Renewable Revolution

Doctored: The Disillusionment of an American Physician

Sandeep Jauhar

Farrar, Straus and Giroux

EXCERPT

ONE

Awakening


A young doctor means a new graveyard.

—German proverb

Snippet:

It was a few minutes past seven-thirty when I arrived at the hospital, and I was late for morning report. I pulled into the attending physicians’ lot and parked between two cars whose license plates read “BEAN DOC” and “GAS MD.” At the sliding glass doors leading into the lobby, two patients in teal hospital gowns were leaning on their IV poles, sucking hungrily on cigarettes. I skipped down a concrete stairwell to the basement. The corridors were deserted, save for a tardy first-year fellow racing ahead of me.

When I walked into the conference room, a fellow was presenting a case from overnight. About a dozen fellows and a half-dozen faculty members were there. The fellows rotated each month through the various cardiac subspecialties: electrophysiology (which focuses on arrhythmias, or heart rhythm disturbances), echocardiography (cardiac ultrasound), nuclear stress testing (which uses radioactive tracers to noninvasively detect coronary disease in hearts under stress from exercise or certain drugs), cardiac catheterization (Rajiv’s specialty), heart failure, the general consultative service, and the cardiac care unit (where the most critically ill patients of any subspecialty usually ended up). As faculty members we were responsible for teaching the fellows: scrubbing in with them on procedures, going on rounds with them, and instructing them over discussions at morning report or noon seminar. In the conference room, Rajiv and two of his interventional colleagues were sitting together, arms folded, legs crossed, in purple scrubs, like some sort of academic tribunal. My brother looked at me sharply, glanced at a phantom wristwatch, and winked. I quietly took a seat in the back.

The fellow was trying to explain his management of a critically ill patient the previous night. “The patient’s pulmonary artery saturation was in the mid-forties, so I ended up putting him on some dobutamine and gave him a little fluid back,” the fellow said. “He started putting out some urine, and his blood pressure went up. Over the next twelve hours, his oxygenation improved dramatically.”

Dr. Morrison, one of the interventional cardiologists, demanded to know why the fellow had given the patient intravenous fluid.

“At that point his central venous pressure was two,” the fellow said defensively, describing a state of dehydration. “His pulmonary artery diastolic pressure was six, and his wedge pressure was like eight.”

“And you’re sure the transducer was zeroed and level?” Morrison pressed him. “We see this a lot with the residents. They look up at the monitor and quote a pressure, but it’s just garbage.”

The fellow hesitated. “When we first put in the catheter, the wedge pressure was in the thirties—”

“Well, see, that’s what I’m saying,” Morrison interjected, as if the fellow had just made his point. “This guy wasn’t dehydrated! He was in florid heart failure. This is a textbook case of acute heart failure, from the frothy sputum to the missed myocardial infarction.”

“Anyway, good case,” the chief fellow said, trying to move things along.

“What this patient really needs is a doctor,” Dr. Morrison added caustically.

“As opposed to a plumber like us?” Rajiv shot back, coming to the fellow’s defense.

“Exactly,” Morrison replied, laughing. (Interventional cardiologists who relieve coronary obstructions with stents are often disparagingly referred to as plumbers.)
Full Excerpt

Review

In his acclaimed memoir Intern,

http://www.youtube.com/watch?v=lcdDLRUJ5k8&feature=player_embedded
http://www.sandeepjauhar.com/
Sandeep Jauhar chronicled the formative years of his residency at a prestigious New York City hospital. Doctored, his harrowing follow-up, observes the crisis of American medicine through the eyes of an attending cardiologist.


Hoping for the stability he needs to start a family, Jauhar accepts a position at a massive teaching hospital on the outskirts of Queens. With a decade’s worth of elite medical training behind him, he is eager to settle down and reap the rewards of countless sleepless nights. Instead, he is confronted with sobering truths. Doctors’ morale is low and getting lower, and when doctors are unhappy, their patients are apt to be unhappy as well. Blatant cronyism determines patient referrals, corporate ties distort medical decisions, and unnecessary tests are routinely performed in order to generate income. Meanwhile, a single patient in Jauhar’s hospital might see fifteen specialists in one stay and still fail to receive a full picture of his actual condition.


Unwilling to accept the prevailing norms, Jauhar fights to keep his ideals intact. But he, too, finds himself ensnared in the system. Struggling to pay back student loans and support a wife and son on his hospital salary, he resorts to moonlighting for a profit-driven private practice that orders batteries of tests just to drum up fees and ward off malpractice lawsuits.


Provoked by his unsettling experiences, Jauhar has written an introspective memoir that is also an impassioned plea for reform. With American medicine at a crossroads, Doctored is the important work of a writer unafraid to challenge the establishment and incite controversy.

http://us.macmillan.com/books/9780374141394