A Labor of Love

I have been working 80 hour weeks for the past five weeks. I have three left to go. I do not enjoy it much. I leave to work with it dark outside and return to work with it dark outside. In these harsh and trying times I like to think of a block back at BAMC when my co-intern stepped in to visit a patient of his.

The woman, elderly, foreign born, and a bit demented, had just had a nasogastric tube inserted through her nose to relieve the pressure building up in her gastrointestinal track. Being so demented she did not terribly appreciate this.

Upon entering the room to see how the procedure had faired she, from her curled up position in bed, waved her grizzled hand and said in her thick East European accent, "Traitor."

"You'll pay for this."

The joys of patient care.

Today a family in clinic gave me a pack of gum. It was pretty good.

Ahh... for the good ol' days....

The Gold Standard

"The gold standard." A descriptive phrase in medicine -- and I'd imagine probably in other disciplines as well -- used to such excess that a little scowl briefly crosses my face whenever anyone says it. With the high value placed on communication in health care and the tendency to imitate I needless to say spend quite a bit of my day scowling. What it refers to, if it is not already clear, is the test, study, drug, whatever, considered the best and most effective in accomplishing whatever task it is you have in mind. For finding vascular blockages it's usually angiography or venography. For identifying offending pathogens it's usually bacterial or fungal culture. For treating penicillin sensitive Staph aureus infection in a non pen allergic patient it's penicillin. When it comes to medical students, I have learned recently, it's Dan Marino. No, not Dan Marino the former Miami Dolphins quarterback -- I am fairly certain he either passed away shortly after filming Ace Ventura or he was immediately cast in bronze and shipped to the football hall of fame shortly after retirement -- but the Dan Marino from Jersey. Or maybe it was New York. I am not entirely sure where Dan Marino the fourth year medical student was who worked with us for two weeks in the Cardiac Care Unit (CCU), but he certainly set the industry standard. Why? Partly because he was always so pleasant, helpful, and interested in his work. Partly because I am pretty sure he was always smiling. But mostly simply because I liked introducing to people my medical student: Dan Marino. Good kid that Dan Marino.

This last week I have learned that although San Antonio has the gold standard in small Spanish missions used in acts of rebellion from foreign powers, it does not in zoos. Nevertheless as San Antonio generally sets the bar pretty low for most things, the Spurs aside, I was mostly impressed. The zoo here it turns out is pretty nice. I was expecting a glorified petting zoo with a taco bar, but actually got something close to a world class zoo, research center, and wildlife repopulation program akin to the San Diego Zoo in California. Except for the fact that, their extensive bird collection aside, they only seemed to have one of every animal. Even when the descriptive plaques would state, "always found in herds of ten or more, the social such and such" would almost always be found alone. Maybe with a single ostrich or antelope to keep him company. So even though the giraffes and zebras had impressively large exhibits. There was just one. One zebra. Hanging out. Probably bored out of his mind. I don't know if animals can go crazy, but they just may here. The scarcity of certain animals animals aside, however, it was a fairly nice place that I would recommend everyone go to. Everyone. Even yo mamma.

Anyway, the gold standard of Pembroke Welsh Corgis ladies and gentleman:

(Her name is Ahi. Or Cupcake. Or Bailey. It depends on who you ask.)