plans. He sat in front of a computer, clearly annoyed. An error message popped up every time he stroked a key.
“Why won’t this thing work!” He implored the computer. “These ‘updates’ just make things worse. I guess I am just a Luddite.” He smiled at me.
I do belong.
April 2018
Every resident needs a lighthouse; a steadfast source of light to guide the way in turbulent waters when one is lost in the fog and in the darkness. Throughout my training, I had called on my lighthouse often. He illuminated paths forward when I thought none existed, explained which paths he thought were illusions, and celebrated with me when I had successfully made it to shore.
My lighthouse and I are alike in many ways. Both humanities majors, our conversations are peppered with Shakespearean quotes and obscure literary references. We both have a love for good narrative. He recounts stories of his life, his Southern speech cadence accented by the long Minnesota “o” revealing the bookend destinations of his extensive travels. With each story, he shares his wisdom; there are lessons of hubris and lessons of perseverance. He tells stories of a different time—of the “Internet machine” and “if you wake up in your own bed, you’re on call,” which harkens back to an era before hour restrictions. There are accounts of achievement and anecdotes of juvenile hijinks. Each story serves a purpose; to allow me to learn from the lessons of his past, to avoid his missteps, and to put my own trials into context. Experience, he says, is how we gain wisdom. I learned that life experiences, particularly the ones that are difficult, are the best opportunities for learning and growth. We talk about life and challenge one another to think critically about its meaning and to be deliberate in determining what we want our place in the world to be.
My mentor and I perhaps get along so well because we are likeminded when it comes to our thoughts about orthopaedics. We do not worship at the altar of orthopaedics. Rather, orthopaedics is the means, not an end goal in our lives. It is the vector to live a good life and a life full of meaning, as well as a life of service, leadership, integrity, humility, and intellectual curiosity. Growth, compassion, empathy, perseverance, truth, and justice are the matters of predominant concern; orthopaedics is the vehicle to achieve a life consistent with one’s values. Thus, fixing a hip fracture well is not about doing the surgery because one is an orthopaedic surgeon, but doing the surgery well to serve the patient with compassion and empathy, not only during the surgery, but also before and after. My mentor talks about a mission-based approach and how we are all on a team to put the patient first. Our jobs are no more important than those of the custodians who clean the hospital. I often see him thanking the janitors as we walk past them in the hallway; “without a clean ship,” he says, “there is nowhere to perform surgery.”
Every resident needs a lighthouse and I am lucky to have mine. I’d be sunk without him.
Footnotes
A note from the Editor-in-Chief: I am pleased to present to readers of Clinical Orthopaedics and Related Research® the next installment of “Residency Diary.” Lisa G. M. Friedman MA, MD, is a resident in the Orthopaedic Surgery Residency Program at the University of Minnesota Medical School Minneapolis, MN, USA. In this quarterly column, our readers have the chance to follow Dr. Friedman as she progresses through her residency, chronicling events and interactions that have made an impression on her.
The author certifies that neither she, nor any members of her immediate family, have any commercial associations (such as consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.
All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request.
The opinions expressed are those of the writers, and do not reflect the opinion or policy of Clinical Orthopaedics and Related Research® or The Association of Bone and Joint Surgeons®.