Sticky Fingers

I have been filling out paperwork and taking computer training to for an upcoming rotation at the local VA Hospital. I was really surprised when I walked into the place the other day as everything was so new and shiny! The VA hospital back home was Maalox green and would make you wonder what the veterans did to deserve such a building.


Anyway... I had to get fingerprinted as part of this process, as apparently there had been a problem in the past with an employee stealing computers. However, instead of inking me, they scanned in my fingertips. For whatever reason, the thing wouldn't accept the prints of my left middle, ring, and pinky fingers no matter how many times I rolled them across the screen. So I guess I can be sneaky, as long as I only pick things up with those three fingers.


As a taxpayer, I think a more economical option would be to just go back to ink and paper, but what do I know? I can't see how sending everyone an "Economic Stimulus" check makes a whole lot of sense, either.

Ketchup and Caulk Fighting

So, tonight I go back to work after having had the past week off. I didn't do anything exciting with my vacation, just stayed put. I had all sorts of productive plans for the week, including organizing all of my digital photos, doing my taxes, cleaning the entire house, doing tons of educational reading like a good little resident, and updating this thing regularly.

Um, none of that happened. The house is somehow actually messier than it was before I went on vacation. I still can't do my taxes as I am missing a few things, so that one's not technically my fault. I did run over 20 miles this week, and my body is now reminding me why it's better to build up miles gradually rather than triple one's mileage out of the middle of nowhere.

I did get quite a bit of painting done. One of the living room walls is now a very bold blue, as is part of the eat-in area of the kitchen. The dining room is in disarray though. I was able to strip the wallpaper, plaster and sand parts of the walls, but now it is even uglier with painter's tape and 3/4 of one layer of primer. The primer boasted of its ability to cover up just about anything, but the half burgandy portion of the walls is still glaring through. I also filled in the gaps between the baseboard and the walls with paintable caulking and found it much easier process with the use of a caulking gun, having learned from last year's debacle. I'll post some before and after pictures once I get things picked up a little around here.

Other activities this week included the recruiting dinner, a social at my program director's house, another intramural soccer game, interview dinner for applicants to our program, and on Saturday a bunch of spent the whole day on a wine tour. I did also get a chance to talk to Army Guy, and he sounded tired, but was in good spirits.

Pimp My Ride

I went to a recruiting dinner last night. It was at a hospital over an hour away, so they sent a limosine out to my house to pick my friend and I up. It was just the two of us that went, so it was kind of awkward. We just hung out and chatted with three of the physicians from their Emergency department over a bottle of wine and some steaks. They seem like a fun group. There's just so much uncertainty about that first job after residency.


It's exciting, and yet I really don't want to spend too much effort thinking about it right now. I'll probably look into the place a little bit more. It sounds like they would be happy to have us moonlight there every now and then, so that would probably be the best way to really check it out.


It was fun having a limo idling in my driveway for about 10 minutes. I hope it got the neighbors talking.

A Little Bit of Sole

The other day I really stuck my foot in my mouth, although it was kind of necessary to counter future embarassment.

I had picked up a new chart, and went to go find my new patient. When I went to claim my patient on the whiteboard (unfortunately we are soon switching to a computerized tracking program), I noticed that the patient was actually in a different room than the one listed on the chart. Patients often get relocated if the room isn't quite clean yet, so I went to the room listed on the whiteboard. Instead of finding a middle-aged male, I walked in on a topless female. I apologized and ducked out.

My second attempt was in the room originally listed on the chart. Nope, that was an octogenarian male, and clearly the wrong room as well. At this point, I threw up my hands and consulted the charge nurse. He had no idea where this patient was, so he called up the triage nurse, who also walks the patients back to their rooms.

"Didn't you see my stickey?" he asked.

"Um, no."

So, the triage nurse flips around through chart and finds a small 2x2" yellow Post-It note. It reads: Patient wants to be called [insert female sounding version of a male name here].

"Um, ok, so what does that mean?" I ask.

The triage nurse just rolls his eyes at me and mouths the words "he looks like a girl."

This isn't helping matters. The patient's chief complaint is hematuria, or blood in the urine, so it makes a big differnce whether or not they have male or female anatomy. I have already observed what are obviously augmented breasts, so there's no getting around asking what other sort of surgeries the patient has had.

Finally, I develop a game plan. I go into the room, and act like I think registration has made an error and marked the patient as a male instead of a female. He says no, and after a lengthy discussion, he explains that other than breast augmentation, he hasn't had any sex change surgeries. Although I think I may have alarmed him at first, I think he probably found me to be concerned and attentive in the end.

I was explaining my technique to the charge nurse later and he said, "I can't believe you did that." When I asked him how he would have handled it, he said he would have asked the patient when their last menstrual period was. Maybe I'm wrong, but that seems a lot less diplomatic way to bring up the issue.

While nobody likes to be asked what sex they are, sometimes you just can't tell. I think it's better to be direct rather than to end up with a male in the stirrups or asking all sorts of unnecessary questions. And in medicine, gender totally matters. Workups revolve around it, so there's no excuse for ending up in court saying, "Well, I didn't get a pregnancy test because I thought she was a dude."

Winter Doldrums

I can't wait for tonight's shift to be over and done with. During this four-week block, there are too many residents in the department. This means that as soon as patients get brought back into a room, they get seen immediately. It also means that I haven't been having to stay late to finish dictations. Last night we all walked down to a local pub and nursed a couple of beers. It sounds like a little slice of heaven, right?

The problem is that I am bored. I don't know what to do with myself when I have less than four patients at a time. I just end up pacing from computer to computer, checking and re-checking lab results. I had a stabbing that promised to be somewhat involved last night, but he was completely stable. The acuity was good: I had an acute stroke, and another one with hypovolemic shock, but when those are your only patients it still gets boring.

Starting tomorrow, I have a week off. This time I am not going anywhere, just planning on sleeping, reading, maybe taking a skiing lesson or two, and doing some projects around the house.

Professional Courtesy

In medical school, we are taught not to bash our colleagues. We all make mistakes, and particularly when you are going to be stuck encountering the same people over and over, it is not a good idea to burn bridges. If someone has mistreated or misdiagnosed a condition, you fix it, and do what's best for the patient without pointing fingers. I think that this is generally a good policy, but sometimes it is hard to not question the other person's judgement or values.

To prevent myself from rambling for several paragraphs, I'll keep it short:

• A small child was accidently overdosed on an antibiotic.
• It was a non-toxic ingestion, and we advised the prescribing physician of this.
• Despite being the one who had potentially harmed the child, the physician was "too busy" to see her in the office and sent her into the ED anyway.
• The only reaction to the medicine the baby had was 2 episodes of vomiting and 1 episode of diarrhea.
• I asked why she was put on the antibiotic just the day before.
• Parents said their doctor "heard fluid in the lung".
• The doctor diagnosed "pneumonia" in a non-febrile infant without a chest x-ray.
• What I saw was a smiling, playful infant with absolutely clear lungs and no signs of dehydration.
• The child was sent home, and her parents were told that she was fine and we did not see any need for the antibiotic (or the oral steroid) prescribed by their doctor, but to discuss stopping the medications with her.

What I would have liked to have done would be to recommend that they find a competent physician, or at least one who cares enough to personally check up on his/her patients when they potentially cause harm. But I didn't. Their doctor will get a copy of the transcribed report about her patient's evaluation, but my guess would be that it will probably just get filed, unread in the patient's office chart.

Willy-nilly handing out of unnecessary antibiotics is a big problem in medicine, but what bothers me more about this case is the apathy of this physician. If you make a mistake, you should do everything in your power to fix it, or at least stay an extra 15 minutes late in your office to see the patient. It is aggravating to be the after-hours dumping grounds for non-emergencies, but this doctor didn't even make a quick call later to see how the patient looked.

I know that primary care providers are under a ton of pressure to see many patients every single day. At the same time though, this family practitioner is the sole provider for this entire family. She delivered this baby, does all of her pediatric care, and she does annual physicals on both parents. From a purely business perspective, isn't it in this doctor's best interests to keep a strong rapport by not just dumping them on the ED? I don't get it.

Footwork

I just got home from playing on our department intramural soccer team. They have been trying to get me to play for several weeks now (not that I'm any good, more that they were desperate for more players), but the games kept conflicting with my work/sleep schedules.

People weren't really into soccer where I grew up. Honestly, I think the last time before tonight that I played was during 8th grade gym class. And the few memories that I did have of it were of getting kicked in the shins really hard. Well, for this intramural league, players have to wear shin guards, which at least is better than the lack of equipment requirements for our pickup softball league last summer. I played most of the game tonight, and it was a good workout. I think it's a little easier to challenge yourself to doing very short sprints when you are chasing someone down rather than just picking up the pace on a treadmill.

After the game (We lost 2-8), we all went out to a sports bar for drinks and food. I really am happy with the program that I am in here. Our team tonight was made up of nurses, residents, and techs. While there was some gossiping going on, everyone here is just so good-natured and fun to be around. For me, I think that's what has really made moving so far away from friends and family easier. I don't know how people can do it in more cut-throat residencies.

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In other news, I turned in my state licensing paperwork yesterday. It will take a few months for everything to get processed, but that means that I should be on my way to moonlighting in smaller hospitals this summer. It makes me kind of antsy just thinking about being out on my own, but there are some options where you can work in a fast track, or double-coverage with another physician, so I may ease myself out with those.

Army Guy started ranger school yesterday, so phone calls will now be few and far between. I am sure that he will do great, and the time will fly by quickly. Talking was kind of awkward leading up to him starting the program, but like I said before, I'm not the greatest at goodbyes.

Treadmill Woes

I generally try to not incorporate the word "hate" too much into everyday conversation, simply because I think that overuse diminishes meaning. For example, people tend to snap their heads around when they hear me drop an f-bomb at work rather than some of the residents who tend to incorporate f-this and f-that into every third sentence. But, I'm getting off topic here...

I hate my gym. Hate it, hate it, hate it. I belong to one of those big organizations with clubs all over the country. When I moved here, I signed up for another 3-year contract as I couldn't beat their renewal price anywhere, and there was a club only 3 miles from my house. Last year, I was using it regularly, when the roof collapsed after a very nasty storm (fortunately it was overnight when no one was in it). Immediately afterward, they put up a sign announcing that they would be re-opening soon. Months went by, and as the weather got better, I started running outside, rather than working out at their other location conveniently located in the city's largest shopping mall.

Now the weather is bad, so I am stuck hitting the treadmill again. I pretty much dropped running almost entirely since my vacation, particularly with my crazy ICU schedule and then the holiday season. Things were fine when I went on Thursday for a quick run. However, when I got there today, there was absolutely no parking. It took me a good 20 minutes to find a spot that left me having to walk through the entire mall, with bargain shoppers everywhere.

Today was probably an exceptionally bad time, but I don't want to deal with all of this on a regular basis. I said something about it to one of the employees there, and she said that she thought they were letting us go to one of the smaller, private clubs in my neighborhood. The "re-opening soon" sign at the old club has been taken down, and apparently they now don't plan on renovating it. Unfortunately, I'm paid through 2009, and I can't cancel the membership since there's technically a location within 30 minutes of my house. Hopefully, this independent club thing will work out, otherwise I suppose I will just be stuck with dealing with mall parking and gaggles of shoppers.

A New Year

I don't really have any deep thoughts about the past year, or any spectacular ideas for 2008. Right now, I'm just scratching my head and wondering exactly where the heck 2007 went. I suppose that in a few years, when I think about 2007 there will be a few rough days that stand out in my head. That's partly what I like about having this blog... the ability to look back and remember what I was doing and feeling at the time. I guess the highlights were hiking the Grand Canyon, scuba diving, renewing an old friendship and starting a new relationship.

2007 Reading List (Somehow, I seem to be reading less every year.)

Old Testament: Jeremiah - Malachi

It took well over three years, but I finally finished reading the Bible (I started with the New Testament) sometime during the spring.

Walk On: The Spiritual Journey of U2 - Steve Stockman

I don't really remember much about this one.

The Lucifer Effect: Understanding How Good People Turn Evil - Phillip Zimbardo

I picked this one up after seeing an interview on television with the author. This guy ran the famous Stanford Prison Experiment in 1971. In it, he compares the breakdown of social conscience between the college students placed in guard roles in his experiment with that of American soldiers towards detainees in Abu Ghraib.

Traveling Mercies, Some Thoughts on Faith - Anne Lamott

"Bird By Bird" by this author is one of my favorites. A large part of the focus of this book is her experiences of raising her son by herself.

The Memory Keeper's Daughter - Kim Edwards

This novel was given to me by a co-worker after she finished it. It held my attention, and I plowed through it pretty fast.

Crocodile on the River Banks - Elizabeth Peters

I haven't read anything by this author before, and this quick historical piece of fiction was written in the 1970s and features a stubborn, independent, and educated English woman who gets herself into all sorts of trouble-- I can't imagine why my mother would have passed it on to me!

Death Comes for the Archbishop - Willa Cather

Ru gave me this one just before I moved here, and I read in on my way back to Arizona for the holiday. It kind of made me homesick for the desert heat.

2006 list

2005 list