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!

Let's Get Intensive

Back on call again. Still sucks.

I've realized, though, that for those whose only impression of "call" comes from Gray's Anatomy and Scrubs, being on call is a hazy, ill-defined concept, and reality's blurred. My repeat assertions that "it sucks" have surprisingly done little to clarify the matter. The truth is, aside from the casual sexual encounters with coworkers, there is not much in common between the real world and the world of make believe. As an example, an average call in the Medical Intensive Care Unit (MICU):

• 0530, Wake up, realize it's a call day, grimace.
• 0600 - 0630, Drive to the hospital in silence. This is likely the happiest I'll be all day today.
  
• 0630 - 0635, Arrive at the hospital and change into scrubs that I have found and scavenged throughout the hospital on previous non call days. Sometimes they fit, sometimes they're stained, sometimes there're huge unexplainable holes in 'em.
• 0635 - 0830, Begin pre-rounding on my old patients. Pre-rounding consists of recording a slew of vital signs, lab values, consult information, nursing reports, radiographic data, drip rates, machine settings, and then, finally, talking to the patient for 5 minutes. Thankfully many ICU patients are on ventilators and do not have much to say.
  
• 0830 - 1200, Round with staff and fellows. Staff rounding consists of telling the staff physicians about everything I have just collected and then politely nodding while my co-interns do the same.
  
• 1200 - 1215, Run the board with the resident. Basically we find a big marker board and cover it with little check boxes of the things we have to do today.
  
• 1215 - 1230, Get lunch at the cafeteria to go. As the food choices are often some sort of fish, often pollock -- whatever the hell that is, and some odd mix of sides that do not go together I frequently find myself eating a lot of grilled cheese sandwiches. It turns out BAMC has the best grilled cheese sandwiches.
• 1230 - 1600, Work. Write notes, write orders, record more information, and repeat. Sometimes I accidently find myself talking to my patients which only puts off all the work I have to do.
  
• 1600 - 1700, Take sign outs. Around this time, while I am still going about my regular business, various other interns page me to come check out their patients for the night's cross cover. This is when I get to add more little boxes to all the previous boxes I had already checked off for the day.
  
• 1700 - 1730, T-cons and emails. If there's a lull in the work and we have not already had to admit any new patients, I just may get to take care of the other, non-ICU, work that builds up 24/7 year round. T-cons are things I need to call my outpatients back about and emails are typically incomprehensible military things I need to delete or poorly characterized tasks I have to take care of somehow, somewhere.
  
• 1730 - 1745, More sign outs.
• 1745 - 1130, Admit patients. Nightly we receive anywhere from 0 - 5 new patients from the ED. Typically it's around 1 - 3. Each individual patient seems to take me about 2 hours to fully work up, admit, and write a History and Physical (H&P) on. I would say I am slow but I honestly do not know how to go about it much faster without cutting corners. Or at least more corners than I am already comfortable cutting.
  
• 1745 - 2330, Cross cover. At the same time I'm admitting patients I also gotta take care of all those pesky check boxes!
  
• 2330 - 2350, Dinner. Hunger pains and hypoglycemia force me to momentarily stop or slow what I am doing to eat. Thankfully there're usually other things that can also simultaneously be done while eating. Like checking boxes for example.
  
• 2350 - 0200, More admits and cross cover.
  
• 0200 - 0205, Think about sleeping, but then do more admits and cross cover.
  
• 0205 - 0245, Take care of a crazy patient. Inevitably someone will completely lose their mind over the course of an evening and I get to try and persuade them not to. It seems restraints and tranquilizers are not in fashion these days.*
  
• 0245 - 0250, Think about sleep again, but then do more admits and cross cover. Maybe watch part of a show in an unconscious patient's room.
  
• 0250 - 0345, Code Blue. Someone is dying and it's my job to stop it! Or at least delay it for another few days or weeks till it inevitably comes about.
  
• 0345 - 0545, Admit again.
• 0545 - 0700, Finish whatever needs finishing, and pre-round on my old patients if there's time. Sometimes I eat a yogurt cup.
  
• 0700 - 0830, Check out with the CCU (Cardiac Care Unit) team. This is when I learn that despite working continuously for > 24 hours straight it just isn't good enough.
  
• 0830 - 1100, Check out with the MICU team and staff. This is when I learn that because I worked continuously for > 24 hours straight it's clear I did my best. Good game everybody, good game.
  
• 1100 - 1230, Finish whatever needs finishing again. Complete notes, complete H&Ps, and sometimes fall asleep at or on my keyboard.
• 1230 - 1231, Leave the hospital. My reward? The sensation that someone has thrown sand into my eyeballs. Whether cloudy or sunny, wet or dry, walking to my car is always a mildly stinging experience.
  
• 1231 - 1300, Drive home with music blaring and singing along. This is likely the happiest I'll be all day today.
  
• 1300 - 1530, Eat, shower, and go to bed.
  

Total time awake: 33 hours

Friggin' miserable.

In international news, President Bush. Guy can dodge bullets. Or at the very least well thrown shoes from close range. And Prime Minister al-Maliki? Way to step in where the Secret Service was not. Batting away gun shots -- err shoes -- with greatest of ease. I know I don't have moves as smooth as that. Would have taken both shoes square on the nose, back to back. No country would take us seriously afterward. Really, though, it seems global politics is going more and more the way of Austin Powers these days.

"Who throws a shoe? Honestly! You fight like a woman!"

In domestic news, we've got Christmas lights!



Almost looks respectable from this angle!



This angle not so much. It turns out I did not quite measure the required length of lighting very well. But, uh, it's the thought that counts?

*Not to suggest that they should be. Restraints and tranquilizers should only be used when absolutely necessary. Like when the patient has made you angry.

Christmas Present Apraxia

Although I am still fully in possession of all my faculties and still have complete control, it would appear, over my senses and motor function, it seems I just cannot wrap a good Christmas present. Despite some 26 years of practice now -- yes I started wrapping gifts just 5 months after birth -- my wrapping skills have improved only marginally, producing most recently this monstrosity:



The fact that the corners are not crisp, there is an overabundance of tape, the flap lengths are all uneven, and that I did not even cut enough paper for the whole project and so had to graft on not one but two extra appendages of wrapping paper are only partially disguised by my not so clever use of bows, poor lighting, and unusual construction patterns. Indeed this is the one skill I have picked up over the years. How to wrap presents so clumsily that it appears as if on purpose. Such a secret is what keeps our nation's postmodern artists fed, and it works for me. Occasionally, though, namely when the gifts are large and square, I do succeed in finishing a presentable product:



Not bad, huh? But then I go and produce something like this:



The wrapping job's ok, but I definitely had to resort to sticky notes as improvised gift tags. And as I ran out of scotch tape I had to resort to staples. Sarah's gift is now securely fastened to her shipping material. Actually I lie about the tape -- it's the one thing I do make sure I have an abundance of. And bows!:


Beautiful! I really don't know how I have failed to get better at this -- perhaps I simply just don't practice enough -- we need Christmas at least three times a year! -- but I have. Although it should simply be a matter of roughly measuring size, slowly cutting smooth lines, appropriately folding corners neatly, and taping conservatively in key areas, I cannot quite pick it up. I even managed to cut myself at one point with the x-acto knife -- someone will get a little extra love and blood with their present this year -- and I am still not entirely sure when or how. Whatever the case, Christmas wrapping makes me merry and my general lack of skills aside I am happy for the time being.

Next up: Christmas trees and Christmas lights. Let's pretend I don't have the ICU coming up in three days!

Busy Like a Hamster

I have been busy!

And not at the hospital. So much. Which is why I used an exclamation mark. (Not just for teenage girls and text messages any more.) I have been so busy I barely even have time to write this garbage -- err blog. Amazing dedication!

So what have I been doing? Well, things! I got my car wash, bought some Christmas presents, visited family in California for Thanksgiving, went to a wedding, saw some college friends in Houston, test drove a MINI Cooper Convertible and Jeep Patriot, returned some presents, paid off my student loans, had clinic, wrapped Christmas presents, decorated a Christmas tree, visited some other family in California, mailed some presents, went to the optometrist, decorated another Christmas tree, got new glasses, got my teeth cleaned, read a book, saw Bolt, Quantum of Solace, and Role Models, cleaned my shower, bought some picture frames, did some research on colistin resistance in Acinetobacter, got a haircut, got an oil change, framed some pictures, went to the mall, bought some groceries, got a filling at the dentist, and saw Boyz II Men (for free mind you) at a USO show. All that and not a single amusing story. Well, I guess the way my 3 year old nephew flexes his shoulders forward when he stutters out his words like some sort preschool bouncer is pretty amusing, but you really have to be there.

In other news, this! Seems despite the oft stated claim by all those liberal, tree-hugging, monkey-headed socialists out there that punishment is not an effective deterrent, one psychology study suggests that it can serve as a corrective force. But the real lesson here: the social sciences are and will always be science-light. In other words: my political science degree is a bunch of high-sounding nonsense. Perhaps this article should be read with this!? Just perhaps.

On a final note. I bought a giant bag of Nerds candy for Halloween and nary a kid showed up to receive it. Despite my best efforts to eat far more Nerds than is reasonable on my own I still have about 70% of a giant bag of Nerds on my hands. I am taking suggestions.

While some people find it helpful to fast before Thanksgiving dinner, we know it's best you prime the pump before hand. Preferably with Cheetos, Lunchables, and as much soda pop as you have cup holders for.