Let's play doctor

Lately, I've been having a lot of no shows to clinic, and my last clinic was no exception. It's really unbelievable, the number of no shows I've had. I think I'm going to have to institute a no show policy. I mean, really, how many of these can I have?

So, bored out of my mind, I was talking with the cute clinic nurses, and I accused her of scaring away my patients, to which she replied, "Well, doctor, we can be your patients! You can examine us!" She grabbed one of the other nurses. "I'll be a good patient!"

Now, while I tend to be the pinnacle of professionalism, my mind went to a very dirty place and I think I may have turned an awkward shade of purple.

lonely

I'll admit it right now, I'm lonely and have been lonely. You know, my life is lacking. Professionally, I'm well on my way and I am enjoying my work, as much as residency can be enjoyed, but I need something more. I see my friends maybe once every couple weeks, I don't have a girlfriend, I don't know anyone in my building. I need human interaction, badly. While I'm sure I would have hated the city where I did med school, at least there were people I knew there.

People ask me why I came to this town. I don't know anyone here. I don't have any family in the state anymore. As far as friends go, just a handful are left. The only reason I came here was the residency program, which seems almost stupid in the internal medicine residency world.

I do a lot of things to keep myself occupied. I find ways to pass the time, and it almost makes me forget all the drama, but it's always there and always uncomfortable. Seems like everybody's got their own lives, so why don't I?

right to die

There's been a lot of press about the Terri Schiavo case, the woman in Florida who suffered anoxic brain injury and for the past 15 years has been mentally on par with a turnip. I could talk for a long time about the pros and cons, about what I think, but none of it really changes the fact that some doc prolly coded this lady far too long and somehow managed to get a perfusing rhythm, and has probably been patting himself on the back for the past 15 years. The fucking bastard.

Yes, doctor

The nice thing about working at different locations is that you get to see different ways how medicine is done. The place I'm at now is very old school medicine, and by that I mean that the doctor is always right. Whatever I ask, it's done, no questions. The only words that come out of the nurses' mouths are, "Yes, doctor." There's no pressure to discharge. I get respect just because my white coat is long.

If my mom hadn't told me about it, I wouldn't have believed it ever existed. Most places I've worked, no one gives me the time of day. I've worked hard to build relationships with the nursing staff at the main hospital I work at. I've got nurses and staff now that are on my side and will get stuff done for me. And it's weird to know that the hospital I'm at now, I don't know anyone and I'm already more productive.

And I'll admit, it feels good to have people follow my lead, but there's a flipside. It's nice to have people acquiesce to my wishes, but there's responsibility with that. Now I know why my mom's always telling me to be friendly and nice and pleasant and kind to the nurses and staff. Because I'm a leader now, and like it or not, people will follow me. And people just feel better following someone they like and respect as a person.

Because I can't be right all the time, and sometimes I'll be wrong, and it's important to have people around me who will forgive me that. It's important to have people working with me who see me for more than a long white coat and a couple letters after my name.

A red letter day

I'm trying to get some quality letter writing done tonight. I haven't written a letter in a while. I'm rusty. No one actually communicates in letter form with me anymore. When I moved in high school, I wrote so many letters, at least a few a month, and dozens over the course of the year. I still find letters to people I barely knew.

Nowadays, I write letters very sparsely. The payoff's not so great. No one corresponds with letters anymore. I send out letter after letter, but I only get one back once in a great while. But there's something very... pure about a letter. Putting words to a page, it has a remarkable feel to it, and it's tough to remember that sometimes, after spending all day writing orders and progress notes.

So I'm trying to get back into letter writing, and it's a tough road, but I'd forgotten how cleansing it is. It's quite something to write something down and give it to someone. Conversation is so transcient. Even e-mail is fleeting. A letter just feels like something more true, if only because it lasts.

"You're so nice"

Today in clinic, I picked up an extra patient due to an unfortunate scheduling accident, and the patient turned out to be a problem patient with stuff and other stuff, and I was venting to the nurses, and I asked why did I agree to see that patient, when I knew something like that would happen, and in stereo, the clinic nurses chimed in, "It's because you're so nice!"

If they knew me better, they would've shut up.

Whenever I talk to people these days about my love life, and it's pitiful status, the irresistable comment is: "but you're so nice!" and if I hear it again, I'll scream. Nice isn't a compliment. It's not. Nice is something you say about a poorly written romantic comedy. Nice is a mediocre restaurant in Tiffin, Ohio. Nice is vanilla yogurt. Nice is mashed potatoes from an instant mix. Nice is the teacup ride at Disneyworld. Nice is plain oatmeal. Nice is the word you use to describe something that you didn't hate, but didn't really like.

I can't imagine someone ever dating me based on the fact that I'm nice. Nice covers all kinds of sins. Nice is fat, nice is lazy, nice is ugly and requiring a bag over head, nice is a personality disorder (like histrionic maybe? Borderline is so passé). Nice is lives with his mom and collects recyclables.

I don't want to be nice. I want to be charming, or classy, or dignified, or mysterious (okay, I'll never be mysterious, but you get the idea...). I want to be something interesting, something that attracts some attention. No one ever fell in love with nice. No one ever said to themselves, "I want to date him. He's so nice!"

Because no one wants nice. Because no one ever dreams of meeting someone nice. Oh, don't tell me otherwise, because I know it's true. I know it because I don't dream of nice either. When I come up with a list of what I find attractive and what I want in a woman, the word nice is nowhere on that list. It's an adjective without a noun. A nice spouse? Nice friend? Nice doormat?

I'm not having a desperation moment. I'm not being all 'boo hoo, my life sucks' or anything like that. I'm just sad that the best compliment I get is 'nice.' And really, the fact of the matter is that while nice may be a lot of good things, nice is also single, without any prospects, and closing in on 30.

The weekend off

This weekend, I had time. It's not often one gets 2 days in a row off. It is in fact so rare that I can only remember it vaguely in the past, maybe November? So, with this wealth of free time, what did I do? Not much. I saw Constantine, and it was okay. I hung out with B and we pretty much did nothing, but that was fine. I went to church and went grocery shopping. Nothing much.

And it used to really bother me that I couldn't do anything more exciting. In college, I went to clubs now and then, went to music venues, hung out in pool halls, all sorts of things. But as I've gotten older and older, it all seems less and less appealing. In med school, I forced myself to go out and have fun, and I seem to remember that being horribly unsuccessful.

Truth be told, it doesn't bother me any more. It's taken me this long in life to realize that the things I enjoy are not very social. The things I enjoy are quiet and more tranquil. I like going to restaurants and art museums and cider mills and parks. I like doing things that are pleasant.

And I realize that people actually do meet other people in bars (although I cringe at that thought), and that it's next to impossible for me to meet a female if I'm not going to go out and be social. But I'm not going to do things I don't like just for the possibility of meeting someone nothing like me.

I want to meet someone on my own terms, someone that's interested in the same things I am. That's not too much to ask, really. And yes, I'm not doing anything to find her. But maybe she's doing something to find me?

Filet-o-fish season

Filet-o-fish season,
originally uploaded by ifinding.

It's Friday, and if you're Catholic, then you know what that means: McDonald's! I got the filet-o-fish and heartily munched away. It's the king of fish sandwiches from fast food.

Of course, I considered Long John Silver's, but it just doesn't have the rich Lenten tradition that McD's does.

I try to be good about Lent stuff. Every year I slip here or there, but I try, nonetheless. This year, I gave up coffee again, and it hurts when you're post-call. I'm still drinking caffeinated soda, because it's too hard to avoid quite honestly.

I'm pretty sure that Lent should feel like punishment, but I never really do anything so grueling. I'd like to say that I come out of Lent with renewed spiritual energy and focus, but really, I'm just sleepy from the lack of caffeine.

People think I'm super Catholic because I go to church every week and follow the rules, but really, I'm not very good at all. I haven't been to confession in 6 years. I'm not really happy with my life. And that's fine, because the funny thing about Catholicism is that it doesn't really require you to be zealous. You're allowed to be lukewarm.

Other Christian demoninations are very fervent, but Catholicism is so calm. And I'd like to think it's because no one can maintain such a ardent fanaticism, but the mild Catholic stance, it's bearable. It grows on you in ways you can't see or sense. And that's why Catholics number in the billion. It becomes a part of who you are.

Romantic rhymes with pathetic

I'm not sure if you can really sympathize with me, but I've been thinking a lot about the one that got away. I really have to admit, there is one girl that I feel like could've been the one, and it's like a bad taste I can't wash out of my mouth.

And I think what sparked all this is the recent influx of romantic stuff I've been watching. "Wonderfalls" and "Shall we dansu?" are both pretty romantically themed.

And I know, deep down, that this is all wishful thinking and that in reality, if I could do it over differently, I'd have fucked it up and she'd be on my enemies list. But still, I'd have liked the chance, y'know?

And it's not fair to all the other women I meet, to be compared to someone that doesn't exist anymore. Y'know, we all change and mature, and the girl I knew back then, she's not the same person now. To be compared to the memory of someone, that's a standard no one could ever live up to.

And there's a small inkling desire to get in the car and drive, find her and see if we can click, but I know it'll never happen. We were two ships passing in the night. Even back then, I think that there wasn't anything there. It was all just wishful thinking. It's just that... it'd be nice if life was like TV, and everything had closure.

Nurses are off limits

It's funny lately. There are a lot of nursing students and young nurses around right now, and I'll admit, it can make it difficult to concentrate. Of course, I try (and fail) to involve these students in patient care, but it's a lost cause. Oh I'm just the student. Oh I don't know. It's an issue with me, because it's a cop out I used a lot. There's a difference in not knowing and not thinking.

I decided early in the game that nurses were off limits. Part of it is a bit of intellectual elitism. Most nurses are as blue collar as they come. It's a job that only in the last 15 years or so actually required formal college education. The BSN degree is a bit of a new thing. My mom barely remembers to list it as her degree of training.

And I'm big enough to admit that I'm a bit of a snob. I want to go out with someone who is a little more cosmopolitan, someone who took some history classes or English courses, someone who took art history because she realized that there's more to art than pretty pictures. I'm not saying that nurses are not capable of this. I've been to museums with my mom, and she's no slouch.

It's just that people who go into nursing, for the most part, aren't looking for intellectual stimulation. In my mom's day, it was what women did; they became nurses and teachers. Nowadays, women go into nursing because it's a job that pays 40k a year plus sweet benefits.

The other reason I try to avoid nurses is that I think it's unwise to dip your pen in the company ink. That's just good practice.

But I'll admit, there have been a few cute nurses that caught my eye. Can't be helped. I have friends who've dated (and married) nurses, radiology techs, and all sorts of support staff. But for the most part, these women do not interest me, other than visually. Funny thing about my life right now: I'm surrounded by women but no real prospects.

Maybe it's time I put myself out there again and tried to make myself more available. Heaven knows, I could use the practice.

Valentine's

So, another Valentine's Day has come and gone. Good riddance. I hate Valentine's Day. It's the worst holiday of the year. Okay, so I'm a touch bitter maybe. I didn't wear black this year at least. It's just such a horrible reminder to me that not only am I single, and other people are happy, but that I've had so many miserable Valentine's in the past.

This year, I went to Best Buy. Not much of a Valentine's Day, I know. I did however buy the Japanese "Shall We Dance?" which was such an awesome movie and I was so angry that they remade it with Richard Gere and Jennifer Lopez. They made a touching, well done movie into some cheesy date movie. Aggravating.

However, I spent the night lying in front of the TV, asleep, while my dinner burned in the oven, watching Wonderfalls DVDs. I'll admit it, I've had better days.

The hostility towards Valentine's Day is waning, I'll admit, but it's still there a bit. You know, I can't help but feel like I'm entitled to be in a relationship by now. I'm entitled to some things. I know that's a very selfish view of the world. It seems a little unfair, you know?

In med school, I realized that a lot of people go to college to get married. It's actually the plan. That's kind of scary. I went through med school thinking I'd get married. That's kind of scary too. Now, all I'd like is to have a relationship. I don't need to get married, but I'd like to know that it's something I'm capable of.

A diversity of friends

calimari,
originally uploaded by ifinding.

My mom always used to tell me that if I'm going to be a doctor, I should be friendly and patient and kind to everyone, because that's the kind of doctor that both patients and nurses and support staff are willing to listen to. A little biased view perhaps since she's a nurse, but true nonetheless.

And while mulling over a plate of calimari with F, I realized that I've been doing this all my life. That's how I ended up with such a diversity of friends. I've managed to gather up a wide variety of folk that (and I've proven this time and time again) don't get along with each other at all. My friends tend not to get along, because in reality, the only unifying theme is me.

And I wouldn't change a thing about my friends. They're like a buffet of life. There's something wonderful about having friends who could care less that you make life and death decisions 6 days a week, friends who are more interested in what I've been reading, whom I've been dating, what I've been eating... interested in my life.

It's a lot harder for me these days to make friends like I used to. And that's kind of sad. But it makes me wonder sometimes whether the girl of my dreams, maybe she's out there and I've blown her off. That would suck.

But if I had to sit down and be honest, of all the stupid crushes and trouble with love that I've gotten into, there's only one or two that bother me, that I feel like I missed my chance, that something so wonderful could have been. And if you know me, you're probably guessing right now. But y'know, you'd be guessing wrong.

There's something liberating about paring down one's list of girls that got away down to one or two, because it reaffirms the truth that in life, you have to wait years before you meet a girl that you'd even think about marrying.

So glancing at my calendar, I seem to be a tad overdue in that department.

fuck you, hospital

The ONLY thing I've been looking forward to these past few months was a new digital camera. I've been checking them out, trying to find the best one for my needs, and I finally decided on the SD300 Elph 4 megapixel. It's sweet. And it delivered today. I was geeked. All I had to do was get out of the hospital and pick it up from the rental office where UPS was bound to drop it off.

Instead, I was stuck in the hospital till 6:30PM. Now, the rental office is closed and I'm on call tomorrow and I won't be able to get to it till Saturday, if then, assuming I get out the hospital on time then to get to the rental office before they close till Monday. I could not be MORE pissed. And it wasn't like I was doing critical stuff. I was trying to sign out the the on call resident and I was trying to get some discharge paperwork done for a patient that won't be going home till tomorrow. It was a complete waste of time.

So you know what, fuck you, hospital. You're not my life and I'm not going to compromise my life any more for your bullshit.

iatrogenic

The strangest thing you learn in the first year of medical school is that there is a word that exists to describe those diseases that physicians actually give to patients. Iatrogenic. And it's about then that you actually start to think about disease and cure in a tangible sense. It's not so simple anymore.

There's a very cold way we talk about risks and benefits and the balance between them. For example, I think that giving someone IV or IM iron is unacceptably risky for small benefit if the patient can take oral medications. Most would agree. But it's not so clear when you start to think about other things, like giving someone a load of poisons designed to kill cancer cells hopefully before they kill the patient, just to extend someone's life for a few weeks to months, with the knowledge that those weeks will be spent in the hospital suffering from every known infection because the patient has all of 4 white blood cells left.

I went to Applebee's today, the home of mediocre American chain restaurant food, because I was too lazy to try to find a decent steakhouse. I just wanted a steak, and Applebee's is close. While I was sitting at my table of one, I overheard some medical students gabbing away. They couldn't have been 3rd or 4th years. They were talking about the real world. Once you start clinicals, you have to make concerted efforts to talk about things other than the hospital. Anyway, it seems so long ago that I was in their shoes. I didn't understand or grasp the idea that everything in medicine isn't as simple as disease and cure.

I wish medicine was that simple again. I wish that I didn't have to think about what diseases I could cause, rather than what I should be treating. It's not fair to have to fight illness and cure at the same time.

Thoughts over a plate of sushi

Sake And Tekka Maki,
originally uploaded by drp.

Today begins my fattening up before Lent. And the best way to treat oneself is by going out for sushi. I sat at the sushi bar, and the best things about sitting at the sushi bar are (1) sometimes, the sushi chefs will give you freebies, since the sushi bar people end up last in the queue compared to table orders. (2) if the sushi chefs are not busy, they'll set you up a few pieces at a time, and you can eat em as they make em. (3) You can watch your sushi being made. (4) You can get tips from the sushi chefs about what's fresh. (5) You can eat alone at the sushi bar and no one will think twice.

My mom sent me an article from Time about Twixters, those lovable 20 somethings that are still trying to find themselves while eating their parents out of house and home. They call this a phenomenon. I call this my friends. I'm not really a Twixter. I pay my own rent, have a job that pays the bills, but as far as marriage and children, well, let's just say that it's not for lack of trying.

So I was reading this article about Twixters while munching on a superb piece of yellowtail and I thought my phone went off, and I instinctively went for it. Silly me. I changed the phone number. No one's gonna call me because most of the world doesn't even know my new number.

And that made me realize two sad things: (1) I don't get many phone calls. (2) Changing my phone number feels like I closed the door on a chapter of my life. It's like I finally signed and sealed my med school life and now it's the grown up world. It feels uncomfortable and abrasive. It's not as fun as I thought it'd be. There's a lot of serious stuff in the real world and it scares the bejeezus out of me, and I miss med school.

Really, I miss the irresponsibility of my former life. I miss the lack of accountability and the lackadaisical attitude towards life. I was so invincible. I was fearless, because there were no consequences. Now everything is so damned serious and life is so cruel. My phone, I bought it while I was moving out of my house and driving to my new apartment and residency life. It still had the taint of med school, and now I've washed it clean.

And I know this is ENTIRELY irrational. I can read F's blog and remember how that stupid town just ate at my very soul. I hated being there, but now that it's in the rear view mirror, I can't help but get nostalgic. God help me, I miss it.

At least the yellowtail was exquisitely fresh. There's nothing quite like sushi to make you forget that your life didn't turn out quite as you planned.

One is too much

Someone asked me one time how I could be a doctor and deal with all the death around me. How was it possible to assume so much damned responsibility and still be able to sleep at night, knowing that my patients could die, and often do. I've already had 4 patients die under my care in the last 7 months. Med school was actually worse. During one month on vascular surgery, we racked up 4 mortalities.

People think that it's this giant burden to bear and that it's such a difficult task. Well, it's not that bad. Really. And do you know why? It's quite simple, really. One is too much. After one, it can't hurt you as much, it can't haunt you as much. It rolls off more easily, because you're tapped. It empties you, and there's nothing left there.

My priest was saying in his homily a while back that his first day of work, he tried to give of himself and was emotionally exhausted, and he had given all of himself, and all that was left was to give God. That's what medicine is like. You give all of yourself to that first patient that crumps. You give your heart and soul, and you die a little when he dies. And after that, you've nothing left to give of yourself.

And you might think that's cold and callous, but you've got other patients to treat, other people to care for. You can't let one person drag you down because there are 15 more where he came from. So after that first one, it gets much easier to let go.

And if you think me heartless, I can tell you this: the first patient of mine that died, in my 3rd year of medical school, I can recreate her history and physical exam from memory. If I sat down for 10 minutes, I could probably come up with her medication list as well.

A change of pace

If you ask any medicine resident, there is no day with more potential for evil than the changeover day from one attending to the next. Residents are on for the month, but attendings cycle through every week or two, depending on where you're at. It's a dangerous day, because one attending may overtly disagree with the current plan of care on potentially all of your patients. Scary.

But the reverse is true as well: there's no day with more potential for joy than the changeover day. I had one attending that systematically discharged half the service in one day. It was nothing short of amazing.

But it's truly unfair when you're on call and it's the changeover day, because there's no excuse to follow through on a whole bunch of new, shiny plans of care. So my last call day was spent in pain: discharging, writing for meds, changing things around, ordering tests, all the while trying to cover call. Never fun. Usually, I can squeeze in 1 or 2 hours of sleep. Last time around, zero.

In eval after eval, attendings seem to think that I'm doing well, and some have said that I'm operating at a senior resident level. That's nice of them to say, but I don't feel any smarter. Maybe I've just got down that whole confidence thing down. Y'know, often, it's not a question of right or wrong, but doing what you say you're going to do. And maybe that's all that being a senior is.