The challenges of firewalls

So, I'm editing the format of this blog, trying to get it simplified and back to the sort of ease of use that I had with my old blog. Ah, I really miss the ease of my lovely manual blog. Technology comes with its troubles.

Worthy of note is the intense hardship of trying to edit this thing from behind the hospital firewall. I'm on call, and that makes trying to edit this thing a pain in the ass. I'm proxied and everything, but Firefox is giving me trouble with the main blogger page, for who knows why.

Anyway, I'm still getting the hang of this, and it's kind of fun, so far at least. Maybe this is the future? Now I need to figure out how I can change the settings for the archives...

Archives

An editorial note: 8/29/09

For those of you who may be wondering, in January of 2005, I transitioned from a manually edited blog to Blogger. It was a rough transition, but allowed me to be more prolific. That being said, it also meant that I had two websites: my blog here and my previous blog. And that was fine until I decided to take down my other website in 2008, leaving only my blogger account.

I am currently going through several years of entries (1999-2004) and trying to put up some selected posts that are worth reading, and edit out the ones that reveal entirely too much about myself and have to be censored. But that process is slow and painful, and I'm not even done with 2004 yet. It doesn't help that I was terribly prolific back then.

So if you're looking for older entries, check back periodically.

The lessons of 6th grade dance class

When I was in 6th grade, my mom sent me to take ballroom dancing classes. This was the height of social awkwardness. We learned a bunch of things, and one dance was of course the waltz. After learning box steps and twirls, it finally came time for dips. This was, for the most part, a splendid failure. It's asking a lot of a 12 year old boy to dip some poor girl who (thanks to earlier onset of puberty) likely outweighs him, and it's asking a lot of some poor girl to let herself be dipped. There were no casualties, thankfully. Just some bruised egos.

And part of when you see two good dancers is the realization that they can do these things with ease and grace, and part of that is the relationship between them: they trust each other. If they didn't, it wouldn't work. It'd be like dance class for 12 year olds.

And that was when I realized that part of the beauty of dancing is that trust. It's the flow between two people who know each other's movements, each other's thoughts. And that's what makes dancing beautiful. And that's true for life too. You have to trust people, and the most beautiful things in life come only with trust.

And I guess that's the take home lesson. You can't be a part of something beautiful without first putting your faith in someone else. You can't accomplish much of anything without trusting in someone.

I did manage one successful dip, and it should go without saying that to this day, I have a near photographic recall of the event, down to her forest green dress, plain satin white gloves, and braces.

Doctors and doormen

There's a certain je ne sais quoi of a good doctor. You know, ask a hundred people about doctors, and they'll tell you a hundred different qualities, but there's something that everyone wants out of a doctor, and it's stuff that keeps people coming back for more. And really, I'd like to think that's all I've got going for me.

I went into a residency interview and I flat out said, "I'm not the smartest candidate you'll interview, not by a longshot. I'm not the sharpest or the most qualified, but I'll be just as good a doctor if not better because if all you were looking for were the smartest and the sharpest, you wouldn't be interviewing me right now." There's truth to that. I think about my med school class, and I know who I think the exceptional ones are, and they weren't the smartest. They were the ones that patients love, because medicine is more about relating to people than treating disease.

I was telling a friend of mine a truth to medicine. Even an incompetent doctor can be loved by his patients if he's willing to stand up and fight for them. And I'm living proof. I have patients all the time in the hospital, and my pitch to them to follow up with me in clinic is about as negative as possible. I'm a first year. I'm in training. There are better, more qualified doctors that abound. They're under no obligation to establish care with me. But still, I've had patients that turned down my attendings to follow with me. I'm not incompetent. I think really it's just that people want to know that their doctor is someone that cares about them. I don't talk down. I talk with.

The reason I like medicine, the reason why I wake up every morning and go to the hospital is because I like working with people. I like helping people out. I like talking to people and getting to know their problems and how I can help. Diseases, treatments, procedures, it's all a means to an end. If there were no patients to care for, I'd rather be a doorman. This is in complete opposition to one or two friends I have that don't want to care for patients at all. And I'll admit, I don't get it. If you don't want to take care of patients, why bother?

To me, being a doorman has the same luxuries and benefits of medicine. It's all about knowing someone who at the end of the day is looking out for you.

Do you really want to be a doctor?

It takes a certain level of masochism to go into medicine. Something in your mind has to actually say that yes, I do think that getting the shit beat out of me on a regular basis sounds like a way to spend my life. Never in all my life have a felt stupider than when I'm taking care of patients. What's the patient's UA show? How do you explain this uric acid level? What are we doing for her renal failure? What medications do we have him on for blood pressure? What has her white count been doing for the past week?

I think that the great advantage attendings have over us lowly interns is that they can cherry pick. They can take aim at us from high above and we really have no recourse. It's wholly their right, since they take the heat if shit starts flying, but it certainly doesn't do much for the ego when your attending shoots a string of questions at you and the only one you can answer is that yes, she has been afebrile for the past 24 hours.

But it balances in ways. My senior has a habit of saying that I did a good job with this or that, and it's unbelievable, absolutely unbelievable how much I appreciate that. It's nice to have someone say, hey, good job, I think that's the right thing to do. One of my seniors questioned an order I wrote. I told him that the on call senior told me to do it and he laughed. He said to me that he knew it wasn't me. I was too smart to do something that dumb. I'm glad that others have such confidence in me, and I'm starting to think that I need to have some confidence in myself as well.

I'd love to talk to pre-meds in college. I'd love to tell them that this glorious career of medicine, it's not what they think. It's work, tough work. It's as blue collar as you can get for six figure salary. It's not noble. It's not honorable. It's work. And if that's your flavor then more power to you, but if I wanted to get some respect, I think that there are better ways.

I think the one beautiful thing about medicine is that despite what other people do to you, no matter how much the system beats you up and down, you can feel good about yourself if you can go home and say that you helped someone. You know, it's not often that you can go home, sip a beer, eat a pizza, and think to yourself that you made the last few hours of someone's life as pleasant and pain-free as medically possible.

A patient looked at me today and asked me what I would do in her shoes. I didn't have an answer. She wanted one but I didn't have one. What would I do? I dunno. Would I fight? Would I give up? I don't know. And sometimes, just knowing that this decision that she's been fighting with is a tough one, that's comforting to know. And so I can go home and sip on a beer and think that in spite of how lousy today was, I did okay.