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Aging Professor in Jeopardy!

2023; Elsevier BV; Volume: 136; Issue: 8 Linguagem: Inglês

10.1016/j.amjmed.2023.03.013

1555-7162

Daniel G. Federman,

Health and Medical Research Impacts

“Bismarck” I excitedly blurt, several decibels louder than necessary, while energetically pressing my thumb against the imaginary buzzer I grip tightly in my right hand (Fargo not even once entering my brain when asked to identify the capital of North Dakota). I allow myself the latitude of not putting the answer in the form of a question, in order to afford myself every advantage competing against the actual Jeopardy! contestants, who have probably been training for months, if not years, and selected from thousands of other brilliant applicants. I furtively look out of the corner of my eye to ensure my wife actually saw me respond well before the actual contestants. For the past several months, we had been watching Jeopardy! together almost nightly, even recording the episodes we are forced to miss when we have to attend to other obligations, though none of those seem as important as being on our nightly date with Ken Jennings at the famed Alex Trebek stage at Sony Pictures Studios. How did I get here? While having intermittently watched Jeopardy! since the Art Fleming days and throughout the entire glorious tenure of Alex Trebek, you may be wondering why my present relationship with Jeopardy! is of such paramount importance to me. You see, I am losing a little on my fastball, my medical fastball, and it both galls and terrifies me. After a less than mediocre medical school career (let's face it, half of medical students are below average), I entered my residency hell-bent on bettering myself and the care afforded actual patients. I voraciously read and savored medical textbooks, journals, Medical Knowledge Self-Assessment Program volumes, and anything else I could get my hands on. I attended every lecture, grand rounds, or conference with rapt attention. I quixotically thought it possible to eventually know almost all of medicine, if one were willing to toil hard enough. I maintained these good habits after completion of a rather arduous training, one only allowable in the bygone Mesozoic era, and this came in handy as I later embarked on an academic general medicine career. Later, when working with trainees, I would never accept a straightforward presentation without the orator generating a broad differential diagnosis. I would probe their knowledge of each condition, hoping to later inject a couple of “factoids” that I hoped they would not only consume, but devour. I am old enough to say that the majority of my inpatient attending time was before the era of duty hour mandates, and that while I would be a major violator today, I rather humbly admit that I was a popular attending. Selfishly, generating lengthy differentials and thinking about medical trivia kept this information fresh in my mind, ready for release at a second's notice should it actually be needed. However, time inexorably marches on, and before you know it, the tummy gets soft, wrinkles suddenly appear, if you are lucky enough to have hair, it turns gray, and whether you intended so or not, you become the Chief of Medicine at the VA. Instead of participating in education, my job has morphed so that I now spend the overwhelming majority of my days responding to multiple e-mail complaints about the overnight temperature in the resident call rooms, the flood in the computed tomography scan rooms, unclosed windows before the impending frigid temperatures, and disinfectant wipes being flushed down toilets, and trying to find non-existent office space for the new gastroenterologist and hospitalist hires. Perhaps most frustrating is dealing with the human resources morass, that too often seems like World War 1 trench warfare: lasting years, filled with peril, occasional explosions, but without an inch of progress being made. Over the past few years, I have developed a relationship with my keyboard and Microsoft Outlook that not only makes my wife jealous, but simultaneously leads me to contemplate priorities—both my own and those of others. Those few times I either intentionally or accidentally get sucked into the wonderful realm of clinical medical education, I find myself no longer able to readily come up with the names of the exact organisms comprising the HACEK group in culture-negative endocarditis, the exact testing algorithm to confirm antiphospholipid syndrome, more than 7 or 8 causes of hypercalcemia, or the latest diagnostic criteria for systemic lupus erythematosus. These are things that used to be on the tip of my tongue, standing ready to impress. I find myself more reticent to speak, more unsure of myself, during those rare occasions I am able to attend resident morning report, fearful that I will use outdated names such as Rochalimaea henselae and Pneumocystis carinii pneumonia. Nobody from the bartonella or jirovecii camps consulted me prior to the name changes. Had they, I would have objected. At my age, it is difficult to learn something, perhaps more challenging to un-learn it. Trainees and staff no longer come to me seeking my medical opinion about specific complex patients or clinical conundrums; instead, they seek me out when they have questions relating to how to get things done, or more frequently, to inform me of often unsolvable problems, both real and imagined, that they want addressed immediately. I know some may interpret this as my own version of complaining. It isn't. It is a true privilege to serve learners, VA staff, and Veterans, and there is no place I would rather be. However, I find myself more reliant on Ken Jennings to allay the fears that being in one's early 60s precipitates the fear of impending cognitive decline. I find myself shouting “Lake Superior!” when the prompt is to name the largest Great Lake. In contrast, earlier that day I couldn't remember what else caused aquatically acquired infections other than Mycobacterium marinum, Vibrio, Erysipilothrix, and Aeromonas. I used to know more. One question later, my confidence grows as I correctly scream “Ben Franklin!” when asked who invented the flexible catheter and bifocals. I glance again at my wife, who now unintentionally embarrasses me by acknowledging that I am clearly looking at her for affirmation. However, my newly found confidence is shattered when the bespeckled librarian from Nebraska, correctly comes up with and beating me in the category of “Starts and ends with the same vowel” (the clue was “red corpuscle,” and she proffered “erythrocyte” before I could). Crap, I can't even get the medical Jeopardy! questions anymore.