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.

Birthday

I recently turned 30.

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

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.

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.

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!

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?

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.

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.

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.

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.

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.

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.

Today
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.

Doctor Doctor!

Here on vacation, thoughts flow much more freely over drinks. My surgical intern friend and I spent half an hour describing the annoying text pages we get in the middle of the night, all regarding very important -- rather: "important" -- topics. (Note: this is not meant to ridicule or take a swipe at nurses. It is how we amuse ourselves to get through the misery of this year.)

• Doctor doctor, please change Colace order from tid to bid. (really, this needs to be done at 4am?!)

• Doctor doctor, FYI: pt's blood sugar is 78, pt asymptomatic. (don't ever again page me to tell me pt is asymptomatic)

• Doctor doctor, pt's systolic blood pressure is 85, shall I give metoprolol? (no, which is why I wrote parameters to hold if SBP<90)

• Doctor doctor, pt is nauseous, please write for Zofran. (who are you? what pt is this for? how about a callback number?)

• Doctor doctor, pt doesn't feel well. please advise! (yup, we've gotten these!)
  

 Luckily, laughing helps wash away the tears.

Hello from the Caribbean

Greetings from the Dutch Caribbean! Believe it or not, I had no clue this island (or most of the others here) was Dutch-owned until I arrived here. Believe it or not again, I also had no clue where this island was (just off the coast of Venezuela). Pretty exotic locale for a simple little intern like me ...

 

Sitting on the beach with a tropical drink in hand is MUCH preferable to being in the hospital. I don't ever want to step foot in there again, and I am already dreading my return. My friend -- a surgical intern -- feels exactly the same way and more.

 

Only a few more days until paradise ends ... time to take advantage of it!

Happy Thanksgiving

There is absolutely no doubt in my mind what I am thankful for this Thanksgiving: not having to step foot into the hospital for two weeks. Yes, two weeks! Today marks the beginning of my two-week vacation, and I have no intention of getting near that damn hospital. I plan to take full advantage of this vacation, starting with turning off my pager followed immediately by a one-week trip to the Caribbean.

Driving home from the hospital this morning was also great, as the freeways were completely empty. It was the perfect opportunity to test out my new car's handling ... as well as its 0-100mph time.

OK, Happy Thanksgiving everyone!

My Pager

If it goes off one more time within the next five minutes, I swear I'm
gonna throw it against the wall. I can't put my head down for a few
minutes without this annoying ass little box beeping loudly and
startling me.

Ideally, I'd put my pager AND the patients in a box ... and send them all away.

Random Thoughts 2

• I am in the CCU these days (cardiac care unit, i.e. ICU for heart patients) and am consistently working 15+ hour days most days of the week. It’s amazing how quickly this sort of schedule can eliminate most of your free time and kill any semblance of a social life.


• Being in the CCU, I am part of the code blue team and thus have to carry an additional pager … bringing my waistline to a total of two pagers (which also tends to pull my scrubs down). For the first few minutes, wearing both pagers made me feel cool. Then I felt like an ultra-dork. And now all I feel is double the anxiety and terror since I am attached to two leashes that can easily and quickly ruin my night.


• I hate nurses who useless send "FYI" pages. I often get text pages that say “FYI: pt X has blood sugar 85 and is asymptomatic”. If he’s asymptomatic, why page me?! I swear, if I get another one of these pages, I’m paging them back next time I’m in the bathroom saying “FYI: I'm taking a crap. But asymptomatic.”


• I bought a new car! New new, not new used. As much as I loved my old car, this new one makes the grieving process much easier.


• It is Saturday night, and I am home alone. Granted I'm on call tomorrow and need to get sleep tonight, but still ... could I be a bigger loser?

Life Sucks

It's 3:35am and I'm admitting my third rule out MI patient tonight. This morning. Whatever.

 

This is why, when med students ask me what field to go into, I say "business".

Clinic Inefficiency

Another clinic day, another day of incompetence. We residents each have one afternoon a week devoted to our own continuity clinic -- in other words, our own primary care clinic where we have our own panel of patients. They are my patients, and I am their doctor.

More precisely, I am their slow doctor. Starting my very first clinic day, I quickly realized that I am very inefficient. We are typically assigned three to four patients an afternoon, and since these patients are all new for us we are allotted one hour per patient -- as opposed to the 30 minutes we get once they are return patients. Despite all this time we get, I still am extremely pressed for time trying to see the patients, presenting them to our attending, returning to finish up with the patient, and then typing up my note ... or at least the first half of it.

No matter how much I struggle to quicken our encounter, I cannot finish in time. Their endless complaining and my endless attempts to “briefly” touch on each of their complaints makes the clock jump forward faster than I believe. I try to rush things, but I still finish at least 15 minutes late each time. Add to this the fact that many patients arrive late, and you can easily see why I leave clinic around 7pm, even though my last patient is scheduled for 4pm.

This situation is both discouraging because I feel so incompetent, and also irritating because I try hard to be efficient ... only to end up failing.

So, all you practicing doctors, I reach out to you ... how do you do it? How are you able to handle your schedules with so many patients, and on a daily basis too? How do you deal with so many patients? the patients with 10+ problems? the patients who don’t stop talking? How do you see them in the 15-30 minutes of a typical clinic office visit? I can barely keep up with my schedule of 3-4 patients, despite the fact that I’m given over twice as much time as most practicing clinicians.

More importantly, how do you not get tired seeing patient after patient, all immediately after one another? Does it get easier? I really hope so, because at this rate I definitely will not be able to see enough patients to remain financially solvent in the future ... student loans aren’t paid back at four patients a day, you know.

Continuing to Sicken Our Veterans

For those who are not familiar, the VA (or Veterans Administration) hospital is the government-provided healthcare system for US military veterans. Considering it is a governmental organization, it actually provides great healthcare. Residents in my program rotate frequently through the local VA.

Anyway, today I saw a sign in the VA cafeteria that said “Continuing to Serve Our Veterans” next to a photo of a discounted meal combination consisting of a greasy hamburger, fries, and soda.

Continuing to serve veterans? Ha! First the government fucked up our veterans’ lungs by packing cigarettes into their lunches, and now they’re continuing to ruin their cardiovascular system by only serving nasty, greasy hamburgers and fries in the cafeteria.

I love it. Thankfully the veterans don’t have to pay for their bypass surgeries.

Eating My Words

You should never challenge the higher powers ...

Remember how I said in my previous post that "there are very few ways" to have this golden weekend of mine ruined? Well "very few" is a bigger amount than I thought.

I walked out of the hospital -- post-call, again -- into the parking lot, only to find my car gone. As in, not in the spot I had parked it in the day before. Not in that spot or any spot for that matter. It is a weird feeling walking into a parking lot expecting your car to be in a very specific spot (since I park in the exact same spot every day), and another car is in its place.

I walked around, stunned, for about 15 minutes, before I realized it had probably been stolen. This was the last thing I needed on a post-call day. Come to think of it, this was the last thing I needed ever.

Anatomy of a Lousy Labor Day Call

Nothing like a black weekend to ruin a holiday weekend. Read on:

Saturday, 7am.
I arrived at the hospital. The radio started playing a song I really like so when I got out of my car in the parking lot, I kept the keys in the ignition to keep listening to the song as I got my belongings together. But then I slammed the door shut ... with the keys still in the ignition. After ten minutes of prying at every car door and worrying about how this could ruin my morning, I remembered I had a spare key in my wallet. Potential bombshell averted.

Saturday, 7am – Sunday, 3pm.
I endured a grueling night of overnight call. On top of getting slammed with patient admissions – apparently Labor Day weekend drives people to the emergency room in hordes – I had to cross-cover 21 other medicine patients. Nothing more enjoyable than being kept awake all night by a patient going into respiratory failure with no urine output, especially when the sign-out reported "Nothing to do". While that patient didn't die, my cell phone did.

Sunday, 3pm.
Done with my night of call! I walked to my car, turned the key, and heard nothing. No engine sounds, no nothing. In that effort to rescue my locked-in keys the previous morning, I had forgotten to turn off my headlights. With a dead cell phone and no other car in sight to help me, I trudged back to the hospital in order to call AAA.

Sunday, 3pm – 5pm.
I waited alongside my car, with nothing to eat or read, wearing goofy green scrubs, for two hours. Just as I was about to return to the hospital to call AAA again -- what a day to have my cell phone battery drained -- they showed up. One new battery and $120 later, I was on my way back home.

Talk about a comedy of misfortunes ... at least I have this upcoming golden weekend to look forward to. There are very few ways to have those ruined.

Unhappiness

It's ten weeks into internship, and I feel surprisingly down, bored, and unmotivated. I can barely get through my long days, which consist of pre-rounding on a bunch of patients whose exams and complaints don’t change from one day to the next, ordering a handful of tests on the computer, rounding for at least an hour, trying to track down all those test results, and then dealing with the pleasure of figuring out my patients’ social situations and dispositions since half of them have nowhere to return to upon discharge – except the street, of course. My day is capped off by going home and having no energy to do anything -- read, socialize, or enjoy previous hobbies -- but sleep.

I am depressed that I don’t get to do anything hands-on for any of these patients to help them get well (unlike the surgeons and emergency room doctors who do lots of procedures), and I am completely uninterested in dealing with all the patients’ medical problems (as opposed to just the one acute issue bringing them to the hospital).

I hate spending hours on rounds. I want more doing and less discussing. I don’t care anymore about patients’ social issues. I actually don’t care much for patients anymore either. I don’t want to be shat on by other services. And most of all, I can’t stand to be around the few of my co-interns who are “having a blast” this year.

Although I hope not, I wonder if this entire "journey" is a mistake. Hopefully this is simply the plight of the intern, and not me having chosen the wrong specialty (internal medicine) ... or, the wrong field entirely (medicine).

I Should Have Gone Into Surgery

Title says it all. But in case you want additional details, here are a few:

They focus on just one problem
While medicine doctors focus on the acute problem during patient hospitalizations and clinic visits, they also have to address ALL other problems (hypertension, diabetes, lower back pain, anemia, etc.) Surgeons, on the other hand, address only their body part of expertise and that’s it. No more optimizing a cardiac patient's complex problems ... and then having to deal with their random bowel incontinence they get once a year.

Their history and physical are focused.
This is the best part. Based on your specialty, you can focus your questions and exam to just that one organ system. Examining the body head to toe gets to be quite tedious and rarely do you uncover a hidden physical finding that changes your management plan. I would love to just examine the abdomen and then be done.

If not altogether unnecessary.
Given how dependent the medical field has become on imaging these days, who cares what the patient complains about. You don’t care as much about chest pain when the echo shows aortic stenosis, and you definitely don’t care if a patient can’t move their arm when an x-ray shows a huge spiral fracture.

They know how long their patients will be hospitalized.
OK, THIS is the best part. Surgical patients fall into one of three categories: pre-op, intra-op, or post-op, and each period usually lasts several days. This is great for morale -- the physician’s morale, that is -- and patient turnover. No more rocks on your service!

They wear scrubs everyday.
I am not as passionate about this reason, but if I could bring my dressing time in the mornings from 15 minutes down to 1, that would be great. Although, I do look pretty good in shirt and tie ... .

Their notes are brief.
No, THIS is the best part, and it's a by-product of the “they focus on just one problem” reason. I would love not to be bogged down by writing notes, which often takes close to an hour with a full load of patients. Surgeon notes are often overly terse, but they convey their message well; on the other hand, medicine notes document every piece of information ever tied to the patient, whether they’re lab values, antibiotic histories, or elementary school grades.

I know some of this might be overly simplified, but it does capture the essence of how I presently see things.

No Longer a Medical Student

While I know that I'm now an intern, I often forget it. In other words I sometimes forget I am no longer a medical student. I am no longer just a tag-along member of the team that needs to feign non-stop enthusiasm and over-eagerness. I am now the intern, and so I'm one of the "real" team members. I can now behave how I want instead of the way that I think will earn me good evaluations.

As a med student, I would only speak when spoken to, cling to the team like glue during rounds, and make sure not to do anything that wasn't directly related to patient care. Now, I speak whenever I want, I walk away from the team at any time during rounds, and say I receive a text message during rounds ... that's right, I whip out my phone right there and reply back.

I realize I probably sound unprofessional -- and perhaps even assholic -- but whatever, I have earned my new position, I am working hard, and so I enjoy taking these little liberties. It's all I have to get me through the day.

First Night of Call as Intern

What did I get myself into? It is 6pm and I just got home from my first night of overnight call at the hospital. Yesterday was the first day of this rotation -- inpatient wards, which will be the bulk of my internal medicine training -- which means I was on call my first day. I guess I spoke too soon earlier when I said they hit you fast and they hit you hard.

Starting off the horrible day/night continuum was the fact that I took over the five patients the previous intern had. Taking on patients that you do not know is always difficult, especially medicine patients who have many problems to manage. Then throughout the night I picked up four new patients, each of whom takes awhile to admit because of admission H&P’s (history and physical exams) and admission orders. On top of this was the difficult task of cross-covering every other teams’ patients, which means getting paged randomly throughout the night by nurses about patient X’s tachycardia or patient Y’s diarrhea or patient Z’s itchiness. Itchiness? Come on, just scratch it yourself! When your team is being slammed with patients, prescribing Immodium is hard to take seriously.

On top of all that, add the grueling struggle of trying to keep my eyes open since it had been months since I was last on call -- last November, precisely, in medical school.

And then, post-call, dead tired, and zombie-like, I had to churn out notes for all my patients, none of whom I knew too well. It took me quite late into the day ... so much for the ACMGE mandated 30-hour limitation.

Again, what did I get myself into?

Patient Surprises

Patients never seem to amaze or shock me. Every time I think I have seen and heard it all -- and I admit I have few clinical experiences to draw upon compared to others -- a patient will come and stun me with his response.

Recently, I was in clinic interviewing a very drunk man who presented with a benign complaint. He reported that he had been experiencing this complaint for several months, so I naturally asked him why he waited so long to present. In very slurred speech he replied that he couldn't return to the state ... because of the federal warrant against him!

I have had many jail patients in the past, but at least they were in restraints because of their crimes. This patient, though, was apparently still on the loose for his deeds ... and I don't know much about the law, but I feel a federal warrant seems fairly serious.

So immediately I distanced myself a few inches from him and made sure to keep a clear path between me and the door. I tried to probe a little and get some details on his warrant, but he really couldn't stay awake long enough. Plus, I quickly deemed he was not much of a threat after all, given that he kept nearly falling off the exam table.

But still, despite the amusement afterwards, it was for a moment one of my more frightening patient encounters.

Dr. DRE

I think my index finger spent more time inside rectums today than it did outside of them. Not really, but I sure performed a lot of digital rectal exams (DRE) ... in fact, I did more today than I did during my entire medical school career. In fact again, I was such an eager intern that I even gave one of my patients not one, but two rectals. Aren't you proud of me?

Cross Cover

Shit, they hit you hard and they hit you fast.

It's yesterday. I got back from clinic around 6pm. Although I was pretty tired, I had just enough energy and time to go on a short run. I returned moderately refreshed from the run and prepared a nice dinner for myself ... fresh fish, fresh vegetables, the works. I was eating this dinner and watching a favorite DVD when my pager went off.

The page was from one of our chief residents requesting that I "help out" at the hospital for the night. I was still hoping for the best, but unfortunately upon calling her back I found out a fellow intern had an unexpected emergency. So "helping out" meant "taking overnight call in the hospital for the night."

Oh no you didn't.

Panic set in, as I my mind raced to figure out what to do, both at home (getting rid of my dinner, changing into scrubs, and trying to remember to turn off the stove [which I have a tendency to leave on]) and at the hospital ... after all, it had been 3 months since I'd dealt with patients and 7 months since I had done any inpatient hospital work. I was in no shape to admit new patients at 3am.

The night was demanding but luckily not at all as stressful and intense as it could have been. I managed about two hours of sleep, and since the team had capped (admitted the maximum number of patients) by the time I arrived, there were no new admissions for me. Thankfully.

This was, however, a rude awakening for my system, and quickly made it concrete in my mind that I was an intern. I suppose I should expect much more of this ... just please, not in the middle of dinner.

Internship Day One

The first day of internship was today. Actually internship began yesterday (Sunday), but I am starting with an outpatient rotation and thus began work today. My hours are set, and I work everyday from 8am to 7pm, mostly in an urgent care clinic. That itself makes my day tiring (there's never a shortage of urgent care patients), on top of the fact that I am now working 11 hour days ... up from zero for the past 5 months!

To top it off, I am also this month's "backup" intern, meaning I have to be available at all times via pager in case another intern gets sick or cannot show up work for any reason. They definitely waste no time making me a slave to my pager.

I am tired so I now have to turn in for the night. More updates to follow ... but I have survived. One day down, 1094 to go.

Medicine Orientation and Overload

Taking a sip from a fire hydrant -- that's what this week has been like. The orientation for our department was today, and we were bombarded with even more information, and this time it affects us in a very real way (as opposed to the fluffy rules and regulations presented in the hospital orientation, such as effective teamwork, etc.).

We were each handed a heavy packet of items, and quickly the realities of internship started to face us. First, of course, was the pager. Everyone immediately began playing with it, causing a roomful of pagers to start beeping. We haven't even started internship and I already hate that little black box, though I know it gets even worse.

Next was our schedule, which is something we have all been waiting for desperately. Right away the next 12 months of our lives were determined, as were our call nights and holidays (or lack thereof). And I am happy to tell you that I will be on call both Thanksgiving Day and Christmas Day.

Finally, the most awakening part of the packet was a prescription pad. Yes, a prescription pad. I'm barely out of medical school, and I'm being given a prescription pad. My impulse reaction was to think "no, those are for doctors", and then I realized that technically I too am now a doctor.

So with that one packet our futures were rudely whipped into shape. It was definitely an informative, if not overwhelming, day. And it will definitely be a busy, if not painful, year.

Hospital Orientation

Orientation began yesterday, and it is extremely boring. Mind-numblingly boring. As if 3 hours of welcome from the hospital chiefs wasn't enough, we had to sit through 9 -- yes, nine! -- hours of computer training. Overwhelming doesn't even begin to explain it, as every two hours a new topic or computer system would be covered. By the end of the night, we had learned about four different systems and I remembered zero.

The day was even more challenging as I could barely keep my eyes open, since for some reason I was unable to fall asleep the night before. I had no reason to be nervous, I kept telling myself as I tossed and turned in bed until 3:30am! Not helpful considering I had to wake up at 5:30am. Luckily I slept well the next night.

This week was also the first time the incoming interns were able to meet each other. While the lecture hall format of the day made it difficult to spend significant time with anyone, we mingled some and no one jumped out as being overly annoying or weird. I'm hopeful they will be cool, as this is a group that will be working very closely together the next few years.

Time to give my eyes a rest now ... 9 hours in front of a screen is no small feat.

Waiting Anxiously for Internship

Life is pretty easy these days as I wait for the start of internship, although the more accurate word might be lazy. My days are filled with watching TV and my DVDs. A large portion of time is also devoted to browsing the web, but I get so bored at times that even the almighty internet cannot entertain me (it is these days that I feel I've visited every site on the internet.) In addition, the dog probably isn't used to me being home this much and so she is slightly confused; I spend a good portion of my day pleading with her not to stare at me.

But as the big day looms closer, I am also starting to get a little anxious. If given the choice I would definitely say I'm excited to start internship -- as opposed to the many people who are dreading it -- but I would also like to delay it almost as long as possible. All of a sudden I am realizing what is expected of me in terms of the responsibilities of patient care.

I keep thinking back to my many interns during medical school and wonder if I can handle those sorts of duties and expectations. I had no problem uncovering problems and communicating them to the intern, but attempting to solve those problems was an entirely different matter ... who knows if I'll even know where to begin. My only comforting thought is that thousands of people have gone through this in the past, and so I too should be able to cope.

And maybe that is why I am engrossed daily in such brainless, non-medical activities ... in addition to passing the time, perhaps I am trying to distract myself from various frightening realities about internship. With that said, time to get back to Boomshine. Watch out, it's pretty addictive!

Paperwork

They certainly don't waste any time piling on the paperwork onto new doctors.

Just a few days after my graduation I received in the mail a large envelope from the hospital where I will be doing residency, filled with a thick stack of papers that dealt with anything and everything related to my upcoming employment with them. Moreover, most of them were important forms that I feel I should be an "adult" to deal with ... this includes forms such as W-2, W-4, I-9, and many other boring federal and state government papers. They weren't just for show, either -- I had to read and sign each of them!

Most amusing was one of the forms I had to sign where I swore to "support and defend the Constitution of the United States [...] against all enemies, foreign and domestic." I suppose this is because technically I will be employed by the state university system -- aka, the government.

Luckily there also were a few forms that dealt with more fun and exciting issues, as there were some papers detailing my salary (money, finally!) and vacation request forms (4 weeks per year!). I also got to specify how I want my name to appear on my business cards.

Time to get crackin' with these worksheets.

Graduation

Say hello to Dr. Axis Deviation!

That's right ... I am now done with medical school. The feeling has not quite set in yet, and it probably won't for some time -- I am guessing it will be around the time internship begins -- but it fun to think of myself as a "doctor". Fun and weird, especially since I still consider myself the same goofy kid as before.

With graduation this past weekend, I have also now advanced past the ranks of medical student to doctor. "Doctor". In the morning I was a lowly student, and then all of a sudden I became a doctor, one of the most prestigious professions in the world. Quite a big jump in social status for one day. Let's see if I can handle it!

Back From Traveling

Yes, it's true. My two months of international travel, sadly, is over. I got a great glimpse of South America (hot beaches and arctic weather) and central Europe (lots of beer and great food), and I hope to return to both places in the future. And unfortunately, no more extensive vacations ... well, ever, probably.

I now have to transition quickly from travel mode to graduation mode, as the next few days will be a whirlwind of graduation related activities, from a pre-graduation banquest and award ceremony to graduation rehearsals and finally the ceremony itself.

Stay tuned for some possibly interesting entries about graduation.

Hello from Central Europe

(I'd translate "hello" to the local language, but it's way too difficult!)

The travelling continues. I am now -- and have been for the past two weeks -- in Central Europe (Middle Europe? Eastern Europe?) visiting several countries. All these countries are post-Communt, so it is interesting to see how they are trying to reshape their image to more, Western ways. Luckily one is famous for its beer and one for its wine, so already they're fine in my book.

I will soon be returning back home to the states, only to deal with med school graduation and all that is necessary for my relocation for residency. Till then, ahoj!

So What Do You Do?

I have just returned from nearly three weeks of travel, touring several countries in South America. It was a great trip and I regret not being able to travel longer.

While I still have no medical anecdotes to report, some interesting moments did occur during my trip as a result of me being in medical school. Because I am essentially done with medical school -- graduation is next month, but my classes/clerkships ended last month -- when people asked me what I did, I simply told people I was a doctor. My responses weren't far from the truth at all ... I said I had just finished with medical school and I would be starting internship very soon.

(Interestingly, Americans were intrigued by newly-minted doctors, while foreigners were not.)

Inevitably they would start asking follow-up questions such as what specialty I had chosen, why I went into medicine, and other related topics. These conversations were amusing and enjoyable at first, however, I quickly grew tired of them. After the first few of these conversations I knew exactly what question(s) people would ask next, and all my answers were canned.

I therefore came up with an alternative response to the question "What do you do?" I just told people I was in "healthcare". That usually elicited a response similar to "Oh that's a good field" ... and then the conversation usually ended.

It was great. With this wise choice of words, I evaded that repetitive conversation. It worked great the rest of the trip ... although one woman pried a little by asking "What do you do in healthcare?" to which I responded "I work in a hospital."

It is funny how certain things in medicine are so exciting initially, but whose novelty wears off quickly. Other examples include wearing my white coat (I was so excited the first time I wore it but now I can't stand wearing that short white coat) and having a pager (my first page was exciting, while every single one thereafter was annoying). I can only assume more of these situations will arise in the future, and so I should just accept them now.

Hello from Argentina

Hola again!

 

I am writing you all from near the bottom of the earth. While I entered Argentina through Buenos Aires -- which is a great and lively city -- we then flew further down south, to the Patagonia region of this country ... which, if you refer to a map, approaches the bottom of the globe. I am probably upside down compared to most of you (at least those in the US)!

 

Patagonia offers LOTS of amazing scenery and some of the planet´s greatest outdoor sites. Mountains, glaciers, towers of granite, fjords, it has it all. It is also quite cold here, which is unfortunate since I wasn´t expecting to take this excursion and thus only packed beach clothing. Not wise, but a little 0.4 degree Celsius never killed anyone, right? (OK, it probably does.)

 

Until next time, chau!

 

Greetings from South America

Buenos dias!

 

I am writing from the nice beaches of Uruguay. This particular city is where many people in South America -- as well as some Americans -- flock to when it gets hot. It is actually fall here (we are in the southern hemisphere) so the masses of people are no longer here, but with Easter weekend approaching there should be a ton of people visiting for the next few days.

 

Uruguay is an impressively modern country, with great internet connections, fancy stores, and drinkable water. If it weren´t so far from America, I might consider buying a second home here ... and with prices starting in the $80s for a small apartment, you gotta consider it!

 

Anyway, we´ll be here for a few more days and then move on to another country. Till then, adios!

 

P.S. I wish I had taken Spanish in high school. French, unfortunately, is a totally useless language for journeys such as this (as well as practicing medicine in California!)

No More Medical School

My rotations finished two weeks ago, meaning I am done with medical school. Since graduation is still months away (end of May) that also means I have nothing to do until then. Unfortunately, this weblog will probably suffer temporarily as I have nothing medically-related to report. Fortunately for me, though, this means I have almost three months to play around.

Which reminds me ... I should start packing soon for my trip to South America tomorrow.

Post-Match Day Thoughts

Now that Match Day is well in the past, I thought I would share some thoughts regarding that entire experience.

When I think about it, that was truly the worst experience I have ever experienced -- at least the worse experience I have participated in voluntarily. Not the overall residency application process, but just Match Day itself.

There is something unusually stressful about this day ... whether it is knowing about Match Day from the very day you enter medical school, or realizing that Match Day is a more significant event than graduation, or just realizing that the envelope you are holding in your hand, once opened, will declare where you will be forced to stay for the next several years of your life (for better or worse) ... whatever the reason, it is enough to turn the sane insane.

What the contents of the envelope reveal is an entirely different story. It is difficult enough waiting for Match Day to arrive, but finding out where on your rank list you were assigned is potentially much more difficult. Unfortunately I tend to set my heart things, and when they don't happen I get demoralized. The same thing occured here -- I was set on my #1 choice and had been planning my short-term future around it; and so when I opened the envelope and saw I was off to #2, I was devastated. It made that day pretty tough when responding to all the people who asked me "Are you happy?"

Anyway, there is a first time for everything ... and luckily this will be its last time too.

Today

So, 15,252,514 minutes ago ...

or, 10,592 days ago ...

or, 1508 weeks ago ...

or, 29 years ago ...

I guess I was born.

Damn.

This is the last year of my 20s. Next year I will be 30, and next thing I know I'll have osteoporosis and be going to sleep at 5pm.

Match Day

Matched to my #2 ... not bad, not bad.

Still in southern California (new city, however).

More to come, most likely.

Seattle Grace Hospital

So I found myself in Seattle Grace Hospital today. For those who aren't in the know, this hospital is the setting of my favorite TV show Grey's Anatomy.

I was invited to give a talk at a VA hospital in the valley ("the valley" is an area about 30 minutes north of LA), and when I arrived I immediately noticed a motorized golf cart labeled with "Grey's Anatomy" driving around the lot. Once I was inside the hospital, there was one section of the top floor filled with camera crews, lighting, screens, and other filming gear. After looking around a bit, I saw that well-known breezeway seen in almost every episode, the concrete pathway leading up to the hospital, and a lot of SGH signs on windows and floormats! I love getting behind-the-scenes and seeing film sets, so I was pretty excited.

(Hm, considering how much I hate this show, I sure talk about it a lot.)

Unmatch Day

Today is a moderately important day. It is known as "Unmatch Day", the day when all applicants find out if -- but not where -- they have matched to a residency program. It is particularly important for people applying to competitive residencies since there is a good chance they might go unmatched.

For someone like me, however, who is applying to internal medicine, which isn't as competitive (except at top-ranked institutions), it isn't as much of a big deal. Having said that, I was up all night tossing and turning, having nightmares about the worst-case scenario of not matching and getting the dreaded email in the morning.

Lucky for me I received this lonely little one-liner in my inbox this morning:

Congratulations! You have matched.

It was a nice relief. It is also kind of strange when I think about it actually, because this email essentially indicates a job offer. It confirms that I have a job awaiting me in July ... salary and all, as a doctor, no less! That's a little frightening and intimidating.

Now all I have to do it last until Thursday ... which is easier said than done.

Less than One Week Until Match Day

The big day is quickly approaching. It wasn't until last Thursday -- exactly one week before Match Day -- that I began getting anxious just thinking about the match. I am fine as long as I don't think about it (which is most of the day), however if I think about it my mind quickly works itself up into a state of mild anxiety and stress ... not very pleasant.

I just want Match Day to come and go without having to actually go through it ... in other words, I want to know where I match without having to experience the actual moment where I open the envelope and face what's written inside.

Grand Rounds 3:24 is Up

I don't like tooting my own horn (or, for that matter, using that phrase), but that latest Grand Rounds is up at GruntDoc. I mention this because one of my posts is included ... so go check it out!

Scrubs vs. Grey's Anatomy

Abortion. Euthanasia. Stem cells.

These are famous examples of some of medicine's oldest and greatest debates. There is no shortage of passionate people on each side arguing their position, and unfortunately there will likely never be a solution that satisfies both sides.

The times are changing, however, and a new debate is emerging, one that involves medical TV shows. Yes I'm speaking of Scrubs and Grey's Anatomy, both of which have huge and loyal followings. Is it Scrubs, the quirky single-camera show about the life of three residents and a nurse, or is it Grey's Anatomy, the new medical drama about a group of surgical interns?

Never fear, Axis is here to help settle this debate. I will attempt to evaluate this dilemma by using several objective criteria to answer modern medicine's ultimate question once and for all.

Medical Accuracy
Let's start with the easy one. The medicine that takes place on Scrubs is nearly dead-on. Internists diagnose and surgeons operate. Classic stereotypes are explained (e.g. surgeons as knife-wielding morons, ob/gyn's as sorority girls, etc.), inside secrets about medicine are revealed, and the emotional aspects of medicine are well conveyed . On the other hand, in Grey's Anatomy surgeons deliver babies and neurosurgeons do abdominal procedures. Most interestingly, the interns have hours of free time on their hands. Point goes to: Scrubs

The Girls
Elliot and Carla on Scrubs are both fairly attractive and well-fed. On Grey's, while Katherine Heigl is hot (albeit whiny), Ellen Pompeo is so skinny she looks like an ashen grey skeleton ... and Sandra Oh looks like a catcher's mitt with eyes. Point: Scrubs

Attendings
You can't beat Dr. Cox: who else can turn a word with two syllables into six? Who can come up with a new girls name every 10 minutes? In fairness, Dr. McDreamy is unusually popular, both on- and off-screen. Point: tie

Chiefs of Service
This is a tough one. On Scrubs, Dr. Kelso is a scowling money-driven Chief of Medicine who makes everyone's life miserable (especially for Ted, that poor attorney). On Grey's, the chief is Dr. Webber, a big guy who simply plays a generic "stern black man". Point: tie

Humor
Scrubs is overflowing with quirky humor (my personal favorite) while Grey's has none (quirky or otherwise). Point: Scrubs

Drama
But what Grey's lacks in humor, it more than makes up in drama. Grey's Anatomy is not so much a medical TV show but rather a soap opera that happens to take place in a hospital. Medicine is occasionally practiced, but only if an intern can hook up with an attending in the process. The winner here is clear-cut. Point: Grey's Anatomy.

Timeline
Characters in Scrubs progress nicely each year, from intern to junior resident to senior resident, etc. In Grey's, the characters apparently are so dumb that they are still interns after three years. Point: Scrubs

And the winner is: Scrubs.

There you have it peoples, objective proof that you may safely avoid watching TV on Wednesday nights. Anyway, it's time to watch Scrubs ... seeing how it's the better show.