Sometimes I have to remind myself to not be so negative, or at the very least, look on the bright side occasionally (which I find blindingly bright). I call myself a realist to make myself feel better about the fact that I'm probably more aptly described as a pessimist. Point? I was listening to NPR the other day (see I told you I listen to NPR!) and they were discussing the new program put forth by Fannie Mae and Freddie Mac to help people 90 days delinquent on mortgage payments. Invariably the conversation centered on the people who are being seriously affected (not to imply anyone hasn't been seriously affected in some way) by the economic downturn, e.g. laid off and thus not able to pay their mortgages.
It got me thinking about my job security. I've often heard it said that healthcare is a 'recession-proof industry,' stemming from the argument that people get sick regardless of how bear a market is. I understand that logic for a hospital-based practice, but would contend that primary care visits and prescription refills, in such a market, could both decidedly decrease in order to save co-pays. Regardless, I am quite thankful that I do have job security -at least for the next year and a half (I can only be so optimistic).
Saturday, November 15, 2008
Wednesday, November 12, 2008
I've Got A Feeling!
One of the most rewarding, yet incredibly humbling aspects of medicine is the perpetual learning curve. People 'in the biz' refer to it as being a lifelong learner. Not just individually, but globally, if we stopped learning or assimilating new information, we, in a sense, would stop evolving (or maturing for those who fear the word evolve). It is humbling to know that I will never know all there is to know within Internal Medicine. At the same time, however, for me, that is also what keeps medicine refreshing and challenging.
I recently stepped back into a 'basic science' laboratory in part to fulfill a residency requirement, but also to journey into a land that I am removed from in clinical medicine. This has been a challenge in another way. As I said previously, I enjoy learning new things each day, but being in the lab for me is less about daily learning and more of feeling completely aloof. I haven't done this sort of work since my early college years (8 years ago at least). Pipetting, dilutions, plating, etc; all basic lab techniques yet now completely foreign to me. To say it is humbling doesn't describe my emotions. It is actually frustrating to think that I spent four years getting a M.D., feel somewhat competent treating patients, and yet when placed in the lab its like I am a freshman in college. Have I learned nothing?! What have I been doing with my life?!
Let me reiterate the dichotomy I'm trying to draw, I enjoy the challenges the medical field brings each day, but I really do not enjoy feeling like a complete idiot! Yet invariably, at every turn of medicine, I do. I did as a first year medical student. I did as a third year medical student. I did as a brand new intern. Now I do again as I foray into the lab.
Will it ever end?
I recently stepped back into a 'basic science' laboratory in part to fulfill a residency requirement, but also to journey into a land that I am removed from in clinical medicine. This has been a challenge in another way. As I said previously, I enjoy learning new things each day, but being in the lab for me is less about daily learning and more of feeling completely aloof. I haven't done this sort of work since my early college years (8 years ago at least). Pipetting, dilutions, plating, etc; all basic lab techniques yet now completely foreign to me. To say it is humbling doesn't describe my emotions. It is actually frustrating to think that I spent four years getting a M.D., feel somewhat competent treating patients, and yet when placed in the lab its like I am a freshman in college. Have I learned nothing?! What have I been doing with my life?!
Let me reiterate the dichotomy I'm trying to draw, I enjoy the challenges the medical field brings each day, but I really do not enjoy feeling like a complete idiot! Yet invariably, at every turn of medicine, I do. I did as a first year medical student. I did as a third year medical student. I did as a brand new intern. Now I do again as I foray into the lab.
Will it ever end?
Tuesday, November 11, 2008
Cash Is King!
I was filling up with gas at a local station recently and came across this sign. 8 cents more for credit card purchases?! Has anyone seen this before? I for one was taken by surprise and immediately pulled a $20 out.
I guess when the economy is tanking, there is only one certainty... cold, hard cash.
Thursday, October 23, 2008
Ah, the rhetoric!!
What can I say, I have a love-hate relationship with politics. Little else frustrates and irritates me more, yet I always come back for seconds, and thirds. AAHHH! The lies and half-truths we are told! The hypocrisy of their words! Even more infuriating to me, is that as an American public we allow them to do it again and again!
So whats the 'sound bite' of the last two weeks? Socialism.
At no point in history has there been as great a dichotomy between rich and poor than in our country right now. But, despite this, we are scared when someone talks about increasing the taxes for the wealthiest and decreasing it for those in the middle-of-the-road. As it stands now, the wealthiest of the wealthy pay a smaller percentage of their total net worth, than 'joe the plumber.' Why? Because they can afford the accountants that know the loopholes in the current convoluted tax system. How is that fair?
The hilarious part of it all, the government has talked about using the 700 billion buyout package to buy stock in private banks!! So lets see. Its ok for us to partially nationalize banks when we are in an 'economic crisis,' but if a dictator of a country we don't like (i.e. Venezuela) does it, we condemn the act? I'm not saying I agree with it either, but interesting nonetheless. Still more interesting, both presidential candidates approved the buyout and President Bush signed it, so how can you point the finger at one candidate about being a socialist?
In my humble opinion, public figures (and the media) play off our fear of what we think socialism means. Surely, the word conjures up memories of the atrocities of the old Soviet Union, North Korea, Cuba, etc. However, haven't we - a capitalistic society - committed atrocities as well? I fundamentally believe the similarity of both is the sin nature of greed. Karl Marx famously stated, "religion is the opiate of the masses." He saw religion temporizing society's desire to 'rise up' against a ruling class in the final transition to communism. Let me say this, it is not religion that pacifies us, it is naivety. We no longer question what we do not know. We as a country have done far to little questioning of our government, our corporations, and ourselves.
Thursday, October 16, 2008
Lets Vote!
The third and final presidential debate is over, so you must be ready to vote! Yeah, neither am I. Watching the debate last night, I was unimpressed. It’s the same old rhetoric again and again.
The most notable aspects for me are the following:
1. McCain comes off as an irritable and smug candidate. The contrast to Obama is striking, because he exudes calmness and a quiet confidence. The presidency shouldn’t be based on this alone, but lets be honest, he seems more ‘presidential.’
2. Obama likes government. A good number of his policies center around spending more money and more government regulatory oversight. I’m not convinced that’s the way to go and I don’t like the government in my business.
3. McCain keeps repeating “We can do it. We’ll get it done.” (this is especially evident in the second debate), which continually gives me the impression he thinks its going to be easy. As a country we are facing a multitude of problems and yes I think we can get through them, but not without changing the way we live our lives and sacrificing a few things (I’m not talking civil liberties here people). It is ludicrous, knowing the scope of the issues, to think we are going to tackle the environment, social security, AND healthcare at the same time like he proposed in the second debate.
Obama was right on in his closing statement and said two important things. First, that we need to make sacrifices. Economically speaking, we can’t continue to live outside our means as a government, as families, or as individuals. We are a credit-loving people, who want everything now. The blame for the current economic crisis does lie mostly on Wall Street, but every citizen should be prepared to accept some responsibility. Secondly he said, we need to get back to investing in the American infrastructure with education, small businesses, jobs, etc.
I still haven’t decided who to vote for and November 4th is coming quickly (even quicker if one has to vote by absentee – which I do). I found a website (www.glassbooth.org) that asks you to answer a series of questions on relevant issues, tallies the answer, then provides the candidate(s) – in rank order – that aligns best with your own beliefs. My choice was strikingly clear: Obama 71% and McCain 71%. So I guess that means if McCain and Obama have an illegitimate son or daughter who runs for president, they’re getting my vote!
The most notable aspects for me are the following:
1. McCain comes off as an irritable and smug candidate. The contrast to Obama is striking, because he exudes calmness and a quiet confidence. The presidency shouldn’t be based on this alone, but lets be honest, he seems more ‘presidential.’
2. Obama likes government. A good number of his policies center around spending more money and more government regulatory oversight. I’m not convinced that’s the way to go and I don’t like the government in my business.
3. McCain keeps repeating “We can do it. We’ll get it done.” (this is especially evident in the second debate), which continually gives me the impression he thinks its going to be easy. As a country we are facing a multitude of problems and yes I think we can get through them, but not without changing the way we live our lives and sacrificing a few things (I’m not talking civil liberties here people). It is ludicrous, knowing the scope of the issues, to think we are going to tackle the environment, social security, AND healthcare at the same time like he proposed in the second debate.
Obama was right on in his closing statement and said two important things. First, that we need to make sacrifices. Economically speaking, we can’t continue to live outside our means as a government, as families, or as individuals. We are a credit-loving people, who want everything now. The blame for the current economic crisis does lie mostly on Wall Street, but every citizen should be prepared to accept some responsibility. Secondly he said, we need to get back to investing in the American infrastructure with education, small businesses, jobs, etc.
I still haven’t decided who to vote for and November 4th is coming quickly (even quicker if one has to vote by absentee – which I do). I found a website (www.glassbooth.org) that asks you to answer a series of questions on relevant issues, tallies the answer, then provides the candidate(s) – in rank order – that aligns best with your own beliefs. My choice was strikingly clear: Obama 71% and McCain 71%. So I guess that means if McCain and Obama have an illegitimate son or daughter who runs for president, they’re getting my vote!
Friday, October 3, 2008
Swapped Out?
I, like most other Americans, was glued to the VP debate last night. Less of my interest was to hear a sincere appeal to a country's citizens - as I'm not sure politicians are capable of sincerity - but to see if Gov. Palin would implode. I, like most other Americans, was surprised; pleasantly.
Was that the same Gov. Palin who gave Katie Couric multiple interviews last week? She was direct and on cue with her responses. She appeared to know what she was talking about. She did, however, fail to answer multiple questions, which is less of a personal failure and more of a character trait inherent to politics. It wasn't, in my opinion, that she hit a homerun, but merely showed she can talk on a national stage. Granted, every day for the last two weeks she's been coached on what to say, but still.
On the other side of the stage, Senator Biden seemed angry and equally as surprised in Gov. Palin's lasting fortitude through the evening. I haven't looked at any poll numbers, but my suspicion is that her performance will boost their ticket into the coming week.
Was that the same Gov. Palin who gave Katie Couric multiple interviews last week? She was direct and on cue with her responses. She appeared to know what she was talking about. She did, however, fail to answer multiple questions, which is less of a personal failure and more of a character trait inherent to politics. It wasn't, in my opinion, that she hit a homerun, but merely showed she can talk on a national stage. Granted, every day for the last two weeks she's been coached on what to say, but still.
On the other side of the stage, Senator Biden seemed angry and equally as surprised in Gov. Palin's lasting fortitude through the evening. I haven't looked at any poll numbers, but my suspicion is that her performance will boost their ticket into the coming week.
Thursday, October 2, 2008
Please Tell Me You're Kidding
I must be irritated to break out from an almost 4-month blogging hiatus to write today. In truth, it seems I only write when I'm irritated and need to vent, or on the infrequent occasion I have an original thought, which, quite frankly, is very infrequent. With still a month left, I am already fed up with this political season. I'm tired of the 'spin.' I'm tired of people who care more about their political party than our country (example). I'm tired of candidates and pundits alike speaking with such astounding certainty, in an uncertain time. Most aggravatingly, I'm tired of being lied and pandered to. I feel so betrayed and skeptical about anyone in politics, mostly because I don't believe my or my country's best interests are represented.
As is plainly obvious, there is little that 'gets my ire up' like politics - unless we're talking traffic, which is entirely another story. Having said that, I find myself continually drawn to watch and be perpetually irritated. This past week I took to catching up on the presidential race, watching interviews and debates. So, I have watched and so have become irritated. Most interestingly, I watched the multiple interviews of Gov. Palin by Katie Couric. I frankly, was utterly amazed and pretty sure I sat with my mouth wide open for a good 5 minutes.
In one of the interviews, she astonishingly stated '...all of them, any of them, that have been in front of me over the years' in reference to the question of what newspapers she read prior to being picked as the VP nominee (video here). Really? I'm supposed to believe you read all the newspapers across the country to keep up to date? How hard is it to merely state one or two examples? Not very in my opinion. Maybe she misspoke. Ok, I'll buy. We all misspeak at one time or another, so I understand that. But did she take a step back and retract or change her statement? No she immediately went into a defensive diatribe about how Alaska isn't a foreign country. Really? Really?
What about all that 'executive experience' Gov. Palin has, lauded over and over again by the McCain campaign. I'm pretty sure they've even gone as far to say she has more executive experience than Obama and Biden combined. I wish not to contest that statement, but merely point out that as the executor of a city or state, one must deal with budgets and the economy, right? Then you would think, having had that experience, one would be better apt to deftly and intelligently converse on the current economic crisis facing the US. Well my friends, you'd be wrong. Take a listen to her ramble: video. I won't pretend for a second that I, myself, understand the cause of and nuances involved in the falling market or how to fix it, but then again I'm not pursuing the vice-presidency of arguably the most powerful and influential (read: imperialistic) nation in the world.
And probably the funniest moment of all these interviews is on the second go-round, when Senator McCain is present to moderate. Right out of the gate, Gov. Palin defends what she said. Hmmm, canned? McCain sits there looking like an unhappy father and smiling uncomfortably. Think she'll have another unchaperoned interview? Unlikely.
Despite what you might be thinking right now, I have yet to determine whom I will vote for. But as this election season continues, I am more and more convinced Gov. Palin is unqualified and McCain chose her in order to shore up the evengelical base and appeal to Hilliary supporters. And no I'm not just attacking her because she is a woman as people argue. The truth be told, I don't care if you are white, black, male, or female; I expect you to be able to answer the tough questions and do the tough job that I can't do. If you're reading this, identify yourself as a republican, and critized Hilliary when she complained of being picked on, don't you think you're being a little hypocritical at this juncture? And for the record, no, I don't want you to be "joe six-pack" because joe-six pack shouldn't be president or vice-president.
Sorry, I said I get irritated. Note to self: take blood pressure medicine before the debate starts.
As is plainly obvious, there is little that 'gets my ire up' like politics - unless we're talking traffic, which is entirely another story. Having said that, I find myself continually drawn to watch and be perpetually irritated. This past week I took to catching up on the presidential race, watching interviews and debates. So, I have watched and so have become irritated. Most interestingly, I watched the multiple interviews of Gov. Palin by Katie Couric. I frankly, was utterly amazed and pretty sure I sat with my mouth wide open for a good 5 minutes.
In one of the interviews, she astonishingly stated '...all of them, any of them, that have been in front of me over the years' in reference to the question of what newspapers she read prior to being picked as the VP nominee (video here). Really? I'm supposed to believe you read all the newspapers across the country to keep up to date? How hard is it to merely state one or two examples? Not very in my opinion. Maybe she misspoke. Ok, I'll buy. We all misspeak at one time or another, so I understand that. But did she take a step back and retract or change her statement? No she immediately went into a defensive diatribe about how Alaska isn't a foreign country. Really? Really?
What about all that 'executive experience' Gov. Palin has, lauded over and over again by the McCain campaign. I'm pretty sure they've even gone as far to say she has more executive experience than Obama and Biden combined. I wish not to contest that statement, but merely point out that as the executor of a city or state, one must deal with budgets and the economy, right? Then you would think, having had that experience, one would be better apt to deftly and intelligently converse on the current economic crisis facing the US. Well my friends, you'd be wrong. Take a listen to her ramble: video. I won't pretend for a second that I, myself, understand the cause of and nuances involved in the falling market or how to fix it, but then again I'm not pursuing the vice-presidency of arguably the most powerful and influential (read: imperialistic) nation in the world.
And probably the funniest moment of all these interviews is on the second go-round, when Senator McCain is present to moderate. Right out of the gate, Gov. Palin defends what she said. Hmmm, canned? McCain sits there looking like an unhappy father and smiling uncomfortably. Think she'll have another unchaperoned interview? Unlikely.
Despite what you might be thinking right now, I have yet to determine whom I will vote for. But as this election season continues, I am more and more convinced Gov. Palin is unqualified and McCain chose her in order to shore up the evengelical base and appeal to Hilliary supporters. And no I'm not just attacking her because she is a woman as people argue. The truth be told, I don't care if you are white, black, male, or female; I expect you to be able to answer the tough questions and do the tough job that I can't do. If you're reading this, identify yourself as a republican, and critized Hilliary when she complained of being picked on, don't you think you're being a little hypocritical at this juncture? And for the record, no, I don't want you to be "joe six-pack" because joe-six pack shouldn't be president or vice-president.
Sorry, I said I get irritated. Note to self: take blood pressure medicine before the debate starts.
Thursday, June 19, 2008
I Fell For It
On the heels of my last post, I came across an article on the Men's Health website titled The 20 Unhealthiest Drinks in America. Quite a bold title if you ask me, but then again you didn't ask me. A number of the entries are exceedingly obvious like milkshakes, soda, lattes, etc. The one that took me off guard, #19, The Worst "Healthy" Drink: Glaceau VitaminWater.
What?! How can something called Vitamin Water be bad for you? Mom taught me water is the essence of life (insert Zoolander reference) and vitamins, well, are things I'm supposed to eat. So where did I miss the boat?
I'm insanely obsessed with my weight, not a sweets person and I rarely eat desserts, but my one guilty pleasure is VitaminWater. I love the stuff. Its quite refreshing, not too sweet and doesn't taste like plain old water. It kinda reminds me of Crystal Light, but just doesn't suck. Plus the little paragraph on the bottle explaining the flavor is pure literary genius.
I'm generally able to spot the marketing ploy behind products, but Glaceau got me good. Touche marketing director, touche... you have won this round.
What?! How can something called Vitamin Water be bad for you? Mom taught me water is the essence of life (insert Zoolander reference) and vitamins, well, are things I'm supposed to eat. So where did I miss the boat?
I'm insanely obsessed with my weight, not a sweets person and I rarely eat desserts, but my one guilty pleasure is VitaminWater. I love the stuff. Its quite refreshing, not too sweet and doesn't taste like plain old water. It kinda reminds me of Crystal Light, but just doesn't suck. Plus the little paragraph on the bottle explaining the flavor is pure literary genius.
I'm generally able to spot the marketing ploy behind products, but Glaceau got me good. Touche marketing director, touche... you have won this round.
Sunday, June 15, 2008
Calories Do Matter
I recently read a well-written TIME magazine piece on childhood obesity that reiterated to me how scary the obesity epidemic really is (the article can be found here). Scary because not only are we as adults overweight, but we are training our children to be just like us. I'm sure lots of people reading this are tired of the constant - nagging it seems almost - by medical professionals and news outlets regarding obesity. Truly, I suspect you will find yourself subconsciously saying, "yeah, yeah, we get it already," as you read this. Well do you? Certainly you've also seen, just as I wrote above, obesity tagged with the word epidemic more than once before. Is this a true statement or merely sensationalism the media often (read: always) uses?
What do I have to offer that is revolutionary? Well likely not much, other than my own experience, BUT if you have never seen the visual representation of how fat we are as a society, then keep reading. Below are CDC (Centers for Disease Control and Prevention) graphs of the U.S. adult obesity rates compiled for the last 20 years. In in the interest of time, I've only provided three: 1985, 1995, and 2005. For the full set visit the CDC's website. Quite impressive I must say.
Not so bad, eh?
Wait for it.....
Whether you are a visual learner or more numbers-based, the point comes across loud and clear (and no, more colors are not a good thing), we are one fat society.
Why does this matter? There are many, but my main concern are the TONS of health problems, ranging from mere nuisances to excess death, either caused or exacerbated by excess weight. I won't bore you by listing them all here, but knowing this and simultaneously viewing the grander scheme, it is easy to see the great weight (pun intended) this epidemic is placing on a healthcare system already in a broken state. It is well-known within the medical field that 90% of medical dollars are spent on 10% of the population. Certainly these individuals are not all obese, but if 30% of your population is obese and obesity causes greater health problems, I'd say thats a pretty causal relationship.
An interesting quote from the TIME article I mentioned above.
"A staggering 90% of overweight kids already have at least one avoidable risk factor for heart disease, such as high cholesterol or hypertension.... Health experts warn that the current generation of children may be the first in American history to have a shorter life expectancy than their parents'."
The article doesn't list it's sources, so I can't guarantee the accuracy of their statements, but hey, its TIME and if you can't believe TIME, who can you? I can tell you that after being in the hospital more than anyone should be allowed this past year, seeing a patient who is actually of a healthy weight is uncommon and I immediately start thinking of possible etiologies for their immense nutritional deficiency.
7 days left of the 'tern life!
What do I have to offer that is revolutionary? Well likely not much, other than my own experience, BUT if you have never seen the visual representation of how fat we are as a society, then keep reading. Below are CDC (Centers for Disease Control and Prevention) graphs of the U.S. adult obesity rates compiled for the last 20 years. In in the interest of time, I've only provided three: 1985, 1995, and 2005. For the full set visit the CDC's website. Quite impressive I must say.
Not so bad, eh?
Wait for it.....
Whether you are a visual learner or more numbers-based, the point comes across loud and clear (and no, more colors are not a good thing), we are one fat society.
Why does this matter? There are many, but my main concern are the TONS of health problems, ranging from mere nuisances to excess death, either caused or exacerbated by excess weight. I won't bore you by listing them all here, but knowing this and simultaneously viewing the grander scheme, it is easy to see the great weight (pun intended) this epidemic is placing on a healthcare system already in a broken state. It is well-known within the medical field that 90% of medical dollars are spent on 10% of the population. Certainly these individuals are not all obese, but if 30% of your population is obese and obesity causes greater health problems, I'd say thats a pretty causal relationship.
An interesting quote from the TIME article I mentioned above.
"A staggering 90% of overweight kids already have at least one avoidable risk factor for heart disease, such as high cholesterol or hypertension.... Health experts warn that the current generation of children may be the first in American history to have a shorter life expectancy than their parents'."
The article doesn't list it's sources, so I can't guarantee the accuracy of their statements, but hey, its TIME and if you can't believe TIME, who can you? I can tell you that after being in the hospital more than anyone should be allowed this past year, seeing a patient who is actually of a healthy weight is uncommon and I immediately start thinking of possible etiologies for their immense nutritional deficiency.
7 days left of the 'tern life!
Wednesday, June 11, 2008
Outside Hospital
I came across a hilarious parody of non-academic hospitals (lovingly referred to as Outside Hospitals for those in the biz) a few months ago during a long Gen Med call. Unless you are in the medical field, you likely won't get the humor, but nonetheless its a must see.
"If you have lungs, we can consult a pulmonologist.... We can consult any specialist to see you for any organ you have..." Love it!
Yes, the video is supposed to be a funny over-exaggeration, but its so very true. This is not about pride on the part of those at academic institutions, that we are in some manner better, but a pervasive opinion (read: fact) based on many many bad experiences. Countless times this year, I have received transfers from community hospitals that arrive with little more than a stack of papers that bear no resemblance to a coherent assessment and plan. Its like an episode of CSI, piecing together what might have transpired during the last 5 inpatient days. The patient says they had test x, y, and z.... any results in the collection of papers sent with the patient? Nope.
Invariably though, when the going gets tough and the community hospital has no idea what they've gotten themselves into, you see "Transfer to the University of _______" scribbled under the 'Plan' portion of daily note.
"If you have lungs, we can consult a pulmonologist.... We can consult any specialist to see you for any organ you have..." Love it!
Yes, the video is supposed to be a funny over-exaggeration, but its so very true. This is not about pride on the part of those at academic institutions, that we are in some manner better, but a pervasive opinion (read: fact) based on many many bad experiences. Countless times this year, I have received transfers from community hospitals that arrive with little more than a stack of papers that bear no resemblance to a coherent assessment and plan. Its like an episode of CSI, piecing together what might have transpired during the last 5 inpatient days. The patient says they had test x, y, and z.... any results in the collection of papers sent with the patient? Nope.
Invariably though, when the going gets tough and the community hospital has no idea what they've gotten themselves into, you see "Transfer to the University of _______" scribbled under the 'Plan' portion of daily note.
Saturday, June 7, 2008
Just Me Raising Questions I Can't Answer
I've been one of the fortunate few to be in the MICU (medical intensive care unit) currently. While I really don't consider myself fortunate to have the hardest block last (16 days of 'tern life left!), it is, however, an eye-opening experience to care for the sickest patients in the hospital. I'm generalizing to say the majority of patients roll into the unit mostly dead, but its hard to adequately describe just how profound the medical deficiencies these patients have, and somehow 'disarray' just doesn't cut it. The proverbial "poo hitting the fan" is probably a better descriptor.
It goes without saying, the capabilities of modern medicine have had exponential advances in the last half century. This does not mean, however, that we, as docs, should advance ourselves to the dangerous precipice of dictating life and death. But, it does seem at times that though we are not the authors of life and death, we can temporize it more than just a little. There is no better example of this than working in an ICU.
Almost mirroring the rise of medical advances, the expectations for the medical field are at an all-time high. The iconic example is curing cancer, but my impression from interacting with a host of patients is, as a society, we expect to never get sick, or at the very least never have our life impacted by disease. This became ever more clear to me after hearing the words spoken by the mother of one of my patients. "I want everything done for my son, there should be nothing held back," she said. Without the proper context, an innocuous statement to be sure. I have to be careful because of HIPAA, but what if I mentioned the patient was around my age. Would that change your reaction? How about if I said that he/she had no less than four major body systems not working, one of which being the brain? What if you knew this all came about because of a deliberate action by the patient? And finally, what if I mentioned the patient had no insurance whatsoever. Would that change anything?
Expectations are good, they push us to excel and reach goals we thought previously not possible. But at the same time, expectations are also quite unwieldy when they are out of proportion to reality. This is the frustration I have experienced time and again this year. As a physician I am expected to heal, to cure, to make all right again; but at what cost? At what cost to me? At what cost to other doctors and nurses? At what cost to the hospital? At what cost to society? I'm not speaking entirely monetarily, but certainly that is a piece of the grander puzzle. I can understand society's expectations for medical care, but doesn't quality of life matter too? Sure I can keep a patient alive on a ventilator for years, but is that whats best given their life consists only of bed sores and recurrent infections?
I've entered wholly into the philosophical realm and I don't have an answer for my previous question. Maybe to you, its a stupid question. But then likely, you haven't seen the horrors I have.
It goes without saying, the capabilities of modern medicine have had exponential advances in the last half century. This does not mean, however, that we, as docs, should advance ourselves to the dangerous precipice of dictating life and death. But, it does seem at times that though we are not the authors of life and death, we can temporize it more than just a little. There is no better example of this than working in an ICU.
Almost mirroring the rise of medical advances, the expectations for the medical field are at an all-time high. The iconic example is curing cancer, but my impression from interacting with a host of patients is, as a society, we expect to never get sick, or at the very least never have our life impacted by disease. This became ever more clear to me after hearing the words spoken by the mother of one of my patients. "I want everything done for my son, there should be nothing held back," she said. Without the proper context, an innocuous statement to be sure. I have to be careful because of HIPAA, but what if I mentioned the patient was around my age. Would that change your reaction? How about if I said that he/she had no less than four major body systems not working, one of which being the brain? What if you knew this all came about because of a deliberate action by the patient? And finally, what if I mentioned the patient had no insurance whatsoever. Would that change anything?
Expectations are good, they push us to excel and reach goals we thought previously not possible. But at the same time, expectations are also quite unwieldy when they are out of proportion to reality. This is the frustration I have experienced time and again this year. As a physician I am expected to heal, to cure, to make all right again; but at what cost? At what cost to me? At what cost to other doctors and nurses? At what cost to the hospital? At what cost to society? I'm not speaking entirely monetarily, but certainly that is a piece of the grander puzzle. I can understand society's expectations for medical care, but doesn't quality of life matter too? Sure I can keep a patient alive on a ventilator for years, but is that whats best given their life consists only of bed sores and recurrent infections?
I've entered wholly into the philosophical realm and I don't have an answer for my previous question. Maybe to you, its a stupid question. But then likely, you haven't seen the horrors I have.
Tuesday, June 3, 2008
How To Make A Million Dollars
When I was in college, I took a summer job managing my own franchise of a nationwide painting business in northern Delaware. It seemed like a great opportunity to not only make money but to hone some leadership skills, as I would be in charge of marketing the business, selling the jobs, and hiring subcontractors to actually do the work. The 'training weekend' that followed was quite exciting, as the company brought in success story after success story. One particular speaker said something that has stuck with me to this day. He said, "You only need to improve an existing product by 10% to make a million dollars." I don't know the credibility of such a statement, but it intuitively makes sense. Looking back on it, I did well monetarily and gained much wisdom through the experience, however I am also quite sour towards the company for a multitude of reasons. One of which was the realization that their desire was to lure young, energetic college students in with the promise of success, and in turn exploit them to make themselves more money.
Back to the point. Since that experience, I am incredibly sensitive towards people 'selling me' and recognize immediately when a salesperson is only interested in lining their pocket and not the customer's satisfaction. Being that when I'm not working I'm usually laying on my couch sleeping or watching TV, I've seen my fair share of infomercials this year. My favorite has to be for a product called Lypozyme, just for the sheer ridiculous assertions the company makes. It got me to think, "If your product is bogus, whats necessary to get people to buy it anyway?"
1. Give yourself a legit name.
If you're going to sell anything, you have to appear legit. How about the Obesity Research Institute... straight cash money.
2. Have a good looking person do the selling.
What infomercial have you seen that chooses a hobo to sell their product? None. In most cases its a beautiful and well-dressed woman, but sometimes a shirtless Abercrombie model with the personality of drywall graces the screen. Furthermore, its a fact that people trust you more if you're beautiful. Don't get mad at me, its science.
3. Offer the consumer statistics, no matter how ridiculous.
If you're going to buy a bogus product, you want to have a little fact on your side, so when your significant other says, "Why the heck did you spend money on that?!" you can respond, "But baby 78% people get ripped with this supplement!"
4. Make sure you mention it requires no effort.
This goes without saying, but we are one lazy society. If I don't have to do jack to have the body of Brad Pitt in Fight Club - done; sign me up.
5. The Free Trial
This is an absolute must. Its like asking somebody if they want free cheesecake - who is going to say no? Rhetorical question, because yes I want free cheesecake! Really, what doesn't come with a free trial these days? Life, thats what. Yeah this post just got real folks.
Back to the point. Since that experience, I am incredibly sensitive towards people 'selling me' and recognize immediately when a salesperson is only interested in lining their pocket and not the customer's satisfaction. Being that when I'm not working I'm usually laying on my couch sleeping or watching TV, I've seen my fair share of infomercials this year. My favorite has to be for a product called Lypozyme, just for the sheer ridiculous assertions the company makes. It got me to think, "If your product is bogus, whats necessary to get people to buy it anyway?"
1. Give yourself a legit name.
If you're going to sell anything, you have to appear legit. How about the Obesity Research Institute... straight cash money.
2. Have a good looking person do the selling.
What infomercial have you seen that chooses a hobo to sell their product? None. In most cases its a beautiful and well-dressed woman, but sometimes a shirtless Abercrombie model with the personality of drywall graces the screen. Furthermore, its a fact that people trust you more if you're beautiful. Don't get mad at me, its science.
3. Offer the consumer statistics, no matter how ridiculous.
If you're going to buy a bogus product, you want to have a little fact on your side, so when your significant other says, "Why the heck did you spend money on that?!" you can respond, "But baby 78% people get ripped with this supplement!"
4. Make sure you mention it requires no effort.
This goes without saying, but we are one lazy society. If I don't have to do jack to have the body of Brad Pitt in Fight Club - done; sign me up.
5. The Free Trial
This is an absolute must. Its like asking somebody if they want free cheesecake - who is going to say no? Rhetorical question, because yes I want free cheesecake! Really, what doesn't come with a free trial these days? Life, thats what. Yeah this post just got real folks.
Saturday, May 31, 2008
Times Are A Changing
I'm sitting in the MICU fishbowl, (thats the resident work area in the MICU, so called because it has windows the nurses use to watch us), waiting for code bongs to go off, and it dawns on me - tomorrow is June 1st! Important because that means only 21 more days of 'tern life for me! Woohoo! Thats either really awesome or really scary, depending on whether you're my patient or not :).
Due to such the occasion, it has me nostalgic for the craziness of intern year and more specifically the multitude of interesting patients I've cared for thus far. The one I'll never forget no matter what I do, where I go, or how senile I become (I would've said bald, but sadly I'm dangerously close to this already)... Mr. O. What makes him so special? Oh only because I've had the distinct pleasure of taking care of him twice and, oh by the way, have I mentioned he's my neighbor! Yeah that kinda takes the fun out of casually passing each other on the steps every other day.
Our first encounter. First month of internship, the doublemint twins and the rest of the team are heading down to the ED to meet the new overnight admit. We're standing in the patients room and I'm thinking to myself, "this guy looks awfully familar." Didn't take him as long to recognize me, as he belts out a heafty, "Howdy neighbor!" with the entire team standing around. Awesome.
Second encounter. I'm on one of my ICU months and is early AM during rounds. Code bongs reverberate the building and direct us to a room down the hall. I rush in the room with about 5 other people and wouldn't you know its my old buddy. Thankfully, it was just a narc overdose, but about 45 minutes later, there was a "Howdy neighbor!" directed at me from across the ICU. Great times.
21 days. Get it done.
Due to such the occasion, it has me nostalgic for the craziness of intern year and more specifically the multitude of interesting patients I've cared for thus far. The one I'll never forget no matter what I do, where I go, or how senile I become (I would've said bald, but sadly I'm dangerously close to this already)... Mr. O. What makes him so special? Oh only because I've had the distinct pleasure of taking care of him twice and, oh by the way, have I mentioned he's my neighbor! Yeah that kinda takes the fun out of casually passing each other on the steps every other day.
Our first encounter. First month of internship, the doublemint twins and the rest of the team are heading down to the ED to meet the new overnight admit. We're standing in the patients room and I'm thinking to myself, "this guy looks awfully familar." Didn't take him as long to recognize me, as he belts out a heafty, "Howdy neighbor!" with the entire team standing around. Awesome.
Second encounter. I'm on one of my ICU months and is early AM during rounds. Code bongs reverberate the building and direct us to a room down the hall. I rush in the room with about 5 other people and wouldn't you know its my old buddy. Thankfully, it was just a narc overdose, but about 45 minutes later, there was a "Howdy neighbor!" directed at me from across the ICU. Great times.
21 days. Get it done.
Thursday, May 29, 2008
The Original I Am Legend
For those of you who saw the recent film adaptation of I Am Legend and walked away saying, "What the hell?" This is for you. I came across the original ending to the movie, which mirrors more closely to the book and I have to say, what were the producers thinking? The original is TONS better. Watch yourself:
This ending - as opposed to the one used - actually gives philosophical weight to the movie. Legend (Will Smith) realizes in this sequence that HE is the monster, not the zombies. For they are attacking only to retrieve one of their own and in fact shows Legend is a ruthless killer, not a saviour! The title even makes sense, Smith is the legend of their (the creatures) nightmares. Furthermore, this ending depicts the creatures in a rational and evolving manner, adding to what we saw in previous scenes of leadership and trap-setting. Quite the revelation!
Some might prefer the non-thinking, slash-and-gore approach, I don't. Rumor has it, the original ending was shot and screened for a focus group, who preferred the alternate ending (the one published). What does this tell us? One, Hollywood does in fact ruin good books and second, the public is filled with idiots (incidentally which I already knew).
This ending - as opposed to the one used - actually gives philosophical weight to the movie. Legend (Will Smith) realizes in this sequence that HE is the monster, not the zombies. For they are attacking only to retrieve one of their own and in fact shows Legend is a ruthless killer, not a saviour! The title even makes sense, Smith is the legend of their (the creatures) nightmares. Furthermore, this ending depicts the creatures in a rational and evolving manner, adding to what we saw in previous scenes of leadership and trap-setting. Quite the revelation!
Some might prefer the non-thinking, slash-and-gore approach, I don't. Rumor has it, the original ending was shot and screened for a focus group, who preferred the alternate ending (the one published). What does this tell us? One, Hollywood does in fact ruin good books and second, the public is filled with idiots (incidentally which I already knew).
Thursday, May 22, 2008
A Magical Experience
Last weekend I went to see the second movie in the Chronicles of Narnia series, Prince Caspian, with Laurie. She was quite excited to see the film as she loves the book series and as it takes her back to childhood memories. Me on the other hand, was less excited and secretly wanted to see Iron Man instead.
There is a ton I could say about the movie, but really, I'm not in the mood to write much. What struck me the most while watching it was the similarities to a recently popular series, Harry Potter. I'm sure there are many ways to draw similarities and differences between these books, but what I realized was the centrality of magic in the stories. As an admission, I've never read a single Harry Potter book, but I do remember when it first came out and the scores Christian organizations and Christians themselves who blasted it's wizardry for teaching children evil things. Even more interesting was the amount of media coverage it received. In contrast, now that C.S. Lewis' series is in the mainstream, where is the opposition? Is not a potion that restores life, talking animals, and rituals to call powerful spirits magical?
I'm not trashing the Narnia series, but rather desire Christians (and everyone for that matter) to cast the same critical eye on all literature. Lets not play favorites. My fear is that Harry Potter received so much opposition is because it was written by an author who denies a sovereign God, whereas Narnia by an affirmed Christian. How can a secular world take what we say seriously if we are hypocritical in our judgments?
There is a ton I could say about the movie, but really, I'm not in the mood to write much. What struck me the most while watching it was the similarities to a recently popular series, Harry Potter. I'm sure there are many ways to draw similarities and differences between these books, but what I realized was the centrality of magic in the stories. As an admission, I've never read a single Harry Potter book, but I do remember when it first came out and the scores Christian organizations and Christians themselves who blasted it's wizardry for teaching children evil things. Even more interesting was the amount of media coverage it received. In contrast, now that C.S. Lewis' series is in the mainstream, where is the opposition? Is not a potion that restores life, talking animals, and rituals to call powerful spirits magical?
I'm not trashing the Narnia series, but rather desire Christians (and everyone for that matter) to cast the same critical eye on all literature. Lets not play favorites. My fear is that Harry Potter received so much opposition is because it was written by an author who denies a sovereign God, whereas Narnia by an affirmed Christian. How can a secular world take what we say seriously if we are hypocritical in our judgments?
Friday, May 16, 2008
Jack Bauer Who?!
I found this post that I wrote back in October, but never published. ahhh memories...
The last 8 hours in the CCU...
10pm: get sign-out from the other team
11pm: first admission arrives (pt#1) heads straight to the cath lab for inferior STEMI
1215am: pt#1 hits the floor, begin to write up h&p
1230am: pt#1 is in Vtach, has BP 70/50, and is vomiting repeatedly
1245am: discover pt#1 is actively infarcting his right ventricle
115am: 3L of fluid later BP still 80/60 --> start Dopamine gtt
2am: second admission arrives (pt#2)... Atrial fibrillation with complete heart block (ie HR is 30)
4am: third admission arrives (pt#3)... 88yo F in cardiogenic shock, no pulse --> code ensues
445am: pt#4 codes four flours up
5am: pt#3 codes again after being stabilized!
515am: pt#4 is pronounced
530am: pt#3 is pronounced
6am: pt#5 HR is 170
630am: sign-out to the primary teams and get the heck out of the CCU!
The last 8 hours in the CCU...
10pm: get sign-out from the other team
11pm: first admission arrives (pt#1) heads straight to the cath lab for inferior STEMI
1215am: pt#1 hits the floor, begin to write up h&p
1230am: pt#1 is in Vtach, has BP 70/50, and is vomiting repeatedly
1245am: discover pt#1 is actively infarcting his right ventricle
115am: 3L of fluid later BP still 80/60 --> start Dopamine gtt
2am: second admission arrives (pt#2)... Atrial fibrillation with complete heart block (ie HR is 30)
4am: third admission arrives (pt#3)... 88yo F in cardiogenic shock, no pulse --> code ensues
445am: pt#4 codes four flours up
5am: pt#3 codes again after being stabilized!
515am: pt#4 is pronounced
530am: pt#3 is pronounced
6am: pt#5 HR is 170
630am: sign-out to the primary teams and get the heck out of the CCU!
Tuesday, May 13, 2008
Book of Crap
I just finished watching the second National Treasure movie, coyly named Book of Secrets. I don't know if I can I adequately express how uninspiring it is (of course I will try though). Obviously the first question one should ask, "Why even see the movie given the first was so bland?" Great point. However, I respond by noting that the first was partially filmed in Philly and Philly rocks. Truthfully though, I have a soft spot for movies that afford me the opportunity to turn off my brain and just be entertained. I say this with a caveat, that the movie doesn't irritate me with its shear stupidity first. So with that expectation I watched Book of Secrets - and was still disappointed!
First, don't treat me (the moviegoer) like a 5-year old child. Both movies present themselves as 'puzzles,' which is almost laughable. I understand the average U.S. citizen reads below a 9th grade level, but that is no reason to create a movie where the actors proclaim truths that are insanely obvious to anyone with a brain. For instance when 4 of the main characters are trapped underground on what amounts to a large seesaw. Nic Cage exclaims, "We need to balance ourselves like counterweights!" No flippin kidding... you don't say. What gave you that impression? Possibly when you almost fell off because it was tipping?! I realize saying big words like 'counterweight' makes a sentence sound intelligent, but still no excuse. How about when 'Abigail Chase' shouts, "The water makes the rocks darker!" Holy crap, she should win the Nobel Prize for that one! Another example? When Jon Voight miraculously remembers his grandfathers dying words, "the debt that all men pay," when they were trying to solve the cypher. So all the years before, when he undoubtedly repeated this story ad nauseam, he simply forgot to share this crucial bit of information? Riiiight.
Secondly, get a better villain. Don't get me wrong, I enjoy Ed Harris and it doesn't get any better than Francis X. Hummel reciting Thomas Jefferson, "The tree of liberty must be refreshed from time to time with the blood of patriots!". It gets me every time. But, in this case, to have a villain whose sole motivation for masterminding a world-wide search for treasure be his slighted family name is frankly stupid. If his family is so bad off where'd he get all his money to travel the world? Heck, the dude trashed his Range Rover, doesn't seem like the Wilkinson's are doing that bad to me.
Thirdly, the 'don't kill my baby' bull expressed by movie-mothers time and again is played out. Seriously. We are led to believe the main characters mother has no contact with her son whatsoever, yet somehow she is brought to debilitating tears over his safety?! If you cared that much, why didn't you pick up a phone? I'm tired of women being portrayed in such a stupid emotional state. Not because it's sexist, but because its so flippin annoying!
First, don't treat me (the moviegoer) like a 5-year old child. Both movies present themselves as 'puzzles,' which is almost laughable. I understand the average U.S. citizen reads below a 9th grade level, but that is no reason to create a movie where the actors proclaim truths that are insanely obvious to anyone with a brain. For instance when 4 of the main characters are trapped underground on what amounts to a large seesaw. Nic Cage exclaims, "We need to balance ourselves like counterweights!" No flippin kidding... you don't say. What gave you that impression? Possibly when you almost fell off because it was tipping?! I realize saying big words like 'counterweight' makes a sentence sound intelligent, but still no excuse. How about when 'Abigail Chase' shouts, "The water makes the rocks darker!" Holy crap, she should win the Nobel Prize for that one! Another example? When Jon Voight miraculously remembers his grandfathers dying words, "the debt that all men pay," when they were trying to solve the cypher. So all the years before, when he undoubtedly repeated this story ad nauseam, he simply forgot to share this crucial bit of information? Riiiight.
Secondly, get a better villain. Don't get me wrong, I enjoy Ed Harris and it doesn't get any better than Francis X. Hummel reciting Thomas Jefferson, "The tree of liberty must be refreshed from time to time with the blood of patriots!". It gets me every time. But, in this case, to have a villain whose sole motivation for masterminding a world-wide search for treasure be his slighted family name is frankly stupid. If his family is so bad off where'd he get all his money to travel the world? Heck, the dude trashed his Range Rover, doesn't seem like the Wilkinson's are doing that bad to me.
Thirdly, the 'don't kill my baby' bull expressed by movie-mothers time and again is played out. Seriously. We are led to believe the main characters mother has no contact with her son whatsoever, yet somehow she is brought to debilitating tears over his safety?! If you cared that much, why didn't you pick up a phone? I'm tired of women being portrayed in such a stupid emotional state. Not because it's sexist, but because its so flippin annoying!
Sunday, May 11, 2008
Mother Earth
Yesterday I drove home after a 30-hour shift, sat in bumper-to-bumper traffic (who knew we had that in C-ville), and for some inexplicable reason - likely my mental stupor - became fixated on the person in front of me who was throwing trash out their window. "What compels someone to do that?," I asked myself. Better yet, what produces such a nonchalant attitude towards pollution?
I'm not a tree-hugger. I've littered myself; many times. But on this dreary afternoon coupled with a monotonous drive home, all precipitated by a coma of my mental prowess lead to this time of introspection turned philosophical daydream. What leads people to throw trash out their windows? On a more global level, why do we trash our planet? Like everything, it is certainly multi-factorial, though I can't help but wonder if being so removed from the idea of this planet providing for our basic needs (ie shelter, food, etc) enables us to disrespect it. For example, we no longer 'hunt and gather' in so much as we go grocery shopping. The earth no longer provides us with shelter, Toll Brothers does. So, if the perceived value (therefore not it's true value) of something is in what it provides, then by stripping those provisions from the source, has that commodity then been devalued? Probably.
In our world today, the cause and effect of pollution have been inherently separated. The further we alienate ourselves from 'nature,' the more we will continue to disrespect what it provides for us.
On a brighter note. Happy Mothers Day Esther, Dianne, Stacey, and Jodi.
If you haven't yet, call your mother and tell her you love her... she deserves it.
I'm not a tree-hugger. I've littered myself; many times. But on this dreary afternoon coupled with a monotonous drive home, all precipitated by a coma of my mental prowess lead to this time of introspection turned philosophical daydream. What leads people to throw trash out their windows? On a more global level, why do we trash our planet? Like everything, it is certainly multi-factorial, though I can't help but wonder if being so removed from the idea of this planet providing for our basic needs (ie shelter, food, etc) enables us to disrespect it. For example, we no longer 'hunt and gather' in so much as we go grocery shopping. The earth no longer provides us with shelter, Toll Brothers does. So, if the perceived value (therefore not it's true value) of something is in what it provides, then by stripping those provisions from the source, has that commodity then been devalued? Probably.
In our world today, the cause and effect of pollution have been inherently separated. The further we alienate ourselves from 'nature,' the more we will continue to disrespect what it provides for us.
On a brighter note. Happy Mothers Day Esther, Dianne, Stacey, and Jodi.
If you haven't yet, call your mother and tell her you love her... she deserves it.
Monday, May 5, 2008
would YOU live through a pandemic?
Haven't you ever been the least bit curious what living through a pandemic would be like? I don't wish harm on anyone, but there's just something in me that is just a bit curious. Maybe its just my medical background, fascination with the unknown, or simply my desire to see 'what I'm made of.' Whatever it is though, its nice to know - as a doctor - who to treat.
What do I mean? Well, in this weeks CHEST, an official list of 'recommendations' has been published that outlines proposed guidelines, designed to be a blueprint for hospitals "so that everybody will be thinking in the same way" when a pandemic hits, ie who not to treat. They include:
-People older than 85.
-Those with severe trauma, which could include critical injuries from car crashes and shootings.
-Severely burned patients older than 60.
-Those with severe mental impairment, which could include advanced Alzheimer's disease.
-Those with a severe chronic disease, such as advanced heart failure, lung disease or poorly controlled diabetes.
The idea (whether bad or good) is intended to better utilize resources at a time when those resources are certain to be scare.
If you listen closely, it almost sounds a bit socialist. Interesting.
What do I mean? Well, in this weeks CHEST, an official list of 'recommendations' has been published that outlines proposed guidelines, designed to be a blueprint for hospitals "so that everybody will be thinking in the same way" when a pandemic hits, ie who not to treat. They include:
-People older than 85.
-Those with severe trauma, which could include critical injuries from car crashes and shootings.
-Severely burned patients older than 60.
-Those with severe mental impairment, which could include advanced Alzheimer's disease.
-Those with a severe chronic disease, such as advanced heart failure, lung disease or poorly controlled diabetes.
The idea (whether bad or good) is intended to better utilize resources at a time when those resources are certain to be scare.
If you listen closely, it almost sounds a bit socialist. Interesting.
Saturday, May 3, 2008
So... funny story
I'm in the hospital at the moment, fearing every page I get is another admission waiting in the ED. In the meantime, I sit in the housestaff lounge watching the Kentucky Derby on the brand new 61" DLP TV we have and remembered a funny patient story.
I don't remember all the details, but the short version goes like this. On a previous call day, I was admitting a particularly contentious and unruly alcoholic for what we thought was acute alcoholic hepatitis. Being the thorough 'tern I am in seeing that his hemoglobin was low, I prepared to do a rectal exam (yes, yes... GH; funny I know). I go into the room, where the patient sits with his daughter, explain everything that is going on and subsequently that I need to do a quick rectal exam to determine if he is bleeding. What happens next even I can't make up.
Patient: you gotta do what?
Me: a rectal exam. It's just a quick procedure to make sure your not bleeding from your bottom.
Patient: HELL NO! My daughter may take it up the ass, but not me!
Needless to say, I couldn't hold back the laughter. Its the only time this year I've laughed in front of a patient (I usually just laugh at them behind their back). Glorious times.
I don't remember all the details, but the short version goes like this. On a previous call day, I was admitting a particularly contentious and unruly alcoholic for what we thought was acute alcoholic hepatitis. Being the thorough 'tern I am in seeing that his hemoglobin was low, I prepared to do a rectal exam (yes, yes... GH; funny I know). I go into the room, where the patient sits with his daughter, explain everything that is going on and subsequently that I need to do a quick rectal exam to determine if he is bleeding. What happens next even I can't make up.
Patient: you gotta do what?
Me: a rectal exam. It's just a quick procedure to make sure your not bleeding from your bottom.
Patient: HELL NO! My daughter may take it up the ass, but not me!
Needless to say, I couldn't hold back the laughter. Its the only time this year I've laughed in front of a patient (I usually just laugh at them behind their back). Glorious times.
Friday, April 18, 2008
No Sleep For The Weary
For some inexplicable reason, sleep did not come easily for me last night. In fact, I didn't sleep at all. Why? I have no idea, I just couldn't fall asleep. I tried all the tricks too: warm milk, reading, and cleaning. Finally I resolved myself to watching TV.
So in the early hours, with the delirium at it's thickest, I began to wonder if there was 'extra-terrestrials' and if they watched overnight TV, what would they think about us? Well here is what I learned about the people of earth last night, based on TV programming.
1. We're all bald.
2. We're all fat.
3. We're obsessed with sex.
4. We're covered in acne.
5. We think we're younger than we really are.
So in the early hours, with the delirium at it's thickest, I began to wonder if there was 'extra-terrestrials' and if they watched overnight TV, what would they think about us? Well here is what I learned about the people of earth last night, based on TV programming.
1. We're all bald.
2. We're all fat.
3. We're obsessed with sex.
4. We're covered in acne.
5. We think we're younger than we really are.
Monday, March 17, 2008
My First Shifflett
I can't believe its taken this long. Surely, one would have thought 8 months into intern year I would have experienced all there is to hospital medicine; so one would have thought. Turns out, there's this unique experience to Virginia, that being Shiffletts. Sure I heard about 'em, mostly in verb form, ie 'dude, he got shifflett'd,' but I never had the opportunity to care for one.
Who is it I speak of? Legend has it, there is a large group of people that have relegated themselves to the Shenandoah National Valley, living on and around the mountains (read: hills). These people for the most part have cut themselves off from the surrounding areas and unfortunately receive virtually no healthcare. However, the MOST interesting part is the naming of said group. The letters of last name of those in question vary in number, meaning you will see these variations: Shifflett, Shiflett, Shiflet, Shifflet, Shiflett. So why the difference? Well again legend goes, it depends on affluence the amount of letters one has in their last name. To this day, I'm not really sure which is better; less or more.
Apparently, at any one time there are a good number as inpatients at the hospital. Yet, for whatever reason, I was never so blessed as to care for one. So whats the big deal? I had a Shifflett for a patient, I just thought you should know.
Who is it I speak of? Legend has it, there is a large group of people that have relegated themselves to the Shenandoah National Valley, living on and around the mountains (read: hills). These people for the most part have cut themselves off from the surrounding areas and unfortunately receive virtually no healthcare. However, the MOST interesting part is the naming of said group. The letters of last name of those in question vary in number, meaning you will see these variations: Shifflett, Shiflett, Shiflet, Shifflet, Shiflett. So why the difference? Well again legend goes, it depends on affluence the amount of letters one has in their last name. To this day, I'm not really sure which is better; less or more.
Apparently, at any one time there are a good number as inpatients at the hospital. Yet, for whatever reason, I was never so blessed as to care for one. So whats the big deal? I had a Shifflett for a patient, I just thought you should know.
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