Rules for interns

Reading through LVT's recent intern experiences, I realized that there are some basic rules for interns that everyone should know once they start. So, before you start on July 1, here's some basic house rules:


(2) Become very familiar with IV and IM haldol. Your new best friend.

(3) If the nurse is freaking out, came down. All is right with the world. Would you freak out if the fire alarm goes off? No. Be glad that the system works.

(4) If the nurse is calm, be very very worried, because now you must ask yourself the following question: why is she paging me at 3AM if it's not a problem?

(5) House of God is required reading.

(6) The proper way to determine if your fellow interns are sane: ask them if they've read House of God. If they've read the book and do not immediately quote a law from the book, I would seriously question their sanity.

(7) If you have a competent senior resident, and he tells you to do something, YOU DO IT. I don't care how insane it seems.

(8) You can determine if your senior is competent using the same intern sanity test (rule #6).

(9) If you need to practice intubations or need a case for M&M conference, then ativan is your friend. If you like your patients alive, be careful with your ativan use.

(10) The greatest crime you can commit is not asking how to do something. That's fine. The greatest crime is asking how to do something twice. If you do this, your senior may freely hit you several times.

That's a pretty good start.

A new clutch

It's almost July, and the interns are pretty much independent now. They are, for the most part, ready to be seniors. It's strange to see these guys that one year ago could barely keep healthy people alive. I'm not really proud. They did most of the work themselves, but it's still nice to see them ready to take on the world as senior residents.

And it's more than a little scary that I'll have another July full of new interns, and more nightmares of trying to keep my patients alive despite my interns. It's more than a little ulcer provoking, and hopefully I'll have attendings that are understanding.

There's a starling that's nested in the tree outside my bedroom window, and every morning this Spring, I'd wake up hearing the chirping and peeping of the little chicks in its nest. And then a few weeks back, the chirping stopped. The chicks were all grown up and left the nest.

And then last week, new chirping. There was a new brood of chicks. And all I could think was, "Hey starling, I know how you feel."


I wish at times that I had the drive to be a superstar. I know that all my attendings think I'm good. I've already been offered jobs by some docs in the area. It's all extremely flattering. But I know that if I had more ambition, I could've willed myself into any field I wanted. GI? Card? I could do it, if I put myself to work.

My life, at its core, is a life lived on minimal effort. And I know why. I only put forth minimal effort because I save it up. There have been times in my life when breathing was something I had to force myself to do. And there are times when all the effort in the world was needed just to get out of bed.

So I never put the pedal to the floor anymore, just in case I need a little extra gas for a tough spot. And maybe that's timid of me, but I don't know how many times I can get roughed up without keeping something in the tank.


Recently, a reader posted a comment about my discouraging 'Don't become a doctor' series. And certainly, people are entitled to their opinions, and to some extent, I agree: there's no goal more rife with naysayers than pre-med.

But it reminded me of a story that a friend of mine Ghetto told me. Ghetto's dad was in a special forces unit during Vietnam. Ghetto was a smart guy, and looking for a way to get into college. The Montgomery GI bill seemed like a smart choice. Remember that I was in college after the first gulf war, and joining the military didn't seem like such a bad idea.

Rather than being proud of his son for considering a military career, Ghetto's dad was mortified. "Are you prepared to kill people, people whose only crime is living on a piece of land? Are you prepared to shoot and stab people because someone else told you to? Do you think you can murder women and children?"

Ghetto decided against enlisting. He went the old-fashioned route of climbing into educational debt. But it all ended happy.

The reason why I tell this story is that it speaks to my purpose. Those loaded questions that Ghetto's dad asked got to the heart of the matter pretty quickly. Ghetto did not have his heart in military service. It wasn't something that he wanted to do, and so when confronted, his resolve disappeared. Nothing against Ghetto. It just wasn't something that he wanted at the time. It was just a means to an end.

And I remember being a pre-med, and I remember talking to other pre-meds. So let's get rid of everyone for whom medicine is a means to an end. Let's take everyone who's looking to make tons of money, everyone who wants to work 9 to 5, everyone who only wants the prestige or some imaginary comfortable lifestyle, let's get rid of those folks first.

The ones that are left, let's show them that this job is tough, with a lot of pressures and demands. Because if their response is, "Oh, well that sounds sucky. I'll pass," then they'd have never made it through med school anyway.

One of my doctors put it quite well. I was getting my physical before starting med school, and he congratulated me on getting in.

"Everyone tells me it's really hard," I said tentatively.

"Oh, well, it's not so hard. If you love it, it's almost easy," he replied with a smile.

My politics

All this talk about immigration and a gay marriage ban amendment pisses me off, because it's so obviously a red herring, so obviously playing into the fears of people and the hot buttons of the ultra-religious. And let's be clear, the issue of illegal immigration has nothing to do with national security. If it was about terrorism, we should turn our attention to the Canadian border instead.

And it got me thinking about the Republican Party. I don't like writing about politics, because I'm not going to convince any of you to change your mind. No one ever changes their mind about politics or religion by arguing. But let me tell you about where I'm coming from at least.

My dad was surprised, shocked in fact, that I'm conservative. Even though he reads the New York Times every day, my dad is conservative. He couldn't believe that his college educated 20 something year old son was already jaded to the world and voting Republican. My mom takes it another step and is a card carrying Republican. She called me in 2004 to remind me to vote for Bush.

My parents are, in that way, typical for Asian immigrants. Most Asian immigrants of my parents' generation came to this country thinking that they could come here, get an education that was unavailable to them or job opportunities that were nonexistent. They love the Republican Party, because they cannot imagine working so hard, scratching out a living, putting two kids through college without a drop of debt, and supporting a bunch of people on handouts? Medicaid? Disability? It's utterly egregious.

Growing up with such influences, I had a strong Republican bias as well. It fit with my conception of government: minimalism, laissez-faire, etc. And when I was coming up in my political awareness, I leaned conservative. And I still do, but read that conservative, not Republican.

Because at the same time, I grew up very Catholic, and very aware that there is much in this world that is wrong that requires us to work very hard to change. There are people starving, people suffering, people requiring social change and justice.

And so, by college, I realized that I am what can be tritely called a centrist. I am one of those socially liberal but fiscally conservative voters, realizing quite acutely that the two party system no longer is able to describe my political ideology.

And until recently, that political view has led me to vote mostly Republican, because if there's one thing that this country needs, it's fiscal responsibility. And only recently did I realize how utterly misguided my voting has been. Because these nuts have been throwing away money like it's going out of style.

And I can't help but feel utterly detached from the entire political system, forced to choose between a party run by rabid fundamentalists who are wasting money and actually building bigger and more government, or a party that is rudderless and without vision or direction.

No cause for alarm

It was 12 hours before I had a meal. And that may not sound too alarming, but think of it this way: if you woke up at 6AM and then didn't eat until 6PM, that'd be a little weird, right? I did have a bowl of cereal, a handful of Doritos, and a rice crispies treat, in addition to some McDonald's. The way I add it all up, I've had about 1500 kcal today.

I'm getting kind of worried. I'm a big fatass. I normally eat 2500+ kcal. I literally could eat another whole meal. Why aren't I eating more? Normally, this is behavior that I've had when I'm depressed, but I'm not depressed! I feel pretty good!

Maybe this is my body finally saying that I eat too much.

Maslow's hierarchy is optional

Lately, I've taken a view that meals have become optional. I have grown fat, and could stand to cut back on the calories a little. I ate a handful of Doritos for dinner, and yesterday I didn't eat dinner at all.

Normally I'd be a little worried. After all, the last time that I took an optional view towards eating, I was acutely depressed and lost 10 lbs in a week because I was barely eating 1000 kcal a day. That was bad news, but I'm not depressed now. I feel pretty okay.

And I'm hungry too. I just don't have the enthusiasm for eating right now. I just don't feel very inspired. It seems like too much work, when I'd rather be sitting around watching baseball (I watched 3 baseball games on TV today...).

I did go to church today, for the first time since Easter. I've been on call or post-call every Sunday since Easter, so it's my first chance. It felt strange being back in church. It didn't feel very fulfilling, but part of the nice thing about being Catholic is that it's okay sometimes to show up just to fill a seat.

Maybe I am in a funk? I don't feel like it. I feel okay. Is this denial?

Back in the day

Sometimes, I marvel at the history of medicine. It's amazing to think that 50 years ago, antibiotics were new to the world. Only 30 years ago, coronary angioplasty was a revolutionary procedure. It's strange to think that only 20 years ago, the thought of using beta blockers in heart failure was an absolute contraindication.

It's one of the things I love about medicine. Things change, and things that we take for granted were only just discovered, and that in the history of the world, modern medicine is barely older than the personal computer.

But I have to admit, if I had to choose, I think the best time to be a doctor would've been the late 1800's and the turn of that century. I can think of no more seminal moment in the history of medicine than when Lister said: Hey, maybe we should clean these tools off?

I love the history of science, and it's drawn me to Neal Stephenson's Baroque Cycle. Because Boyle, Newton, Leibniz, Hooke, these gentlemen are known to me. And my accomplishments in life are along a road paved by men such as these.