Phew!

I was driving home the other day after taking stepson back to his dad's. I was listening to the radio and looked down at the clock while changing stations. 8:15pm.

Suddenly a cold sweat broke out on my forehead.

"Shit!" I exclaimed. "Did I certify my list?"

You see, it was the 27th of February, the last day to certify and submit rank lists for the match, and I couldn't remember if I'd certified the last time I made a change. The time to get those done was by 8 pm my time. I was already past the time if I hadn't...I cranked up the accelarator and raced home.

As soon as I arrived I checked - and, much to my relief, found that I had indeed certified. If I hadn't I'd have been SOL for this year. Thank god.

Please, Not There

Wife has talked about getting another tattoo. She’s received a couple since we’ve been together, the first being the day before we got married, but I’m a little hesitant about the location she wants to have one placed.

You see, I’ve seen a lot of trashy people in the hospital where I’ve rotated through the most. Several women have tattoos of hearts, roses, etc. on various parts of their bodies – but the most trashy always had at least one on their ankle or breast (sometimes on both or multiple). I began to associate a tattoo around the ankle or breast as a sign of a white trash ho or a ghetto bitch, regardless of the level of class the person sporting the tattoo evoked.

Wife wants to get one on her ankle. I’ve told her my reason for not wanting her to get one there and she’s laughed at it. Apparently there are many women who get them on their ankles, but it still looks trashy to me. She’s also stated that I shouldn’t be one to talk since my tattoos are all of a rather trashy sort (I guess demons and skulls aren’t the most friendly looking) and I’m being a hypocrite.


Despite that rather sound argument, I've not received any since I was 18 and wouldn't get anything similar now. I've matured...a little.

Sigh…I just wish that she didn’t want to get one there. And if that’s how I think, Lord knows how others view them.

Not A Real "Doctor"

Dr. Jarvik is not a real doctor - at least in how the Lipitor ads were trying to make him appear.

Although he has a medical degree, Dr. Jarvik is not a cardiologist and is not licensed to practice medicine.

Learning about his history earlier when he began hawking the drug instilled in me the desire to never prescribe it. But at least now Pfizer has pulled the ads and I won't have to look at him talking to "real doctors" in the hospital or running with his goofy looking kid.

Ah, Dr. Jarvik. How you will not be missed.

Too Pretty

I saw this on one of Wife's celebrity news shows yesterday. It was hilarious to watch - since it was clearly evident that these "pretty" bitches were the trouble. Their pictures that they gave the "news program" to use were rather trashy as well. It was great.

By far the best part was when the blond admitted to starting a yelling match with a passenger after she felt they'd been in the bathroom too long. Another factor against them being singled out for being too pretty? The fact that the FBI had to get involved after they landed. It seems to me they are the problem.

Coddled? Yeah, I think so too. I applaud Southwest for having the guts to actually stick up and deny people like this their "rights".

Campaign 2008

The reason that Hillary is struggling? Perhaps this hits the nail on the head.

Personally I hate the Clinton machine and her attempt to run on her husband's coat tails (running on 35 years of change my ass). Plus Hillarycare is scary to think about working under. I imagine it would be kinda like Stalinistic - but worse. And yes, I hate her that much.

I would like Obama to take her under, but he also worries me as well. The more he gets going the more I see someone who could potentially be dangerous. Little leadership experience running the country? Hmmm. Plus, anyone who believes that universal care is going to "fix" our healthcare system has their head up their ass. Period.

Republicans? God, another lose-lose situation there. Maybe I won't vote this time - then I won't feel bad when one of the godawful choices fucks everything up and messes with medicine even more.

Oh, and today is the deadline to submit the rank order list to the NRMP. I changed a program's location yesterday up one, but other than that I haven't touched my list. 3 weeks to go.

Their Take

Some bloggers have been posting some great topics recently. Rather than submit you to more of my drudgery, I offer their takes on a couple topics I've spouted off on here and there:

Psychiatry by the Half MD (posted under clinical rotations - you might need to dig a bit).

CRNA and MDA "relationships" by Mitch Keamy over at The Ether Way. *

Enjoy.

*And just so we're clear - I like CRNAs and think they provide a valuable service. But they're not MDAs and shouldn't think that they are as qualified - ever. It's the same problem that occurs in retail clinics - a few thinking they know more than they actually do with no one to tell them differently and believing they're doctors..

Like a First Year

The last couple days of my mandatory, don’t come and you’ll not graduate, “Doctoring” class are this week. Ah, it’s been an adventure. I’ve learned so much. I’ve come away with a great deal of useful knowledge that wasn’t already learned on the wards or from reading resident’s blogs. I feel like a first year – everything had weight to it, everything was important, and I love being a medical student…but not really.

4 weeks of this class and I really think it could have been condensed into one week. It was very disappointing – it had a great deal of potential, but as usual we’ve been led astray. At least I was able to catch up with some of my classmates and hear about where they’d like to be going.

Despite this farcical educational process, I did learn a couple of important items:

1) Sipping caffeinated drinks over an hour will keep you going longer than if you chug. Caffeine downregulates itself and if consumed in large quantities (as I’m wont to do when on call) it actually diminishes sooner, leaving you dead tired in 1-2 hours. Good to know.

2) Get through the first day and you’ll be OK. Expect to be on call – many interns start out on call.

3) OB/GYN residents (at least here) are very pessimistic.

4) Money scares the hell out of me – at least knowing what to do with it outside of paying off stuff.

5) You will get very depressed – most likely in the winter months.

6) Discharge planning starts at the time of admission – and sucks ass.

7) Government funded healthcare has already suffered from poor resources and funding – so why do we think that we can cover everyone?

And that’s about it. Aside from learning that a couple people are matching into specialties that I didn’t ever think they’d go into and getting the final touches on my case report done so that it can actually get published this month has been a waste. At least I don’t have to take senior Psychiatry!

Revelation

At a family dinner my uncle asked me a question:

“Would you do it all again?”

Simple question, hard answer. My parents, grandmother, brother, and various other family members were there – all awaiting what, I'm convinved, they were sure they’d hear. Instead I dropped a blow. After refusing to answer at first and being cajoled into answering I replied:

“It’s not that I wouldn’t, but right now I’m not sure. It’s really not been worth it and it’s a helluva lot harder than anyone understands. I don’t know…I don’t think I’d do it again. I know I wouldn't want my kids doing this.”

Almost everyone sat there, rather stunned. I’m sure they thought they’d hear me praise my training and the love that has grown inside me for medicine. Instead I was honest. Honest about the hardship, the frank disappointment, the depression that had set in many times, and just let them know I wasn't sure if I'd made a good decision. My uncle, who is by trade a lawyer, looked at me and shook his in agreement.

He then went on to expound on how he hated being a lawyer for the first 10 years following law school, which his wife agreed completely. This received incredulous replies from my grandmother and mom, to which my uncle and aunt echoed my frustrations - debt, disappointment, pressure, self-doubt, and the feeling of accepting a lie. He explained how the debt, the lack of esteem, and overall bullshit that he had to endure while fresh out of school made him almost quit several times. He expounded on how he hated people assuming he was "rich" because he was a lawyer and that he had originally believed he'd be wealthy when he entered law school. The harsh fact was, that for many years, they barely could afford to live.

He then looked at me directly and proceeded to inform me that it got better. It took time, but once you find what makes you happy it makes the job fantastic. He now loves what he does – though it wasn’t what he initially thought he’d be doing.

That was, for me, the only time that I truly felt that someone in my family understood what I felt. The sad part is that the only reason he understood it was because he had to endure something similar. You just can’t explain this to people who haven’t dealt with the process. They all look at you like you’re crazy and talk about the money, the prestige, and the myths that shroud the professions of medicine and law.

I hope that I'll find the peace and happiness that he has in law. I would really like to wake up most days and want to go to work. Right now I don't.

Power Whore

There’s something about power that makes people crazy. The other day I had to take a senior OSCE that was supposed to help us get ready for Step 2 CS. However, many of the participants that day had already taken and passed the exam, therefore making this just another useless exercise. To add to this day was the fact that Wife was trying to get seen for an illness and I wanted to be there, but couldn’t.

The day started out on a bad note – those in charge were running around, barking orders, and trying to look organized while they were, in fact, the opposite. Threats of 5 points off the total grade were tossed at us because some students didn’t bring more than a stethoscope. The 10 students in attendance tried to remain in good spirits, regardless of the absurd nature of the requirement, but soon realized that we were dealing with power whores and this would not be fun.

The man in charge of the standardized patients was by far the worst. He actually believes he is a doctor – though I’ve never seen any proof beyond his proclivity to wear long white coats while he yells rules at students. He proceeded to yell at us about everything, claim that we weren’t being “professional” (once again, I completely hate it when anyone uses that as an excuse to blame students for being human), and told us that no one could talk. At all.

“No one should be talking. This is a serious exam and if you fail because you can’t keep quiet and remain professional, well…that’s on you.”

“Excuse me! I’m talking. Table all conversations!”

Various re-utterances were heard of the above for almost 2 hours while we were oriented. Yes, it took them 2 hours to get us through the orientation. We had 10 cases to get through at 25 minutes a piece. Everyone of us knew that it was going to be a long day. Preparation for Step 2 CS? Hardly.

And that’s where I get a little miffed. People in these kinds of positions have lauded their authority over us for the last 3.5 years. We’re close to being done. We’ve passed every examination that’s been required and we’re over the threats. What? You’re going to fail us because we wouldn’t sit in fear while you assaulted us with rules and regulations – all of which we’ve already heard numerous times?

Power corrupts. In this case it made people who have low self worth try to use it to swell their image. I see this quite a bit, but that day it was just a little too much to deal with.

Failure to Communicate

Wife recently had to get treated for an overwhelming sickness that she couldn’t ignore anymore. Almost 2 months had gone by with her having various URI and a constant shortness of breath or tightness in her chest. These feelings were more marked with cold air, exercise, and exposure to cigarette smoke.

Diagnosis? Asthma with complications related to non-treatment.

Easy enough to see.

But she didn’t believe me, as she’s wont to do, and a few times I got upset and would castigate her for complaining. After all, coughing constantly and complaining about feeling tired/ ill when you could get better from an inhaler just began to wear on me (even more is the idea that she didn’t think I was correct – but that’s a different post).

So the other day, after she developed some night sweats, productive cough, fever, and chills I forced her to go and see a physician. Ironically she couldn’t get in that day and instead went to a retail clinic. I wasn’t with her as I had an obligation to get through in order to graduate (more on that in another post) and only found out about her treatment later.

The NP was very nice, from what Wife says, but it was clear to me that she was a little overwhelmed by Wife’s symptoms. She gave her an antibiotic, an inhaler, and cough suppressants stronger than the OTC variety. I didn’t agree with some of what was done – like giving a very strong antibiotic normally reserved for hospitalized patients or those with community acquired pneumonia, or the suggestion that she go to the ER to “maximize her breathing”, but at least something was accomplished. I was glad to hear that the NP took her time to explain things out to Wife and even told her that she felt she was incredibly sick.

What was funny to me, however, was that Wife was told almost the exact same things that I had for months told her about her asthma. She didn’t want to believe she had it and refused to go to a doctor and “waste her money while they guess”. I find it ironic that a lot of what I try to champion in others and get heated about on this blog has not been instilled into Wife. Somewhere she’s lost her faith in medicine, despite being exposed to it more than ever, and doesn’t trust doctors. Gotta work on that.

Boys and Girls

Parents. Gotta love ‘em.

Daughter has started T-ball and had her first practice last weekend. We had prepared for this by obtaining various tools that she’d need – like a glove, bat, bat-bag, etc. and hoped that they’d have helmets. When we received her team’s information and met for their first practice we noticed that, to our horror, she was the only girl on the team!

GAHHHHH!!!!

Naturally we were proud to watch her match the boys in many aspects and wallop the ball off the tee just as well as some of the others, but we wanted her to stick out. Like all parents do, I guess. But mostly because she was the only girl and Wife wanted to spread GIRLPOWER all over the field.

So afterwards we went to the sports store and spent a large sum of money on pink and purple gear (helmet since theirs were only blue and black, balls, cleats that have pink accents, and a mitt that was a correct size). So now, when she gets up to hit, play defense, or just hang out with the boys, she’ll be a standout. Because we’re shamelessly promoting that OUR DAUGHTER IS THE BEST!

Where’s that parenting certificate?

Just Go and Read

You have to read this commentary from the Happy Hospitalist. Dead on.

America has lost her way. We once were a nation of proud people. We were once a nation that took care of itself. Now we're a bunch of freeloaders blaming "the rich" for everything that's wrong.

You want universal healthcare? Then you pay the damn taxes to fund it. I sure as hell won't.

Dead Blogs

I'm toying with the idea of eliminating some of the blogs on my blogroll for being dead. I prefer to think of a blog as being dead if it hasn't had activity in 2 or more months and have a few on my list that meet or are close to meeting this criteria. Plus I've noticed that there are some blogs that aren't necessarily dead, but I just don't enjoy them as much anymore. We've grown apart, I guess.

So here's a fair warning to those blogs: you know who you are and you need to post something before next week...or off with your head!

Courtship

There is a fine and delicate game that is played between soon-to-be residents and various programs. It’s akin to a courtship, where each tries to feel out the other while attempting to remain diffident about their desires.

E-mails or phone calls are sent between the two parties, informing the other of the intents, without being completely honest. It’s really quite a lot like dating:

Do they like me? I can’t tell them that I like them that much, but I need to let them know I’m interested – lest they hook up with someone else.

High school politics in a lot of ways are rekindled.

Amidst all of this, the potential for confusion, frustration, and stress accompanies students and programs alike. Woe to the student who matches, but only to a program where they really didn’t want to go. While they have a job, they’re not pleased with the outcome – like getting the uglier of two sisters.

While students can suffer from match diappointments, programs are just as susceptible. My mother once regaled me with a story about a program director who moped around for a long time after discovering whom they had matched. Apparently they were less than stellar candidates, but now he was stuck with them, and he proceeded to let everyone know how disappointed he was in the result.

So now the game is on – over the last few weeks I’ve received several e-mails from programs informing me of their intentions, but not so much that it violated NRMP rules. I've been listed as “favorable”, “strong”, and “well-suited” to subvert the NRMP designation that programs should not tell candidates where they are on their rank list. I’ve been informed, but I still don’t know.

A lot of this courting deals with word-play. Only once have I been so bold as to let any program know where I ranked them – and only because I really want to score (continuing with the dating analogy). However, despite all of the words being passed around, the interview feelings, and some rather overt indications, a student should always be cautious – as you can read about here. Heed the warning.

I Don't Heart Today

Valentine’s Day. God, what a waste of time and money.

Let’s consider some of the inevitable, if not blatantly stated, perceptions about this “holiday”.

1) If you are a woman you expect to receive some romantic display of affection, even if that display is just a repeat of last years. As such you can expect to be disappointed more often than not.
2) Men don’t know how to be romantic anymore – we wait till the last minute and buy flowers and chocolates from the grocers.
3) Jewelry stores make a killing off stupid, cheap, and unoriginal heart shaped “diamond” necklaces and charms as men try to find something that doesn’t take a lot of time to do, but will get them some points.
4) If you receive said jewelry, expect that the person delivering it wants you to reciprocate physically. It’s the oldest exchange of goods in the book: money or valuables for sex.
5) Relationships on a somewhat rocky ground will be brought down by this one day.
6) Many people think that this day is special and should be used to cherish your loved one. Those of us who have been with their loved one for more than a few months know of much better ways and times to demonstrate their affection than to capitulate to the card gods on 2/14.
7) A lot of people hate Valentine’s Day.

Wife and I are of the #6 variety. We exchange cards, chocolates (since Wife really wants those every year), and will do something out of the ordinary for each other. Tonight I plan on cooking more than my usual spaghetti or hamburger dishes, but I won’t go overboard as I have in the past. I had thought about taking us to a fancy dinner, but Daughter came down with a fever and cough (again) yesterday and would have forced us to stay home anyway.

Personally I hate Valentine’s Day, but I’ll say it anyway – Happy Valentine’s Day everyone!

Enough Already - Please!

A trend that has started since my class has been mandated to be in attendance at a course similar to our "Doctoring" courses during 1st and 2nd years. Essentially the executive body of the class has taken this opportunity (as they rightfully should) to talk to us about dues, class gifts, monetary "responsibilities", etc. since we're all together - perhaps for the last time before graduation.

Fine. I would do the same. What's upsetting me, though, is the amount of money that's being asked for and how often I've been asked to give to some charity, event, dues, or other item. It's beginning to get really upsetting as I'm budgeting to make it through July with little to no money to spare.

Thus far I've been asked to pay dues of almost $200, to pay for a dinner for my AOA induction ceremony (which I'll attend of course), to give to various clubs and charities, asked to consider committing to 4-5 years of a monthly donation in regards to a class gift, and have been told about the commencement invitations and cap/ gowns we have to purchase in the very near future. Let's not even consider the fact that I'll have moving expenses, licensing fees, and a host of other forseeable and unforseen costs in a few months that are more pressing and concerning to me than a lot of these "extravagances".

I'm about to lose it.

I haven't graduated yet, received a fucking paycheck yet, or even know if I'll have a job yet and the vultures are already at my door. What I find is that this makes me less inclined to give anything - because I'm freaking out.

***Addendum*** Now, since I just attended an AOA meeting the other day and I was told about the dues, dinner, and other events that are quickly approaching I freaked out a bit. I'm planning on paying for this society since I worked hard to get accepted and know the priviledge that's involved. The other stuff, though, is getting a little ridiculous. It's like they can sense our student fees are slipping out of their grasp and it's a last ditch attempt to get anything from us.

And as far as freaking out about my, ahem, upcoming divorce? Let's not be jerks, shall we?

Confessions

I read a post where an ER physician “confessed” their likes and dislikes. It received a great deal of feedback, both pro and con, and was a rather powerful post generator amongst several bloggers. Having some time to think while I attend mandatory “Doctoring” lectures left me with a desire to “confess” as well. So, here goes – hopefully it won’t be as negatively viewed by the powers that be…

1) I’m scared. Scared to death to start intern year. I’ve been losing sleep over this, staying up late trying to read on treatments, planning on making flashcards on drug dosages and when to use them, etc. I’ve gone through a few of my reference books trying to find the “golden book” that will house everything I need – and make me a doctor. But I know that one doesn’t exist and it all comes from experience and repetition. But it still doesn’t deter my mind from freaking out about not being able to handle the first day…or week.

2) I’m impressed with how I’ve grown over the last 4 years. I’ve seen slides, talks, and discussions related to certain aspects of medicine that, when I began, were completely foreign and mind blowing that I now understand a great deal. A slide of a surgery was once viewed with complete unfamiliarity that I can now view systematically and understand what’s going on – at least a little. It makes me feel pretty good.

3) I feel a constant guilt about taking my family through medical school. Wife and I fight about things that, normally, wouldn’t cause a great deal of trouble. I get mad quickly about any inference that she’s been betrayed or dragged along in this maddening process – and I lash out. Tax season lends itself to this more often than not – as I want to use the refunds towards future expenses or emergencies, while Wife has ideas of her own. It is, after all, her money. She worked for it, not me, and therefore should be able to use it as she deems fit. I get really upset when stuff like that comes up – I’m working hard too with little more than debt to show for it.

4) I hate the increasing belief that doctors are overpaid and that a great deal of what they do can be done by lower-level providers. Enough said about this topic.

5) Frequently I have fits of jealousy when I look at others. I constantly compare myself to what I don’t have and what I think others have. Living in an apartment, driving a car that looks trashed and lacks a driver’s side door handle, and struggling with mundane financial issues at the age of 30 infuriates me at times.

6) I think nurses are great sometimes and terrible others. When they do their job and understand the gamesmanship between them and the doctors they can rock. Others, either through time, jealousy, or just a bad attitude can be obnoxious and draining – leading to a lot of time spent maneuvering around them. I’ve found that if doctors can’t evaluate or hold a certain level of expectation on the nurses, the worse they are. I hate the fact that they can make life miserable without any fear from the interns/ residents - we are helpless and a bad nurse can really make a rotation godawful. Hopefully there will be less of those and more of the patient, tolerant, and kind nurses.

7) I hate pop culture music – R&B, rap, hip hop, etc. I find it absurd that white people buy a great deal of this music that promotes sexism, racism, and bigotry towards the white population. I find it even more deplorable that the literacy and grammar of the upcoming generation, buying into this cesspool, is becoming increasingly fragmented and acceptable. We pretend like they’ll be OK, using double negatives two or three times in one sentence, while secretly hoping that we’ll be dead before they take power. Our country has lost itself in trying to be PC and allow any form of stupidity to exist.

Like A Fat Big Bird

Did anyone watch the Grammys last night?

Ok, I know, they always suck and the most pop trendy at the time walks away with awards as if they're the second coming of Christ. Or they applaud the hell out of drug addicted minor talents - because they show "courage" in defying lawful behavior. I get that.

But I wanted to know...did anyone see Aretha Franklin perform? In that yellow dress?

Personally I'd think twice about wearing a color that doesn't hide anything - especially when the only time you put down the fork is to pick up the microphone. God that woman is BIG!

I couldn't find a picture of it - yet - so I picked up this one. Imagine a yellow dress instead of this blue one and that's about what you'd have seen. Damn scary.

Nothing Diet About It

Thanks be to Lone Coyote for reminding my of an article I had read last week and wanted to post about.

I’ve always been one of those people who refused to drink “diet” sodas. Partly because I had a fear that I’d be branded effeminate, like a guy seen drinking Tab, I steered clear of them. Another part of me, especially when I was in middle school science and my teacher went on a rant about the fact that the body still reacts to the fake sugar like real sugar, knew that they weren’t anymore healthy than a regular drink. The fact that many fat people I've known will eat like crazy, but say they're on a diet because they're drinking Diet Coke also dissuaded me.

Some researchers seem to believe this as well, as I read about from this article. So I guess my crazy ol’ teacher and Diet Dr. Pepper are right – there’s nothing diet about it.

Taking PCPs Out Back

In a ridiculous turn of events, it appears that Wal-Mart is starting to link their retail clinics with hospitals and other physician offices – in order to have name recognition.

“We have learned that people are willing to receive their health care from the front of a store or the back of a drugstore,” said Dr. John Agwunobi, a medical doctor who is a Wal-Mart senior vice president. “But customers also have said they would rather it be delivered by a trusted name, a local health care practice, a trusted local provider of care.”

Thankfully there are still some people who are actually thinking straight regarding these “trends”:

Medical societies are inclined to be skeptical of the clinics. The American Academy of Pediatrics opposes them, saying they add to fragmentation in the health care system.

The American Academy of Family Physicians and the American Medical Association have set forth principles for clinics to observe, including sending patients’ medical record to their doctors and finding doctors for patients who do not already have them.

It’s a rather interesting read overall, stating that many clinics have yet to even break even and there are a few that have closed down, leaving NPs and patients alike without much to show for it.

What I would like to know is whether people actually think these are the “way of the future” or a “fix to primary care medicine” as often touted. Yes, it increases a patient's ability to get seen that day, but it also increases the amount of interactions, reduces the medical record keeping by spreading it out over many providers, and runs the risk of patients receiving medications that will interact with drugs they're already taking. When I think about how hard it is to just get a hospital to send over the records from a patient's stay or ER visit, I can't even fathom what places like these will do - regardless of their claim to be connected with your doc. I'm not buying.

We keep dumbing down our healthcare delivery systems all for the sake of convenience, reducing costs, and providing more access. The problem is, when you pay peanuts, you get monkeys.

If I were a physician and the hospital or clinic I was considering working for showed this level of concern related to medical care, I’d walk right out the door. They're getting ready to take you out behind the dumpsters and shoot you in the head...just as soon as you're not beneficial.

A Little Too Calm During the Storm

So apparently the storms that came through here the other day were actually a huge deal. I heard that they were some of the worst seen in the last decade or so…which makes me kinda puzzled.

You see, I was at my apartment’s gym, working out, and could see the lightening flashes, the downpour of rain, and hear the gusts of wind – but didn’t think anything about it despite normal programming being interrupted to warn about the twister formations. Didn't consider that I should go into a room that wasn't lined with large windows, or that I probably shouldn't have walked back home when the red from the doppler radar was centered around where we live. Even though I know the warmth that day would surely lead to tornado conditions and the storm was definitely making some trouble, I didn’t seem to care.

Since moving to this area I've had some history with severe weather, but have been less than concerned about it.

When I was in undergrad I apparently wasn’t aware of the tornado siren and walked to class while one was within a few miles. Some of my classmates yelled at me when I walked into the building for being an idiot and witnessed the proximity of the destruction later as I drove home.

Another time the store where I was a security manager* had the roof severely damaged by hail and high winds while a tornado ripped through a rural area 5 miles away. When it began to rain the water poured through into our building, causing some of the lights to spark and forcing us to use tarps and turn off all but the most essential lights. Maybe my calmness resulted from the fact that we were ordered by the district manager to stay open – despite the water coming in everywhere and lights shooting off sparks. I’m surprised no one was hurt.

So what I’m saying, I guess, is that I might want to take these warnings a little more seriously. My family and everyone we know are OK, but jeez. After all, it’s people like me who end up getting carried away, into Munchkin Land, because we’re walking around like idiots.

* Call me rent-a-cop and I'll kick your ass!

Oh Dear

Consider this:

This is my local grocery store, where I am waiting in line*, observing a brand new addition – a retail clinic. In a grocery store. WTF?

They call this little shack “The Little Clinic”. Clearly. What makes me laugh though, is the signs in the background stating that this is a “perfect compliment to your primary care provider”. My question, of course, is: How?

How is this complimentary in the least? Do you actually think that the doctor will be informed of the “diagnosis” arrived at by the provider? Neither do I.

What I do know, however, is that the CVS store next door recently opened a retail clinic and was apparently taking too much business away from this store’s pharmacy – located just off camera to the left. I’m sure we’re all much happier knowing that this little shack is taking care of patient complaints.

In case you're interested, the AAFP has a quick tidbit about what these "complimentary" services should actually deliver - to be complimentary. Personally I wonder if this actually happens much at all.

*And yes, I did need chocolate milk. It's quite tasty.

** For more on my thoughts on retail medicine (like you don't already know), please check these posts.

More About Balancing Life and Medicine

Yet another comment has fueled some need to post within me. Essentially the comments from my last discourse were interesting. Receiving a hint of disdain for my belief that a medical career is just a...gasp... J.O.B. I wanted to touch a little more on what makes my day (and maybe not disdain, but a certain level of disbelief that a medical student didn’t want to put medicine first was clearly evident).

The other night I was in Daughter’s bedroom, reading a couple bedtime stories to her. While I was leaning against her bed reading, she lovingly placed her head on my shoulders, stroked my hair, and kissed me several times on the head. After I finished she rolled over and said sleepily: “I love you Daddy”. My heart melted.

This happens on a regular basis when I’m home. I have memories that make me smile, laugh, and occasionally make me sad. I relish them, but realize that almost all of them are from the 3rd and 4th years, where, after spending most of my time in the school studying during the first couple years, I decided that I needed to spend a lot more time at home. I’ve done well throughout, but I certainly have more fond recollections of my times at home than freaking out over some quiz or test.

Now this being said, let me explain that at the same time I have always been committed to the patients I’ve worked with. I read a lot at home, about diagnoses and treatment plans that related to diseases I’ve seen or will see the next day, and never abandoned my duties in order to get home sooner. However, I do not have a great deal of memories from the hospital that would make me want to replace anytime spent with the wife and kids. I’m sorry, but patients just don’t fill a need in me the way my family does.

Other physicians and medical students may find that they have no better times than being in the hospital. While I applaud them and thank them for their dedication, I feel sorry for those who sacrifice their family life in order to obtain this satisfaction. I won’t state that I feel certain careers shouldn’t have families involved, but I think they’re more apt to be strained and the relationships more miserable regardless of the persona involved. I didn’t want that…that’s where my decision came into place that ultimately steered me away from a surgical career and into the anesthesia field. Others may decide that medicine is their priority and they’ll sacrifice everything else towards that end. So be it.

Yet, despite my understanding that some people love being at work, I find the most pleasure, solace, and love when I’m home, not amongst the sick. My favorite place in the world is not in the hospital, that in and of itself is proof enough that a career as a surgeon should not be attempted, but with my family. A quote I heard during interviews described my situation perfectly:

“If your favorite place in the hospital is the OR, then anesthesia is the right path for you; if your favorite place in the world is the OR, then be a surgeon.”

Perfectly Said

A comment on OB/GYN really hit the nail on the head for me. From Agraphia:

I divorced my husband during the third year of obstetric residency, which was a second residency. My daughter and I hardly missed him by then. He never made it to her school functions, recitals, science fairs, ever. But, I think that was just him. He found time for things he wanted, like on the phone and hanging out rehashing the political garbage of residency with his “family” of residents. He was rarely home when he was there. He was chronically exhausted, mean, and self-focused. He became obsessed with malpractice issues and how to keep everyone from getting his money. I started the first residency “with him” and my focus was appreciating him when he was there, not bitching like I heard so many wives. Our lives were on hold all of the time … at age fourteen his daughter doesn’t know him and doesn’t want to. Nothing is more sad or tragic. I know it would be that way either way. The system of training, indoctrination, and expectations beyond what is humane is the cause. Why do people go along with it … and lose their loved ones/families? It is so unnecessary .. it is about control of money and litigation. He went from being disturbed about the way women and babies were treated and wanting to get a journalist to cover it in his first year, to becoming shut-down and numb so he would become stuck in the financial obligations that keep them there.

If the system would allow real midwifery, the load of the care needed could be divided between doctor, nurse, and midwife. A midwife is glad to be a woman’s primary caregiver and be there throughout, which is really important emotional support. Doctors have to be in the office doing monthly exams, available for surgery and births night and day. It’s crazy-making for everyone except the hospital coffers. If nurses and midwives helped play a part in the care of pregnant women, it would be acceptable for the doctor to just show up at the last minute, do the medical deeds and move on.

Of what service is the current system to women? They are forced to accept only the care of an OB, that when all is said and done is so inadequate and minimal. The tragedy from my perspective is seeing a man turn into someone so nasty to women. Why do we expect them to be all to everyone … so that end up tragically giving such poor quality to all?

The reasons that I feel surgery wasn’t for me drew along very similar concerns. Having a family, who doesn’t want you home, being completely consumed by your job and having nothing to do with people outside of the hospital are absurd events that many residents go through when entering demanding fields. To me, it’s just not worth it. I feel, and hopefully will always feel this way, is that there is no failure more complete and absolute than to fail as a parent.