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.

Residency, By the Numbers

Years of residency	3
Months of residency	36
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

Nasty

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.

Nasty.

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".)

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.

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.

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.