Crossed out

My attending likes to cross out things. He does so quite liberally. "This isn't right. There's a 3/6 holosystolic murmur at the apex." And then he'll line out the finding and rewrite it. The same goes for plans. "No, we're going to give vanco. He's from a nursing home and needs MRSA coverage." Line out.

I quite literally measure the quality of my notes by the number of times he crosses something out. He sees my notes nowadays as writes his little agree with above thing, and I feel good. It was a good note. Then I see the intern's note, and there are so many line outs that my attending's written his own note.

Just goes to show you something that I've loved about medicine. You can be the most knowledgeable person around, but it's meaningless if you don't have the skills of being a doctor.

Medical students that work with me know that everything I teach will never be on their tests, but they always have a good time, because I don't teach them how to pass a test. I teach them how to be doctors.

Fancy pens

Montblanc 146, uploaded by Wil Lau.

I don't take drug rep pens. I try to minimize my free items from drug reps, because I don't want my patients to think that I support a drug or therapy because they gave me free stuff.

So I use my own pens, and lately, I've been breaking out my fancy pens. And when I say fancy, I don't mean that they're nice. I mean fancy. I mean Cross and Mont Blanc and Waterman. I mean pens that cost $70, come in a fancy box, and have refills worth 20 lesser pens. In my pocket, at any given time, I'm carrying $100 in writing utinsels.

And as if that wasn't bad enough, I bought a new Waterman pen, ballpoint, retails $50. A little spur of the moment, but I've gotten in trouble only having 2 pens in my pocket. And most people don't notice. I mean, a pen's a pen.

But when you write for a living, and as an internist that's pretty much what I do, it's nice to do it with a little class. I used to think I was nuts to buy and use these fancy pens, but every now and then, I'll meet up with an attending, and the guy drives a beat up 10 year old Honda Civic hatchback, but he's got a Mont Blanc in his pocket. And that's when I know that I'm not the only one.

My junior is an idiot

My intern, he's an idiot. I mean, I've tried to be sympathetic and tell myself (on an almost hourly basis) that he's just starting, it's only October, but every day, he finds some way to amaze me with his tremendous stupidity. And I don't mean that in a jovial manner. I mean stupid, like when I found one of his charts, I was so angry that the nurses brought me coffee and tried to calm me down.

And the problem is that his deficits are not the deficits one should have as an intern. An intern should not know what to do or which antibiotic. He doesn't know what meds the patients are on. He doesn't know the labs. He's missed stuff like a hemoglobin of 7, a creatinine of 3.

He'll tell me that something was done yesterday, but it wasn't done. It wasn't even ordered. Or that a consultant recommended a medication, but the consultant made no mention of it. Essentially the problem is this: he cannot be trusted to report accurate information.

This would be fine, if he was a medical student. Then, I would see the patients and write my note and that would be the end of it. The problem is that you cannot manage a patient when you don't know the patient. Every day on rounds, I have to tell him something about his own patients.

And today, I couldn't believe it. One patient was off Lantus for 2 weeks. It was lost in an ICU transfer. But for 2 weeks, he's been telling me that he's taking care of her blood sugars, but he's done nothing. Worse than nothing in fact, because we've taken steps backwards. And it's my own fault for trusting him. I should've checked the accuchecks. I should've monitored the doses, but I just believed him. I had sicker patients to worry about.

Frankly, I'm ashamed. We've had multiple consultants on the case, and they must think we're morons. Internists that can't manage diabetes. I sent him home today and wrote all the orders to fix it.

Man in the moon

I spent a good twenty minutes staring at the moon tonight, and for the life of me, I can't see the rabbits.

In Korean myth, there are 2 rabbits on the moon making rice cakes.

And so it begins

I got my personalized Christmas cards in the mail yesterday. I ordered online from Hallmark. I wanted to get started early this year, as I'm planning on sending out at least 50 cards. In the last few years, I've been sending out 40 to 60 cards a year, and this year, I'm sending out professional contacts as well, so I'm thinking I'll likely be in the 70 to 90 range.

I love Christmas cards. It's nice to get them, but I like sending them, because I have a lot of friends out there, people that I've long since lost touch with. It's kind of sad really that I know so many people and it's been so long since I've talked to most of them.

And so I send people Christmas cards, kind of as a reminder that I still think about them and as a reminder to me about what people mean to me. Because I'm a pretty solitary guy. I went an entire month without one personal call on my cell phone. And every now and then, I need to remind myself that there are people out there that care for me, and people I care for.