I’m on call again today. I don’t know what to say yet. Maybe I won’t say anything.
It’s just one of those months.
I’ll update as the day goes on.
[ … 6:25 PM … ] Busy day so far. I feel removed from it all somehow. I’m not sad or anything … maybe I’m just hitting my daily caffeine withdrawal crashpoint. I don’t feel much like talking about my patients. I mean I’ve got two alcoholics dying of liver failure in the MICU (medical intensive care unit)… oops! My attending told me that I shouldn’t write “alcoholic” or even “alcohol abuser” in the chart. It looks bad. He suggested the term “alcohol user.” Just in case the patient’s records get out somehow and they come back and sue the hospital for libel. As if their bright yellow skin, jaundiced eyes, and comatose state while passed out next to a pile of empty whiskey bottles wouldn’t give them away.
Okay… roll call so far includes: (1) Another stroke patient. (2) A “train wreck” dumped on the medicine service (mine) by ORTHO (the orthopedic surgery service). I walk into this 85 year old woman’s room and her family is pointing out the dip in her blood pressure taken 15 minutes ago. (3) A 40 year old woman who overdosed on Ritalin of all things. So far, she gets the “MOST CREATIVE SUICIDE ATTEMPT” for this month. Of course, she’s the ONLY suicide attempt this month but I’m sure when I’m on call Christmas Eve that will change. It could have been fatal but it wasn’t, so it’s funny, to me at least. “If it doesn’t kill you, then it’s funny.” I’ve just never heard of anyone O.D.’ing on Ritalin before. The unfunny part is that she was kicked in the stomach by her husband the night before. Thank God for social workers, I tell you. (4) And lastly, we have a jaundiced “alcohol-using” woman who smells like she took a bath in Milwaukee’s Best who just might be brain dead, but please don’t call her an alcoholic … someone might hear you.
Even though I’m here all night, I have other things on my mind…. I gave a talk yesterday about “Myotonic Dystrophy,” a common form of muscular dystrophy. Even the Chairman of Medicine himself was quietly laughing as he saw my cartoon of “Maya Tanya Dystrophy,” the evil cyberbionic femininja. I had to look twice to make sure he was really smiling and not just having a bad case of gas.
The future. I’m afraid of it. Actually I fear being stuck doing something that I don’t want to do. I fear change. I’m looking for a job and the scary thing is I have some options. I can opt to work IN the hospital and stay with this current hospital (which is becoming pretty huge, reputation-wise and financially). There’s also an opening with Dr. Goodhumor’s lipid and obesity clinic. It’s almost perfect. A five day week, 9 to 5, WEEKENDS OFF FOR GOD’S SAKE! The only down side is that I’d be managing just cholesterol and obesity patients, which is fine, but … well, the most exciting day of mine would be written something like this,
“… I’m so excited. There’s a new drug out that lowers LDL cholesterol and triglycerides a full 17% more than any other antihyperlipidemia agent. It’s called “FATBEGONEX. I’m still quivering …”
… Still, like I told Amy, I’d have lots of time to do other things in my life. Plus I’d be an expert in a finite field of knowledge. Unlike Internal Medicine which is an infinite field. Bah. The job is already taken I bet.
I almost think I might miss the resident-stuff I complain about all the time. I’ll miss the intensity, the drama, the blood, the urine … well, not so much that last one. To think, these are the last months of call and life-death situations I may ever manage again. It almost makes me nostalgic. And this journal? What happens to this journal then? How boring will it be? I mean I can only say how much I love my baby so many times right? (Chorus of readers: “Apparently not.”) I’m contemplating the future of my life and I’m worried about having a boring journal. Okay, time to admit it and sign up for the 12-step program at “Net Nerds ‘Nonymous.”
I talked to a fellow 3rd-year resident, Giovanni, in the library the other day. He says the other two residents in the area are going to be supported by The Hospital and that we were passed over because he’s “too aggressive” and I’m “too quiet.” So, he’s thinking about starting his own clinic. He’s telling me how he plans on cutting overhead (a word not in my vocabulary) by not hiring any medical assistants. “Why should I pay a tech $23,000/year to draw blood when I can do it myself. I’ll draw blood from the carotids if I have to! HAHAHA!” He also plans on constructing his own building all by himself. “I’ll just study everything I can find on construction like I crammed for my entire Anatomy Final in medschool in a week,” he adds. At this point, I think he may be going from “aggressive” to “dangerous.” He always makes me laugh and feel better about things though.
[ … 8:04 PM … ] I finally found out what my 4th year student’s name, “H.L.,” stands for … “Harry Larry.” I overheard him hitting on a social worker. He was pretty smooth I must admit, going from “Zero to DATE” in less than sixty seconds. Of course she was obviously interested to begin with so that helps.
[ … 11:45 PM … ] ARRGGGGGGHHHHH!!!!!!!!!!! I’ve just spent the past hour arguing over every possible irrelevant detail regarding my “alcohol-using brain dead” patient in the ICU with my attending. My whole team just drops their jaws after hearing some of the things he suggests. The ICU attending will laugh at me if I even do HALF the things my current attending wants me to do. I think the only thing he didn’t ask me was “What kind of toilet paper does the patient like to use — two-ply or one-ply?” I’m usually never this disrespectful or even vocal towards my superiors but — AARRGGHHHH!!!!! My entire team is near mutiny too. I’m sure he is an excellent doctor in his element, but I just don’t think managing ICU patients is that element. I believe I am far enough along in my residency to differentiate between when someone is questioning you because it matters and when they are questioning you in an attempt to try to impress/overbear you. And besides, I am supposed to be running the show this month — that’s MY job this month. He’s supposed to be an advisor-when-needed of sorts.
[ … 1:17 AM … ] I was sitting upstairs listening to another fellow 3rd-year, Jihad, talk about some psych patient who used to be a billion-dollar CEO when my beeper vibrated. (It’s on vibrate mode while I’m awake now. Now when I get paged, it feels a little less like an ice-pick being stabbed in my ear.) “FUCK IT’S A CPR!!” We both ran out the door, down the stairs, leaping 7 or 8 steps in a single bound, and when we got to the floor discovered it was a mistake. No CPR called. Someone was probably calling a nurse and hit the BIG RED BUTTON on the wall instead. That’s one way to get a nurse I guess. It seems like every CPR this month has been some kind of mistake.
On the way back Jihad tells me about another resident, Musashi, who once had 3 CPR’s in one night. When Jihad had asked him how they went, Musashi said, “They were all successes.” Then Jihad inquired, “But I heard one of them died.” To which Musashi replied,
“That depends on your definition of a success.”