Worth checking out

Regina Spektor
I just got this album. I had to. Two separate people recommended it to me within a week. I've not been disappointed. I'm tempted to write a review, but I'll just say I recommend clicking on the link above, listening to the track and then buying the album.

Because I'm too tired to write anything serious...

I think it should be illegal to ride an elevator down one floor if you are able to walk and aren't pushing a gurney or cart.

Especially in a hospital. Come on people. Take the stairs and work off that plastic packaged 1000 calorie, 22 gram of fat cinnamon roll you're munching.

This is odd

Apparently, if you are making an offering to a heathen wight, you should use whole milk, never 2% or skim. Seriously. Scroll down to section V, "Calling and Speaking with the Wights."

I guess Thor doesn't like Jenny Craig.

Back to work...

First page...and second.

I've gotten paged before. But never before have I been expected to act as the intern and decide what to do about a patient at 2am. I still remember the conversation, which is good. I had just laid down to sleep (how typical, I'm thinking) when I got the page, and calling the phone number, I rang a nurse who told me that "Mrs. Wright has a diastolic blood pressure of 109, and I rechecked it manually and got 101, and though she's asymptomatic, I'm worried about her."

At this point, I was probably sweating. All of a sudden, I didn't know anything. What the heck is blood pressure anyway? Luckily, I managed to keep my head a little, and asked the question "she's asymptomatic?" despite the fact that the nurse had just answered it. Then I said "I'll come see her."

This has a double purpose. One, it's what we're trained to do, as it's the right thing to do, since you can't make a decision about someone without seeing them. At my level anyway. Two, it allows you the time it takes to walk to the patient's room to think about what you might do.

In my case, it didn't matter. I still had no clue when I reached the bedside, so I gathered some information and paged my resident. Of course, while talking to him on the phone, I felt like a complete idiot, as he rattled off questions I hadn't asked, including basic ones like "what is the ranger her blood pressure has been running?" Mortified, I set the phone down and ran over to grab the patient's chart, and we figured out what to do.

I returned to bed about ten minutes later very angry with myself. I had completely failed to add anything substantive, and had needed to page my resident over a really simple problem.

Half an hour later, I got a chance to redeem myself. I was paged again, on another patient. This time the question was simpler, but I hurried downstairs and clarified medication orders, wrote telemetry orders, and had, in general, a minor success. Very minor.

An hour later, I seriously redeemed myself. I got another page on Mrs. Wright, and this time, I asked the nurse the questions my resident had asked me, then went and saw the patient, and then made a treatment decision on my own. I decided not to page the resident, as I was now comfortable with handling the problem.

It struck me, as I decided it was now too late to go back to bed and I started my morning rounds, that this is probably how most learning takes place as a resident. Seeing an example, and next time, not needing to call.

The end of the story is that my resident was impressed at rounds this morning. I hadn't realized, but I admitted more patients last night than either of the real interns, and I only needed to page the resident once. I feel almost like a doctor.

Sub-Intern

The rotation I'm doing now is an official "subinternship," which means I am to act as much like a real doctor as possible, clearing all my decisions with my resident, but writing all the orders, all the notes, and in general "carrying" the patient. I get paged by the nurses with questions and requests for clarification of orders. I talk to the subspecialists for consults.

I love it, I think. In part, what I do is just glorified secretarial work. I file papers, review papers, summarize papers. The fact that three years of med school is necessary to file these papers doesn't really seem to matter. It is here, in the headaches of paperwork, that the dehumanization begins. Patients become numbers, become diagnoses, because we see a stack of thirty pages about them more than we see them in person. In "The House Of God" the Fat Man comments that it is never necessary to actually see a patient, and in modern medicine, that's probably true. There are so many notes about the patient that it is possible to write about them, make decisions about them, and even cure them, without setting foot in their room.

That's the part I don't like.

So today, getting bogged down in phone calls and the elaborate system of documentation necessary to comply with the often whimsical requirements of HIPAA and JCAHO, I took a break and actually went to see my patient.

She's a wonderful woman, unfortunately without a bright future ahead of her. But she's come to terms with her poor prognosis and speaks quite frankly about her decisions. She doesn't want resuscitation, doesn't want surgery, and (a bit frustrating to the medical team) she doesn't even want a surgical biopsy of what we think is cancer, because she doesn't want to go through the treatment. She realizes she's old(er) and probably dying. Unlike Mr. Ashman, she doesn't have a family to support her, and after seeing her husband die of cancer a few years ago, doesn't want to go through treatment without support. All in all, a wise decision, if not an uplifting one. But we still managed to chat amicably for a half hour or so. She's from England originally, so (working from past experience) I got her talking about tea. Brits love talking tea, and she's no exception. It is a bittersweet conversation, since she has a nasogastric tube and can't drink tea right now. She may never again. For reasons much more aesthetic than mine her one wish now is to be able to drink coffee once more, "because though I do like tea, I fancy a spot of coffee now and then." It's maybe a bit odd that such a phrase can bring tears to my eyes listening, and now again while writing.

So then I went back to my papers, back to the headaches, back to the phone and pager. But now I'm not just trying to get my work done. I'm trying to help an old lady return to drinking tea, with a spot of coffee now and then.

Extreme, but he has a point

The New York Crank: Necessary and urgent, but political poison: Why the United States needs to restore the draft

One of the great things about fourth year is being able to read and write non-medical stuff. In the former of those categories fell this blog, whose author has an excellent point. One I can't agree to without caveat, but something worth considering.

I love this place

Another day, another hospital. I'm now in my rotation at my number one choice for residency, and I am reminded regularly of why. Everyone is happy here. The patients are similar, the workload is, if anything, greater, but the people are uniformly happier to be here. I don't really have a great explanation for the difference. I just really like it here.