Sunday, January 28, 2007

I'm not done yet.

I've been really distracted by this whole being fired thing. My friends tell me it's no big deal but to be honest, I've never had such a bad experience with a patient. There's a really good quote by Gabrial Garcia Marquez: Anger is just guilt turned inward. (well, ok, I can't remember it verbatim, but that's the gestault. JEEZ PEOPLE.)

Which had me I just feel guilty? I reflected back on how I treated this patient and tried to see if I had done anything I felt guilty about. Ok, maybe I was a little aggressive explaining the team's plan to him, especially when he yelled at me about how he felt he needed to stay in the hospital for 3 more days to receive physical therapy even after I very patiently explained that he was medically clear, and no, physical therapy is not a reason to stay in the hospital. I am kind of an authoritative person. Some might say bossy.

In the spirit of learning a lesson when dumb things happen, I've come up with my lesson from this experience: I will be more empathetic to my patient's emotional needs. Even when those needs are totally. Fucking. Senseless. I ended up signing this patient out to one of the interns on my team, who later remarked, "Peg was trying to do the right thing. I'm just giving this guy whatever he wants."
Ok!! So I thought for a while there that my blog was down...I couldn't log in to at all, and I had tried to post the video a few times and it sort of broke my blog, but then it seems like a few days later it sorted itself out, so we're back in business! Thanggod...who knows what would happen if the Internet lost my wisdom.

I'm still on my medicine subI. I was really loving it at the beginning, but now I'm just sick of all the bullshit. Medicine wards has made me think a lot about healthcare in America and where all our money is actually going. I'm starting to realize I'm a huge cynic. I love helping sick people, and I think everyone is worth the effort to treat. When you can actually figure out what is causing someone's illness and help make it better, it's the best feeling in the world. Unfortunately, so much of what we treat for is chronic illness. And when your patients feel great, you're their biggest hero.

Unfortunately, 3 days in the hospital can't undo the consequences of a lifetime of bad habits, like smoking, drinking, eating poorly, and not exercising. There's no medication to fix someone's congestive heart failure. We can just give them medicine to help them pee out excess fluids so their heart doesn't get overburdened by volume and more medicine to help their heart beat a little harder to push that fluid out. We practice medicine, we don't work magic.

Like I said, I love medicine when you're actually practicing it. Making the diagnosis of a medical mystery is the most heady feeling in the world. There's no greater privilege than taking care of someone who's actually sick -- key word there being ACTUALLY.

Anyway, the long and short of this is, I can't do internal medicine. Give me a surgical subspecialty any day. I get frustrated having to deal with the unretractable results of people's bad habits when they can't take care of themselves, and it pisses me off even more when they hold it against US that we can't fix their bullshit. Clearly, I'm far too judgmental to make a good primary care doctor.

I'm bringing this up because I got fired by a patient for the first time 2 days ago. He was upset because I dared to suggest that he could go home because we were doing nothing for him at the hospital that he wasn't doing at home. He got all pissy and said, "Do I look like I can go home?" Um, well, no, I think you're the perfect candidate for subacute rehab but you refuse to go. You are, however, inappropriate for the hospital. We take care of acute illness here; we don't kee people here for physical therapy, which is basically what he wanted. He's a good friend of some hospital administrator though, so he got to stay here for a few extra days, after threatening to have me "dealt with." Um, ok. I'll be upstairs waitin' for my whuppin'.

I don't get it. Do people LIKE being in the hospital? I can barely stand it and I work there. To be sick enough to be admitted to the hospital means you are REALLY FUCKIN' SICK. Eh, whatever. This is actually nothing. When I was a 3rd year we got fired as a team by 2 separate patients.

Tuesday, January 23, 2007

Ok, ok, I'm sorry I've been MIA for so long! I interviewed in Philly and loved their program, which, if I decide to leave the midwest, I'll rank it #1. Ok...ENOUGH!! I'm not going to think about the match for at least another 3 weeks.

So let's see..I've been on my medicine subI, so busy with the SAVING OF LIVES and QUALITY PATIENT CARE. In all seriousness, a few days ago I was discharging a patient who had just gotten cathed and needed stents for 2 separate coronary vessels. I was trying to explain the importance of taking your medicine and following up with your doctor in reducing the chances of dropping dead, all leaning on the bedrails, trying to make good contact and being earnest. After nodding gravely throughout my sermon, when asked if he understood exactly what I was saying, his response was, "Doctor, you're very pretty." Hard to be mad under the circumstances, but pay attention!!

Also, the medical school variety show was a couple of days ago. Shanmugam and his friends put together a video, which I have linked here. It's a parody of The Office, my favorite TV show, and is actually pretty funny. (That's him playing Michael Scott...he won the Golden Glove award for best actor!) Enjoy!
The Doctor's Office

I've been MIA for a while ya'll, sorry! (SO BUSY, what with the VITAL PATIENT CARE and SAVING OF LIVES) Anyway, at my med school there's a variety show every year and this year Shanmugam and his friends submitted a video, which I thought was pretty f'in hilarious. That's him there playing Michael Scott.

Wednesday, January 10, 2007

I just figured out how to text page from outside the hospital, and I just sent the website to my parents "For use in EMERGENCIES only, ie someone is dead and the house is on fire." My parents have a hard time with the concept of "emergencies," for instance when I worked nights on ER and on obstetrics I asked my parents to please not call during the day except in case of EMERGENCY because I kind of needed to sleep and then my mom would call me to say that her orchids were blooming and my dad ran over a snake in the driveway. [But I still like keeping my phone on when I'm around because I like being available to people, and also because Shanmugam tends to lock himself out of the apartment quite a bit.]

Anyway, my mom showed great restraint and instead left me a voicemail saying how much she wanted to text me today but didn't want to violate my silly "emergencies only" rule so she thought she'd just call and tell me how cute Reflux was looking in the little doggy golf shirt she got him at Walmart.

Tuesday, January 09, 2007

And...please validate my existence!

I was just making the rounds on some of my favorite blogs and Punchberry alerts us to the fact that it's the blogger holiday known as De-Lurking Week. So if you read my blog and would like to say hi, please feel free! And if you don't, that'd be ok too. [But dammit, why the hell not?! It makes me feel so special.]

Happy New Year! Yeah, I know, I'm like 3 weeks late.

Hello!!! Ok, sorry, so first I panicked because I was supposed to take Boards on Dec. 27th, then I got supermotivated and studied really hard for like THREE DAYS STRAIGHT (and people, it was a CHALLENGE. I cried myself to sleep on Reflux's smelly confused back every night.), then I stopped caring and rescheduled my test for sometime in march, then I started my medicine subI and got all excited about medicine again, then I got sort of lazy and really sick of manually disimpacting all the rectums around me, and now I'm back to blogging again! 2007 ROCKS!

(And seriously why do all my patients have constipation? Why has my finger been up so many butts in the last 3 days? And in all seriousness, actually, one of my patients is a paraplegic and was admitted SOLELY so she could be manually disimpacted by my expert fingers 3 times a day, and this morning on rounds she told my attending that I, the square peg, yes, who has forgotten to order meals for every single patient she's admitted so far such that they're starving and pissed off at her by the time she comes to round on them at buttcrack o'clock, was the only doctor she liked. Because I, apparently, am the only one that "knows shit from shinola." And she would know.)

In other news, I haven't been on an interview in 3 weeks and I'm sad! I miss it! It's true that I'm all out of fake interest, but on the other hand, being schmoozed is kind of fun! Anyway, I have my last one this Saturday in Philly, and it'll just be fun to run into some of the other girls I've met on the interview trail.

Also, I really love internal medicine! Taking care of the whole patient and not just their uterus is kind of fun! The chronic untreatable stuff really depresses me though; I felt this way after I did medicine as a 3rd year too. It was just too depressing by the end to be a serious career choice. And medicine residents, I'm sorry, but they're huge nerds. Just...NERDS. I can't even describe it any better than that. They get excited about making fun of the ED residents for their "lame" admits and how the ortho residents don't know the insulin drip protocol.

It might also just be that I like being an intern WAY more than I like being a medical student. You tend to feel like less of a redundant asshole when YOU are the one that comes up with the plan and are solely in charge of the patient. And..when your patients are getting better, they love you! When they're still not pooping and miserable, they make you feel like the biggest idiot in the world you sometimes secretly feel like on the inside. On the whole, though, major upgrade. My only peeve is that without an MD by my name (which I'm starting to realize more and more is totally f'in arbitrary...what am I going to know in 6 months when I have the degree in my hand that I don't know now?) I can't sign any of my own orders. Which is fine for, like, anti-arrhythmics, and anti-coagulants, and you know, stuff that's kind of a huge fucking deal. On the other hand, when I have to page my resident 3 times so she can cosign my order for Tylenol for my patient's headache or a plastic bucket to be put in my other patient's toilet so we can measure her urine output, it feels pretty dumb. Often I'll just find the plastic bucket in the supply closet and put it in the toilet myself. It's much faster.

TCL and I are over. We hung out one night a few weeks ago and he just came on a little strong. Ok, Internet, prepare yourself. He was breathing on me. It was so gross. Also, I don't like people stroking my hair, because people, I DON'T WAKE UP LOOKING LIKE THIS. It took a flat iron and several grooming products and dammit, I don't want some dude's greasy fingers fucking it up. Well, ok, I just didn't want TCL's greasy fingers on it. I'm just trying to find the right greasy fingers, ok? And they definitely weren't TCL's.

Ok, Shanmugam just came in with some girl and a bag of 40s (sometimes I REALLY miss being a first year) which is....romantic, but he also brought me a Subway sandwich and my favoritest greasy potato chips in the world!! I lurve him. I almost want to match in Chicago just so I can live with him again, but then I would be pretty much guaranteeing that I would put a big motherly damper on his mack.

Alright, well, good night! I just admitted 2 patients today so I should read up on methadone overdose and aortic dissection.