Take Your Daughter to Work

In 1993 Gloria Steinem and the Ms. Foundation for Women (as in the magazine Ms.) founded the Take Our Daughters to Work program.  Ten years later it was officially expanded to include boys, although many schools (which had to participate by excusing students from classes) and businesses had insisted from the beginning that it be gender-neutral.  The central purpose of the program was to encourage girls to engage in career exploration at an age when their ideas about gender roles are flexible.  The day for this exercise is the fourth Thursday of April.

This year I have had the delightful experience of a take-your-daughter-to-work summer.

My younger daughter, Rose, decided years ago that she wanted to be a physician.  There is no longer much of an issue of gender roles in this profession, as many medical school classes are about 50-50.  She has just returned to college for her sophomore year of a pre-medical curriculum.  Midway through her freshman year I investigated the possibility that she could accompany me during some shifts in the emergency department as an observer.  This is sometimes called a "shadowing" experience.  (While particular words and phrases sometimes make me think of songs, the famous duet performance of "Me and My Shadow" by Frank Sinatra and Sammy Davis, Jr. really didn't fit.)

Rose embraced this opportunity with greater enthusiasm than I had expected. She spent part of her summer completing a training course to become an Emergency Medical Technician (EMT), so she will be able to serve in her college campus EMS organization for the next three years.  Whenever she wasn't in class, she was in the ED with me for nearly every shift I worked.  Evenings, nights, weekends, all of them.  When her mother asked why so many, and especially why the night shifts, Rose astutely pointed out that every shift is different and that night shifts are different from the rest.  It rather reminded me of the famous story about the chair of surgery at Duke University who said the only bad thing about being on call every other night during surgical residency training is that you miss half the interesting cases.  She accumulated about 300 hours of experience.  That is more time in the ED than many medical students have spent before they must, in the fourth year, decide what specialty they are choosing for post-graduate residency training.

Despite my obvious source of paternal bias, I will assert that she was a model of professionalism in both behavior and dress, her short white coat always quite neat and clean over blouse and slacks, and her manner of interacting with nurses, residents, attending physicians and patients always exhibiting proper decorum.

Because I have the good fortune to be practicing my specialty at a tertiary care, academic medical center, Rose got to see not only what it is like to take care of patients but also what it is like to be a trainee and what it is like to teach them.  In our department we have medical students; students in training to become physician assistants; residents training in the specialty of emergency medicine; and residents from other specialties completing required rotations in the ED.

The great value of the emergency medicine rotation for trainees who do not intend to pursue the specialty as a career is that it teaches them how to approach what we call the "undifferentiated" patient. In the ED we see patients who are seeking help with every kind of medical problem imaginable - as well as some problems that don't really seem to be medical at all.  As you might imagine, for a college student who wants to get some sense of what it is like to be a doctor, this is perfect.

My colleagues were most welcoming, gracious, and generous.  They answered all of her questions that weren't, for whatever reason, directed to me, and they sought her out when there was an opportunity to observe something they thought she might not have seen yet.  She was able to observe as the trauma surgeons opened the chest of a patient with what ultimately proved to be a fatal gunshot wound; as the neurosurgeons placed a drain through the skull of a head-injured patient with critically elevated intracranial pressure from a hemorrhage; as the residents and I used bedside ultrasound to try to sort out what was going on in the chest or abdomen of a gravely ill patient; as gastroenterologists used an endoscope to peer into the gut of a bleeding patient to find the source and put a stop to it; as young doctors painstakingly pieced together traumatic wounds so they would heal and the injured body part would look as much as possible like it did before.  She saw patients who were crazy, intoxicated, or both.  (Very often both!)  And she saw the wide spectrum of intensity of interaction between doctor and patient, from kind and gentle reassurance to the fervent efforts applied to snatch a human being from the jaws of death.

When I was a high school student I decided I wanted to enter the medical profession with only the vaguest notion of what that meant.  In the thirty years since I graduated from medical school I have realized that the same was true of many of my colleagues.  One of the consequences of making inadequately informed decisions with lifelong consequences is that some will turn out to be regrettable. The medical profession is very demanding.  For those who have a passion for it, the rewards are great.  For those lacking that passion ... suffice it to say that some of the most unhappy people I have met over the last three decades have been doctors who really don't like doctoring.

Assuming Rose stays on her chosen path, her decision to do so will be very well informed.  And for that reason I am most grateful that she could spend so much time with me this summer.  Even more, though, I am grateful for having had the opportunity to gain a fuller appreciation for what a delightful young lady she is.  I suspected when, at the age of 12, she helped care for her grandmother, who was dying of emphysema, that she would some day be a fine physician.  And this summer she was tremendously helpful to her mother, who is recovering from surgery for a serious injury to her foot.  She parlayed her excellence in the organic chemistry laboratory during the freshman year into gourmet cooking in our kitchen.

Last October I wrote an essay for this blog titled "Hope for the Future of the Medical Profession."  That essay was inspired by my having learned that the daughters of two of my emergency medicine colleagues were in residency training, one in emergency medicine, the other in internal medicine.

This summer Rose has given me so much more hope that the next generation of physicians will be able to give their patients all they need, want, and expect of their doctors.