You must unlearn what you have learned

My friend, being the jerk that he is, corrected my golf swing. If you've ever seen my golf swing, you'd know that this is no easy task. My golf swing is entirely wrong. There's so much wrong that you can't really point out one thing to fix.

My friend is of course a natural and hit the ball 200 yds on his first time on the range. No one ever said life was fair. I took my piece of humble pie like a man. But the problem came when he tried to fix my swing. He made me move up on the ball, change my grip, fix my mechanics.

Now, I can't even remember how to swing my way. It's completely lost. But I'm no good at swinging the 'right' way, which means that the last few times I went to the range, the furthest ball I hit was 70 yds, and it rolled that far with a downslope and a tailwind.

But every now and then, you need to unlearn comfortable habits. You need to relearn and rediscover things, and find a new and different way, because it's exciting. It's exciting to hit a ball again. It's exciting to watch a ball sail high in the air, and it's utterly heartwrenching to miss on my swing and top off a ball.

I hate having to relearn how to swing, but it's nice to remember how wonderful it felt to be excited again.

Capped

I capped on admissions for the first time. It's a novel experience, knowing that I actually cannot admit any more patients. I'm not sure if it's scary or comforting. I do know that I'll probably live to regret it. I usually live to regret things.

Game day

I was cursing up a storm today watching football. I was dropping f-bombs like it was my job. I remember now why I try not to watch a lot of football. My blood pressure must be sky high right now. Oh well, that's life I guess.

But it made me remember when I was in college and how much I loved football back then. Oh, I guess I still love it, but it made such a difference being in college and surrounded by the environment, y'know?

I probably should have done something social today, but I just wasn't in the mood. I've been sitting on some replies to my online personal ads, I just feel kind of stalled out. I need a second wind on life.

As a note, if you're wondering where all the posts are coming from, I sit on posts for a couple days usually to edit them, etc.

First children

I was thinking about my friends the other day, and I came upon a disturbing realization: nearly all my friends are either the first child or an only child. All my best friends from high school and college are first kids. Only one or two of my med school friends are younger siblings. It's absolutely astounding.

I'm not sure why that is, since I don't know many only children. Most of my friends do indeed have a younger sibling, if not multiple younger siblings. Just seems like I've got many friends in the older sibling department. Maybe it's that older siblings tend to be the achievers and younger siblings tend to lay back and watch the world drift by. I don't know.

Similarly, I find myself very disturbed that I was talking to a single friend of mine, and the fact that I've had a total of 3 dates in the last 5 years is entirely non-representative of single doctors out there. With my doctor credentials, I really should be doing better. What am I doing wrong? Oh yes, working 70 hours a week, that's right.

I should note, I'm a younger sibling. -9/25/05

Do your fucking job

Nothing irritates me more than when I'm asked to do someone else's work. It is, far and away, the most aggravating thing imaginable, and the greatest offenders without comparison are the ER folks. And today was no exception. I was called to evaluate a patient in the ER who was hemodynamically stable, and all that was done was an EKG. There was not a physician eval completed, no labs were back, nothing. For all I knew, the guy could've had a troponin of 56.

So now, I'm taking an H+P from scratch. I am for all intents and purposes now an ER doc that can admit. The ER doc did his charting AFTER I did orders and dictated my H+P. At that point, why even bother? H+P trumps ER papers. All you can do is make me look bad, because what if a lab comes back now and you chart it? Now I've got to make extra special point in my H+P to note that this wasn't done and that wasn't done, just to guard against the possibility that you'll chart on it way late.

I told the ER to get my patient upstairs as fast as they could not because he was acute or urgent, but I didn't want my patient to stay in the ER if that was the level of shitty care he was going to get.

If you have anything to do with the ER, please remember two things. (1) If you're going to call for admit or consult on a patient, be sure to have your own paperwork done. (2) If you're going to call for admit or consult from cards and you haven't even got labs back yet, someone better be dying.

Male piggishness. Please skip this post.

I have lately found myself staring at breasts. I've had to be a little proactive about not making an ass of myself, but lately, it's been tough. It seems like it's not so easy when some of the nursing staff wear see-through shirts, or spaghetthi straps. This is not helpful, and mostly rather distracting. It's hard not to stare. I mean, honestly. When it's right out there, how can you not?

Even worse when the breasts are of a patient. When some college aged girl comes in needing me to do an exam, then it's my business to take a look. I'm not doing anything unethical or anything like that, but it's a chore to keep the libido in check.

I'm not sure why the new breast fascination. I mean, yes, I'm a guy, I like breasts, but why it's been so much trouble recently, I don't know. Maybe it's just that I've been thinking about being single for a while, and how I'd like to see a pair of breasts on a recreational basis that I don't have to examine and that I haven't had to pay a cover charge to see.

She wasn't there

I went to church today, and she wasn't there. Strangers on a train, I guess.

Weighing in

[Beware: this post is long and preachy]

First, it should be said that if you haven't contributed to the effort to help the people affected by Katrina, then you'd best read quietly and shut up. People unwilling to be part of the solution should avoid being part of the problem.

Now, over the last few years, I can't say I'm very fond of W. He is not the brightest man we've elected to the presidency. But I'm pretty annoyed at how he is being blamed for Katrina's aftermath. I wish to make the following 3 points.

(1) Working in health care and being inundated with courses and lectures on disaster management, I have learned one big lesson: disaster planning is local. When a hospital knows that it's gonna get fucked, it's ready to run independently (without outside power or water or help) for about 72 hours. That's because everyone who's ever run a hospital knows that it will take a minimum of 72 hours before any help may be expected.

The reasonable timetable for federal aid is usually at the week mark. The CDC and other agencies usually will take at least that long to come in force. That's reality. That's life. Big things don't just happen. And Katrina aid makes a bomb or contagious disease look like a stroll in the park.

That's why the most effective disaster planning is local. The closer you are to the problem, the quicker the response. So, local government is responsible for preparing and managing immediate disaster. And I'll give the New Orleans mayor some credit, it takes balls to call for the evacuation of a city.

But to say that the federal government and GWB are to blame for the poorly coordinated relief, that's just wrong. Sure, FEMA was stupid, but when you're handed a pile of shit, no matter how you pretty it up, it'll still be a pile of shit. State, regional, city, and even neighborhood recourses share as much blame as anyone else. Case and point, Memorial Medical Center's backup generators were in the basement. This was not the wisest move for a building that sits below sea level, in a town where most buildings don't have any basements at all.

That's just a microcosm of what I usually refer to as a cluster fuck. It's very similar to medical malpractice: one person making a mistake almost never kills someone. It takes several people making many mistakes to result in death. On a local, municipal, state, and federal level, it was one big cluster fuck of poor planning. If you think that one man could manage to do this, then you give GWB far more credit than he deserves.

(2) Let us consider that a good deal of the city of New Orleans is built below sea level and has such a horrible history of flooding that a whole system of levees and other measures to stop water had to be created by the Army Corps of Engineers. This city was destined to flood, and no matter how much you'd like to think you're safe, you cannot prevent disaster like this. You can only prepare. Nuff said.

(3) As much as I've already belittled the disaster response, there were some basic rules that were followed quite well, and it's easiest to think of it in the START model (Simple Triage And Rapid Treatment). Get rid of all the walking wounded (think Superdome folks). Get them to a safe location. Then assess those unable to leave. Medical supplies, food, all that other stuff is secondary to sorting the walking wounded from the rest. If you've done any mass casualty training, you know that the first priority, beyond anything else, is triage. Making sure that the walking wounded have food and medical supplies comes later.

Secondly, safety is paramount. Several hospitals and other locales came under gunfire. You cannot evacuate a location that is not safe for evacuation. If you've seen Black Hawk Down, you know what I mean. You cannot add more casualties to a casualty rich environment. If it wasn't safe to get folks out of hospitals and such because of gunfire and criminals, then the first priority becomes making the area safe for evacuation. I cannot find fault with putting military in the city to crack down on lawlessness, because you must make evacuation safe for evacuators. It's the medic principle. A medic is worth more than one soldier because a medic has the ability to save the lives of multiple soldiers. If you kill a medic, you can kill more than one person.

Don't get me wrong, I'm no fan of GWB, but let's get this right. Like any disaster, it begets disaster, and the common theme in all poor disaster response is that no one was in charge, or more aptly, no one was willing to take charge. Having run a few codes now, I know the value of having someone take point. The person in charge may not be the brightest or smartest or most capable, but at least someone is taking responsibility and making decisions. When no one steps up, then everyone loses. That's why nurses and respiratory therapists take ACLS training too. Someone's got to step up, and someone (anyone) is better than no one.

Docere

Docere is the Latin word from which the word doctor originates. It means to teach, as in documentary or doctrine. I've taken this to heart. I love teaching the medical students. It's a lot of fun for me, because it's more than just imparting knowledge. It's teaching someone how to think.

It's one of the things that gets me excited in the morning. It's actually fun for me. It's not a chore or anything. And part of it is that I want students to see what I see in internal medicine, but more of it is that I want students to see that there is so much more to medicine than just diagnosis and treatment. There's an art to it.

I'd love to teach professionally. I'd love to work at a med school and be a teacher and get paid for it. That sounds like a dream come true. There's one problem. I hate research. Hate. But it's tough to imagine not having med students around me. Maybe there's some school out there looking for someone to be grunt labor for them.

To the girl sitting in front of me

Hi. You were sitting in front of me in church today, and normally I'm not distracted in church, but I have to say, you were quite distracting, but in a good way. Not like the girl last week whose thong underwear was showing, or the girl who was next to her with the skirt that was far too short for church.

I have to admit, you're beautiful, and I don't mean that in a lustful, sexual way, but in all the best ways. You have that brunette hair that is just fetching and you have a gracefulness and allure that is pleasant to see.

There aren't a lot of us, people who go to church by themselves. It's hard to find the motivation to go to church when you're by yourself. It's not quite as intimidating as going to the movies by yourself or a restaurant, but it becomes more of a chore and less of something that should be redeeming.

So if I see you next week, and you're sitting by yourself again, I'll say hello, and maybe (in my little fantasy world, perhaps), we won't have to be two sad folks going to church by ourselves.

On prescribing coumadin

I was rounding with the cardiologists, and there was a patient with atrial fibrillation, new in onset, but the patient was 90 something years old, with severe dementia, bed bound, and cared for in a nursing home, where the patient needed help with all ADL's (activities of daily living: from dressing yourself and brushing your teeth to simple stuff like wiping your ass and chewing).

And the medical student couldn't understand why I was against starting coumadin (a blood thinner that would prevent strokes) in this patient. It works. It's effective. In this patient, where fall risk is nonexistent, it's even pretty safe. So we went to the cardiology fellow, and he was for coumadin as well. The student even felt a little vindicated.

Of course, the primary medicine service asked for Hospice to see the patient, and no coumadin was started. And that's why I went into medicine. Because the art of medicine is all about the simplest lesson in life: just because you can, doesn't mean you should.

Strip clubs

I'll admit, I go to the strip club every now and then, and it's not anything that I'm particularly proud (or ashamed) of. It's just something to do. And I guess that most go for the nudity. I mean, that is the intended purpose. But that's not really the draw for me. It's the illusion of intimacy. It's being around women, and not being a doctor.

And I know, I know, it's fake. It's not real. It's ego-stroking and playing to weaknesses. But sometimes, it's nice. It's nice to remember what it feels like to be close to another person. It's nice to feel a woman's skin when it's not behind a glove. It's nice to catch the hint of perfume. It's nice to remember what a woman smells like.

And I guess there are better ways to spend my money, on less morally objectionable habits, but it seems like every passing day, I find myself less and less connected to the rest of the world. So it's nice to feel close to a woman for a brief moment, even if it is fake, if only to be reassured that I am still a man.

You're nice

one of the nurses came up to me today to tell me that I'm a nice doctor, and all the nurses think so. It's nice to hear it sometimes.