Nurses

I wrote, for the first time, an order which made a nurse angry with me. The good thing about the situation is that the order was necessary for patient care, but I still felt bad doing it. I even apologized to the guy, but hey, if a patient needs an enema, she needs an enema, right?

I'll admit though, with this guy, I felt less bad than I might have with another nurse. He was the reason I started a morphine PCA on my patient. She didn't really need a PCA, but she kept getting him as her nurse, and he would take two hours to get her the morphine shot I had written for. So I gave her the PCA, with some hesitation, and though her morphine use is about the same, her mood and outlook on life is miles better.

Most nurses are amazing. Even the ones I'm not flirting with. Seriously, though physicians (and budding physicians) are great at figuring out the long term plan for a host of patients, performing complicated procedures and interventions or surgery and guiding a patient towards recovery, none of that would take place without good nursing. But like most things done well, good nursing is difficult to notice unless you are looking for it. Bad nursing sticks out like that ghastly Millenium Wheel on the Thames.

So good nurses, (which includes all those who read this blog, I'm sure) thank you. It is people like you who keep us from going completely insane when your colleagues let my patient sit with a heart rate of 160 for two solid hours before calling me.

I don't want to end this on a negative note though. With this same patient, Mrs. Dalrymple I'll call her, I have dealt with three other nurses who were absolutely amazing. Nurses who are good enough not to demand a cosignature on my orders for Tylenol. Who have the patient's vital signs ready when they page me. Who know how to draw blood from a PICC line without causing a lab error by drawing TPN into the blood tube. I'm sure there are a thousand additional thankless things you do that I never see, without which my job would become infinitely harder. You guys rule.

Odd rewards

I guess I'm doing a pretty good job being friendly with my patients. One of them, whom we recently discharged, was so pleased with my care that he and his wife offered me a free weekend at his rental property on the coast. He told me "anytime you want it, call us up, and we'll figure out a time that works. Bring beer, bring girls, bring whatever." "Um, ok, thanks" was my response. I don't know that it is ethical to take him up on his offer, but still, it's nice to know he approved of my work that much.

So weird.

In other news, my posting has slacked off lately because I have been sicker than many of my patients. Listerine, cough drops, and orange juice are all that's gotten me through the last three days. And I'm on call again tomorrow. Hooray!

The good news is, this is my last week. If I can survive, and still make a good impression through the end of Friday, I'm free, and the easy part of fourth year starts with cardiology clinic.

Mr. Montoya

I see the rainbow in the sky
The dew upon the grass;
I see them and I ask not why
They glimmer or they pass.

I met Mr. Montoya in the Emergency room. He was concerned about some indigestion he'd been having, and my diagnosis was an ulcer. He had some concerning factors in his history though, so we admitted him overnight for a EGD in the morning. He is a great patient, easy going, upbeat, nice to the medical student who presumes to act as liason between the real doctors and him, and with an interesting, bread and butter problem.

So I got him up to his room, checked in on him, and then went on about my business. I came and went a few more times, met his wife, his son, son-in-law, and two grandchildren. The next morning he went down for his scope, and in all likelihood, his life changed forever.

See the scope found ulcers, so I was right about that. What it also found was that the ulcers are likely cancerous. Gastric adenocarcinoma allows only about half of its victims another five years.

The tell us in med school that patients often know what is wrong with them, if you just ask. So when I gave the news to Mr. Montoya, I wasn't surprised that he wasn't surprised. He just asked me some intelligent questions about prognosis, prefacing his comments with "assuming the worst here doc..." I've told him I'm not a doctor, and he has repeatedly said "you're a doctor as far as I'm concerned." At the time, I didn't know much, as I hadn't done a lot of reading on this type of cancer. But now, having done my reading on the subject, I will talk to him tomorrow about the hard facts. This is not a conversation to look forward to.

He's been a wonderful patient. He asked me today to give him my home address so that he and his family could send a Christmas card to me. I'm praying he lives to send many of them.

But I understand why he's staring out the window at the horizon praying the rosary when I come by.

The autumn wind's
Icy morning breath
Is on the hill of Sanu.
I wish, to you about to cross,
I could lend my coat.

The moral of the story is...

...don't try to die in radiology.

One of the patients my team has needed a paracentesis this morning. This involves, basically, sticking a needle into someone's belly and pulling out excess fluid. Despite what you might think from the title of my post, this went quite well. I pumped about 2 liters of fluid out of Mr. Block, and he felt better immediately.

Then, we started ending the procedure. This involves pulling the needle out and putting a band-aid over the hole. Seriously. But we also packed gauze under the band-aid to absorb some fluid. So, thinking one band-aid was not enough, I asked the tech for another. But we were in the radiology department. And the tech wasn't able to find one.

Now I have heard that the two toughest things to find in a hospital are aspirin and band-aids, so I tried again.

"Have you any tape?"
[tech leaves
[tech enters
"No, we don't."

I was a bit surprised, but perhaps naively so. A procedure clinic without dressing tape? What is up with that?

Also, I came up with a few witticisms which are probably way funnier since I've spent the last thirty-four hours without sleep:

A hospital is a lot like a casino, because in both a)time has no meaning, and b)the only people doing well are the ones working there.

Also, you might be a med student if...you've ever needed to check your cell phone to tell what day it is. Apparently it's Tuesday.

Interview

So my interviews for this residency site are complete. As usual, I find it difficult to judge how well or poorly I did. Fortunately, I didn't get the worst question ever: "Tell me what you see as your greatest weakness?" I did, however, get a difficult question which, though better from the point of view of the interviewer, can be awkward and off-putting: "Tell me about yourself."

What do you say when pressed with such a question? I've often thought how I would try to define myself in a few words or phrases, but I'm not concise enough to do so. I don't know that anyone really could. And when it's asked as the first question in an interview, I'm not nearly warmed up to the interviewer enough to give an answer I'm happy with. What is it that defines a person? Where you're from? What you do? How you spend your spare time? Do you answer honestly, even if that means "I've been so tired lately my spare time when I'm not asleep has been spent sitting on the bed in the hotel room thinking I should just turn off the TV and go to sleep?"

For I have known them all already, known them all:
Have known the evenings, mornings, afternoons,
I have measured out my life with coffee spoons;

Probably I'm just frustrated. I was recently discussing my situation with a classmate, also in the midst of applications to residency, and we were both remarking upon how it has taken a lot of effort and drive to get where we are in life. But the end is not in sight, and if anything, it is harder work to move ahead now than it ever was before.

Which is why I don't know that I'd recommend a medical career to anyone asking me for advice. Fewer than ten percent of applicants to medical school are accepted, nation-wide. But that's not the end of the bottle-neck. The competition you see and participate in before medical school only gets worse. Before medical school, you can pretend that it's only a facade, it's not really you, the competition is just a phase.

But it's not. You become that person, and if you don't, you fail. Two of my classmates actually dropped out of school, because they saw that. One is now a weatherman, and the other drives an armored truck. Mad props to them both. (Sorry, dated reference)

So, who am I? I'm a guy who doesn't mind working hard, but is tired of making life about a competition, who wants to help people, but doesn't want his life completely subsumed in others. Maybe that means I won't be a great doctor. But if being a great doctor is defined by the number of textbooks I've authored, I don't think I want that. At least, I didn't back when I was sane. I don't know.

Dang, that's what I should have said.

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.