"Medicine is a job, not a life."

Gail Garrison works as a family practice doctor in a rural Georgia practice with a married couple. She is a 46 year old lesbian mother of grown children..

I started working as a nurse's aid literally on my sixteenth birthday. Then at twenty-four I found myself with a child and a husband who didn't seem to be able to get a job. I needed to be able to support us, so I got a two-year nursing degree. But I had always worked in and around hospitals.

For about five years I worked at Vanderbilt as a floor nurse, med/surg, gyn, before I went back and got a master's. I was thirty-two then and I thought I was too old to go to medical school. I got a certificate as a family nurse practitioner and did that for four or five years.

What made me rethink going to medical school was working side by side with physicians, essentially doing the same things they were doing. But being under their licenses. I set up the medical end of a feminist women's health center in Nashville in 81-82 but the physicians backing us up were all men because there weren't any women that would do it.

I didn't know whether I could get into medical school but I felt that if we were going to have an alternative institution, people like me had to go to medical school. So I decided to try.

I think I was the first person in my family on either side--my mother's or my father's--to even go to college. My parents thought of secretarial work as a profession. My going to college was purely because of the free money available in the 60's. After watching me go through it, my parents understand what it takes to be a doctor now, but graduate school then was completely mysterious to them.

When I decided to apply to medical school I was thirty-five and I had to take two years of pre-med courses. But in order to take chemistry and algebra I had to take remedial math courses. I had gone to an unaccredited high school and I didn't even have high school chemistry or any high school math beyond geometry. That was really rough.

At one point I was taking 16 hours of organic, physics, histology, and embryology, all of which had labs, and working 32 hours a week at Planned Parenthood. I was literally running the whole time. And my youngest child was maybe 18 months old.

I went to a very small Baptist school and the faculty, for whatever reason, believed that I was perfectly capable of going to medical school. They were very, very supportive. The Ph.D. who taught the physics class sat down with me right away to see what my problems were. When he realized that not only had I not had trig, my geometry was almost twenty years old, he procured geometry and trig books for me to speed read on the weekends. I had to do the same thing with chemistry--read a high school chemistry book to be able to know what an acid and a base were. I didn't know the basic terminology. Those fifty-year-old Ph.D.'s, all white men, were incredibly supportive.

At thirty-seven I applied to five medical schools and got interviews at all five. Having written a couple of books, having founded that clinic, my application was very strong. So I got accepted at my first choice, which was East Tennessee. I chose a small medical school, realizing that the faculty would be more supportive, which they were.

I read voluminously and very, very fast. I was one of the people they studied speed reading techniques on in the 60's. That was one of the things that paid for me to go to school originally, my being studied as a natural speed reader. So in any academic setting I quickly get to be infamous or notorious. People are intimidated by what I can do. But the fact that I read so fast, and that I organize myself, allowed me to get a lot more sleep.

As an interest on the side, I had been buying and renovating old houses. When I sold my houses in Nashville, I had over $100,000 clear, and I was able to buy a house and pay cash for it. I would have had the expenses for my three years in the bank, except that my ex-husband sued for custody of my kids when I started medical school and I ended up spending almost $20,000 in legal expenses.

Other people my age were starting IRA's and talking about long-term investments and here I was borrowing money for medical school. Nonetheless I knew that when I sold my property there I would clear enough money to repay that.

Whenever I did anything well, people said it was because I was a nurse, and whenever I did anything poorly, it was because I was not overcoming my nursing background. Probably to some extent that was true, except that being a nurse was so consistent with my class background. If there were times when I had trouble thinking independently and performing independently, I don't think it was because I was a nurse. I think it was more because I was a woman from a working class family, born and bred to do what I was told to do.

When I took family practice in medical school, I really enjoyed the textbook and actually read it cover to cover, which was all of 1100 pages, twice. And I really felt like I picked up a lot--on tuberculosis, and what things influenced the TB skin test. The guy who did my closing interview in that rotation said they felt they hadn't taught me anything. I still don't know what he meant. Did he feel I wasn't learning, or did he feel they had nothing to offer? Was it their self-esteem?

They knew I had been involved in writing the national certification exam for nurse practitioners in family practice, and had written parts of the review manual, but I think it was more my air of authority and the fact that I would debate points with them.

In medical school I was occasionally older than the faculty, which made them uncomfortable. When I was an intern, the nurses would say, "Gee, Dr. Garrison it's hard to remember you're not on the faculty, that you have to call somebody else, because you always sound as if..."

Maybe that's being a mother, too. I've had three children. They're now 30, 22, and 14. At some point, one of my fellow students said to me, "Do you realize that Jennifer [my middle child] is closer to our age than you are?" She was amazed. I said, "Yes, I never forget that." Some of my fellow students did kind of treat me as a parent figure. They would come to my house to study, and come to my house for chicken soup.

In medical school in particular I started striving for some kind of middle ground, consciously not trying to be at the top of the class, understanding that the competition at the top of the class was life-threatening. There was no competition to be 30th at all. And that's where I wanted to be.

My first year they told me, this was how you did it, class notes, study groups. And my first year I did that. But after first year I dropped class notes, I dropped out of study groups. I studied on my own. I read books. I learned what I wanted to learn. And there were areas where I paid. On my psych rotation they gave us two tests and they said, "One of these is your final exam," and the final exam was thirty percent of the grade.

I refused to read them. I suspect this was largely ego. I went into the final exam with what I'd learned from reading and made a C on it, which was the lowest grade in the group. Basically there were 15 A's and a C. But I still preferred my C.

The guy said, "Why did you do that? What is this--shooting yourself in the foot?" I couldn't get it across to him that it offends my personal ethics to read and then go in and take the test, that I would frankly have rather failed.

My undergraduate average was something like a 3.96. Medical school was the first time in my life I ever saw an F under my name. I was going through a custody fight my first year. I ended up with about a 3.2 average in medical school and when they did my dean's letter the guy said, "You've done all these things. You've gone to Africa and you've done this and that. What in your life are you proudest of?" I put some thought into it and said, "My children." I'm really proud of my children, with their friends and their B averages. He laughed at me. He thought that was a foolish response. I said, "Fine, don't put it in the letter, but if you want to pick one accomplishment that I'm proud of, it's my healthy, happy children."

I came here to Huntsville for my residency. I had done excellently on boards and my grades were good. I got interviews at all nine residency programs, which was unusual. I chose Huntsville because I liked the city and their program had a good reputation. A guy ahead of me in medical school, who'd had about the same working class experience as me in East Tennessee was happy here.

Family practice was a pretty pragmatic decision. I felt that was where the jobs were. In medical school and in most areas, family practitioners get treated as step children and I was really ambivalent about going that far to put myself in another stepchild role. If I had done what I was interested in doing, I would have gone into internal medicine. But by then I was forty-one and I felt internal medicine as a job was just too physically hard, because it was going to be more and more intensive care work. Much as I loved medicine, I just couldn't see being in intensive care units until 3 AM.

I ran codes barefoot. There was no way I was going to try to sleep in tennis shoes, since I'm a chronic insomniac. There were people who always slept in their tennis shoes. The nurses would throw me a pair of foot covers, but I don't know how many times I came sprinting into intensive care barefoot. I can remember it being a compromise to sleep only in scrub tops, a bra and underpants, and put my scrub pants on the floor with the seat down.

Five years ago, when I started internship, I was forty-one. Medicine is kind of a funnel where you get spit out of the bottom. Internship is the tight part of the funnel. It feels like marathon training.
My background as a nurse allowed me to learn my way around quickly. I knew things I had to do to maintain myself as a person, so right away I got out into the community and got to know people, formed other relationships, formed a support network. My ability to form relationships was really important, because those relationships sustained me. If I called down and asked for films, the people in X-ray would have them ready right on time, or five minutes early. The emergency room nurses, the intensive care nurses, would give me extra help, which would end up in my looking good for morning report.

There was one guy who did the exact opposite. In particular he pissed off the X-ray people, and he would have the wrong patient's CT scan, or no films at all. He'd just throw films up on the screen and they'd be the wrong ones, consistently. His assumption was that people down there were incompetent, never realizing that they were out to get him.

There is a women's community health center here which is run by a physician's assistant. It was physically located one block from medical school. Kathleen and I got to be good friends right away. I could go over and sleep on her office floor. Sometimes I would just walk into her office and curl up and she'd sit and rub my back.

The head of ob/gyn is a Catholic guy who is a fanatic anti-legal-abortion person, and I was actively involved with the abortion rights people here, and very openly. As soon as I was able to, I started moonlighting over at Kathleen's clinic. So this guy went after me during my three months of ob/gyn. That was the time I was told that my problem was I wasn't overcoming my nursing background. Actually he tried to fail me. I had made above the 96th percentile on my board scores. The school had to get into it and override his failing grade.

I don't associate a lot with the rest of the medical profession here now. I have a growing number of very good friends who tend to be people similar to me. They have strong interests and activity outside medicine. Medicine is a job, not a life. One of my best friends in the medical community here, who interestingly is about to be made dean of the medical school, is a guy who's also from a working class background. He worked his way through medical school as a lineman for the phone company. He's not in any way typical. He's very involved with patients.

Most physicians are upper middle class or upper class even. When you have a mother who waits on you hand and foot, and you get pretty much what you want, you can grow up not knowing how real people think and feel. You can grow up insulated from suffering. If you grow up in a poorer family, you're more likely to have been closely associated with older people who were dying, and you understand more of what they go through and you respect that.

I try to get advance directives with my patients in the office. What I'll say to them is, "If I think in your future is a nursing home, then I don't think we should treat pneumonia, kidney infections, etc. But if I think I'm going to get you back home and back into your garden, then I think a ventilator, etc., is justified." My experience with patients is that very rarely will I have somebody who says, "I want you to do everything to keep me going." Ninety-five percent of the time people say, "Yeah, if my best possibility is a nursing home, I don't want to live. I don't want artificial feeding, I don't want anything."

We don't have a lot of trouble pulling the plug here now. We can put people in intensive care, ventilate them for three days, and then pull the plug. I don't know if that's unusual, but I feel very strongly about it. If we realize that we're not going to be able to get this person back to quality of life, we're able to stop care, here in Huntsville, anyway.

My suspicion is that one of the crippling effects of growing up upper middle class is having a more sanitary, sterile life. The old people in your family are likely to be in nursing homes. You see them once a month on Sunday. They seem subhuman to you. Whereas, if you grow up with somebody who has a potty chair beside the bed, then those people are more real to you.

I'm in a rural private practice. We accept everything in the way of insurance. We don't advertise it, but we accept Medicaid. And we accept indigent patients, which is interesting because we have a 95% pay. I work with two other family practitioners who are married to each other, but the practice was started by my friend Jim and he still technically owns it. We have a lot of Medicare, we have a lot of older people, we have a lot of complete families.

The two physicians I work with persist in having children. They have a two year old and a three week old baby. So right now I'm working close to five days a week, but I normally only work three and a half days a week. I don't want to be a "doctor," I want to be a person who's a doctor. I don't have to do call but I've slid into doing it and I've found that I actually enjoy it. It's a way to make more money.

In the emergency room, if somebody needs to be cleaned up, I will assist with that as a way of getting a good look at their bottom. We don't have nurses in our office, so if somebody needs to be cathed, I do it. I do a lot of procedures in the office. I try to round at the time when patients are likely to be getting bedbaths because it's such a good way to get a good look at their skin.

I'm polite and I clean up after myself. That's important to people, that you not assume you can throw things on the floor. I put the sharps in the sink and the trash in the trash. I don't assume that I can walk in and the nurses are going to drop whatever they're doing. I always say, "Is there anything else you would suggest or is there anything else you think we need to do here?"

I've run into so many people, when I'm in the doctors' lounge, who hate medicine. People who would be out in a second if they could make the same amount of money doing something else. It's amazing to me to look at people who are younger than I am and totally burned out, who will say they feel as if their lives are over, they feel it's downhill from here on in. They hate it.

I enjoy what I do. I can't say that I burst out of bed in the morning eager to go to the office. But when I get to the office, I'm glad to be there. I like the people I work with, I enjoy the patients. If you tell them what they can do to get healthy, most people do it, including quitting smoking and exercising. I have good luck with getting people to quit smoking. Maybe it's partly self-selective, the people who come to me.

Last year I got into a fight with one of the radiologists in town. I was getting too many complaints about mammograms in his facility. A woman came back with the skin under her breast actually split. I called him a couple of times and complained. Then I wrote a letter and described the patient who'd had the skin under her breast split. He responded with a phone call saying he'd checked with other places and my patients were demanding and people had to understand, etc. I wrote back and said I was delighted my patients were demanding, that I try to nurture that quality.

I feel estranged from a lot of other doctors. I was trained in the era of regulations, so I don't find that particularly onerous. Somebody looking over my shoulder all the time is part of life for me. If medicine had regulated itself, if we had not covered for alcoholic physicians, if we had not spent a hundred years covering up incompetence, the government would never have gotten into it. We wouldn't have these committees. We wouldn't have people doing drug screens.

I feel very strongly about universal access to health care. We accept indigents. I have a couple where the man is diabetic, insulin dependent juvenile diabetic, who doesn't smoke, is thin, watches his diet, checks his blood sugars, and he and his wife are both employed full-time. He's a surveyor and couldn't get coverage. His wife finally changed jobs to get him health insurance.

I can't tell you how many episodes of DKA we've treated in the office. He's brittle. He comes in at eight in the morning and gets flooded with fluids all day. We've done that two or three times. But he's finally got health insurance. It was such a relief the first time I put him in the hospital.

We know that theoretically that if it doesn't go well, somebody like that could turn around and sue you. I also know that people don't sue because they're hurt, they sue because they're angry. This family probably wouldn't sue, even if the patient went home and died that night. The family will understand that you worked with them and did the best you knew how.

I've had an increasing trust in the fact that doing things the way I think is right will work out for me. It's better to know that you made your best contribution and failed than to do what essentially feels to me like cheating. I've watched people cheat and I know they wanted something so badly they didn't care what they had to do to get it. I've always been grateful there was nothing I wanted that badly. I've always understood that I'm lucky to be as smart as I am and to read as fast as I do.

Everybody I meet may be potentially brilliant in something. I hope I treat people as individuals, which brings out whatever their talents and abilities are. Certainly with kids you get pretty much what you expect from them. I have one child who might be smarter than I am. I'm trying to teach her that she has a responsibility to society. You are not a gift to the world. You have a responsibility.

My youngest child, who's only fourteen, I would love to see go into medicine. Right now she wants to be a rock and roll singer. I try to keep my wish so tamped down that she won't even know. Wanting them to do something is the best way in the world to have them do something else.

Becoming a doctor has freed me and given me a confidence in my judgment and ability that I somehow didn't have before. Having gone through medical school and through residency has built my self-confidence. I'm willing and able to work at self-actualization in many more areas. I'm interested in creative writing and I feel I've been freed up to be more creative. I've achieved some almost impossible goals.