Representing

I am not accustomed to dealing with drug reps. During residency, they were banned from our program by our department chair. Generally speaking, I think that emergency physicians are a much less optimum target for sales than internists or family practitioners. Probably at least 75% of my prescriptions are based on about five different medications. In addition to the fact that I stick with tried-and-true medications, emergency physicians tend to write prescriptions that don't have refills. It is a lot less appealing to get an EM doc to write for a 30-day supply, rather than an internist that's going to write for 365-days worth, and has the potential to renew that prescription year after year.


Anyhow, at the new job, there are drug reps that occasionally drop in. I never know when they are going to be around, and they typically just show up in the break room with food. Apparently, the last time one came while I was working, they were offended that I didn't take time to visit them. I don't really have any interest in looking at brochures or reading about receptors. If your product is not in any of my books, I am not going to write for it. Period.


The last one that I did sit down with, I felt guilty the whole time. There were patients waiting to be seen, but I needed to shove some food in my face anyway, so I figured it might as well be a fresh salad and wrap instead of the standard PB&J I bring to work.


Care to guess what his product was?


It was a reversal agent for narcotic-induced constipation. Yup, for 10 minutes while I crammed food in my mouth and nodded, he went on and on about success rates of inducing bowel movements within an hour's time. I might be a physician, but I don't really want to talk about intestinal transit times WHILE I AM EATING!

Gracias

It is that time of year again. As always, there is a lot to be thankful for. I think that it is important to remind myself of that from time to time.

-I am thankful that the boards are over. I think that I did ok, but am mainly just happy to put a checkbox by that bundle of stress.

-I have a wonderfully thoughtful and supportive fiance, who won't be home until after the holidays, but as of now, he is safe and warm.

-My friends are wonderful and in good health.

-My family is doing well. Although one uncle has cancer, it's operable, and 3 aunts and uncles continue to be in remission.

-I have a job that is secure, and challenges me daily to be a better person and a smarter physician.

-The basics: food and shelter are secure. And then there are bonus items like a functioning vehicle, cable TV, internet access, and books to read.

So despite my mutterings and occasional grumblings, I really don't have much to complain about. Overall, I am pretty blessed. And that is the attitude that I need to arm myself with on a daily basis. I am working the next couple of overnight shifts, and it is sure to be a Turkey-fest in more ways than one!

Testing

I am taking my EM Boards on Wednesday. I'm not feeling so confident, and yet I am so tired of studying.

Two Weeks of Normalcy, Sort of

AG was recently home on leave. The two weeks flew by faster than I think either of us would have liked. It felt almost like he had never left, right up until I had to take him back to the airport. He seemed to re-adjust to life back home well--razzing me about my driving, "Slow down, I can't find IED's at 75 mph!"

We did a few wedding things-- cake testing at a bakery, and menu tasting at our reception venue. It was his first time seeing the church and reception site, and he seemed pretty pleased with my choices. Initially, when we got engaged, he said I could just tell him what to wear and when to show up. However, over the past 11 months he has been interested in every detail of the planning. I think that it has been a nice distraction from war talk.

We also squeezed in some car shopping because about this time last year, AG's car decided to throw a piston through one of its cylinders and it had to be sold to an auto recycling company. Several days were also spent at his parents' home, and we were able to see a stand-up comic that came into town.

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One of the most memorable parts of his visit was a trip to his old college campus. We went into the Telecommunications building and ran into one of his professors. It was amazing to me to see how easily AG makes an impression on others around him. We walked into the professor's office and there was a blue FBI hat sitting on top of his computer. The hat was from AG when he did an internship with them over ten years ago! Apparently, it was quite memorable as several agents had come in person to interview the professor and to do AG's background check.

That is probably a big difference between the two of us. AG doesn't really know any strangers. Although I am a friendly person, I am slow to warm up to people, and especially tend to stay under the radar when it comes to authority figures. I don't think very many of my college or med school professors could pick me out of a police lineup, let alone would they keep something that reminded them of me in their office.

As it turns out, despite being an infantryman by Army training, and a more recent stint with law enforcement, AG has been thrown back into his old telecommunications realm. With his last promotion, he was transferred to a different province in Afghanistan and now has a much more political position. His job mainly involved promoting the recent Afghan elections, and he set up several remote radio stations and was in charge of their programming. When he got there, the higher-ups were pleased to suddenly have someone with broadcasting training amongst them. They were so impressed with him, that they wanted to promote and transfer him yet again, but he turned it down because it would have meant another 6-8 months in Afghanistan. Apparently, everything fell apart while he was gone, but now that the re-elections have been canceled, they are now focusing on influenza prevention.

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Putting him on the plane was easier this time, particularly now that he re-deploys in just two months. I found myself being more emotional when people would come up to him randomly out of a crowd and thank him for his service. It is nice to see soldiers being treated with respect. Apparently, on one of his flights in, random passengers gave up their first class seats to all of the soldiers. Other than some security stupidity in Atlanta (They made him throw out a pair of tennis shoes and a sleeping bag because they had foreign soil on them, despite all the dirt on his boots and uniform!), he did not run into any problems.

Before he left, he gave me a boyish grin and said, "Come on, what can happen in six weeks?"

I keep cringing because I do not want to find out.

Tricks and Men In Black

The other morning when I went into work, there were a slew of patients waiting for me. One was a guy who obviously needed suturing done on his face, and appeared to still be a little intoxicated. There was more blood on his shirt than I thought the lacerations warranted, so I made him strip down to make sure that he hadn't been stabbed anywhere in the chest. (Stranger unnoticed injuries have been found on drunk patients.) He laughed at me when I explained my reasoning. Apparently, the blood all over his shirt was fake and part of his Halloween costume. The joke was on me, I guess.

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My shift started to clear up, when I suddenly looked up to see three men in long, black trench coats staring at me from across the department. At first, I thought maybe I was about to be indicted, but as it turned out, they were with the Secret Service. Apparently, some political figure was going to be in town in the near future, and they wanted to check out nearby hospitals, "just in case."

Their timing was perfect, as just before that I had just seen a paranoid schizophrenic that was screaming about people being out to get her, with hyper-religiosity, and making all sorts of bizarre statements. "WE HAVE A CURE FOR AIDS, YOU FOOLS: IT'S MOSQUITOES!" As it was, she was loud, threatening, and required multiple sedatives. I cannot imagine what seeing their little entourage would have done to her.

I did not have any personal conversations with the Secret Service, which was just as well, because they probably would have decided to bring in their own physician.