No, I'm not a doctor

I don't like telling people that I'm a doctor. It's not because I'm humble or bashful. It's because I can't stand the questions! The first thing that people do when they find out I'm a doctor is to pester me with medical questions:

Can you feel something wrong in my knee?

Why did they use two different stitches?

I have this lump in my arm. What is it?

Stop, stop, stop, stop, STOP WITH THE MOTHERFUCKING QUESTIONS!! I don't want to answer your damn questions It's cancer, okay? Fever? Cancer. Sweating? Cancer. Leg pain? Cancer. The answer now is always cancer.

The worst was a stripper that had me do a joint exam. WTF.

Some of you may think, well, I went into medicine so people would seek my opinion. However, what you need to understand about free medical advice is that you get what you pay for. Without knowing anything about someone's medical history or doing a thorough H+P, I can't really give a decent opinion.

So stop asking me so many questions, unless you're in my clinic. Then ask away.

Ego dystonic

Part of what I love about internal medicine is tragedy. I've come to realize that I love flaws, injuries, cracks, holes in armor. It's like how everyone has a favorite Star Wars movie. Mine is The Empire Strikes Back. The movie ends with Luke's hand severed, Han Solo frozen in carbonite, and the Rebel Alliance fighting to stay alive. Everything is wrong; I like wrong.

And it's not that I want to fix things. I just want to know the tragedy of it all. I don't get any particular thrill fixing someone's blood pressure. I don't pat myself on the back over a glycohemoglobin of <7. I have a patient who's smart and attractive and in their 50's, and single. Whenever I see this patient, I think to myself, aren't you lonely? Isn't your life empty? What meaning do you find in life? I want to see their pain, their hurt.

I read the book Man's Search for Meaning recently, and in it he poses the scenario: if there was an ape being used to develop polio serum, and it is punctured again and again. It cannot comprehend the meaning of its suffering, but undeniably we can see a purpose to his pain.

"Is it not conceivable that there is still another dimension, a world beyond man's world; a world in which the question of an ultimate meaning of human suffering would find an answer?"

So sometimes I truly enjoy seeing the suffering of others, and not for some cheap masochism, but because it is in suffering that people often reveal their raison d'être, their will to exist. Because anyone can tolerate good times, but it is the pain and injustice that one is willing to tolerate that defines purpose.

Clinical acumen

The most common admission that we see on general medicine is chest pain, and at this point, I'm about 90% accurate on my calls. It's that 10% that presents so much trouble. And that's why I order enzymes even when I think I know. Because I'm just not sure.

It makes me think about those Pepcid Complete commercials where they show these 50-60 yr old folks with 'heartburn' and I'm thinking, "Umm... couldn't that be an MI?"

I'd like to think that I have that treasured 'clinical acumen' of an attending, where you can stare at a patient and walk away with some sort of quasi-impression of how sick someone really is.

The problem with this is that in order to develop this acumen, you've got to kill a lot of people. A lot. Because how do you know that someone's going to die if you don't kill a few people so you know what someone who's dying looks like? Seriously!

That's why residency is so nice sometimes. Every now and then when I kill a patient, it makes me think, and I try to put my finger on what I did wrong. Because I've done a lot of things wrong, and when I go home, at least I can tell myself that I'm working on developing my clinical acumen.

Working with nurses

There are a few nurses that I really enjoy working with. Most of the nurses in the hospital are okay, but there are 3 or 4 that are just a pleasure.

Blondie is a funny nurse. I always seem to see her around the hospital completely randomly, and she's always cheery and pleasant, and never fails to give me as much attitude as possible. But it's okay, because she's way hot.

Then there's Sarcasm, the best nurse ever to work with. She just drips sarcasm and biting cynicism. I was sitting at the nurses station, and I hear from one of the rooms, "Hey you! Ifinding! Get over here!"

I ran into the room expecting to find a patient coding but it was just Sarcasm, taking care of a comatose patient. "Your intern told me that I'm bossy! Can you believe that? WTF?"

But my favorite nurse is Done. Done is like having another intern. "Hey, Done, this patient is having diarrhea-"

"I'll get it done." Then I come back a few hours later to a chart full of orders that I supposedly gave, and Done is sitting reading the newspaper. "It's done."