this afternoon.I was walking to my car, wearing my long black coat and heavy bag, walking towards two heavyset, well-dressed men in long black coats with heavy bags. One, with aviators and a shiny tie, asked me expectantly, "Is there still room on the list for us?" I stared at them for a minute, having no idea who they were or what they wanted, and finally I said, "I'm not sure what you mean. You'll have to ask someone smarter than me. I'm just a med student." Ohhhhhhhh, they grinned together, and went inside. Then I realized that they were drug reps, and they thought I was one of their tribe. That would be the only reason why a girl in heels and a long coat would be leaving a low-slung dull-bricks & fluorescent-tube-lit suburban family clinic whose nearest neighbors are a liquor store and a SuperAmerica.
I was leaving early so that I could attend a special bioethics committee meeting at which the author of the above-linked article was going to discuss the hopeless enmeshment of the drug industry with our institution. My previous day at this clinic, the doctors were talking about which days they would and would not have lunch catered by Merck, or Pfizer, or AstraZeneca. "How often do you have lunch?" I asked. That single question was enough to get Dr. B to launch into a long and practiced speech about how no amount of pizza would get him to change his prescribing habits and how his patients were helped by the well-stocked sample cupboard that Aviators and friends refill on their twice-weekly visits, and how much he learned from their educational education. I nodded, thinking that if this level of defense was provoked by such an innocuous question, I'd better leave the topic the hell alone. We rotate sporadically through these clinics. We are their guests and not their moral or Freudian provocateurs. "I'm hearing a lot of hostile feelings. Do you think we could explore that?"
At the meeting, surrounded by the committee members - chaplain, ICU nurse, community leader, pediatrician, risk lawyer - Dr. Elliott details a number of scandalous cases involving our faculty's ethical transgressions. Describing one, he mentions my brand-new psych department advisor, who does indeed accept drug company study money, by name. I feel oddly guilty by association. Stories of wrongdoing and lawsuits flow forth, familiar and still incredibly gross. Rants and raves ensue, a general depression descends over the room. I discuss my clinic predicament with Joy and Dr. Elliott. I ask, what is the best course of action for the conscientious objector? No one knows.
Today, mercifully, there was no drug lunch. People came and went from the back room between phone calls, eating their lunches in the narrow space left between appointments. Dr. A said that she listens to the New England Journal on podcast while she makes dinner. There is never any time to spare, only overbooking and lateness, and this makes visits from pretty salespeople carrying literature and pitching new drugs in 30-second increments attractive.
Not long after lunch, a man staggers into the clinic and collapses on the front desk. He is having an asthma attack so intense that he can barely speak. "How long has this been going on?" we ask, wide-eyed, and he holds up three shaky fingers instead of trying to explain. It turns out that he had been at the clinic with his wife that morning, and when he had an attack a few hours later, oxygen deprivation told him to walk a mile in the cold back to the clinic. It is not his clinic. We have no idea what his name is until we read it off his asthma inhaler's pharmacy label. His surprise appearance derails the schedule significantly. Dr. A and Dr. C both try to hand off Mr. Wheezy to each other, but Dr. A wins because of her next patient. "Would you rather tell Ms. K that she has breast cancer?" Dr. C admits that she would prefer the wheezes. "I like asthmatics," she says, and goes to listen to him wheeze some more. I am useless. No one wants a med student around when they find out they have cancer, and Mr. Wheezy is too sick to tell me what happened to him. I listen with my steth to his sad huffing-honking sounds and pretty soon he has a syringe of epi in his arm and a puffing nebulizer strapped to his head, and pretty soon some crabby paramedics are hauling him to the ER. The wasted drops of epi that swelled and fell from Dr. C's needle dry up on the workroom counter, while I read about chemotherapy. Kool 108, the favored radio station of this clinic, begins playing "Stayin' Alive."
