There's an intern that I've been working with, and every time he has a problem or question, he asks me. And normally, this is fine. But it gets absurd. He asks me what to do about home medications. He can't find the list of home meds. As if somehow I secretly know everyone's home meds.

But more concerning to me is that whenever something medically relevant arises, he asks for the answer. I do all the thinking, and that's not appropriate at all. Because the whole point of being an intern is to think. If you just want to get the opinion of your senior every time something comes up, you might as well quit residency and become a nurse. No disrespect to nurses, but the whole point of being the doctor is the responsibility.

I feel like I need to let him flounder a little. Not in a bad way. When I was an intern, my senior was busy cardioverting someone, and another patient was hypotensive. His words to me, "Take care of it." I had all of 36 days of being an intern under my belt. I learned. Sometimes, you have to jump out of the nest and try to fly.

Teach me

Having been a less than stellar intern, I find it very odd when interns now come up to me and ask me to teach them something. I'm used to medical students. In fact, I love teaching medical students. It's fun. It's just strange to think of myself as a repository for information.

I mean, honestly, it took me the better part of 6 months to figure out how to select an antibiotic. I mean, seriously, 6 months. 6 months of "My patient has a UTI. Can I give Bactrim?" or "My patient has pneumonia, should I give levaquin or ceftriaxone and azithromycin?" Even better, "My patient has MRSA. Should I start vancomycin?"

The fact that people come to me for information wows me every time. And I love to teach, I really do. I never thought I'd find something that I loved, but it's very strange finding something out about yourself.

The real truth about teaching though is that you have to know something really well. And it's surprising when you try to teach something to find out just how little you really know.

My first code

I recently ran my first code. I thought it would be horrible, but in actuality, it wasn't that bad. Of course, initially, it was miserable. I was ready to wet myself. However, after the first 5 minutes and the patient hadn't turned around, I realized something somewhat profound. This person, if I stopped right then and there, was dead. The only thing keeping the patient from being dead dead was the nurse pumping his chest and another bagging his lungs.

The thing about ICU that one of my attendings impressed on me is that you can't save everyone. Heck, you can't even save most. You do what you can with the tools given to you, and let God do the rest. The thing about the unit is that the only patients that get to the unit are ones that are dying. And if you're not dying, then you don't deserve the unit bed.

I feel better about codes now, and I've got a few under my belt. The shock of watching someone die, it goes away after a while. You do what you can with the tools you have.


This post is simply to inform you that I've established 2 ancillary blogs. One is History of present illness which is a fictional site, with storied inspired by patients (but not real stories, mind you. HIPAA and all, you know).

Merry X-Mas.

First names

In med school, I was taught to address patients formally. Mr or Mrs or Doctor or Sir or Ma'am or Father or Sister or whatever. It's a matter of establishing professional boundaries. I'm not there to make friends with my patients. I'm there to care for them, and that should be clear.

Sometimes, patients like to be called by first name, but for the most part, people appreciate the respect. But with some patients, things change. On my terminally ill patients, I can't help after a few weeks to start calling them by their first names. I've been seeing them for so long, and I've met all their family and friends, their spouses and children, their parents and best friends and siblings. I've talked to them all about matters of life and death.

It seems to me that after all that, I should be calling that person by first name, and they can call me by first name too, because you can't be that intimate and still stand on formalities.

The longest night of the year

It's officially Winter now, and the Winter solstice is gone days ago. The days can only get longer. Thank God. After my bout with seasonal affective disorder a few years back, I always dread November and December. It's the worst.

Seasonal affective disorder is a funny thing, because I always think that I'll do okay, but it's very much hit or miss whether the lack of sunlight will make me feel miserable, or whether I'll be fine.

A few years back, I had it bad. I was clinically depressed, and all of the sorrows and tortured issues of my life came flooding back to me, and I wanted to die. I just wanted everything to be over. I wanted to lose all the pain and heartache and self-pity. And one domino kept knocking down another. A girl rejected me. A friend abandoned me. A test was nearly too hard for me. And things just got worse and worse and worse, till I very sternly questioned what it was that made me get out of bed and bother to be alive.

And looking back on it now, it's strange to think that I was that depressed, because the things that bothered me back then, nothing's really changed now. Just a little perspective I guess. If I don't post before then, Merry Christmas.

All the king's horses

I admitted someone to the unit that when I saw her, she was alert and conversive and doing quite well other than the fact that her body was starving for oxygen. So, quite naturally, we intubated. Turns out she had sepsis. So, full court press. I poured fluids in this lady, threw pressor after pressor after pressor at her. I used everything in my arsenal to treat her. But the best pressure I got was 60's systolic, and on the vent with 100% FiO2, I had pO2's of 60 (these numbers are horrible, for you non-medical folks).

I had to talk to the relatives, try to tell them why this lady who is, undoubtedly, the strongest person they've ever known, why she is now as meek as a kitten, hanging on to life by cobwebs. I do the talk well, and that's the only thing I like about critical care. I do the talk surprisingly well, and people listen to me. But here's the deal, this skill is only valuable when I've already failed.

We weaned off pressors, and she expired. I went home in the morning, and I just wanted to throw up. I couldn't even get this lady 24 hours. I talked with my attending, and there were a few things we could've done, but in the end, it's just second guessing. It may have been that all the medicine from all the best doctors couldn't have made a difference.

I may not be a Republican, but I'm no Democrat

I've been hearing quite a lot of buzz about the NYC transit strike, which has really caught my interest, because after all I lived in NYC. And normally, I'm sympathetic to unions, but I gotta say, these guys blow my mind.

They get paid more than I do (and let's compare, I owe $130,000 for the privilege), they work less hours than I do, they have full health benefits, and a pension, and they get to retire at 55. If I retire at 55, it'll be thanks to several shady business ventures, or the lotto. And in this day and age, let's be honest, pensions are a pipe dream.

It's illegal for them to strike, by law. What an unfair law, you might say, but consider this: a lot of people in NYC live by the subways. When I lived in NYC, I had to take the train to school. Far more people use public transit to work at jobs that earn far less than what the transit workers are making. And even if the folks in NYC got to work, they depend on other New Yorkers to buy their sodas or newspapers or hot dogs or whatever.

This strike is actually threatening the livelihood of millions of New Yorkers who live paycheck to paycheck. And that's the thing that pisses me off the most. Strikes are supposed to be about standing up for the working poor. Instead, this strike is all about punishing them. I have no sympathy for the striking workers. In order to cling to unrealistic outdated labor practices, they've put people's lives at risk.

Fuck you, ActiveSync

To anyone contemplating buying a handheld, let me tell you, do NOT get a PocketPC product. Do yourself a favor and get a Palm OS product. I have had my battered Palm for the better part of 4 years and it's weathered a world of abuse in my pocket, and despie 2 new computers and 3 computer OS upgrades, it's still plugging along.

However, in the 2 years I've had my PocketPC device, it has now THREE TIMES decided on a whim to stop synchronizing with my computer, for no discernable reason, and I have now wasted 4 hours of my life trying to fix it, to no avail, and I give up. I will never use the blasted thing again. It has now been relegated to the status of paper weight.

Trust me when I tell you that PocketPC is shit and do not waste your money on it. I thank God that my educational account paid for this heap of shit and I didn't have to lay out any cash for it.

Not so happy holidays

Lately, the Religious Right has gone absolutely apeshit over the de-Christmasification of Christmas, and the use of Happy Holidays and Season's Greetings. For me, it's part of the reason why I don't consider myself Republican any longer.

I had a problem with the lack of Christmas in Christmas starting several years ago. The first year I did a lot of Christmas cards, it was either super religious cards, or else cards so secular that if not for the snowflakes, you wouldn't know they were Christmas cards at all.

But let's be honest with ourselves here. There wasn't much Christmas in Christmas to begin with. Christmas trees? Santa Claus? Candy canes and mistletoe? None of it has anything to do with the birth of Jesus. For the majority of the world, Christian or not, December 25th is a secular holiday first. And I'm at peace with that. I've divested myself of the trappings. I don't have a tree or decorations. I just do my cards and that's it. Sometimes, I get a poinsettia.

I think as long as we have Christmas in our hearts, that's all that matters. And that's why it's always nice to watch the Charlie Brown Christmas special, and hear Linus recite Luke 2:8-14. That's Christmas. And regardless of what other people do or say or write or whatever, in the end, Christmas is a celebration in our souls. God's not gonna freak cuz your card says "Happy Holidays."

Success boot camp

I saw a commercial on TV for Burlington Coat Factory, and it was a bunch of guys in Success Boot Camp, and what's the first lesson they shout out? "Don't lick your knife at a power lunch!" Hah!

People that know me know about my absolutely strange obsession with etiquette. I read Miss Manners all the time, and I've taken an active interest in all levels and rules of etiquette, to the point where I could probably, quite comfortably, function at a white tie event, with royalty and dignitaries. I could be upper crust.

However, people that know me also know that I love to wear shorts and t-shirts, I had a strange thing with flip-flops, and I answer my phone simply "Hey."

I can't help myself sometimes. I was raised this strange mix of white collar and blue collar. I went to private schools for the rich and elite of the world, the children of the people who make the world go round, but went home to a single parent mom who worked as a nurse and had multiple Spam recipes.

It's nice to know that at the drop of a hat, I could be in that world of formality and grace, and I'll admit that I look a little disdainfully on knife lickers, but I really am pretty blue collar at heart. I mean, I'm going into internal medicine. That's proof in the pudding.

Danish Butter Cookies

So, I decided to get some Danish butter cookies and candy canes for the nurses in the clinic and on some of my more loved floors of the hospital. Danish butter cookies are a bit of a family tradition. My mom would buy them every year around Christmas, and we all had our favorite shapes. I personally swear by the pretzel shape.

Anyway, we'd go to the store, or sometimes we'd go to Macy's and get them. And it came in a metal tin and we'd carefully eat one or two, trying to savor the enjoyment.

And so, I went shopping on Sunday practically everywhere. I went to 3 supermarkets, 2 specialty food stores, and finally, I found myself at Wal-Mart, the most evil store in America. Wal-Mart has single-handedly destroyed small business, got all of America buying everything in excess, and doing their best to ruin everything wonderful about this country.

And of course, Wal-Mart had the cookies, for $2 a tin. They're cheap quality, disappointing, and another precious memory from childhood ruined. Thanks for nothing, Wal-Mart. Of course, I bought 4 tins.

Breakfast memories

I was remembering this morning something very random. I was eating breakfast at a restaurant as the snow came down in torrents, and I remembered eating breakfast in Mexico. I was sitting out on the veranda with a friend, having a pleasant conversation over a simple breakfast and hot coffee, soaking in the beautiful weather, 70's and sunny, with tropical birds flying overhead. It was a beautiful morning, an excellent meal, pleasant company, and it's a precious slice of my life. It's one of my very fond memories of late.

And it makes eating bad scrambled eggs in a crappy restaurant, alone, in the middle of the Midwest, in a freak snowstorm, seem pretty shitty.

The last Christmas card push

Rather than take anyone off the list (oh, alright, I did take one person off the list), I've added 4 more. I'm nuts. So, I've got 4 more cards to write now. Yikes. I'm going to try to churn through them in the next few days. At least the bulk of the cards went out now, and the only ones I have left really are cards in desperate need of addresses, and some cards I've just been lazy about mailing. What kind of an excuse is that? A bad one.

It feels good to get back into the Christmas card spirit, and I'll admit, this year's not a personal best. I've only done around 40 some cards this year, whereas in years past I've gotten as high as 60. But I feel good about it. There's a certain... pleasure in dropping a big stack of cards into the mail.

The magic "Asians call tell each other apart" skill

I know nothing about the book or movie "Memoirs of a Geisha" other than the commercials I saw on TV, but I was a little curious when I saw the commercial, because everyone's Chinese. I dismissed it in my mind. Maybe the book's set in China or maybe this is about a Chinese girl in Japan. Who knows.

Well, of course, it's not. It's about Japanese people, in Japan, played by a cast of Chinese superstars. Now, maybe for white bread America who doesn't know Thailand from Taiwan this isn't a problem. But for me, I didn't even have to look at the screen to lose the feeling of Japan.

Their accents, so Chinese it's unmistakable. Their faces and even mannerisms from the 30 second spot, so very Chinese. It's too much. It's like watching Japanese animation dubbed into English. It has a certain lack of authenticity that is palpable. It's like a bulb that flickers in a movie theatre, never letting you forget that it's a movie.

Chinese is not Japanese, even if you dress Chinese in a kimono. Let me tell you, for the most part, it's relatively easy for Asians to tell each other apart.

Maybe I'll see the movie, but I'm not in a rush. It's hard to get excited about something that reminds you through the whole movie that it is fake.

The final 10 cards

I'm down to the last ten people on my Christmas card list. For some people, there's a system to doing cards. Some people save the best for last, and I've gotten touching cards from some friends about how I was their last card because they wanted to save me for the end. That's sweet. I have no such system.

A couple are family, and I usually save them till the end because they won't mind as much if they don't get a card. They know I love them, and don't need a card and a cheap sentiment (not so cheap this year with the amount I've spent at Hallmark) to validate our relationship. A few are really good friends, and I just haven't found the right words yet this year. And the last few are the tough ones.

The last few are people that I haven't been in touch with much at all. They're folks that have more or less evaporated from my existence, and it's hard to find the words to say, when more and more they're letters on a page rather than people I care for.

And it's a battle every year to decide whether I should just fill out the cards and be done with it, or whether it's time to take them off the list. And that's a hard call, because it's a lot to say that a person means so little to you that you can't spend the time to write even the most trite of sentiments on a piece of paper.

So it's going to be a tough week churning out the rest of the cards, and there's some value in this kind of catharsis, because in the end, Christmas cards to me are more than a chore. And I hate to think that for some of these cards, it's become just that.

Doctor's hours

I like to hang out with my friends as much as I can, but I've come to the realization that there is no schedule quite so hard to coordinate as trying to get a resident's schedule to conform to the working week of the rest of the world. The rest of the world doesn't work random nights or have to work 30 hour shifts. The rest of the world thinks a 50 hour work week is shit, whereas in medicine, we practically jumped for joy at the thought of only 80 hours a week.

I'm quickly realizing that the reason why so many doctor marriages fail is that the medical world just doesn't exist on the same temporal plane as the rest of the world. We don't have the time.

This has significantly dimmed my hopes for romance outside the hospital.