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!