"I can't stand the sight of blood."

Karen Wilson is a pediatrician practicing in a three-person group in Connecticut. She is forty, married and has two children..

It's a very intense time of your life and you're focused on yourself. You want to take care of your patients, get your paperwork done, and get home to your own family. I had two children, and a tremendous support system. Most of the students came from far away states or foreign countries, and they were all by themselves.

When you're chronically tired and overworked, after a while you adopt a facade that you don't care about anything. You need to do that to survive. You can develop behaviors that make people think you're not a nice person or that you don't care.

A lot of doctors are so consumed by their education process, and the mechanics of being a doctor, that they don't learn the psychosocial part. Even if you're a surgeon, you need to have a good bedside manner. You need to be able to communicate. In my practice I send patients to specialists. After they go they call me up so I can tell them what the specialist really said because they have no clue what he's talking about.

In residency I knew enough to make me a good solid doctor, but some of these guys were really into the esoteric. They would go home every night to read up every possible article ever written about a certain subject so they could dissertate on it at morning rounds. Maybe it was because I was a little older, maybe it was because I had more responsibilities at home than they did, but I wasn't that competitive. Some of them were really book-smart but didn't have any common sense with daily planning. They were all excellent people, and I enjoyed working with them, but our focuses of where we were going with our careers were different.

When it came to patient care, I had a better overall picture because of my pediatric nursing. I didn't only worry about why the child was in the hospital, I worried about the family going home, about what the kid was eating, and was the kid getting all its regular shots. Parents who have sick children look differently upon people who are young and have no children, like `You can't possibly understand.' Knowing that I had children gave me a different bond with parents.

I had done nursing for eight years on the pediatric floor. I really loved it. The pediatrician I worked with was wonderful. When I started to show an interest in questions beyond nursing, he was very encouraging. My second year there I started in college, because I had made a conscious decision to go to a three year diploma school for nursing, for the clinical experience.

I was two or three years into college before I talked to an advisor and started heading in the direction of medicine. I was working full-time, going to school part-time, paying for it out of my own pocket. So I had a vested interest in getting my money's worth, and I was mature enough to be disciplined.

My daughter was born while I was finishing college. I applied to eight medical schools, all in the northeast region. They had to be within driving distance so I could come home on weekends. I was wait-listed on three of the eight schools. My husband had heard that people don't show up on the first day, and that I should call to ask if there were any openings. That's what I did.

I went to New York Medical College in Valhalla, New York, which was a wonderful experience. The first year I lived in a college dormitory. My daughter was two and my husband works for the State of Connecticut government, and all my family was here in Connecticut. My extended family was our support system and helped raise her while my husband was at work and I was away during the weeks.

I loved medical school, but it was not easy. Every night you had to keep up with your studies; otherwise you could absolutely not deal with the material by the time a test came. It was overwhelming.

My roommate was also married, from Connecticut, and she had two children. We roomed together for four years and gave each other the moral support we needed while we were away from our kids, and the moral support to keep picking those books up every night. Usually one of us would go home and the other one's family would come to New York for the weekends.

The first month of internship at UConn, which is minutes away from where I live, was my last month of pregnancy. I worked my entire month, all eight calls. Then I got eight weeks off because it was a caesarean delivery. The difficult part after I came back was the emergency rooms and intensive care units, when I had to deal with babies that were my baby's age. I had a sudden infant death my first month back, a little girl who was four days older than my son. It was her mother's first day back to work and my second week. I had a very good attending who led me through it, explained how you do these things and how you speak to the family.

Sometimes my attitude and my approach were not what the clinical instructors would have liked. I have my own personality, my own style, and I didn't aim to fit their mold. If they can't find anything wrong with my work, they'll just have to deal with my personality. I sensed friction with some of the faculty over that. There were others who appreciated my honesty and it made our relationship stronger.

When I was an intern there was one attending everybody was especially fearful of, an excellent physician. I loved her approach. She was a specialist but she had that overall view, she didn't miss a thing. One day she said, "Nancy, what do you think?" I said, "I'm an intern. I am not supposed to think." The doctor burst out laughing, and I never had a moment's problem with her. Any time I had a question or a suggestion on patient care I had no trouble bringing it to her and getting a dialogue going.

She's just like I am. She's looking for the best care for her patient. And if you didn't like her personality, it didn't matter, because in the end her patient got what her patient needed. That was how I wanted to be.


I remember one of the faculty members telling me she didn't know if one child would survive because the child needed so many calories to grow that she was very close to the point at which we couldn't meet those needs. Yet I see this child today with minimal dysfunction, going to school. You can't always predict when babies are born which ones will survive. You have to give life the benefit of the doubt. Unfortunately, it's going to come to the point where dollars and cents rule.

Some of those kids I took care of as a resident come to our practice. I said to one mother, "At last I see a happy ending." Because we very rarely got to see them after they left the hospital. You need that positive reinforcement.

The nurses in the hospital would say, "Don't you think you've tortured that child enough?" I wasn't trying to torture the child. I was trying to get an intravenous line in so they wouldn't die of dehydration. But sometimes you felt you were torturing them, the neonatal babies, and for what? A lot of them die. But a lot of them don't.

It's really difficult to come to the agreement with the parents that you should "Do Not Resuscitate."

It's overwhelming for parents to have to come and talk to the doctors and say that they're going to actively disconnect the machines. And some people make you feel guilty about it.

As a doctor you have to be comfortable with the fact that this illness is not going to get any better. It's only going to get worse. If this really is the end, then you shouldn't inflict any more pain. We shouldn't be sticking needles in them. We shouldn't be drawing blood.

Every hospital has an ethics committee. Hopefully there have been a lot of meetings and discussions with the family along the way, so they are prepared. Sometimes they feel overwhelmed by what has happened and they give up prematurely. Sometimes you have to tell parents you can't disconnect the machines, that even if the child is overwhelmingly handicapped, this child is aware of what's going on, this child in some way can communicate and be communicated with. This is not a hopelessly terminal, irreversible situation.

I took care of children who died of AIDS and its complications. It's difficult to know when their days have reached the point of no return, where there are so many bad days that the good ones don't count any more. You want to give them the benefit of the doubt. There's always someone who has a story about some patient everybody gave up on and they rallied and had a week or a month. It's difficult when you have that responsibility.

We also had a baby where agreement was reached between the physician and the family that we would do nothing. A nurse called the Health and Human Services hotline and reported the physicians for neglect because of all those handicaps. A third party comes in then and takes over. The family has no control and the doctor has no control.

Then there are parents who insist on everything being done. It costs so much money, and they're not paying. It gets to the point where you know it's futile but how do you end the cycle? Those Siamese twins who were separated, that was an unGodly amount of money spent, and that child lived her poor one year life in the intensive care unit. Society hasn't come to terms with this. They're blaming physicians for the position we're in. Sometimes it's the consumers, and not the physicians, who demand this.


After residency I took a vacation and bonded with my children. We made a conscious decision that I would spend the summer at home with the kids and start to look for a job in the fall. And I dragged it out a little longer. I've been working since then. We recently reached an agreement on partnership. I'm with two men. It's an experience for them to have to work with a woman, and one who's not too shy, who's outspoken.

One partner has an interest in neurology--learning disabilities, attention deficit, headaches. And the other one has had training in hematology/oncology. I have a following of teenage mothers and preadolescent and adolescent girls who don't want to take off their clothes for a man anymore. Some women just prefer a woman.

In private practice when you're on call, you're it. You have to make the decisions. As a resident you could call all these other people for help if you needed it. There was some security in that.

Now you are the opinion. When you think of how many patients you see, how many people you talk to on the phone and how many you have in the hospital, it's a tremendous responsibility. And some parents invest you with responsibility for everything. They make no decisions. They call you for everything.

I use my parenting experience, my nursing experience and my doctoring. I tell parents: There are very few rules. That's the good thing about kids. They're very forgiving. With new babies whose parents are afraid to wash their bellybutton when their cord comes off, I say, I'm sorry. Don't take offense. This is the mother in me. They see what I'm trying to tell them is they don't have to be so delicate, they don't have to be so afraid of touching it. But I always take the blame. It works out fine.

When I first got there they had closets full of outdated samples because nobody was using them. Now I have a little basket at the front desk with sunscreen and moisturizer and soap, formula coupons. Mothers like that extra touch, letting them know you think about them as people and as families.

I can't stand the sight of blood. I'm always honest with my patients. All my kids know. I go in the room, and say, "Are you still bleeding?" And they say, "No, you can come in. The nurse cleaned up the blood." They all say, "I don't know how you can be a doctor." I say, Well, let me tell you, it wasn't easy. But we all have things. I don't mind if they throw up and I don't mind if they have diarrhea and I can even stand wound infections, but bleeding I just can't deal with.

I read articles and sometimes wonder where these guys come from. One doctor said, if an adolescent came in and wanted to talk about acne, wanted to talk about sex, had a whole bunch of issues, he would make them come back, saying, "We need a lot more time." You can't do that. It's hard for a kid to come in and say, "Oh, these pimples on my face, I'm so embarrassed. Can we do something about them?" We should address that while they're there. Because a lot of times they don't come back for follow-ups. If it didn't get better, they think you're no good. If it does get better, they won't come back to tell you.

I read an article last week about counseling pregnant adolescents. Counseling pregnant adolescents through their whole pregnancy? Nobody pays for that. We average at least two teenage mothers a week. There's no way I could accommodate that. All these insurance companies are starting to go capitation. You could see the teenage mothers as many times as you want, but you're only going to get the same amount every month. You have to see so many patients to pay your bills.

There are some days when I have so many needy people come through the door that at the end of the day I could just cry. I feel I haven't met their needs. I guess it's an honor that they think you're the one who can help. I can send them in the right direction. But it's tremendously demanding.

The part I find most depressing about my job is being on call. We each have one week night and I get very depressed. I eat all day in the office. Sometimes I'll have no phone calls but I'll have to go to the hospital three times. And the weekends on call, I'm just awful at home. My husband tells me, "Please go away. Don't come back 'til Monday." If I could work in an emergency room where I could just put in my hours and go home, that would be nice. The part all of us dread is that beeper.

The paraprofessionals, the ancillary roles, most of them work a nine to five job. They don't have to be on call at night, and they don't have to be on call for the weekend. The weekend starts for me five o'clock on Friday and ends at seven o'clock Monday morning, but I still have to go to work. Even if I've been up.

The average doctor works something like fifty or sixty hours a week. If you look at what I get paid, then figure a job and a half, I'm not getting paid that much more, in pediatrics anyway, than most people with a college education. If you figure it that way, I don't get paid any more than my husband, and he never has to work holidays or weekends or night call. He never has to carry that darn beeper.


When I do an admission, I go to the nurse with the order sheet. I say, "Is there anything you don't understand? Is there anything that we haven't talked about that you think might be a problem? Is there anything that I've written that you don't like or disagree with? Tell me now. Don't be calling me at 2 AM, I tell them, because I'll be very cranky. I try to explain why I'm ordering what I'm ordering, why I want it done a certain way, because if they're part of it and they understand why you're doing it, it makes them more responsible.

Doctors feel they need to make the ultimate decision, because it's their ultimate responsibility. I don't mind discussing it with other people, but I reserve the right to be the one who makes the judgment.


When I was a resident it was very stressful being in the neonatal unit because as residents you realize you don't know it all. You're not the expert. You're learning, but you feel like you never get any respect from those nurses. Everything you say is second guessed. If they don't like your answer, they keep going up the line, even if you're right. Sometimes administration would support the nurses and you would find yourself being talked to about something that wasn't wrong but the nurse was offended or upset. There were nurses I had difficulty with the first year who by my last year were coming to me about things other residents had done. If they would call you from where you were in the hospital to ask your opinion, you knew you had earned their respect.


When I first came to this office we used to do all our own phone calls, so in addition to seeing forty or fifty people in a day, I still might have thirty or forty phone calls. What we have done is gradually train the nurses to provide instructions and protocols for the common problems.

Sometimes mothers will buy Dimetapp and their child is only four and it says under six consult physician for dosage, so they call us. The nurse has the dosages written out and she can look up how much the baby weighs on the chart and tell the mother how much she should give. It saves the patient waiting time and us a lot of phone time. For the most part the nurses are excellent at saying to us, "Listen, this is over my head. You need to call this person."


You need to be very careful who you trust making decisions on your patients. You need to know your nurses and they need to know you. When I was a resident, there was one nurse who, if she was concerned about a patient, you knew there was an impending disaster. She called one night, wanting to put this child on a monitor. Without thinking, the intern said, Oh, yeah, sure, no problem. She hung up and we looked at each other and thought, Oh, my God. We went running down the hall. This kid got transferred to ICU.

When things happen to patients, they can happen really quickly. I live a distance away from our hospital. We don't have any house doctors. We have no PAs. So we have to go to all the complicated deliveries, all the c-sections. We have to do our own resuscitation.

I got into a disagreement with a respiratory therapist one night. I said, I'm telling you this is what must be done and if you're telling me that you're not going to do it, that's fine. I will stay in the hospital, I will do it myself. Just don't tell me you're going to do it and then I go home and it doesn't get done, because that is unacceptable. He didn't have the nerve to refuse my orders. That was one instance where I pulled rank, but it was important for my patient's care. Speaking up like that got me put on a committee to avoid such a problem in the future.

Sometimes there are things beyond your control. That's a hard thing for men to accept in general, but male doctors tend to feel that everything must go well and you must heal them all, and you can't. It's easier for women to say that we can't fix it, that every booboo doesn't respond to a bandaid.

It's hard for men to show emotion. As a woman I can go to a mom who's not having a good experience, and put my arm around her and give her a hug. But the male-female thing makes it harder because if a man came up to her and put his arms around her, it might be misconstrued. You have to be really careful about that in this day and age. Better for the men to keep their hands to themselves.

I find professional isolation the hardest part. Most of the physicians on the medical staff are men. There aren't that many women. It's almost impossible to get together. And most of us have young families, so we have our family responsibilities and our work responsibilities. It's a couple of minutes in the hall and that's it.

My son had surgery a couple months ago. It was just day surgery, the doctor said he could probably go to school the next day. Being the nice person I am, I only took that one day off. The next day I had to bring him to my mom's to spend the day with her and his eye was still all swollen and bruised. He hadn't eaten anything the day before, probably from the anesthesia.

Why didn't I take two days off? Why was I so afraid to spend two days home with my kid? I was thinking of those patients who would have to be rescheduled and the extra work for the office staff. I put their needs ahead of my own child and I felt badly. Some days I have a lot of those feelings and other days my kids don't seem to care whether I'm here or not.

I hate when people ask my daughter if she wants to be a doctor like her mother. I don't want her to feel that there's pressure from me or her father to achieve whatever we've achieved. I tell her, Oh, be a hairdresser. It's cheaper and then I won't have to make an appointment. I don't want my children to feel they must achieve a certain level, not even that they have to go to college. You need to find a way to make a living that makes you happy. Sometimes I have mothers who tell me they think about going back to school. I say, It's never too late. Maybe because of the age of my kids they don't realize how old I am. I'm soon to be forty-one.

I feel I never have enough time for what I want to do. There are more things I'd like to do for my patients than I am able to do, and more things I'd like to do with my family, for my family. But I have a choice: I can spend my days cleaning or I can spend them with my children, who will soon enough be leaving.

Some days I think that if I had realized the cost, I might not have gone back to school. I probably would have, but some days you wonder. When I left nursing my maximum salary, and I was one of the management people, was $17,000 including my overtime. If I knew nurses were going to make then what they make now, I might have stayed.

When you're the nurse, whatever environment you work in, if it's a well child clinic or if it's a hospital, you only have knowledge of that facet of your patient. When you're the doctor and a pediatrician, you see the baby when it's born, you see him when he rolls over, just like the parent. Some people consider you almost part of the family; you get to share everything. You share the illnesses, you share the happy things. They can't wait to tell you the baby's walking, talking, whatever. You get to share your knowledge with the parents. You tell them this is what's going to happen, and they get so excited when it does happen the way you said it would. That ongoing, long-term relationship with the family, that was the control that I felt was missing from nursing.