There are alot of guidelines and "rules" these days in pediatrics..so much so that I'm often annoyed by them as my more type A counterparts stick to them with a facist zeal. Some are for good reasons like keeping a child on it's back during sleep (because there is an increased incidence of SIDS - sudden infant death syndrome - if left to sleep the other way) and others are much like the ever increasing list of "don't"s that constitute modern law (ie. NO!... it is not ok to feed you child an all water diet). As I read an article that pointed out how "ungoverned" and "unsafe" the children of the previous generations were and how they survived dispite lead paint, despite tummy time...during sleep time, and even in some cases despite a lack of seat belts I found myself rumminating on this subject. Like most answers to complex and controversial subjects the truth is often not black or white but a very fine gray, these guidelines are here to help save lives, but life itself requires a fair amount of chance, fate, luck and/or the hand of God, whatever you call it there is more to surviving than simply following guidelines. Just as life will find a way to survive, if you are "meant" to die, I do believe, death will surely find a way...uhhh...to kill you ;-P despite the unending spools of guidelines we churn out year after year in an attempt to wall it off from our children (still though, you can't blame us for trying).
Newbie Doc
Friday, December 3, 2010
Wednesday, December 1, 2010
My Little Teacher
I'm on vacation, but it doesn't feel like vacation. Our son is over 2 weeks old now, but the moment of his birth only seems seconds ago. What a life changing experience parenthood is, what an amazing change Bode has brought on our lives. It's a change that's both wonderful and terrible at the same time. When he has even the tiniest smile, I laugh and my heart swells and when he cries, it breaks.
Although I'd tried to prepare myself for how it would change our lives, my assumptions were neive at best. He's changing the way I view my patients and I'm finding new empathy where before I had only cold reason and logic. For the doctor who is supposed to know everything about kids, I'm getting yet another lesson in all that I don't know.
In returning from vacation, my patients will find a new doctor has taken my place. A doctor who understands them much better, who can relate to a child keeping them up all night for weeks on end. A doctor who has seen first hand the pathetic amount of comfort medicine's "supportive" advice can sometimes yield. A doctor who has been there.
Bode can't even talk, yet he's already taught me so much about life, love, and even medicine...there's so much more to write, but I'm so tired I think more would be less at this point. We are immeasurably blessed with this new addition to our family.
Newbie Doc
Although I'd tried to prepare myself for how it would change our lives, my assumptions were neive at best. He's changing the way I view my patients and I'm finding new empathy where before I had only cold reason and logic. For the doctor who is supposed to know everything about kids, I'm getting yet another lesson in all that I don't know.
In returning from vacation, my patients will find a new doctor has taken my place. A doctor who understands them much better, who can relate to a child keeping them up all night for weeks on end. A doctor who has seen first hand the pathetic amount of comfort medicine's "supportive" advice can sometimes yield. A doctor who has been there.
Bode can't even talk, yet he's already taught me so much about life, love, and even medicine...there's so much more to write, but I'm so tired I think more would be less at this point. We are immeasurably blessed with this new addition to our family.
Newbie Doc
Sunday, November 21, 2010
Our Son
It was a Thursday 11th of November, when my wife's contractions started. I had just gotten done helping bring a little girl into the world with illicit drug exposure and a concern for congenital syphilis. I had to perform a lumbar puncture on her which went perfect. I was just finishing patting myself on the back when she texted me, "My contractions are about 5 minutes apart. I think I'm in labor, but don't come home yet cause I'm not sure..." Needless to say I called her right back.
What I had always imagined in my mind was the typical "movie pregnancy" where suddenly dad gets a call at work and then there is a screeching of tires, maybe a hub cap lost in the hustle to get the wife and baby to the hospital before he/she delivers in the car, but life doesn't read from a script, just like medicine doesn't read from a manual. What followed was a 2 day ordeal of driving Kate back and forth to the hospital (30 minutes away) each time thinking this would be the time, and each time being disappointed (she wasn't in active labor...just annoying labor ;P)
Through the grind of trying to induce labor with walking and all the false alarm OB visits, suddenly I found myself awaking to my wife's deep, fast breathing at 4 am on the 13th. We had just visited the hospital 4 hours ago and been sent home, my wife had been sedated so she could sleep through the painful contractions, which despite being regular and painful were not progressing the labor as we would hope. So I awoke in confussion to her breathing that was quite unnerving to me. It certainly seemed like we needed to be hauling it to the hospital...but if that was the case why didn't she wake me up?!?! I was groggily in the middle of processing this when she got up and went to the bathroom. My thoughts were immediately shattered with the steel hammer of her yelling words, "We need to go!!!". In shock and disbelief I gathered what few things wern't in the car and drove my wife as fast as safety would allow to the hospital. It had been such a long labor even after she was admitted I didn't believe my son would be born until they ruptured her membranes (broke her water artificially). My mind was in a haze as I watched it all happen, it seemed unreal that we were in labor, that our son was coming....OUR SON!!! Wow...
Things went great for the most part. Kate got an epidural...which was awesome, for the first time in two days she was without pain and she actually smiled and joked between contractions and pushing. At the very end of labor, my little guy's heart rate dropped and they had to use the vacume which was a little scary for us, as it's been associated with increased incidence of problems post labor (brain bleeds, etc.), but the little one came out quickly and it wasn't used much. He did come out blue and floppy, which wouldn't worry a typical parent likely, but we knew that wasn't good. They ran him quickly over to the warmer where I couldn't help but to go into doctor mode. Luckily my skills weren't needed, as he quickly recovered and pinked up. As a doctor you could almost be considered a professional student and as such I considered it an great honor to be the one to administer his first "test", his physical exam. Most daddies look for 10 fingers, 10 toes...my son has red reflexs, stable hips, lacks a simian crease, has an intact palate, had a three vessel cord, and on and on and on...in short, save for a slight "friar tuck" bump on his head left by the vacume suction...he is perfect : D.
His name is Brian Dexter. Born on November 13th, 2010, he's named after my brother-in-law, Brian or "Bo", as we sometimes call him (We call this little one "Bode" for short). His middle name is an attempt to give him something unique like his daddy's, if he chooses to go by it, it's my hope that it will set him apart from the others at school, like mine did for me. We are so happy, so proud, and so very blessed. Thank you so much God for this amazing blessing, our son Bode.
Newbie Dad
What I had always imagined in my mind was the typical "movie pregnancy" where suddenly dad gets a call at work and then there is a screeching of tires, maybe a hub cap lost in the hustle to get the wife and baby to the hospital before he/she delivers in the car, but life doesn't read from a script, just like medicine doesn't read from a manual. What followed was a 2 day ordeal of driving Kate back and forth to the hospital (30 minutes away) each time thinking this would be the time, and each time being disappointed (she wasn't in active labor...just annoying labor ;P)
Through the grind of trying to induce labor with walking and all the false alarm OB visits, suddenly I found myself awaking to my wife's deep, fast breathing at 4 am on the 13th. We had just visited the hospital 4 hours ago and been sent home, my wife had been sedated so she could sleep through the painful contractions, which despite being regular and painful were not progressing the labor as we would hope. So I awoke in confussion to her breathing that was quite unnerving to me. It certainly seemed like we needed to be hauling it to the hospital...but if that was the case why didn't she wake me up?!?! I was groggily in the middle of processing this when she got up and went to the bathroom. My thoughts were immediately shattered with the steel hammer of her yelling words, "We need to go!!!". In shock and disbelief I gathered what few things wern't in the car and drove my wife as fast as safety would allow to the hospital. It had been such a long labor even after she was admitted I didn't believe my son would be born until they ruptured her membranes (broke her water artificially). My mind was in a haze as I watched it all happen, it seemed unreal that we were in labor, that our son was coming....OUR SON!!! Wow...
Things went great for the most part. Kate got an epidural...which was awesome, for the first time in two days she was without pain and she actually smiled and joked between contractions and pushing. At the very end of labor, my little guy's heart rate dropped and they had to use the vacume which was a little scary for us, as it's been associated with increased incidence of problems post labor (brain bleeds, etc.), but the little one came out quickly and it wasn't used much. He did come out blue and floppy, which wouldn't worry a typical parent likely, but we knew that wasn't good. They ran him quickly over to the warmer where I couldn't help but to go into doctor mode. Luckily my skills weren't needed, as he quickly recovered and pinked up. As a doctor you could almost be considered a professional student and as such I considered it an great honor to be the one to administer his first "test", his physical exam. Most daddies look for 10 fingers, 10 toes...my son has red reflexs, stable hips, lacks a simian crease, has an intact palate, had a three vessel cord, and on and on and on...in short, save for a slight "friar tuck" bump on his head left by the vacume suction...he is perfect : D.
His name is Brian Dexter. Born on November 13th, 2010, he's named after my brother-in-law, Brian or "Bo", as we sometimes call him (We call this little one "Bode" for short). His middle name is an attempt to give him something unique like his daddy's, if he chooses to go by it, it's my hope that it will set him apart from the others at school, like mine did for me. We are so happy, so proud, and so very blessed. Thank you so much God for this amazing blessing, our son Bode.
Newbie Dad
5 pounds 14 ounces at birth. Little guy but a whole lotta cuteness. We love you buddy.
Friday, November 5, 2010
War and Peace
This blog is far less exciting than the title would suggest.
"If you want peace, prepare for war."
Regardless of whoever said this quote, his job and mine are similar in the fact that if we were to achieve our ideal our jobs would become obsolete.
You'll often here a similar sentiment batted around between health professionals without work (such as I right now). I'm sitting in a resident room, bored out of my skull, and part of me really would like a sick baby to be admitted...did I just say that?!?! Sometimes you'll hear the rationalization, "Well, there are going to be sick babies, they might as well be sick here."
Most likely the world is still filled with sick babies. Most likely they have chosen not to come here. I find myself as the steriotypical nieve, overly immature infantry man whose seen little or none of war. Although I've been told it's "bad" I'm so bored I can't help but wish for a little action (despite deep down knowing it to be horrible).
Newbie Doc
I'm having a tough time finding motivation to do anything, so I thought maybe you could share in this by checking out these demotivational posters that I googled. Cheers.
"If you want peace, prepare for war."
Regardless of whoever said this quote, his job and mine are similar in the fact that if we were to achieve our ideal our jobs would become obsolete.
You'll often here a similar sentiment batted around between health professionals without work (such as I right now). I'm sitting in a resident room, bored out of my skull, and part of me really would like a sick baby to be admitted...did I just say that?!?! Sometimes you'll hear the rationalization, "Well, there are going to be sick babies, they might as well be sick here."
Most likely the world is still filled with sick babies. Most likely they have chosen not to come here. I find myself as the steriotypical nieve, overly immature infantry man whose seen little or none of war. Although I've been told it's "bad" I'm so bored I can't help but wish for a little action (despite deep down knowing it to be horrible).
Newbie Doc
I'm having a tough time finding motivation to do anything, so I thought maybe you could share in this by checking out these demotivational posters that I googled. Cheers.
And some others I thought were funny...
These can be found at http://www.despair.com/.
Thursday, November 4, 2010
Big Shoes
My wife is due any day now. It's a source of a lot of anxiety for us. We have her bag for the hospital packed and by the stares. It's a constant reminder that at a moment's notice I may have to pick it up and run. Being on the NICU right now is something of a worry for me, as there are times when I'm "THE" guy who takes care of the babies...but I've worked that out with my other residents and fellow nurse practitioners, who all agree that I shouldn't miss the birth of my son :P With all the bumps now seemingly smoothed out I feel like I'm riding a bullet trainl, speeding unimaginably fast towards something I can't possibly comprehend or imagine, something I know I'm not ready for yet...but I'll have to be.
The baby these days is really big. My wife has the cute pregnant woman "waddle" that one gets about 36-37 weeks gestation. Seems like I give her massages every second that I'm with her, she deserves them, between pregnancy and her rotation on surgery I doubt that I could fair even half as well. That little guy is so big when he kicks her it causes her stomach discomfort, so now she hardly lets me talk to him...especially if he is sleeping, she doesn't want me to disturb him...as she is the one that pays for it.
The other day while I was on call, I helped delivery a lady who was in the most excrutiating pain I've ever seen. I've seen a lot of deliveries at this point, but she was "exercism" mad/in pain. I really hope my wife takes an epidural, I don't want to see her like that, but if it happens it happens...right?
Every parent I talk to says its simultaneously the most exhausting and most rewarding thing you'll ever do. I thought I've been exhausted in residency, but this advice is coming from other residents...I'm really nervous for this...but at the same time I'm looking forward to it a great deal.
I imagine becoming a father is a lot like when I first became a doctor. I remember the first day, how nervous I was putting on that white coat...but you have to put it on anyway. You feel self conscious and undeserving of it for awhile, but as more and more work pile onto you, and greater and greater responsibilities get levied upon you that feeling fades and you grow into the role...not an immediate transformation as you'd secretly imagined in the back of your mind, but a slow process of growth that gradually fills the giant shoes you've been called to step into...shoes that I'm not even close to filling yet...suddenly I'm going to have two pairs that I'll have to wear at the same time...sounds combersome and uncomfortable...hope I can manage without tripping up to much...or falling flat on my face.
Newbie Doc
The baby these days is really big. My wife has the cute pregnant woman "waddle" that one gets about 36-37 weeks gestation. Seems like I give her massages every second that I'm with her, she deserves them, between pregnancy and her rotation on surgery I doubt that I could fair even half as well. That little guy is so big when he kicks her it causes her stomach discomfort, so now she hardly lets me talk to him...especially if he is sleeping, she doesn't want me to disturb him...as she is the one that pays for it.
The other day while I was on call, I helped delivery a lady who was in the most excrutiating pain I've ever seen. I've seen a lot of deliveries at this point, but she was "exercism" mad/in pain. I really hope my wife takes an epidural, I don't want to see her like that, but if it happens it happens...right?
Every parent I talk to says its simultaneously the most exhausting and most rewarding thing you'll ever do. I thought I've been exhausted in residency, but this advice is coming from other residents...I'm really nervous for this...but at the same time I'm looking forward to it a great deal.
I imagine becoming a father is a lot like when I first became a doctor. I remember the first day, how nervous I was putting on that white coat...but you have to put it on anyway. You feel self conscious and undeserving of it for awhile, but as more and more work pile onto you, and greater and greater responsibilities get levied upon you that feeling fades and you grow into the role...not an immediate transformation as you'd secretly imagined in the back of your mind, but a slow process of growth that gradually fills the giant shoes you've been called to step into...shoes that I'm not even close to filling yet...suddenly I'm going to have two pairs that I'll have to wear at the same time...sounds combersome and uncomfortable...hope I can manage without tripping up to much...or falling flat on my face.
Newbie Doc
Monday, November 1, 2010
The Phantom Page
So at this point tonight I've already had two deliveries which were pretty much cake, both requiring very little from me. I'm a little less solo than I thought, turns out there is a nurse practitioner that stays here with me, she watched me like a hawk as I was running the last two, at the last one she told me, "Ok the next one is all you.", meaning she would only come if called...that made me nervous, so much so that after much tossing and turning I finally got to sleep...for like 5 minutes.
I heard my pager go off.
Suddenly I was fully awake. I jumped out of bed, through my shirt on, laced up my shoes, and jogged down to the delivery room...where there was nothing going on. I checked my pagers...was I dreaming? I still don't know, but the HUC (head unit coordinator) thinks I was cause they havn't heard of any babies being born. This often happens to me where I think I'm not nervous, say I'm not nervous, and for the most part act like I'm not...right up until the point when I imagine pages and jump at the slightest pager like noise.
Newbie Doc
I heard my pager go off.
Suddenly I was fully awake. I jumped out of bed, through my shirt on, laced up my shoes, and jogged down to the delivery room...where there was nothing going on. I checked my pagers...was I dreaming? I still don't know, but the HUC (head unit coordinator) thinks I was cause they havn't heard of any babies being born. This often happens to me where I think I'm not nervous, say I'm not nervous, and for the most part act like I'm not...right up until the point when I imagine pages and jump at the slightest pager like noise.
Newbie Doc
The Night Owl
Today I find myself back in a NICU again, and today I experienced the same uncomfortable morning that I've come to expect when starting a new rotation, the feeling that you are in over your head. Admittedly, it's not as bad since I have worked in the NICU once before, but it was a different NICU...which is like going to a different country and practicing medicine; sure both countries have similar forms of medicine (it's unavoidable because a human is a human is a human) but the protocols, guidelines, computer systems, and bureaucratics are completely alien to a newcomer.
Another oddity of this NICU, which is particularly immigrant heavy, is that it currently is very quiet. There are several theories to the cause of this, as NICUs are normally very busy, but the main two is that a lot of surrounding hospitals have opened level 1 and 2 NICUs of their own, stealing my patient population; the other theory involves certain legislation passed this year which is allegedly scaring away my "illegal" patients. So I find myself on call, sitting, waiting for something to happen with a slight undercurrent of anxiety running through my brain.
While my patient load and patient complexity are likely to be lower than the previous NICU, I am at the same time, burdened by the fact that my attendings, at the end of the day, go home, leaving me to fend for myself. If a child comes in overnight (which will eventually happen), it's me and only me delivering it. Those infrequent nights (at the other NICU) of an attending not making it to the delivery room in time (leaving me to do it by myself) will likely become buisness as usual here. I've heard previous interns who work here tell horror stories of having to run codes on kids by themselves. I suppose at some point the little night owl gets kicked off his branch and must learn how to fly solo, but that doesn't mean I have to look forward to it. Right now I'm standing on the branch, staring down at all the places I could go, and thinking about all the things that could happen...I'm hoping that when I do fly solo (be it tonight or some other dark night in the future) the weather will be clear, the luck will be abundant, and the ground will be soft : P.
Newbie Doc
Another oddity of this NICU, which is particularly immigrant heavy, is that it currently is very quiet. There are several theories to the cause of this, as NICUs are normally very busy, but the main two is that a lot of surrounding hospitals have opened level 1 and 2 NICUs of their own, stealing my patient population; the other theory involves certain legislation passed this year which is allegedly scaring away my "illegal" patients. So I find myself on call, sitting, waiting for something to happen with a slight undercurrent of anxiety running through my brain.
While my patient load and patient complexity are likely to be lower than the previous NICU, I am at the same time, burdened by the fact that my attendings, at the end of the day, go home, leaving me to fend for myself. If a child comes in overnight (which will eventually happen), it's me and only me delivering it. Those infrequent nights (at the other NICU) of an attending not making it to the delivery room in time (leaving me to do it by myself) will likely become buisness as usual here. I've heard previous interns who work here tell horror stories of having to run codes on kids by themselves. I suppose at some point the little night owl gets kicked off his branch and must learn how to fly solo, but that doesn't mean I have to look forward to it. Right now I'm standing on the branch, staring down at all the places I could go, and thinking about all the things that could happen...I'm hoping that when I do fly solo (be it tonight or some other dark night in the future) the weather will be clear, the luck will be abundant, and the ground will be soft : P.
Newbie Doc
Saturday, October 30, 2010
Sickie
My last week at the clinic was brutal. It's amazing that I'm saying that considering that it is "clinic", which is outpatient, which is "easy"...but it was rough. I'm not coming down on clinic work, I actually enjoy it and I look forward to working in a clinic again...just not that one. Please understand that I am speaking very objectively without prejudice when I say that working with a Spanish population when you don't speak Spanish is a complete pain in the @$$. I would see maybe one English speaker a day, which was always a treat because of how fast I could fly through the interview, diagnosis, and treatment process. But those intermittent "treats" were not enough to "lighten the load" of patients who took twice the time to speak to. To make that last semana (I've gotten much better at my Spanish by the way) extra special I also got sick.
This is my first time getting sick as a doctor. While it sounds stupid to say it that way, getting sick in previous "roles" has always afforded me the option of actually taking sick leave when you don't feel like going to work. As a student in grade school and high school, you always had to convince your parents to let you stay home. In college you wore the pants and going to school wasn't "mandatory" anymore. In medical school we were similar to residents in the type of work we did, however the responsibility of taking care of patients, in the end, always rested solely on the residents shoulders, which is what I am now. Suddenly I find myself in this new world without sick days.
Yes we still have sick days, but we might as well not. On inpatient, if I am sick, who is going to take care of my complex patients? Sure, the other residents are top notch and could manage, but deep down you still have this feeling that your patient's care would suffer if a new person were to be suddenly thrown without warning into all their health complexities. On outpatient, where I am now, there is no obligation to the patient. Most aren't actually "sick" and shouldn't even be there. Also even if I were to be gone, another resident just as good as me or better would see that patient that should have been mine. What has changed is that suddenly my absence ends up hanging my friends with all of my work. Suddenly, although I feel like crap, although I feel like laying in bed and dieing, there is this stabbing pang of responsibility and obligation. To my horror, I find myself slowly getting out of bed and placing one foot in front of the other towards that damn white coat ;P.
It's a trivial thing to write about, the change in your sick days from a student to a doctor...but it's not such a trivial thing when you are used to having that freedom and now you find that particular nicety barred from you by new found responsibility. Beware students...beware. ;P
Newbie Doc
This is my first time getting sick as a doctor. While it sounds stupid to say it that way, getting sick in previous "roles" has always afforded me the option of actually taking sick leave when you don't feel like going to work. As a student in grade school and high school, you always had to convince your parents to let you stay home. In college you wore the pants and going to school wasn't "mandatory" anymore. In medical school we were similar to residents in the type of work we did, however the responsibility of taking care of patients, in the end, always rested solely on the residents shoulders, which is what I am now. Suddenly I find myself in this new world without sick days.
Yes we still have sick days, but we might as well not. On inpatient, if I am sick, who is going to take care of my complex patients? Sure, the other residents are top notch and could manage, but deep down you still have this feeling that your patient's care would suffer if a new person were to be suddenly thrown without warning into all their health complexities. On outpatient, where I am now, there is no obligation to the patient. Most aren't actually "sick" and shouldn't even be there. Also even if I were to be gone, another resident just as good as me or better would see that patient that should have been mine. What has changed is that suddenly my absence ends up hanging my friends with all of my work. Suddenly, although I feel like crap, although I feel like laying in bed and dieing, there is this stabbing pang of responsibility and obligation. To my horror, I find myself slowly getting out of bed and placing one foot in front of the other towards that damn white coat ;P.
It's a trivial thing to write about, the change in your sick days from a student to a doctor...but it's not such a trivial thing when you are used to having that freedom and now you find that particular nicety barred from you by new found responsibility. Beware students...beware. ;P
Newbie Doc
Monday, October 25, 2010
Under the Magnifying Glass
I remember my first week of college. I remember sitting at a stop light with my new room mate, Kyle. As we sat there a green light turned in the perpendicular street and cars slowly started to march across our path, as they made an arching left turn, driving down the opposite way we had came. He asked me if I ever "just watched the faces in the cars as they passed by" wondering who they were, what they were doing...what they were going to do. That memory sticks in my head, a person I considered a relative stranger making such a randomly honest statement to me, it caught me off guard, I lied stating I hadn't ever put much thought into it. When he had said that, I thought he was weird...and I thought was weird for secretly doing the same thing, but I was young, and as time went on I realized it's one of those taboo things we, people in general, don't exactly "talk" about, after all, it's not always so "benign" to quickly place a person under your magnifying glass.
A very naive 6 year old says, "Are you pregnant?" to a store clerk as his mother checks out at walmart...the mother blushes and begins to check out faster...the store clerk is not pregnant.
A white supremacist screams racial slurs as an African American carries her back pack into a desegregated school for the first time.
The truth is making quick decisions and judgments off of very little is what we all do, it's a survival instinct that is as burned into us as much as the instinct of a bird flying south for the winter. The truth is most of the time it is very useful helping us navigate this social world we are all apart of, but in the rare instances when it doesn't work, you end up as the example of the word "moron" in some doctor's blog ;P
In training to be a doctor, that magnifying glass isn't "gifted" to you, it simply adds a couple more powers of vision for you to see through. Before school you see a sickly man pushing a cart down the isle of a supermarket. You look at the man, you see his disheveled appearance, you look at the large amount of booze he has in his cart and you know what's got him that way. After medical school you look at a similar sickly man, you realize he is jaundiced, you think he probably has liver failure, you glance at his shopping cart expecting booze...but it has toilet paper and cereal in it, (laughably) you STILL immediately think, "alcoholic".
However, as I'm going through residency I'm discovering how it's tempering my judgments. How in meeting patient after patient and getting to know the most intimate details about them, that nothing is as simple as the magnifying glass makes it seem. The alcoholic sometimes has a VERY good reason for being that way, even if his lifestyle is an unsavory one. You start to see that the mother who hit the child isn't always a monster, sometimes she's just a very stressed out woman in a bad situation, that was pushed and pushed 'till she snapped. More and more, I'm coming to the realization that this "magnifying glass" was never meant to be used all by itself, that's why when our teachers were sharpening our vision in medical school they were also teaching us to talk to our patients...to empathize with them...otherwise we run the risk of focusing that glass too much in one place and that can be a very dangerous thing.
Newbie Doc
A very naive 6 year old says, "Are you pregnant?" to a store clerk as his mother checks out at walmart...the mother blushes and begins to check out faster...the store clerk is not pregnant.
A white supremacist screams racial slurs as an African American carries her back pack into a desegregated school for the first time.
The truth is making quick decisions and judgments off of very little is what we all do, it's a survival instinct that is as burned into us as much as the instinct of a bird flying south for the winter. The truth is most of the time it is very useful helping us navigate this social world we are all apart of, but in the rare instances when it doesn't work, you end up as the example of the word "moron" in some doctor's blog ;P
In training to be a doctor, that magnifying glass isn't "gifted" to you, it simply adds a couple more powers of vision for you to see through. Before school you see a sickly man pushing a cart down the isle of a supermarket. You look at the man, you see his disheveled appearance, you look at the large amount of booze he has in his cart and you know what's got him that way. After medical school you look at a similar sickly man, you realize he is jaundiced, you think he probably has liver failure, you glance at his shopping cart expecting booze...but it has toilet paper and cereal in it, (laughably) you STILL immediately think, "alcoholic".
However, as I'm going through residency I'm discovering how it's tempering my judgments. How in meeting patient after patient and getting to know the most intimate details about them, that nothing is as simple as the magnifying glass makes it seem. The alcoholic sometimes has a VERY good reason for being that way, even if his lifestyle is an unsavory one. You start to see that the mother who hit the child isn't always a monster, sometimes she's just a very stressed out woman in a bad situation, that was pushed and pushed 'till she snapped. More and more, I'm coming to the realization that this "magnifying glass" was never meant to be used all by itself, that's why when our teachers were sharpening our vision in medical school they were also teaching us to talk to our patients...to empathize with them...otherwise we run the risk of focusing that glass too much in one place and that can be a very dangerous thing.
Newbie Doc
Clouds
One of the things that has really helped me through medical school and now residency is my childhood on the farm. It was a place of uncharacteristic freedom as well as unending responsibility. From an early age my brothers and I were expected to get up before the sun did and do the chores, though I'm sure by my father's and my grandfather's standards we would be considered highly spoiled, yet our "spoiled" is a far cry from what I see roll into my clinic these days. I remember times when Jason (my brother) and I would return home from school. As we sat around the house, watching TV, playing video games, and (in Jason's case) playing basketball, the radio would sound off and it would be our father. He would be needing our help with something, although now I'm sure the task would seem trivial, to two young boys wanting nothing more than to play it was something to be feared and hated. Upon hearing the radio, "Jake. Jason. Ya got a copy." We would often share a quick moment of recognition, our eyes would narrow, thinking the same thing, we would both bolt for the bathroom...you see if you could lock yourself in the bathroom, you could say that you were busy, if you were busy, the other would have to answer the radio, and if only one of us was needed for work (which would be the one that answered the radio), the other would get to stay home, free from work and worry.
Recounting that story, it always seems to make me smile. As the years went by and our responsibility increased that knee-jerk reflex to work was slowly trained out of us and somewhere in there we gained our father's ability to simply get the job done. It seems like such a simple thing to say it - if a job needs done, better get to it. Yet, everyday I see a large number of my co-workers which can't manage a task without an inordinate amount of complaining and foul attitude. In that respect, a few are still much like 7 year olds, hiding from the call of responsibility.
In medicine, there are residents that get marked as "dark clouds". These are the residents that seem to always get the complicated patients, they are forever stuck with more patients than others, and should it come to a competition in "horror stories" they have the market cornered. There are also those residents which are known as "white clouds", for which only good things happen. It seems that these "white clouds" are constantly getting patients that turn the corner, they join services that seem blessed by God himself, and even when things turn a bit "stormy", somehow things seem to work out. I can't speak for other white clouds, but in my experience I'm less of a white cloud for the work I get and more so because I don't complain. I've had horrible nights and dark days during this residency, some of which I have shared on here, but even when it's rough, I make an effort to contain it, to keep it from spreading to the people I work with. Not to say that I haven't learned that there is a place and time to ask for help...because there definitely is...but life on the farm with my father taught me that there is a grind to life and it is made worse if one of the cogs in the machine is a squeaky one.
For the longest time I really did believe in these "clouds". It really did seem like my dark counterparts were amazingly unlucky. One rough night on call I was working with a fellow "lucky" senior resident, Sam. We went into call with a low load of patients and went on to gain the maximum amount of patients we could admit that night, we capped out. It was a long and sleepless night and at the end of it we sat with 20 minutes of spare time before the morning residents arrived and checkout would begin.
- at 6am all of the day residents arrive and you hand over their patients to them, telling them if any issues or problems occurred overnight..you then go back to work taking care of your patients until 12pm, when you get to checkout and leave -
I don't remember the whole conversation specifically just a quick exchange that left me thinking. Sam was saying how he and another senior residents were really annoyed with a particular co-worker who never seemed to stop complaining. I reminded him that in her defense, she was a dark cloud. To which he replied, "I can never tell if they are dark clouds because they are unlucky or they are dark clouds because they complain so much." And I realized that I couldn't either.
It's not my intention to come down on those of the "stormy" disposition, but lucky or unlucky, you still have a choice in how you present yourself to the world and in my experience it can have a very positive or negative effect on not only yourself, but also those around you.
Newbie Doc
Recounting that story, it always seems to make me smile. As the years went by and our responsibility increased that knee-jerk reflex to work was slowly trained out of us and somewhere in there we gained our father's ability to simply get the job done. It seems like such a simple thing to say it - if a job needs done, better get to it. Yet, everyday I see a large number of my co-workers which can't manage a task without an inordinate amount of complaining and foul attitude. In that respect, a few are still much like 7 year olds, hiding from the call of responsibility.
In medicine, there are residents that get marked as "dark clouds". These are the residents that seem to always get the complicated patients, they are forever stuck with more patients than others, and should it come to a competition in "horror stories" they have the market cornered. There are also those residents which are known as "white clouds", for which only good things happen. It seems that these "white clouds" are constantly getting patients that turn the corner, they join services that seem blessed by God himself, and even when things turn a bit "stormy", somehow things seem to work out. I can't speak for other white clouds, but in my experience I'm less of a white cloud for the work I get and more so because I don't complain. I've had horrible nights and dark days during this residency, some of which I have shared on here, but even when it's rough, I make an effort to contain it, to keep it from spreading to the people I work with. Not to say that I haven't learned that there is a place and time to ask for help...because there definitely is...but life on the farm with my father taught me that there is a grind to life and it is made worse if one of the cogs in the machine is a squeaky one.
For the longest time I really did believe in these "clouds". It really did seem like my dark counterparts were amazingly unlucky. One rough night on call I was working with a fellow "lucky" senior resident, Sam. We went into call with a low load of patients and went on to gain the maximum amount of patients we could admit that night, we capped out. It was a long and sleepless night and at the end of it we sat with 20 minutes of spare time before the morning residents arrived and checkout would begin.
- at 6am all of the day residents arrive and you hand over their patients to them, telling them if any issues or problems occurred overnight..you then go back to work taking care of your patients until 12pm, when you get to checkout and leave -
I don't remember the whole conversation specifically just a quick exchange that left me thinking. Sam was saying how he and another senior residents were really annoyed with a particular co-worker who never seemed to stop complaining. I reminded him that in her defense, she was a dark cloud. To which he replied, "I can never tell if they are dark clouds because they are unlucky or they are dark clouds because they complain so much." And I realized that I couldn't either.
It's not my intention to come down on those of the "stormy" disposition, but lucky or unlucky, you still have a choice in how you present yourself to the world and in my experience it can have a very positive or negative effect on not only yourself, but also those around you.
Newbie Doc
Thursday, October 21, 2010
Wednesday, October 20, 2010
Getting Bucked Off
What an amazingly beautiful day. I woke up with a quiet sprinkling of rain drops on our bedroom window, when I walked out the door I was greeted with a vanilla sky with a shining sun, rays bursting through the clouds. That's how the whole day went, the patients came in on time, things moved silky smooth. My fellow residents joked around in between patients and things just seemed uncharacteristically optimistic. I had a patient come in with text book illness, which shows just how odd the day was...there is no such thing as text book illness. We read about diseases, but they don't read about themselves, it's a very rare day when you get a patient that presents exactly like a test question.
A 6 year old male previously healthy presents with a 6 month history of behavioral changes and pica (eating odd things). He lives in a house built before the 1970's that has lots of pealing paint. He likes to play outside in the dirt, unsupervised.
Uhh...is the answer B. High Risk for Lead Poisoning?
So rare does it happen that I really didn't expect the lead level to come back abnormal...but it did. That's how the whole day was...uncharacteristically perfect...but then I checked my email...I hate email. We had to take an "in-service" exam the day we entered residency. It's a test that checks to see if your knowledge base is adequate enough that you will likely pass your pediatrics boards at the end of a 3 year residency program...there is a 30% chance that I will fail. Damn...
I'm not exactly worried about it. I've never had a problem passing tests, but from time to time I get caught with my pants down...the day I took this test was one of those days. I just wanted to squash the rumors that I'm perfect ;P in case any were floating around...this isn't the first test that I have failed to pass. I often do very well on exams, but this would be my 5th "bad" test in my 9 years of upper level schooling. I remember every one I've done poorly on and there isn't a one that I look back on and say "Gee that was a great life lesson!" Nope every one of them depresses the hell out of me, regardless of all the rationalization I throw into my fire of disappointment, it never seems to quash the flames. I know I'll pass boards. I've never failed a standardized test and my board scores (the tests you take at the end of medical school) predict that I have a >90% chance of passing the pediatric license exam at the end of residency, but I still feel like an idiot. They aught to have a class on failing before you start college, because knowing how to get back on the horse is almost as important as learning how not to get bucked off in the first place. I don't know if this is great advice to those in similar situations but here's what I do.
1. I try not to freak out about my bad performance. I do something that relaxes me for a bit.
2. I then tear apart the events leading up to the failure until I have a good understanding of what caused the it (ideally that's #2 but I've usually been doing it for awhile before I find time for #1).
3. I work on any weaknesses that I spot from #2.
4. I try like hell not to make the same mistake twice.
I've always thought that if you follow those steps...especially #4 that you can close your eyes at night with a clear conscience...that's the only thing that puts me at peace when something like that happens...that and a couple beers when I get home. Alright...it's time to study : )
Newbie Doc
A 6 year old male previously healthy presents with a 6 month history of behavioral changes and pica (eating odd things). He lives in a house built before the 1970's that has lots of pealing paint. He likes to play outside in the dirt, unsupervised.
Uhh...is the answer B. High Risk for Lead Poisoning?
So rare does it happen that I really didn't expect the lead level to come back abnormal...but it did. That's how the whole day was...uncharacteristically perfect...but then I checked my email...I hate email. We had to take an "in-service" exam the day we entered residency. It's a test that checks to see if your knowledge base is adequate enough that you will likely pass your pediatrics boards at the end of a 3 year residency program...there is a 30% chance that I will fail. Damn...
I'm not exactly worried about it. I've never had a problem passing tests, but from time to time I get caught with my pants down...the day I took this test was one of those days. I just wanted to squash the rumors that I'm perfect ;P in case any were floating around...this isn't the first test that I have failed to pass. I often do very well on exams, but this would be my 5th "bad" test in my 9 years of upper level schooling. I remember every one I've done poorly on and there isn't a one that I look back on and say "Gee that was a great life lesson!" Nope every one of them depresses the hell out of me, regardless of all the rationalization I throw into my fire of disappointment, it never seems to quash the flames. I know I'll pass boards. I've never failed a standardized test and my board scores (the tests you take at the end of medical school) predict that I have a >90% chance of passing the pediatric license exam at the end of residency, but I still feel like an idiot. They aught to have a class on failing before you start college, because knowing how to get back on the horse is almost as important as learning how not to get bucked off in the first place. I don't know if this is great advice to those in similar situations but here's what I do.
1. I try not to freak out about my bad performance. I do something that relaxes me for a bit.
2. I then tear apart the events leading up to the failure until I have a good understanding of what caused the it (ideally that's #2 but I've usually been doing it for awhile before I find time for #1).
3. I work on any weaknesses that I spot from #2.
4. I try like hell not to make the same mistake twice.
I've always thought that if you follow those steps...especially #4 that you can close your eyes at night with a clear conscience...that's the only thing that puts me at peace when something like that happens...that and a couple beers when I get home. Alright...it's time to study : )
Newbie Doc
Tuesday, October 19, 2010
Stay Tuned For "As The Colonoscope Turns"
I got an email from a friend about my last post on well child checks and I realized I may have not given them the good "shake" they deserve. The truth is that while well child checks are extremely boring...so are vaccines...you never get to run down the hall shouting "QUICK THIS CHILD NEEDS 50 CC'S OF THE FLU VACCINE STAT!!!" That's because if your kid already has the flu, the vaccine isn't going to help diddly. It's preventative medicine...it is in a way pretty boring, but if I asked you what the single greatest medical miracle of the 20th century was...it's not the heart transplant, the gene transfer, or even the invention of antibiotics...it's mass distribution of vaccines to the public...boring, quiet, unassuming vaccines. It's also well child checks that catch childhood heart defects before the little guy drops dead on the base ball field. It's prevention-medicine that stops mom from giving her baby girl 8 sippy-cups of apple juice a day...if you help a child live a healthy childhood you can do all sorts of amazing things that McDreamy could only Mcdream of...you can, in effect, "cure" diabetes, cut out heart disease, and even in some instances prevent cancer. The truth is that although preventative medicine is the single strongest "pill" we have against disease, there will likely never be a TV show drama "Vaccine Central" or "Preventative Medicine: Miami" (as catchy as those names may be). Preventative medicine saves life and even gives it in a way, I hope this young, immature doc didn't put to much of a bad spin on it in his last post, and if he did, hopefully this will set things straighter.
Newbie Doc
Newbie Doc
Monday, October 18, 2010
Two Towers
I had a girl with "chest pain" as the chief complaint as my last patient before exiting the ED tonight. It really made me think how far I had come and how much more experience I've had in the few months that I've been a "doctor". As I walked into see this patient, I walked in with an interpreter and a student, confidently I took control of the situation, slowly dissecting the history to reveal what was causing her problem. Quickly ruling out the serious causes and pairing it down to only a few unconcerning possibilities. As my diagnosis became more clear the plan seemed to logically follow from it to get an electrocardiogram and a chest x-ray to rule out the unlikely but serious problems and have her follow up with her pediatrician for what likely were panic attacks. Not to say that I've suddenly become this genius in the past few months, but I've become much more confident in my logic and my decisions. That patient 3 months ago would have freaked me out. I would have stuttered my way through the history/physical exam, likely missing a lot because of nerves...and then I would have followed that up by serving up a half-baked plan to my attending (and I definately couldn't have done it with a student under my wing).
Now I find myself actually telling (very politely ;P) the attending what I'm going to do, where before I would "suggest" my plan. It's really a good feeling to see myself growing into the shoes that seem so big at times. There are moments when I'm walking by my hospital, when I gaze up at the tower that houses the patients. My hospital is expanding. Right next to the old tower is this shiny, new one...that is about 4 times as big as the old hospital. Looking at the two side by side, the leap of moving from that "small" hospital to a hospital that will be one of the largest in the country (maybe the largest) is daunting...that's how I feel when I look at myself in comparison to just the 2nd year residents (let alone full blown Attendings)...such big shoes to fill and I'll be expected to fill them sooner than I'd like. It comforts me though to remember those two hospitals, the difference between the two may be overwhelming, but my small, old hospital won't suddenly become that new, big one in a single night...it will grow into it one room at a time, one step at a time...until one day months, maybe years, later it will finally become that thing which it has for so long aspired to be.
Newbie Doc
Now I find myself actually telling (very politely ;P) the attending what I'm going to do, where before I would "suggest" my plan. It's really a good feeling to see myself growing into the shoes that seem so big at times. There are moments when I'm walking by my hospital, when I gaze up at the tower that houses the patients. My hospital is expanding. Right next to the old tower is this shiny, new one...that is about 4 times as big as the old hospital. Looking at the two side by side, the leap of moving from that "small" hospital to a hospital that will be one of the largest in the country (maybe the largest) is daunting...that's how I feel when I look at myself in comparison to just the 2nd year residents (let alone full blown Attendings)...such big shoes to fill and I'll be expected to fill them sooner than I'd like. It comforts me though to remember those two hospitals, the difference between the two may be overwhelming, but my small, old hospital won't suddenly become that new, big one in a single night...it will grow into it one room at a time, one step at a time...until one day months, maybe years, later it will finally become that thing which it has for so long aspired to be.
Newbie Doc
Sunday, October 17, 2010
Finding Out The Hard Way
I mentioned in my last post how there a lot of subtle body language cues and voice inflections that go into dealing with patients. I got to thinking about my rules in dealing with patients, my little pointers that I would pass on to someone going into medicine. I wrote a couple of them down. It will be interesting in a couple of years if my perspective changes on this. I may look back years from now and say how stupid or naive I was in writing this, but I feel right now like these are pretty solid ones.
1. Sit down and speak eye level with a patient, never talk down to them if you can help it.
You'll notice that some people are immediately confrontational if you stand there talking while looking down at them. It's much better if you find a chair or seat 2-3 feet from them at eye level.
2. Always explain; do it slowly and patiently (even if you don't feel that it needs done).
People often really appreciate it if you take 5 minutes out of your day to educate them on what is REALLY going on. I break it down very simply and explain what is causing there problem (if I understand it myself ;P), sometimes understanding a problem is as relieving as the medicine.
3. Don't use big words, speaking to a patient isn't the place to show off your education.
I had the displeasure of working under a doctor who would push his ideas and treatments onto people by saying big words. "Ohhhhh you've got Myotonic Dyskenesis...You should take my vitamin supplement." (He was more of a snake oil salesman than a doc). I don't really know if Myotonic Dyskenesis is a real disease, it's medical Latin for "muscles that move wrong". If you can help it never use medical words in conversation with a patient. Use it for naming the disease, don't use them in anything else and if you do, explain what they mean.
4. If you don't know, don't hide it, explain and tell them you'll find out.
Amazingly it's appreciated when you cop to your ignorance, it shows you know your limits, and patients trust you more for it. Just do your best to find out and you'll be great in their eyes. Plus it's much easier to me than trying to bury their question under a pile of BS and big words, which more Doctors do than you would imagine (not a ton, but more than their should be).
5. Fix your mask on tight even before entering the room. You never know what they will say.
A good portion of "being" a doctor is acting. Among your friends and family you are allowed to be yourself, but in a room with a patient, you must be non-judgmental, passive, and more mature than anyone you'd ever care to meet ;P I had to put stitches into a kids leg last night (huge knee wound, almost to the bone), sweat was pouring from my face as I did it...it was nervousness, but I asked the nurse very nicely to blot my forehead and I finished without incident. If that kid knew how nervous I was or if I had acted the least bit freaked out by his wound, none of what we did that night would have worked with him...the patient has to buy into you as the doctor or you can't help them (or at least not near as well).
6. Don't be afraid to show that you are human, just do it in a controlled and intentional manner.
If a patient tells me something horrible, I will empathize and acknowledge it, but it doesn't do the patient any good if you are overcome with emotion and can't do your job. Some might debate me on this.
7. When you don't know what to say, sometimes silence is the best answer.
I remember this mother finding out she had inoperable cancer in her stomach. I didn't have clue what to say. Something made me keep my mouth shut, but I sat with her and her husband as they cried, and when they were done, then we talked, but sometimes your silence and time is all there is to give.
I'm going to stop at 7, cause the others I can think of aren't that interesting (ie. how to sit when talking to a patient). But if I think of anymore I'll add to this and change it as my experience dictates. Thanks for listening guys.
Newbie Doc
1. Sit down and speak eye level with a patient, never talk down to them if you can help it.
You'll notice that some people are immediately confrontational if you stand there talking while looking down at them. It's much better if you find a chair or seat 2-3 feet from them at eye level.
2. Always explain; do it slowly and patiently (even if you don't feel that it needs done).
People often really appreciate it if you take 5 minutes out of your day to educate them on what is REALLY going on. I break it down very simply and explain what is causing there problem (if I understand it myself ;P), sometimes understanding a problem is as relieving as the medicine.
3. Don't use big words, speaking to a patient isn't the place to show off your education.
I had the displeasure of working under a doctor who would push his ideas and treatments onto people by saying big words. "Ohhhhh you've got Myotonic Dyskenesis...You should take my vitamin supplement." (He was more of a snake oil salesman than a doc). I don't really know if Myotonic Dyskenesis is a real disease, it's medical Latin for "muscles that move wrong". If you can help it never use medical words in conversation with a patient. Use it for naming the disease, don't use them in anything else and if you do, explain what they mean.
4. If you don't know, don't hide it, explain and tell them you'll find out.
Amazingly it's appreciated when you cop to your ignorance, it shows you know your limits, and patients trust you more for it. Just do your best to find out and you'll be great in their eyes. Plus it's much easier to me than trying to bury their question under a pile of BS and big words, which more Doctors do than you would imagine (not a ton, but more than their should be).
5. Fix your mask on tight even before entering the room. You never know what they will say.
A good portion of "being" a doctor is acting. Among your friends and family you are allowed to be yourself, but in a room with a patient, you must be non-judgmental, passive, and more mature than anyone you'd ever care to meet ;P I had to put stitches into a kids leg last night (huge knee wound, almost to the bone), sweat was pouring from my face as I did it...it was nervousness, but I asked the nurse very nicely to blot my forehead and I finished without incident. If that kid knew how nervous I was or if I had acted the least bit freaked out by his wound, none of what we did that night would have worked with him...the patient has to buy into you as the doctor or you can't help them (or at least not near as well).
6. Don't be afraid to show that you are human, just do it in a controlled and intentional manner.
If a patient tells me something horrible, I will empathize and acknowledge it, but it doesn't do the patient any good if you are overcome with emotion and can't do your job. Some might debate me on this.
7. When you don't know what to say, sometimes silence is the best answer.
I remember this mother finding out she had inoperable cancer in her stomach. I didn't have clue what to say. Something made me keep my mouth shut, but I sat with her and her husband as they cried, and when they were done, then we talked, but sometimes your silence and time is all there is to give.
I'm going to stop at 7, cause the others I can think of aren't that interesting (ie. how to sit when talking to a patient). But if I think of anymore I'll add to this and change it as my experience dictates. Thanks for listening guys.
Newbie Doc
No Hablo Espaniol
One thing that I wish I had done before going into medicine was learn Spanish. I've heard several different doctors bat around the statement that by 2030 the US will be predominantly a Spanish speaking population. That statement doesn't hit home anywhere else more than it does in clinic, where I would say I see about 1 English speaking patient for every 9 Spanish. To talk to a Spanish speaker I have to use a phone interpreter, which is not only a huge pain in the @$$, but also really decreases the level of care they get (not to mention the added cost to the clinic in using an interpreter). I can't hear the subtle inflections in a mother who is being abused, I can't tell when a dad is really worried about his kid and he's trying to hide it, and I can't relay my advice, my directions, and my health care nearly as good as I can with an English speaker. There is a lot of subtle body language cues and language inflection codes when dealing with patients and I miss a lot of those cues because I was stubborn. When I went through high school and college my thoughts on the subject were pretty one sided.
"They are the foreigners, they need to learn OUR language, not the other way around!"
Now that I'm seeing these patients every single day, to be honest, my thoughts on the subject hasn't changed much ;P. I still feel like they should learn the national language if they want to live and work here, but my view has changed in that I now see that it's less their fault and more ours. We (Government, Business, or whatever) are enabling it. I really can't blame them for wanting to come here, it's a better life. I would do the same for my wife and child (which is exactly what our ancestors did before us). I don't pretend to understand all the political under currents of what's caused this, but I can see the way the country is going and one thing I do comprehend is that I was an idiot for not learning Spanish ;P.
Newbie Doc
"They are the foreigners, they need to learn OUR language, not the other way around!"
Now that I'm seeing these patients every single day, to be honest, my thoughts on the subject hasn't changed much ;P. I still feel like they should learn the national language if they want to live and work here, but my view has changed in that I now see that it's less their fault and more ours. We (Government, Business, or whatever) are enabling it. I really can't blame them for wanting to come here, it's a better life. I would do the same for my wife and child (which is exactly what our ancestors did before us). I don't pretend to understand all the political under currents of what's caused this, but I can see the way the country is going and one thing I do comprehend is that I was an idiot for not learning Spanish ;P.
Newbie Doc
Saturday, October 16, 2010
Reading At Grade Level
I've had a rough week. Not so much in the amount of work I've had to do, but in the type of work I've had to do. My previous post dealt with an attending that for whatever reason had a problem with me. When it's someone irrationally berating or yelling at me, I find that easy enough to rationalize away and deal with...however, when it's someone very passively tearing me down, pointing out my every little error, and embarrassing me about in front of my co-workers, I find that much harder to deal with...but I manage. What's worse is that this attending has managed to find my greatest weakness in my medical skills regimen. What could that be? I'll be the first to say I am not an expert in any part of medicine, I'm in training and learning, but there is one part of medicine where I'm not much more skilled than a third year med student fresh out of the books. Could it be clinical knowledge? Procedures? Infectious Diseases?...nope...it's WELL CHILD CHECKS...I capitalize that for effect.
Well checks are when a parent or parents brings there kid in to clinic in order to make sure they are growing and developing normally. This is the appointment where I "simply" ask about eating, drinking, peeing, pooping, weight gain, smoking, drugs, abuse, car safety, child proofing, keeping poisons locked up, gun safety, proper sports wear, sun safety, sun screen use, nutrition, obesity, family diseases, and any questions or concerns the parents might have (I'm not including all the topics if I did this would be a much longer post). A seasoned doctor could talk about any one of these for half an hour...but you only have 15-30 minutes total for the encounter...so get busy and stay on point!
In medical school I always saw checking on a child that was "well" as something that was easy and so I ignored it. I took rotations that I considered exciting, rotations that were difficult, rotations where the kids were actually sick, thinking that I would take care of that "easy" part someday. As time went on I continued to push it aside and "get by". All the while neglecting a really fundamental part of pediatrics. In the end, I compare how I felt to how an illiterate adult must feel when confronted with reading. The longer you go without knowing it the harder it is to ask for help...the more embarrassing it is to not know how to do it...the more you dread it.
But in running into this particular attending, she wouldn't let me "get by" anymore. She grilled me on exactly what I was "checking". She did it in front of my friends...and I felt very, very stupid. I'm sure my face was flushed as she pointed out how disorganized my approach was, how poorly I questioned, and brought up my pathetic attempts at anticipatory guidance (car seats, child proofing, etc). It's times like these when you feel like someone is antagonizing you. You can choose to say "Screw You"...and I REALLY wanted to say it. But there is this "wise man" proverb from some book I read in childhood that has always stuck with me...the idea at least, I may be butchering the wording.
A Wise man seeks out advice and a fool despises it.
I think it stuck with me because I'm often too proud and too often don't have the skills or ability to back up that pride. That quote has saved me countless times, times where I felt embarrassed, where my pride told me to shut my ears and close my eyes, but then that thought would strike me like an arrow, and it would give me the strength to grit my teeth and open them.
That's what happened this last week. I realized that she was right and since my last post all I have chosen to do is those dreaded, damn well child checks...embarrassing as it is to have me friends see me slowly, painfully stutter through them day in and day out. It has seriously been such a depressing and dull week. I can't count the number of times I saw two patients one with something exciting in the header like "seizures" or "blood in stool" and instead I would choose the one next to it saying "Well Child Check"...it's been a very humbling two weeks, but I console myself in knowing that every day I get a little bit better and my weakness gets a little bit stronger...someday soon I'll be "reading at grade level".
Newbie Doc
Well checks are when a parent or parents brings there kid in to clinic in order to make sure they are growing and developing normally. This is the appointment where I "simply" ask about eating, drinking, peeing, pooping, weight gain, smoking, drugs, abuse, car safety, child proofing, keeping poisons locked up, gun safety, proper sports wear, sun safety, sun screen use, nutrition, obesity, family diseases, and any questions or concerns the parents might have (I'm not including all the topics if I did this would be a much longer post). A seasoned doctor could talk about any one of these for half an hour...but you only have 15-30 minutes total for the encounter...so get busy and stay on point!
In medical school I always saw checking on a child that was "well" as something that was easy and so I ignored it. I took rotations that I considered exciting, rotations that were difficult, rotations where the kids were actually sick, thinking that I would take care of that "easy" part someday. As time went on I continued to push it aside and "get by". All the while neglecting a really fundamental part of pediatrics. In the end, I compare how I felt to how an illiterate adult must feel when confronted with reading. The longer you go without knowing it the harder it is to ask for help...the more embarrassing it is to not know how to do it...the more you dread it.
But in running into this particular attending, she wouldn't let me "get by" anymore. She grilled me on exactly what I was "checking". She did it in front of my friends...and I felt very, very stupid. I'm sure my face was flushed as she pointed out how disorganized my approach was, how poorly I questioned, and brought up my pathetic attempts at anticipatory guidance (car seats, child proofing, etc). It's times like these when you feel like someone is antagonizing you. You can choose to say "Screw You"...and I REALLY wanted to say it. But there is this "wise man" proverb from some book I read in childhood that has always stuck with me...the idea at least, I may be butchering the wording.
A Wise man seeks out advice and a fool despises it.
I think it stuck with me because I'm often too proud and too often don't have the skills or ability to back up that pride. That quote has saved me countless times, times where I felt embarrassed, where my pride told me to shut my ears and close my eyes, but then that thought would strike me like an arrow, and it would give me the strength to grit my teeth and open them.
That's what happened this last week. I realized that she was right and since my last post all I have chosen to do is those dreaded, damn well child checks...embarrassing as it is to have me friends see me slowly, painfully stutter through them day in and day out. It has seriously been such a depressing and dull week. I can't count the number of times I saw two patients one with something exciting in the header like "seizures" or "blood in stool" and instead I would choose the one next to it saying "Well Child Check"...it's been a very humbling two weeks, but I console myself in knowing that every day I get a little bit better and my weakness gets a little bit stronger...someday soon I'll be "reading at grade level".
Newbie Doc
A Rat In A Cage
1. Have you ever felt you should Cut down on your drinking?
2. Have people Annoyed you by criticizing your drinking?
3. Have you ever felt bad or Guilty about your drinking?
4. Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (Eye-opener)?
This is the C.A.G.E. questionnaire. This is one of the screens my colleagues in adult medicine use to check for problem drinkers. If you answer yes to 2 or more of these questions, it's very likely that you have a drinking problem, that you are addicted. Now insert your own addiction. Do you have one?
1. Have you ever felt you should Cut down on your ________?
2. Have people Annoyed you by criticizing your ________?
3. Have you ever felt bad or Guilty about your ________?
4. Have you ever had a ______ to steady your nerves or get over something stressful (Eye-opener)?
I do. It's not something that is as destructive as a drug addiction, but it's detrimental to my life. It's an addiction that I can get caught up in for hours upon hours. When I'm at my worst I let homework go overdue, blogs don't get written, bills get paid late, my wife is neglected, and life, in general, passes me by. I think those who know me, know what my little problem is and that I struggle with it. The reason I'm able to write this blog tonight is because I had my wife lock up this little habit and hide the key...I'm not strong enough to totally get rid of it...like most addicts I have an excuse to keep it around...and I'm worse for knowing it's an excuse. Maybe you'll see a few more blogs on here now that I've temporarily "fixed" my little problem. You might even get to see first hand my withdrawal...it's funny that I actually have them, but apparently I do, according to my wife. I once got totally rid of this habit for months on end and she said I was so dull and "mope-y" that she bought me another...to which I am presently hung up on. Am I really like the alcoholic that isn't as "fun" when he/she is sober? It's just video games...why the hell am I so pathetically attached to them...I know it's pretty lame...I'm working on it (why, when I say that, do I feel like the hundred thousand smokers that I've heard say "I'm trying to quit").
Newbie Doc
2. Have people Annoyed you by criticizing your drinking?
3. Have you ever felt bad or Guilty about your drinking?
4. Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (Eye-opener)?
This is the C.A.G.E. questionnaire. This is one of the screens my colleagues in adult medicine use to check for problem drinkers. If you answer yes to 2 or more of these questions, it's very likely that you have a drinking problem, that you are addicted. Now insert your own addiction. Do you have one?
1. Have you ever felt you should Cut down on your ________?
2. Have people Annoyed you by criticizing your ________?
3. Have you ever felt bad or Guilty about your ________?
4. Have you ever had a ______ to steady your nerves or get over something stressful (Eye-opener)?
I do. It's not something that is as destructive as a drug addiction, but it's detrimental to my life. It's an addiction that I can get caught up in for hours upon hours. When I'm at my worst I let homework go overdue, blogs don't get written, bills get paid late, my wife is neglected, and life, in general, passes me by. I think those who know me, know what my little problem is and that I struggle with it. The reason I'm able to write this blog tonight is because I had my wife lock up this little habit and hide the key...I'm not strong enough to totally get rid of it...like most addicts I have an excuse to keep it around...and I'm worse for knowing it's an excuse. Maybe you'll see a few more blogs on here now that I've temporarily "fixed" my little problem. You might even get to see first hand my withdrawal...it's funny that I actually have them, but apparently I do, according to my wife. I once got totally rid of this habit for months on end and she said I was so dull and "mope-y" that she bought me another...to which I am presently hung up on. Am I really like the alcoholic that isn't as "fun" when he/she is sober? It's just video games...why the hell am I so pathetically attached to them...I know it's pretty lame...I'm working on it (why, when I say that, do I feel like the hundred thousand smokers that I've heard say "I'm trying to quit").
Newbie Doc
Wednesday, October 6, 2010
Eh..I've Got Enough Friends Anyways ;P
I can't say that I really like my outpatient clinic that much yet maybe things will change, but I got a bad vibe going in. I had heard as much from older residents...I believe the quote was, "There is WAY to much estrogen running through that place and that's coming from someone who has estrogen." I honestly don't mind things to much except for one attending in particular, she's a lot like my fourth grade teacher who used to send me to the principles office all the time way back when. She's just really "catty" and aggressive...and you never quite know when she's gonna hit you with it, so you have to be in a constant state of increased awareness...which is exhausting and demoralizing...you think she's being nice, but she's really just lulling you into a false sense of security then...WHAM!!! Even my fellow co-workers have noticed that she doesn't like me...it's really weird, I don't usually rub people the wrong way but when I do, it's like I can't do anything but continue to push them...not necessarily on purpose...it's kinda like when someone tries to grab you and push you off balance, you either fall or you instinctively reach out and grab their arm...simultaneously keeping yourself up and tossing them in the water. Today she was speaking on a particular vaccine. She was speaking about how you couldn't give a particular vaccine after you had administered a totally different treatment for a completely different virus...this on the surface doesn't make sense and I simply asked her to clarify...instead of clarifying she told me to "THINK about it" (not in a nice and non-judgmental tone)...I told her, "if thinking about it would get me an answer then I wouldn't have posed the question in the first place."...she didn't like that response. I finally figured it out, without her help. To multiply the badness, later in an effort to make peace I asked her a question that I figured she would know the answer to. She had been harping on how important it was NOT to get these two very similar vaccines mixed up...she had said, "if you mix up the Tdap and the Dtap vaccines, you will FAIL this rotation." Thinking that this would be an obvious question to pose and one she had to know the answer to, at the end of the lecture, when the teacher asks, "Does anyone have any questions?" I wanted to show her that I had been listening, so I asked this seemingly very simple question. Not because I knew the answer, but because I figured if she were going to beat on something so much, that there must be a very good reason to go on about it. So I asked, "What's the big deal with switching up the Tdap and the Dtap? Does something bad happen?"...in retrospect, it probably looked like I knew what the answer was, because I asked it so pointedly, and I was setting her up to look stupid...but that wasn't my intention...regardless, it worked out that way when she stumbled and looked for help from her fellow attendings (I thought to myself "OH $%@!, here we go...") and I caught a couple of my fellow interns grinning just out of her eyesight....I hope it was out of her eyesight anyway. I haven't found a good way to deal with these types of people yet, my routine when I meet someone that is just constantly irritated by me is to treat them as best you can and try not to get into a tennis match of meanness...sometimes it happens though despite your best efforts and when it does it's another one of those things where you've just got to take it one step at a time.
Newbie-Doc
Newbie-Doc
Tuesday, October 5, 2010
Greener Pastures
I'm back! This morning I didn't have to get up at 5am. Life is looking up. I was able to wake up WITH my wife this morning and actually take my time getting ready. I was in grid lock traffic with the rest of the world but somehow nothing seems to effect me because I'm done with the rotation that shall-not-be-named. It truly is a horrible month. I actually stayed 3 hours later than I was expected to yesterday to help out the new interns that were coming on...I felt bad for them...it took me right back to my first week there and how quickly I was beaten down, I felt obligated to help them through it a bit. I knew that I would catch some hell for it, but really all I got was people asking me, "DO you SERIOUSLY like being here?!?!" and "DUDE, what the HELL are you doing, ESCAPE!" But that was from my seniors...who I was also helping out. It was easier working when I knew I didn't have to be and that my friends would benifit a little bit. I'd be lying though if I didn't say what I'm going to say - having a good reputation is key when you work on a team. You want to be the guy or girl that people can turn to over and over again for help in solving problems...it seems like more work and it is in a way. But it puts people in your corner and when its YOU that needs the help (which any resident can appreciate...especially me). Anyways I eventually did leave that place and when I left, I left with a clear conscience knowing that I had given my friends the best start I could...and now I'm on to greener...later starting pastures (ie. Outpatient Clinic!!!!).
I won't totally hate on that place though, I have to say that leaving that place I'm a far stronger doctor than I was going in. The place wasn't hell because of the people or the paper work or any other reason that people normally hate work...it was hell because of the sheer volume and complexity of my patients...it was a hell, but it was a hell that I chose and I wanted and when the time comes, I'll go back to it willingly...but I need a break first :)
Newbie Doc
I won't totally hate on that place though, I have to say that leaving that place I'm a far stronger doctor than I was going in. The place wasn't hell because of the people or the paper work or any other reason that people normally hate work...it was hell because of the sheer volume and complexity of my patients...it was a hell, but it was a hell that I chose and I wanted and when the time comes, I'll go back to it willingly...but I need a break first :)
Newbie Doc
I'm So Sorry
I was actually told once that the letters "MD" mean never having to say you are sorry. There is that stereotype that the public has. That being a doctor means you are "less human" than others, that you make less mistakes, and that when errors do happen it wasn't the doctor's fault. Like hearing Superman apologize for not being able to save a bystander from a flood or an exploding volcano...you never see him apologize in the comics for something that was actually HIS fault. As doctors there is that idea, that somehow we are similar to this, but in my experience at least, I have found that I am still very much human and prone to the same errors of poor logic and dumb mistake that I was susceptible to before I became an MD. I think I had this thought in the back of my head that when they handed me my diploma I would somehow change and instantly become this infallible super-human figure...but it's just like when they ask you if you feel any older on your birthday...you don't.
Even still, it's this feeling that you shouldn't apologize that I struggle with. I think you could take the most kind and considerate person on the planet, place them in the shoes of a doctor, and even they would struggle with apologizing to a patient. Every single time that I say the words "I'm sorry..." to a patient, my mind mentally pauses and I feel guilty. I think the guilt stems from that idea that doctors don't apologize because doctors don't make mistakes and from the idea that I shouldn't have made the mistake period...maybe also a little bit because I feel like I'm opening myself up to litigation ;P (but really more for the latter reason). You have this thought that when you admit to a mistake or an incorrect course of action that they will tear you apart, that they will fire you from their care, or that they will not trust you (and that may happen) but it won't happen near as fast as it does if you refuse to communicate with your patients and if you refuse to admit your mistakes to others.
I recently had to apologize because I hadn't communicated how poor a prognosis this little 12 year old girl under my care had. I honestly just assumed they knew how bad it was and I let it catch them and me off guard when they realized that she was going to stay the way she was for possibly the rest of her life. The girl who I speak of is an eleven year old who is currently bed bound from a infection of the brain that went untreated too long. The hospital received her from an Indian reservation where medical care was poor. She isn't improving, she won't be improving, she is actually getting worse. The parents are frustrated, the medical plan is not changing, and my attending after discussing what our patient's course of care is likely to be (chronic, unremitting, dismal - seriously pick a word - the clinical prognosis SUCKS for this kid), with tears of frustration hanging in the mother's eyes his words are, "I can see that you are impatient mam, I can see the frustration in your eyes, but this is how it's probably going to be for your daughter for the foreseeable future." He then coldly walks from the room without another word. I then spent the next 40 minutes speaking with the parents and a lot of that speaking involved saying that I was sorry. Sorry that we couldn't do more. Sorry that I hadn't updated them frequently enough and that they had felt surprised by this statement of prognosis. Sorry that their daughter is dying and there is little we can do. I honestly admitted to them one of the reasons I hadn't spoken directly of her prognosis was because I didn't want to be the one to say it...which was more than a little true...I should have though, I knew them best. Having me state the tell them in two words would have been better than what we had done to them just then. I let them down.
In horrible moments like this, moments even Supes could not bear, he would go back in time by flying around the world rediculously fast (like the movies), he'd go back, and give the child antibiotics and this little girl would be running around causing trouble with her friends present day...but she's not playing with her friends...she's laying there in a diaper, with a hole in her neck, and a tube in her stomach...she's laying there with an unblinking stare. She and I share a terrible truth which the parents are now beginning to realize as well...there is no Superman, it's just me and all I have for them is my pathetic apologies. I'm so sorry.
Newbie Doc
Even still, it's this feeling that you shouldn't apologize that I struggle with. I think you could take the most kind and considerate person on the planet, place them in the shoes of a doctor, and even they would struggle with apologizing to a patient. Every single time that I say the words "I'm sorry..." to a patient, my mind mentally pauses and I feel guilty. I think the guilt stems from that idea that doctors don't apologize because doctors don't make mistakes and from the idea that I shouldn't have made the mistake period...maybe also a little bit because I feel like I'm opening myself up to litigation ;P (but really more for the latter reason). You have this thought that when you admit to a mistake or an incorrect course of action that they will tear you apart, that they will fire you from their care, or that they will not trust you (and that may happen) but it won't happen near as fast as it does if you refuse to communicate with your patients and if you refuse to admit your mistakes to others.
I recently had to apologize because I hadn't communicated how poor a prognosis this little 12 year old girl under my care had. I honestly just assumed they knew how bad it was and I let it catch them and me off guard when they realized that she was going to stay the way she was for possibly the rest of her life. The girl who I speak of is an eleven year old who is currently bed bound from a infection of the brain that went untreated too long. The hospital received her from an Indian reservation where medical care was poor. She isn't improving, she won't be improving, she is actually getting worse. The parents are frustrated, the medical plan is not changing, and my attending after discussing what our patient's course of care is likely to be (chronic, unremitting, dismal - seriously pick a word - the clinical prognosis SUCKS for this kid), with tears of frustration hanging in the mother's eyes his words are, "I can see that you are impatient mam, I can see the frustration in your eyes, but this is how it's probably going to be for your daughter for the foreseeable future." He then coldly walks from the room without another word. I then spent the next 40 minutes speaking with the parents and a lot of that speaking involved saying that I was sorry. Sorry that we couldn't do more. Sorry that I hadn't updated them frequently enough and that they had felt surprised by this statement of prognosis. Sorry that their daughter is dying and there is little we can do. I honestly admitted to them one of the reasons I hadn't spoken directly of her prognosis was because I didn't want to be the one to say it...which was more than a little true...I should have though, I knew them best. Having me state the tell them in two words would have been better than what we had done to them just then. I let them down.
In horrible moments like this, moments even Supes could not bear, he would go back in time by flying around the world rediculously fast (like the movies), he'd go back, and give the child antibiotics and this little girl would be running around causing trouble with her friends present day...but she's not playing with her friends...she's laying there in a diaper, with a hole in her neck, and a tube in her stomach...she's laying there with an unblinking stare. She and I share a terrible truth which the parents are now beginning to realize as well...there is no Superman, it's just me and all I have for them is my pathetic apologies. I'm so sorry.
Newbie Doc
Thursday, September 23, 2010
Just Passing Through
Just a quick post. I'm coming up on my black Saturday and I'm utterly out of energy. It's like when you are on call and you are exhausted and you look at your watch and it's only 8:30 pm and you realize as you count the hours that you aren't even half done yet. Yesterday I was on call and I started to fall asleep while writing a note, I wrote 2 sentences before I came to. I wrote something about bleeding and a patient needing a transfusion...the patient in question was in for irretractable migraines...scary...I went down stares and chugged two energy drinks...big ones (and then finished the day as fast as I could). I did a friend a favor today and stayed a little later. As a reward I got the most horrible admit a pediatrician has ever seen, I stayed an extra 3 hours on top of what I was already there for...seriously this kid has 20+ medications and his problem list is bigger than a geriatrics patient. People were apologizing that I was there that long, I don't complain to them, especially when it's something like that...I hate seeing other people do that - sometimes you get screwed, there isn't anyway around it, just deal with it and move on...when other people complain about their bad luck during work it just demoralizes me...but honestly I'd be lying if I told you staying way late and getting crazy patients like that doesn't effect me. I stay up late these days playing video games, surfing the net, and blogging (occasionally) mainly because I'm procrastinating...I really don't want to go back to work...at least not so soon. My wife and I feel like we get home, eat, sleep, and go back to work...I think in the back of my mind all this staying up is me trying to infuse a little "non-medicine" between the work-sleep-work part of things (not exactly a bright idea). We're both really starting to feel it. She complains that we never see each other anymore, but we really see each other as much as we can. I try to be the "bright side" of things and tell her it's just a blink away from over...I don't really feel like that either, but I feel like admitting to it would make it that much worse for both of us :P
Maybe that's why I really hate complainers at work...what makes it worse is that the ones that complain about work are also the ones that do the least amount of it. I like that country song - that says when you're going through hell, don't stop in it, just keep on going...don't pause to remark on the scenery just get on through it...on that note maybe I should stop messing around and get to sleep so I can get this rotation over with. Goodnight everybody. I hope you all are doing great and things are looking up : ) I'm out.
Newbie Doc
Maybe that's why I really hate complainers at work...what makes it worse is that the ones that complain about work are also the ones that do the least amount of it. I like that country song - that says when you're going through hell, don't stop in it, just keep on going...don't pause to remark on the scenery just get on through it...on that note maybe I should stop messing around and get to sleep so I can get this rotation over with. Goodnight everybody. I hope you all are doing great and things are looking up : ) I'm out.
Newbie Doc
Monday, September 20, 2010
The Clouds Break
So a continuation of my last post, "Doing The Right Thing". I arrived today surprised to see that the mother of the little boy who couldn't stand had decided not to leave AMA after all. The ultrasound studies that we had ordered over the day I was gone had come back as normal, but we had ordered a bone scan today which I REALLY felt would show us something. (A bone scan shows where the "activity" is in the bone - whether normal or abnormal - it's similar to the difference between taking a picture of a car engine running -MRI- or taking a video of a car engine running -Bone Scan-).
Well what followed was a massive effort to navigate the bureaucracy of medicine. We had ordered a bone scan for today...but my attending over the weekend didn't think it was necessary at the time and took it off the schedule until Monday. Putting it back on the schedule last minute was a massive effort requiring me to call and smooze 5 different schedulers, 2 different doctors, and bribe 2 nurses with chocolate...which actually works way better than I ever would have believed (I'll never forget the power of chocolate after today) ;P...seriously though. It took an act of God to get it done...and then another act to get the thing read by a radiologist today...but it was a big payoff as we were able to figure out what was wrong with this little guy.
DISKITIS!!!! It's awesome, because 1) it was on my differential of suspected causes 2) it had gone undiagnosed at two other different hospitals 3) I had to fight tooth and nail to get this bone scan which ended up being the one test that we really needed and most importantly 4) this is a treatable disease (not cancer thank God!). Anyway it's a big win for my team and for my patient...I had to stay 4 hours longer than normal, but I would do that day in and day out if everyday were like today.
It seems as a resident sometimes you are lost in a sea of "wrongs", you don't know down from up, north from south and all you really have is your faith that you'll get to where you are going, but every once in awhile when you are feeling lost in the storm, the clouds will break for what may be only an instant, and with a sudden shining beam of light, you'll see a bright blue sky with a radiant warm sun - a stark reminder of where you're going and who you want to be.
Newbie Doc
Well what followed was a massive effort to navigate the bureaucracy of medicine. We had ordered a bone scan for today...but my attending over the weekend didn't think it was necessary at the time and took it off the schedule until Monday. Putting it back on the schedule last minute was a massive effort requiring me to call and smooze 5 different schedulers, 2 different doctors, and bribe 2 nurses with chocolate...which actually works way better than I ever would have believed (I'll never forget the power of chocolate after today) ;P...seriously though. It took an act of God to get it done...and then another act to get the thing read by a radiologist today...but it was a big payoff as we were able to figure out what was wrong with this little guy.
DISKITIS!!!! It's awesome, because 1) it was on my differential of suspected causes 2) it had gone undiagnosed at two other different hospitals 3) I had to fight tooth and nail to get this bone scan which ended up being the one test that we really needed and most importantly 4) this is a treatable disease (not cancer thank God!). Anyway it's a big win for my team and for my patient...I had to stay 4 hours longer than normal, but I would do that day in and day out if everyday were like today.
It seems as a resident sometimes you are lost in a sea of "wrongs", you don't know down from up, north from south and all you really have is your faith that you'll get to where you are going, but every once in awhile when you are feeling lost in the storm, the clouds will break for what may be only an instant, and with a sudden shining beam of light, you'll see a bright blue sky with a radiant warm sun - a stark reminder of where you're going and who you want to be.
Newbie Doc
Sunday, September 19, 2010
Doing The "Right" Thing
Ahhhhhh. I'm on break today - I was reading my last post and I don't think I gave my wife enough credit, her rotation IS harder than mine - I do have the 30 hour calls every 4 days but she works from 5am till 7pm every day and she'll do it straight through for a month - no days off (she did take a half day off a week ago...that was nice...turns out she miss read the schedule and wasn't supposed to though).
Anyway I thought I'd take a second to talk about crazy people. Beings how hospitals are places for sick people, it stands to reason that we tend to attract all kinds of nuts...I'm not just talking about the doctors and nurses ;P Occasionally, you run into someone that you just can't understand - there is no logic in there action and none of what they do makes sense...in adult medicine it's a lot less painful to watch these people make poor decisions that effect their health...it is after all their life and their choice...but what happens when one of these people is a parent, and the poor decision their making doesn't effect the adult but instead is effecting their innocent child?
It was late evening two days ago now, I was on call. I got paged to a new admit. It was a small little boy named Alex. He was a pretty cute little guy - just over a year, he had been previously health...until he stopped walking or even sitting up. For the last 2-3 weeks he has been laying on the ground and would not get up. If you try to make him stand or sit he will scream out in pain. This mother has taken Alex to several different hospitals, each doing their best to figure out whats going on. What I get is all the records of previous testing for this little boy. So far despite other hospitals best efforts the best we can say from the massive amount of testing ran is that there is something causing a major inflammatory response in his body. This is one of those things that is causing such a response, we know that we WILL find it...it's not one of those things that goes undiagnosed and then disappears...this will likely continue to become more and more of a problem as time goes on.
Alex's problem is two fold though, not only does he have a serious problem already effecting him, but also he has a mother who has really poor coping skills. As I admitted Alex, I thought I caught a hint of it here or there in the way the I gathered the history...for instance you ask a concerned parent, "Did the vomit have blood in it or green bile?" and the parent responds (instead of a quick "no" or "yes"), "uhhhhhhh...I...don't know....".
Why wouldn't you know facts like that about your child. Anyway as time went on it became increasingly apparent that Alex wasn't at the top of her priorities list...the mother's excuse list was a mile long...never ending and it was impossible to get to the bottom of it and figure out what was really bothering her, it just seemed like she HAD to get out of the hospital as fast as possible and she would make up any excuse necessary to do it...none of which were very good. Throughout the rest of the morning I was intermittently called back to her room to argue for the child's benefit - someone needs to find out what is wrong with Alex and it's not going to get done if she keeps leaving hospitals AMA (against medical advice) which is what she has done with the last two hospitals (and what she is planning on doing with us). She is demanding, she is unreasonable, and she is shows a general lack of concern for her child! I had my "mask" on like it was my face, I honestly have never been so two faced in my life. Talking to her all the while with compassion and faked understanding, trying to remain calm, as she slowly brought up reason after pathetic reason for her to take her child out of the hospital.
"I have school on monday." -- "I'm not doing well in school." -- "My kids are at home with my grandmother." -- "I don't like hospitals." -- "People will think I'm a bad mother, if I leave my kid alone in the hospital."
We discussed that she didn't have to be here all the time. Her husband even said he could be here for some of the time and we are a children's hospital - set up for really sick kids and parents that can't always stay 100% of the time with their children. We have social workers that can help her school understand what she is going through and cut her some slack.
Every issue she had (there are many more than I listed - all equally small concerns compared to your child) we addressed. However, it would only be another hour or two until she would call again wanting to leave. She would have the same exact concerns - no different than before. We would speak with her regarding those concerns (basically saying the same thing as before). This happened four times before I left. On the fourth time, we had had enough and simply told her unless she had something new to say, she knew that she could leave if she chose to - however we recommended against it for her child's sake. I went off post call that afternoon...something tells me she's left by now.
I've seldom felt so much frustration and rage, wanted so desperately to direct it at one person, and been unable to. Instead I had to play the doctor role...her kid is really sick and she cared more for her own comfort than her child...I wanted to punch her in the face...but I didn't, I remained cool and collected...and I did the "right" thing.
Newbie Doc
What I wrote right there makes me feel really immature and emotional, but it's how I felt, right or wrong...it's how I still feel.
Anyway I thought I'd take a second to talk about crazy people. Beings how hospitals are places for sick people, it stands to reason that we tend to attract all kinds of nuts...I'm not just talking about the doctors and nurses ;P Occasionally, you run into someone that you just can't understand - there is no logic in there action and none of what they do makes sense...in adult medicine it's a lot less painful to watch these people make poor decisions that effect their health...it is after all their life and their choice...but what happens when one of these people is a parent, and the poor decision their making doesn't effect the adult but instead is effecting their innocent child?
It was late evening two days ago now, I was on call. I got paged to a new admit. It was a small little boy named Alex. He was a pretty cute little guy - just over a year, he had been previously health...until he stopped walking or even sitting up. For the last 2-3 weeks he has been laying on the ground and would not get up. If you try to make him stand or sit he will scream out in pain. This mother has taken Alex to several different hospitals, each doing their best to figure out whats going on. What I get is all the records of previous testing for this little boy. So far despite other hospitals best efforts the best we can say from the massive amount of testing ran is that there is something causing a major inflammatory response in his body. This is one of those things that is causing such a response, we know that we WILL find it...it's not one of those things that goes undiagnosed and then disappears...this will likely continue to become more and more of a problem as time goes on.
Alex's problem is two fold though, not only does he have a serious problem already effecting him, but also he has a mother who has really poor coping skills. As I admitted Alex, I thought I caught a hint of it here or there in the way the I gathered the history...for instance you ask a concerned parent, "Did the vomit have blood in it or green bile?" and the parent responds (instead of a quick "no" or "yes"), "uhhhhhhh...I...don't know....".
Why wouldn't you know facts like that about your child. Anyway as time went on it became increasingly apparent that Alex wasn't at the top of her priorities list...the mother's excuse list was a mile long...never ending and it was impossible to get to the bottom of it and figure out what was really bothering her, it just seemed like she HAD to get out of the hospital as fast as possible and she would make up any excuse necessary to do it...none of which were very good. Throughout the rest of the morning I was intermittently called back to her room to argue for the child's benefit - someone needs to find out what is wrong with Alex and it's not going to get done if she keeps leaving hospitals AMA (against medical advice) which is what she has done with the last two hospitals (and what she is planning on doing with us). She is demanding, she is unreasonable, and she is shows a general lack of concern for her child! I had my "mask" on like it was my face, I honestly have never been so two faced in my life. Talking to her all the while with compassion and faked understanding, trying to remain calm, as she slowly brought up reason after pathetic reason for her to take her child out of the hospital.
"I have school on monday." -- "I'm not doing well in school." -- "My kids are at home with my grandmother." -- "I don't like hospitals." -- "People will think I'm a bad mother, if I leave my kid alone in the hospital."
We discussed that she didn't have to be here all the time. Her husband even said he could be here for some of the time and we are a children's hospital - set up for really sick kids and parents that can't always stay 100% of the time with their children. We have social workers that can help her school understand what she is going through and cut her some slack.
Every issue she had (there are many more than I listed - all equally small concerns compared to your child) we addressed. However, it would only be another hour or two until she would call again wanting to leave. She would have the same exact concerns - no different than before. We would speak with her regarding those concerns (basically saying the same thing as before). This happened four times before I left. On the fourth time, we had had enough and simply told her unless she had something new to say, she knew that she could leave if she chose to - however we recommended against it for her child's sake. I went off post call that afternoon...something tells me she's left by now.
I've seldom felt so much frustration and rage, wanted so desperately to direct it at one person, and been unable to. Instead I had to play the doctor role...her kid is really sick and she cared more for her own comfort than her child...I wanted to punch her in the face...but I didn't, I remained cool and collected...and I did the "right" thing.
Newbie Doc
What I wrote right there makes me feel really immature and emotional, but it's how I felt, right or wrong...it's how I still feel.
Friday, September 17, 2010
Getting By
I'm looking at my calendar and I've only got 16 more days of Wards...I can't wait till this is over. I'm getting much better at managing it, however, between Wards and OB (what my wife is on - which may actually be even harder especially since she is pregnant) our house is falling apart. My wife and I come home exhausted, we plop down on the couch and eat whatever we can scrounge from the fridge or freezer, we watch a 30 minute episode of TV, and we go to bed...we wake up (her at 4am and me at 5) and we repeat the cycle. We do the bare minimum around the house, so unless you need scrubs or a bowl for food you really don't do either (if you can help it) and errands/chores just pile up...and they will keep piling up until this little horror of a month is over for us...I really don't mind when it's just one of us on a hard month, but when we both get "hit" it really throws us for a loop...you basically just crawl along, slowly getting toward your goal - you do only what absolutely needs done in your "life" and you try to make it to that better schedule in the sky.
Cursed
One thing you come across regardless of the area of medicine that you are in is the "chronic" family. While we all have our diseases that run in the family or problems that occur infrequently (sometimes tragically), for these rare few tragedy, pain, and suffering is the norm. If you saw them walking down the street a dark cloud might be following in their wake. I'm almost apprehensive in writing about this because I feel I may jinx my own family as God has blessed us with relatively good health. Today I came across one such family and having a little extra time than I'm usually accustomed, I spent some of it getting to know them after I checked on how their son was doing. This is a family with a genetic disease. The father carries the gene, which although not tested, is probably the most severe form of the disorder. They, throughout their life, develop tumors all over their body, these tumors develop as early as 18 years of age and effect everyone who inherits the gene. The tumors themselves are usually not malignant (the kind that spreads all over the body), but the size and frequency of these masses are problem enough as they develop behind eyes, block arteries, and even compress brain tissue...basically they spend more time in and recovering from surgery than you or I could imagine in the darkest corners of hell...and yet the most amazing part of it (for me) is that they somehow manage it and find a way to move on. I suppose I could find inspiration in a group of people like this and to some extent I do - I am amazed at what the human body and spirit can endure, but from a scientific point of view I find myself slightly angered by their choices.
While the field of genetics has only really blossomed recently, the idea of inheritable diseases has been around for a very long time. Why did these people keep reproducing?!?!? It seems selfish to me to knowingly put a child through this type of medical horror day in and day out...really for any argument I can come up with to justify it...it still seems ridiculously selfish.
I can see the argument for wanting your "own" child. I realize there is an argument for the family that is so used to it, having tumors pop up all over your body isn't abnormal to them. I know that some will argue for God's will. I spoke with this family for a good little while, but I never got up the guts or got comfortable enough with them to find out what their argument or reasoning was for bringing children into a world to be tortured.
The patient I am seeing, is here for a stomach flu (gastroenteritis), something totally unrelated...to be totally understated...he is just REALLY unlucky. As of right now he is completely healthy and hasn't shown any signs of the tumor growth, but, as he has been tested, he very likely will start developing them sometime in high school. Looking at the father, who is in his late 30's, I can see how difficult this life will be for the child. The father is missing an eye, walks with a limp, and (as I found out from speaking with them) has had most of his bowel removed. His face is scarred and areas of it are hollowed out from various tumors that have been removed....although chronologically this man is only a decade older than I, the life he has lived has advanced his age far beyond his years.
I see the father and the older sister who is similarly effected and I wonder why you would do this to someone you love? why you would put them through this, bring them into this world? I don't have an answer or a clever thought to end my post, I don't know why and I know it's beyond me to judge them...but I can't help but do it a little anyway...I think I'm judgemental because I don't understand them and maybe the closed-off, relatively "good" reality I live in doesn't want to understand them...I think deep down it's really that this cowardly doctor hopes and prays he never can relate to or understand such a horrible thing.
Newbie Doc
While the field of genetics has only really blossomed recently, the idea of inheritable diseases has been around for a very long time. Why did these people keep reproducing?!?!? It seems selfish to me to knowingly put a child through this type of medical horror day in and day out...really for any argument I can come up with to justify it...it still seems ridiculously selfish.
I can see the argument for wanting your "own" child. I realize there is an argument for the family that is so used to it, having tumors pop up all over your body isn't abnormal to them. I know that some will argue for God's will. I spoke with this family for a good little while, but I never got up the guts or got comfortable enough with them to find out what their argument or reasoning was for bringing children into a world to be tortured.
The patient I am seeing, is here for a stomach flu (gastroenteritis), something totally unrelated...to be totally understated...he is just REALLY unlucky. As of right now he is completely healthy and hasn't shown any signs of the tumor growth, but, as he has been tested, he very likely will start developing them sometime in high school. Looking at the father, who is in his late 30's, I can see how difficult this life will be for the child. The father is missing an eye, walks with a limp, and (as I found out from speaking with them) has had most of his bowel removed. His face is scarred and areas of it are hollowed out from various tumors that have been removed....although chronologically this man is only a decade older than I, the life he has lived has advanced his age far beyond his years.
I see the father and the older sister who is similarly effected and I wonder why you would do this to someone you love? why you would put them through this, bring them into this world? I don't have an answer or a clever thought to end my post, I don't know why and I know it's beyond me to judge them...but I can't help but do it a little anyway...I think I'm judgemental because I don't understand them and maybe the closed-off, relatively "good" reality I live in doesn't want to understand them...I think deep down it's really that this cowardly doctor hopes and prays he never can relate to or understand such a horrible thing.
Newbie Doc
Tuesday, September 14, 2010
Worn Out
I'm so worn out. Yesterday was my fourth 30 hour call...I'm counting em down like Xmas...or days of detention. I'm not even half way yet. I had a long night, but I was able to manage my patients without any screw ups and even had a couple of good "catches" on some patients (ie I recognized a drug reaction no one had considered). All in all a brutal day, I didn't sleep a wink of it and I seriously went from one admit to another. There wasn't a single "easy" admit, the one admit they told me was "easy" ended up being the most complex kid of the bunch (he had a major heart defect, born premature, poor weight gain, and now with new sudden episodes of turning blue - cyanosis...where did they get "easy" from). Much to my surprise I weathered it all and lived to tell about it...I'm now having trouble going to sleep. I've only had about 1-2 hours of it in this 48 hour time period...but if I go back to sleep that means I'll soon wake up and do it all over again...I don't know if I'm ready for that - but I guess I better do it anyway :P
Here Goes Nothing.
A Very Exhausted Newbie-Doc
Here Goes Nothing.
A Very Exhausted Newbie-Doc
Monsters
Person: "What do you do for a living?"
Me: "I'm a pediatrician."
Person: "Wow, I couldn't do it dealing with all that sad stuff."
They are right...in medicine there is alot of sad stuff and in pediatrics it's the sad stuff that can really jump up and grab you. You will see countless adults in medicine that have made poor choices and now they are at the end of the line, honestly it's easy to get over that - they had thier choice now they are living with the consequences, you do your best to help them and the sadness of their situation (cold as it may seem saying this) washes over you...because you don't know them and you can tell yourself that. In pediatrics, that statement is never made or even thought about. No kid deserves to be sick. I think that's why I'm in pediatrics, every day my patients actually DESERVE help...it drives me nuts working with a 40 year old diabetic who doesn't listen to my advice or take my prescribed medication. Ussually if there is any frustration in caring for my patients it is derived from the parents. The parents are often the source of the child not taking the medication or the child being sick...and none of these undeserved problems is more frustrating and sickening than child abuse.
The typical case you'll see on TV is where suddenly they see a child with abdominal pain and the doctor walks in while the parent is hitting the child. Suddenly the doctor slams the parent against the wall and screams for the police, its all very draumatic and leaves you with this rewarding feeling that "good" has been done. That's not typically how these cases go. In real life the child comes in with some injury...something just slightly conspicuous (ie the child rolled off the table and got a skull fracture). At first it doesn't seem all that concerning...you want to believe in this beautiful and perfect world...the mother is going to tell the truth about her little girl...you will believe her...and that's that. However, when you speak to the father...his story doesn't quite match up. As you begin thinking about it, how many children fall 3-4 feet onto the floor and get a serious skull fracture (very few - there have been studies). As you involve child forensics and the cross examination begins of the parents and the family, this perfectly optimistic world you live in develops "cracks". After multiple tellings of the story from the parents, the mother finally collapses in tears, snapping under the stress of trying to hide that her mother is the cause. Suddenly it's as if this magic bubble of a world you believe in shatters...suddenly you wake up in the real world...a world where monsters really do exist.
There isn't always this black and white answer to the abuse or accident. Sometimes it's nobodies fault, sometimes it's everybodies. One thing is for certain, at the end of the day you don't feel like somebody's hero and you don't feel like your TV episode is rolling with credits, playing a happy song. You feel like the world is "darker" than it once was and as you walk out the door of your hospital...maybe even before you go to sleep that night, you'll be thinking about how your patients don't deserve this...and that's why, no matter how tough it gets, you'll walk back through the doors in the morning.
Newbie Doc
Me: "I'm a pediatrician."
Person: "Wow, I couldn't do it dealing with all that sad stuff."
They are right...in medicine there is alot of sad stuff and in pediatrics it's the sad stuff that can really jump up and grab you. You will see countless adults in medicine that have made poor choices and now they are at the end of the line, honestly it's easy to get over that - they had thier choice now they are living with the consequences, you do your best to help them and the sadness of their situation (cold as it may seem saying this) washes over you...because you don't know them and you can tell yourself that. In pediatrics, that statement is never made or even thought about. No kid deserves to be sick. I think that's why I'm in pediatrics, every day my patients actually DESERVE help...it drives me nuts working with a 40 year old diabetic who doesn't listen to my advice or take my prescribed medication. Ussually if there is any frustration in caring for my patients it is derived from the parents. The parents are often the source of the child not taking the medication or the child being sick...and none of these undeserved problems is more frustrating and sickening than child abuse.
The typical case you'll see on TV is where suddenly they see a child with abdominal pain and the doctor walks in while the parent is hitting the child. Suddenly the doctor slams the parent against the wall and screams for the police, its all very draumatic and leaves you with this rewarding feeling that "good" has been done. That's not typically how these cases go. In real life the child comes in with some injury...something just slightly conspicuous (ie the child rolled off the table and got a skull fracture). At first it doesn't seem all that concerning...you want to believe in this beautiful and perfect world...the mother is going to tell the truth about her little girl...you will believe her...and that's that. However, when you speak to the father...his story doesn't quite match up. As you begin thinking about it, how many children fall 3-4 feet onto the floor and get a serious skull fracture (very few - there have been studies). As you involve child forensics and the cross examination begins of the parents and the family, this perfectly optimistic world you live in develops "cracks". After multiple tellings of the story from the parents, the mother finally collapses in tears, snapping under the stress of trying to hide that her mother is the cause. Suddenly it's as if this magic bubble of a world you believe in shatters...suddenly you wake up in the real world...a world where monsters really do exist.
There isn't always this black and white answer to the abuse or accident. Sometimes it's nobodies fault, sometimes it's everybodies. One thing is for certain, at the end of the day you don't feel like somebody's hero and you don't feel like your TV episode is rolling with credits, playing a happy song. You feel like the world is "darker" than it once was and as you walk out the door of your hospital...maybe even before you go to sleep that night, you'll be thinking about how your patients don't deserve this...and that's why, no matter how tough it gets, you'll walk back through the doors in the morning.
Newbie Doc
Monday, September 13, 2010
Chinese Torture Chamber
I really never had an opinion before on torture. When all the water boarding controversy was in the media I knew about it but didn't really give it much thought. I guess it was because I didn't have any background information on it and didn't really expect it to happen to me anytime soon. I'd also never been around anyone that had been tortured or that had tortured anybody. Well......maybe that's a little white lie 'cause I do have some brothers. But since I started on wards I know without a doubt that I am against it. It's inhumane and it screws with your mind and by the time you've been tortured for 30 hours straight who knows if the information your spitting out is truth, lies or a dream. When you're on call on wards you take care of your regular patients and you take care of other doctor's patients and somewhere among the chaos you try to eat, sleep and go to the bathroom. You expect to be overworked, overtired and at times overwrought by the challenging decisions you have to make. But one thing you don't expect is to be tortured....not by water, but by the pager. The nurses on the other end of the pager don't have a clue that you're in the bathroom, or eating or drifting off into desperately needed sleep, and they don't care. What they do care about is their patient, but that means if there are 40 different patients then there are 40 different nurses (they come and go over 8 to 12 hour shifts) that want orders, updates and an occasional pat on the back. Between their coming and going they sleep, eat and visit with their family. For the most part they arrive at their job refreshed and ready to start the day and sometimes forget that hour number 1 of their shift might be hour number 19 of mine. So to all you nurses out there reading my blog (like nurses would want to read my blog) here are some tips. Please read through all the recent and prn orders before you page me; it just might be that the last shift had the very same problem you are having and has already called me about it. Please get a current and accurate set of vital signs and know the patient's intake and output for the last 12 to 24 hours. Peruse the lab work and see if there is anything new or pertinent that I might need to know. Ask your co-workers if they have any questions for me about their patients so I can take care of several problems with only one page. And last but not least try to solve non-life threatening problems yourself and if you are a new nurse ask a seasoned nurse first what she would do and if she thinks your patient's problem is worth paging the doctor. Please remember that we are a team and for some unknown reason I was picked to quarterback and I am trying my best to win.....not just for us or notoriety or that next paycheck.....but for all the kids that are counting on me. I can't do that if I'm walking around like a drooling idiot who has only had a total of 1 hour of sleep in a 30 hour period.
Thanks for letting me vent....if only I had a bullhorn instead of a blog I might actually feel better.
Newbie Doc
Thanks for letting me vent....if only I had a bullhorn instead of a blog I might actually feel better.
Newbie Doc
Thursday, September 9, 2010
Shotgunning
It's my third call and I'm anxious. The first call was so horrible and the second was so much improved that I have no idea what to expect...but I do know that it's with anxiousness and trepidation that I accepted that little red pager this morning (the call pager). I only have 3 patients so I am wide open for getting crushed by admissions...here we go.
So this little girl we have here presented to us with swelling of her legs below the hips and a rash that looks like it may have little tiny bleeds in it (petichiae - probably misspelled). This kid was getting better and much improved from the history so I ran a few preliminary labs that would check generally for any worsening (blood count, inflamatory markers, and a couple common infectious diseases that present like this around here). The next day I come in with a new attending who, without looking at this little girl, FREAKS OUT. I'm inexperienced so maybe she had a right too and I just don't know any better. Instead of conservatively ordering labs, she puts everything under the sun in her differential diagnosis (what could be causing this), even if it was VERY unlikely, she consults three different teams, and starts "shotgunning" labs.
Shotgunning labs is where you get labs like you are shooting a shot gun at a diagnosis. You don't try to narrow down or aim your labs...you just order thousands of dollars in time consuming mostly pointless labs and hope that you hit your target.
As expected it didn't work. The reason we didn't get alot of labs is that the kid had recieved steroids and a host of different antibiotics before coming to us. That's why we checked the "general" labs as well as a few likely culprits and decided to observe. The reason for this is it's unlikely we will ever know what caused it. The peripheral smear (where you actually look at all the cells in the blood) looked like a leukemoid reaction (where your WBC's can "over react" to a stressor/infection) and his white blood cell count and inflamatory markers kept getting better, so why torture this kid.
I honestly don't know if I'm inexperienced and stupid for doing this or if my attending is the one who doesn't know what she is doing...my experience would be that it's me...but watching her order 10,000$+ in lab tests before even seeing the patient was sickening (not to say I would have been bothered had I considered it necessary).
Anyways, she's getting better and better and will likely go home today...after we have done nothing at all...but cost tax payers alot of money.
I don't want to totally come down on my attending. There are different ways of doing medicine. She is a liberal and I'm a conservative, in other circumstances her reaction would have been more acceptable...in this one I'm not sure it was the "most" acceptable, but all her labs she ordered were appropriate and would hold up in court should they ask her, "Why did you order this?"...it's a safer way to practice I guess, but I feel it's lacking in common sense.
Newbie Doc
So this little girl we have here presented to us with swelling of her legs below the hips and a rash that looks like it may have little tiny bleeds in it (petichiae - probably misspelled). This kid was getting better and much improved from the history so I ran a few preliminary labs that would check generally for any worsening (blood count, inflamatory markers, and a couple common infectious diseases that present like this around here). The next day I come in with a new attending who, without looking at this little girl, FREAKS OUT. I'm inexperienced so maybe she had a right too and I just don't know any better. Instead of conservatively ordering labs, she puts everything under the sun in her differential diagnosis (what could be causing this), even if it was VERY unlikely, she consults three different teams, and starts "shotgunning" labs.
Shotgunning labs is where you get labs like you are shooting a shot gun at a diagnosis. You don't try to narrow down or aim your labs...you just order thousands of dollars in time consuming mostly pointless labs and hope that you hit your target.
As expected it didn't work. The reason we didn't get alot of labs is that the kid had recieved steroids and a host of different antibiotics before coming to us. That's why we checked the "general" labs as well as a few likely culprits and decided to observe. The reason for this is it's unlikely we will ever know what caused it. The peripheral smear (where you actually look at all the cells in the blood) looked like a leukemoid reaction (where your WBC's can "over react" to a stressor/infection) and his white blood cell count and inflamatory markers kept getting better, so why torture this kid.
I honestly don't know if I'm inexperienced and stupid for doing this or if my attending is the one who doesn't know what she is doing...my experience would be that it's me...but watching her order 10,000$+ in lab tests before even seeing the patient was sickening (not to say I would have been bothered had I considered it necessary).
Anyways, she's getting better and better and will likely go home today...after we have done nothing at all...but cost tax payers alot of money.
I don't want to totally come down on my attending. There are different ways of doing medicine. She is a liberal and I'm a conservative, in other circumstances her reaction would have been more acceptable...in this one I'm not sure it was the "most" acceptable, but all her labs she ordered were appropriate and would hold up in court should they ask her, "Why did you order this?"...it's a safer way to practice I guess, but I feel it's lacking in common sense.
Newbie Doc
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