a little girl came in to the ED today with a fever to 39.5. i had spoken with her mother several hours earlier about the fever, as well as some bug bites that looked infected and asked them to come in to make sure the bites weren't cellulitic. at that point, her mom told me over the phone that she wasn't too worried, because she was still playing.
by the time she got to the ED, she was no longer playing.
she was, in fact, lethargic.
the dreaded L word that parents throw around willy-nilly without proper respect for the weight it carries. it does not mean they're sitting on the couch all day playing video games or just wanting to watch movies. it means that they are sleepy and very difficult to wake up.
this girl slept through my exam, including the belly exam. even still, this mom did not describe her daughter as lethargic, but, rather, as "a little more sleepy than usual".
1 IV, 300cc of NS, 240mg of tylenol...and presto!
all better.
up, talking, smiling, asking for apple juice and stickers that were pink.
i gave her all the pink stickers we had, including the one of the bear with a pink bow and the caption, "i'm all better!"
Sunday, July 30, 2006
Friday, July 28, 2006
non sequitor(s)
went running today. on a windy, hilly dirt road, i could have sworn i saw a mushroom as big as a basketball. turned out to be a rock. some runner's high.
i have a new housemate who is about to start med school after his first career in computers. he's a total wiz and is, as we speak, figuring out how to transfer all my music on my ipod (that came from a computer that no longer exists) to my current computer. brand new music library for me. well, not brand new. it's all my music. but it's now manipulatable on my iTunes.
my new favorite show on t.v. when i can't seem to wind down from a night in the ED is "Throwdown with Bobby Flay", in which the Iron Chef travels hither and yon to challenge ordinary, everyday people to a cooking challenge. Last night was a Texas Chili cookoff. hey, new yorkers can cook chili, too.
work beckons in the morning. at the moment, i am feeling masochistic enough to get up even earlier and run before clinic. i think i really am nuts.
i have a new housemate who is about to start med school after his first career in computers. he's a total wiz and is, as we speak, figuring out how to transfer all my music on my ipod (that came from a computer that no longer exists) to my current computer. brand new music library for me. well, not brand new. it's all my music. but it's now manipulatable on my iTunes.
my new favorite show on t.v. when i can't seem to wind down from a night in the ED is "Throwdown with Bobby Flay", in which the Iron Chef travels hither and yon to challenge ordinary, everyday people to a cooking challenge. Last night was a Texas Chili cookoff. hey, new yorkers can cook chili, too.
work beckons in the morning. at the moment, i am feeling masochistic enough to get up even earlier and run before clinic. i think i really am nuts.
Thursday, July 27, 2006
bad day
ugh.
(post edited)
on a brighter note, i did my long run yesterday and feel fairly good today. minimal diaphragmatic irritation. hills that used to kill me are now an afterthought. could it be that i am actually getting in shape???
(post edited)
on a brighter note, i did my long run yesterday and feel fairly good today. minimal diaphragmatic irritation. hills that used to kill me are now an afterthought. could it be that i am actually getting in shape???
Saturday, July 22, 2006
when you are sicker than your patients...
so it's never a good omen for your day when you feel worse than most of your patients. there's a lovely gastroenteritis going around and, lucky me, i seem to have caught it. not surprising, considering how many times my face has been sneezed and coughed in over the last few weeks.
here's a tip that i learned the hard way. wear a mask when swabbing people's throats. that way, when they gag and cough, you are somewhat protected.
saw some neat stuff today, though, despite feeling wretched.
a resident came in with a dislocated shoulder from a slip-n-slide incident (presumably involving a lot of alcohol). pretty much behaved like an ass, which is sort of what he's known for. a little boy with a septic joint from a laceration that was sewn up a few days ago. a young baseball player with a nasal fracture from trying to catch pop-up flys with his non-dominant hand who had clear rhinorrhea ever since the injury...didn't turn out to be csf rhinorrhea, but it was good to go through the differential. lots of non-specific viral stuff but overall really pleasant families, which always makes things easier.
plus, i was working with one of my favorite ed docs who totally gets my sense of humor. we have a good time. he wouldn't give me an iv, though, for my own rehydration, but that's ok. i guess i didn't really have mental status changes...yet. i've been working on the ORT. alternating gatorade with emergen-C. if i wake up tomorrow obtunded, you'll know why.
based on the number of parents that i convinced over the phone to wait until clinic tomorrow to be seen instead of coming to the ed tonight, tomorrow is a busy day. off to sleep i go...
here's a tip that i learned the hard way. wear a mask when swabbing people's throats. that way, when they gag and cough, you are somewhat protected.
saw some neat stuff today, though, despite feeling wretched.
a resident came in with a dislocated shoulder from a slip-n-slide incident (presumably involving a lot of alcohol). pretty much behaved like an ass, which is sort of what he's known for. a little boy with a septic joint from a laceration that was sewn up a few days ago. a young baseball player with a nasal fracture from trying to catch pop-up flys with his non-dominant hand who had clear rhinorrhea ever since the injury...didn't turn out to be csf rhinorrhea, but it was good to go through the differential. lots of non-specific viral stuff but overall really pleasant families, which always makes things easier.
plus, i was working with one of my favorite ed docs who totally gets my sense of humor. we have a good time. he wouldn't give me an iv, though, for my own rehydration, but that's ok. i guess i didn't really have mental status changes...yet. i've been working on the ORT. alternating gatorade with emergen-C. if i wake up tomorrow obtunded, you'll know why.
based on the number of parents that i convinced over the phone to wait until clinic tomorrow to be seen instead of coming to the ed tonight, tomorrow is a busy day. off to sleep i go...
a running question
a question for fellow blog-reading runners out there.
i've been training for a half-marathon of late. it's a fund-raising event for the hospital where i work. it's going well, now that the blister is healed. but every day when i start out, i have left shoulder pain, no matter how much stretching i do. after about a mile or so, it stops. why is that?
on a somewhat related note, i was just down in new york visiting family and went running in central park, one of my favorite things to do. i started out near columbus circle and ran up around the reservoir. it was a weekend morning, so the park was full of other runners and bikers and families and couples. it was quite distracting, and still somehow motivating, to have other runners around. not that i was competing with any of them, but it helped a bit with pacing, particularly since it was 11am and 95 degrees out.
there was a musician playing on the grass near tavern on the green, a crowd of people sitting and listening raptly. lots of people having picnics on the great lawn with their coffee and bagels. i absolutely love the peace and quiet of living in a small place, but it was nice to be immersed in the city again, even just for a few days.
i've been training for a half-marathon of late. it's a fund-raising event for the hospital where i work. it's going well, now that the blister is healed. but every day when i start out, i have left shoulder pain, no matter how much stretching i do. after about a mile or so, it stops. why is that?
on a somewhat related note, i was just down in new york visiting family and went running in central park, one of my favorite things to do. i started out near columbus circle and ran up around the reservoir. it was a weekend morning, so the park was full of other runners and bikers and families and couples. it was quite distracting, and still somehow motivating, to have other runners around. not that i was competing with any of them, but it helped a bit with pacing, particularly since it was 11am and 95 degrees out.
there was a musician playing on the grass near tavern on the green, a crowd of people sitting and listening raptly. lots of people having picnics on the great lawn with their coffee and bagels. i absolutely love the peace and quiet of living in a small place, but it was nice to be immersed in the city again, even just for a few days.
Monday, July 10, 2006
blisters and such
i've not been able to run this week due to a nasty blister on my left heel.
it's finally healed.
well, sort of.
enough to try running again today on my day off from the ED.
life on the ED rotation is sort of interesting. it's a little lonely, as i work when most of my other friends are sleeping. but it's also pretty neat. i get to see people who are really freaked out, whether for valid reasons or their own imagination, and help them in a very real way. whether it's getting a kid with an asthma exacerbation a neb and a wopping dose or steroids or sewing up a laceration on a little boy's knee. i always tell them how brave they are, even if they weren't really, because that's as much of a band-aid as anything else i can offer.
the families whom i've met so far in my short 2 weeks on this rotation have run the gamut from those reeking of cigarette smoke and neglected dental hygiene to the most well-educated with glowingly polished veneers. i have to say that i learn something from each and every encounter.
even if it's just that i should really floss more.
here's to healed blisters (and other body parts) and to a glorious, sunny day off.
it's finally healed.
well, sort of.
enough to try running again today on my day off from the ED.
life on the ED rotation is sort of interesting. it's a little lonely, as i work when most of my other friends are sleeping. but it's also pretty neat. i get to see people who are really freaked out, whether for valid reasons or their own imagination, and help them in a very real way. whether it's getting a kid with an asthma exacerbation a neb and a wopping dose or steroids or sewing up a laceration on a little boy's knee. i always tell them how brave they are, even if they weren't really, because that's as much of a band-aid as anything else i can offer.
the families whom i've met so far in my short 2 weeks on this rotation have run the gamut from those reeking of cigarette smoke and neglected dental hygiene to the most well-educated with glowingly polished veneers. i have to say that i learn something from each and every encounter.
even if it's just that i should really floss more.
here's to healed blisters (and other body parts) and to a glorious, sunny day off.
Friday, July 07, 2006
quiet afternoon
i spent the afternoon sitting on a bench at the edge of the town green reading my latest favorite book, The History of Love. it was an interesting exercise in people-watching, too.
there was the group of girls who all looked the same, as if they had consulted one another before getting dressed that morning. the little boy in his motorized wheelchair who was racing in circles around his nanny and her friends with their young charges, all the while a huge grin on his face. the family waiting for their dinner reservation at the fancy restaurant across the street, all dressed up in suits and high heels. they seemed like such a content family. the youngest amongst them was a 9yo girl who reminded me an awful lot of myself at that age. she was just dancing around on the grass, blissfully un-self-conscious, doing cartwheels and congratulating herself when she did a particular move well. she caught me looking at her at some point and we forged an immediate bond, as if she sensed that we were dopplegangers. when they all went across the street for dinner, she looked over her shoulder at me and waved good-bye. i smiled and waved back. i wish her well, oh so well, in this crazy world.
there was the group of girls who all looked the same, as if they had consulted one another before getting dressed that morning. the little boy in his motorized wheelchair who was racing in circles around his nanny and her friends with their young charges, all the while a huge grin on his face. the family waiting for their dinner reservation at the fancy restaurant across the street, all dressed up in suits and high heels. they seemed like such a content family. the youngest amongst them was a 9yo girl who reminded me an awful lot of myself at that age. she was just dancing around on the grass, blissfully un-self-conscious, doing cartwheels and congratulating herself when she did a particular move well. she caught me looking at her at some point and we forged an immediate bond, as if she sensed that we were dopplegangers. when they all went across the street for dinner, she looked over her shoulder at me and waved good-bye. i smiled and waved back. i wish her well, oh so well, in this crazy world.
Tuesday, July 04, 2006
independence day
today was one of those amazing days that i want to preserve forever. if only you could put those days in little snow globes so that you could pick them up, look at them and remember why it was that the day meant so much to you at the time.
my sister and i hiked mt. moosilauke with my chief resident and his girlfriend, who also happens to be an old med school friend. from the ravine lodge, we hiked up the gorge brook trail to the summit. it's a steep hike up but so incredibly beautiful. there's something so amazing about how the vegetation changes from tall, dense pines and birches to the wind-stunted dwarfs at tree line. it was not the best day for views, but that didn't seem to matter, as there was a mystical, blue-purple haze that gave everything a somewhat ethereal hue.
we sat on the rocks at the summit and ate nutella and pretzels. there's nothing quite like chocolate at the top of a mountain. french fries might be better, but i've never been able to find them in such a place.
we hiked down the carriage road (beware the poison ivy!) to snapper, re-entering the dense, lush forest. so many wildflowers blooming, growing in the crevices of the rocks that lined the trail. i wish i remembered more botanical names from my undergrad ecology labs, but they have been replaced with the names of muscles and nerves and bones. for some reason, bird calls have stuck in my memory, though. white throated sparrows were in abundance, singing heartily as we entered their territory. i've always loved their call, so plaintive and almost melancholy.
at the convergence of snapper and gorge brook, there's the class of '97 swimming hole. the water as deliciously cold and made my tired feet feel so much better. i splashed the water over my face and head, feeling the freezing rivulets drip down my neck. nothing quite like it in all the world. it was almost torture to put my shoes back on for the walk up the hill to the parking area.
the last time i was at moosilauke was late fall. the lodge was deserted and it had already started snowing. yesterday, however, the lodge was full of summer staff and visitors, the sweet smell of cornbread lingering in the air. there was a man with dreadlocks playing guitar, trying to learn a song before tonight's 4th of July celebration perhaps.
we filled up our now empty water bottles and headed back, stopping at fat bob's for ice cream. to give you a sense of why it's called fat bob's, a baby size is 1 scoop, kid size 2 scoops, small 3 scoops, medium 4 scoops and large 5 scoops. no wonder americans are overweight. i got a twist with rainbow sprinkles. a little girl in line behind us said excitedly to her mother, "she got rainbow sprinkles!" i remember being that excited for rainbow sprinkles once upon a time.
after a late afternoon nap, my sister and i went to watch the fireworks. it was really quite impressive. greens and golds, red, white and blue, pinks and purples all showering over the river, the boom echoing loudly off the hillsides. during the finale, the song "born in the USA" was blasting over the loudspeaker. my sister and i both looked at each other and wondered why they chose that song, as the lyrics are not the most glowing portrait of life in this country. but i guess as long as the chorus is catchy, what does it matter?
all told, it was a cleansing, restorative and grounding day...reminding me of my own, innate independence and strength and also of my inextricable link to the earth and the people in my life whom i love dearly. i think i'll have to make this a new july 4th tradition.
my sister and i hiked mt. moosilauke with my chief resident and his girlfriend, who also happens to be an old med school friend. from the ravine lodge, we hiked up the gorge brook trail to the summit. it's a steep hike up but so incredibly beautiful. there's something so amazing about how the vegetation changes from tall, dense pines and birches to the wind-stunted dwarfs at tree line. it was not the best day for views, but that didn't seem to matter, as there was a mystical, blue-purple haze that gave everything a somewhat ethereal hue.
we sat on the rocks at the summit and ate nutella and pretzels. there's nothing quite like chocolate at the top of a mountain. french fries might be better, but i've never been able to find them in such a place.
we hiked down the carriage road (beware the poison ivy!) to snapper, re-entering the dense, lush forest. so many wildflowers blooming, growing in the crevices of the rocks that lined the trail. i wish i remembered more botanical names from my undergrad ecology labs, but they have been replaced with the names of muscles and nerves and bones. for some reason, bird calls have stuck in my memory, though. white throated sparrows were in abundance, singing heartily as we entered their territory. i've always loved their call, so plaintive and almost melancholy.
at the convergence of snapper and gorge brook, there's the class of '97 swimming hole. the water as deliciously cold and made my tired feet feel so much better. i splashed the water over my face and head, feeling the freezing rivulets drip down my neck. nothing quite like it in all the world. it was almost torture to put my shoes back on for the walk up the hill to the parking area.
the last time i was at moosilauke was late fall. the lodge was deserted and it had already started snowing. yesterday, however, the lodge was full of summer staff and visitors, the sweet smell of cornbread lingering in the air. there was a man with dreadlocks playing guitar, trying to learn a song before tonight's 4th of July celebration perhaps.
we filled up our now empty water bottles and headed back, stopping at fat bob's for ice cream. to give you a sense of why it's called fat bob's, a baby size is 1 scoop, kid size 2 scoops, small 3 scoops, medium 4 scoops and large 5 scoops. no wonder americans are overweight. i got a twist with rainbow sprinkles. a little girl in line behind us said excitedly to her mother, "she got rainbow sprinkles!" i remember being that excited for rainbow sprinkles once upon a time.
after a late afternoon nap, my sister and i went to watch the fireworks. it was really quite impressive. greens and golds, red, white and blue, pinks and purples all showering over the river, the boom echoing loudly off the hillsides. during the finale, the song "born in the USA" was blasting over the loudspeaker. my sister and i both looked at each other and wondered why they chose that song, as the lyrics are not the most glowing portrait of life in this country. but i guess as long as the chorus is catchy, what does it matter?
all told, it was a cleansing, restorative and grounding day...reminding me of my own, innate independence and strength and also of my inextricable link to the earth and the people in my life whom i love dearly. i think i'll have to make this a new july 4th tradition.
Friday, June 30, 2006
morning edition
one of the good things about being on my ED month is that i get to listen to the entirety of morning edition, as opposed to the 10 minute snippet i usually get on my drive into the hospital. so today, there was a really neat piece on jerry falwell. i was not aware of this, but apparently, everyone sends him Tinky-Winkys and the guy who ghost-wrote his autobiography has come out of the closet and sits front and center in his church every sunday. talk about poetic justice. i highly recommend a listen.
Sunday, June 25, 2006
last day as an intern
so, it's almost done. everyone has been congratulating me today for getting through this year. like it's some great accomplishment, like i did something more worthwhile than running around like a chicken with my head cut off.
truthfully, i'll be glad when tomorrow morning comes and i can sign out the ward to the new crop of interns, all bright-eyed and trepidatious (if that's even a word). but i have no real sense of accomplishment about it. i've just been barely keeping my head above water. if that's an accomplishment or giant feat of strength, well, then i guess congratulations are in order.
frankly, i'm just exhausted and numb. everyone says second year is better. is it better or are you just used to feeling this way?
i am the runner up for the black cloud award (an award given to that lucky resident who has the worst call nights). my chief said i would have won it outright, except the girl who won it was graduating and i had 2 more years to achieve that particular honor. my goal for my pl-2 year is to win the white cloud award. my fortune is bound to change. here's to quiet nights (knock on wood)...
truthfully, i'll be glad when tomorrow morning comes and i can sign out the ward to the new crop of interns, all bright-eyed and trepidatious (if that's even a word). but i have no real sense of accomplishment about it. i've just been barely keeping my head above water. if that's an accomplishment or giant feat of strength, well, then i guess congratulations are in order.
frankly, i'm just exhausted and numb. everyone says second year is better. is it better or are you just used to feeling this way?
i am the runner up for the black cloud award (an award given to that lucky resident who has the worst call nights). my chief said i would have won it outright, except the girl who won it was graduating and i had 2 more years to achieve that particular honor. my goal for my pl-2 year is to win the white cloud award. my fortune is bound to change. here's to quiet nights (knock on wood)...
Friday, June 23, 2006
i'm an aunty!
well, sort of.
my housemate for most of med school recently had her baby.
she's absolutely beautiful. really, objectively beautiful. her head wasn't even very squashed, which is impressive.
i'm an honorary aunt, which translates into buying her lots of really cute baby clothes and toys.
aren't kids amazing?
my housemate for most of med school recently had her baby.
she's absolutely beautiful. really, objectively beautiful. her head wasn't even very squashed, which is impressive.
i'm an honorary aunt, which translates into buying her lots of really cute baby clothes and toys.
aren't kids amazing?
Monday, June 19, 2006
what do you do when you don't know what to say?
i went to visit a boy today. i've taken care of him a lot on the inpatient floor. i wrote the discharge summary when he was going home after his 207 day hospital stay for his bone marrow transplant, complicated by everything you could possibly imagine. he's in our picu right now, on an oscillator, edematous, in multi-system organ failure. he has graft vs host disease from his bone marrow transplant. he's dying. i had no idea what to say.
i stood awkwardly in the doorway for a second, my eyes meeting his mother's. there was still so much hope in her eyes, as well as defiance. it was almost as if she were silently daring me to say something sympathetic, as if that would be confirmation that her son was dying.
so i said nothing.
i walked past him, barely glancing at him but seeing immediately that look...if you've ever seen a dying child, you will know what i mean.
i sat down on the chair by the window next to his mother.
"how are you?" i asked.
she smiled. apparently, i had passed the test.
"i'm doing ok," she said with a shrug. "he looks better than yesterday."
i stood awkwardly in the doorway for a second, my eyes meeting his mother's. there was still so much hope in her eyes, as well as defiance. it was almost as if she were silently daring me to say something sympathetic, as if that would be confirmation that her son was dying.
so i said nothing.
i walked past him, barely glancing at him but seeing immediately that look...if you've ever seen a dying child, you will know what i mean.
i sat down on the chair by the window next to his mother.
"how are you?" i asked.
she smiled. apparently, i had passed the test.
"i'm doing ok," she said with a shrug. "he looks better than yesterday."
Monday, June 05, 2006
national headache awareness week
it's day 2 of national headache awareness week. does this mean that i'm going to have this headache that started yesterday all week?
Sunday, June 04, 2006
things that irk me...
...that are, in the long run, not important, but irritating nonetheless.
a friend of mine was supposed to call me before she left her house (as she is without a cell phone) to give me directions to a picnic that we're going to today.
she didn't call.
luckily, she was picking another friend up on the way, so i called him and got directions after all.
when asked, she said she just forgot. she was sorry. that's just how she is. maybe she'll get better about calling people.
i guess it irritated me because if the roles had been reversed, i would have called her. i'm sorry. that's just how i am. maybe i'll learn to be more forgetful.
a friend of mine was supposed to call me before she left her house (as she is without a cell phone) to give me directions to a picnic that we're going to today.
she didn't call.
luckily, she was picking another friend up on the way, so i called him and got directions after all.
when asked, she said she just forgot. she was sorry. that's just how she is. maybe she'll get better about calling people.
i guess it irritated me because if the roles had been reversed, i would have called her. i'm sorry. that's just how i am. maybe i'll learn to be more forgetful.
Saturday, June 03, 2006
rainy saturday idealism
So I awoke this morning to the sound of the work truck backing up the driveway. They're here to put in the new kitchen counters. They were supposed to come yesterday, along with the plumbers, so I could have a functional kitchen. The plumbers showed up yesterday afternoon as planned, but the installers did not. So here they are now.
It's gray and raining here today and fairly dreary. So I guess it's a good day to have workmen tromping in and out of the house, drilling and filling the air with the smell of silicone. Mmm, silicone.
I spent the morning sitting on the couch trying to develop a new curriculum for professional development, something that has been fairly ignored in our program to date. But now we have an RRC site visit coming up and our new program director is suddenly very interested in what research and advocacy projects the residents are involved in. Not very many, that much is clear. How many residents attend national professional society meetings? Hardly any. How many residents have an updated CV? Probably only the ones graduating who nad to finish them for their job applications.
So the idea we came up with is to have a certain number of PEDs, or personalized education days, to devote to professional development. The pun wasn't my idea. But it's a good idea. Maybe it will inspire people to try again to make a difference on a larger scale, something that seemed to be more expected when we were med students.
I think we've lost something in medicine of late. A sense of professional responsibility. Collectively, we've lost our way and have gotten bogged down in the quagmire. A respected surgeon from my med school once said, “There are three professions in this world: law, clergy and medicine.” The implication of his words is that being a doctor or a lawyer or a religious leader entails more than going to work everyday and going through the daily grind. There is a professional duty and responsibility that pervades every aspect of life.
In this era of the 80-hour rules, rising health care costs, and cynicism about the practice of medicine in general, there is the temptation to do only what is necessary to get through the day. The practice of medicine is becoming ever more specialized and compartmentalized. The 80-hour work rules that were intended to protect us from grueling hours and fatigue have only served to give us a sense that what we do is shift work; our hours are up and we punch out, not literally but emotionally. There is an emphasis on more efficient delivery of care and RVU-generation that attendings have likened to working in a factory: 15 minutes in one room, then on to the next and the next and the next. There is an emerging sense that we, as physicians-in-training and future leaders of our profession, cannot make a difference. This in contrast to the dewy-eyed new medical student who fought to get into medical school so they could make a difference in the world and help people. There has never been a greater need to promote professional development and responsibility in our learners, to re-instill in them that sense of passion and motivation to do good works.
I'm not sure that this new curriculum will change anything, but maybe it will give someone an opportunity to try. An idealistic attending that I respect enormously for his passion and dedication to some of the most desperate children in this world once said to me, "We've got to save the world." At first, I thought this was a silly thing to say. But then I realized that he was right.
Who else will if we don't?
Here's a rainy day toast to passionate idealism...
It's gray and raining here today and fairly dreary. So I guess it's a good day to have workmen tromping in and out of the house, drilling and filling the air with the smell of silicone. Mmm, silicone.
I spent the morning sitting on the couch trying to develop a new curriculum for professional development, something that has been fairly ignored in our program to date. But now we have an RRC site visit coming up and our new program director is suddenly very interested in what research and advocacy projects the residents are involved in. Not very many, that much is clear. How many residents attend national professional society meetings? Hardly any. How many residents have an updated CV? Probably only the ones graduating who nad to finish them for their job applications.
So the idea we came up with is to have a certain number of PEDs, or personalized education days, to devote to professional development. The pun wasn't my idea. But it's a good idea. Maybe it will inspire people to try again to make a difference on a larger scale, something that seemed to be more expected when we were med students.
I think we've lost something in medicine of late. A sense of professional responsibility. Collectively, we've lost our way and have gotten bogged down in the quagmire. A respected surgeon from my med school once said, “There are three professions in this world: law, clergy and medicine.” The implication of his words is that being a doctor or a lawyer or a religious leader entails more than going to work everyday and going through the daily grind. There is a professional duty and responsibility that pervades every aspect of life.
In this era of the 80-hour rules, rising health care costs, and cynicism about the practice of medicine in general, there is the temptation to do only what is necessary to get through the day. The practice of medicine is becoming ever more specialized and compartmentalized. The 80-hour work rules that were intended to protect us from grueling hours and fatigue have only served to give us a sense that what we do is shift work; our hours are up and we punch out, not literally but emotionally. There is an emphasis on more efficient delivery of care and RVU-generation that attendings have likened to working in a factory: 15 minutes in one room, then on to the next and the next and the next. There is an emerging sense that we, as physicians-in-training and future leaders of our profession, cannot make a difference. This in contrast to the dewy-eyed new medical student who fought to get into medical school so they could make a difference in the world and help people. There has never been a greater need to promote professional development and responsibility in our learners, to re-instill in them that sense of passion and motivation to do good works.
I'm not sure that this new curriculum will change anything, but maybe it will give someone an opportunity to try. An idealistic attending that I respect enormously for his passion and dedication to some of the most desperate children in this world once said to me, "We've got to save the world." At first, I thought this was a silly thing to say. But then I realized that he was right.
Who else will if we don't?
Here's a rainy day toast to passionate idealism...
Saturday, May 27, 2006
parent phone calls: episode II
04:44 5/27
mommy: yeah, i'm calling about my son. he's 8 months old. he's had this cold for a long time.
girlMD: how long is a long time?
mommy: a couple weeks. he got some medicine for an ear infection last week, but i know his ear is still bothering him 'cause he's still digging at them. and now he's got this cough.
girlMD: can you describe the cough at all?
mommy: well, it's dry but tight.
girlMD: any fevers?
mommy: no, not really.
girlMD: do you feel like he's having trouble breathing?
mommy: no. right now he's pretty calm.
girlMD: alright. he's not flaring his nostrils or retracting or breathing fast?
mommy: no. he's drinking his bottle.
(awkward pause as girlMD tries to figure out how to politely say, why the heck are you calling me at 5 in the morning if your kid is fine and has been sick for several weeks?)
mommy: well, i guess i'm just worried that you might think he needs to be seen now, instead of waiting until the clinic opens.
girlMD: well, if you don't think he's having trouble breathing, then i think it's ok to wait. our phones open at 8am and our appointments start at 9am. do you feel comfortable waiting until then?
mommy: yeah, i think so. we'll get some rest and call in the morning. thanks a lot.
girlMD: oh, you're welcome.
mommy: yeah, i'm calling about my son. he's 8 months old. he's had this cold for a long time.
girlMD: how long is a long time?
mommy: a couple weeks. he got some medicine for an ear infection last week, but i know his ear is still bothering him 'cause he's still digging at them. and now he's got this cough.
girlMD: can you describe the cough at all?
mommy: well, it's dry but tight.
girlMD: any fevers?
mommy: no, not really.
girlMD: do you feel like he's having trouble breathing?
mommy: no. right now he's pretty calm.
girlMD: alright. he's not flaring his nostrils or retracting or breathing fast?
mommy: no. he's drinking his bottle.
(awkward pause as girlMD tries to figure out how to politely say, why the heck are you calling me at 5 in the morning if your kid is fine and has been sick for several weeks?)
mommy: well, i guess i'm just worried that you might think he needs to be seen now, instead of waiting until the clinic opens.
girlMD: well, if you don't think he's having trouble breathing, then i think it's ok to wait. our phones open at 8am and our appointments start at 9am. do you feel comfortable waiting until then?
mommy: yeah, i think so. we'll get some rest and call in the morning. thanks a lot.
girlMD: oh, you're welcome.
Wednesday, May 24, 2006
lost art forms
the laying on of hands is truly a lost art form. tonight, i was asked by one of the floor nurses to come evaluate a baby who was quite agitated and setting off her alarms. this baby has quite a complex past medical history and has plenty of scary reasons why she could be setting off alarms. so, with respectful trepidation, i walked in to her room (after washing my hands, of course...hey, we've got a pertussis outbreak here).
she was lying in the crib, exposed, mottled, crying. her sat was 78, she was breathing 60-70 times per minute. i listened to her chest, a cacophony of sound that is a testament to her cardiothoracic surgeon in Boston. no crackles, though. no heart failure. no pneumonia to explain why she is needing more oxygen. she's still crying. i look around for her mother, who is usually, tirelessly, present. however, she is not. she is hopefully home getting some much-needed rest.
i decide to stand-in, imperfect as i may be.
i rub her back, make soothing sounds. shhh. you're ok. shhh. i covered her cold little feet with a blanket.
i look at the monitors, still blinking red alarms, but numbers that are moving in the right direction. respiratory rate down, oxygen saturation up. crying stops. she sleeps again.
the laying on of hands. it may just be coincidence, but i'm going to delude myself and believe that it worked.
she was lying in the crib, exposed, mottled, crying. her sat was 78, she was breathing 60-70 times per minute. i listened to her chest, a cacophony of sound that is a testament to her cardiothoracic surgeon in Boston. no crackles, though. no heart failure. no pneumonia to explain why she is needing more oxygen. she's still crying. i look around for her mother, who is usually, tirelessly, present. however, she is not. she is hopefully home getting some much-needed rest.
i decide to stand-in, imperfect as i may be.
i rub her back, make soothing sounds. shhh. you're ok. shhh. i covered her cold little feet with a blanket.
i look at the monitors, still blinking red alarms, but numbers that are moving in the right direction. respiratory rate down, oxygen saturation up. crying stops. she sleeps again.
the laying on of hands. it may just be coincidence, but i'm going to delude myself and believe that it worked.
parent phone calls: episode I
"Hi. I'm calling about my son. He's been crying for over 2 hours and I can't get him to stop."
(I listen intently to the background, waiting for the wailing she described.)
"Uh, what's he doing right now?"
"Sleeping."
This was at 1am.
(I listen intently to the background, waiting for the wailing she described.)
"Uh, what's he doing right now?"
"Sleeping."
This was at 1am.
Tuesday, May 23, 2006
coffee break
i think coffee breaks are essential to sanity. we run ourselves ragged virtually every day. sometimes, we just need to stop, put our feet up and have a hot cup of coffee.
to what do i owe this luxury? well, both my attendings started their afternoon evals before i got back from noon conference.
i've already had one cup this morning, but there's no such thing as too much coffee.
to what do i owe this luxury? well, both my attendings started their afternoon evals before i got back from noon conference.
i've already had one cup this morning, but there's no such thing as too much coffee.
Friday, May 19, 2006
nostalgia
i was browsing the itunes music store this evening and stumbled on their U2 collection. i was somehow magically transported back to summers with my best friend, sunbathing on her lawn and listening to war or october. this was before joshua tree, although we loved that, too, in it's time.
in our girlhood fantasies, anne was going to marry the edge and i was going to marry bono. no offense to larry mullen or adam clayton.
of course, we also pretended we were the go-go's, but that's a story for a different day.
in our girlhood fantasies, anne was going to marry the edge and i was going to marry bono. no offense to larry mullen or adam clayton.
of course, we also pretended we were the go-go's, but that's a story for a different day.
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