You Don't Have Cancer

During my 3rd year surgery rotation I was allowed to work in our “ED” for 2 weeks. While it was called an Emergency Room it was really nothing more than an urgent care clinic for the homeless and stupid, but it’s what we had. I had some thoughts of entering this field, but had been wavering since beginning my clinical rotations. The cases regularly seen by our department and the nature of the work soon wore on me and forever soured me against this specialty.

However, despite the absurd complaints, the runny noses, the drunks, and the pride-swallowing displays I saw on a regular basis there was one encounter that made me realize that EM was truly not suited for me.

I arrived, late one day due to a morning conference, and found the usually cheerful chairman in a very foul mood. Thinking that his anger was due to our tardiness I tried to explain where we’d been. He quickly told me he didn’t care, told me to see patients, and walked into an exam room.

A few minutes later, while talking to an EMT student, I heard this doctor and a patient yelling at one another in a room. The chair left the room, clearly upset, followed by a strung out, gaunt, crazy-looking woman crying afoul.

“You’re heartless! I have cancer! I have cancer and you’re not doing anything for me! I always get this for my pain! You’re an asshole. I’m calling your supervisor and getting you fired!”

Chair, turning around quickly, pointing his finger at her: “No you don’t! You do not have cancer, there is not a shred of proof you have (certain type of) cancer, and I don’t care anymore. Go ahead and complain, I’m the highest you’ll get in this department and I’m done listening to you!”

With that he turned, finishing her discharge. When she tried to yell at him further he threw his hand up, like a teen-aged girl expressing her worldly wisdom with a quick “talk to the hand” and summarily dismissed this woman. She, furious, stormed away, paper in hand, cursing loudly and threatening to sue the “whole fucking bunch of you assholes!”

I was slack jawed - amazed at this seeming display of physician cynicism and the fact that he had actually thrown up his hand to shut her up. An hour later, as he predicted after she left, an administrator came down to the ED with the patient and confronted him.

Admin: “Why didn’t you take this patient seriously? How can you be so certain that she doesn’t have cancer? I want you to take care of her and do as she requests.”

This was all said to the chairman of the ED, with the patient acting like a spoiled child, arms folded over he chest and displaying a most distasteful “I told you so look”, while the staff stood around, trying to look busy, but clearly watching to see what would transpire.

The chair didn’t budge. He called out the administrator, asked what degree he had that conferred upon him the power to diagnose this woman with cancer when several physicians agreed that there was no evidence, and told him to write the script himself because he would not – he was not a drug dealer. He then added that, if this was the type of support they could expect from the administration and CEO they’d been promised during their monthly meeting, this would be his last shift.

Of course the administrator, trying to remain calm but clearly unnerved, relented and informed the woman that, unfortunately, they would not be able to help her at this time. They walked away and a nurse said he was inviting her to fill out a survey in order to help “increase efficiency”.

Aside from the humorous and tragic aspect of this case, this settled any desire to enter emerg for me. There was no way that I would tolerate that kind of abuse, by people who held MBAs or MPHs and knew nothing of actual medicine and only cared about customer service and maintaining a "hotel" image. There was no way I could stand up to that form of degradation regularly and feel that my sacrifices had been worth it. Medicine is not in the business of letting people "have it their way" only to get sued for complications. While it's not for me, I applaud anyone who can look at that on a daily basis and come back for more.

Mining for Gold

“How’s your pain today, Ms. Drugseeker?”

“It still hurts like hell!”

“How’d you rate it?”

“Same as yesterday, a fucking 10! God, why don’t you give me anything?” Her eyes demonstrate a clear desire for pain meds; desperate and conniving as is often seen in connoisseurs of opiates.

“We are giving you pain medications. We aren’t going to increase the dose at this point as you've yet to gain any relief over several days.” I lie to the patient. Really we know she’s full of it and we’re planning on taking her down, giving something for her iatrogenic constipation, and giving her the boot.

I proceed to complete the requisite physical check which includes the patient jumping with “pain” each and every time I touch around her left chest. Oddly enough every test performed to this date has come back negative. Wonder of wonders. She doesn’t have ACS, an MI, or any other problems - except drug addiction and vagrancy. I’ll be glad when she’s outta my hair.

I learned quite early in my 3rd year of training that some patients need a place to stay, some need a bed and a meal for the night, and others just want drugs and use the hospital for these purposes. Things that I knew already, but never quite understood how it was that they were able to manipulate the system so well. I've seen the scams and read about others. Oddly many are very similar, but unique with the person involved.

Ms. Drugseeker will receive a bed because she is middle aged, has abused her physical and psychological health for years, ingests varied amounts of drugs which she obtains by doing unmentionable acts, and has not seen a regular physician since Nixon was in office. An abnormal EKG results and labs will most likely surface, relegating the on-call team to take on this freeloader in a useless search for the etiology.

The patient stays, getting a bed, free food, free healthcare, free drugs, and a place for her hubby to sleep as well while the doctors, nurses, and medical students try to not think about the waste of money this person has become. Hubby remains sedated throughout the process until he hears they're being "evicted". Then he suddenly is concerned about his wife's condition.

Unfortunately for our society this is an all too common occurrence. Many private hospitals won’t take them and will either give a quick drug cocktail and/ or street the druggie. Then the charade plays out all over again, at another ER, another clinic, wasting the same taxpayer dollars; but nothing can be done because god forbid if the constant abuse of heath resources by a parasite might actually lead to the discovery of some illness. Then the lottery is in town.

Hell, we might find gold in them thar hills…so wouldn’t it be a shame to not go looking at the same or slightly varied complaint for the upteenth time while knowing full well that you‘re most likely not going to find anything other than someone who can only tolerate a “D“ drug? That’s what a litigious society has constructed for our kids.

Personally this abuse pisses me off. If we’re going to ever have a healthcare system that has any potential to become universal this exploitation has got to stop. Personally I like the idea that people have a certain amount of points that they can use. Use it up and your done for the month, year, etc. If you’ve been diagnosed with a legitimate disease that will increase your healthcare use then you receive additional points.

This would reduce the overuse of ER’s for minor ailments, reduce the ICU stays with ridiculous attempts to prolong lives already long lost, and might just curtail drug seeking abuse. Of course there's a lot to be desired from this plan; it won't define what an actual "emergency" is, it won't create jobs and decrease poverty/ addiction in many abusers, and it won't take care of the illegal immigrant crisis. But I like it in it's infancy.

Till then the exploitations will continue, the drug seekers shall refine and perfect their lies, the viral URI's will get treated with antibiotics at 3am, illegal immigrants shall continue to invade ED’s for each and every complaint to avoid INS troubles, and my taxes and health insurance premiums will continue to increase.

MS 4

YES!!!!

It is fucking OVER! I'm finished with 3rd year rotations, tests, quizzes, bullshit - FOREVER!!!! No more shelf exams, no more class days, no more stupid classmates who think that submitting their review of a few research papers for publication automatically makes it publishable. No more.

GAHHHHHHAHHAAHHAHAHHAHAHAHAHAAHHAAHA!!!


Can you tell I'm a little excited?

Enough Already

I’ve noticed something that has developed within me towards the end of 3rd year. My tolerance, as little as I have, has been almost completely eliminated. Mostly my intolerance of members of my class has begun to become far more evident the closer I get to being away from them. I look forward to 4th year for this reason - a long vacation from the laziness and abject stupidity that multiple people have evidenced throughout this year and the 2 previous.

I’m done with them. Thankfully I’ve had very little contact with Worst Medical Student Ever and have only interacted with him for a short duration during morning rounds (when he’d actually show up that is) and the one day a week class. During that time I’ve told him to shut up, grow the fuck up, damn near turned around and bitch-smacked him for comments he was making during lectures, and developed a very fun game with some friends related to Chewbaca. I can’t really explain it because you just won’t get how hilarious it is to mimic his “Ohhhs” with a Chewy purrrr. Hey, I already warned you about not getting it.

I’m not the only one who has just had it with our peers. A friend of mine told me recently of being bullied by another poor student. Unfortunately I’ve not had a rotation with her and have only received this information from the few and far between contacts we have. Mostly I get updates from her blog (which I will not share here as it’s not anon and would only help to out me as well as her) as to the recent insult received by this ass. She’s close to taking it to a physical level with the punk and I whole-heartedly agree with this line of action. No reason for that type of behavior.

So as this week comes to a close I believe that I’ll take a long and much needed breather from classmates. I plan on studying for Step 2 CK which I'll take in August, but I’ll steer clear of the various forums where classmates may be found.

******
On another note, I think I’m becoming an alcoholic. Daughter saw a beer bottle under the stairs of our apartment last week and told Wife “Daddy’s home! There’s daddy’s drink!” I think that says something - like perhaps it’s time to stop having a beer with every dinner (OK 2 or 3 beers, sheesh).

3...2...1

So, with one week left in OB/GYN and no more clinical or floor work required (fuck yeah) I thought I’d capture the craziest and just plain bigoted statements I’ve heard on this rotation. With that being said, enjoy:

“You have to have a vagina to do that. You can’t do that without a vagina.” (nurse telling me I can’t perform a certain procedure on a patient)

“The uterus and vagina are incredible. Amazing. Truly God knew what She was doing.” (attending discussing the changes made during pregnancy and afterwards)

“The womb is sacred and should be worshipped. Bow down!” (resident screwing with me)

“I hate fat people. Can’t see shit and it smells.” (ARMY doc after speculum exam that took a little too long with a rather ripe patient)

“Anesthesia? Really? But you can’t do cool shit...like cutting people up.” (ARMY doc during a hysterectomy)

“My mom usually goes to a male OB/GYN because back in her home country most of them are males. She’s seeing one now and told me: He’s gay, but a good doctor anyway.” (friend telling me about the differences between American women wanting to see mostly female OB/GYNs and his home country)

“I had my hand deep inside her vaginal orifice” (worst medical student ever discussing his examination during morning rounds - I truly hate this jackass)

“I thought the hater-nation was over after 2nd year ended” (worst medical student again trying to fight back tears as all the medical students on service turned against him and his incessant laziness before morning rounds)

“So you put it against the os-hole?” (Another ARMY doc discussing a tool with a rep)

"I'm taking that for my Bipolar Disorder. Oh yeah (stares blankly at ceiling and then head slowly turns back towards physician) I also take it for my multiple personalities." (various patient encounters where a history was being taken)

One more week and then it’s all over. This week’s going to be fucking hard as hell - at least 5 or 6 exams, reports, presentations, etc. Just breath and get through it. It’s almost over. I had a friend tell me that she thought I'd enjoy it because there's a lot of procedures. I did like the OR, but everything else just was painful. I truly had the easiest out of most of the students and am thankful for that. God I hate OB/GYN.

Paying for It

Recently there was a week in which the hospital staff were shown how much their work was appreciated through various means. These included cake and ice cream day, free lunch, day, game day, etc. You know, feel good stuff that mostly consisted of feeding people.

I thought it a good idea since many of the people working in the hospital feel undervalued by the current system and this could boost employee moral. However, what I didn’t anticipate was getting my self-esteem beat-down a couple notches during the week.

One day when I’d forgotten my lunch I decided to take advantage of the free food being served in the cafeteria. I entered the long line of various colored scrubs and talked with some of the nurses with whom I’d worked with in various rotations. As I tried to collect the food being offered the server gave me a rather hesitant look. She then asked, clearly displaying her annoyance:

“You’re a medical student?” (said very slowly and with disdain - try it...it's fun)

Curious as to the reason behind this unnecessary interrogation I answered in the affirmative with a brilliant smile. After all, a smile always works on these types of assholes -right? Almost instantaneously I wished that I had replied differently.

The server proceeded to launch into a full blown rant about the reasons for the appreciation week, the people it catered to, and that, as a medical student, I was not one of those people. With this stunning, newfound, and ridiculous knowledge I was summarily excused from the line and told to purchase my lunch from the cafeteria with all “the rest of the patients and stuff”.

This infuriated me. Not part of the hospital staff? Hmmm. Do I not work here? Do I not pay to take care of patients and other items that other staff members get paid to do? How then am I not considered worthy of your free hamburgers for lunch? Honestly. I want to know.

Truly there was some distaste left in my mouth from that experience. Medical students, apparently, are not considered part of the “team” or “personnel” or even the dental students (as many were receiving their food while clearly displaying their dental school logos on their khaki scrubs) of the hospital. Rather I’m right there with the people I get histories, physicals, and rectal exams on – except I’m paying for the honor without the blanket of insurance to pad the damage.

So I purchased my lunch with borrowed money that I will pay back at a later time with accrued interest. Because, clearly, I don’t need to be appreciated for the work I perform - smirk.

I really feel appreciated now! Thanks!

3rd Year - Tale of 2 Truths

With a new crop of 3rd year medical students making their way through their final exams and getting prep’d for Step 1 I’ve thought about what 3rd year truly entails. Essentially it involves 2 things: confusion and humiliation.

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.