call me... please...

I'm hastily writing this blog from the hospital. If we get a trauma call, blog will have to suffer. So far: 0 Trauma calls 3 consults. Consults were nothing cool. I'm supposed to be staying busy the whole time here, but my resident is sleeping along with the intern. So... I napped. Not good sleep. Waiting for a flight in an airport sleep. Sleeping in the Surgery Lounge on a couch sitting up sleep. I'm outtie in 30 minutes to go see my own patients before rounds and our Friday meetings.

More to come later. I know my posts have blown lately, but I haven't had time to thoroughly write a good one. I am working on an article... Soon. I promise.

You're going to cut what?

My last day of Anesthesia has come and gone. I am stuck at home studying for a final essentially over pharmacology. I am not worried. Obviously... I'm blogging when I should study. On my last day of Anesthesia, my resident and I were assigned to the GU OR (Genitourinary Operating Room). As I perused the list of cases for the day, I knew it would be an interesting day. Circumcisions, Orchioplexy, and a couple other minor procedures. I raised an eyebrow at these cases, not because of the type of cases, but rather the ages of the patients. One kid was seven and in for a circ and an orchio. Yes, seven years old. The child was 84 months old and just now having a circumcision. (read between the lines => OUCH!)

Anyhoo, my day was made better when I saw a colleague of mine get pimped by his resident. I have the unfortunate pleasure of knowing this sack of shit from my first two years. He is/was on a Urology rotation. Now, the image of this kid doing any kind of urology is just funny. First, he is as blind as a bat. He would literally have to have the penis within 6 inches of his face. Humorous. Very Humorous. So, I witnessed this kid get pimped on the indications for performing an orchiopexy. He was giving the deer in the headlights stare at the questioning. Funny for me, since he thinks he knows more than attendings. Basically, you perform an orchiopexy for ease of diagnosis of testicular cancer and other testicular anomalies later on in life and probably more importantly, for cosmetic reasons. As my staff Anesthesiologist said, "Everyone wants two." (I almost pissed my pants when SHE said it.)

So, I got to witness firsthand the awful mess that a circ entails as well as an orchio. Why you would subject any child to this, let alone a SEVEN year old, I am not sure.

On a lighter note, plans for my departure from Indianapolis permanently have been started. I am thinking an orthopedic or plastic residency somewhere in the Western US. Hell, I'll even do General Surg if I have to. Anything to get out of IN and somewhere with more scenery and better cycling and running. I hear Oregon is nice... Seattle has a good music scene... Wyoming has some great skiing... Utah has some great skiing, climbing, cycling and running, and Mormons...

This is an aside, and then I have to study, but can we talk about how clean Salt Lake City really is? Holy Cleanliness Batman. That is one of the cleanest cities I have seen, ever. Those Mormons, they know how to control their followers huh? Also, I've never met an asshole Mormon. They are always so nice (minus the extremists, who kill at the drop of a hat.)

woes

I'm kind of in a shitty situation. There is a girl I want to date. She wants to date me. We would work out so damn well. Basically, it would be a great relationship. It was so easy when we were together. We hung out and did everything and nothing and were both satisfied with the outcome. Downside => she lives 2 time zones away. I am not one to chase love. I have dated long distance before and it hasn't worked, but I am really considering doing at least one if not more away rotations where she lives. It is possible and quite likely that I will be able to do them. I also will have 3 months of vacation built up. Downside => the vacation isn't until May/June of 2007.

It's not that I can't find people close. There are people close, but I have been so smitten with this wonderful and beautiful girl that no one compares right now. And I have tried looking. I tried to tell myself that I was just infatuated and that it would pass, but it hasn't yet. I'm not infatuated. That is something that is reserved for looking at puppies and cute babies. It's more of a kinship, a commonness shared through similar experiences, common yet separate. Aaaaghh. Frustration. Longing. And god damn high gas prices are driving up the price of plane tickets. At least I have tons of time off next month. No, wait, I have 80 hour weeks for 5.2 weeks starting in a week. Shit. I'm looking forward to October and November. Easy rotations.

I need to go ride and run off some anger. A good 40 mile ride and a 5 mile run should help that. Catch you on the flip side.

The sweet life

I wish that I had more of an interest in Anesthesia. Dealing with pharmacology is interesting. I like thinking about what drugs to give in what situation, but after a couple cases, it got a bit boring. I had a couple interesting cases. A preemie was in for a procedure and we couldn't get a line in very well and called for help. Not 30 seconds later, there were 10 Anesthesiologists in the room crowding this 3.2 kilo child. She was so tiny and was getting flooded by a sea of hands and angiocaths. (Angiocaths are used to start IVs) We finally got a line started and just as quickly as they came, they left the room. Also, preemies, and young kids in general, have very little fat, so the room temp was about 80 degrees. Needless to say, I was sweating like a Malaysian whore in church. The sweat was rolling. Thank God I didn't have to scrub in on that case. I might have sweated right through the gown.

We had a kid today who was in for a dental procedure. (I'm on peds anes. So lots of stories about kids.) He had a Hx of seizure disorder, asthma, and MR. So, the kid was not really with it to begin with, but we had all kinds of problems with him. He just didn't want to cooperate. I started a line, which went in fine. I was nasally tubing him when suddenly I couldn't see. So we reset things a bit and tried again, but couldn't get a nasal, had to switch to an oral. Then my IV had shitty pressure, so we had to start another one. Then he had poor lung fxn, then he was tachy, then... It just went on and on with this kid. I just have no passion about doing that. And then I had a nurse try and pimp me. I was shocked. She was asking me what to use to paralyze and what I would do if I lost my IV and blah blah blah. For those of you interested in nursing, or are nurses, don't take offense to my next comment. My resident and I started talking about how nurses don't think when they do something, they just follow a procedure. Things have to be laid out for them, b/c they don't have even close to the amount of schooling that MDs have. Now, nurses run the hospital, there is no denying that, but some of them are a bit uppity about what they think they know. Granted, they know a lot, but it is superficial knowledge about what another doc did in a certain situation. They don't know all the reasons why. That's all I have to say about nurses. Just like everyone there are good ones and shitty ones.

A career in Anesthesiology? Probably not, but it's not completely crossed off like FP and Medicine. I do have some sweet hours right now. Average of 07:00 to 14:00 every day. That's an awesome day compared to the 06:00 to 18:00 on ortho (which didn't feel like a 12 hour day. Probably b/c I really liked it.)

No thanks

Welcome to the first in a series of posts entitled "Specialties I Don't Want To Do."

Well, lets get right to it, I don't care for family practice. I have no aspirations of managing meds and talking to every patient about their depression and what we can do to change it. There is nothing wrong with that. We need primary care docs. I'm just not the candidate for that.

Next. I recently decided that I will have no part in becoming a critical care doc. For those of you unfamiliar with that position, let me explain a bit. A Critical Care physician is one who deals with and manages the patients in the Intensive Care Unit (any intensive care, PICU, NICU, SICU, MICU, CCU... you get the idea). Granted, there is a huge difference between what an internal medicine hospitalist does and a CC doc's duties. But, there is too much of a similarity. Put this into context you ask? Okay.

I was in our clinic (it's an orthopedic clinic) when my resident got a page about a patient in the CCU (Critical Care Unit). The nurse said something about him having a tib/fib and yada yada yada come take a look. (I'm assuming that was the jist of the conversation, since I didn't talk to the nurse right then. Anyways... we take a look at the patient's x-rays of his lower leg and see that he has a nice tib/fib fracture and he is in a long leg cast. No problem. So, my resident tells me to go up and see what the deal is.

Still with me? OK. So, I get up to CCU and find this patient. Find his nurse, who tells me she is concerned about his wrist and not his leg. (Good thing I looked at his wrist films... not so much). So I go into the room, which is about the size of your average airport Starbucks. (It's a big room by hospital standards.) This guy is the only patient in the room. He has tubes emerging from everywhere underneath his gown. Picture a tube in any hole you have. That is this guy. He's got a feeding tube, a foley, IVs, drains, you get the idea. He is not intubated though, so that's a step up for him. Anyways, to further complicate matters, this guy is about in a coma. He's one step out of a coma. So, he can't answer questions, can't point to where it hurts, can't walk, talk, feed himself, none of the above. So, I start evaluating his wrist and not his leg and find that it looks a bit swollen and that's about it. There are no other findings that indicate a fracture or really anything else wrong with this guy.

I mean, nothing wrong other than the fact that he was hit by a car and now he's pretty much a vegetable. A nice piece of celery in a bed with machines keeping him alive. He's breathing only because his brain stem's respiratory center has taken over. And people really want to do this for a living? I just value talking to the patient too much. Also, he wasn't a candidate for surgery, so that nixed that idea. He'll probably end up in a nursing home somewhere with no family visiting him while he's hooked up to machines for the rest of his life. The kicker is that he's only 70. He could live another 20 years like this theoretically. In reality, there is a huge 6 month mortality for people who become non-ambulatory (they stop walking around). Sad? Damn right. And something I don't want to deal with every day of my life at work.

Those are two of the several specialties which hold no appeal to me. More to come, but first a public service announcement.

Life is precious; treat your body as a sanctuary. For those of you wanting to harm your bodies with drugs, let me paint a little picture for you of what you can look forward to. You can be 46 years old, with no job, no house, and no future. You will be in the hospital for back pain. When people look at your CT they will see that all those IV drugs you did allowed bacteria in your blood stream. Now those bacteria have taken up residence in you spine. They have found a nice home in the vertebral body of your lumbar vertebrae. The unfortunate thing is that they have eaten the bone away and left a small shell of what used to be a weight bearing structure for your entire upper extremity. One day you got up to walk to the corner to buy steal something so you could buy more meth or heroin or whatever and your upper body's weight compressed and crushed your vertebrae. Now you are in excruciating pain and your back is broken. Hooray. But it gets better. During your stay at the hospital you can't drink for a couple days, so you go into withdrawal from the drugs as well as the alcohol. So now you are in fulminant delerium tremens as well as narcotic withdrawal. HOORAY!!!! Your short little jaunt to the corner turned into a 4 day hospital stay, which cost the taxpayers 1000 a night for just the room plus nursing and doctor expenses, and a lifetime of back pain because you have no viable spine now. Looks like you should have stuck to prostitution to feed your 3 kids and stayed away from being a crack whore.

More to follow on what not to do with your life.
Topics include: not jumping off the roof, not slicing your hand with a butcher knife, and my personal favorite not running from the police on your motorcycle.