Wednesday, December 31, 2008
no. 9: panic! at the ED.
it's snowing again. and it's new years's eve. this means snowblowers and alcohol. this means more amputated fingers. also, i recently read that new year's is the most deadly day of the year for pedestrians--about 500 people will be struck and killed within this 24 hour period. this may not seem like a lot (it's not really, considering that about 250,000 people die each day), but this rate is nearly 10 times greater than other days. yikes.
speaking of unlikely ways to meet one's end...i conversed with a man last night who had a trip planned to isreal in a week. he confessed that with the current clash in gaza, he was worried about the threat of a terrorist attack on his plane. he asked me if i worried about such things and i responded in the negative. he asked why this was the case and i answered that the probability was so low as to be something that i could accept. how low? i did some loose estimating: how many people travel by air in a given year? i went with an easy to work with figure of 30 million, thought i suspect the true number to be much greater. how many people die from terrorist-related activities on aeroplanes each year? not very many. even in 2001, a far deadlier-than-average year, maybe 300 people? i'm not counting those on the ground, since my friend was worried about air disasters. 300 out of 30 million is 1 in 100,000. in a "regular year" how many die? 10? 20? 30? even 30 per year would be a 1 in 1 million chance of dying. since that is far more representative a number, i took that as the chance of this chap being the victim of air terror.
1 in a million is a pretty slim chance, i told him. he still seemed worried. to try to assuage his fears i quoted some other numbers that i had in my head, as i just read some year-end EM-related data, from which the opening stat was gleaned. chance of drowing: 1 in 20k. shark attack: 1 in 6 million. bike accident: 1 in 70k. choking: 1 in 80k. car accident: 1 in 5k! i told him he was actually safer once he got to the airport, onto the plane, than in the car en route (even worse if he was eating and driving!). he still wasn't convinced.
i thought for a while and come up with the following solution to reduce his probability of death: if the chances of there being a bomb-toting terrorist on his plane were 1 in 1,000,000, the chances of there being two shoe bombs would be obscenely small (using the multiplication principle of probability, the chances of 2 independent events occurring is the product of their individual probabilities: (1/1,000,000 x 1/1,000,000); that is a tiny number.).so all he had to do was hatch a plan to bring down his plane--say, putting some TNT inside his prosthetic leg (did i mention he had one? well, he did)--and put it into action. once he did that, the probability of their being 2 bombs on his plane would be 1x10^-12. as in, 0.00000000001 percent chance, or 1 in 10 billion! as long as he didn't detonate his leg-bomb, his trip would proceed death-free.
yeah, that's right, i told a one legged man to put a bomb in his prosthetic. i have to go now, homeland security is at my door.
speaking of unlikely ways to meet one's end...i conversed with a man last night who had a trip planned to isreal in a week. he confessed that with the current clash in gaza, he was worried about the threat of a terrorist attack on his plane. he asked me if i worried about such things and i responded in the negative. he asked why this was the case and i answered that the probability was so low as to be something that i could accept. how low? i did some loose estimating: how many people travel by air in a given year? i went with an easy to work with figure of 30 million, thought i suspect the true number to be much greater. how many people die from terrorist-related activities on aeroplanes each year? not very many. even in 2001, a far deadlier-than-average year, maybe 300 people? i'm not counting those on the ground, since my friend was worried about air disasters. 300 out of 30 million is 1 in 100,000. in a "regular year" how many die? 10? 20? 30? even 30 per year would be a 1 in 1 million chance of dying. since that is far more representative a number, i took that as the chance of this chap being the victim of air terror.
1 in a million is a pretty slim chance, i told him. he still seemed worried. to try to assuage his fears i quoted some other numbers that i had in my head, as i just read some year-end EM-related data, from which the opening stat was gleaned. chance of drowing: 1 in 20k. shark attack: 1 in 6 million. bike accident: 1 in 70k. choking: 1 in 80k. car accident: 1 in 5k! i told him he was actually safer once he got to the airport, onto the plane, than in the car en route (even worse if he was eating and driving!). he still wasn't convinced.
i thought for a while and come up with the following solution to reduce his probability of death: if the chances of there being a bomb-toting terrorist on his plane were 1 in 1,000,000, the chances of there being two shoe bombs would be obscenely small (using the multiplication principle of probability, the chances of 2 independent events occurring is the product of their individual probabilities: (1/1,000,000 x 1/1,000,000); that is a tiny number.).so all he had to do was hatch a plan to bring down his plane--say, putting some TNT inside his prosthetic leg (did i mention he had one? well, he did)--and put it into action. once he did that, the probability of their being 2 bombs on his plane would be 1x10^-12. as in, 0.00000000001 percent chance, or 1 in 10 billion! as long as he didn't detonate his leg-bomb, his trip would proceed death-free.
yeah, that's right, i told a one legged man to put a bomb in his prosthetic. i have to go now, homeland security is at my door.
Tuesday, December 30, 2008
it was the best of times, it was the blurst of times.
as 2008 draws to a close i find myself reflecting on the events that occurred in the past 365 days and what is to come in the next. how much can change in a year? obviously, a lot. at this time last year, i was earning $9 an hour answering phones, fixing bikes, organizing a stock room, and boondoggling. now i spend my days getting coughed on, peering into infected vaginas, ordering needless laboratory and imaging studies, sticking my finger into any-and-all rectums, and completing a ceaseless flow of inane paperwork. i miss my old job.
anyhow, the end of the year is a time for lists--of the "best of" and "worst of" variety. what follows are some of my most prized and most reprehensible moments of the last 52 weeks.
magnanimous things i did, witnessed, or took credit for (in no particular order):
1) placing chest tubes is particularly rewarding--i put in 2 in the last few months; one lady subsequently died--not due to my chest tube--but that is immaterial to my enjoyment.
2) i also enjoy draining abcesses; it gives me an enormous feeling of satisfaction. the largest i have seen so far was the size of a healthy grapefruit.
3) diagnosing a very large abdominal aortic aneurysm by ultrasound. yes, someone else probably would have seen it too, but the point is, i saw it first!
4) testing negative for HIV, hep b and hep c after squirting blood into my face and mouth (see #6 below).
5) again testing negative for HIV, hep b, and hep c after sticking myself with a scalpel.
6) i won $300 at a bike race. woo hoo!
7) being able to correctly identify drug-seeking patients in the ED (see #8 below).
8) patient comments can be fairly amusing: a sixty year old man said to me, after 2 female nurses had attempted to put a catheter in his bladder: "that's the most that my penis has been touched in the last 10 years!"
9) my childish antics, my willingness to embaress myself and to be unprofessional are amusing, uplifting, and often enjoyed by my pediatric patients and their families.
10) in spite of the repugnance, on both a mental and physical level, of what i do every day, of the degenerates and troglodytes i am forced to see, of what seems to be an ever-multiplying level of misanthropy inspired by the aforementioned, i occasionally care for someone whose plight is so awful, whose condition is so severe, yet who, in the face of it all, still manages to be pleasant, hopeful, and so free of turpitude that i actually want to help them and feel good about myself when i do.
ignominous actions perpetrated, observed, or of which i claimed to have no knowledge or participatory role:
1) withdrawing care (ie, "pulling the plug") on an aged lady in front of her 25+ family members, including 3 encarcerated sons who were handcuffed to wheelchairs (why wheelchairs? i don't know. presumably, less of a flight risk.) and later pronouncing her dead.
2) gluing my finger to the forehead of a 6 year old while closing a laceration with dermabond (medical superglue).
3) eating a dozen donuts over the course of 8 very stressful hours in the MICU.
4) i used a larger-than-necessary needle to drain an elbow effusion on a man who was a gigantic asshole. in my defense, i did anesthetize him first.
5) there was a horrible incident with a mentally retarded, HIV positive, spanish speaking man and a spinal tap. that is all i will say.
6) i squirted 5cc of blood into my face and mouth after not properly securing the cap on an ABG syringe. this was likely payback for the smugness i felt after successfully attaining the sample, which 3 other people were not able to get.
7) halloween party: liederhosen, free mgd, and chocolate do not mix well.
8) getting duped by drug-seeking ED patients. seriously, it's humiliating.
9) my capacity for empathy has declined: at my current level, i can only care about 1 problem per patient. unfortunately, the average ED patient has 6 complaints.
10) there are times when i insinuate to patients that their complaint did not necessitate a visit to the ED, or that their finger pain for 3 months was not a reason to call 911. but they are probably too stupid to pick-up on it.
anyhow, the end of the year is a time for lists--of the "best of" and "worst of" variety. what follows are some of my most prized and most reprehensible moments of the last 52 weeks.
magnanimous things i did, witnessed, or took credit for (in no particular order):
1) placing chest tubes is particularly rewarding--i put in 2 in the last few months; one lady subsequently died--not due to my chest tube--but that is immaterial to my enjoyment.
2) i also enjoy draining abcesses; it gives me an enormous feeling of satisfaction. the largest i have seen so far was the size of a healthy grapefruit.
3) diagnosing a very large abdominal aortic aneurysm by ultrasound. yes, someone else probably would have seen it too, but the point is, i saw it first!
4) testing negative for HIV, hep b and hep c after squirting blood into my face and mouth (see #6 below).
5) again testing negative for HIV, hep b, and hep c after sticking myself with a scalpel.
6) i won $300 at a bike race. woo hoo!
7) being able to correctly identify drug-seeking patients in the ED (see #8 below).
8) patient comments can be fairly amusing: a sixty year old man said to me, after 2 female nurses had attempted to put a catheter in his bladder: "that's the most that my penis has been touched in the last 10 years!"
9) my childish antics, my willingness to embaress myself and to be unprofessional are amusing, uplifting, and often enjoyed by my pediatric patients and their families.
10) in spite of the repugnance, on both a mental and physical level, of what i do every day, of the degenerates and troglodytes i am forced to see, of what seems to be an ever-multiplying level of misanthropy inspired by the aforementioned, i occasionally care for someone whose plight is so awful, whose condition is so severe, yet who, in the face of it all, still manages to be pleasant, hopeful, and so free of turpitude that i actually want to help them and feel good about myself when i do.
ignominous actions perpetrated, observed, or of which i claimed to have no knowledge or participatory role:
1) withdrawing care (ie, "pulling the plug") on an aged lady in front of her 25+ family members, including 3 encarcerated sons who were handcuffed to wheelchairs (why wheelchairs? i don't know. presumably, less of a flight risk.) and later pronouncing her dead.
2) gluing my finger to the forehead of a 6 year old while closing a laceration with dermabond (medical superglue).
3) eating a dozen donuts over the course of 8 very stressful hours in the MICU.
4) i used a larger-than-necessary needle to drain an elbow effusion on a man who was a gigantic asshole. in my defense, i did anesthetize him first.
5) there was a horrible incident with a mentally retarded, HIV positive, spanish speaking man and a spinal tap. that is all i will say.
6) i squirted 5cc of blood into my face and mouth after not properly securing the cap on an ABG syringe. this was likely payback for the smugness i felt after successfully attaining the sample, which 3 other people were not able to get.
7) halloween party: liederhosen, free mgd, and chocolate do not mix well.
8) getting duped by drug-seeking ED patients. seriously, it's humiliating.
9) my capacity for empathy has declined: at my current level, i can only care about 1 problem per patient. unfortunately, the average ED patient has 6 complaints.
10) there are times when i insinuate to patients that their complaint did not necessitate a visit to the ED, or that their finger pain for 3 months was not a reason to call 911. but they are probably too stupid to pick-up on it.
Sunday, December 28, 2008
no. 7: unexpected.
i cried at work last night. that's right, i shed actual tears. it started with sadness and tears welling up inside me, and i'm sure i had that look of one about to cry--you all know what it is, perhaps a quivering lip, as well as well as glassy eyes with a stream of tears just waiting to fly forth. i got to that level, and then just beyond. i let 3 icy drops fall from my eyes. and i was not able to hide them. i was kneeling when this happened, and when i arose, it was as if a crowd had gather around, and they were all looking right at my giant tears. i'll never live this down.
You see, i had forgotten than the woman to whom i was talking was nearly deaf, so i was essentially screaming, which allowed everyone within 50 feet to hear what i was saying. the woman to whom i was speaking was a cute little 95 year old who had been sent in from an nursing home with complaint of chest pain. she had a host of medical problems, including heart disease, afib, an ICD, diabetes, etc. in addition, she was 95, but she looked good for 95. i initially told her that she would likely be staying in the hospital, and she was not thrilled. she basically told me that she wanted to die. she wasn't happy, she said, "what do i have to live for?" was something she repeated at least 6 times. i explained what the casue of her chest pain could be and what could happen if we didn't know for certain what was going on inside her. i received an emphatic "no" when asked if she wanted to get better. at this point i became evasive, as i often do in this situation--which is fairly common--i told her that we would wait for her lab results and then make a final decision at that point. This given the patient some hope of avoiding an admission and gives them time to think about the pros and cons of coming in. this is taking a bit of a gamble since you don't know what their lab work will show, but there is a good chance that something will be far enough out of whack that i can use that one factor as a reason necessitating admission, and i was sure this lady was no different. after all, she was 95!
but i was wrong. her labs looked great. nothing going on with her heart, kidneys, or liver. my last hope was the urine--sweet, sweet, urine--often so filled biwth bacteria in old folks. but alas, hers was pristine (except for for blood, the result of spending a fair amount of time searching for her urethra with a catheter); not a bacteria in sight!
at this point i thought i had good news for her: she wouldn't have to stay. i passed along the joyous message with a grin on my face; one that was quickly erased by her replies. to distill what she replied down to it's true meaning: i'm 95, i shit myself. almost all of my friends are dead. i live in a place that smells like urine, and the people who work there to take care of us don't care at all what happens. sometimes i don't get to eat for more than a day. sometimes my diaper gets changed only once a day. i don't want to live like this, not anymore. i thought if i stayed in the hospital i'd get sick and they'd pull the plug (her phrase, not mine) and save me from all this. she even asked me to pull the plug. i laughed and told her there was no machine, at least not right then. she told me she had nothing to live for. i responded that i was happy she had come in on that night, since it gave me the opportunity to meet her and make me smile. i got down on my knees next to her bed as i said this, and i continued by telling her that i don't always see the greatest people in the ED at night, that i am often surrounded by the dregs of society, by heinous actions, one after another, on people hurting others, and that that has made me sad, and angry, and hard. but then i got to meet her, and after working christmas eve, chirstmas day, and spending the first christmas of my life away from my family, i felt sad and disconnected from humanity. but in less than 5 minutes of talking to her, i felt restored. it was strange--i actually cared about one of my patients again, i was empathetic. i don't know when that last reared it's ugly head--probably sometime in med school.
as i told her that i wished there was something i could do to help her, the ambulance crew arrived to take her back to her nursing home. as i stood up, i realized there were tears in my eyes, and that everyone from the department was crowded around because they could hear me conducting this conversation at an insane volume. basically everyone saw me--the three other residents working that night, the attending, the nurses, the techs, even the security guards. there goes my street cred. i had to walk away quickly, as she was loaded onto the ambulance stretcher, for i couldn't bear to see her face as they took her away. fortunately, since everyone was still crowded around her, they did not see the copious stream of tears running down my cheeks as i headed for the desolate back hallway of the department to collect myself.
i told her that i wouldn't forget her, so i have committed her story to words, hoping that myself and others will not forget her.
You see, i had forgotten than the woman to whom i was talking was nearly deaf, so i was essentially screaming, which allowed everyone within 50 feet to hear what i was saying. the woman to whom i was speaking was a cute little 95 year old who had been sent in from an nursing home with complaint of chest pain. she had a host of medical problems, including heart disease, afib, an ICD, diabetes, etc. in addition, she was 95, but she looked good for 95. i initially told her that she would likely be staying in the hospital, and she was not thrilled. she basically told me that she wanted to die. she wasn't happy, she said, "what do i have to live for?" was something she repeated at least 6 times. i explained what the casue of her chest pain could be and what could happen if we didn't know for certain what was going on inside her. i received an emphatic "no" when asked if she wanted to get better. at this point i became evasive, as i often do in this situation--which is fairly common--i told her that we would wait for her lab results and then make a final decision at that point. This given the patient some hope of avoiding an admission and gives them time to think about the pros and cons of coming in. this is taking a bit of a gamble since you don't know what their lab work will show, but there is a good chance that something will be far enough out of whack that i can use that one factor as a reason necessitating admission, and i was sure this lady was no different. after all, she was 95!
but i was wrong. her labs looked great. nothing going on with her heart, kidneys, or liver. my last hope was the urine--sweet, sweet, urine--often so filled biwth bacteria in old folks. but alas, hers was pristine (except for for blood, the result of spending a fair amount of time searching for her urethra with a catheter); not a bacteria in sight!
at this point i thought i had good news for her: she wouldn't have to stay. i passed along the joyous message with a grin on my face; one that was quickly erased by her replies. to distill what she replied down to it's true meaning: i'm 95, i shit myself. almost all of my friends are dead. i live in a place that smells like urine, and the people who work there to take care of us don't care at all what happens. sometimes i don't get to eat for more than a day. sometimes my diaper gets changed only once a day. i don't want to live like this, not anymore. i thought if i stayed in the hospital i'd get sick and they'd pull the plug (her phrase, not mine) and save me from all this. she even asked me to pull the plug. i laughed and told her there was no machine, at least not right then. she told me she had nothing to live for. i responded that i was happy she had come in on that night, since it gave me the opportunity to meet her and make me smile. i got down on my knees next to her bed as i said this, and i continued by telling her that i don't always see the greatest people in the ED at night, that i am often surrounded by the dregs of society, by heinous actions, one after another, on people hurting others, and that that has made me sad, and angry, and hard. but then i got to meet her, and after working christmas eve, chirstmas day, and spending the first christmas of my life away from my family, i felt sad and disconnected from humanity. but in less than 5 minutes of talking to her, i felt restored. it was strange--i actually cared about one of my patients again, i was empathetic. i don't know when that last reared it's ugly head--probably sometime in med school.
as i told her that i wished there was something i could do to help her, the ambulance crew arrived to take her back to her nursing home. as i stood up, i realized there were tears in my eyes, and that everyone from the department was crowded around because they could hear me conducting this conversation at an insane volume. basically everyone saw me--the three other residents working that night, the attending, the nurses, the techs, even the security guards. there goes my street cred. i had to walk away quickly, as she was loaded onto the ambulance stretcher, for i couldn't bear to see her face as they took her away. fortunately, since everyone was still crowded around her, they did not see the copious stream of tears running down my cheeks as i headed for the desolate back hallway of the department to collect myself.
i told her that i wouldn't forget her, so i have committed her story to words, hoping that myself and others will not forget her.
Friday, December 26, 2008
no. 6: post-chirstmas blues
when it comes to certain subjects, i try to keep my expectations low, since i am less likely to be disappointed if things go poorly, or even slightly better than that. for example, if i expect to leave work an hour late and i wind up leaving only 30 minute late, then i am more satisfied than if i expect to get out on time and wind up leaving 20 minutes late. i try to expect that most days will be very busy, so that if it's slow for a while there is the sense of having received an unforeseen gift.
however, being that last night was christmas, i was hoping--maybe even expecting--a somewhat lower patient. in hindsight, this was fatuous of me, given the cast of lunatics who paraded through the ED on christmas eve. but it was with all the holiday cheer i could muster that i prepared for a slower-than-usual night.
it appeared that i would get my chirstmas wish, since when i arrived the ED was fairly quite, lacking the characteristic patients stuffed in every possible nook of free space, the moaning of people in pain, the caterwauling of the soused, and the indignant complaints of those who have been told "we'll have those results shortly" every 30 minutes for the last 6 hours. (as an aside, i will mention here that these aforementioned waiters are of two types--like so many other ED patrons--those who came with a serious issue, have legitimate cause for concern and who thus anxiously await and fear their results. the second group are those whose chief complaint is certainly not of an emergent nature who are simply restless and angry at having to wait. to this group, i generally reply--with a degree of asperity directly proportional to my tiredness and the inanity of their complaint, and indirectly proportional to my level of patience--that there are people in the ED who are sicker than they (or who are actually sick), and that we take care of the sickest people first. issues that would be best addressed in an outpatient setting or by their primary physician (read, "you didn't need to come here today") are given lowest priority when there are true emergencies.)
when i heard about the 8 patients who were there when i arrived, at least 5 of their stories included the phrases "he was drunk" and "he fell." but these were the amateur, holiday drunks--not the hardcore, chronic folks--who were reportedly jolly, so i wasn't worried.
all was fairly quite, as per my holiday wish, until about 1am. with the turning of the calender from decemeber 25th to december 26th, all vestiges of the holiday lull vanished. ambulances arrived by the barrel-full, depositing asthmatics, abdominal pains, kidney stones, vaginal bleeders, and drug addicts into the formerly peaceful department. i tried to keep the holiday spirit alive by grazing all night at the endless supply of cookies and other sweets that had been left in the nurse's lounge. all that got my was some serious eater's remorse, and and blow to my self esteem.
by 7am i was completely exhausted; my eyes were burning, my head hurt, and my patience was at a dangerously low level. i tried to keep to myself and finish my work quickly and quietly, but some good-natured ribbing by a nurse was more irksome than usual and i snapped at her--a lapse that will likely cost me in the future.
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after all that, what will i take with me to my next shift? some fruit for the benefit of my waistline, and lowered expectations for the benefit of my sanity.
however, being that last night was christmas, i was hoping--maybe even expecting--a somewhat lower patient. in hindsight, this was fatuous of me, given the cast of lunatics who paraded through the ED on christmas eve. but it was with all the holiday cheer i could muster that i prepared for a slower-than-usual night.
it appeared that i would get my chirstmas wish, since when i arrived the ED was fairly quite, lacking the characteristic patients stuffed in every possible nook of free space, the moaning of people in pain, the caterwauling of the soused, and the indignant complaints of those who have been told "we'll have those results shortly" every 30 minutes for the last 6 hours. (as an aside, i will mention here that these aforementioned waiters are of two types--like so many other ED patrons--those who came with a serious issue, have legitimate cause for concern and who thus anxiously await and fear their results. the second group are those whose chief complaint is certainly not of an emergent nature who are simply restless and angry at having to wait. to this group, i generally reply--with a degree of asperity directly proportional to my tiredness and the inanity of their complaint, and indirectly proportional to my level of patience--that there are people in the ED who are sicker than they (or who are actually sick), and that we take care of the sickest people first. issues that would be best addressed in an outpatient setting or by their primary physician (read, "you didn't need to come here today") are given lowest priority when there are true emergencies.)
when i heard about the 8 patients who were there when i arrived, at least 5 of their stories included the phrases "he was drunk" and "he fell." but these were the amateur, holiday drunks--not the hardcore, chronic folks--who were reportedly jolly, so i wasn't worried.
all was fairly quite, as per my holiday wish, until about 1am. with the turning of the calender from decemeber 25th to december 26th, all vestiges of the holiday lull vanished. ambulances arrived by the barrel-full, depositing asthmatics, abdominal pains, kidney stones, vaginal bleeders, and drug addicts into the formerly peaceful department. i tried to keep the holiday spirit alive by grazing all night at the endless supply of cookies and other sweets that had been left in the nurse's lounge. all that got my was some serious eater's remorse, and and blow to my self esteem.
by 7am i was completely exhausted; my eyes were burning, my head hurt, and my patience was at a dangerously low level. i tried to keep to myself and finish my work quickly and quietly, but some good-natured ribbing by a nurse was more irksome than usual and i snapped at her--a lapse that will likely cost me in the future.
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after all that, what will i take with me to my next shift? some fruit for the benefit of my waistline, and lowered expectations for the benefit of my sanity.
Thursday, December 25, 2008
twas the night before christmas.
who, i wondered, as i made my way to the hospital for a 7pm-7am shift, comes the the ED on christmas eve?
it wasn't long before i found out; not as many people come in as on a regular night, but there were more than i expected. they seemed to fall into 3 broad catagories: 1) the truly sick: truamas (eg, car accidents, of which there were 2 major ones and sadly, a 31 year old man died), major medical problems (eg, heart attack, of which there were also a few, and one 50ish man never went home); 2) those who just seem to want a place to spend the evening (eg, homeless folks, drunks, angry lenders, the unemployable...), about half of whom are benign and just want a sandwich and a few hours of sleep, the other half being angry and prone to screaming obscenities when not given exactly what they want, when they want it; 3) those whose motivation for visiting i was completely unable to determine (eg, a woman who had had pain in her right leg for 3 months and had never sought medical attention and decided that 315am on christmas morning was the time to finally do it.
not surprisingly, it was the folks from category 2 who provided the most...entertainment? intrigue? headache? a little bit of each.
i have quite a bit more to share about these gems, but i am due back at work in 29 minutes. there are drunks out there who need someone to bring them a sandwich, some ginger ale, and a urinal since they can't get up because they got strapped to the bed after cursing and spitting at the staff when asked not to walk around the ED with their pants off.
what does chirstmas day have in store for me? i'll find out in 27 minutes.
it wasn't long before i found out; not as many people come in as on a regular night, but there were more than i expected. they seemed to fall into 3 broad catagories: 1) the truly sick: truamas (eg, car accidents, of which there were 2 major ones and sadly, a 31 year old man died), major medical problems (eg, heart attack, of which there were also a few, and one 50ish man never went home); 2) those who just seem to want a place to spend the evening (eg, homeless folks, drunks, angry lenders, the unemployable...), about half of whom are benign and just want a sandwich and a few hours of sleep, the other half being angry and prone to screaming obscenities when not given exactly what they want, when they want it; 3) those whose motivation for visiting i was completely unable to determine (eg, a woman who had had pain in her right leg for 3 months and had never sought medical attention and decided that 315am on christmas morning was the time to finally do it.
not surprisingly, it was the folks from category 2 who provided the most...entertainment? intrigue? headache? a little bit of each.
i have quite a bit more to share about these gems, but i am due back at work in 29 minutes. there are drunks out there who need someone to bring them a sandwich, some ginger ale, and a urinal since they can't get up because they got strapped to the bed after cursing and spitting at the staff when asked not to walk around the ED with their pants off.
what does chirstmas day have in store for me? i'll find out in 27 minutes.
Wednesday, December 24, 2008
the weather outside is frightful...
not long ago, a string of storms passed through the area and deposited a thick layer of snow on the ground. with snow, comes the need to move or remove it in order to facilitate travel by foot or car. there are many devices available for performing these tasks--brooms, shovels, snow plows, snow blowers, snow throwers. the act of snow-relocation can be irritating and time consuming, but as well as deadly or disfiguring.
these things were not on my mind as i made my way to work through the mostly unplowed streets of my cozy village. perhaps it is due to budget cuts in city government, or maybe they wanted it to look festive for the holiday season. whatever the reason, the lack of this service caused a significant extension in my travel time, and adding a bit to my daily rage quota.
i purchased a cup of coffee, ate liberally from the sample muffin basket and felt my anger melt away. i was prepared to see a few cases of snow-shoveling-induced chest pain a phenomena with which many are familiar: a sedentary or older person, generally a male, goes out to clear their driveway, not realizing that their heart is not up to the task of delivering blood to those working muscles. The result of this is often chest pain, which prompts a visit to the ER. In addition, people also fall down with astonishing regularity. I heard a story of a woman who fell while getting into her car; she fell into traffic and was nearly run over.
car accidents are, not surprisingly, a frequent motivation to see emergency medical care. what did puzzle me was the number of people i saw on the day of this storm who were on their way to the emergency department (herein, "ED") for other reasons, whilst en route they were involved in a wreck. what i found so astonishing were the reasons they decided that they needed to be seen in the ED on that day. it's not infrequent that someone's presenting complaint is "abdominal pain for 3 months." i always ask "why did you come today?" and not infrequently get answers ranging from sensible ("my pain got worse"), to a trifle bizarre, to completely insane (my neighbor got shot and his girlfriend was driving here to visit him, so i figured i would come to get this checked out since i could get a ride). but why, on a day when there is a snow emergency, schools are closed, roads are unplowed, does one decide that they need to seek care for something that has been going on for months? i don't think i'll ever know the answer.
i was particularly impressed by one gentleman, who despite the 8cm laceration on his forehead and what sounded like the near-total destruction of his father's car--which he was not allowed to be drive but that had been left at home since his father had opted to take the bus to work in lieu of driving given the weather--was most concerned with a "bump" on his penis that he noticed about 5 weeks ago that he was worried was a genital wart (it wasn't). furthermore, he had an appointment to see his own doctor in 3 days, but apparently, after 5 weeks, it couldn't wait another 3 days.
finally, there are the snow blower related injuries. these are primarily finger amputations or maimings. occasionally a foot gets injured: "i was afraid my fingers would get hurt if i stuck them in, so i used my foot." wait--let me see if i understand--you were concerned about sticking your fingers into a machine with moving metal parts (no one ever seems to turn the machine off, although one guy told me he turned down the throttle) so you decided that your foot was a better option? one country-fried rube even suggested that i didn't know what i was doing when i was testing to see if the digital block i had performed (numbing the entire finger from the base rather than just the area of the wound) had had sufficient time to take effect. before i begin sewing someone's skin, i test to see if they are appropriately anesthetized. what raises my ire is not having aspersions cast about my knowledge or competence per se, but rather that in this case, it was coming from someone who didn't have enough sense not to stick his hand into a machine with rotating metal parts.
i love when it snows!
these things were not on my mind as i made my way to work through the mostly unplowed streets of my cozy village. perhaps it is due to budget cuts in city government, or maybe they wanted it to look festive for the holiday season. whatever the reason, the lack of this service caused a significant extension in my travel time, and adding a bit to my daily rage quota.
i purchased a cup of coffee, ate liberally from the sample muffin basket and felt my anger melt away. i was prepared to see a few cases of snow-shoveling-induced chest pain a phenomena with which many are familiar: a sedentary or older person, generally a male, goes out to clear their driveway, not realizing that their heart is not up to the task of delivering blood to those working muscles. The result of this is often chest pain, which prompts a visit to the ER. In addition, people also fall down with astonishing regularity. I heard a story of a woman who fell while getting into her car; she fell into traffic and was nearly run over.
car accidents are, not surprisingly, a frequent motivation to see emergency medical care. what did puzzle me was the number of people i saw on the day of this storm who were on their way to the emergency department (herein, "ED") for other reasons, whilst en route they were involved in a wreck. what i found so astonishing were the reasons they decided that they needed to be seen in the ED on that day. it's not infrequent that someone's presenting complaint is "abdominal pain for 3 months." i always ask "why did you come today?" and not infrequently get answers ranging from sensible ("my pain got worse"), to a trifle bizarre, to completely insane (my neighbor got shot and his girlfriend was driving here to visit him, so i figured i would come to get this checked out since i could get a ride). but why, on a day when there is a snow emergency, schools are closed, roads are unplowed, does one decide that they need to seek care for something that has been going on for months? i don't think i'll ever know the answer.
i was particularly impressed by one gentleman, who despite the 8cm laceration on his forehead and what sounded like the near-total destruction of his father's car--which he was not allowed to be drive but that had been left at home since his father had opted to take the bus to work in lieu of driving given the weather--was most concerned with a "bump" on his penis that he noticed about 5 weeks ago that he was worried was a genital wart (it wasn't). furthermore, he had an appointment to see his own doctor in 3 days, but apparently, after 5 weeks, it couldn't wait another 3 days.
finally, there are the snow blower related injuries. these are primarily finger amputations or maimings. occasionally a foot gets injured: "i was afraid my fingers would get hurt if i stuck them in, so i used my foot." wait--let me see if i understand--you were concerned about sticking your fingers into a machine with moving metal parts (no one ever seems to turn the machine off, although one guy told me he turned down the throttle) so you decided that your foot was a better option? one country-fried rube even suggested that i didn't know what i was doing when i was testing to see if the digital block i had performed (numbing the entire finger from the base rather than just the area of the wound) had had sufficient time to take effect. before i begin sewing someone's skin, i test to see if they are appropriately anesthetized. what raises my ire is not having aspersions cast about my knowledge or competence per se, but rather that in this case, it was coming from someone who didn't have enough sense not to stick his hand into a machine with rotating metal parts.
i love when it snows!
no. 3: a brief interlude
It's Christmas Eve. Yes, I started this on December 24th. While many others are headed home for the holidays I have elected to begin my blog on this fine morning as I sit here, alone, in my chilly abode. I'm not looking for pity, I am simply describing reality. Most of the people that I know, or at least, those that I can consider my friends--which number approximately 6--are at work right now, doing god knows what. Meanwhile, I am at home, drinking coffee and telling my story. If I wanted some human contact right now, that would be difficult, since as I mentioned, everyone I know is at work. It's not a matter of waiting for them to get home either, because I have to go to work at 7pm tonight. I will work until 7am on Christmas day, come home, go to bed, and then go back at 7pm. This is a somewhat roundabout way of explaining why, rather than spending time with loved ones, I am internetting with strangers. Unfortunately, this is not all that uncommon an occurrence, for me, or others in my position.
post: the second; getting started.
Disclaimer
The following tales and perseverations are my attempt to document my life and experiences as a a hired medical goon (ie, Resident Physician) at university hospital some where east of the MIssissippi. Some of what is to come may seem callous or inappropriate, depending who you ask, for someone in the medical field whose job is to care for the sick and dying; but like so many other situations in life, one does what one has to in order to survive. When your job is of the ilk that, every day when you arrive, there is a decent chance that one of your projects (I use that term for the sake of comparison to other jobs , not in the pejorative sense…at least, not yet) has died overnight and moreover, there is an equally good chance that another person will shuffle of this mortal coil during the day, it becomes difficult—even dangerous—to form emotional attachments to those in your care.
In fact, one needs to develop coping mechanisms, and quickly, in order not to curl-up into the fetal position and cry the day away. For me, the coping mechanism is humor and my day is suffused with a constant stream (both internal and external) of witty, though perhaps inappropriate, observations and one-liners without which I would almost certainly be reduced to a quivering mass of flesh and hair by the preponderance of misery, suffering, and social injustices by which I find myself surrounded on a daily basis.
Think long and hard about the conditions in which I work before you pass judgment—I see drug addicts, rapists, child abusers, teachers, nuns, cops; I see people that remind me of my mother, of the kid who beat me up in high school, of two brothers I met at summer camp. I had a patient with severe COPD (chronic lung disease) who an hour after being extubated had her daughter bring crack to the ICU so the two of them could smoke together; in the next room was a 64 year old man dying rapidly from leukemia who reminded me a great deal of my father, who died of that very same disease.
Medicine is unlike nearly any other profession—not only in the magnanimity of saving lives but also because doctors deal heavily in a trade of materials and subjects that most of society goes out of it’s way to avoid thinking about or discussing: body fluids—urine, feces, pus from every orifice and organ on the body; odors—rotten flesh, unwashed feet; chronic pain, terminal illness, end-of-life decision making, and of course, that appointment we all have with the Grim Reaper. Add to that the myriad social injustices of the day, violence, addiction, deception, etc; If that is not enough, there will always be the sweet old ladies that remind us of those we love, who have likely committed no serious transgressions against anyone, who still die horrid, painful deaths, sometimes—literally—right in front of you.
This continues, daily, for the duration of Residency—4 years in my case, and anywhere from 3-6—during which time you are chronically sleep-deprived, working for what comes close to minimum wage because of the number on hours you work, in what in most cases is a socially isolating environment because 1), you hardly see anyone besides other physicians, 2) as hackneyed a notion as it has become, it is tremendously difficult for those not in the medical profession to fully appreciate and understand the enormity of what the average resident sees and does on any given day, and 3) in many cases, including my own, due to the vagaries of The Match, many residents, as they start their career, find themselves in new cities, far from home without friends or a true social support structure aside from their co-residents who, by the way, also suffer from all the aforementioned tribulations. So if, at times, my words and thoughts seem cold, uncaring, bizarre, or even outright mean, try to remember the words that my father—in what was an unexpected display of paternal affection and guidance—uttered to me as he lay in a hospice bed hours before he died: “Never judge a person until you have walked a few miles in their shoes…not just one mile, but several.” That was the last thing that he ever said to me, and to this day, I cannot decide if those are poignant or pathetic last words…probably some of both. What didn’t occur to me until much later was the fact that these were somewhat ironic last words from a man who was fairly stern and unyielding is his own judgments and words; he once told me that if I did not get accepted to college, I could not continue to live at home.
The following tales and perseverations are my attempt to document my life and experiences as a a hired medical goon (ie, Resident Physician) at university hospital some where east of the MIssissippi. Some of what is to come may seem callous or inappropriate, depending who you ask, for someone in the medical field whose job is to care for the sick and dying; but like so many other situations in life, one does what one has to in order to survive. When your job is of the ilk that, every day when you arrive, there is a decent chance that one of your projects (I use that term for the sake of comparison to other jobs , not in the pejorative sense…at least, not yet) has died overnight and moreover, there is an equally good chance that another person will shuffle of this mortal coil during the day, it becomes difficult—even dangerous—to form emotional attachments to those in your care.
In fact, one needs to develop coping mechanisms, and quickly, in order not to curl-up into the fetal position and cry the day away. For me, the coping mechanism is humor and my day is suffused with a constant stream (both internal and external) of witty, though perhaps inappropriate, observations and one-liners without which I would almost certainly be reduced to a quivering mass of flesh and hair by the preponderance of misery, suffering, and social injustices by which I find myself surrounded on a daily basis.
Think long and hard about the conditions in which I work before you pass judgment—I see drug addicts, rapists, child abusers, teachers, nuns, cops; I see people that remind me of my mother, of the kid who beat me up in high school, of two brothers I met at summer camp. I had a patient with severe COPD (chronic lung disease) who an hour after being extubated had her daughter bring crack to the ICU so the two of them could smoke together; in the next room was a 64 year old man dying rapidly from leukemia who reminded me a great deal of my father, who died of that very same disease.
Medicine is unlike nearly any other profession—not only in the magnanimity of saving lives but also because doctors deal heavily in a trade of materials and subjects that most of society goes out of it’s way to avoid thinking about or discussing: body fluids—urine, feces, pus from every orifice and organ on the body; odors—rotten flesh, unwashed feet; chronic pain, terminal illness, end-of-life decision making, and of course, that appointment we all have with the Grim Reaper. Add to that the myriad social injustices of the day, violence, addiction, deception, etc; If that is not enough, there will always be the sweet old ladies that remind us of those we love, who have likely committed no serious transgressions against anyone, who still die horrid, painful deaths, sometimes—literally—right in front of you.
This continues, daily, for the duration of Residency—4 years in my case, and anywhere from 3-6—during which time you are chronically sleep-deprived, working for what comes close to minimum wage because of the number on hours you work, in what in most cases is a socially isolating environment because 1), you hardly see anyone besides other physicians, 2) as hackneyed a notion as it has become, it is tremendously difficult for those not in the medical profession to fully appreciate and understand the enormity of what the average resident sees and does on any given day, and 3) in many cases, including my own, due to the vagaries of The Match, many residents, as they start their career, find themselves in new cities, far from home without friends or a true social support structure aside from their co-residents who, by the way, also suffer from all the aforementioned tribulations. So if, at times, my words and thoughts seem cold, uncaring, bizarre, or even outright mean, try to remember the words that my father—in what was an unexpected display of paternal affection and guidance—uttered to me as he lay in a hospice bed hours before he died: “Never judge a person until you have walked a few miles in their shoes…not just one mile, but several.” That was the last thing that he ever said to me, and to this day, I cannot decide if those are poignant or pathetic last words…probably some of both. What didn’t occur to me until much later was the fact that these were somewhat ironic last words from a man who was fairly stern and unyielding is his own judgments and words; he once told me that if I did not get accepted to college, I could not continue to live at home.
post: the first; introduction.
The (not) Posthumous Papers of The Critwick Club, containing a faithful record of the perambulations, perils, travels, adventures and sporting transactions of the corresponding members.
Members of said club include myself and a cast of others who, unknowingly, have become embroiled in the daily activities of my life and thus through no fault of their own will have their actions recorded here.
Information contained herein is largely fictional, although often times will be based on actual people and events. Names are not real, places are not real, and ludicrous behavior and thoughts are possibly embellished. None of the other characters are aware of their involvement in this narration, so they can neither be faulted nor credited with their alleged thoughts, actions, etc., no matter how magnanimous or facinorous such transpirations may appear.
Members of said club include myself and a cast of others who, unknowingly, have become embroiled in the daily activities of my life and thus through no fault of their own will have their actions recorded here.
Information contained herein is largely fictional, although often times will be based on actual people and events. Names are not real, places are not real, and ludicrous behavior and thoughts are possibly embellished. None of the other characters are aware of their involvement in this narration, so they can neither be faulted nor credited with their alleged thoughts, actions, etc., no matter how magnanimous or facinorous such transpirations may appear.
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