Atul Gawande

Atul Gawande

A weeklong electronic journal.
June 5 1997 3:30 AM

Atul Gawande

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       Let's talk money (I got my pay stub in the mail yesterday). I make $33,000 a year. The last year of residency that increases to $41,000. My fellow residents, scrimping to pay off their $100,000 loans, chafe at this. Fortunately for me, my parents are doctors and put me through school. Even with two kids and a high-maintenance wife, I've got it better than most.
       When this is all over, though, you're talking big bucks. New general surgeons start at more than $100,000 a year. The average doctor makes $180,000 a year (so why does Dr. Mark Greene on ER still have that crummy apartment?). In the late 1980s, cardiac surgeons made the most--$675,000 on average, with the top 10% making a million bucks. People say managed care has slashed this by half. Still pretty freakin' good, though.
       My son, Walker, needed cardiac surgery my first year of residency. His surgeon was incredible, operating on him in the day and then again in the night. Walker survived a condition that until recently killed most children. I'd pay his surgeon a million bucks myself. But I wouldn't do cardiac surgery if you paid me. After finishing general surgery residency, cardiac fellows put in more than 120 hours a week (that leaves only 48). I'd be 40 years old at the end of the training. And once in practice, I'd still have to work like a dog. I want to see my kids some day.
       I'd also like to stay married. I've watched too many residents' marriages fall apart. Spouses have to be pretty independent, and put up with moodiness, 2 a.m. phone calls, and dashed weekend plans. The female surgeons have it worst. How well do you think men tolerate all that? Surgeons divorce nearly twice as often as the average doctor. (Can you believe there's a study on this?) For those of you looking for a doctor to marry, psychiatrists have the highest divorce rate (surprise, surprise), pediatricians the lowest. Oddly, doctors who had a parent die while they were in medical school also have a low divorce rate.
       I also know two residents who killed themselves this year. But this is getting too grim.

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       This morning, my twenty-something splenectomy patient was combative and talking nonsense. His fevers were worse. His oxygen levels were low. This made him confused. Since he was confused, he wouldn't keep an oxygen mask on. I got angry with him, and he finally kept it on. An X-ray showed he had pneumonia. I hadn't prodded him out of bed enough. That would have made him take full breaths and cough up the junk in his lungs. I had the nurses bang on his chest to loosen up the pneumonia and browbeat him to cough. I started antibiotics. If he gets any worse, he'll need to be put in intensive care. I hope he turns the corner.

Atul Gawande is a surgical resident in Boston who will be starting a regular column for SLATEcalled "Medical Examiner" in July.