The Great Pee Pee Mystery

Today, from roughly 1100 to 1700, I waited for an old man to pee so that I may take it and look at it under a microscope. Around 1715 I was given word that the long awaited urination had taken place. Briefly taking care of other urgent matters, I attended to my wee sometime around 1745 only to find it was nowhere to be found. Some masked stranger had run off with my urine. I asked the nurse, she didn't know. I asked the patient, he said "a doc" took it. I asked my interns, they were clueless. Somebody, for whatever clearly no good reason, had absconded with my wiz. I was upset. Although few will every appreciate this, there are few things more frustrating then waiting an entire day for urine only to have it disappear. Nevertheless it seems to be the running average for Williford Hall these days. Most labs get sucked up by gremlins in the vacuum tubes, most daily radiographs become every other day radiographs by the x-ray tech fairy, and half of our electrolyte panels seem as if the masked stranger himself is urinating in them yielding the wildest most ridiculous and inaccurate of results. Wilford Hall, you're too much for me. I don't know what to do with you.

Someone will pay dearly for the pee, though. Someday I will have my revenge.

Through the Prison Gates

Talking to some of my patients you'd think we're running a penitentiary at Wilford Hall. If I had a dollar for every patient begging me to let them go or who asked that I call the cops, FBI, OSA, CIA, etc I'd have, like, seven bucks. This is not because of particularly poor patient care -- I am inclined to believe we treat our patient's better on average than most hospitals -- but because our patients are out of their minds crazy. Delirious more specifically, but crazy nevertheless. Sometimes they try to bribe me, sometime they try to convince me through semi-coherent cookoo logic, and sometimes they just ask very nicely, but the universal statement always seems to be, "I shouldn't be here! Ahhhh!"

And how do I respond to these requests?

"Sir, would you like a BOOST?"

Actually we're instructed to talk them down which I am not sure has ever actually been scientifically shown to work, but it's what we do nonetheless. "Sir, why do you think the nurses are trying to kill you? They're sticking tubes in your penis, needles in your arm, and waking you up every few hours because they want to help you!" The restraints are good for you, ma'am.

In other news, this last week I won the lab lotto. Laboratory tests are ordered to confirm probable diagnoses and rule out improbable ones. Checking them every day is always a little like a scratch off ticket to see if we have just another case of pneumonia and diabetes or something much more exotic and rare, and a couple of days ago I won big. An insulinoma! Or at least I thought I did. The patient was hypoglycemic and with super high serum insulin and c-peptide levels but it turned out it was just a gnarly side effect of her floroquinolone antibiotic. Still pretty unusual and still quite a prize. I was excited. Now I am told I get to write up an ACP poster for it, whatever that means.

And here's our Christmas tree!


Happy New Year!

The Disorientation Process

Twenty-one days into the USAF residents and fellows orientation process and still I am not entirely sure what is going on. We have been given a scavenger list of various quests to complete, all usually involving taking a form to at least three different offices only to be rewarded with another form, and have been vaguely made aware of the existence of a second, secret list which must also be completed less we offend the Major General Travis in his omnipresence. When not wandering about the base we are either treated to a series of uncoordinated, often redundant lectures in the WHMC Auditorium, a comfy if not soporific locale, or are sent to undergo a seemingly never ending list of computer training and online courses concerning everything from the dreaded HIPAA to the international human trafficking problem to the proper use of tobacco in treating wounds and disease when trapped in occupied territory. The knee bent scattered running about is further worsened by the general lack of clear headship in the orientation process and the frequent ignorance of those who seem like they should know. It is not uncommon -- and in fact is the norm -- to receive multiple different answers to the same question depending on who you ask. This is not to complain about the individual efforts of those immediately involved, they've certainly tried to be helpful, but rather the seemingly complete lack of planning and foresight in the construction of the orientation process by whoever it was that was in charge of it. Alas, it seems planning and foresight are not common traits at certain levels of the armed forces so I suppose the orientation of one hundred plus physicians in the largest medical training program of the Department of Defense should be no different. Thankfully waiting weeks for moving boxes because they have been put in storage, waiting three plus hours for a simple CAC card, and driving thirty minutes each way to attend mandatory picnics are all made at least a little bit more tolerable by the fact that we're at least getting paid for the tomfoolery. Paid too much of course -- and that money will be paid back lest you be prosecuted as an enemy combatant under the ICMJ -- but paid nevertheless.

Orientation has had its good points. My fellow internal medicine interns seem to be good chaps all. Weekends have been completely free. Most people have been graciously kind with our collective ignorance. Other things I undoubtebly simply cannot remember right now, like, I don't know, cheap Time Warner cable at the BX are nice too I guess. It's just that, three weeks later, the only thing I am confident about is that I have not done everything that has not been asked of me. The prolonged time for orientation was supposed to give us ample time to take care of life's problems so we could be ready to focus on internship. Well, they've done that, but instead handed us a list of military-based headaches in exchange.

Speaking of internship. I am about to do this thing in a little over a day from now. There is some anxiety, a little bit of fear, and a whole lot of, "let's get this the hell over with already." Orientation was the finishing exclamation mark to a whole year of silly things which generally speaking had nothing to do with medicine. It was delightful, but I am now ready to do the real thing. As long as someone holds my hand of course. And it is knowledge that there will be that someone, indeed a whole chain of someones, that gives me confidence that though I will surely mess up a hundred times over there will be people to protect my patients from me. I am not happy that my life will be essentially nothing but medicine for the foreseeable long term, but, really, my life was not terribly exciting to begin with. At least now I will be smartening myself and saving lives in the process, at least on average. So overall things are changing and change is scary but not when the change involves things I mostly don't care much about so, in conclusion: orientation with the air force is wacky; life goes on.