"My son stopped talking to me."


Phyllis Dodson is doing a straight medicine internship before completing an ophthalmology residency. She is thirty-three, married and has two children..

My dad's a doctor, and when I was growing up I initially thought I'd be a doctor. But I was concerned about the time obligations of being a physician--both training and practice. Then I did really badly my freshman year in college, and though there were reasons for that, I thought I wouldn't be capable of becoming a physician. So, with both thoughts in mind, I went to nursing school.

For two years I worked on a telemetry floor, a cardiac step-down unit. People's perception of nurses is based on the stereotype of the handmaiden, back rubs and bathing, but it hasn't been that way since I can remember. As medical care has gotten more technologically sophisticated, it takes smarts to give chemo and manage hyperalimentation and patient care analgesia and intensive care nursing.

When I went to the VA , which was a teaching hospital, I started working with residents. I actually remember the moment when I thought again about going to medical school. I was working with a young female surgical resident and I thought, There is no way I can be a nurse when I'm looking at my peer doing what I want to do. On the telemetry unit I hadn't thought about it. All the attending physicians were men. I didn't relate to them and it was a sub-specialty that just seemed unobtainable.

At the VA they would round in the morning and the attending or the chief resident would ask questions. A lot of times I could answer them. It dawned on me that this was a learning process. I'd always seen people after their training, with many years of experience, and they seemed so smart or so different. When I saw them learning, I recognized I could do that.

It used to irk me, when I was a nurse, that when the residents in training programs started out, they'd know less than I did. Six or nine months later they knew a lot more than I. And they could explain. They understood better what was going on with the patient, about the disease process. It bothered me that I didn't know those things.

Also, I wanted to be the one who directed care. When I was young--twenty-two, twenty-three--I never had a problem taking directions from other people. Now I know at some point I'm going to be giving the directions, and that's important to me.

One of the reasons I wanted to leave nursing was because I had not done what I was capable of doing. I lived in an upper middle class neighborhood and I was at the top of my class in high school. My counterparts became doctors and lawyers and Indian chiefs. It bothered me when physicians would just see me as a nurse. They didn't really know if it was me or someone else, whereas I knew who each of them was, knew their style. Some of them would make an effort to listen to what you had to say or get to know you, others had no interest in doing that.

I thought about becoming a nurse practitioner but that's like a wannabe. They can have a good role in the health care system but I wanted to have the knowledge, the training, the title, the everything. I didn't want to be under someone's direction. I was capable of being a physician.

One of the luckiest days of my life was when I got into a state medical school. It made a huge difference in terms of debt. We don't have any debt but we still live like people in our mid-twenties. My husband's almost forty. And the training at my medical school was different than a lot of schools. Overnight call was pretty infrequent. They felt their goal was to help you learn how to learn. I thought they accomplished that. My school wasn't a UCSF or a Harvard, but its graduates get good residencies.

Medical school is four years but I took six. They were extremely accommodating. We adopted our son between my first and second year, so I split my second year into two years. I tried to work some in the summer but it was awful. I felt like I should be at home. We had our daughter what would have been, if I'd graduated on time, the end of my fourth year. I took a year off, did research and stayed home with her for a number of months.

Having kids during this time was exceedingly difficult. Taking extra time for school wasn't the problem. Most women can pull it off despite the difficulties, but I don't think it was by chance that I had two friends who quit medical school. I had a lot of ambivalence, especially with my son. When I split my second year into two years my hours were very regular. It wasn't that difficult. But then when I had to do my third year, that involved a lot of pressure and I was gone all the time. My two year old son stopped talking to me for a long period, weeks and weeks. He was so upset and angry with me. That third year was tremendously difficult.

I only made the decision to go into ophthalmology because of the kids. I'm sacrificing what I think I would really like, which is internal medicine or a subspecialty of that, because I need to be home when my kids are, from age two to twelve. They've already had to put up with enough. I cannot spend another five or six years in their young lives while I'm not home a lot. I'll still not be home a lot, but at least I'll be home more.

My husband (an engineer) really wanted me to go to medical school. He really wanted to have the kids. But it's been a lot more difficult than he ever envisioned it would be. I think he feels I'm more successful than he is, because I did really well in medical school and was near the top of my class. And he got fired. His company wanted him to work fifty or sixty hours a week. He wasn't able to do it during my last year of medical school, given all the rotations. So he really has had to sacrifice. He's definitely as capable as I am.

My husband is from the south and my mother-in-law is there, so my top choice for residency was back there. My husband really wanted to go back, although the economy is depressed there. There's not a lot of engineering work and the people who get jobs have to travel a lot. His mother's going to be there and if he has to travel, he has to travel. That was the understanding. I would try to set something up to not take advantage of his mother, but it is a reality she is going to be there.

The kids are five and one and a half. The five year old is in kindergarten so he's pretty stressed out about moving, because he's made friends here. His grandmother is a big draw. During my third year my mother-in-law flew out at the end of each of my rotations so that I could study. She stayed for several weeks at a time. When I interviewed, she stayed with us for six weeks.

My son handles the absences better now. He loves me. My daughter is like Merry Sunshine. She's Miss Song and Dance, outgoing and bubbly. My son is more intense. He's more like me. I understand him perfectly, because I'd feel the same way. I hope I'm not kidding myself, but I think my daughter is going to have an easier time because of her own native disposition.

There's nighttime call in ophthalmology but it's from home. Sleep deprivation shouldn't be an overriding factor like it can be for some training programs. The first year there's call on the weekends, but it's from home. There won't be those long periods of time when you don't even see the kids. The ophthalmology choice was purely for that. I have some apprehensions. You do a six week rotation, and then you make this decision. Maybe this isn't for me. I'll just have to see.

I wanted to have a relationship with my patients over time. That eliminated a lot, like anesthesia and radiology, and a lot of the other more lifestyle specialties. In ophthalmology you see kids, you see adults. You have more of a range. And the ophthalmologists are very satisfied in their profession. You don't hear of people leaving ophthalmology the way people leave other things.

What the ophthalmology program wants you to do is internal medicine first, or a transitional year. I'm glad I made the decision to do internal medicine. At my Oakland hospital the training program is more humane. The pressure's off you a lot more than it would be at UCSF. If I were to go back when I was older, I wouldn't go to UCSF or its equivalent.

I can't stand the academic setting, actually. For me this internship year has been wonderful in that there are no grades. There's evaluation but it's a very minimal one. When I was at medical school I knew if I wanted to do ophthalmology I had to do well and it drove me insane. In academics they just keep doing that. They compare who has a bigger desk and where their chair is. I can't imagine spending my life worrying about that. I like it a lot better just trying to learn what I can and enjoy it and not worry about competition. It makes me a happier person.

When I worked at Mt. Diablo as a nurse, I saw these young cardiologists trying to build their empires. You can't do that with this HMO. Nothing changes, you just work harder. I fit in a lot better there than I would in an academic setting. I can't relate to people just trying to get the best reputation and the most business and make the most money. That doesn't interest me.

Another reason I chose ophthalmology was that I got sick of intensive care. I've not had one patient go down to the intensive care unit and be put on the ventilator. I get all of mine made Do Not Resuscitate. Resuscitation is great in a very limited setting. For the most part it's intuitively obvious what those situations are going to be. The young asthmatic, sure, because the likelihood is that they'll do well. If someone's old and dying, that's not the time. I feel strongly about that.

There will be some people who die who would have lived if you had provided them with all this expensive technology, but we deprive everybody else of so much. We make such odd decisions about what we have money for and what we don't. We decide we don't have the money to provide immunizations for children. Even the babies that you could save and have a good outcome, it's so interesting that we choose to spend our money that way. It seems like there's a better use of the money. We withhold it from so many other situations.

I saw a lot of elderly people who lived alone, really tenuously, and I would rather give them all an aide to come in four hours a day, because they're the people who are already here. I'd consider that a basic right, or daycare or preschool for poor children.

There was a patient who had AIDS and insisted on going on the ventilator. He was on the ventilator for weeks and weeks before he died. Why do we have money for that? We wouldn't have had money for all kinds of other things that perhaps he needed. In Europe I'm sure they never feel obligated to offer someone a futile therapy like that.

This HMO is better about that, although I see eighty-seven year olds with pneumonia on the vent. The attendings I talk with have such common sense. One of them was telling me her philosophy: You provide support up to a certain level. If it's meant to be and they get better, they weren't as sick as you thought. The likelihood is they'll go on to have a higher quality of life than if you rushed in and did all this stuff and sent them off to a nursing home. I saw that a lot when I was a nurse and I thought it was cruel.

But at my hospital once they get down to intensive care, it's no better, because that's what they like to do. So you're in a hopeless morass. But in general I've encountered a lot more compassion. They try to talk with their elderly patients beforehand and work it out with them. Most people have no idea what you're offering them when you offer them all this technology. I've had people who, when I've asked, "Would you want to be on a life support?" they think I'm talking about oxygen. And they say, "Oh, well, sure. I have that on right now." How would they know?

There's a huge emphasis on communication in nursing school. In medical school there is none. In training, doctors will tell you what they have found works for them, but it's pretty hard to pass on formally. What works best is when you observe how other people handle the situation and you take what you like and incorporate it into your own style.

Psychiatrists have a certain mannerism, which people in medical training could really benefit from, because so many times with patients the real message is something else. They come in saying they have this or that, when really they want to talk about how they're not getting along with their husband. But that scares me because I don't know how to help them get along with their husbands. People have such expectations that you'll be all-knowing, you'll be unfailingly compassionate and sensitive, that you'll hear the underlying message. How can they expect that of anybody?

During medical school they were all county patients and most of them lived on the river bank and had drug and alcohol problems, or psychological problems. And that was all right, but I felt like I never had anything in common with them. Sometimes they'd get mad at me and I had no idea why. It didn't seem to relate to anything I'd done. It's very nice to be with more middle class people. I understand what they're saying and they understand what I'm saying. We share some values.

I like seeing the patient and hearing the problem and making the differential diagnosis, and then hearing someone more experienced add about fifty things that I haven't thought about, and then seeing what it is. I definitely like the intellectual challenge of medicine.