ndab Ah Yes, Medical School

Tuesday, September 22, 2009

Consider My Enthusiasm Curbed

Apparently, I have a problem. Well, that’s not exactly a shocking revelation, because I have lots of problems: being awkward, lacking in social graces, excessive attractiveness. But I knew about those problems. It wasn’t until today that another problem dawned upon me while walking the halls of the hospital. See, I have a completely irrational fascination with people’s names and the jobs people perform in the hospital.

That’s not the problem.

The problem is that this key information is almost universally carried on little ID badges that the vast majority of people wear on one particular part of their clothing, the chest pocket.
This, it turns out, is a problem.

It’s a problem because there’s something else that is commonly found in that exact same region on about half of the people who work in the hospital: boobs. And when word gets out that some jackass resident is blatantly staring at all the doctors and nurses chests with blatant disregard for decency (and, apparently, common sense), then that jackass resident is about to get his (or her) ass handed to him. This leaves me with a dilemma: Do I continue to stare and satisfy my insatiable curiosity, or do I conform to social norms and constantly feel like I am missing out on something interesting?

In other words, I would have to risk living out my career as the physician embodiment of Larry David, a horrible fate despite the awesome music that would be playing in the background of every moronic thing I did. Or I could live out my fate as any of the Real Housewives of any city: in complete and utter ignorance. Neither option seemed particularly appealing. What about making the conscious effort to only examine the names and professions of the male and poorly chested individuals? Doing that would then force me to consciously judge the attractiveness of females (rather than the subconscious norm that most men achieve), which would be exhausting and in some weird way maybe even more disturbing than the innocent inquiries I’m doing now. Perhaps a hospital-wide mandate that all IDs be displayed via a holder that hangs from the neck? Good luck enforcing that.

In sum, I have absolutely no idea how to resolve this, as I don’t know if I can consciously control my subconscious yearning to discover the names and vocations of passers by. Am I alone with this problem? And does someone else have a better solution?

Any and all ideas would be greatly appreciated.

Tuesday, September 01, 2009

My Anti-Buddy And Me

Walking to the gym today to tone my perfect body, I noticed I was missing something. Not my confident swagger, nor my boyish charm. Somehow, my right hip felt lighter than it had in some time. Did I forget my gun and holster, as I planned to attend a town hall after pumping some iron so I could pump some bullets into liberals hippie bastards and their "keeping people healthy" crap? Or maybe my crackberry, yearning to review all the spam emails that normally would be waiting for me to review at a set time before I succumbed to an instant gratification culture that we find ourselves in curr-oh, nevermind.

Instead, what I found was that I was missing the clunky black pager I had been sporting 24/7 for the month of August while on “jeopardy”. As explained earlier, this rotation afforded me the opportunity to be forever on-call, filling in for sick, absent, or otherwise miserable residents in any capacity at a moment’s notice (or at least within an hour). Practically, this meant that no matter where I went, no matter what I did, no matter how I was humiliating myself at any moment in time, I had to have my pager and cell phone with me at all times just in case my services were needed. To say that this was awful would be somewhat of an understatement, akin to stating that the current Southern California wildfires are just a little burn, or that propofol as a treatment for insomnia might be a tiny bit of a bad idea.

When I went to the gym, I had my pager on me. When I went to the market, I had my pager on me. When I went to bed at night, I put my pager, at its loudest beeping cacophonous craptitude, on my nightstand, waiting for that moment at 3 AM when I would be awoken from a blissful dream involving Baja Fresh and Natalie Portman (so disturbing that I will spare the details, but let’s just say it involves the green sauce, a Padme costume, and a lot of melted cheese) to deal with the overflow crackheads, drunks, and demented people needing a home at my delightful county hospital.

The irony of this experience was that, now that it is all over, I can say that I only allotted a total of 29.5 hours of time as a jeopardy resident. I was only called in twice the whole month, serving 18 hours one time and 11.5 hours the second time. This is in comparison to the poor saps on jeopardy in July, who were logging roughly 50-60 hours a week for the month (in addition to their regular Monday to Friday 9-5 rotation). The rest of the month was, in some sense, completely free (save a radiology rotation that required sparse attendance). And by free I mean I could not travel any farther than an hour from any of the major hospitals in my city that we rotate through, I could not even inhale the fumes of alcohol, and I could not sit through the most recent vapid wasteland that is Entourage without thinking halfway through that I was going to be paged away before finding out which random girl was going to show her boobs in that episode.

I realize this all may sound a bit petty and whiny, which I admit it is (especially since, again, I barely got called in). But what this month taught me is a) clearly I am neurotic because I can’t stop thinking about my pager potentially going off and b) I never, ever want a job where I am perpetually on-call. I can’t imagine living my life this way, and I can think of nothing more liberating than being able to put my pager down, turn it off, and enjoy some quality time away from the real ball-and-chains in life: work.

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?

Thursday, May 17, 2007

A Step Down, A Step Up

As graduation rapidly approaches, I have felt this growing pressure to come up with some creative way to capture, summarize, and otherwise wrap-up my four years of medical school for you. After all the freaks encountered, bodily fluids sprayed with, and orifices probed, I figured it would be pretty easy to come up with something good for a grand finale. But then I realized that I haven’t actually worked up, talked to, or been within ten feet of a real patient, doctor, or classmate for almost five months, so my arsenal of pathetic real life experiences has been severely depleted (although as an aside, isn’t fourth year of medical school just the most amazing thing ever?).

Given this dilemma, I attempted to turn to other sources of inspiration in my quest to forever enshrine the experience that is medical school. At first, it seemed as if popular culture was going to make this really easy for me. Almost immediately after beginning my quest, I discovered that Keith Richards admitted to snorted his father’s ashes. A ha!, I thought. If snorting your own father’s remains in a drug-induced stupor isn’t what medical school is all about, then…umm…actually that’s just really fucked up. But after all, that right there is about as ridiculous as anything I’ve experienced these last four years, and if there’s one thing that sticks out about medical school, it’s the sheer ridiculousness of the whole process (for examples, see…the rest of this website). But then I realized that that makes absolutely no sense whatsoever, and I moved on.

Only moments after doing so, I was blessed with yet another pop-culture discovery that I thought could enlighten me on how to commemorate my medical school experience. Flipping through the channels one night, I happened upon ABC’s The Bachelor (“happened upon” or “lustly devoted to”, I’ll let you decide). At first nauseated by the profile of the bachelor and his freakishly tool-ish qualities, I soon discovered that he was a physician, which seemed to account for all of his forced, tool-like behavior. A tool doctor on a tool dating show, now that’s medical school! To my delight, the show turned from simple comedy to pure spectacle, for I would have never thought that this show could have encapsulated the true narcissism, comedy, and humiliation of medical school until I saw the distinctly familiar face of one of my classmates emerging from one of those limos they herd the women through during the introductions. What follows is a severely edited version of my stream of consciousness during this historic moment of television:

Holy crap, that crazy chick from my class is on The Bachelor.
Holy freaking crap, that crazy chick from my class just read the bachelor a fortune cookie note.
Holy freaking mother fucking crap shit balls ass fuck, that crazy chick from my class just sang the national anthem to the bachelor in front of millions of viewers.

Unreal. I was literally laughing on the floor for a few minutes, and I had the chance to see her sing over and over again (and subsequently roll on the floor over and over again) courtesy of my friend’s DVR. Un-freaking-believable. Did that really happen? Did she really sing that entire thing? Did she just provide one of the most awkward moments in television history? Seriously, if that isn’t the most ridiculous thing that has happened, if that display of shameless comedy doesn’t summarize the, umm, shameless comedy of medical school, than I don’t know what does. Yet, following her progress through the next few episodes, I couldn’t help but feel that while her hapless moment in the sun has provided my friends and I with a lifetime of unintentional comedy to bond over, this scenario is wholly hers, not mine, and that there was really no way to adapt some moment of hers to summarize four years of my misery.

Yet, just when I thought I was out of luck, that I would have nothing of substance to submit to you, the reader, that could fully capture the last four years of my life, that cruel, ugly bitch known as Fate intervened. For you see, I had the privilege of being in the wedding party for one of my best friends wedding last week (I also came to that city a little early to find an apartment). While not a best man, I was an usher and given the responsibility of reading a poem selected by the couple-to-be during the ceremony. I walked up to the pew, read the piece (a stirring rendition, I should add), and turned to my left to walk back down the stairs.

Except a funny thing happened while walking down the stairs. You see, I was wearing those shiny rental tuxedo shoes and…well…I slipped, fell, and tumbled down the stairs with a monstrously loud thud. During the wedding ceremony. In front of just about every single one of my best friends from college.

I immediately jumped up, ignoring the enormous welt I just delivered to my behind, and walked to my seat, my face now literally as red as my thunderstruck ass. I then had to hear about me being a monstrously large jackass for the next six hours at the reception (deservedly so, I admit). And, to top it all off, I returned to my car that evening to discover that someone had smashed my driver side window and stolen the GPS thing I bought from Costco to help me navigate the city while looking for apartments (which I of course was not planning on returning to Costco immediately after this trip, cough cough). Crap. Did I mention that I never even found an apartment?!? So the next day I had a six hour drive home with no driver-side window, no apartment, and a huge, painful bruise on my ass.

Ladies and gentlemen, that right there, that’s medical school.

Well, not entirely. The following day, I discovered that an apartment I thought I was aced out of had become available, so I snagged it. And my now-married friend thanked me for my tumble, because it made him feel infinitely less nervous standing up there about to get married. And, while I still had a massive, painful bruise on my backside, I took a picture of it and emailed it to all my friends to force them to at least share in my misery by having to look at a picture of my ass.

Now that’s medical school.

The frustration, the embarrassment, the comedy, the pain, the promise, the shared misery, the occasional burst of inspiration, that 24 hour sequence captured it all, and that is what I have been trying to convey to you these last few years. After all, the vast majority of questions emailed to me go something like “So what’s medical school really like?”, and my answer is simply:

Medical school is like falling on your ass at your friend's wedding in front of your best friends from college, having someone break into your car shortly thereafter, but having it all somehow work out for the best in the end.

I still don’t know if I am doing the right thing, I don’t know how long I am going to last as a resident, and I don’t know how much I am going to want to last as a resident. I do know that these last four years have been some of the most frustrating, embarrassing, funny, inspiring, and painful years of my life. So when I step up to receive my diploma in a couple of weeks, I’ll try to keep these racing emotions and memories in mind. Well, that, and not slipping and falling on my ass again. But I genuinely hope that I have been able to share some of what I have gone through with you, in a way that you can understand, so that perhaps you have a newfound insight into how the person responsible for making sure you are healthy, well, and fit becomes that person in the first place.

And, finally, I wanted to thank you for entertaining me with your comments, questions, and (most especially) hate mail, for pushing me to get off my lazy ass and whine on the Internet from time to time, and for maybe, just maybe, helping me remind myself why I keep doing this in the first place.

Thank you.

Oh c’mon, you think I was just going to end it like that? Gratuitous wounded Fake Doctor ass shot for everyone!!!

Oh, and just in case anyone was curious, I did reserve Ah Yes, Residency...

Wednesday, April 11, 2007

World Tour 2007

Greetings. I just wanted to pass along two quick things:

1) I have been getting an inordinate amount of email asking me which speciality I have matched into. While I have previously discussed my interest in hematology/oncology, you can't match directly into that and have to do something else first. Rather than try to come up with another witty, hilarious romp through the medical profession as I try to pick a residency, I will instead point you to the post where I discussed this ad nauseum and let you go back to sending me plain old hate mail instead.

2) I will be out of the country for a little while, taking full advantage of the fourth year of medical school and all of its rigors (don't worry, I have a lot to say about this...and what this has to do with Keith Richards and The Bachelor...however, I don't have time to explain right now, because my plane is leaving in a few hours and I should probably start packing), but I promise to return with the aforementioned rant on fourth year and my need to complain about something even when I am on vacation.