alec guiness/genuine class

i've recently realized that when my mental well-being is in a favorable location, i have less drive and desire to write. it seems so hackneyed to use writing as a cathartic (that is, as therapy), but i guess i have to admit that for me, ranting in print made me feel better.

in any case, i have not written in quite a while, which is a positive indicator as far as my happiness is concerned.

life is much better as a 3rd year resident--not only because the shifts are shorter (9 or 10hrs rather than 12hrs), but also because i know more, i'm comfortable doing my job, and as a senior resident more people listen to me. it's an odd phenomena--i've spent 2 yrs as an underling and although i felt like i was more respected and "listened to" by the end of 2nd year, i showed up for my first 3rd year shift and suddenly everything i say (ok, most things) are taken as true. 28 days ago i would ask a nurse to give something to a patient and if she didn't like it, i'd get pushback ("did you ask the senior about that?"). attendings have made a similarly rapid and near-complete jump in terms of respecting my opinion (or at least agreeing with me, or letting me implement my plans). these factors make life in the ED somewhat easier since in some ways i am the authority--when i decide what a patient needs i just make it happen, rather than having to talk to someone else about it.

being a 3rd year also brings with it supervisory responsibilities. this is new and exciting; and it is also difficult (but not difficult enough to drive me to write, apparently). more on this in the future.

in 4 days i start in the MICU, so we shall how things play out. my initial worry is that the intern will be a disaster, which will make my life extremely difficulty. i don't know the intern with whom i'll be working so i have no idea if the fear is founded or not. i really enjoy critical care so in many ways i am looking forward to this month, but only time will tell...

a wilderness of mirrors

a internal medicine resident friend sent this out:

you know shit went down overnight when you open up internet explorer to this...

oh, the places you'll go!

maybe it's the festive holiday air, or the cold is keeping people indoors, but whatever the reason, i've seen a lot of sexually transmitted diseases in the ED over the past few weeks.

the two most memorable were a woman in her 20's who had gonorrhea. i delivered her diagnosis, provided some anticipatory guidance, and then went to get her discharge instructions. she had asked me for a phone so that she could call to get a ride home. when i returned to the room, she was on said phone, yelling at her boyfried: "you're damn right it'f fucking over! you fucking cheated on me and now i have a fucking disease in my vagina. i hate you!" i stood there awkwardly for a few seconds, and i didn't step-in to remind her that the disease was affecting her cervix, not her vagina, and then i muttered "i can see you're busy, i'll be back in a few minutes."

the other notable encounter was a mother-daughter pain who both had their first outbreak of genital herpes. i had seen them both, not knowing they were related (different last names) and remarked to the attending that it was funny that both the patient in room 2 and 3 had herpes. the attending had seen room 2--the mother-- (although she hadn't done a pelvic) and had been told that her daughter was in the next room with similar complaints. we could only wonder at the array of possibilities that could account for such a situation; i felt both amazement and revulsion.