Change of Guard

I have a new Epi advisor. My old one is no longer head of the PhD in Epi program, and now I have this new dude. He is not a clinician, has never been to med school. He is a former sociologist.

My first conversation with him 5 months ago consisted of him telling me that he felt medical school was too short.

TOO SHORT. 4 YEARS IS TOO SHORT?!?!?*

I have this sinking feeling he feels the same way about the Epi PhD program, since the requirements for graduation are not quite what I remember them being when I applied 4 years ago. Now I have 20 required classes, 7 of which are electives. As of now there is no overlap whatsoever between the med school curriculum and the Epi PhD.

And you take 3 classes at a time.

At that rate, I will never graduate.

Never.

At any rate, I'm meeting with the combined degree office today to share some of these concerns.... we'll see if anything comes of it.


*At some point in the near future, I will write something on why I think that med school should actually be 3 years. It revolves around the fact that 4th year of medical school is consumed by 4 months of interviewing for residency and 2 months post match, and the rest is spent doing as little as possible in preparation for intern year. But that is a post for a later time.

1,001

Ladies and gentlemen, this is my 1,001st post.

Anyway.

My husband and I spent our first weekend in our new house. It was lovely, and he only spent a *relatively* small amount of time in manic cleaning mode. At least we have immaculate floors right now (I say this as he turns on the vacuum and whips out the swiffer once again).

I also got to purchase some plants for the garden. The previous owners put in a bunch of tacky annuals just before they put the house on the market, half of which are expiring now and need to be replaced. We're in zone 6B, and have a garden that gets a lot of light in the morning, but then less so in the afternoon. Also we have a tree that makes a good part of it shady.

So I bought some hosta for the shady part and a hydrangea bush for the part that gets more sun. I'm hoping to add more plants as I figure out what I want and what will work in my garden, but so far so good. I promise pictures. I promise, I promise.

The hydrangea was a little wilty this morning, but perked up nicely with the addition of some water.

I've also become one of those boring adults who thinks about how she'd like to remodel her kitchen. As lovely as this house is, the kitchen SUCKS. Also, the refrigerator has a tendency to pop open for no apparent reason which makes me INSANE. We'd really like to knock out a the wall between the kitchen and the breakfast room to make it more open.... but that is for next summer I think, when we have replenished our bank accounts somewhat.

Ah.

Well this week I start biostats and will hopefully wander around the department making meetings with various faculty. Should be a lot easier than doing it by email -- SINCE I CAN LITERALLY STAND OVER THE ADMIN -- as the appointment gets made.

So Medicine, Neurology, Medicine, Neurology. Which to do? How will I choose? Behold, to your left, the updated list of career preferences du jour.

Heathers

Heathers is one of the best teen movies of all time. It also has to be the #1 movie that would never ever get made in this century post-Columbine. I'm honestly sort of surprised Netflix carries it, given that it glorifies teenagers offing the popular kids and blowing up the school.

Ah the 90s. When it was still ok to admit you hated particular people and talk about what you wished would happen to them in public.

Made back when Christian Slater was actually hot, Shannon Doherty had not been blacklisted, and before Winona Ryder started her shoplifting habit, this movie has everything that is not ok to talk about in today's PC world of high school. Thank God I was a teenager in the 90s and not now, because I am sure I would have been expelled. Or at least sent to the child shrink. Oh wait, that happened. Oops.

Here's the warning Netflix provides to parents about Heathers:


Common Sense Note
Parents need to know that teens will probably want to see this pitch-black comedy, but it's better for those just exiting high school and up. This film goes to extremes portraying the cruelness of the popular crowd and the rebellion against it. The popular kids are murdered by poisoning and shooting and their suicide notes are forged. There are two more "real" attempted suicides, some self-mutilation, and bulimia. There's lots of gunplay by the main characters and one bloody scene. J.D. attempts to blow up the school and all its students with dynamite. Teens have sex (outdoors and at a college party) and speak crudely about it. Two boys are sexually aggressive. And there's plenty of harsh and homophobic language.

Families can talk about popularity, suicide, depression, and any number of hot-button teen subjects. High school is a high-anxiety microcosm of what awaits teenagers post-graduation. How do you deal with pressure successfully? How do you learn to make positive decisions?

Sexual Content
Lots of teenage sex (outdoors and at a college party) and crude mentions of sex: "spin her around on my Johnson like a goddamn pinwheel." Veronica is the victim of a rumor that she had oral sex with two jocks in one night. Jocks make a nerdy student say "I like to suck big dicks" outside a church. Two jocks strip down to their boxers. Veronica is forced to kiss J.D. and a college student against her will.

Violence
One poisoning where the victim falls through a glass table. Plenty of gunplay by J.D. and Veronica: at school with blanks, in the woods resulting in two deaths. J.D. and Veronica fight each other with guns, shooting off a finger; lots of blood. Dynamite is planted under bleachers of school kids at a pep rally, then strapped to and detonated by J.D. Teen suicide is a huge focus and faked suicides lead to real attempts by two students. J.D. admits that his mother probably committed suicide. His father blows up buildings. Veronica burns herself with a lighter on purpose. A Barbie is hung in Veronica's room as a threat and Veronica pretends to hang herself.

Language
The F word is used frequently in over-the-top expressions like "f--k me gently with a chainsaw," "f--king psychotic," "stupid f--k," "they all want me as a friend or a f--k."

Social Behavior
Extreme bad behavior is intrinsic to this dark comedy. J.D. thrives on chaos and death and drags Veronica down with him. When she starts to resist him he stalks her and threatens her. High school pecking-order stereotypes are rampant. Parents and school administrators shown as bumbling and ineffective in dealing with the "suicide epidemic." Suicide notes are forged, then circulated and revered by students and faculty. One Heather uses holy water to fix her hair at a funeral. The fake suicide pact of two male athletes is staged as a gay tryst with "gay artifacts" like mineral water and played for laughs. Cow-tipping. Kids pander to TV crews in a display of public mourning and one asks for a copy of the tape for his Princeton application. A college boy and J.D. act sexually aggressive toward Veronica. One Heather throws up lunch every day. J.D.'s dad blows up buildings and gloats about it. Girl gets laughed at for attempting suicide for real and living. Veronica does learn a lesson in the end about popularity and befriends the most laughed-at girl in school.

Consumerism
Swatch, Coke, Limited, MTV, Barbie

Drug/Alcohol/Tobacco
Veronica, J.D., Veronica's dad, and a teacher smoke. A teen smokes pot under the bleachers. High schoolers are drunk at a college party and Veronica throws up.

It made me crack up. Seriously, "F*** me gently with a chainsaw" has to be one of the most ingenious phrases of all time. And the section on discussion points for parents to address with their teen children upon seeing the movie? Oh. My. God. And not teens having SEX!!! Oh no, we can't have that!

Anyway, I just thought I'd share my amusement.

Also

Dear new Epi advisor,

You do not get to act shocked and horrified that I do not know what courses are being offered this summer and fall when in fact an accurate course schedule is not actually posted anywhere.

I sense this whole "PhD thing" may be a bit of an uphill battle.

OMDG

Swiff

When I made the decision to move on Tuesday it basically came down to this: Do I move now in the spot of a person who canceled last minute? Or do I wait two weeks.

I am so glad that I decided to move then. I love my house, and just this morning I cleaned out the last of the boxes and odds and ends that were lying on the dining room floor waiting to be put away.

And then I swiffed the DR.

See, moving on Tuesday meant that we didn't have time to clean all the sawdust off of every surface that had collected after getting our floors re-finished over the weekend. This gave my husband no small panic attack.

"But we'll NEVER get it clean if we unpack now!!" he moaned. "We'll be finding sawdust in our clothes 20 years from now!!"

Ah my dear OCD husband. Such was his angst over the sawdust that he was completely unable to function on Tuesday. He spent the entire afternoon cleaning one corner of the kitchen over and over again, and repeatedly misplacing the scissors.

I have to say that all appearances aside, I was minorly repulsed by the floor situation as well. I couldn't walk around barefoot without picking up a fine layer of sawdust, and I had to wipe off my feet before I got into bed.

It didn't help that the dust kept reminding me of my patient with nasopharynegeal cancer. I guess there's an association between that particular affliction and woodworking. Judging by the way in which the veneered dust clung to my nose and throat, making everything I ate taste like varnish, I can't say I'm especially surprised at the association.

But anyway, the house has been mostly swiffed. Thank god.

As so it was

That we moved yesterday.

I feel that my sub-i prepared me well for this. Go ahead and laugh. I'll have you know that I outlasted my husband in 4/6 categories of moving day endurance, no small part of which was due to my intensive training last block.

I was a finely tuned machine.

I....
1) Managed to go almost all day without eating. And I didn't even notice.
2) Worked tirelessly into the night, and then woke up at 6AM and sprang out of bed into action.
3) Managed to remain bright and cheerful throughout the move into the evening when I ran into a classmate of mine and her attending husband, even though I thought I might keel over from exhaustion.
4) Got 50% of the boxes unpacked, and their contents into the proper room. And some cleaning done. Accomplished by working for 16 hours with no break.

My husband soundly defeated me in the categories of lifting heavy things and reaching things off the high shelf. I have to say, the sub-i was good for psychological endurance but not so much for the physical endurance.

Which is to say that I could barely walk when I woke up this morning. Ouch.

I am really getting old. If I feel this sore at age 32, I don't even want to think about what it will be like when I'm 64.

At least I love my new house!

Toilet paper

The paper that I alluded to in a previous post made the toilet paper blog yesterday.

Does that mean I can retire?

New House

I am moving..... tomorrow.

Because if it wasn't tomorrow, it would have to be after July 7th.

And I just don't want to wait that long, and besides. We had 1/2 of the packing done anyway. Of course it was the easy half, but I figured I'd be ok with doing the rest today.

The movers were like, "Are you sure? Are you SURE you'll be ready????"

Me sayeth: Yes.

Well, I hope so. Right now I need more boxes.

Yes I know. I am crazy.

Oh and I found out that my PhD class starts on July 1, NOT on July 6.

Poo.

Yet another reason to move now.

I suspect this is the point at which the masses will become bored with my blog

Since I will have limited fodder for interesting stories about the hospital or being a doctor. Like the time I had to watch a man drown in his own secretions all weekend because the hospice conversation hadn't taken place yet and the next of kin were on the other side of the world.

On Monday I have a meeting with my overarching PhD advisor who wants me to be a neurologist and for whom I have been writing a paper for 2 years. About 2 months ago we had a conversation along the lines of, "Goodness no! Do not work on your paper during your neuro rotation!" While all through my *medicine* rotations he'd been a giant nag about it.

So, now that I am technically his, I forsee the resumption of the nagging, with me saying, "DUDE. I have to MOVE. And have ONE DAY OFF. Give it a rest please!" Except not with those words.

My stories will instead revolve around boring statistics classes and disagreements with my future yet to be determined mentor. Oh, no. You wanted to hear about what I'm going to be researching? Hahahahaha.

See if I told you that, dear internet, then I'd have to kill you. Because I don't want to be scooped. Graduation will be mine, you see. Eventually.

*****

In other news, I hear I will be contributing to the bad-doctor fodder on the toilet-paper blog on Tuesday. Indirectly of course, since I am not an author on the paper (though I am officially thanked), and the bastard who commissioned the work from me didn't pay me my last 100 bucks. But I suppose it's all worth it in the end if for once I'm on toilet-paper's side.

(not)

We'll see if this actually comes to fruition.

Exciting!

As a side question: If you are a doctor, and write a piece about "bad doctors" which gets cited on the toilet-paper blog, does that mean YOU'RE not a bad doctor?

EDIT: It did actually make the NYT-online. We'll see if toilet-paper picks it up on her blog.

*****

And we have started to pack! And we got the floors redone yesterday! And they look awesome! And OMG I am so excited to move into my new house!

And also, I am very out of shape since I have not exercised in 2 weeks. At all.

Sigh. Well, now at least I have the time to do it.

Converting the overbearing relatives

I think this is one of the things I like best about medicine.

So that overbearing relative I told you about the other day? I wouldn't say I made him into an easy person to deal with, but in the end we bonded.

I was in the process of discharging his wife, and my pager went off. "Excuse me for a minute," I said, "I have to get this."

As I walked out the door, I considered not going back. That's what most of the other doctors I know would have done. That's what they DID do with this family. Over and over again. Not without reason, mind you. They'd usually make a break for it after the 200th antagonistic question in the 47th minute of an unpleasant conversation.

I've never felt comfortable just cutting and running. I know when I am an intern and have 10 patients of my own to see, I might not have the luxury of these marathon conversations, but I always feel really terrible if I just ditch out. Dismiss myself from the conversation when I know that the family has more questions.

After I answered my page, I went back into the room and said, "I'll bet you thought I wasn't coming back."

The husband said, "No, I knew you'd come back. YOU always do."

You have no idea how much that meant to me.

Then he asked me what I was going to do with all my time now that his wife was going home from the hospital, and I would no longer have to spend my days answering his questions.

I gave him a mischievous look, raising my eyebrow "Oh, there will always be SOMEBODY," I said. Then I teased him about the fact that he'd forgotten to bring his wife some clothes to wear on the ride home. "You, the most organized person I know."

He smiled.

Don't get me wrong, he could still be a total pain. But it felt amazing to have been able to make a connection regardless. To get him to relax enough about his wife's care to be an actual person. That I was the one who had been able to do this for them.

I love the thought process in medicine too. And the pace. But I think these connections with patients are the part that matters most to me. The part that makes me glad I chose to become a doctor.

OMG OMG OMG

I just finished my sub-i.

I loved it. It was by far my favorite rotation of the year.

I think I will seriously have to weigh medicine versus neuro.

I finally felt like a doctor.

And now, commence process of forgetting everything......

The overbearing relatives

On the toilet paper blog at the NYT, the author frequently tells readers who are dissatisfied with their care to be more assertive. To "force" those doctors to give them answers. To refuse to leave until they get what they want.

I'm here to tell you that there's another side. We have this patient who, every time you walk into the room, the relatives pepper you with aggressive questions, laced with how every doctor before you has screwed up in some way. In this case, at least the family member doesn't ALSO throw in, "My son is a lawyer," but I've heard that one too.

It is a guarantee that you will be in there at least 45 minutes every time you see the patient. And the husband has issues with everything. And he's rude. And he's unpleasant. If the plan is to consult a specialty service, he'll sneer, "That doesn't sound like a 'plan' to me. It sounds to me like YOU DON'T HAVE a plan." And he'll demand to have non-emergent issues addressed on his schedule. It's not enough to treat the sepsis, we also have to treat the non-incarcerated hernia that has been there for years. NOW.

I won't even get started on how they treat the nurses. How they threaten to call their supervisors at the drop of a hat. How the nurses have started avoiding their room.

I want to say to him, "Look. There's a reason that things have gone badly for your wife these past few months. It's because she has [insert rapidly fatal incurable disease here], not because people have wantonly screwed up her care. It's because people with her disease tend to die quickly. From infections, from complications, from side effects of therapy, as well as the disease itself."

I know that part of this guy's problem is that he's stressed out and in denial.

You know what though? I have a ton of patients in exactly the same situation who don't act like giant turds.

I wonder if he realizes that his behavior causes his doctors to avoid seeing his wife. To time their visits when they know he won't be there. I know one attending purposely put his wife last on his list of patients to see yesterday because he knew that he'd be in the room for a long time engaged in unpleasantness.

Involved in your care is one thing.

Overbearing and unpleasant is quite something else.

Inappropriate thoughts of the day

Conversation after being paged 6 times about a patient's NPO* status.

Her: I WANT MY FOOD NOW. YOU ARE ALL STARVING ME. I CAN'T BELIEVE YOU HAVEN'T FED ME ALL DAY WAITING FOR THIS STUPID TEST. I'VE BEEN UP HERE SINCE LAST NIGHT WITHOUT FOOD.

Me: Mrs. Jones,* you were admitted at 5AM. That was this morning.

Her: I DON'T CARE YOU ARE STARVING ME.

Me (inappropriate thought #1): I've been NPO as long as you have today, and you don't see me wailing about it.

Me (actual response): I'm sorry you feel hungry, but you can't eat before your test. If you eat, then we'll have to do it tomorrow, and then you won't be able to eat again.

Her: IF YOU STARVE ME AGAIN I WILL LEAVE. I CAN'T BELIEVE THE SERVICE AT THIS HOSPITAL. THIS IS THE WORST EXPERIENCE I'VE EVER HAD IN MY LIFE. I'VE NEVER HAD TO GO THIS LONG WITHOUT FOOD. EVER!!!!

Me (inappropriate thought #2): Perhaps if you were NPO more often, we wouldn't be sitting here right now.

Me (actual response): Well, I just have to ask you to hold on a little while longer. We'll get you food as soon as we can.

Her: IF YOU DON'T GET ME FOOD RIGHT NOW I AM GOING TO LEAVE.

Me (inappropriate thought #3): Be my guest!

Me (actual response): You really need to have this test now. I strongly urge you not to leave against medical advice.

Her: HARUMPH!!!




*NPO=nothing by mouth
*Not her real name

Bizarro conversation of the day

Me: Hey, I don't think I've seen you before. Did you take a year out?
Her: Oh, I took a LONG time off.
Me: Oh yeah? (insert joking tone of voice) I'll bet I'm still older than you are though.
Her: I doubt it. How old are you?
Me: 32.
Her: (annoyed) Oh, I guess you're three years older than I am.
Me: So are you taking [insert elective here] now?
Her: (terse) Yes.
Me: What did you do in your time off?
Her: X, Y, and Z.
Me: Oh that sounds interesting! Has it been hard coming back?
Her: Somewhat. You know, I have a friend who is 30 and SHE'S JUST APPLYING to medical school now. And she'll be EVEN OLDER THAN YOU ARE when she finishes.
Me: That's great for her, but she still won't be older since I'm doing a PhD next, and won't be done until I'm, 37.

Newsflash guys: If you're young enough to still think it's cool to be old, then you probably aren't old yet.

I know I'm not old. Or mature.

Hee.

Day Off

Today I had the pleasure of speaking with a family member about our plan for his father. Someone else would be covering for us tomorrow, but the plan was to increase activity as tolerated, encourage PO intake, and monitor fluid levels.

"But... but... but... why won't you be here tomorrow?" the family member demanded wanted to know.

"Well, we get one day off per week, and that's tomorrow," we told her.

"But... but... but... Oh."

Clearly, we are slackers.

Nurse: Part Deux

When I was on call over the weekend, I assumed care of a patient who had been in the ICU for several weeks and was transitioning to the medicine floor. When I walked into the room to introduce myself and get a history, her nurse was there recording vitals.

I'd seen her around a few times before, but didn't know her very well.

She asked me: Are you taking over her care?
I said: Uh huh.
She said: Good.

That was the biggest compliment that I have received during my entire medical school career.

I said: Really? Thanks!
She said: Yes, really.

I couldn't actually believe it. Everyday I feel incompetent in some way or another. Everyday there is something that I forget or feel I should have known. But still I got this fantastic compliment from someone who I barely know. From someone who has no interest in blowing smoke up my ass.

Contrary to popular opinion, I do not spend my time ordering the nurses around. Yelling at them. Acting like "their boss." I try to listen to them and take their concerns seriously. I hope if I do that, the patients will get better care. And that the nasty stool culture (thank god I don't have to collect these things -- ew) will get collected as soon as possible.

There's still a hierarchy in the hospital, even though we walk around pretending it doesn't exist. Doctors ask the nurses to do things for the patients -- not the other way around. But "boss" is not the right word to describe the relationship between doctor and nurse. Team is the obvious (and most PC) word choice, but doesn't capture all the nuances. Not sure what word does.

I'm still glad I'm going to be a doctor. I like being the one synthesizes the data and who makes the clinical decisions. The one with the responsibility. I don't think there's anything wrong with wanting to be called what you are.

We closed!

Luca and I are officially homeowners!

We are really excited and can't wait to move in. But first we need to finish the floors, get a few things fixed, paint some closets, etc.

It's so exciting! We actually feel like adults!

How good I have it

One of the things I love about medicine is how humbling it is. How it puts everything in perspective for me. I guess for some people, it's overwhelming to see such suffering, and you also see people treating each other badly. Things like child abuse. This btw, is one reason I'd have such a hard time going into peds.

But every so often you see miracles. Like the 23 year old who takes care of her mother-in-law with really bad primary progressive MS as well as her 5 year old son and 3 year old daughter. Because her mother-in-law's husband not only can't handle seeing his wife so debilitated, but also because he's an alcoholic who's never home with health problems all his own.

That woman is a saint.

Or the man who is taking care of his friend as he dies of cancer because the patient's family wants nothing to do with him.

You see these people and the hardships they are going through and you realize how good your own life is. How lucky you are to have what you have. Despite all the stress and bumps in the road that we all encounter. And in addition to seeing how evil people can be, you also see how beautiful it is when people come together to help one another in times of hardship. It can be beautiful and awe inspiring.

I only hope that if the situation presented itself to me that I'd be a good enough person to rise to the occasion. You never know how it will be until it happens though, do you?

Incentive Spirometry

That's this breathing exercise you do to help keep your lungs from collapsing when you're in bed most of the day where you suck into a tube as hard as you can and see how high you can make the blue ball go.

What's funny is when you watch someone try to explain how to use this device to a patient without using the word "suck." It's pretty much impossible.

I've heard, "use it like a straw," and, "inhale as hard as you can." Yesterday I even heard, "use it like you would a cigarette." I don't know what kind of cigarettes that nurse smokes, but I can tell you they ain't like any "cigarettes" I've ever seen. Perhaps some other inhaled substances?

To put it bluntly, somehow I suspect that if she wouldn't tell the patient to "suck on it as hard as you can," the phrase, "use it like you were taking a hit from a bong," wouldn't be on her list of socially acceptable phrases either.

Anyhow, after she left my resident and I got together a mini cheering section. "Suck as hard as you can! Suck! Suck! Suck!"

I don't think the patient was offended.

five digit extensions and other craziness

When someone pages you 10 times in 5 minutes, and it's to extension 74999.

Or you get paged to 215-859-38*22.

Or when you return the page, and it's busy. Or better yet, a fax number.

When you end up spending an hour and a half rounding on one patient because she won't let you complete a single sentence.

And the next patient tells you to get the f out of his room and that he's reporting you after you say, "Good morning Mr Jones, how are you feeling today?"

When you've finished a discharge for a very NOT ill patient, arranged transport and social services, and a mentally ill distant relative convinces the attending who hasn't even spoken to the patient that he needs to stay in the hospital.... even though the mentally ill distant relative hasn't seen the patient in months.

When you get paged by an irate consult service about being called at 5PM for a consult without being given any information about it. And you didn't actually consult them.

When your patient becomes unresponsive during a procedure and gets transferred to the unit and nobody bothers to call the primary team. And you wonder why all of a sudden there are all these ABG results popping up in the labs.

When your patient's labs are drawn at 10 when they were supposed to be drawn at 4.

When your nurse makes a face when you remind her that she was supposed to do stool cultures.

When your attending tells you how stupid you are for putting down the wrong dose of a medicine, tells you what she wants the dose to be, writes a different dose in the chart that is actually 5x the maximum daily allowed dose, and then she doesn't return your pages for clarification when the patient is being discharged and wants to know why the dose was being changed, here look at my note from my doctor with my dose (which is where I got her dose in the first place).

Sigh. It was just one of those days.

I finally found an answer!

Me: I'm doing my PhD in Epidemiology.
Person: Isn't that an awful lot of math?
Me: I certainly hope so! I love math and working with data.

Yay! I finally figured out a way of answering that question without getting defensive. And it's even true.

Not available

Me: My availability is extremely limited the month of my sub-i. I will not be available on many evenings or on weekends. I cannot take any time off.
Real Estate Agent: Well, why don't you just get this mandatory-or-else form that I could have told you about earlier but didn't, notarized on Saturday then?
Me: Am I talking to myself over here?

Take Four.

Former Smoker

Me: So, Mrs. Wilson,* do you smoke cigarettes?
Her: No I quit.
Me: Good for you! When did you quit?
Her: Yesterday.


*Not her real name

Cookie Monster

Me: Mr. Jones,* how are you feeling this morning?
Him: I want my cookies.
Me: Are you having any chest pain? Shortness of breath?
Him: Bring me my cookies.
Me: Mr. Jones, can you please answer my questions? Any more trouble with the swallowing? Nausea? Vomiting?
Him (getting frustrated now): No. I want my cookies. Are you going to bring me my cookies or not?
Me: You're going to have to ask your nurse to bring you some cookies. She has to keep track of what you eat.
Him (GIANT eye roll): I'm not answering any more questions until I get my cookies.


*Not his real name.