Thursday, August 20, 2009

The Gift That Keeps On Taking

Medicine has ruined many things in my life. My sleep, my social life, my pleasant and sunny demeanor. Hell, even my ability to be disgusted by all orifices of the human body. But there’s one thing I thought medicine could never ruin, something so sacred to my upbringing and heart that it has gone with me unscathed for 28 years. That is, until tonight. While on this heinous “jeopardy” rotation (see below), I am technically signed up for a radiology elective when I’m not covering for a sick or overwhelmed colleague, but in actuality, I am taking this time to catch up with the basic things in life. These include sculpting and toning my already perfect body to new heights, sleeping dangerous amounts, and my favorite pastime: watching movies.

(As an aside, I am a huge (HUGE) movie nut, and were my testicles larger I might have forgone the stability and predictability that a career in medicine provides to become a third-rate writer-director-producer and finally bring to life a full-screen adaptation of Tiny Toons and ThunderCats.)

Since my local video store went out of business a few months ago (thanks, Netflix!), I have resorted to perusing the cable movie options frequently and watching whatever interesting comes my way. Why not go to the theater, you ask? Well, because of this jeopardy rotation I can get paged away at any moment, and as such I wouldn’t be able to truly enjoy every minute of G.I. Joe and really feel like I spent $14 wisely.

Tonight, in another episode of my attempt to watch all the “good” old movies, I decided to view “Double Indemnity”:
This is a classic Billy Wilder film noir movie about a crooked insurance salesman, a psycho-bitch, and their attempt to commit some good old-fashioned murder/insurance fraud. I am sure there was great acting, brilliant repartee, and master film craftsmanship…but honestly I couldn’t say for sure whether there was or not. Why? Because I spent the whole movie having thoughts like these:
  1. Do these people realize that with the amount of smoking that they do on a daily basis (as depicted frequently in the film), they are going to come down with some pretty serious lung cancer in ten years?
  2. Why aren’t the people in the market who are around the people smoking having any problem with all the second-hand smoke?
  3. Do the guys in this film know that if they wear their pants up so high they’re probably decreasing their fertility by crushing their testicles and bringing them too close to the rest of their bodies?
  4. Why does the psycho-bitch not bleed profusely when she is shot twice in the chest at point blank range?
  5. I wonder if the short insurance salesman guy knows about the long-term risks of excessive alcohol abuse.

So, thank you, Medicine, for ruining yet another part of my life. Fortunately for you, almost every movie made these days sucks anyways, so I don’t think you can do too much harm. That is, unless you manage to distract me from the brilliance of Up by reminding me of the old dude’s Framingham risk score. Damn it.

Tuesday, August 11, 2009

Final Jeopardy

(Please note that any identifying information about the case described here has been changed to respect the privacy of all involved)

Let me just get this out in the beginning, because as much as it hurts to write this, it will hurt more the longer I wait: a patient I admitted broke a window in her hospital room and jumped out, plummeting five stories to her death.

I’m going to let that sit there for a moment while I digest it.

Now, suicide is unfortunately a relatively common problem, but what is likely much rarer is suicide done within the confines of a hospital. And it hurts. Real bad. But what hurts more is that, in retrospect, I cannot think of anything in that individual’s hospital course that could have changed what happened. Let me explain:

I was actually at a Costco, bargaining with the cell-phone people about switching to a new phone at around 2 PM, when I was paged by my boss, informing me that my services were needed at our county hospital. As one of four “jeopardy” residents, I am spending this month perpetually on-call, required to fill in at a moment’s notice for sick or absent residents, or when there are an overflow of admissions that require a warm body to assess them. On this day I was being called in because the primary team was full at an early hour and there were patients waiting to be admitted in the emergency room.

When I arrived at the hospital, I was immediately handed the admission pager and the names of two patients who needed admission. While catching up with those, I was called about a young woman in her 30s who needed to come in after being diagnosed with alcohol-related liver disease. Upon meeting her one hour later, she quickly explained the circumstances of his current state. A chronic alcoholic, she descended further into abuse after losing her job months ago – we’re talking pints and pints of the hard stuff daily. She was a classic “medical student” case, ripe with physical exam findings to demonstrate the characteristics of liver disease. This, however, was hardly interesting to any seasoned medicine resident.

What was so fascinating about this patient was that, in talking with her about her disease and alcohol abuse, she seemed so genuinely interested in quitting. For herself, for her health, for her family. For life. In fact, upon signing this patient out to the resident who would inherit her the following morning, I vividly recall saying “You know, among the hundreds of alcoholics I’ve admitted over the last two years, this lady may actually be the one person who might listen to us and quit.”

A striking statement, if only for its baseless irony. Looking back, I wonder whether the realization of her damaging addiction was too much to handle. Or whether the sudden cessation of alcohol, combined with the shocking settings of a poorly-funded county hospital, was too much for this brain to handle. Or any number of other issues below the surface that we just were unable to uncover before the end. Then I think of more practical things: why was the window break-able, why was there no gate, and why didn’t the other person in the room scream for attention while there was still time? Why didn’t I pick up on this earlier?

Why didn’t I pick up on this at all?

Excuses, but there is no blame here.

I know that none of that would have affected the outcome. I can only hope that I can learn from this experience, never discounting the torture that may be occurring inside a patient’s mind.

It is truly a cruel lesson.

Double Vision

Just an FYI for the fascinated masses (all three of you!) - since I suspect there is a fair amount of confusion is posting to three separate blogs at the same time, I will be posting the same daily medicine-related stuff on both this and the Ah Yes, Medical School site...just so I capture that fourth reader. Once I figure out a better way to do this, I'll let you know. Don't worry, the health care bill stuff will remain on Ah Yes, Health Policy. Thanks for reading!

Monday, August 03, 2009

To My Glorious Fan Base...

First, I want to apologize for my stunning year-long unannounced leave of absence. You see, I have this disease called “residency” and it sucks up the vast majority of my “time”. If that was not enough, I also did this thing last year called “fellowship applications” that sucked up the most of my remaining time. The sliver left over was devoted to (in no particular order): watching the Lakers journey towards another championship while trying not to urinate all over myself every time something bad happened along the way, sleeping, gorging myself on a bean-and-cheese-black-bean-extra-pico-de-gallo-extra-crispy burrito from Baja Fresh (I have no ties to Baja Fresh, I just am strangely addicted to those burritos), engaging in meaningful intoxicated conversation with random people on the street, or on the pooper. As you can tell, this left (and still leaves) little or no time to do what I truly enjoy doing: making idiotic observations about my life and career as a physician-in-training on this blog.

Sadly, this is not the first time I’ve had to explain inability to entertain the masses, and it is not the first time I’ve attributed this inability to being completely overwhelmed in every other aspect of my life. However, it is not just that because something really strange happened over the last year: I started to see the light at the end of the tunnel. Granted, this tunnel has another four years to it when you count fellowship and all, but I finally feel like I have waded through enough crap to see the goal on the other side of that hypothetical mountain of poop (that’s three poop references so far in case you’re counting). And because of this feeling, I no longer have the same yearning to rehash my repeated frustrations with this field by finding increasingly awkward (and occasionally forced) ways of making fun of it. After all, there’s only so many ways to depict a drunk homeless dude pissing on your scrubs in the middle of a crowded emergency room at 2:00 AM before you stop thinking that that is a strange experience in the first place and it stops becoming as original.

As such, while I can’t say that I’ve lost my desire to write about my experiences – in fact, I’ve been able to publish here and there and broaden my technique in other venues under other names – I don’t know how much more irony-induced maniacal fury I have to direct towards my field…

…Or so I thought. Fortunately, providence has once again reared her beautiful, poop-smeared face and provided me with inspiration from a rather odd corner of life that I generally find extremely tedious and wholly uninteresting. So, as a pause from my usual (or every nine months) medical school and residency commentary, I invite you to join me in a social experiment, and I hope that you find it entertaining and maybe a little enlightening – dissecting the proposed health care reform from the perspective of a neurotic young physician who will spend his entire career in the depths of this reform. I’ll be at Ah Yes, Health Policy (getting a little old, eh?) for the foreseeable future, but will try to write here…when I have some time. Poop poop poop.


The Fake Doctor