Thursday, May 31, 2007
It’s enough to scare anyone and make them consider what we write and just how anonymous any of us truly are.
Dear Dr. Flea… I wish you peace and tranquility my friend. Peace and tranquility.
Monday, May 28, 2007
I'm glad to see that she decided there was really nothing she had done that was in violation of HIPAA or was detrimental to her work. Assholes abound and they can try to stop the medical blogger, but damn if they won't fail.
Welcome back FD, it's great to have you back again.
Sunday, May 27, 2007
I liked IM enough. I figure I could be a rather great internist because of the knowledge aspect and the detective work that goes into managing patients. I really enjoyed that part of Medicine. The problem that I had, however, was that I didn’t like the patients.
And not just the patients, I didn’t like the type of patients we mostly catered to: poor, underserved, homeless, etc. The “scum of the earth” as some might put it. I thought about these patients and how most of them came to us from the ER. I evaluated the prospect that I would have to deal with these kinds of patients on daily basis many times over for year and years. And I knew I couldn’t do it.
It just wasn’t in me. I would have burned out incredibly fast had I decided to enter this field of medicine. Partly because I think many of these social parasites shirk their responsibilities and trust in others to do everything for them while continiuing their immoral behaviors. I can’t remain humble and self-less to people that I can’t even stand to talk to or interact with in some semblance of humanity. For that reason I knew EM was not for me and I believe that these patients would be better off without me as their “primary care giver”.
Friday, May 25, 2007
That’s right. I had you guessing about what kind of shape I’m in, what I might look like, and what you, my avid and voracious readers, thought MSG's fitness level is based on numbers because I'm an incredibly vain person. Happy?
The result? Well, basically most of you had me fairly well described: slightly overweight with a muscular build, often mistaken for weighing far less than I actually do (usually 40 pounds or so). I do not, regrettably, have legs of steel or “guns of nazarone”. Yet. So thanks for playing.
I was thinking about using this as a BMI discussion since I honestly feel I'm not "close to being obese" as the BMI suggests, but I think I’ll hold off on it. Afterall, most of us understand that this particular tool is useful but is clearly subject to interpretation.
Yesterday Stepson had his elementary school graduation. I was given a reprieve for the morning, but was supposed to return to the Army base afterwards. Instead I just didn’t go. I was essentially AWOL.
What's interesting to me is the fact that I’ve never done this before – completely forgoing my responsibilities because I despise a rotation. But here it is…I missed a day for no real reason. I just didn’t want to drive that far to deal with that crap.
Do I feel guilty? In some ways, yes, I do feel guilty. But in an abundance of others I feel completely OK. I had a great day with my family and enjoyed a picnic with his classmates. I spent some quality time celebrating Stepson's accomplishments and this movement into a new phase of his life. Hell, in one year we might be moving several thousand miles from him and his asshole dad, so taking time to enjoy these moments is even more important.
The only issue is whether I'll receive a reprimand on Tuesday for not returning. Either way - whatever. I really don't care anymore. I've got a couple more weeks and then 3rd year's over.
Wednesday, May 23, 2007
Despite this comment and the feelings that I initially felt towards her, I came to enjoy reading her thoughts on a semi-regular basis. I have not read her posts for some time though and was informed by Dr. Couz of her turn for the worse.
Sarah is most likely going to die within the month from malignant melanoma. The cancer has become very aggressive and all treatment options are not helping. Her husband is currently updating her blog as she is no longer capable. It was shocking to say the least.
I urge all of you to please take some time to read her story and learn about this courageous woman. If, for nothing else, than to realize how fulfilling life can be and how someone can take adversity and turn it into triumph. She has been tremendously brave and steadfast through this time and her courage has been awe inspiring. I honestly felt that she was going to be OK.
I wish Sarah and her husband the best with the time she has remaining with the strength needed as they endure this trying time. Despite our first impressions I came to feel like I knew you, Sarah. You are in my thoughts. Find peace.
I ask you to come up with some assumptions of the following patient information:
Weight: 221 lbs
BMI: 29-30 (good BMI is 18-25)
Age: late 20’s, early 30’s
Got it? So, what I want to know is what you think this patient looks like. Obese, healthy, scrawny, etc. Are they in need of a special discussion regarding weight control or are they OK? Please play along - it will be interesting to see what people think. And yes I’ll discuss this on my next post.
Anyways, I’m at the Army hospital again. I was there for surgery in November and have returned. Many things are constant (including the salacious scrub tech who winked at me during a hysterectomy - remember, I’m a married man, married man, married man) while others are completely different.
For one: the atmosphere is not as sullen since the sun is out and the weather quite pleasant. Second: the OB/GYNs are quick and efficient, thereby allowing me to get in some reading between patients. Third: the nurses still eye you with some trepidation, but are more likely to allow you to see a patient without a doc with you. And Fourth: my surgeon with whom I was paired was deployed to Iraq. I hope he’s OK.
I’ve also got a couple good friends with me up there who help pass the time. It’s been a nice break from the hell of last month despite the 160 mile round trip days I’m making. However, with this long time for driving and the typically 9-10 hour days I’ve been having trouble getting anything done outside of this. Internet connection is hard to come by since I need a special card to access any computer terminal and coordinating anything has been rather impossible. So, if you’ll please allow me some time, I promise to update as I can…just not as frequently as I have been.
Saturday, May 19, 2007
So now I have the "outdoor type" that's all manly looking and burly. I kept tripping on them yesterday. Damn near fell down some stairs, but hopefully I'll get better at walking. I've only been doing it for 29 years now.
And the best thing? My feet remained relatively comfy and rather non-malodorous throughout a 13 hour day. Awesome. My residents of the past are thanking me right now.
Friday, May 18, 2007
So, for now, a fond farewell with hopes that you will soon return:
Fat Doctor (invite only)
FifeMe (invite only)
Hospital Phoenix (who turns up again and again only to disappear again and again)
It’s scary to wonder what’s happening here. Censorship, either self induced or forcibly mandated, is continuing its strangle hold of a profession who’s sanctity is quickly slipping away. Where have all the bloggers gone? Sad days indeed.
But here’s the thing: these other hospitals that these tragic patients want to have their care transferred to won’t see them. They’ll kick their asses straight out the door should they try and walk-in and they sure as shit won’t receive them as a transfer. Why? No ability to pay for services rendered.
So instead this hospital accepts these patients, hemorrhaging money by the millions each year in order to give the extremely poor a place to receive equal and fair treatment. Because of the huge financial pitfalls there are areas where we suffer. We don’t have the newest, most expensive, and most advertised machinery or treatment options. Instead patients receive quality care with methods proven to work. And all at almost no expense to themselves (since we all know they’re not paying for anything anyway).
Despite these efforts and the obvious level of gratitude that should be inherent in these people I often see them ungrateful. Upset at the conditions they “perceive” in a place that’s never out of the red.
“I’m going somewhere else. They’ll take better care of me.”
“You don’t know what you’re doing. Over at (huge research hospital with lots of fancy and expensive new equipment) I’d get this test done. I’m outta here.”
“I’m leaving AMA. I don’t care what you say. Some doctor out there will take me and care for me without insurance and a stable income.”
I hear these lines or variations everyday. Trying to explain to a patient who has not had a job in over 5 years, drinks 12 or more beers a day, smokes like a chimney, and has absolutely no means of paying for services for his congestive heart failure, kidney failure, and rectal cancer that no doctor in town will touch him other than those currently seeing him is just futile. They don’t get it. They don’t want to get it. All they want is a handout and feel entitled to the services and care received by the best insured and wealthiest in society.
I guess it’s the delusional aspect of many of these patients that got them where they are in the first place. Believing that someone will always take care of them, trusting in the fact that Uncle Sam will never stop giving them money or food or clothing. Ensuring that they’re not responsible for their own damn care – ever and behaving like spoiled children with surrogate parents. Why else wouldn’t they think they can get that new drug, fancy treatment, or costly surgery with little to no cost to themselves? It’s how they’ve been living their entire life.
Thursday, May 17, 2007
Flea! Where are you?
Whatever has occurred I hope that he is well and that the court case has not taken a turn for the worse. You're in my thoughts.
Wednesday, May 16, 2007
Yeah, you read that right. This event could, if the patient wanted to, go to trial. I'm not going to discuss what the infraction was that I committed, but needless to say it was not done with malice of forethought. Rather I was just trying to be proactive and fucked up royally. My ability to think ahead was apparently impaired and I went about the task without considering the magnitude of the undertaking at hand. When I informed the nurses of my findings their looks and gasps were enough for me to understand how truly screwed I was.
I was talked to at least 4 times yesterday by increasingly higher levels of power within the OB/GYN program. Just grateful that they were understanding to a degree, but I could sense how concerned they actually were. When you're scrubbing into a C-section and get pulled out, already gowned up, you begin to understand how big a deal this is. When they use the terms: "You could go to jail for something like this" (well actually the nurse said that, but still) you're apprehension heightens.
And all of this after I hated this rotation so much, but have begun to get a feel for it, feel like I can accomplish some tasks without being completely deflated and demoralized, and was not dreading everyday as I had the first couple weeks. But now...
Stupid, stupid, stupid.
Tuesday, May 15, 2007
"I love you!"
Apparently the patient was quite satisfied with her pain control.
Monday, May 14, 2007
1) Cathartic. Where else can you bitch to a seemingly unknown audience who’ll chime in with you about the pressures I’ve been undergoing.
2) Self aggrandizing. Come on now. Who doesn’t think that they’re writing some masterful post every now and then and come back over and over again to see who’s commented. It makes me feel important – like a dictator.
3) Good way to waste time. Honestly I never thought I’d become a blogger. But now I’m hooked. I hate missing people’s new posts and feel bad about not updating if I go a few days. It’s a good release from studying.
4) Historical. Ironically since I’ve lost my first 1.5 years worth of material I still find that blogging is a good way to keep track of events in your life. I’ll go through this once and looking back has always been a way to remember how much I’ve progressed. I know I’ll look back at the posts about OB/GYN and laugh. Just not right now.
5) Good way to feel connected. In a kinda sad way blogging has made me less introverted. I have people that I enjoy “talking to” through posts, comments, e-mails. I’ve thought about the possibility of asking for housing assistance during interview season with the very minute amount of authors whom I’m aware of where they live. I don’t think I would, but it’s kind of nice to know that there’s already a connection with these people, despite our differences. It’s also a great way to lose the physical prejudices we all have and just enjoy someone for being themselves.
So there you have it. I’m not going to tag anyone. I know you’re all breathing a hefty sigh of relief.
Saturday, May 12, 2007
First, confusion occurs based on your concrete belief in what you’ve learned from your books, what you’ve inculcated for Step 1, and the honest-to-God belief that you know what field you want to enter. 3rd year throws all of this out the door. I remember wanting to be an ER physician. I remember believing I knew a lot about congestive heart failure and treatment.
Then, Internal Medicine, my first rotation, completely turned my world upside down. ER was suddenly despised due to the patient aspect, CHF was complicated, and patients scared the hell out of me. Everyday I just hoped that I could answer enough of someone’s questions to not get yelled at. Answers that had been satisfactory for Step 1 were no longer "current treatment regimens". I was frustrated and confused.
The second is humiliation. And by this I mean the humiliation that accompanies the medical student as they traverse the harrowing halls of hospital wards, talk to patients without betraying the forbidden secret that they are scared to death of them, and attempting to maintain some semblance of your pride as much as possible while being humiliated by every aspect of hospital employee.
“Do you know how to draw blood? No? What a tool!”
“Do you know how to put in a foley catheter? What? Even my grandmother knows how to do that!”
"Can you find a mop and clean that up? What? No?! Fuck you!
In some parts of the hospital the phones are complicated, thus relegating you to asking how to answer your resident’s call as they return your page.
“What a dumbass you must be – how’d you get to be a medical student?”
You wonder why the nurses yell, attendings scoff, and residents roll their eyes. You’re trying, but it’s never enough. And just as you begin to feel comfortable and start to appreciate your surroundings your rotations end, your month schedule changes, or your attending/ resident changes. The confusion and humiliation remain as constant as the smell of ripe feces and sterile scrub on the internal med floor.
So, tread softly oh ye brave soon-to-be 3rd year medical students. It’s not always bad, but it’s definitely a trip.
Friday, May 11, 2007
Thursday, May 10, 2007
Ummm…wait. Scratch that.
Did I forget to tell you that the presentation needs to involve various specialties of medicine that are involved in the patient's care? Have I also informed you that it needs to be around 45 minutes in length? I haven't? Well, here's something else to chew on while you consider the enormity of this proposal.
The surgeon I'm supposed to be working with has remained quite clandestine. On Monday, while I spoke with him in the holding room of the OR, he got a little upset that I took it upon myself to ask a specialist (who is also a very well known physician in his field and would make a great person to have write me a letter of recommendation) about some information he can provide on the topic. He told me to only be in contact with him and that we'd talk later in the week. Since then I’ve e-mailed and attempted to contact him several times to get his feedback, the patient’s current status, etc. only to have no replies. I can't find him in his office and he won't return my phone calls. At this point I’m essentially flying blind.
So what would you do?
Here’s what I did: I enlisted that specialist’s assistance anyway in critiquing my power point slides, but not providing me any information. I figured that if the person who signed me up for this presentation wasn’t going to assist me then I’ll go to someone who will at least let me know if what I've got is crap or not.
Now, certainly some concern is warranted at this point. It might make this surgeon mad and he could theoretically try to damage my chances of residency (not very likely, but certainly it's possible). However, he’s right out of residency, still has to take his boards, and has made it rather clear that he’s too busy to actually do this himself. I think that’s part of the reason he drafted me into presenting and I think he feels that I've made him look bad by asking for help. Personally I just want to do a good job and waiting until the last minute is not the way to go.
Wednesday, May 9, 2007
A couple weeks ago I had a student moment. I lost it on some of my “colleagues” because they’d not been on time to round on patients for a week and we had a patient that wasn’t seen. 15 minutes before rounds my friend and I quickly obtained the information and saw the patient for rounds, but did not write a note. During rounds I explained this, telling the other students (in the presence of the resident) that I would not write the note. There were enough students to see at least one patient and these 3 students had not seen anyone in a week.
This week I was taken aside by the resident who was present during my tirade. She explained that she understood me being upset, but that I was in the wrong for not writing a note on a patient I’d seen. My job was not to monitor other students. I was supposed to ensure that I was seeing patients and covering where it needs to be done. In essence, be a team player.
I find it extremely absurd that when people who have been victimized by parasites and suffer from it are expected to remain stoic. Apparently my expression of frustration showed “weakness” to this resident and showed her that I was a potential “problem student”. Hmmm, what about those who don’t even do their damn work? Aren’t they more of a concern? What about the fact that they’re going to get a very similar evaluation because no one has paid attention to the fact that they aren’t presenting during rounds? Am I just supposed to accept this chronic and habitual laziness while I work longer and harder? And if so, why?
I’ve heard of people talking about letting “gunners” do the work while they slack. I joked about letting other students who were interested in OB/GYN perform all the deliveries, but when it comes down to it I have a work ethic. I’m in no way a gunner on this rotation (perhaps on surgery I was, but certainly not here), but I still feel that when there is a requirement for students to see postpartum patients then everyone needs to be getting here on time and getting their notes written. If there’s a paucity of patients for a couple days and not everyone gets a chance to present at rounds then you can read. Not showing up till morning rounds start is not an option.
It’s just shows a general character flaw in some people who feel they’ll get away with as much as they can whenever they can. It shows a general lack of concern for patients and poor medicine in general. My problem is that I’ll get the same evaluation they do when they clearly don’t deserve it.
Monday, May 7, 2007
“Daddy, [son] needs to go to timeout!” She demanded. Her finger accusingly directed to the indifferent 11 year old standing at the door. “He broke my Hippo.”
I examined the animal, noted that it was a rather easy repair, and figured I’d work on my suturing. So, while Daughter watched, teetering between pure horror and abject giddiness, I sutured the animal’s dangling appendage back into place. There was minimal blood loss and a local anesthetic was all that was needed for pain control - smirk.
Afterwards you could hardly tell that there’d been any damage and Daughter, quite happy with the result, gave me a kiss on the cheek and said: “Thanks, Doctor!”
She then skipped merrily back into her room where she showed the animal’s newly fixed leg to Son who promptly took the animal from her and threw it on her bed. Sigh.
***I wish I had a picture of the before and after, but I didn’t think about getting out the camera before I’d completed the task. It was fun, even if it was on a stuffed animal.***
Sunday, May 6, 2007
My brother was recently hired on at a franchise company where he’ll make the above income. He has a bachelor’s degree in aeronautics? or something like that. I’m glad for him, but at the same time, damn.
I was the one who was moving in the right direction. I was the one who’s future was all roses while his was covered in obscurity. Not anymore. Talking to him today on the phone I wondered if there isn’t something else I’m supposed to be doing. I knew there wasn't, but it just seems like I'm in limbo while others are moving on around me.
Now, don't get me wrong here, I’m glad that he’s doing well. It's just that he’s younger than me and will have been doing quite well while I struggle with debt, loans, and a $40,000 or so a year resident salary for 4+ years. But then who becomes a doctor to get rich? No one who knows better that's for sure.
Friday, May 4, 2007
During every rotation thus far I’ve noted the abundance in foreign med grads (FMG) who occupy the slots at my school’s main teaching hospital. I’ve also noticed that on OB/GYN, which is considered hands down the best program here (although not necessarily by the students), the majority of residents are United States med school grads (USMG). This fact in and of itself speaks volumes of the quality of the other residencies.
Now, nothing against FMG’s, but there is certainly something to be said about any program who can’t staff their residency positions without 75% of their residents coming from other areas of the world. In fact, the majority of residencies will rank USMGs before they’ll consider an FMG. Got it, G?
When looking at the recent NMRP data from the last batch of newly minted docs some variables are evident that would appear to weaken this post. For instance, some of the primary care fields like family med skew the results a bit. Less USMGs are entering this field which leaves it wide open for FMG's to get into American medicine. Despite these outliers, however, the program(s) that consistently relies heavily on FMG’s in order to have a functional program warrants a serious consideration by any medical student (US or F) towards the training being doled out.
Certainly FMG’s are necessary to help level out the physician decline in this country. Rural areas desperately require physicians who are willing to work in less than stellar conditions with less pay. Often times FMG’s are the only ones to do so. But when considering a place for potential employment, I stronly suggest evaluating their creed of residents. More then 30% made up from FMG makes me nervous. With that being said, I would never apply to the current school that will confer to me my MD. And that is quite sad.
Thursday, May 3, 2007
This thought crosses my mind as I head towards my patient’s door. It’s 5:45 am and I’m dragging. I don’t want to be here. I don’t want to walk into a stranger’s room and feel them up (not truly, but checking for breast tenderness and discharge as well as vaginal exams seems an awful lot like it – especially at this ungodly early hour).
“Shit. I can’t remember. Can’t go calling her senora 4104 now, can I?”
I head back to the census sheet, taking a few extra moments to talk with my friend. I then head back to the door. Stopping tentatively at the door, hand poised to knock and shatter the stillness within the room.
“Goddammit! What’s her name again!?”
This plays out more often than you would like to think. I’ve read the chart, understood what transpired overnight, know where she and her newborn child stand amongst the new admissions, and know exactly what phrases to employ in order to get my SOAP note complete. I just can’t remember her name.
This is medical education. Patients begin to loose their identities to us as we try and get through rotations alive. The pressures placed on our shoulders, already weighed down by the heaviness of our short white coats overloaded with multiple tools to assist our "brains", lend themselves towards our thought blocking. It's the only defense mechanism we have left.
Patients stop existing as people and become numbers, diseases, diagnoses, and procedures to be added to the ever growing patient encounter log in my right pocket. They’re just not people. That impedes my daily progress. That notion cannot be considered - it will delay me.
Why do you want to be a doctor? I can no longer answer this question without wondering if the reason(s) I had entered medical school have been completely abandoned; lost along the way during the inculcation of my medical knowledge. Maybe next year I’ll pick it back up and patients won’t be just a number. But I fear that this won't transpire. After all, I've got things to do and people (numbers) to see.
Wednesday, May 2, 2007
Terrible is a brief enough adjective to describe my experience in OB thus far. I am on an elective week block right now where we tour various fields of the profession. However, since the instruction and directions are patchy at best my colleague and I have no idea what we’re expected to do. To add to this confusion the residents and attendings don’t know either. To further add to this farce is the fact that this is the end of the year. This is not a new bolt thrown in to jam up the works. So why doesn’t anyone know what the fuck to do with us? Yesterday, before rounding with the Gyn/Onc team we were suddenly asked to get a patient presentation ready in 15 minutes. Not fun and pretty much worthless.
My schedule, despite not being part of the labor and delivery team, requires me to arrive at the hospital by 5:30am every morning (except weekends – the one blessed thing about this hell) to round on completely non-English speaking patients. Thankfully I know enough Spanish to get a quick SOAP note and avoid continuously asking the only medical student who speaks fluent Spanish how I would ask: “Do you have blood in you vagina?”
After morning rounds have completed my day varies. I have no idea what to expect nor can I schedule anything around my day. It’s chaos. Absolute chaos. Then, once everything is finalized with whatever I’m imprisoned with that specific day (ironically one day a week we do go the prison) I have to re-round on patients in the afternoon and get all their discharge paperwork ready for the morning (if they need it).
Gyn surgeries are interesting, but when I’m trying to help close I don’t enjoy being told that everything I learned on surgery was wrong. Yesterday I told the resident he was upsetting me after his constant castigations caused me to lose the needle in subcutaneous fat. He proceeded to tell me that grabbing the needle with pickups is incorrect and he was teaching me the correct way. Fine. Your way caused me to lose the damn needle, but whatever. Just get me the fuck outta here.
14-hour days are the norm. Depsite this norm I often find myself standing around with nothing to do yet mandated to remain. Something will come up if we wait long enough.
My wife hates me right now. She’s a single mother again trying to get both kids ready, get them to school, and get to work before 6:15 am every morning. She then has to pick them up, get them fed, bathed, homework done, and in to bed all by herself. I rarely get home before 8pm. I come home stressed and all hell breaks loose because I'm not "helping out". I hate this rotation and the worst is still to come. This is the “easy” portion.