It's Multi-Discipline Time!
A little bit of everything means a whole lot of nothing. This next month I will practice a little bit of psychology, a little bit of ophthalmology, a little bit of ear, nose, and throat, and I would, were I not taking leave, also practice a little bit of orthopedics but ah shucks I just won't have the time. Practically speaking, however, no one really wants to orient and integrate someone into a team who will only be with you for a week so I will spend most the next 28 days ignored while fondly staring off into the distance.
Even better, though, no pages!
And what's better than that?
No call!
And what could possibly be better than no call you ask?
Two day weekends!
Fantastic. Morale is much improved.
So the Snow Birds are finally making their way south. "Snow Birds," for those of you not fortunate enough to live south enough in this fine country of ours to be familiar with the term, are elderly folk who migrate with the seasons. Generally they only stop through San Antonio along their way further down into the Valley, but some do stay awhile. What that means for us at the hospital, practically speaking, is an influx in patients who have half their medical records inaccessible in the great barren, frozen North. Not terribly convenient. Medical care aside the Snow Birds are remarkable for their migratory habits and ability to always return home regardless what obstacles may come their way. Some say they follow the stars, some say the have an innate ability to tract the global electromagnetic field, others say it has something to do with all the hardware in their knees and hips , but whatever the reason it's pretty impressive. Sometimes we affix clinic notes to their legs with TED hose when the server's down. It's almost as efficient as electronic medical records.
And lastly a cat update. Despite repeated application of moth balls the cat problem has not changed significantly. An opossum has joined their ranks oddly enough -- I would have figured cats eat opossums or vice versa -- but by and large they still generally do as they please. What is new is that the they seem to have taken to the trees. Whether for nesting or roosting or the simple fact that there is simply not enough space for them any longer on the ground, every tree on the street seems to have a cat or two in it. Whenever I come home from work one will inevitably jump down and scurry away for whatever crazy cat reason they have in mind. I would like to shake the trees and see what comes out, but the last thing I need is a cat on my head so for now I will tolerate them. Soon they will move into the attic and under the furniture. At that point hopefully my apartment will be done; I don't expect Laura to make it through the year.
Catz!
Wednesday, November 19, 2008
Thursday, November 13, 2008
My Greatest Weakness is I Care Too Much
Or rather am forced to care -- personally I don't give a damn.
It is perhaps ironic, or perhaps not, that the process of training physicians arouses in its would-be doctors feelings that are often so exactly the opposite of what it is clinicians are supposed to feel. Case in point: coumadin. Perhaps it'll make you bleed out your bottom, perhaps it'll make you bleed into your noggin, perhaps, just perhaps, it'll save your life. Of course that's on a running average over a sufficient time period. For most people it'll just seriously inconvenience their lives and lead to unsightly bruising. But oh the joys of administering it, and ho what greater joys are to be had if the patient cannot competently do so themselves. This last block what did I get to do? Give coumadin! What does that mean?! Well let me tell you.
It means I had to convince the patient that first she needed to start taking Lovenox shots because, you see, coumadin takes a few days to find itself. It's a slow acting drug. Then, once she had conceded, I had to write a prescription for the Lovenox, find out the fax number of the home health company that would take care of her, fax the prescription to them, ensure they'd receive the fax, fax it again when they didn't, ensure receipt a second time, order additional every other day blood testing to ensure medication levels were sufficient, arrange for someone to follow up these levels while I was out of the hospital for the weekend, and then report all of this information to my master and commander for their seal of approval. Then we get to the coumadin. We start with a dose that sounds about right, repeat the prescription writing process above, explain to the patient to take all the dose and not just part of it and that no her belly pain is not due to the coumadin, ensure she has extra different sized pills in case we have to change the dose, and again ensure there is someone willing to follow up the numbers while I am gone. In the days long gone I am told docs had to follow the blood levels themselves indefinitely. Today, however, we have a coumadin clinic. The clinic it turns out, however, has phones that do not work (how terribly convenient?), only has classes on Tuesdays and Fridays, works ridiculously little hours, has an intricate consulting process requiring secret passwords and ancient languages, is closed completely on Thursdays, and seems to be generally run as clandestinely as possible. I almost wish for the good ol' days. The end result of my labors? A woman can live a little longer. Or die a little earlier it's hard to say with statistics. All for 45 minutes of my time and a tiny bit of my soul.
But there are good stories too! Like my colitis patient who kept an intricate record of his diarrhea for me every day in the hospital so that my work was a little easier in the morning. And the illuminated, plastic landscapes hanging in the Intermediate Medical Care Units (IMCU) that make it feel a little less like a dungeon while also suceeding in keeping the patients awake at night. And the dirty old man in clinic who told me naughty jokes while his half-demented wife whom he lovingly cared for cackled on about who knows what in the background.
Internship sucks right now. I hate it. The reasons are varied, some good, some bad, some legitimate, some not so much, but overall it's a demoralizing drain. There are some good times to be had -- though looking over my list the term seems to have become quite relative -- but mostly the best of times are had as far away from the hospital gates as possible. Only one and a half years left before some semblance of a good life returns. Only one and a half years left.
We did go to Six Flags for Fright Fest, though. Lots of fake blood and plastic skulls to be found. Spun around a lot and then had a funnel cake.
And I did finally venture up top the Tower of Americas to the Charter House bar. It was nice. The view was lovely. We went home.
I am feeling ambiguous and muddled. Perhaps it the lack of an appropriate sleep wake cycle.
Excelsior!
It is perhaps ironic, or perhaps not, that the process of training physicians arouses in its would-be doctors feelings that are often so exactly the opposite of what it is clinicians are supposed to feel. Case in point: coumadin. Perhaps it'll make you bleed out your bottom, perhaps it'll make you bleed into your noggin, perhaps, just perhaps, it'll save your life. Of course that's on a running average over a sufficient time period. For most people it'll just seriously inconvenience their lives and lead to unsightly bruising. But oh the joys of administering it, and ho what greater joys are to be had if the patient cannot competently do so themselves. This last block what did I get to do? Give coumadin! What does that mean?! Well let me tell you.
It means I had to convince the patient that first she needed to start taking Lovenox shots because, you see, coumadin takes a few days to find itself. It's a slow acting drug. Then, once she had conceded, I had to write a prescription for the Lovenox, find out the fax number of the home health company that would take care of her, fax the prescription to them, ensure they'd receive the fax, fax it again when they didn't, ensure receipt a second time, order additional every other day blood testing to ensure medication levels were sufficient, arrange for someone to follow up these levels while I was out of the hospital for the weekend, and then report all of this information to my master and commander for their seal of approval. Then we get to the coumadin. We start with a dose that sounds about right, repeat the prescription writing process above, explain to the patient to take all the dose and not just part of it and that no her belly pain is not due to the coumadin, ensure she has extra different sized pills in case we have to change the dose, and again ensure there is someone willing to follow up the numbers while I am gone. In the days long gone I am told docs had to follow the blood levels themselves indefinitely. Today, however, we have a coumadin clinic. The clinic it turns out, however, has phones that do not work (how terribly convenient?), only has classes on Tuesdays and Fridays, works ridiculously little hours, has an intricate consulting process requiring secret passwords and ancient languages, is closed completely on Thursdays, and seems to be generally run as clandestinely as possible. I almost wish for the good ol' days. The end result of my labors? A woman can live a little longer. Or die a little earlier it's hard to say with statistics. All for 45 minutes of my time and a tiny bit of my soul.
But there are good stories too! Like my colitis patient who kept an intricate record of his diarrhea for me every day in the hospital so that my work was a little easier in the morning. And the illuminated, plastic landscapes hanging in the Intermediate Medical Care Units (IMCU) that make it feel a little less like a dungeon while also suceeding in keeping the patients awake at night. And the dirty old man in clinic who told me naughty jokes while his half-demented wife whom he lovingly cared for cackled on about who knows what in the background.
Internship sucks right now. I hate it. The reasons are varied, some good, some bad, some legitimate, some not so much, but overall it's a demoralizing drain. There are some good times to be had -- though looking over my list the term seems to have become quite relative -- but mostly the best of times are had as far away from the hospital gates as possible. Only one and a half years left before some semblance of a good life returns. Only one and a half years left.
We did go to Six Flags for Fright Fest, though. Lots of fake blood and plastic skulls to be found. Spun around a lot and then had a funnel cake.
And I did finally venture up top the Tower of Americas to the Charter House bar. It was nice. The view was lovely. We went home.
I am feeling ambiguous and muddled. Perhaps it the lack of an appropriate sleep wake cycle.
Excelsior!
Wednesday, November 5, 2008
The End of the Beginning
I have often wondered if I would salute the current Commander in Chief. Misgivings aside I likely would. Shortly, however, I will feel no such compunctions.
I voted for Barack Obama a little over a week ago. I would have enjoyed being part of the excitement of a November 4th election as I have in years past, but my work schedule simply would not make it practical. The sentiment I felt tonight was not mostly one of excitement that my candidate won, however, -- though I am excited -- but rather one of reverential sadness that my other candidate lost. As I have said before I would have liked to vote for both men. McCain is, I believe, one of the United States' truly great men currently. He would be a president whom I would proudly serve and a leader we would be undeserving of. In 2000 and 2004 there would have been no question. But this year, unfortunately, he tried to have it both ways. He wanted to be both independent Maverick and reliable Conservative at the same time. Whether he was always this and I had simply lived for years in blissful ignorance or this was a miscalculated political blunder I do not know, but whatever the reason I could not vote for him when the alternative was Obama. And so now I'm a little sad. McCain is a good man who turned to bad policy. I wish I could have voted for him.
The election done and over with we are still faced with a staggering economy, two undecided wars, an immigration policy in need of reform, a host of rogue nuclear states, an infrastructure in need of repair, a resurgent Al Qaeda, a mediocre education system, an addiction to foreign oil, a bloated and inefficient health care system, an international name in disrepute, and a "planet in peril." Good luck Barry, McCain may have dodged a bullet with this one.
I voted for Barack Obama a little over a week ago. I would have enjoyed being part of the excitement of a November 4th election as I have in years past, but my work schedule simply would not make it practical. The sentiment I felt tonight was not mostly one of excitement that my candidate won, however, -- though I am excited -- but rather one of reverential sadness that my other candidate lost. As I have said before I would have liked to vote for both men. McCain is, I believe, one of the United States' truly great men currently. He would be a president whom I would proudly serve and a leader we would be undeserving of. In 2000 and 2004 there would have been no question. But this year, unfortunately, he tried to have it both ways. He wanted to be both independent Maverick and reliable Conservative at the same time. Whether he was always this and I had simply lived for years in blissful ignorance or this was a miscalculated political blunder I do not know, but whatever the reason I could not vote for him when the alternative was Obama. And so now I'm a little sad. McCain is a good man who turned to bad policy. I wish I could have voted for him.
The election done and over with we are still faced with a staggering economy, two undecided wars, an immigration policy in need of reform, a host of rogue nuclear states, an infrastructure in need of repair, a resurgent Al Qaeda, a mediocre education system, an addiction to foreign oil, a bloated and inefficient health care system, an international name in disrepute, and a "planet in peril." Good luck Barry, McCain may have dodged a bullet with this one.
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