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REVIEW: Something for the Pain (One Doctor’s Account of Life and...

Dear Dr. Austin,

A dear friend of mine is a doctor. She and I graduated together over twenty years ago from UNC-Chapel Hill. I went into my profession and she headed off to medical school. Then came her internship and finally residency. The whole time she was struggling through her learning and training to become a doctor, she would occasionally moan, “I should have done what you did. I’d have a life. I’d sleep at night. I wouldn’t have to deal with patients who show up in the ER complaining that they slept crooked last night and now they have a crick in their neck.” Life’s a little better for her now that she’s an attending but the slog to get there was long and hard.

So when I read about your experiences in medical school, in training and doing your day-to-day (or evening-to-night, or night-to-morning) job in the emergency room, I had to laugh, nod and grimace as I remembered what she’d told me years ago. Yes, I know what the SCUT Monkey Manual is. I’ve laughed at the stupid things interns will do as they’re learning the actual nuts and bolts of their new profession. I’ve marveled at the fact that doctors can retain their humanity after 36 hours with almost no sleep and I’m in awe of how the good ones can still comfort their patients – even the unlovable ones – even as they try and fix what’s wrong with them. And even if it’s something the patient brought on him or herself.

I’m also in awe of your gut wrenching honesty, not only about your job and your thoughts on the patients you’ve seen, the people you work with and the situations in which you’ve found yourself, but also your personal life. I’m not sure I could open up that much of myself to total strangers to read about. Bravas to your wife for not crossing out much of what you wrote on how being an ER doctor has impacted her life. My parents are friends with my childhood pediatrician and his wife and have watched them struggle to maintain their marriage over the years. The friend who recommended this book to me used to be married to an ER doctor. Note the past tense.

Having done some shift work in my time, I can totally understand the need to sleep after working night shift. I used to get comments from people that “you must get so much done since you’re off all day.” Some of them never did truly grasp the concept that if you work all night, then you gotta sleep sometime and that time is when they think you’re happily sunning by the pool or shopping or watching daytime TV.

For anyone contemplating becoming a doctor, I think your book should be suggested reading. For anyone who’s ever sat in an ER waiting room wondering why it’s taking so damn long to be seen, here’s the answer. For an honest view of the stresses the people who work in most American emergency rooms endure, take a look here. I’m glad I did. B+

~Jayne

This book can be purchased in hardcover from Amazon or Powells. No ebook format.

Another long time reader who read romance novels in her teens, then took a long break before started back again about 15 years ago. She enjoys historical romance/fiction best, likes contemporaries, action- adventure and mysteries, will read suspense if there's no TSTL characters and is currently reading very few paranormals.

28 Comments

  1. Midknyt
    Dec 04, 2008 @ 04:22:15

    Thanks for the review. Too bad it’s not in ebook form – I’m overseas for the time being so it’ll have to wait for a while.

    Maybe it’ll help me feel better about my decision to not become a doctor, even though I wanted to since I was 5. Even though I love emergency medicine, I don’t want the life of an ER doctor. It sounds like I wasn’t too far off on that thought.

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  2. Jayne
    Dec 04, 2008 @ 07:47:42

    Midknyt, I know a lot of ER doctors go into that specialty because it’s less grinding day to day work than almost any other medical specialty. They get more pure patient care work than almost any other doctors. No office hours, rarely being oncall and just less generalized crap than their collegues. Things can get hectic and there’s little downtime during their hours of work but when they go home, that’s it.

    If becoming a doctor is what your heart is set on, then I say don’t rule it out. Talk to people. See if you can observe what really goes on in an ER. Of course if you can get your hands on a copy of this book (and bummer that there’s no ebook) then you can read all about it. ;)

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  3. Keishon
    Dec 04, 2008 @ 08:40:58

    I know when I was in college most of the people I met and became friends with were going to be a doctor. Note the past tense since they decided to do what I do, well a few. It’s never been my goal. I remember a PBS special I watched years ago, titled “So You Want To Be A Doctor” and it was pretty good. I heard that not many doctors are going into family medicine for all the reasons you stated in your review. Hey, my job_ is_ stressful but at least I get to sleep at night.

    If I see this, I’ll give it a look. Thanks for the review.

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  4. Shiloh Walker
    Dec 04, 2008 @ 10:11:45

    Now this is the type of non-fiction that I could probably get into.

    I think I’m going to add it to my list.

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  5. ruth
    Dec 04, 2008 @ 10:22:50

    What a great review and book. Would loe to read it. Your review was so well written and fabuous. My son is a first year pedatric resident and this is so true.

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  6. JulieLeto
    Dec 04, 2008 @ 10:46:13

    I have been to an emergency room twice for myself and both times, I received absolutely excellent care. Even the last time, when I spent 12 hours on a gurney in a hallway (not sick enough to be put in a room) and in miserable pain, the doctor who actually saw me was fabulous and was instrumental in my making a decision to have surgery I’d been putting off for years and years. I wish I remembered his name, but I was kind of out of it. Sounds like an interesting book and I love the cover.

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  7. Meljean
    Dec 04, 2008 @ 10:59:32

    Keishon, was that PBS special the one about Harvard medical school? Because that was the one that convinced me I didn’t want to be a doctor :-D

    Thanks PBS.

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  8. Michelle
    Dec 04, 2008 @ 11:08:52

    Hey don’t expect to have sleep through nights in Family Medicine. Most still take call, and still do the hospital rounds. I don’t mind legitimate calls, but it sure is easy to be pissed off with the call at 3 am about a problem that has been going on for several days.

    An oldie but classic is Samuel Shem’s The House of God.

    One of the worst things now is all of the paperwork, insurance crap and prior authorizations. I now hate with a keen and unabiding passion the words “needs a prior authorization”.

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  9. Keishon
    Dec 04, 2008 @ 11:45:11

    for Meljean:

    So You Want to Be a Doctor?
    In a two-hour special, NOVA follows seven aspiring doctors through four years of medical school. The first examination, the anatomy lab, the first death, the first baby-it’s all part of becoming a doctor. Neil Patrick Harris, star of ABC’s Doogie Howser, MD hosts. (Follow-up to the program 1521 “Can We Make a Better Doctor?”)
    Original broadcast date: 10/09/91
    Topic: medicine/health care & surgery

    I don’t think it mentions what medical school but that’s the one I saw.

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  10. Leah
    Dec 04, 2008 @ 12:56:36

    My husband is a general surgeon, and he often says he doesn’t want our kids to follow in his footsteps. The job pretty much owns you. Even during the weeks he’s not on call, it often seems like he is, and when he’s on call, I might not see him at all. As a dr’s wife, you always have to realize that you and the kids will never, ever come first. If you make plans, someone out there who’s been nursing an inflamed appendix for three days will finally decide that maybe, just maybe, they need to go to the ER (by which time, it’s burst). You can’t even be mad about it either–because while your plans are trashed (or your house, or your nerves), that person might DIE, so you just suck it up and go on. And as reimbursements decline and liabilities increase, it’s not like the buckets-o-money are there anymore, either. Maybe for the older guys, but not for people coming in during the last 5-10 yrs.

    So if you want to be a dr, you have to really, really want it. You’ll have to love doing your job, and love helping people. You’ll also have to be able to let it go when people die, because they will, when people sue you, because they will, and when you make a bad call, because you will. You have to be able to make hard decsions quickly, without hesitation. You have to have a great memory. You need to be able to tell the truth, regardless, and to boss people around nicely, but without any hint of being a doormat. It’s not an occupation for the sensitive, emotional, broody person.

    Oh, and DH recommends radiology (although that is often outsourced) and dermatology for lower stress, and, he says, plastics for reimbursement, because people usually have to pay for that themselves. They’ll finance larger breasts, but then not pay for an incarcerated hernia, go figure. If you love stress, go for surgery (any kind), ob, and anaesthesiology.

    It’s funny that you mention your friend’s remarks on missing her 20′s. Brett says the same thing. It’s like he thinks everyone else just ran around and had fun, dated all the time, went to parties, traveled, or whatever, instead of being broke and clueless. I keep telling him it wasn’t the funsville he imagines.

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  11. Emmy
    Dec 04, 2008 @ 12:58:09

    Having done some shift work in my time, I can totally understand the need to sleep after working night shift. I used to get comments from people that “you must get so much done since you're off all day.” Some of them never did truly grasp the concept that if you work all night, then you gotta sleep sometime and that time is when they think you're happily sunning by the pool or shopping or watching daytime TV.

    No shiyt. I work 12 hour night shifts in a hospital, but I’m *so* not a morning person, so it works out for me. Still annoys the snot out of me when people call me in the middle of the day, or the landscaper shows up late and cranks up the loudest lawnmower EVER.

    Also, I’m stuck with the retarded interns on call at night. The smart ones realize that I was resuscitating babies while they were still in high school and listen to my advice. The dumb ones end up in another career that doesn’t involve being around my patients.

    Thanks for the book rec. I have got to get this one for work, so we can read and commiserate.

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  12. Jayne
    Dec 04, 2008 @ 13:05:33

    Shiloh, I remember you mentioning your job and as I was reading the book I thought, now Shiloh Walker might enjoy this. Austin has lots of lurve for the ER staff nurses he works with and heaps praise on most of them. Hell, I’ll heap some praise now for the ones who looked after me when I was suffering from a spell of kidney stones years ago. Yeah nurses!

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  13. Jayne
    Dec 04, 2008 @ 13:10:06

    I heard that not many doctors are going into family medicine for all the reasons you stated in your review. Hey, my job_ is_ stressful but at least I get to sleep at night.

    And this is the very specialty that we need to have more go into. I read something online the other week about how so many of the ones who are family medicine docs now want out of the profession.

    And I used to know a lot of friends who were thinking of becoming doctors. Some did and others decided it wasn’t worth it.

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  14. Jayne
    Dec 04, 2008 @ 13:12:59

    Keishon, was that PBS special the one about Harvard medical school? Because that was the one that convinced me I didn't want to be a doctor :-D

    Oh, oh! I saw that. And the follow up that showed them during their internship and residencies. Great show.

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  15. Jayne
    Dec 04, 2008 @ 13:17:38

    Hey don't expect to have sleep through nights in Family Medicine. Most still take call, and still do the hospital rounds. I don't mind legitimate calls, but it sure is easy to be pissed off with the call at 3 am about a problem that has been going on for several days.

    Oh yes, this pisses my doctor friend off to no end. “Why are you calling me at 3am!?” “Well, I saw that this still hadn’t been taken care of. So, I called.” ::insert slow burn of my friend::

    An oldie but classic is Samuel Shem's The House of God.

    An absolute goodie and one that I did a review of two years ago. Fantastic book.

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  16. Jayne
    Dec 04, 2008 @ 13:20:27

    My son is a first year pedatric resident and this is so true.

    Oh, God love him! The specialty where you not only treat your patients but their parents too. Good luck to him, Ruth.

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  17. Jayne
    Dec 04, 2008 @ 13:28:27

    No shiyt. I work 12 hour night shifts in a hospital, but I'm *so* not a morning person, so it works out for me. Still annoys the snot out of me when people call me in the middle of the day, or the landscaper shows up late and cranks up the loudest lawnmower EVER.

    LOL. I hear ya, Emmy. I remember the days. When I was doing this, I lived on the top floor of my apartment building. And of course the management decided to reroof my unit while I was working. It sounded like a platoon of Marines jumping up and down on the building all day long. I was almost psychotic by the time they finished.

    Also, I'm stuck with the retarded interns on call at night. The smart ones realize that I was resuscitating babies while they were still in high school and listen to my advice. The dumb ones end up in another career that doesn't involve being around my patients.

    Thanks for the book rec. I have got to get this one for work, so we can read and commiserate.

    Another college friend of mine – well, actually lots of college friends of mine – were nurses. She started working in the NICU of a major medical center. Loved the work but the emotional toll on her finally took its course and she switched to radiology nursing.

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  18. Jayne
    Dec 04, 2008 @ 13:32:33

    I have been to an emergency room twice for myself and both times, I received absolutely excellent care. Even the last time, when I spent 12 hours on a gurney in a hallway (not sick enough to be put in a room) and in miserable pain, the doctor who actually saw me was fabulous and was instrumental in my making a decision to have surgery I'd been putting off for years and years. I wish I remembered his name, but I was kind of out of it. Sounds like an interesting book and I love the cover.

    I read so many accounts of horrible things going wrong in emergency rooms but I think the vast majority of the time, people do get good care under stressful conditions. Sorry to hear about your 12 hours of pain though.

    I like the cover too. And when you’re standing in line with it, you won’t have to fend off the ‘neked man’ comments from the boors of the world. ;)

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  19. Jayne
    Dec 04, 2008 @ 13:44:58

    As a dr's wife, you always have to realize that you and the kids will never, ever come first. If you make plans, someone out there who's been nursing an inflamed appendix for three days will finally decide that maybe, just maybe, they need to go to the ER (by which time, it's burst). You can't even be mad about it either-because while your plans are trashed (or your house, or your nerves), that person might DIE, so you just suck it up and go on. And as reimbursements decline and liabilities increase, it's not like the buckets-o-money are there anymore, either. Maybe for the older guys, but not for people coming in during the last 5-10 yrs.

    Austin, as I said, is honest almost to a fault about the impact his job has had on his wife and family. And in his author’s note, he stated that their deal was that he could write whatever he wanted but she then got to read what he’d written and could cross out what she didn’t want to go in the book.

    I don’t envy doctors’ spouses at all. If your spouse is any good at his/her job and has the compassion needed for the job – along with the bossing skills as you mentioned – then they’re going to be gone for huge chunks of your life. My doctor friend pulls down a good living but IMHO, she earns that money.

    I recall in the PBS show that Keishon and Meljean mentioned that two or three of those interns the show followed were already divorced after only a few years of marriage.

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  20. Leah
    Dec 04, 2008 @ 14:00:09

    I recall in the PBS show that Keishon and Meljean mentioned that two or three of those interns the show followed were already divorced after only a few years of marriage.

    I dated my husband when we were in high school, but didn’t hook up with him seriously until we were in our 30′s. I often wish I had married him much earlier, because I think that we missed so much time. I know residency really sucked and I think “I could have helped him” (cue the violins). But in reality, I know it would have been difficult, and at that age, I might have been a hindrance instead, particularly if the babies had shown up. Brett said that when he interviewed at Duke for a 7yr residency (in 1989 or 90), the person he talked to declared with pride that no one who entered their program married was married by the time they finished.

    And as for nurses–there is no one better than a good nurse. Doctors need you guys to survive, and if they’re smart, they’ll remember it.

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  21. Jayne
    Dec 04, 2008 @ 15:10:15

    Brett said that when he interviewed at Duke for a 7yr residency (in 1989 or 90), the person he talked to declared with pride that no one who entered their program married was married by the time they finished.

    Another person I know – gee, I seem to know a lot of doctors and nurses – went to med school at Duke. He said there was a pot that all the incoming interns contributed to at the beginning of the year (July) that would go to the first one who either 1) got his wife pregnant or 2) got pregnant herself. Generally it took until May for someone to claim the money.

    And as for nurses-there is no one better than a good nurse. Doctors need you guys to survive, and if they're smart, they'll remember it.

    Nurses, med techs, radiology techs….it takes a lot of people to get sick people well.

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  22. Michelle
    Dec 04, 2008 @ 15:28:40

    I loved most of the ER nurses and ICU nurses, as an intern they could be your best friend and be on your side.

    I don’t envy the surgeons, they have the rawest deal. I remember as a med student the surgery interns/residents were told they would only get 1 day off for a wedding-first marriage only, no time off for second marriages.

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  23. Jayne
    Dec 04, 2008 @ 15:36:17

    This is a blog written by a guy in med school. Or this was while he was in med school. Now he’s in his first year of residency. It’s absolutely hilarious. He now has another blog called “Ah yes, Residency.” I think he managed to put up 4 posts the whole intern year.

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  24. Emmy
    Dec 04, 2008 @ 15:37:08

    He said there was a pot that all the incoming interns contributed to at the beginning of the year (July) that would go to the first one who either 1) got his wife pregnant or 2) got pregnant herself. Generally it took until May for someone to claim the money

    *gigglesnort* Somebody needs to write a non-fic book about hospital romances. Diamond rings have been flying around my medical center like popcorn lately. Four of our staff on my unit got married last month alone, and several more are engaged. Also, three women are preggers, and an equal amount of the guys have pregnant wives/girlfriends.

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  25. Nikki
    Dec 04, 2008 @ 15:51:38

    I rarely ever pick up this kind of a book. It feels like a little PTSD gets triggered when I read about an experience similar to my own. The crappy hours, the idiot interns, the nurses who didn’t know what they were doing… it goes on.

    I will say that if you really want to become a physician, people need to carefully evaluate their reasons. The pay is less than fabulous, the amount of debt is astronomical, and you end up giving away a very large portion of your life with questionable return. I know that I question the value of my sacrifice sometimes when I see my high school friends married or with children. Meanwhile… I am still in training. My med school friends ask, what happened to our youth, where did our twenties go!!

    And Leah, I agree with your husband about what fields he thinks are best. The only thing is with the way the economy and possibly the entire health care machine is going it might not be that way in a few more years. Even in my 3 years of residency the medical world changed a lot, primarily because of reimbursements. After my fellowship I will likely try to avoid private practice as much as possible because there is more time spent on filling out forms than on taking care of patients.

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  26. LizA
    Dec 04, 2008 @ 15:56:53

    This sounds interesting, esp. from a cultural point of view. It seems from all these posts, that there is a lot more pressure on doctors in the US than in other parts of the world. At least over here where I live, if you are off, you are off. if you work in a hospital, someone else is taking your job. and if you work outside the hospital, people are referred to another doctor (who will refer to you when he is off). it is probably a bit different in the deep country, but not by much. Of course there might be emergencies that require every doctor in 100 km to attend, but these are extremely rare…. at least in my experience, and I grew up as the daughter of two MDs and now have a brother who is one.
    That’s not to say that it is an easy life – lots of night/weekend shifts, lots of pressure, mobbing, long hours….

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  27. Paul Austin
    Jan 15, 2009 @ 15:01:51

    Dear Jayne,

    I just came across your posting and want to thank you for your kind words about “Something For the Pain.”

    It means so much to find out that people find something of value in the book.

    And yes, you’re right, Sally was brave to let me write the book. There were some things I half-way expected her to delete, but she didn’t. A friend said, I should’ve called it, “I Married a Goddess.” No argument there.

    Again, thank you for your kind words about SFTP.

    Paul

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  28. Jayne
    Jan 15, 2009 @ 19:21:50

    You’re very welcome. It was a pleasure to read. And thanks for stopping by. I always enjoy getting a chance to chat with authors.

    ReplyReply

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