ndab Ah Yes, Medical School: December 2005

Tuesday, December 27, 2005

Parenting 101

This being the season of giving (although I do not recall being given a Tivo just yet), I thought I'd give back to the general public in the only way I know how...by giving unsolicited advice in areas of medicine and/or life that I am wholly unqualified to give advice in. With that as a primer, I thought it'd be appropriate to delve into the tricky task of parenting, how to act, what to say, which babies are really just ugly, etc. Seeing as this is a massive topic that would take volumes to cover in its entirety, I thought that, for now, I'd focus on the immediate newborn period, based on my time working in the newborn nursery during my pediatrics rotation and offer up a few tips to carry you through to the new year:

1. Remain Calm. Something remarkable happens to many parents at that moment the baby is delivered, something wholly separate from the heartwarming issues regarding deliveries that I've explored in the past (see exhibit A...and then try to resist me). What I'm referring to is the sudden drop in IQ that occurs to even the brightest of parents when the baby arrives, and whereas only minutes before the prospective father, laden with enough degrees to make even the biggest dork cringe with envy, could be seen calmly reciting lamaze instructions while formulating mathematical equations inside his head, he is soon found saying after the baby has delivered such gems as:

"OH MY GOD SHE'S BREATHING. SHE'S ACTUALLY BREATHING! Wait, is that normal?!?"
"His arms keep moving. Is that normal?"
"She's crying. Do babies cry?"

Of course, having yet to have a baby I in no way feel like I have the right to judge anyone in this position, but I must say that after hearing these same moronic comments from countless parents for the last twelve weeks I'm pretty close to jabbing a speculum through my eye.

So in summary, yes, that is normal. And yes, you are retarded.

2. It's All In The Name. This is not a statement about people who choose peculiar names for their children, seeing as I am not exactly in a position to judge given my rather...umm...ethnic first and middle names (my first name, spanning a whopping seven letters, even has a 'Z' in the middle). So three cheers for all the Darcquan's, La Fawnda's (I guess that qualifies as a not-so-obscure movie reference), and Zzyzzx's out there. This is not about them. This about all the parents out there who have the chutzpah to pick out from among the vast landscape of potential names a small subset that are almost guaranteed to send that kid straight to the NICU with some sort of awful disease. Yep, this is a warning to all the future Miracle's, Destiny's, Hope's, and Prayer's out there: if you ever find yourself in the hospital for reasons utterly out of your control, it's only because your parents had the balls to dare God, Allah, Buddah, or the stunningly efficient forces of natural selection into screwing you over purely on principle. Quite frankly, I've never seen so many Miracles in the NICU! Did I seriously just write that? I need a vacation.

3. Make Believe. This applies to those of you who, unlike the parents discussed in part 1, have trouble maintaining consciousness after a baby has come into their lives. Congratulations, it's a boy! Excuse me, sir? It's a boy. A bo - hey, are you awake? Seriously people, it can't be that hard to at least pretend like you care and fake some interest, at least for our sake. I couldn't believe the first time I was denied after offering a father the chance to cut the cord, not out of fear or disgust but simply because "Uhhh it's cool man, I don't really care". Look, if that's your attitude, then maybe, just maybe, you shouldn't be making babies in the first place. Just a hunch. In fact, the only thing worse than apathy is antipathy, as you get parent who, only moments after delivery and responding to comments overheard that include things like "The baby seems lethargic, a little out of it, but I guess he's happy..." with (I swear this actually happened):

"He damn well better be happy, he's got more than $100 worth of crack running through his veins right now!"

Good grief.


Well, I hope this has been helpful, but who am I kidding? Anyways, I've just begun my vacation, and will be enjoying some serious down time as I try to figure out what to do with my life and take care of other small tasks, so I don't know when I'll be around to ramble on and on about nothing of significant importance over the next few days. Happy holidays and happy new years, and if anyone sees a drunk fool who vaguely resembles Matthew Perry running up and down the Las Vegas strip on New Year's, please say hello (see I didn't even bother with the pathetic solicitations for Jewish women this ti-oh, wait, I guess that counts).

Friday, December 16, 2005

The Fade

I met a girl on Sunday. In the ER. Only twelve years old, she came in with some nausea, some vomiting, and a sudden inability to remember the name of her own mother. She was going to have surgery the following day to remove the recurrent tumor that had been insidiously growing inside her brain ever since her first surgery failed to remove it all nine months ago, but her parents brought her to the hospital a day early after these new symptoms scared them to the ER. Her vitals were stable, her labs within normal limits, and she was admitted to our team as my patient after an extensive workup showed nothing imminently dangerous, other than the malignancy in her brain that was going to be removed the next day.

I met a boy on Sunday, too. Also in the ER. Only four years old, he came in with a grossly swollen right eye, a fever, and an impeccable ability to kick any examining hand that came within a foot of his personal space. This eye problem had been getting worse for a few days now, did not respond to outpatient antibiotic treatment, and he was admitted to our team as my patient after an exceedingly frustrating and futile attempt at a physical exam forced us to keep him around on IV antibiotics for further monitoring because we simply could not see if his eye was affected...


On Tuesday, after a particularly good day that included a trip to the mall situated across the street from the hospital with my co-medical student (in the middle of the day no less, after informing our superiors that we were going to go study since there was clearly nothing to do on the wards), I had the privilege of speaking with one of my former interns while I was on my way home. Asked how my day went, I responded enthusiastically that it had been a fabulous day and proceeded to explain why, much like I have just explained above. The mall. A glorious lunch outside, sitting on the top of the mall overlooking the city. No patients in sight, no hassles, no notes, no screaming kids, no vitals to be checked, no orders to be written, no phone calls to be made to people who will not even listen, no boredom to be endured watching our superiors write endless notes, no lectures, no demeaning tasks to be performed, no harassment from the nurses, no scut, no worries.

Six months into my third year of medical school, after getting a taste of what my internship and residency years will be like and only beginning to appreciate the demands, the stress, and the frustration of it all, I had to admit that an exhaustion had set in and explained to my intern, albeit more briefly than what I have just expounded on here, how refreshing it was to get away, even for just a few moments.

"That's why it was so good?", she responded quite innocently. "I guess I would have figured you'd say something like 'I saw an interesting case' or 'I met an interesting patient.' "

That evening I was walking home and it was dark outside. A little cold as well. Shoving my hands in my pockets and walking briskly to make it back to my apartment, I started thinking about the tasks that lay ahead in the coming morning. More notes to write, more vitals to check, more lectures to go to, more charts to grab, more superiors to please…

It was at that moment that I realized I could not even remember the names of my patients, much less who they really were, which may not seem like a big deal were it not for the fact that I was only carrying two at the time. Yet, somehow, in spite of this I had managed to take care of all of their hospital needs up to this point.

At that moment it occurred to me that, as was subtly suggested to me that afternoon by my intern (whether intentionally or not), I had somehow fulfilled all of those mechanical needs while clearly missing the point of what I was doing there in the first place. Putting aside the exceedingly common times I have moaned about the maddening frustrations of this profession, most recently evidenced by my previous post, up until six months ago I still believed that I was clinging to those profound moments I had experienced as an undergraduate, when I was truly helping people, as the sources of my motivations for going through with all this in the first place.

Yet, somehow, in a matter of months, I had begun fading from that which I had been into what I had now become, proficient in the mechanical daily tasks of being a physician (or at least a physician's scut monkey) but having completely lost sight of the simple human picture that I had once firmly understood and promised to uphold in spite of the sheer nonsense and stupidity inherent in the first two years of medical school.

Only six months into my third year of medical school, my first sixth months as a semi-functional physician, and I had already started veering down that path of apathy, that fade into indifference that I see so many of my superiors and peers having already disappeared into. I could no longer feel the coldness of my surroundings, as I was now humbled by a frigid sense of shame I had never before felt and never wanted to feel again.

Racing back now, eager to get out of the cold and into the comfort of my bed to get my five hours of sleep, I realized that I was lucky this time, that I had someone call me out for my behavior (even if it was not done consciously), and that I was wise enough to know I was not wise enough to know better.

Utterly exhausted, frustrated, emotionally spent. A final exam in a specialty I thought I was destined to pursue, but now had serious doubts about, looming in the coming week.

But The Fade would have to wait, even if only for a day…


I met a girl on Wednesday. Only twelve years old and coming off her second brain surgery, she cried with her family before her surgery, calling out for her mother after remembering her name, and she cried heavily again Tuesday night, begging her mother to let her go home so she could be with her friends from school. Her head was swollen, and there was a huge bandage running across her forehead concealing the incision below. The radiologist confirmed that the surgeons did not get all of her tumor, that she would definitely need radiation and chemotherapy but would still likely succumb to the terror growing inside her brain. I confirmed that she had big brown eyes that spoke her of innocence and youth, that she was growing up very close to where I had lived before going to college, and that she smiled widely and brightly for me every time I walked into the room in a profound effort to keep the pain, the agony, and the uncertainty of her condition from boiling to the surface and piercing her spirit.

I met a boy on Wednesday, too. Only four years old, and his eye was no longer as swollen as it had been just two days before. His crying had long stopped, as it had been replaced by the devilish grin of a healthy four year old with a vast array of donated toys at his disposal. He gladly showed me that he could not only move his eyes without pain, but also that he could spell out his full name when I gave him a piece of paper and a crayon to write with. He showed me his train set and he even let me play with it, if only for a moment. He showed me some of the pictures he had been drawing while in the hospital, and he even gave some of them to me as a present before he left the next day, pictures now proudly displayed on my desk.

Thank you.

Sunday, December 11, 2005

Discharge

Before you get your panties all up in a bunch (excuse me while I dip into my self-deprecating humor grab-bag-o-rama and say something like...oh here's a fun one: I should know, seeing as my favorite pair of satin pink panties are currently halfway up my colon) over the title of this post, fretting over the next time this delightfully charming young fake doctor will revel in a diatribe on secretions known to only the dirtiest of vaginas, anuses (ani?), penises (peni?), and eyes (eye-i...Matey! Seriously, how can you not love pirates? I think a part of me just died.), I would instead like to talk about one of the few moments of satisfaction in my day, the one lingering thread of joy woven into an otherwise questionable piece of clothing my mom bought for me at The Gap known as my third year of medical school (wait, your mom doesn't still buy your clothes for you anymore?) . That moment, ladies, gentlemen, and future patients of the world, is the time of my day when I get to fill out a whole wad of paperwork that serves one simple purpose: to get you, the patient, out of the hospital, out of my line of sight, and out of the rooms I am responsible for at any given point in time.

Now, if you haven't been reading much of this blog over the last few years, you might be thinking, aww isn't that sweet, he wants to help patients recover from their respective illnesses until they can triumphantly return to the real world, vibrant and refreshed, with a new lease on life and blah blah blah? Sorry folks, but one thing I've found common to all residents, one trait I've learned to adopt without hesitation, is the urgent desire to discharge as many patients as humanely possible in an effort to save us the trouble of writing painfully long notes that no one is going to read, writing orders the staff may or may not actually follow, and doing physical exams on patients who are, more often than not, about as appreciative of anything we do as they are aware of their own personal hygiene.

Ah, that felt good.

But seriously, as soon as those discharge orders are in, that little flag on the chart that reads "Discharge Order" is being proudly displayed for the clerk behind the desk to process in about 4 hours (and now you know why it takes so long for stuff like that to happen), I feel a sense of satisfaction that is borderline orgasmic (I'm too tired to come up with a joke about current state of sexual repression, so feel free to insert your own joke here - by the way, hi mom!). Not only has the patient made it through the hospital course and been healed enough to leave, the patient accomplished this stunning feat despite the substandard care delivered by none other than yours truly. Really, it's pretty remarkable.

I guess I don't really have much of a point to this post, other than to glorify a morsel of joy in my day that can easily be overlooked, and I apologize to those of you who have read this far waiting for one. As has been seen now and then, I sometimes need this venue as a means of venting out a slim measure of the frustrations I'm experiencing at any given point in time, just as I'm currently on my pediatrics rotation right now being run around like a chart monkey and wondering on a regular basis why exactly I'm actually paying money to be there in the first place.

And the worst part about it is, unlike previous times, I can't say I feel much better.

Christ, I'm getting myself all depressed. I promise I'll try harder to entertain next time.

Monday, December 05, 2005

The Happiest Place On Earth

When you start spending the vast majority of your time in a place full of sick, miserable people who's sole purpose in life is to make your life as heart-wrenchingly painful as possible (and don't even get me started on the patients), you have to find some place where you can decompress, unwind, and clear your mind. A place where life is more simple, where you can daydream about beautiful women, your fantasy life as a rockstar, your dreams, your wishes, your hopes (Natalie Portman). The list goes on and on. This is a place where you cannot be interrupted, where you cannot be judged by your superiors for slacking off, where you are more than likely to produce your greatest achievment of any given day.

Over the course of the past few months, having had the privilege of working at least a week in six different large hospitals spread around the city in which I currently attend medical school, I have found this one constant reassuring place in each hospital where I can achieve these goals and unburden my mind from the cacophany of confused thoughts that are normally racing through it, thoughts such as "Why did the residents tell me to do something they know I, being the lowly medical student, have no power to do?" (that's everything, in case you're keeping score), "How can that girl possibly resist my charm, good looks, and at least marginal social graces?", and the always scintillating "But seriously, what the fuck am I doing here in the first place?"

The residents lounge? The hospital cafeteria? The closet where they keep all the drugs?

You may have already guessed that I am actually referring to...the bathroom.

In what has become a daily rite of passage, I play a game to see how many times I can excuse myself to go to the bathroom while asking as many different people as possible, only to escape to the comfortable confines of the toilet, paper, and sink that is my oasis, if only for a few beautiful minutes. You see, ladies and gentlemen, the bathroom is the only, and I mean only, place in the entire hospital where I am free. Free from patients and their constant smattering of questions I quite obviously don't know the answer to (that's $60,000 of medical school education, and counting). Free from residents and their judging eyes. And, most importantly, free from my medical school collegues, who make up for their lack of common sense and social skills with a persistent desire to ask as many pointless and shallow questions as possible in a pitiful effort to grab attention and feign interest (Bitter? Hardly!). When I'm on my ivory throne (that's the crapper, for those of you not into imagery), I am king of the hospital, master of all who come before me and my imaginary court of wives, jesters, and the occasional palace whore, and...umm...well, maybe I'm taking this a little too far.

Anyways, perhaps the most beautiful thing about this sparkling majesty of white tile and ceramic fixtures is how perfect the bathroom is for explaining away absences. Lets take the all too common event when I have finished all the work for my patients, can in no way help out my residents, but must still sit there and essentially watch them plug away at mounds of useless paperwork. My options are to:

a) Continue sitting there, only to draw their ire and resentment when they look at me and my vacant eyes while they have a million things to do.
b) Get up and wander around, risking the tragic situation of being called by someone else to see something "really interesting!" (which invariably means something coming out of a hole it's not supposed to come out of).
c) Just say I have to go to the bathroom and play the now classic "Hide From My Residents" game.

There's only one clear choice here. What are they going to say? "No! I demand that you crap here and watch me work!"? Not likely. "No! Even though you have nothing to do, hold it until I say you can go!"? Well, I guess I wouldn't be that surprised, but still not likely. "No! Piss on me instead!"? I haven't heard of any R. Kelly sightings at the hospital I'm at now (although I wouldn't be that surprised given it's clientele)...but, again, no. The point I'm trying to make is, when the shit is hitting the fan, the only place I feel safe, comfortable, and at peace is where the shit, having hit the fan, proceeds directly down the pipes. And that's good enough for me.

So this post is for you, my beloved bathroom, for giving me a place to be me.

The End.