In medicine we have roughly 8 years to weed out the psychiatrically
unfit med school + residency... It doesn't mean that we always
succeed - but we try - and we usually weed out the blatantly unstable
personalities...

The problem is that people change... For instance, during the years as
student and resident we are always subordinate to others who train,
observe, and discipline us... The borderline personality cases can
survive this by keeping a low profile and going along to get along...
Once licensed to practice on their own a small percentage of those
borderline cases then begin developing destructive behavior patterns,
unfortunately...

I remember one incident when I was a lowly intern first year
resident... I was called in to an operating room to help during an
abdominal surgery under a surgeon who was reknowned for his temper
tantrums and throwing things I didn't know that though, as I had only
been there a couple of weeks and had not been on surgical rotation
yet...

Before I finish this story you need to know that I was 35 years old
when I started med school... I had been in charge of plant
engineering for a tiny multinational corporation, been an electrician,
been a foreman of construction gangs, etc. In short I was not a kid
and had been around some tough guys... Whereas the typical first year
resident was 22 or 23 years old, had always been a student, and had
little real world experience...

Anyway, I am gloved, gowned, and wearing a face shield, and standing
across an open abdominal cavity from our tempermental surgeon and
indistinguishable from the fresh faced interns... My job was to hold
a retractor and move organs, etc. out of his way as he worked on
cutting out a cancer from the bowel...
"Move that retractor. ", he says...
I move it..
"Not that way, dammit!", he screams and he whacks the back of my hand
with the flat side of the scalpel handle he is holding... Now had he
twitched when he did that, the razor on the end of that handle would
have instantly severed all the tendons on my hand...

There was instant silence in the operating room as everyone there
lived in fear of his tantrums...

In that silence I said in a flat voice..
"Sir, if you do that again two things will happen... First I will come
around the table and punch you silly. And second I will have you
arrested for assault with a deadly weapon. Exactly where do you want
the retractor?"
Now the silence in the room was really intense... Everyone was looking
elsewhere but at us...
He stared at me hard for about two seconds as I looked him right back
in the eye - then he said in a mild tone, "Towards my right hand and
tip it so I can see under the gallbladder." The rest of the operation
went smoothly and the patient recovered and went home the following
week...

Down in the cafeteria for lunch, the story had already spread across
the hospital like wildfire... A couple of the residents sidled up and
said, "Man you are gonna be fired."
I told them that absolutely nothing would happen... The surgeon would
not file a complaint with the medical director because he knew he was
wrong and because he had just been faced down in front of witnesses...

I would like to say that his behavior improved after that, but it
didn't... I heard that years later another surgeon did punch him and
he wound up having his privileges suspended for a time...

denny