ndab Ah Yes, Medical School: August 2009

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 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, Residency 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!

Tuesday, August 04, 2009

Two Years Later

Two years ago I wrote a post on this blog detailing my triumphant final rise and fall as a medical student before closing that chapter in my life. In the interim, I sporadically updated a residency blog and just started a blog to address health care reform with only the incompetence and lack of grace that I could provide. (As an aside, I strongly encourage anyone even remotely interested to take a look at the health policy blog and contribute your thoughts, because I am genuinely clueless about this but know it will affect the next 30 years of my career and am strangely intrigued by pretending like I am a real citizen of this country.)

During this time, I received occasional comments and emails from you, mostly filled with name-calling, taunts, and put-downs that I have come to cherish. Some tamer selections included “You should be strapped down and have you dick cut off, you fucking asshole” (if only Roberto Leone from Rome knew how much that meant to me) and “Face it big butts are very sexy and the garment industry has made millions off padded butts.” Indeed.

But the most consistent note I received would be from a starry-eyed pre-med, asking me whether taking the medical school plunge was really worth it, or whether another career path, like any of those pursued by the Entourage gang, was more worthwhile (in a season that is turning increasingly lame and incredulous, impressive even by Entourage standards). The answer, it seemed to me at the time, should have been obvious, and that answer was a resounding “ARE YOU FUCKING INSANE? DON’T DO THIS.” But two years down the road, I think I have a little more perspective on the matter and would like to chime in with some additional insight.

First, some aspects of this job do not change. Pre-meds become medical students become residents become attendings, but personalities generally don’t change. Thus, the crazy gunner medical student hypertalker freakshow persists in residency as the obnoxious pediatrics resident. The toolish beefcake medical student becomes the toolish beefcake surgery attending. And the freakishly handsome quiet thoughtful Jewish medical student transforms into the freakishly handsome quiet thoughtful internal medicine resident. In a similar vein, the human body remains filthy, covered in scabies and lice, and persistently pouring out oddly colored bodily fluids from many an inspired orifice. I know this because my finger has made its way into many of these orifices. Additionally, the hours spent in the hospital only serve to accelerate the transition from normal human being to blood-eating zombie, but perhaps I have belabored this point.

What changes, however, is ones sense of normalcy. This came up yesterday when I was trying to explain to the cleaning service why I could not give them an exact time when I would be free to let them into my apartment. This is a result of me being the “fill-in” resident this month, necessitating that I jump in at a moments notice to cover for sick residents or to help with overflow patients. The conversation went as follows:

Cleaning service lady (CSL) – So we will come tomorrow at 10 AM to clean your apartment.
Me – OK, but I’m not entirely sure I’ll be there.
CSL – What do you mean?
Me – Well, I might get paged at any time and have to go to the hospital.
CSL – So we come at 11 AM.
Me – No, I just can’t give a fixed time.
CSL – So we come the next day.
Me – See the thing is I might even get called in the next day, I just don’t know.
CSL – So when would you like us to come?
Me – Hopefully tomorrow, but I might get pag-
CSL – So we come tomorrow at 11 AM. Have a nice day bye bye.

Whereas during medical school I had a hard time reconciling what I was learning, filled to the brim with freaks and genitalia, with real life, residency has so immersed me in the life of medicine that it has now become my real life and I have a hard time reconciling my previous notion of normalcy with this new reality. Why can’t the cleaning lady understand that I might cancel twenty minutes before she is scheduled to come because I have to run to the hospital and admit five patients from the emergency room? Why does my mom think it is really strange that I haven’t had time to establish a local doctor to call my own in over two years? Why do my non-medicine friends, imaginary or otherwise, frown as I try to explain (yet again) why I am busy all weekend in the hospital and can’t hang out? Why have I been unable to keep up with Jon’s latest tramp or Kate’s newest meltdown?

Yet, as medicine has subsumed my former life, I find it harder and harder to criticize the profession as a whole because deep down I am only insulting myself, something I’m generally glad to do so long as I limit it to my odd physical appearance, mental ineptitude, or emasculating fragility…but not my big life choice. So now when I honestly want to tell you that this isn’t nearly as bad as it used to be and is occasionally even heartwarming, humbling, and hilarious, I must check these thoughts with the notion that it is awful to admit that my career choice was a truly bad choice to begin with.

In all, I no longer have a fuming hatred for the experience and, in retrospect, it really isn’t that bad and is occasionally even good; perhaps not a stunning endorsement but hardly the words I would be writing two years ago. And it's not like the business school route has turned out so well.

But in retrospect, Entourage hasn't been that bad either. Right?