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.