Moving the Rock and getting Out of the Hardplace

So I have to admit to something: I've been inordinately spoiled in my working life. I have had a variety of jobs that I loved going to and never felt like I had to drag myself out of bed to get to them. My Medicine rotation has been a bit of a rude awakening for me because of this. Oh, I still really enjoy taking care of patients and I've meet a character or two that have always managed to put a smile on my face at 6:30 in the morning. But I find the various rounds, sometimes up to four times a day, somewhat inefficient and impersonal to the patient we interrupt.

Added to that is just a general feeling of frustration. A lot of the problems which bring people to the hospital are problems they leave with. Yes, their acute issues are dealt with and for the most part they're stabilized back to baseline. But so often what we can do for them is only a small bandage over a hemorrhaging wound. Admittedly, today was a bad day. We essentially told a patient who came into the hospital, functional and relatively healthy, that they were probably going to die during this admission. Beyond supportive care, there isn't anything that can be done. I can only halfheartedly imagine what is going on in their mind. My own reaction to this has been more visceral than it should be: I like this person, I care about this person, and this just freaking sucks! A part of me longs for the caring but separated reaction of my residents and attendings, but I'm not sure if I'm ready yet for that kind of emotional detachment. I know that it has to come in order to develop the necessary professional objectivity, but getting to that point means that I have truly lost touch with the individual I was three years ago. And sadly, I liked that person quite a bit better.

Ultimately, I really admire people who can go into internal medicine, but I wonder how they can stand it sometimes. You loose the majority of your battles. People you've known for years die on you slowly and piece by piece till there is either nothing left of their body or their humanity. Obviously, this experience has been very disheartening for me. And yes, I realize that this is the reality even in surgery. But there you seem to win enough cases to give you some sense that hope isn't just a pretty word.

Ah well, tomorrow is another day and to paraphrase: If I can get one warm blanket I shall not live in vain.

If you can't say something nice....

I've been on my Internal Medicine rotation and I've come to several very important conclusions. One, I am definately going into surgery as a career. Which is a marvelous decision to have firmly settled. Two, I am running out of black inked pens. Which wouldn't be so bad if I hadn't already purchased a pack of 20 black pens. Are my residents 'borrowing' them? Nope, the truth is by far worse: I'm actually using the black ink up. Some how I made it through third year of medical school prior to this without writing an HPI that took up more than 2 pages. These days, that's a daily SOAP note. So sorry for essentially two month hiatus, but mum's been the word of late. On the positive note, I've gotten to see a side of the field of medicine which will make me highly admire the detailed driven folks who go into it~ I just really really don't want to be one of them.

Greatness

“It is not the strength, but the duration of great sentiments that makes great men”
Beyond Good and Evil, Nietzsche
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I think I’m continuing my trend for the oddest experience on general surgery that a third year ever had….Both my senior resident, Neo, and I are reading Beyond Good and Evil at this moment. Nope, we’re not involved in any odd duck book club. Its just serendipity at work, I suppose. We sort of got into a random discussion, of the above aphorism, while we were on call together today (yes they finally let me out of the Norovirus quarantine box of hell that I’d been living in).

I am a bit of cynic when it comes to the general goodness of mankind. I think that we all aspire to greatness, not for any benefit to society or others, but for our own selfish gain. I think that we start out saying grand things but as soon as we find an easier way to personal glory and fame we dump the grandiose society helping methods faster than a funnel cake goes down at my family reunions. In other words, I agree with Nietzsche.

Neo on the other hand believes that the existence of great sentiments makes all men great. In his opinion, ideals, though not always uplifted by everyone, exists to make everyone greater. The duration of an individual’s adherence to an ideal is less important to that person’s greatness than the actual purity of the ideal in question. In fact, that we are all great men and women because the ideals that we only transiently adhere to are so impressive.

Four hours later we took care of two teenagers that had beaten the snot out of each other to the point that they both required surgery. Following that up was a drunk driver and even drunker passenger who needed a few sutures and their child who had their spleen removed and a touch and go course over the evening. Some men and women are great. The rest of us just squeak by.

Norovirus=Devil's Plaything

I hate being sick. There is just something utterly vile about feeling as weak as a three month old. Not to mention the complete dissatisfaction that comes with missing out on the world around you as you lie ill in bed. Oh, and having projectile (sorry I hate this word too for all those in medical land~ but it fits!) liquid out of both ends of my digestive tract really hasn’t improved my disposition. Yeah, I could use this to reconnect with my touchy feely patient care principles that have slowly eroded over the course of third year (no my bed side manner doesn’t suck. I just no longer ask silly questions like “do you wear a bike helmet. If not, how does that make you feel?”).

The worst of it is that I’ve been feeling much better after the past couple days and am actually doing pretty good. Unfortunately, when I went in this morning for rounds every single person who took one look at me said ‘man you still look bad. Go home’. Which is not exactly what a gal wants to hear first thing in the morning. But home I went for a little more recuperative napping and orders not to return tomorrow morning unless I have a ‘little color’ in my cheeks. I think I might be breaking out the blush tomorrow if all else fails.

Boobie Bean Bags

I came across this article and the only thing I could think of was this: weird.

Now, I’ve used the nifty, if expensive, latex boobie to demonstrate lactation and breast feeding to a new mom. Which by the way was an absolutely hilarious experience given that the mom in question had had 5 previous breast fed children and I have never in the whole of my life lactated(thank God!). The situation was awkward enough with the professional looking latex fake breast that I was given to use as a prop. I know I conveyed the correct information, demonstrated proper technique, and came across as a professional and caring doctor (I was being assessed at the time by a midwife and a lactation consultatent on OBGYN~ two professionals who sort of have a hate/hate relationship with the OBGYN docs. They gave me the above written eval so I know that I did more than fair in my attempt). However, I got the direct feeling that both the new mom and myself were looking at the fake breast with the same ‘hehe’ third grade humor thoughts that most normal people have when confronted with a plastic prop of the human body. Not the most conducive to a professional conversation.

So after reading this article and looking at the models offered the only thought that ran through my mind was: ‘Great now they’re going to make med students play with sock puppets and attempt to sound and look professional’. Thank goodness I won’t ever be tossing around the boobie bean bag.

Call Rocks!

I am about to commit myself to dorkdom and more with the following: But I just love being on overnight call for surgery! Last night I got paged into a case of unknown bleeding. The patient had received 10 units of packed red blood cells and was still spewing red stuff from both ends. Pretty gruesome, even I’ll admit. We opened them up and found jejeunal diverticuli (which are not all that common and totally looked cool!). After running the bowel, which basically entails grabbing one end of the large tube and going to the other, we found an ulcer in one of the diverticuli that was the cause of all the patient's problems. A little bowel resection, a few packets of FFP, a little luck and the patient is going to be a ok. Man, I really love this rotation!!!

Scientific Hottie

Well, it looks like its offical: Dr. McDreamy beats the pants off that kid on Scrubs soley because of his career choice.

In what has got to be the result of a drunken bet: A group of hospital yokels in Barcelona Spain got together to decide, based on an attractiveness scale and height, if male surgeons were better looking than their non surgical doctor counterparts. The results of this undoubtably 'valid' study showed that McDreamy is in an entirely different sphere than poor old JD.














I think I might have to agree with the drivel on this one....

Wash Your Hands!!

Well, if social etiquette isn't enough to convince you to spend a minute at the sink maybe this will:

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Scientists have found that our skin is even filthier than previously believed. They've discovered several new species of buggies running around on our skin through the use of genetic testing (sound like a fun grad project anyone?) The best part is that they think we are each the host of our own particularily special buggies.

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Which is a delightful thought given that the average guy or gal is already carting around about a 100trillion bacterial buggies on an average day. I guess they'll have to up the estimate on this one. Doesn't that just make you want go rush out, kiss and swap skin flora with your sweetheart?

Saint in a Box

The world is a very strange place sometimes. An individual was apparently attempting to sell the remains of St. Philip of Moscow. Now, it seems that this nice little Russian lady saved the Saint's remains after the Soviet Union was going to liquidize the stock of a Moscow museum. So the Saints bones are hers free and clear and she was attempting to sell them to the highest bidder. Blanket financial need/greed I understand. Wanting a saint in the box...well that I think is kinda creepy.

One minute he’s holding a urine bag, the next minute he’s kissing me:

Alright, I'm going to let you in on a little secret: I'm never going to understand the human male. Oh, I get them on a physiological level, a pathologic level, and an anatomical level. But I ain't ever going to understand what goes on in the 'upstairs' brain. And I'll even gracefully admit that men probably don't understand women, in general and me probably in particular, for the same reasons that I'm utterly perplexed by the male specimens in my world. All I have to say is it seems like there is the good the bad and the ugly. The ugly is the guy you love as a friend who keeps trying to be something else or the guy you just can't quite stand who seems to care far more for you. The bad is the guy who you have that childish crush on but you know isn't aware of your existance. And the good....well I'm still working on that one. All I have to say is that he better not be touching a urine bag prior to kissing me (you know there IS spillage when the pee is drained don't you~ puts a whole new spin on that Grey's Anatomy moment doesn't it)