Thanksgiving With the Doctor.

Welcome to the third installment of "Relatives of mine and their dangerous, scary, disgusting, highly difficult and courageous careers."

I can't believe how many of these people are sprinkled throughout the family along with the rest of us losers. While the majority of us make up life's vanilla ice cream, these people are the chunky, chocolaty, cookie dough morsels of society.

I've previously written about my two brothers-in-law, each of whom served at least twenty years in the Air Force and Navy. This month's ROASP family member of the month is my cousin—actually my dad's sister's son's daughter—Hillary Goodwin. She's been an emergency room physician for the past fifteen years.

I actually remember when she was born, and the reason I know this is that when I was around five, we went to see my cousin Craig's new baby girl at my aunt's (her grandma's) house. I remember thinking, "Hmmm. Hillary. Never heard it before. That's a good name."

We attended many Thanksgivings together during the experimental 1970s, an era when I was torn between being ten pounds overweight and fifteen or sometimes eighteen. I was determined to detract attention from my beaver teeth and black rimmed glasses with the glare of my multi-striped slacks. I looked like Bobby Brady in a funhouse mirror.

Oh yeah, back to her. She was never a brat to her brother and parents like my sister and I were. She never ridiculed my sweater vests. And I'd have to think that Hillary observed a few of my well-placed kicks to my sister's shin. There's a certain thud it makes when you hit the sweet spot.

I don't remember seeing Hillary much during her teenage years. Her comments are italicized:

We moved around a lot growing up which was a little hard at the time but I am so appreciative of that experience now. I was born in Pullman, moved to Delaware, cross country again to Tacoma, spent Junior High and part of high school in the small southern town of New Bern, North Carolina and then back to Kent, Washington to finish high school at Kentwood.

Were you already thinking of going into medicine?

I had wanted to be a doctor as long as I can remember but probably for all the wrong reasons. There are likely a few witch doctors in our family but I never had much exposure to the field of medicine. For me it was picking one of most challenging careers I could imagine and also proving that as a girl, I could do it. When I was in medical school, the majority of the students were still men and certainly when I went into my ER residency that was true.

One thing I do remember vividly as a child is the story of my grandma. She worked for a chiropractor for years. When she started developed edema, he increased the number of "adjustments" she got and after that didn't seem to work, he referred her to an "herbalist".

I remember.

When she finally got so swollen and short of breath that she could barely walk, she agreed to see a medical doctor. Within a week she was in the hospital getting emergent surgery for critical mitral valve stenosis. It made me appreciate forever the value of science based medicine.

Our paths crossed again at the University of Washington, but not until your freshman year and my second senior year (yes, you heard right), during the spring of 1986. She showed up at a fraternity dance with a guy from the house I actually liked a lot. Which helped.

Hillary, what was your take on sorority life ?

My feelings about the sorority experience have morphed over the years. I was the sorority president and the editor of the Greek System yearbook so at the time I was fairly entrenched. went from this relatively conservative experience (one boyfriend used to have a pic of Ronald Reagan on his wall) to medical school which was very liberal. In the end I am pretty thankful for my Greek sorority experience. 

It gave me leadership opportunities, a smaller social network at such a big school and social skills that benefit me tremendously to this day. I also made some life long friendships with many men and women who have gone on to be very successful, generous people.

And now it's time for med school. Where did you go?

I attended the UW School of Medicine and during that stint spent six months in Boise, Idaho as part of the WWAMI (Washington, Wyoming, Alaska, Montana and Idaho) program. It's such a great way to see medicine practiced in our small towns; it is very different then the tertiary medical centers.

It's also where you met your husband Dan.



Dan and I couples-matched to Cleveland, where he did his ER residency and I did my pediatric residency at Rainbow Babies and Children's Hospital. I then did another residency at UC Davis in Sacramento in Emergency Medicine. (Interesting side note is that since I did that residency match independently, I found where I had matched in one of the daily editions of US World and News Report?! I guess they made a deal with the residency matching process.) I had the joy of doing two residencies before they had weekly hour limitations. Can you say six years of 80-100 hour work weeks?

Wow. One hundred hours? Since I turned fifty, I haven't gone for a good twenty minutes without nodding off. Sleep is what I do...and I do it well.

It is amazing what adrenaline will do, and I don't think my decision-making has ever been compromised by sleep deprivation. The rides home, however, after such long hours as a resident were always a little scary. I remember holding it together after one long shift, making it into my carport and falling asleep in the car. Dan woke me up an hour later with a cell phone call. 

We get pretty used to weird hours and pulling all nighters at work is par for the course for me. Ironically, the old-school docs among us worry a bit with the contracted work hours, that the new doctors coming out of residency aren't seeing enough cases because they are not logging the hours we did.

I'm sure you've been asked this a million times. You're a mom to a son and daughter. You work in the ER. How do you deal with seeing kids in such tragic situations, especially those that remind you of your own?

All ER staff develop a pretty good mental barrier between work and home life. I don't think we could function in either venue without that. A couple cases do stick however. I recall caring for a young girl who was critically wounded in a car accident during residency. She was so terribly injured it was difficult to identify her but she had tiny hair clips that made her death more personal somehow. She comes to mind on occasion when I worry about my own kids.

Oh, man, I can see how that could happen. Okay, switching gears. What's your take on Obamacare so far? Be honest, but remember my lefty leanings. I may have to edit your answer out or just make something up.

Obamacare? I don't know how this all is going to play out. In the ER since the rollout, we have seen a huge increase in census. Because it has been a major flu season, we in the Emergency Department worry that because the biggest increase in enrollees is in Medicaid, our ERs will be more and more overwhelmed. Unfortunately the reimbursement rate is so low with Medicaid that many primary care doctors won't take these patients so as a last resort they end up in the ER which is an expensive and inefficient way to deliver care.

Yeah, I thought the whole idea was to give people more choice and take some of the heat off the ERs. Let's hope that improves..quickly. Wrapping things up, what would you say are the best and worst parts of your job?

In the ER, we see the best and worst of humanity, which is a blessing and a curse. It can give you a distorted view of the world when you see unbelievable tragedy. I remember helping with a young woman who was dying from a pulmonary embolism (blood clot to the lungs) a few days after she had elective plastic surgery. It was a horrible case as she was a mother and her husband was sobbing in the hall as we were coding her.

She ended up dying and I finished my shift to run pick up the kids from school and go to a PTC meeting. I sat in one of the small kindergarten chairs listening to the parents talk about collecting box tops and looked down to see a dot of this poor woman's blood on my scrubs. The discussion seemed so inane with this perspective, I felt like telling the PTC where they could put their box tops.

I got up and quietly left instead. . .

The huge number of people struggling with addiction is also a challenge. On the flip side, many of these experiences are also big blessings. Most of us have a huge appreciation of how fragile and finite life is. We also don't suffer fools well which is pretty helpful when you have teenagers.

Amen to that. Thanks, Hillary.