I was reminded recently of the theory in animal breeding called “The Coolidge Effect.” Laura Zigman wrote about this in wry and hilarious fashion in her book Animal Husbandry. In summation, when a bull is brought in to mate with a field of cows, his first arrival reveals his libido and ardor in full swing. He just about wears himself out, the poor thing. He mates with all of the cows in the field multiple times, until, well, he loses interest. He’s had those cows you see? And farmers have tried to outwit the bull. They take the “old cows” and put pretty hats on them, and spray them with nifty new cow fragrances, and sure, the bull may develop a transient interest, but mostly, well, he’s just not interested. Those cows are “old cows.”
I am an “old cow.” Oh, well not exactly in the animal husbandry sort of way. But I do sometimes feel like no one can hear or see me. I’ve been saying the same damn things forever. And who can hear me what with all of the “new cow” that surrounds me? The average age of a hospitalist is about 37, with nearly a third being less than 35. I’m way beyond that in years, though discretion and fear of “old cow” discrimination forbids me from saying how much. And I have students who round with me who possess quicker feet and slightly more agile minds than mine, who likely often think I’m dithering around too much when I’m making a decision, or truthfully when I’m putting off making a decision. And I sometimes work with physicians who are much younger than that average age. And at times, I get frustrated when they want to do something that I’ve seen fail many times before. But they can’t hear me or see me — I’m old cow.
But you know who can see me and hear me? Patients. Patients know that my crow’s feet and grey hair are medals that are fairly won on the battlefield of inpatient medicine. They respect my badges. They know that the “dithering” is because almost all the simple things are not truly simple, that there are risks to nearly everything, and that critical evaluation and thoughtful commencement is needed. Patients know that they need us, they trust us, they listen to us “old cows.”
We have a physician hospitalist in our group who is definitely way beyond the “average” hospitalist age. Even I, a semi-old cow, had to fight the urge to dismiss her, to avoid pulling her into our embrace. She looked different and was a different demographic. I worried that the pace of work in our group would break her in a million pieces, that she wouldn’t be quick enough, or have enough stamina. But the truth is, she is a fantastic doctor. An intelligent caring practitioner of sensible patient-centered medicine. Forget the bull. Forget the cow. She has it going on. She is one of us.
I think we have to find a way to honor all of the “old cows.” We have to respect and recognize that experience is precious and valuable, priceless really. We need to develop ways to retain, attract and acknowledge the “grey beards,” or the “old cows;” the battle worn generals of a fight that never ends in defeat or victory. We need them. And patients need them.
Maybe we can start by calling them “sacred cows.”
Tracy Cardin, ACNP-BC, SFHM is the Associate Director of Clinical Integration at Adfinitas Health and also serves on SHM’s Board of Directors. Prior to this, she was the Director of NP/PA Services for the University of Chicago and worked in private practice for a group of excellent pulmonologists/intensivists for over a decade. She has been a member of SHM for over ten years and has over twenty years of inpatient experience, which seems incredible as she cannot possibly be that old! Her interests include integration of NP/PA providers into hospital medicine groups and communication in difficult situations.
In her free time, she likes to run and lift, read and write and hang out on the front porch of her semi-restored Victorian house with her dear family and friends while drinking a fine glass of red wine and listening to whatever music suits her whimsy.