"Post Call"

There is an interesting phenomenon in residency called being "post call" It refers to the day after your 30 hour shift in the hospital. It refers to the time when you go from the high of running around the hospital taking care of patients in the middle of the night, to the exhaustion of morning rounds when all you want is the comfort of your bed at home. When you finally get home and get in your bed around 2pm or so it is better than the best orgasm you've ever had. The relief is tangible.Yes, this is what I look like post call :)

Anyway, it's hard to complain this month. I went camping up in the Blue Ridge Mountains last weekend. (Funny that I first wrote "Bluetooth Mountains"- truly I am a child of the digital age). Beautiful! It does wonders for washing the hospital from your soul.

My First Inpatient

It's ironic that it's just dawning on me now, but being in health care is a bit of an emotional roller coaster. One second you're laughing with a patient, the next you're comforting someone who is struggling with making changes in their life. And that was just in the outpatient clinic where people are relatively healthy.

Enter the ICU- intensive care unit. Most patients are on ventilators and have multiple tubes extending from their bodies carrying medications for everything from blood thinners to stomach acid reducers to blood pressure supporters. Many do not leave the ICU.

So that leads me to my story from today, my first day there. I arrive there and pick up only two patients- fantastic! Except that one of them is ready to be taken off life support. So I call the palliative care team and I call the family to introduce myself. And the family comes in and we (meaning the palliative care physician) discusses taking this woman off life support. They agree that since she is very sick it's the best idea.

By the day's end I've learned how to extubate (remove the breathing tube) someone and keep them comfortable with sedatives and I've learned how not to become too teary-eyed while talking about a dying woman's final hours with other physicians. Now I understand why the doctor's of old were taught to intellectualize and not to get close to their patients. Fortunately, this woman will be out of her suffering and I'll have learned something.

And to cheer up this rather dark post I leave you with this silly photo. :)

'Tweet Tweet' - [Cough Cough]

An interesting story from several days ago. So I'm in our parking garage and there are two birds on the floor- not just on the floor actually, but stuck to a rat trap. It's the kind of thing that is a tray with super sticky goo that is supposed to attract the animal and then catch it by sticking its feet to the ground. Seems like the kind of thing you'd see in the Road Runner cartoons, but it's actually real.

So there's these birds trapped on it, and they're obviously not very happy. My roommate comes in and she wants to do something for them. Clearly they're too gummed up in this stuff to free- in fact one is stuck by its body and head. They are- no pun intended- dead ducks.

So we start thinking of ways to put them out of their misery. The idea of running them over with the car seems draconian and messy. So, of course, we turn to the web. The American Vetererary Association has some lovely guidelines for how to euthanize little birdies. Contrary to popular belief the site tells us, "Rapid freezing as a sole means of euthanasia is not considered to be humane." But... if you first anesthetize the bird, then it's okay.

Okay I'll get to the point. So my roommate comes up with a good idea. We put them (and the tray of goo) at the bottom of our trash can and hold it up to the car exhaust. Beautiful, this puts them down in about 10 seconds. But just to make sure they won't awake in the trash, my roommate wants me to hold them underwater. I no longer have any say in this and find myself compelled to follow along. Besides, they're clearly dead anyway.

So yes, perhaps I violated my hippocratic oath. Perhaps Dr. Kevorkian would be proud. Perhaps I feel like Macbeth ("Out damn spot; out I say!). But the birds stoppped struggling and didn't have to die of thirst. Excellent...

(Note: I will not be trying this technique on any human subjects. Even if they're stuck to a rat trap.)

Transformers... More than meets the eye

Saw the Transformers movie last night. What a fun romp! Robots, guns, attractive women and intergalactic warfare- really it doesn't get much more entertaining than this. I laughed through most of the movie- partly because the plot was so god-aweful and partly becuase the action scenes were so cool. Anyway, it was an entertaining flick and I'd recommend it to anyone who has 10 bucks burning a hole in their pocket and wants a nights worth of diversion.

Work has been pretty slow this week with me getting out of clinic by 3pm most days. So I got some mountain biking in on thursday, a run yesterday, and going fora hike and swim today. The parks are few and far between around here- you drive through stripmall land to get to a lot of them, but once you're there they're rocky and quiet- nice. I'm committing to get out at least once a month of the city.

I'm using ebay for the first time. Looking for a good PDA? Check out my listing and then buy it :) Kind of cool- but so many scammers looking for your email address and postal address. Watch out on both ebay and craigslist!

Hay dolor aqui?

Well it seems that I've become the spanish-speaking resident in my clinic at Grady because more of my patients so far have spoken spanish than engligh. Thank you Petoskey High School and U of M for my rudimentary español. Unbenownst to me, I know just enough to conduct a basic medical interview. Cool :)


I've taken to reading slashdot.org lately. It's fully of articles for the technophile- some are more technical than I'm really interested in- I still don't know anything about these new fangled programming languages like Python. But some are really interesting- like about the Facebook. Makes me really want to get back into IT on the medical side. Perhaps study the organization of medical information- a rapidly growing field.

Truth be told the highlight of my week was playing ultimate frisbee in Piedmont Park (about a block from my house. I played for a solid 2 hours. good to know I can still sprint around a field with the young 'uns :)

Stark reality

It's the end of week one- a relatively easy one for me as I spent a day in orientation, another day in lecture and the rest in outpatient clinics. My friends, however, don't have it so easy. While I've been working an average of 8 hour days and sleeping as much, they are working on the wards at Grady (the poor, about-to-go-out-of-business county hospital) with some of the sickest patients in the country. Their days average 12 to 14 hours- when they're not on call. Overnight call, which thankfully is only every 8th night is a 30 hour shift. Everyone is asking themselves why they're here.

Entering medical school, most students are glad they got there- it's a very competitive process after all. We're idealistic and excited to learn the material needed to treat patients. We put in countless hours at the library and learn (and devise) countless mnemonics to remember volumes of information about livers, sugars, and medications. Some leave because it's not what they expected, but most put their all into it. Sacrificing time, money, and career development as their peers find jobs with average hours and do normal twenty-something things like, say... go to the bar. Revolutionary ideas like these seem out of reach to many med students who are competing with themselves (or their insecurities) and their peers for grades that will win them the best residency. Many friday nights med students can be found studying- a pastime favored second only to listening to lectures online.

So I can only speak for myself. But the bright-eyed idealsim which I brought to medical school, the change-the-world attitude is withering as the realities of the workload of residency sink in. I sat at dinner tongiht listening to stories from the wards of having to stay extra late for a sick patient, rounds that last upwards of 3 hours, teams of residents that don't function well, etc. I've never seen so much job frustration at one table. It's good that we have each other to help get through this. It's not going to be fun. I hope it will be worth it. Only time will tell.

The winds of Change...

It’s funny how change occurs in our life. We know it’s coming- sometimes years in advance. But no matter how much we plan and anticipate, there is no way to know whether we’ll be happy once the change actually occurs. I think about moving to a new city (oh let’s just say Atlanta) or having a baby or something big like that. Sure we can think this is what we want, but you never know how you’ll feel about something until you actually get there. And it’s never all happy or all sad about something- always it’s a mix.

First day in the big city

I just arrived in Atlanta yesterday. It’s 4am and I’m wide awake. Starting residency is like jumping into Lake Superior. Likely the anticipation is much worse than the actual event. Or perhaps it’s the initial shock that gets you. Or maybe- and probably most accurate- the body-numbing cold is analogous to the mind-numbing long hours. Hm.

The drive down was beautiful- through the hills of virginia- green, rolling, steamy, magestic. Truly God’s country there. Georgia is green, but flatter and with more traffic. It’s harder to see God around here. I suppose it’s in the people and the city. I’m living right in the middle of the urban area here in a very cush gated community. Kind of a shock, kind of exciting.

Certainly this is not Portland and the life of tevas and gore tex that I once thought I’d be living at my age. Funny how life works- you go to med school and somehow you’ve lost the dream of owning your own outdoor outfitter, being a forest ranger- living that bohemian lifestyle of camping along a road trip, relaxing with a guitar after a long day canoeing, Not a huge surprise really… Most people don’t go into medicine for the camping.

But seriously I always said I’d do what I wanted to do for a living and the money would come naturally because I was smart and driven and was enjoying my work. But I’m on about the most traditional path there is- the “Jewish doctor” Pragmatism in my life wins over idealism and heart just about every time. But the pleasures here will be different and perhaps richer than climbing mountains. We’ll just have to see…

Welcome to my Blog

So here it is. Dr. Dave hits the bigtime in the big city. Residency.
Patients. Fun with other residents. Long hours. Bustling traffick. Hiking in the blueridge mountains. Drinks with the interns. You'll hear all the stories here. So tune in. The next couple posts are one's I wrote before I had internet at my apartment. So they're obviously old and out of order. Deal with it.