Monday, October 21, 2013

Sunday, August 25, 2013

Saturday, July 03, 2010

Start of Fellowship

Today marked the first day of fellowship, peoples. No more internal medicine ... from now on, your Axis will be in cardiology fellowship training. What will this mean for us?

For me, it will mean finally being in the specialty I enjoy. It means no longer dealing with patients with issues that are beyond the sphere of my interest. No more dealing with social issues and where to place patients upon discharge. And most importantly no longer am I the Plan B (or C, D, or worse), in terms of the service to whom patients should be admitted when no other service wants them.

For you all -- for those very reasons -- it might mean this Axis might just be happy for once, which, in turn might mean blog posts that aren't quite as bitter and venomous.

Who knows? We have several years to find out. Stay tuned.

Wednesday, June 30, 2010

Residency, By the Numbers

Years of residency3
Months of residency36
Days of residency 1094
Number of them I spent overnight in the hospital 223
Most hours worked at a time 36
Most hours worked in 48-hour period 40
Number of pts I admitted (approx) ~1500
Number that died under my watch Small handful
Number of pages received TNTC
Number of times I threw my pager into the wall 0 (!)
Number of lumbar punctures 12
Number where I shook the needle because of a page 2
Number of patients in my clinic panel 110
Number who I truly liked 2
Number of pelvic exams I did 36
Number I enjoyed 0
Number of times I pinched a cervix 1 (so sorry)
Number of times I performed the "whiff test" 1
Number of times I converted my PPD 0
Number of needle sticks 1 (pt HIV negative, whew)
Number of lawsuits 0
Number of days left of residency 0

Friday, June 11, 2010


I stepped into an elevator at work today just as another patient joined me. It was only the two of us. He was in the hospital for, among other things, ulcerative colitis, and thus was having large amounts of bloody diarrhea.

A few seconds into the ride a loud rumbling noise emerged from the depths of his GI tract, prompting a look from me in his direction. He proudly clutched his belly and announced, "Sorry, I've got gas!" When the elevator stopped on his floor, he walked out wearing nothing but his hospital gown ... which, at this time now, was dripping multiple globs of light brown watery stool with each forward step.

As if that weren't bad enough, while walking out myself, I accidentally stepped in one of his disgusting puddles.

I spent the next hour at a nursing station with every anti-infective spray, cream, and wipe that they had. You can find my shoes in the garbage.


Tuesday, May 11, 2010

She Had a Cold

I was in clinic today talking with a new patient, a fairly healthy 40-year-old woman, and as part of my routine sexual history I asked if she had ever had a STD (sexually transmitted disease). She responded with "I had something a few years ago, but it turns out she had a cold." I did not understand at all what she meant, so I asked her to repeat herself, to which she again said "She had a cold."

I had no clue what she was talking about. I had no idea who "she" was. I assumed I was simply zoning out while the patient was talking earlier and thus must have missed who "she" was. Thinking the patient may have been referring to a female sexual partner, but not wanting to appear as if I hadn't been listening, I casually asked her "Oh, your female partner?" and she again responded with "No, she had a cold."

Still without a clue as to who had this cold, I then asked "You mean your doctor? So your doctor had a cold?" and she again said "No, she had a cold."

I was about to lose it. Who is she? Who had this cold?

I finally blurted aloud, "OK who are you referring to?"

She then pointed with both hands to her crotch and said, "SHE had a cold!"

Oh. Ohhh. Her. Well excuse me. Couldn't you simply have given her a name and made this easier from the start?

I did laugh, though ... and yes, in front of her.

(And no, I still have no idea what she meant by "a cold".)

Wednesday, May 05, 2010

Scrubs, the Huffington Post, and Me

Recently I came across this Huffington Post article. Yes I know I am reading it one year and four months after it was published, but that aside, it reports how the television show Scrubs will be returning for what ended up being its ninth and final season.

Obviously I was excited -- both at the time and also currently -- to read about Scrubs, for as many of you know I am what may be considered a fan. But what was even more thrilled was that they mentioned one of my posts in their article! I had reached the end of the first full paragraph, which finished with:
Scrubs remains the most realistic medical show on television according to most actual doctors and nurses.
With intense curiosity I clicked on that link, which very unexpectedly brought me to my own article. Apparently I'm "most doctors or nurses" ... me, yours truly, your favorite Axis.

I wish I had come across this in a more timely manner, but this delayed surprise isn't so bad. Unfortunately, Scrubs has since come to an end (even after a brief and weak effort at resurrecting itself with a newer version involving medical students) so all I have of that unique show are memories ... and great articles like this.

Monday, February 22, 2010

25 Things I Didn't Do Before I Entered Medicine

Wake up before 8am.
Go to sleep after 2am.
Look forward to sleeping nearly every night.

Wear a shirt and tie to work.
Shave more than three times a week.

Stick my finger up peoples' butts.
Ask people how many people they’ve slept with.
Ask men to tell me about their erectile dysfunction.
Ask for men to show me their penis.
Dread seeing vaginas.

Be able to tell police officers what to do (in the hospital, at least).
Talk with police officers.
Talk with prisoners.

Slam the phone on people.
Hate pagers.
Hate anything that beeps.

Drink at home, alone.
Want to drink this much.

Be thankful I am alive.
Hope that certain people would die.

Struggle for money.
Dream of money.
Despise people with money.
Despise people.

Wish I didn't enter medicine.

Friday, January 15, 2010

Holidays Are Over

Now that Christmas and New Years have come and gone, there is only one thing I can say ... thank goodness the holidays are over. I cannot be thankful enough. I was unlucky enough to have to work on Christmas Eve, Christmas Day, New Years Eve, and New Years Day. And for most of them, notably New Years Eve, I had to work night shifts.

I used to love the holidays. I loved the Christmas decorations on the streets, Christmas music everywhere, and the feel of the weather (yes it's California, but still). This job, however, has gradually eroded my passion for the holidays (among most other things in life), and this year sealed the deal.

Working through the holidays, and those four days in particular, was dreadful. Putting in my thankless slave labor hours while watching my friends and family get time off -- some of whom got two weeks off! -- was extremely discouraging and depressing. I absolutely dreaded going to work each evening, I was grumpy with co-workers in the hospital (many who reciprocated for similar reasons), and I found patients extra hateful. What kind of person prefers to be in the hospital on Christmas Day as opposed to home. Who thinks "instead of opening presents or spending time with family let me go to the hospital, complain, and get attention"? Those people are not sick in body, they are sick in mind.

Holiday season 2009 was the worst I have experienced ... and I sincerely hope no future holiday season tops it.

Monday, November 16, 2009

The Best Things in Life

I saw one of my favorite patients today. He is a 30-something-year-old guy with a history of diabetes for the last seven years who has been doing a great job over these last few years of keeping his diabetes very well-controlled. He takes his meds on time, calls in for refills when they start to run out (a rarity not to be underestimated among patients!), and has been very compliant with his routine visits. Like any diabetic, despite maintaining a good diet most of the time, he occasionally gets tempted by very sugary and starchy foods, but for the vast majority of the duration of his chronic illness he has done a great job of showing restraint.

This visit, however, he had news for me. Apparently a new bakery moved in next door to where he worked, and he fell under the spell of some tantalizing cakes they made. Initially he did not even notice the cakes. Then one day he had to go in for a non-food related reason and his interest was slightly piqued. Soon things escalated to the point where almost every day he would walk in and ask for a tiny sample of a cake. That was a few months ago. These days he was at the point where he'd ask for a slice on a daily basis. He still took his meds; he still measured his sugars; but now he was also having a generous slice of cake ... and frequently too.

So he finally succumbed. Despite his initial strength, his many years of good diabetic control, and full awareness of the consequences, he bought an entire cake and went home to eat it. Not just eat it ... scarf it down. From what I hear, he really enjoyed it. It seems that before this bakery, he had not touched cake in many years. And now, he tells me, he splurged three nights in a row, one cake each night.

After this encounter, I couldn't help but think why is it that the best things in life have the potential to be the most dangerous? Not only are they not free as the adage suggests, but they really are the most harmful, whether physically or emotionally or financially. I am not only referring to sugar, salt, fat, and other tasty foods, but other entities in life as well (e.g. excessive money, extreme sports, a neighbor's wife.) Our brains seem naturally wired to crave that which is bad for us. Or maybe it's just we covet that which we can't have. I don't see how this helps with natural selection. In fact, I bet some grand designer up above designed this system intentionally and must love observing us.

Back to my patient, he has now radically thrown off his blood sugar readings and who knows what sort of complications he may face down the line. He is regretful, although he really did enjoy it in the moment. He claims he will be back to good behavior, but we shall see.

Anyway, I don't know why I even wrote this entry.

Saturday, September 05, 2009

New Interns

That time of year is here: the brand new interns ("baby interns", if you will) started a few weeks ago in the hospital. I have been looking forward to this day for nearly one year now, as last year I was on an outpatient rotation during the start of the academic year and thus did not get to interact closely with the new interns. It didn't take long, however, to realize why most senior residents dread this day.

I met my two new interns on a Sunday, a day on which our team was on call. So not only did these poor interns -- essentially just fourth-year medical students -- have to start their internship on a weekend, but they had to start on call and stay overnight in the hospital. It was a whole new world ... a whole new, brutal world that didn't care about weekends, holidays, or "after hours".

The rest of the day was spent orienting them to the hospital, describing the way things work in the hospital, and providing them with an overview of day-to-day operations. In addition I had to teach them how to use the VA computer system, which is intuitive and joyful to use once you know the basics, but those basics take some time to learn. Juggling all this while receiving annoying calls from the ER for patient admissions made for a very busy and oftentimes trying day. The day was an exercise in patience, disguised as a fresh start for a group of frightened newbies.

Most surprising, although it shouldn't have been, was watching the interns' clinical skills in action. Understandably, they had not interacted with patients in many months, nor had they made any sort of oral or written presentations in that same time. The minutes of the day where I wasn't teaching them how to order medications or learn the phone system, I had to work on how to present a basic H&P. And by "basics" I mean just that. I spent more than one sitting explaining how one first presents the history, then the exam, then labs, etc. Those basics.

On a final note, just when I was thinking the next day how it couldn't get any worse, of course it did. I soon met two very young guys who introduced themselves as my new third-year medical students. In case you are not familiar, that means they were fresh-as-can-be, had-never-set-foot-in-the-hospital-before, hearts-still-racing-from-waking-up-at-7am medical students. Interestingly, though, while at times the new interns seemed like seasoned pros compared to the new medical students, much of the time they were very similar: new, scared, learning, and above all overwhelmed.

Looking back, despite some of this grumbling, the mere novelty of the week and its participants made it an exciting one me. I am glad I was present to welcome the new interns and students, but it is not something I want to repeat as a resident. Hopefully, as a fellow, I will be slightly shielded from them ... by the poor residents.

Wednesday, July 08, 2009

Fellowship Match

Match Day for fellowship was a few weeks ago, and dear readers, your Axis got his #1 choice!

The fellowship matching process is identical to the residency matching process, which is nice for the sake of familiarity but painful because it involves repeating a long, expensive, and tiring process.

Matching for fellowship was exciting mostly because it indicates that residency will soon end and I will begin training in a field I am actually interested in, cardiology. A third year of medicine residency lies ahead of me, but the end is now in sight.

Exciting and motivating as it is to see that end now, it reminds me yet again that I have will have had to wait several years before I can be immersed in the field of my true interest. Unlike my counterparts in, say, neurosurgery, urology, obstetrics/gynecology, psychiatry, or radiology, all of whom started training in their fields immediately after medical school (save one year of internship, of course), I have to suffer through three long years of general internal medicine before reaching cardiology. Three years of low back pain, diarrhea, runny nose, GI bleeding, and countless other symptoms/illnesses that I simply do not care about. It's hard to be good at what you do when you don't like what you do.

Regardless, the end of general training is near and soon the game of sub-specializing and sub-sub-specializing will start. I will now be Axis, second-semester senior.

Tuesday, April 21, 2009

Latest Grand Rounds

Check out this week's Grand Rounds, hosted by Diabetes Mine, who did a great job of organizing it. Look out for a post from your very own Axis!

Wednesday, April 08, 2009

New Design

Axis Deviation is growing up. Throughout its lifetime of nearly three and a half years, this blog has kept the same design. While I have enjoyed the red and grey of old, it is time to retire it and inject a new energy into this blog's appearance. So in the spirit of change, especially since there is no such thing as timelessness on the web, I have changed this site's layout.

Allow me to explain the reasons for choosing this particular template. The theme's block design offers a subtlety lacking in the old theme, which some might deem overly aggressive. I appreciate how the magenta titles contrast the melancholy blue-grey overtones, making the site approachable, pleasing, and even bosomy. Finally, the header's rounded grey squares -- majestically translucent and overlapping -- are delicately spread out, such as might give the effect of confetti blowing into the sky on a warm summer night. Plus it looks cool.


Tuesday, April 07, 2009

Clubbing and Coding

Excitement, dear readers, excitement! And outside the hospital, no less ... read on.

In a rare weekend where I had both days off, I went with some friends out of town and then to a club (you know, to read the articles). At one point while I was busy talking, I noticed a large group of people huddled around something across the room.

Automatically I assumed that the "something" was a person so I darted over, pushed my way through the crowd, and then saw a young man collapsed on the floor. Instinctively I jumped in. I didn't even know I had such instincts.

A few muscle-headed security guards were also kneeling down, but I squeezed myself between them. I went straight for the collapsed guy's neck to feel for a pulse, when one muscle head barked that I could not help if I was drunk (which I was not). Normally when a bouncer-type person yells at me I shy away, but this time I barked back that I was a doctor and could help. Immediately -- satisfyingly -- he retreated.

I continued assessing the guy and performed some simple BLS (Basic Life Support). For some reason -- perhaps in the excitement of the moment -- I cannot remember exactly what I did the next few minutes, but I do recall one of the security guards pulling out some gloves from his pocket for his own use, and me snatching it from his hand. I put it on my own, and then he surprised me by offering the other.

Initially I thought the victim had no pulse, so the guards turned to me to see if chest compressions should be started. Just as I was about to nod we tried a sternal rub. The guy immediately started groaning and then he came to. I stepped back and left him to the guards and the newly-arrived medics.

The guy was then wheeled off and hauled away to an ambulance, slurring, belligerent, and all. Good ol' alcohol intoxication.

Any sudden and unexpected situation is an exciting one, but this scenario held special significance. Since medical school or early internship, I have had recurrent daydreams (fantasies?) where I imagine being in a public place when someone collapses, and I rush to the rescue. Whether I do this because of boredom, an overactive imagination, or a latent desire to be a hero -- in one of my dreams I order the pilot of our plane to make an emergency landing! -- this scenario has crossed my mind many times.

Sadly, when the real thing occurred, I wasn't nearly as graceful as in my dreams. In the heat of the moment I had to spend a few seconds reviewing BLS algorithms, and then later I was slightly hesitant to tell people to start chest compressions (which, as mentioned, ended up being unnecessary.) In addition, finding the victim's pulse was close to impossible with loud music pounding in the background and having multiple crowd members yell out idiotic comments does not help one's focus.

Regardless, my work and play don't often mix, so having these two worlds run into one another was definitely exhilarating.

Monday, March 30, 2009











It's really annoying, isn't it?

Tuesday, January 27, 2009

Thank Goodness for Scrubs

Nearly everyone I tell I am a doctor asks almost immediately, “Is your life like Grey's Anatomy?”

It is annoying because 1) it isn’t, 2) I wish it was for the sake of (unrealistic) excitement, and 3) I hate Grey’s Anatomy.

Anyway, the conversation that follows usually goes like this:

Me: “No.”

Person: “Ha ha! So what is it like then?”

And this is where it gets a little annoying. It is difficult to explain to non-medical people what an internal medicine resident or internist does all day long. What I do is not that interesting, and I am sure the average layperson would be downright bored hearing a description of my day-to-day activities. (“I start the morning by reviewing labs on a computer. Then I walk from patient to patient asking them how they were last night. Then I spend the rest of the day struggling with the computer system trying to order a lab, paging consults who never call back, and occasionally doing some procedure that inevitably takes ages to set up for.”)

Non-medical people likely don’t understand the concept of rounding, the importance of ordering and following up labs, reviewing films with radiologists, and most importantly, how the time it takes to perform countless small tasks like these quickly adds up.

Surgeons have it easy here. They could simply say “I do surgery”, and everyone in the world would know what that means. Lucky bastards.

Enter Scrubs. This TV show has done a great job of capturing the realities of internal medicine residency and making it interesting. And because it is a popular show, many people are familiar with it.

I have therefore found the best response to “Is your life like Grey’s Anatomy?” is, “No, it’s actually like Scrubs.” People immediately understand.

Scrubs ... relieving doctors like me from painful conversations everyday.

Sunday, January 25, 2009

Fellowship Applications

It's that time of career again. I am now applying for fellowship, which means yet another round of filling out applications, begging for letters of recommendation, and sending lots of money to programs. I felt like I just went through this ... and what do you know, I did.

I am beginning to feel that the rest of my life will consist of this dreadful cycle.

Friday, January 09, 2009

A Catastrophe Waiting To Happen

There is a lady on my service that I admitted to expedite her pre-transplant workup. Her family comes to visit nearly every day, and here is who her family members are:
  1. Husband -- the "high maintenance" type (wants to be updated every day about the latest plan regarding his wife's care).
  2. Daughter -- the head pharmacist at a nearby hospital (of note, she is not a physician, yet parades around as if she is one, by constantly demanding detailed information regarding her dad's lab values and other numbers).
  3. Son -- a lawyer ('nuff said).
Can you imagine a worse patient family?

Wednesday, December 17, 2008

I Hate Internal Medicine

Last night I was on call for the first time as a resident on the wards (i.e. general medicine inpatient wards, the basic/core inpatient rotation in internal medicine), and more than ever do I hate being a resident in internal medicine.

First of all, it was a busy and brutal night. From the time we opened for admissions at 2pm and until midnight, my pager was going off nonstop. The ER certainly had a non-stop supply of patients that needed to be admitted.

And by "needed to be admitted" I mean patients for whom the easiest thing for the ER to do would be to admit them because they were feeling a little too ill to be at home (or a lot too lazy to want to return home). The ER definitely could have discharged them, but because ER doctors are too spineless and unconfident, the patients were admitted to the hospital. Honestly, a quarter of patients admitted to internal medicine teams are admitted for so-called “social” reasons, referring to reasons like those I’ve just mentioned.

Therein lays my biggest gripe -- to put it politely -- with the night and with the field of internal medicine in general. We get dumped on. We have to admit every patient. We accept every patient the ER decides to admit to the hospital; or every patient from a surgical service that no longer has a surgical issue; or -- and this is the one I absolutely hate the most -- every patient presenting with a surgical problem that the surgery team who’ll tend to it is just too lazy to admit.

(As an example, I just admitted a young man with several neck masses that he had noticed over the last several weeks. He had no other medical problems and was completely stable; and somehow the ENT teams decided he would be better served on a medicine team. All I do every day is look for the latest recommendations by ENT. Seriously, talk about lazy and work-avoidant doctors.)

Ridiculous admissions like these make me hate what I do. Yes I hate what I do, I really do. I feel that if one wants to be an inpatient internal medicine doctor, one must have a pushover personality. There is no other way to survive each day without feeling discouraged and powerless. Fortunately I will be sub-specializing with a fellowship and thus hopefully avoiding such lame admissions in my future career, but I am not sure I can survive another year and a half of this. Each new admission boils my blood and makes me resent even more the patient population at large.

Anyway, let's go back to my night of call. Lucky me, that was only my first night of call this month ... and I have four months of wards left this year. At least I'm paid well.

Monday, November 17, 2008

Ads Are Gone

Just an note on a minor update to this site's design: I decided to take down the Google Adsense ads that used to be on the sidebar. I felt they were not very relevant or useful, especially since they displayed ads mostly about hospitalist positions.

More importantly they cluttered up the page, which I like to keep very clean and uncluttered.

Let me know if anyone is horribly distraught by their absence.

Sunday, November 16, 2008

It's All In the Hands

Much of the training to become a doctor involves the physical exam. This is the time-honored skill of performing tasks like listening to the heart and lungs, palpating the abdomen, feeling for pulses, etc.

(Many people currently will also argue that the physical exam is obsolete, being rapidly replaced by lab tests, imaging, and other fancier technology. Personally, I don't entirely disagree.)

One of the most important parts of the exam, however, is the mere task of inspection, which involves just looking at the patient. This simple act can provide volumes of information. I feel a patient's hands, and in particular their fingernails, are very telling and provide useful information that the patient herself will not reveal. Here are a few findings I have observed over the last few years.

Dirty nails -- It doesn't take much time or effort at all to maintain fingernail hygiene, so if a patient has clean and trimmed nails it is inconclusive. However, nails that are ungroomed and dirty usually suggest clues about the patient's underlying social history, such as a broken or non-existent housing situation (e.g. as an extreme, being homeless).

Clubbing -- A classic, and the most medical of all these. Clubbing is the buildup of material at the proximal part of the nail bed, giving them a very exaggerated curvature. Often a sign of occult lung disease or cancer, if you notice clubbing consider evaluating the lungs in some detail. I once had an old man present with a set of very vague symptoms. When I noticed his hands and toes had severe clubbing, I started a workup that revealed metastatic prostate cancer.

Long fingernails -- Subtle, but in my view, very telling. I have noticed that long, unclipped fingernails often indicates someone with psychiatric issues. A mind fraught with psychosis or depression has more pressing issues than clean fingernails. Again, it doesn't take much to maintain one's fingernails, so when I see this I wonder if the patient is mentally sound.

One long, groomed pinky fingernail -- Historically this was a trait of gangster bosses, drug dealers, or the like, who proudly displayed a long and groomed nail to signal that they were white collar, and not a manual laborers who used their hands to make a living. Today, it means you're a douchebag. While this finding doesn't provide true medical information, it is always good to know when you're dealing with a douchebag.

Resuming Post-Election Life

The election is over, and thank goodness. I can now get some sleep without stressing over whether America will have sense enough to vote the right person into office. For the first time in a long time (8 years, in case you were wondering), I can say I am proud of my country.

Anyway, with that said, regularly scheduled programming will now resume. Stay tuned!

Tuesday, November 04, 2008

Election Day!

Go vote peoples (if you already haven't)!

Seriously. No seriously.

If you need help finding your polling location, go to

Monday, October 13, 2008

The Dumbest People Ever


I know that I -- in my vast bitterness -- have insulted patients many a time, insulted nurses many a time, and insulted fellow doctors many a time as well. However, no one tops the following people in terms of sheer, absolute dumbness (for lack of a better word).

(In case you require a medical-related reason to watch this video, just imagine the blood pressure effects of listening to the people featured in this video.)

Tuesday, October 07, 2008

Silver Lining

There was a bomb scare in the hospital today. A suspicious package was found and the hospital went into emergency mode. It was actually an impressive event, where all of a sudden the hospital police and city police department came rushing through the floor and very unceremoniously shoved us out of the wing ... and then proceeded to evacuate all the patients too!

The police also ordered everyone in the hospital to refrain from using their cell phones for some reason ... whether it was because the signals might interfere with their communication, or perhaps even because the signals might activate the suspicious package, no one was sure.

Better yet, they also made us turn off our pagers. So while this entire event was a tense and even frightening situation, it was almost worth it to be free of our digital leashes for several hours!

Oh, and it wasn't a bomb.

Sunday, September 21, 2008

The ICU Resident

I am now a real resident. The last several months I was on a research rotation, which kept me very busy ... not as busy as a clinical rotation, but even more so in another sense, in that I spent all my free time (home or at work) thinking about my project.

Regardless, even though I was technically a resident, I didn't have any clinical duties or activities. All that has changed now. I am now on my first clinical rotation, and it is in the ICU no less ... and it is quite a rude awakening.

Not only have I been out of practice for several months, I am now thrown into the ICU, where things change by the hour. No more merely doing what I am told (because I’m the one doing the telling). No more nodding along upon hearing the management plan (because I’m the one doing the planning). And no longer do I have the the luxury of possibly having several hours of sleep while on-call (because I’m the one getting paged down to the ER every few hours for their bogus ICU evaluations)! Like I said, definitely a rude awakening.

Especially scary are the nights on call. Since I admit to both the ICU and CCU, I am the only ICU/CCU doctor in the hospital during the night. My first night of call, when I first realized that, was a momentous occasion. It was extremely scary to think that I alone was responsible for taking care of the sickest patients in the hospital. Someone in the ER getting septic? Someone arriving via ambulance with an acute MI (heart attack)? A patient on the floor going into respiratory distress? It’s all me to take care of!

Granted -- and this is the only thing providing an iota of comfort -- the fellow is always available by phone, and not only that but I have to page him for every admission, but I am still the first line. I can no longer face a group of nurses and say “Let me ask my resident”. These thoughts alone were enough to keep my anxiety levels sky high through the night, and to keep me from relaxing even when I had the chance to sleep.

It has been a few weeks now, and luckily -- thankfully -- I can say it is getting a little easier, and I am getting a little calmer. But it is still frightening.

So … all that bitterness and anger from my internship? Well it is now replaced by terror and anxiety. Not sure if that was a fair trade!

Wednesday, September 10, 2008

Sorry For the Hiatus

Residency life overtook my life the past several months. I will start posting regularly again, starting very soon. Thanks (if you're even reading this!)

Sunday, July 13, 2008

Looking Back At Internship

Internship is over. Done. I still can’t believe this year is over. While definitely not unbearable -- it was in fact very manageable -- it was among the most exhausting and busy years of my life.

Looking back at internship, many thoughts come to mind naturally. On one hand I feel like I learned nothing, but upon deeper consideration, I really have come a long way in terms of personal growth and knowledge.

(As an example, I like to think back to my first few weeks of the year-- where I was afraid to order even a Tylenol -- to the last few weeks, where I had no problem making preemptive orders at night, announcing to nurses and patients alike, “Benadryl 50mg at 10pm, so we can ALL sleep well tonight.”)

Additional thoughts? For one, I did not learn medicine. It sounds odd and impossible, but it is true. I don’t feel like I learned how to heal people. However, I did learn how to write admission order in my sleep, draw little “To Do” boxes and check them off, and, most importantly, how to mask patients’ pain with Vicodin (“page me if you need more”). Middle of the day or middle of the night, I did these with such ease you’d think I had been doing this for years.

And somewhere -- somehow -- amidst all this ridiculousness, patients healed. Or perhaps, they just left the hospital in slightly improved condition, but either way I never felt it was any of my knowledge that contributed to their discharge.

Another unfortunate realization that developed this year is that I don’t like patients. Once again, odd but true, and it began as early as day 2 (on day 1 I was too nervous and enthusiastic to let it bother me.) Patients would describe their symptoms to me (or more accurately, explain in detail every aspect of their health except what I would be interested in), and all I could think about is “I don’t care.” Because I didn’t. I didn’t care about their problems, and as they would talk to me I would silently bet myself if they would stop talking within the next minute. I rarely won.

For me, the patient wasn’t a sick person. They weren’t poor humans seeking my skills in their time of sickness. To me, they were yet another obstacle to me getting sleep or going home. It is unfortunate how much this year has turned me against patients, and much as it may seem otherwise, I’m not proud of it either.

Anyway, regardless of how this year has changed me -- whether to make me more bitter, detached, wise, efficient, whatever -- it was a unique year. I mean, where else can you get on-the-job training that is simultaneously demanding, educational, frustrating, sleep depriving, and low paying? But enough is enough, I am ready to see what being a resident has in store now.

Tuesday, June 24, 2008

Internship Is Over!

Title says it all! I can't believe this year is finally over. Sorry for the paucity of posts lately, but stay tuned ... more coming very soon.

Wednesday, June 04, 2008

Asshole Patients

See if I ever ask you -- out of genuine compassion (a rarity in the hospital) -- if there is something I can do to help you sleep more comfortably, as you looked uncomfortable. Normal people don't respond to such compassion with yelling and barking out "Is it against the rules to sleep like this?"
Just for that I'm making you NPO until you leave AMA.

Wednesday, May 14, 2008

Some of My Favorite Things

Forget raindrops on roses and whiskers on kittens ... I prefer the following any day:

Post-Call Breakfast Burritos
The only good thing about being on-call and staying in the hospital overnight is the anticipation and feeling of leaving the hospital post-call. And rewarding yourself on a post-call day with tasty, unhealthy food is part of that joy. Breakfast burritos seem to be something all hospital cafeterias prepare, and prepare well. It may be a plate of artery-clogging comfort food, but it definitely feels well-deserved after staying overnight at the hospital.

Patients Who Leave AMA
A patient can leave the hospital at any time they want (with a few exceptions, of course). If it is before the doctors feel they can be discharged home safely, they have to sign out against medical advice ("AMA"). Early in the year when alerted by the nurses that a patient is considering leaving AMA, I used to rush over and negotiate with them to stay. Nowadays, I seize the opportunity to get a patient out. I still rush over ... but this time with the AMA papers in one hand and a pen for them to sign with in the other. Patients think they are threatening us, but in reality they are giving us a gift.

Good Nurses
"Duh", you might be saying to yourself. Yes, anything or anyone good is a desirable thing: nurse or otherwise (co-worker, friend, turkey burger). But the difference between a good nurse and a bad one is priceless. Good nurses try to handle unexpected patient situations before jumping to page you, they shield you from patient complaints that don't require your (or anyone's) attention, and best of all, they don't send you really dumb pages. So really, the difference can mean a few extra hours of sleep. To the up-and-coming newbies: identify the good nurses and get on their good side. Their great side. You will appreciate the kickbacks.

Sunday, April 27, 2008

Dumbest Page Ever #2

(Seeing how I established a Dumbest Page Ever, it is natural that another page would try to steal that title.)

I was woken up to receive this page at 5am:

"Doctor, doctor, patient is very sleepy. He is arousable but then falls asleep again."

My ideal response: "I see. Now how about I wake you up at 5am and see how awake you are."

My actual response: "OK, thanks for the update."

Tuesday, April 22, 2008

Outside Hospital

I just came across this hilarious YouTube clip depicting an advertisement that touts the infamous "outside hospital". "Outside hospital" simply refers to any hospital that is not your own -- the hospital you work at, that is.

While it strictly just refers to a hospital, this term actually has much richer connotations. A patient being transferred from an outside hospital usually has had many unnecessary procedures, countless tests, and, most irritating of all, is transferred over with a surprising shortage of records and documentation describing what happened there ... and the very few that are sent are of no help at all. Unfortunately you probably cannot fully appreciate this video unless you have worked or trained at a large -- and probably university-based -- hospital.

The best part is the series of back-and-forth comments at the bottom of the page that viewers have posted, particularly by some very defensive people.

But ... the bestest part? "We'll send the nursing notes".

Tuesday, April 15, 2008

Grand Rounds 4:30

The latest Grand Rounds is up at Women's Health News, where yours truly is among the featured posts. Take a look, as she did a great job putting it together.

Thursday, April 10, 2008

Job Benefits

There are some definite benefits to being a doctor that I have noticed in the less than one year I have been working in this field -- other than the “main” benefit of helping people. Here is a short list I compiled.

Fewer Clothes
Dressing half the time in shirt and tie and the other half the time in scrubs makes my shopping bills and cleaning bills much lighter. Luckily, men are not expected to have as much variety in their shirts and ties as they are for their casual and going-out clothes; just observe any guy and within a week you will start seeing his attire cycle. As such, I rarely need to go shopping or do laundry. (Don’t worry, you will always see me clean and presentable).

Weekdays Off
Granted having no/few weekend days off is miserable, since having a set and regular week is a great way to make it through said week. However, if forced, having weekdays off is not so bad since places are usually much less crowded during the day. A little less hassle in grocery stories, shopping malls, and restaurants is a small, yet helpful, perk.

Job Security
Not by any means a new observation, but I am starting to appreciate this better. Now that I am (more than) several years out of college, I have unfortunately watched more than one friend get laid off or leave because of dissatisfaction and then unable to find a new job. Luckily I doubt I will ever be in this position. Barring any sort of unethical, unprofessional, or incompetent behavior on my part, it is safe to say physicians of almost any specialty will always be greeted by open positions in nearly any part of the country. So while I struggle with an inflexible schedule and low, low pay now compared to my friends, I like to think that in the end this will all pay off.

Cheaper Bills
One benefit of living in the hospital and having no personal or social life is that there is much less time to spend at home or in a social scene to spend money. As a result I have fewer food bills (since the hospital provides lunch), fewer electricity bills (spending one out of four nights away from home), and less time and money to spend in bars (well...).

Speaking of money, being a doctor gives you immediate and great credibility with financial institutions. I had to interact with several lately, each of which asked for my profession. Upon stating “physician” whatever algorithm their systems used boosted up my reliability. I just received a huge increase in credit limit and nice low interest rates. I realize one’s profession doesn’t make or break financial transactions, but it definitely appears to help. (The above is also true -- to a point -- if you substitute “financial institution” with “the ladies”. But not really.)

Tuesday, April 08, 2008

Sponsored Links

You might have noticed a new "Sponsored Links" section of this website's sidebar, which was in fact newly added. A friend informed me about Google's AdSense program, which allows website publishers to host targeted advertisements on their website. If enough people visit the site and/or click on the links, the website publishes gets a few sense. While I haven't had time to examine the details of how things are calculated, I will give it a shot for awhile.

If anyone has any overwhelming objections to this let me know, but for the time being I am curious to see how it works.

Tuesday, March 25, 2008

Buffing and Turfing

I can’t believe that I am fixing people. When I say that I don’t mean it in a I-am-so-honored-to-have-the-ability-to-heal-people way, but rather in a What-the-hell-am-I-doing-that-actually-makes-people-less-sick? sort of way.

Why? Because I feel I do nothing that directly helps people get through their times of acute illness. All I do during my day is order lab work, consult other services, and then follow up on those tests and consults. Then, seemingly miraculously, I get to discharge patients home because somehow their symptoms -- or, more importantly, their lab values -- have improved. I don’t know precisely when in the above process patients actually improve. They come to the hospital sick, I order countless tests, the patient and I both wait for the results, and then I discharge them home.

All this makes me wonder: is this medicine? If so, it is kind of shocking ... especially since I have already seen the inner workings of a hospital before, as a medical student. I cannot help but think of House of God, that classic novel of life inside a hospital during the internship of six new interns. Early on the main character describes this very sentiment, saying:
“This internship is nothing like what I thought it would be. What do we do for these patients anyway? They either die or we BUFF and TURF them to some other part of the [hospital]”
His resident then responds with “That’s modern medicine”.

(Turfing is slang for the act of transferring patients to another service, and buffing is the term for fixing up a patient enough so that they can’t return back to your service once you turf them).

Great. Again, maybe this really is modern medicine -- just doing whatever it takes to get patients off of your service. That book, by the way, was written in 1978.

I feel this is the point where the surgeons get to laugh and say, “I told you so”. They always mock internists for doing too much thinking (and rounding) and not enough doing. It is the heart of the rivalry between medicine and surgery, and it’s based in truth. We, as their medicine counterparts, don’t get to solve medical problems directly by fixing them with our hands, but achieve it indirectly via ordering drugs. The immediate satisfaction surgeons feel after a successful procedure is hard to achieve when a patient’s improvement comes as a result of administering a drug.

In any case, the future -- at least the next three years of it -- is looking a little more bleak and a little less satisfying now that I realize I’ll be doing this for 80 hours a week for the duration of my training. Perhaps it will change for the better once I become a resident. Or, perhaps, I’m destined to a life of buffing and turfing.

Tuesday, March 18, 2008


I recently turned 30.

It's hard to believe the next "big" age for me is 40, when really I feel 12 at heart.

Sunday, March 02, 2008

Squeezing Blood From a Turnip

I received a fancy-looking envelope from my medical school a few days ago. Without a clue as to what it would contain, there I opened it to find a letter. A very formal letter. One that proceeded to ask me to donate money to the school.

Are they kidding? It is less than one year after graduation -- graduation from medical school no less, which implies that I am making pennies as my salary -- and they have the nerve to ask for money! However, they did show their generosity by stating that I could spread out donations greater than $25000 across multiple payments.

They couldn't wait a few years before sending me letters to donate. They couldn't even wait one year. And now, because of this one cruel, unsympathetic letter, they shall never receive a dime from me.

Thursday, February 28, 2008

My Priorities

There's a sick patient in the emergency room right now. He will either be admitted to me or go straight to the ICU. His vitals look horrible,and he's guaranteed to die tonight.

And all I can think about is how I much I hope he goes to the ICU, so I won't have to deal with his paperwork once he dies.

Thursday, February 21, 2008

How To Be A Good Patient

Throughout medical school and residency, we are continuously taught how to be a good doctor. We are taught doctors should be professional, knowledgeable, well-read, and culturally competent (although I still don't know what this ridiculous concept means), all while nothing is expected from the patients.

That needs to change. Patients are as much of a part of their care as are doctors. This sounds obvious, yet you would not believe how uninterested, lazy, and ignorant many patients are. While doctors struggle to adhere to the intense scrutinies of professional requirements (and popular media) many patients do nothing but expect 5-star medical while they sit back and relax.

One thing in particular patients -- all patients -- need to do -- in fact, must do -- is to know their medications. Again, it sounds again obvious, but I am amazed by the number of patients that do not know the details of their medication list. Not just names, but exact dosages, frequencies, and dosing schedules.

It is not sufficient just to know the names of your medication -- although that would be a great start for some of my patients. It is not at all useful to us if you say "I take a little blue pill". Sorry you tool, we don't know what pills look like. We may prescribe pills, but we have no idea what color, shape, or size pills are. So enough of this "a little white pill", "that little square blue pill", or "a really big pill". Pharmacists don't even know that information.

"But doctor", you might say, "my memory isn't good". Or, "I take too many medications to memorize them all". Both are legitimate complaints, but you are not excused. If you cannot remember your med list for whatever reason, then write it down or type it out and -- this part is key -- carry it with you at all times. Yes, all times. You never know when you will have to go to the ER without warning, and have to report this list to your doctors. When your life -- or an improved version of it -- depends on medications, you better be damned sure you know everything about them.

There aren't many situations in this world that are the proverbial black or white; almost everything is grey in this world. Except this. So patients listen up, get involved in your own care, show some responsibility, and learn your meds!

Tuesday, February 05, 2008

You Are Crazy If ...

Every physician has their "oh no" patient. This is the patient with the medical condition that you just cannot bear to deal with, typically because you don’t fully understand their condition and don’t know how to effectively manage it. As an example, gastroenterologists would probably consider patients with irritable bowel syndrome (IBS) as their “oh no” patient. There probably is a legitimate origin causing the symptoms of IBS, but we just haven't discovered them yet. As such we cannot offer good treatment, thus making interactions with those patients difficult and unsatisfying.

As for me, my “oh no” patient is the crazy patient. Yes, the crazy patient. Who is this crazy patient? Here’s a non-exhaustive list of those who quickly get that label. If I know you satisfy one of these, I expect you will be nothing but trouble during your stay at the hospital. So, I’m gonna call you crazy if…
  • You have a pan-positive review of systems – in other words you answer “yes” to everything on the review of systems (our flurry of questions to see if there are any other symptoms you're having: chest pain, shortness of breath, constipation, weakness, etc.) This is a classic one. Those of you who answer yes to everything -- or even 3 items -- have nothing wrong with you ... except your heads.

  • You have an Actiq (Fentanyl lollipop) in your mouth as you walk in through the door, or as you're talking to me as I interview you.

  • You admit to having more than 3 allergies. Very few people are allergic to that many things. Trust me, this is a telltale sign!

  • You have fibromyalgia. Don’t even get me started. I am not denying that pain syndromes don’t exist; it’s just that people who like to have this label have lots of other, um, issues.

  • You ask specifically for IV dilaudid. If you are my patient and you ask for this, please, just get the hell off my service. Your words scream drug seeker. (And briefly, as long as we’re on the topic of drug seekers, it’s not just me … we all hate you.)

  • Finally, the “frequent flyer”. The patient that’s in and out of the hospital every other month, week, or day (yes, day). Words cannot begin to describe how much I loathe you people. Who in the world prefers the hospital to their own home?

Monday, February 04, 2008

Dumbest Page Ever

Capping off a miserable day filled with endless obstacles more pages than I have ever received in one afternoon, I get paged by a nurse saying how a patient was refusing his medications. This didn't bother me per se, but I was annoyed that she didn't specify which med. I returned her page and asked which med it was, only to hear that it was a pain med. A pain med. A PRN medication. She was paging me to tell me a patient was refusing his prn pain med!

I couldn't believe it ... I really couldn't. While I didn't get angry on the phone, I did try to convey my anger with a stern voice. Unfortunately, my logic was completely lost on her.

A prn med ... I still can't believe it.

Tuesday, January 22, 2008

Feces and Food

Our hospital is pretty big. It has almost 400 beds, spread over 12 floors, with 4 wings on each floor. And the hospital is nearly always crowded, with its over 100 housestaff and nearly 500 other employees. Like I said, pretty big.

And now, all of a sudden, the hospital seems incredibly small ... unusually and suffocatingly and uncomfortably small. Not smart.

Wednesday, January 09, 2008

Dumbass Patient

I am on call right now and was walking to my call room when I heard a loud banging on the doors on the opposite side of the hospital (this hospital has a big open-air inside, much like a hotel, making it easy to see from one side to the other).

So ... I walked over to see what all the banging was -- maybe not the smartest of idea to investigate weird noises in the middle of the night -- and saw that it was a patient, who had locked himself out, after he had walked outside, for a smoke, with his oxygen tank. OK, that's not the smartest of ideas.

Wednesday, December 26, 2007

Merry Christmas, Sicko

I was on call on Christmas day and night. Initially I expected it to be a calm night with an empty emergency room, however, I soon realized it was the complete opposite.

The ED was full of people seeking medical attention for what I considered trivial reasons: a sore throat, a wound check, or best of all, a medication refill. It was truly surprising. Were these issues that important that they couldn't wait another day? Did they really find it preferable to be in a sterile, crowded emergency room than at home with their family or friends enjoying a nice Christmas evening?

I do realize that half of these people were likely homeless and were thus looking for a warm place to spend the holiday, but that doesn't explain the other half. To them, I simply wanted to yell at them to go home and leave these minor issues for a later date ... thus giving them, and me, a less hectic Christmas.

Merry Christmas, welcome to the hospital tonight.

Thursday, December 20, 2007

Halfway There

I almost forgot: today marks precisely the halfway point of this retched year!
Only 26 more weeks of being at the bottom of the ladder. Only 26 more weeks of scutwork and paperwork. And most importantly, only 26 more weeks of pre-rounding.
Not that I'm counting or anything ....

Holiday Dinner, Hospital Style

I had a special holiday dinner here at the hospital tonight, and the food was actually pretty tasty. Even more amusing was having the CEO of the hospital in the cafeteria, serving us food. And to top it off, we all got gifts!
This is my second holiday dinner served by the hospital -- first Thanksgiving, now Christmas. I suppose I could be saddened how my workplace (and not mama) is serving my holiday dinners, but it's ok ... at least it was festive.

Friday, December 07, 2007

Paradigm Shift

One Week Ago
The Caribbean is not enough. This island isn't quite as good as I expected it to be. The beaches are too crowded, there aren't enough beaches, the sun is shining too hard, and I'm getting bored just sitting on the beach reading all day long. I feel I should be more productive with my life.

I am a complete idiot. I would give almost anything to be back on that beach (in fact, I would give almost anything to be anywhere but the hospital). I cannot believe I was unable to fully appreciate a Caribbean island -- any Caribbean island -- when it was filled only with beaches and sun and large an abundance of lazy days. I knew how miserable the hospital was, and I knew I would have to return to that hell within a few days, and I still couldn't fully appreciate it. Now look at me ... I've spent 40 of the last 48 hours in this hospital. Damn.