Lately my body has been sending me messages. These arrive in units equivalent to somatic emails or text messages: isolated aches in the sacroiliac joint, shooting plantar fascia pains, tension-type headaches. Furthermore, I've been noticing a distressing increase in facial blotchiness after a long night on call. The first bloom of youth, which masks the mundane ugliness of fatigue, is fast disappearing, leaving behind baggy eyes and big pores.
I suppose I practice a particularly awkward style of medicine when it comes to my physical well-being. I don't require women to labor and deliver in dorsal lithotomy position (the infamous "on yer back" position), which means my own position has to be a great deal more creative and acrobatic when I am in attendance. I have caught babies kneeling on cold linoleum floors, squatting in front of the woman in labor, and seated side-saddle at the foot of a bed. On the medical-surgical unit, I'll make rounds standing up, old-school style--a habit pursued more out of necessity than desire, due to the smallness of the patient rooms and general insufficiency of extra guest chairs. If a patient has been mobilized to a chair--a good thing!--and I need to examine her foot ulcer, I will crouch down on the floor to remove the dressing. Our vintage hospital building doesn't help matters much--the floors are concrete-based and have no give at all.
Long ago, I converted to the Cult of Comfy Shoes and elastic-waisted pants. Cuteness no longer enters into the equation when I get dressed in the morning. More recently, I got desperate when the plantar fascia pain became a daily affair. One of my surgeon colleagues suffers greatly from pain in his feet, after two or more decades of operating 7 days a week, and he turned me on to Z-Coil shoes:
The decision to buy these shoes was the last nail in the coffin of my fashion sense. These are ugly shoes. These are quite the ugliest shoes ever made. Not only are they not sexy, they are the Anti-Sexy. Slipping my feet into these shoes, I know I have given up my strutting rights for good.
But do they feel good! The bouncy coil absorbs some of the impact of each heel strike, and if you stand on hard floors for 12 hours at a time, those heel strikes add up. After a long day in the Z-coils, I do not feel like walking on my hands, like I used to do, and my right sacroiliac joint doesn't feel like it's been locked into an Iron Maiden all day.
I also look taller in these shoes. This is such a good thing.
There is a serious side to this issue. Over the last few years I have come to realize that the physical toll of doctoring will eventually limit my participation in clinical medicine. I just can't believe I'll be able to do long stretches of hospitalist shifts in ten years, and I'm almost certain I won't want to be catching babies if it means the general stiffening up of my cervical spine the day after a particularly grueling second stage. I suspect that being up all night and awake all day in the classic 36-hour call scenario--which I have faced more often since leaving residency--is going to lose its glamour.
I'm not the only health care profession confronting the physical toll of their job. One of our hospitalists resigned from our group because the long hours were sapping his energy. He had a lumbar laminectomy years ago and is very protective of his physical endurance. I don't blame him. On the blogs, I see that Reynolds of Random Acts of Reality is contemplating career change due to the physical challenges of transferring patients on an off gurneys, up and down stairs. I know of another medical blogger who has obtained another professional degree in preparation for a career shift, providing cognitive rather than bedside services in the health care system.
I wish we all talked about this issue more. There is a cowboy-tough mentality within medicine. I've heard of doctors who claimed physical limitations as a reason to restrict call responsibilities called wimps: "What, she can't take call because of ARTHRITIS???" Indeed, I've been guilty of these attitudes myself, but now I realize we must acknowledge the physical challenge of clinical medicine. This will inevitably influence the arc of a physician's career.
Please comment on your own experience of the physical toll of medicine.