Cheating

How many times in politics are you maddened by someone getting elected who was clearly incompetent.  Why are they elected? Deep down you know it's because they have that social "spark", they are just the right amount of attractive, friendly, and conversational that they carry votes despite how stupid they are.  A similar thing happens with doctors, luckily there is a bottleneck of rigourous testing that keeps the truly stupid out of our field, if you are a doctor, it is likely that in some way you are bright...even if it's not the kind that is going to make you a good physician.  It's been my ever present lament, but rarely voiced complaint that I'm one of those doctors.  I wouldn't go so far as to say that I'm an idiot, but in the mass of doctors out there I am average at best.  Over the years, what I've found, to my surprise, is that this massive heap of intellect fails against an average one with superior social skills ...just to be clear, I'm not the popular kid in school...I'm more like the poorly adjusted kid who got stuffed in lockers, but in this heap of geak, I'm a social power house. 

I remember a conversation I had briefly with my attending over a difficult patient that I treated.  I didn't do anything better than he did, didn't do anything better than the resident that saw them before me, but I sat and talked to the patient, and smiled with the patient, and probably (seemed) to listen to the patient better than they did.  He was telling me how they were singing my praises.  My response was, "They have no idea how incompetent I am." (it was my second month as a doctor).  What he said back stuck with me and has haunted me ever since, "It doesn't matter, you're going to do very well for yourself."  Am I a fraud? Do I do well because I can talk to people better than my peers? Over time I've found the answer to be Yes and No.

There's a hundred ways I can describe this, but these are two examples.  The first is that I'm never going to be a cardiothoracic surgeon, in matters of the "heart", I know I am a weakling.  Over time I've been able to accept my place here and when it comes to the heart I know I will likely over refer my patients to cardiologists to check out benign murmurs and passing out episodes...I'm just not comfortable enough.  What I've realized is that in the areas I'm weak I know enough to know I'm out of my depth and in those instances I swallow pride and send them to someone smarter...that's how I cope with my weakness.  Does the patient notice that I'm an idiot and just sent something totally normal to the cardiologist...No...she likely thinks it's great I found that and will thank me for being safe.

The second is this, a patient has chronic pain with a large component being psychological (in the patients head).  Dozens of capable, highly intelegent doctors have come in to help this mothers daughter.  Nothing helps the pain, the mother is in tears and has fired several docs from her care because she feels they arn't worried about the pain her daughter is experiencing.  The daughter continues screaming despite all the drugs they throw at her.  All of us doctors are thinking the same thing, there is no reason for the patient to be in pain, all the signs are pointing to here using the "pain" for attention...but none of the doctors can say it...or want to say it.  The mother bothers the doctors every hour all night long for three nights of her stay.  Finally when I'm called to deal with the crazy, I ask the mother to step out of the room and then I use my ability to talk to slowly break it to her that her daughter is using this to get her attention (this takes 30 minutes to break it right and not offend her).  As I'm listening I'm writing down all her complaints so she can "see" that I care.  As we role onto 45 minutes of talking, I'm addressing every problem.  Most I'm treating with small things, abdominal pain I'm going to put warm packs on, sleep problems I'm going to give melatonin for, none of my "solutions" have any proven medical efficacy, but in suggesting ways to cut out her daughters attention grabbing behavior, in providing miniscule treatments that I confidently explain, her daughter sleeps through the night without further complaint...the other residents are in awe of what I've done.  The mom put's me up for a patient nominated award at the hospital.  The patients behavior continues and I've solved the problem of what was ailing both the doctor's and the mother, the patients unremitting pain. 

Superficially you'd think I was an excellent doctor...wow all the other doctors looked up to me, I got nominated for an award, I fixed the little girls pain...guess what...I see myself as a fraud.  Deep down I know I'm not the guy who found the brain tumor she had, I'm definately not the guy who took it out, I'm just the guy who used "Jedi mind tricks" to take away a girls "pain"...everytime I'm congratulated on patient care, it's like they are saying, "Good job...Faker!"..."Keep up the good work...Fraud!". 

I can tell I'm likely going to be successful with this "skill" of mine, but it's like I'm winning at a game because I'm cheating...and I really wanted to win fairly...

Newbie Doc

Farm Thinking

One of the things I learned on the farm was to think on my own. It's something you don't get taught in a book, how to problem solve. It was taught to me sitting in a field with broken down equipment, waiting for my father to arrive and help me. It was taught every morning as my brothers and I planned out how we were going to get our work done the fastest that day. It was taught watching my Dad do things others pay mechanics thousands of dollars for, he has no formal training in many of the things he's adept in, yet he has a sharp mind and like me, his father taught him to problem solve. It's a characteristic that seperates me from many of my peers, both young and old. I pride myself on solving problems others give up on, problems we weren't schooled on solving, things as simple as finding a way to communicate with a swahili immigrant when we don't have interpreters on hand to figuring out what mysterious ailment is hurting my patient and evading detection.

A couple of months back I was between a rock and a hard place. A patient my team was caring for very likely had a GJ-Tube malfunction (a tube that goes directly from the outside abdomen into the stomach and then courses down into the small bowel). My patient's GJ quit flushing and his abdomen became increasingly distended. Stopping GJ feeds allieviated the distention, but how was my very ill patient going to get food? You can give nutrition many ways, but giving it through the gut is the healthiest and sending him to get it fixed requires that we have diagnosed there is a problem with the tube. This is a catch 22 when there's no in house radiologist to perform the study on the weekend. After some inquiry I found it requires a radiologist in house to inject a XRAY contast material down the tube and then take some "pictures" of the abdomen. When confronted with this problem they suggested I leave my patient on IVF over the weekend and get the study monday (There's so much wrong with that thinking that it would be another blog post entirely). As I sat there pondering the stupidity of the situation, I asked why they needed a radiologist to inject the material, they can easily do the XRAY without him. The tech responds, well it's hospital protocol to that only a doctor do this. 1 hour later we have had the patient rolled down to radiology, I simply push a syringe of yellow stuff into his GJ and we take 3 pictures...was that so hard? Apparently it is to some. The problem now is truly "diagnosed" and the IR doctor (who is in charge of fixing the GJ) begrudgingly agrees to come in to help my patient out. I write about this because the other day I was in cardiology watching them in the cath lab when I heard the IR tech complaining about how the peds residents were now doing these G-tube studies by themselves over the weekend and causing more work for them...I smiled secretly to myself...Thanks Dad!

Newbie Doc

Playing for the Bulls

The last time I held a job I took seriously I was 19 and I was a farmer.  Here I am at 27 years of age and I finally have my first real job offer (it's official) in my chosen career.  Sure residency is a job they pay me for, but it's like driving with your learners permit...they still havn't said your experienced enough to "drive". It's a mind job to have someone accept me as an actual peer, a whole year early no less.  To feel like you are a doctor (if only a young one) is one thing, but to have other doctors older and more experienced than you accept you...the feeling I get is akin to that little kid who looks up to Micheal Jordan who grows up and gets an offer to play for the Bulls, I'm extatic.

Newbie Doc

Get My Posts By Email !!!!

So I don't post very frequently, it becomes a bother to check my site.  I've had several people ask me for this since I post once every blue moon.  Well it's here!!!  New posts sent to your email.

1. Go to the bottom of this page.
2. Type in your email address and click on the black box that says "submit".
3. Type in the security code that appears afterwards.
4. Go to your email (the one you just entered) and click on the provided link that was sent to you by email from "feedburner". 

That's it, now you should get an email whenever I decide I have the time to update my blog...I think it might even come with the post itself. Let me know what you think, if it doesn't work ect.

Thank you all for reading!

Newbie Doc

So Lucky

You know I feel like alot of my posts spiral into depressing thoughts.  It's hard not to go there when writing about medicine, it's a vast ocean of choppy waters, I'm a new doctor learning my way.  Sadly, it's often said "you don't want to be interesting in this place".  When something exciting happens, it's often at the expense of someones health...that's why I think this place is so peculiar, this hospital I work at looks like a child's paradise with the vibrant colors, the smiling faces, the lush parks and playgrounds around it...but for most it's a place where they hurt more than they ever hurt before, for others it's a place where they lost there little boy or girl.  It's hard not to get sucked into that and think about that when I come home, it's easy for me to write about in this blog where I talk about what I see, but I also see patients get better, far more often than not.  It's a place where I run into patients visiting the clinic who I treated that are now doing "much better".  Those kids smile and laugh and go home to play another day. 

What I wanted to post about is this, it's easy to get sucked into negativity, but the truth is that we are living in one of the best countries in the world.  Despite it's faults, we are all insanely lucky to live here.  Yesterday, when I was playing with my little boy, laughing at how much of a goofball he is (like his dad), the words just slipped out of my mouth, like it wasn't my brain that actually said it, "We are so damn lucky."   I know it's all relative, that it's not always great for me and it isn't always great for you, sometimes I work 30 hour days, sometimes I cry at work, sometimes people die, but the truth is each of us should be saying that every day we get, we don't but we should.  Remember that it could all go away in an instant, easier than any of us could possibly imagine, so don't take them for granted.  We are all, in some way, so Lucky.

Newbie Doc

What's the Worst That Could Happen?

It's been awhile since my last post, since that time I've passed my test and now am considered a full doctor of medicine, though I felt that way for some time.  I felt like my true test was in finishing my first month of the PICU.  If you have a cold you go to an out patient clinic, if you have a illness that might kill you if untreated in days you would go to the floor of an inpatient hospital (the "wards"), if you are sick enough that you might die within the hour you will inevitably end up at an ICU...or in a coffin...in some sad cases both.  During that month, I've had time to test my true metal and although I've passed through it's fires and I measure up to their standards I find myself lacking.  Not in any one thing in particular, just in general, it's like my first day as a doctor, realizing how over your head you are...only its worse because this time you thought you actually knew something.  Not to say that the month was a failure, I did well...I wanted to write about the first time I intubated a "crashing" kid while everyone was screaming and in chaos around me...I would have called that blog "clutch" because as soon as the tube was down the kids throat and they were bagging him life saving oxygen, I had this feeling of sinking a winning 3 just as the buzzer sounds in a basketball game (though I've never done the latter- in my head the crowd was going wild).  There were moments like that punctuating the depressing drone of my conscience telling me that I don't know enough yet to soundly treat a truly critical child...I'll get there though.

I'm also going for a job interview in a few days...that's probably what has me writing right now, funny that an interview could make me more nervous than a child dying in front of me, before last month it would have been tough to say, but now its not.

I remember this little girl in the PICU that had a horrible cancer.  We are so good at keeping humans "alive", she died (at least for me) the first week of our rotation, but our science kept her body pumping blood to the brain, kept the lungs oxygenating the muscles and the gut, which we fed with a tube in her stomach.  All this time I watched God or Fate continue to hammer new nails in her coffin, so many unlucky events for her and every time a nail went in (one day she'd develop a pneumothorax, the next an fungal infection, and on and on) I had this nagging voice telling me that some force greater than us must want her dead because of how persistently unlucky she was.  I never had to care for her myself, I'm glad...because I have a different word for the "care" that we do to the ones who have long since passed that we keep alive...I'll say it...torture, of the most sickening kind...the kind you wouldn't wish on your worst enemy...on Hitler or Satan himself.  One day if humanity survives itself and can look back from a better place, we'll look down on the concentration camps and the Tuskegee experiment's and, yes, the "caring" we show to our loved ones in the same manner of trepidation.  I'm not saying I'm in a "better place", I've just gotten to see enough of it, more than the most educated politician espousing how horrible it is to "euthanize" someone or one saying how righteous it is.

Here's what I want.  If I'm on a ventilator or a heart machine for more than a week I want you to take me off of them and give me a nice long morphine induced nap, don't feel sorry for me, not one bit.  There are far worse things than dying...I've seen them.