Who says you can't enjoy prison?...

Residency is hard... I am currently in the middle of a string of 20 days without a day off. Obviously it’s not ideal... Most of the time, it’s not even all that fun. I mean, I spend the bulk of my time doing paperwork, entering orders in the computer, reading/preparing to get “pimped” about anything from skin cancer to drug interactions to home health arrangements. A lot of times, I feel like the guys in this picture... However, there is a brightside to all of this (and it certainly isn't the money)...

To prove it, I submit the following stories. We’ll mark them Exhibits A and B.

Exhibit A. As an intern I don’t operate much So when I do get to the OR it’s very, very exciting. Last month, I met a patient with an occlusion in the artery to the leg. The patient came in with a lot of leg pain, and the patient's first morning in the hospital I listened closely and changed the patient's pain medicines (super small decision... but ended up making a big difference to the patient). When it became clear that the patient wouldn’t respond to medical therapy we decided to amputate the occluded leg... After talking to the patient about the procedure the patient still seemed unsure of the procedure but said, “I don’t care if that tall blonde guy is the worst surgeon in the hospital... I want him to do it...” I of course responded with, “Ummm, my hair is NOT blonde...” And we took the patient to the operating room.

It’s a simple procedure, we didn’t have any complications and I got to do a lot (which basically means it was the blinding brilliant light from heaven on an otherwise craptastic day). We finish, and as we’re leaving the operating room I had the following exchange with my chief resident:

Chief: Alright I’ll take the patient (PS we don't refer to everyone as the patient... it's just my way of keeping the patient's story private... see there I go again) to recovery, can you go talk to the family?...
Me (never one to allow complete ignorance or lack of skill to stop me from doing something), Sure.... yeah.... ummmm... anything in particular you want me to talk to them about?
Chief (quizzically): Why don’t you start with the surgery and see where that takes you?
Me: Oh... right...

I walked up stairs to the waiting room, and nonchalantly asked the patient's family to step out into the hallway (good or bad news I feel like it should be private)... Because I wasn’t sure where to begin, I started with, “Well we finished the surgery

and everything went well.” Thinking that would be a sufficient explanation of a relatively routine procedure, I opened a huge can of worms with, “Do you have any other question?” They in fact had exactly one million questions about how the procedure was carried out, what exactly we did, and how the patient tolerated the procedure... It only took about 5 minutes, but the calming influence seen on their faces while hearing an explanation of a relatively routine procedure is really why I do this.

Exhibit B. One night on call I was covering the burn unit (usually not a lot of big issues... more just little things throughout the night), but occasionally you have to “admit” someone. Meaning you go see them, get the history and examine them. This can be more or less involved depending on the degree of the injury. While on call an elderly patient was transferred in from an outside hospital following a really bad burn. It became apparent right away that the patient would not live through the night. The doctor in charge spoke with the family over the phone, and they quickly realized that nothing could be done. They said they would be on their way and hoped their relative would make it until they arrived....

The patient’s family arrived, and the patient passed shortly after. In the midst of an insane night on call, I had to go to the intensive care unit and pronounce the patient’s death. The exam itself isn’t hard, but explaining the procedure to the family, asking them to step out of the room, examining her and then speaking with them about the pronouncement was definitely something that makes you pause and think. I won’t get into everything it makes you think about, but it certainly makes you miss the family and friends you have at home. It also makes you grateful that even on those busy nights, when you don’t think you have time to breath, you still get to come into people’s lives at a moment they’ll never forget and be a positive influence. So I guess if I’m going to be stuck somewhere doing something... it might as well be something that gives me opportunities like this every day...

When good advice goes bad....

Saddest story: (and this is for my sister-in-law’s mom... she loves sad stories... she’s probably never read my blog, but if she’s anything like my brother describes she’ll probably start reading based on this story alone...). I was on call last week, and I was covering the transplant service. When you cover the transplant service if someone comes in over night for a transplant and you have to admit them (write a history and physical and put in their orders). So of course someone comes in over night... now healthy people don’t get transplants, so if someone comes in for a transplant it can dramatically improve their life, saving it a lot of times. Of course it’s not without risks... sometimes transplants don’t work... sometimes surgery doesn’t work... (I know... I’m giving away the ending). The sad part is this... a guy comes in with his huge family for the pretransplant admission. While I was interviewing them, they asked me, “If this was your mom or your sister what would you do?” I said that I would want her to go through with the transplant... and I absolutely meant it. Sadly, this man has not done well, to the point where they had to remove the transplanted organ (now every transplantable organ is very important.... that’s why they transplant them, because without them you die... see where I’m going?) and his poor family is holding a vigil outside the ICU (mostly crying), just hoping that another organ becomes available within the next few days (because again, you don’t last long). I walk by every day and look them in the eye, they don't look mad, or even sad really, they look helpless and afraid. I smile at them and nod, but it’s tough... it honestly breaks my heart. It's been an intense reminder of how much people rely on your answers for direction in the most vulnerable times of their lives. It's what makes my job the best and the worst job in the world, but knowing that there are ups and downs doesn't make it any easier when it's the worst job in the world...

At this point My sister-in-law’s mom can stop reading that’s where the sadness ends...

Crankiest Story: On a completely different note, I am slowly gaining a reputation as... how do I say this... someone who can sometimes, on rare occasion, not have a lot of patience. I know... I know... it’s hard to believe. The running joke is, “M, who in the hospital haven’t you yelled at?” (the short answer is... everyone at my level or below...) Well sometimes the rants become outrageous, but I honestly don’t think of them as outrageous at the time. I am just frustrated, and this is how my particular frustrations manifests itself... as an example, the computer system at the hospital was just changed. They “updated” our old system and we are having several “unexpected” problems (really?... we overhauled a computer system and we didn't foresee any problems?... really?). Because it’s only an update, it still looks like the old functional system. This only adds to my frustration, it's like a flashlight with a dead battery.... it looks like it should work, it feels like it should work, but it could not be any more useless... I guess that makes it more like a Democrat (but that’s neither here nor there). So after my work comes to a grinding halt for at least 2 hours on one particular day... I call the complaint desk, and the following exchange occurred:

Me: Umm... the charting program is down...
Her: What seems to be the problem?...
Me: Umm... the charting program being down isn’t enough of a problem?...
Her: What do you mean down?
Me (feeling myself getting snippier... see how I make it seem like I can’t control it? I'm like the incredible hulk of snarkiness): Ummm.... what part of down is confusing to you?... awkward silence... I mean, the program isn’t responding. And frankly, it’s really frustrating...
Her: I understand, but hopefully it won’t be down much longer...
Me: (avoiding the urge to ask her what she means by down) Ummm... Much longer?... are you kidding me?... This is ridiculous! How am I supposed to work if my sole means of accomplishing my job is taken away from me by circumstances out of my control...
Her: I understand sir...
Me: I’m not so sure you do!.... how would you feel if every day I came into your job turned off your computer, unplugged your phone, and stared at you for hours at a time? How much work would you be able to accomplish?... Well that’s how I feel right now... and it’s not a pleasant feeling....

The conversation of course ended with me apologizing for the problem not being this particular person’s fault and saying I didn’t mean to be mean to her. But man... I was on a roll... And yes, I’m trying to be nicer... but sometimes mean things just come out, I mean you should have heard what I said to the guy who runs the pizza line in the cafeteria...

UPDATE: After three long days (roughly 45 hours for me... and about 3,287 passes by the crying family outside the ICU) the guy finally got another organ... which he received and is doing great now... so long story short the family cries less...

Uncreative Title....

So now that I'm almost two months into this whole residency thing, I thought I would include an update along the same lines as my last one. You know, "Funniest," "Most awkward," "Most annoying..." and other such memories that struck me as memorable at the time... Honestly, (and you may have noticed without my saying so) I'm really verbose... I know... I know... it comes as a surprise, but it's true. So I decided to break it up into more manageable single stories...


On that note, here's the story I dubbed as Most Speechless Moment:


I was working on the floor (code for hospital) one day, and I got a call from my Chief Resident (code for “One of My Many Bosses, aka the Highest Resident Boss on my team). My chief says, “Intern (code for me... some day I hope to get a name), go see Ms X in clinic and tell me what you think.” Now a little background, my chief was in the operating room and not able to go see this lady so he asked me to... which is cool because I get to do things I normally wouldn’t be asked to do. I also get to see a patient and make a decision with at least the 3 minute walk down the hall before someone tells me what to do. (More background) Ms. X is a 63 year old woman who had been in the hospital the week before. She had a big wound that was now draining some clear fluid and needed someone from the team to see her (don't worry this is not terribly uncommon and very treatable). I show up to clinic to see her. I find her there with her sister (who had been taking care of her at home.... clearly two "women" cut from the same cloth). She’s sitting there in a wheelchair with her nightgown on and we had the following exchange:

Old Lady: Oh Dr. P, I’m glad someone that I know came to see me. I’ve had a lot of drainage from my wound and I’m worried (not her exact words, but you get the idea).
We talk for 20 minutes (which is a long time for me)... and at the end of 20 minutes I recap everything we talked about (I’m an excellent communicator... I get it from my dad).
Old Lady (in a very Southern-elderly-woman-accent):“Why no Doctah P, I believe that’s everything... unless there’s something else you’d like to tahlk about?... What should we tahlk about?... We could tahlk about sex if wahnt?...” (Her and her sister giggle wildly.... and I mean wildly...)
Me (probably blushing):....
Me:....
Me:...
Me:...
Me:... Well Ma’am, I’m not sure how much I could add to that conversation, so I’ll just get goin’ now (apparently, I have a printed Southern accent)... I will be back once, I have talked to your surgeon...

Her and Her sister: Still giggling wildly... “Ahlright Doctah P... we'll see you in a minute”

Me:... Ummmm.... "Alright... Ma'am?"

One down.... Eighty-three to go....

The first month of residency is behind me… seems like a good time to reflect on what my most memorable moments were for me…

• Loved peds surgery… definitely keeps it on top of my list of career options
• Making a ton of great friends among the residents… Really excited about spending the next 5-7 years with them…
• Rounding alone with the attending for the first time… It was cool because, normally we round as a team (which consists of 4 residents and 5 medical students) with the attending. Usually the attending listens while only the chief resident talks about the patients. The rest of the team usually only get asked either general medical questions or random tidbits that our chief doesn’t know off the top of her head. Doing it alone made me realize that I was more familiar with the intimate details of their care than I thought
• Doing a whole operation… even though it was only the removal of a port used for chemotherapy (making it neither difficult, dangerous, or all that interesting), but it was cool to do every step by myself (with direction and supervision of the attending of course)
• Not sleeping nearly enough… but that’s what I asked for…
• Signing out on my last night, and realizing how much I learned and how well I knew my patients
• Missing my family… but don’t worry only 83ish months to go right?.... right?...
• A new addition to the family
• Seeing how fast the G-monster and the A-lady are growing… tough to see kids every day and not think about those two…

Funniest hospital story: It’s sometimes sad to see how institutionalized some of the really sick kids become. They know the doctors, nurses, and details of their care better than I do, and you’re just grateful you didn’t have to go through childhood worrying about things like that. However, sometimes it leads to funny stories… When I was getting ready for the case I mentioned above about removing the port (it’s a catheter that can be left in someone’s vein for a long time so that you don’t have to get an IV placed every few days). The kid is in remission and doing great so the port is no longer necessary and coming out. He tells us how excited he is to have it out because he hates it… but he also hates, hates, hates anesthesia. He doesn’t want the anesthesia induced by the IV or the face mask because they both make him nauseous. We tell him can’t take out the port without it… he thinks for a second smiles goes, “FINE!” Sticks his finger in the air like a little general and goes “But I want Zofran after!” and lays day on the table with a smile. Now Zofran is an anti-nausea medication… and maybe you all know that but it was probably the last thing I ever expected the little guy to say… the whole room was laughing, including his mom.

Funniest outside the hospital story: I was having dinner with a collection of residents. We were at a medicine resident’s house, and she was talking about how much she loved Twilight. Some people were giving her a hard time, but everyone was talking about the movie, vampires, and a lot of other things my older
brother would love… to roll his eyes at. In the group is the girlfriend of another medicine resident (she’s a senior dental student and a super nice girl, that had never met me before). The conversation turns to the storyline of the book. Someone mentions that the author is Mormon, I think in a nod to the only Mormon in the room. The dental student says, “I know! I heard there are a ton of Mormon themes in the book…” (dramatic pause….) Looks left… looks right… smiles, and says, “Are any of you guys Mormon? (Silence falls on the room and worried looks cross some of the faces) Because…” At which point I interject, “I am…” Now this might be hard for you to believe but sometimes people have trouble knowing whether I’m being serious or joking (apparently the spectrum of my emotional expression ranges from sarcastic all the way to sarcastic)… She looks at me surprised, “Are you serious?...” I responded with another grin, “Uh, yeah…” She responds, “No you’re not… are you serious?....” As she flounders a little, the other three people who know me at the table say, “He’s Mormon…” (Awkward doesn’t begin to describe the mood… it is better described as excruciating… for her of course, because I was dying both inwardly and outwardly). She quickly explained how nice the Mormons at the dental school were and how much she respected Mormons… we made it through the rest of a very pleasant dinner, but I don’t know how many times I’ve seen people from the dinner and asked them, “Are any of you Mormon?...” and gotten a big laugh… Now if I can get that nice girl to stop feeling bad about asking such an innocuous question, the story will have a happy ending.

Adventures in Haircutting...

One of the fun parts about moving to a new place is trying new things. New restaurants, new cultures, new sights… However, that’s also one of the bad things about moving to a new place. When you think about the hurdles you cross in a new area, one of the most underestimated hurdles is the haircut… I know what you’re thinking… “He’s such a man! Why does he care about his hair?... I mean I thought he cut it himself with a piece of broken glass, for Pete’s sake?” And you’re absolutely right… maybe I am obsessing about this a little more than I should. However, as I moved from Utah to Milwaukee (where it took me 2-3 disasters before I settled on a place) and now to Chapel Hill I’ve had some interesting haircuts… Here’s the highlights:

• When I first arrived in Mil-town I was getting ready to go do dinner with some friends. Without saying too much I was definitely trying to impress the people I was going to dinner with, so I figured I’d get a haircut the day of this particular dinner (I mean nothing impresses people more than good personal hygiene). With all of my nervous energy, I head to the nearest SuperCuts (or something of that ilk)… the kindly haircutting fellow says, “How do you want your haircut.” After a moment of stunned silence with the classic, “Ummm… just a trim… I guess.” (I almost said “Like my mom always cuts it,” but figured it probably wouldn’t have gotten me as far as the answer I actually gave). He proceeds to start cutting, I relax a little bit until a moment later when he says, “do you want me shave around the ears?” Now, I had definitely memories of my mom shaving around my ears (although I couldn’t say with any degree of certainty whether or not it was during the same period that she was giving me mullets), so I gulped and franticly said, “Yes!” He proceeded to give me what I can only describe as a bowl cut for my ears, with a good half inch border all the way around. Now I have no idea whether the people I met that night even noticed, but I can tell you it’s hard to be yourself when you feel like you have a haircut that Opie Taylor would’ve made fun of…

• This is by far the most surreal of the stories… A few months later (after a busy test week in school) I decided to spend my Saturday off with a haircut. I proceed to find the nearest GreatClips-type place (and I will always remember this one as the definitive reason that I will never patronize one of the places ever again). I get in line and I’m called by a sweet little Chinese lady (I know she was Chinese because she told me she was). When I say sweet, I mean it… Definitely one of the nicest most caring people I’ve met in a while… I guess that’s why I feel bad when I tell you that her accent made her impossible to understand… Luckily, this sweet lady and I both admitted, at some point in the conversation, that we both speak Spanish (although my definition of speaking Spanish was definitely different than her definition). How do I know what exactly she described as “speaking Spanish?” Well because she proceeded to spend the rest of my haircut, speaking broken Spanish to me through a Chinese accent. The result you ask?... my hair was three inches longer in the back than the front (literally 3 inches!). I asked her, in both English and Spanish, to maybe take a little more off the top, and like the fantastic stylist that she is…. She took a little more off the front, before whipping the cape off with some Spanish flare…

• After completely swearing off bargain basement hair stylists, I went to a salon in CH (whose name we won’t reveal here). After getting a decent haircut, we went to the shampoo bowl. Unlike conventional shampoo bowl/chair sets… this chair did not move up and down… the bowl did. Only this bowl just tilted, and instead of allowing me to rest my head comfortably in the bowl it was like having a plexi-glass shovel rammed into the base of my skull. If this exact chair wasn’t used for shampooing hair in Medieval dungeons it should have been. So instead of spending the entire shampooing thinking relaxing thoughts, I spent it wondering why me? What had I done? The pain was definitely overwhelming and definitely enough to make me decide this salon is not one that I’ll continue to patronize…

I haven’t lived in Utah for a little over 4 years. Of all the things I knew I’d miss about Utah (the Jazz, the mountains, the hunting… well maybe not the last one), the one that I miss the most with absolutely no idea that I would’ve missed it this much are my mom’s haircuts. I mean between ear-bowlcuts, Chino-Spanish reverse mullets and the torture chair of death… I’d almost rather have a real mullet with lightning bolts, so long as it was my mom doing the cutting… you really can’t beat it.

Newbie...

So I've got a new job... you may have heard (link the graduation post). For those of you who don't know I started on pediatric surgery, and it's been a steep learning curve (especially, since my fourth year of medical school would never be described as "rigorous"). Every fifth day, I take call and cover the thoracic, urology, and trauma surgery services. That means that on call I cover anywhere from 50-65 patients (some of whom are in the ICU, and way too complicated for me... which means that if it's serious, I cover them by immediately calling someone else). It's definitely a far cry from a fourth year full of transfusion medicine, radiology, noon quitting times and a little bit of golf. The adjustment; however dramatic, has been a smooth one and I've never felt overwhelmed (there are too many people around waiting to take over for any feelings of inadequacy to set in). However, it is frustrating to be reminded on a daily basis that although you've spent years in school, you have very few practical skills. It's like getting punched in the face by Mike Tyson, only he's wearing pink boxing gloves with extra padding... so while there are plenty of benefits to pad the new job and make it look pretty... you're still getting punched in the face.

The pink gloves and padding...

• Every time, you page someone/return a page and the overhead intercom calls out Dr. P....
• When pharmacists call you on your day off to clarify prescriptions, that you wrote...
• When you walk into a room, and speak with parents and children of are sometimes rather sick and you get to see the look on their face when you can give them more information about their child's hospital course...
• Making a decision late at night, and finding out the next day that it was the decision the real doctors would have made...
• Getting paged by a nurse to do something, because hospital policy states that only a doctor can do it...
• Doing a procedure on the floor that someone else couldn't do, and successfully doing it...

Punches to the face...

• Answering the page, to learn that it's only your co-intern looking for someone to go to lunch with... and you can't go because you're busy.
• The clarification is only necessary because you prescribed a tylenol suppository for a 15 year old, instead of the oral medication like every other 15 year old in the world gets (it's only happened once)...
• The look on the faces of worried parents when, fifteen minutes after you've given the parents a long drawn out explanation, the attending comes in and completely contradicts everything you just said. Because he just got off the phone with another attending because they didn't want to talk through the intern...
• In the morning you learn that the correct decision you made over night, was neither important nor necessary (i.e. the nurse didn't see the order already in the chart)...
  Learning that hospital policies are silly and require stupid things like a doctor pushing down a plunger on a syringe... and of course you have to walk clear across the hospital at 3AM to do it...
• Doing the procedure and no one ever knowng, because the nurse never paged anyone else... so all your superior have to judge you are all the mistakes/"I need your helps"...
• Realizing that after all this, you've never loved your job more... So while someone who loves being punched in the face is clearly not a logical person, at least I'm a happy one...

Well off to bed... The hospital needs its punching bag...

If It's Real...

I’ve been through a lot since my last post… short recap of my trip to Utah:

• Family dinner with the Riddle Family
• BBQ with the Soelberg’s
• Teaching Matt how to apply an arm bar (including offering my own arm for him to practice on... he will debate who's actually made the decision to allow him to use my arm... him or me, but I maintain that it was me)
• Trip to St. George with Greg, Nat & Garrett (in which Garrett did his best 3-hour impersonation of a stabbing victim… I don’t remember teething being that bad…)
• Dinner at my favorite restaurant with 2 of my funniest/coolest cousins
• Trip to Golden Corral with the Phillips Family, in which my dad was suspiciously absent
• A smattering of blind dates

Needless to say, a lot happened during that trip. It’s hard to describe how much fun I had seeing everyone, and it definitely got me ready to head back to North Carolina.

Which brings me to the present… I started orientation for residency on the 17th. We practiced suturing in the morning and then in the afternoon it was off to the ropes course. For those of you have done a ropes course, you know exactly what I’m talking about. For those of you that haven’t done one, let me see if I can paint you a picture.

The way I figure it, the ropes course was probably invented by two friends (not unlike me and my best friend… very similar in a lot of ways, but extremely different in many many ways). The first friend (we’ll call M. Ropes) was probably like a modern version of Robin Hood… you know... into climbing trees, ropes bridges, cargo nets, and what not. Basically your average Man’s Man. The second friend (we’ll call N. Course) was much more touchy-feely and preferred to talk more about his feelings than to climb through trees… definitely the more sensitive of the two. So these two get together, and turn a portion of the forest into an obstacle course where you talk about your feelings... like Boot Camp for your feelings...

It was a lot of fun to do the ropes course and to get to know the people that I’m going to be spending 80 hours/week with for the next 7 years of my life. Everything was great except for the leader of the ropes course Dan (picture a young, chubby Mr. Rogers with short shorts on). During one portion of the course Dan asked each one of us to describe “how residency would be like an island for each of us.” The following exchange occurred between Dan and a resident that I’m calling Steve:

• Steve: Residency will be literally be like an island for me because I am going to be alone for a large portion of it. My wife doesn’t finish PA school until December so she’s staying in Texas until she finishes. I know it sounds cheesy but we’ve been married for almost 3 years so it’s going to be hard to live away from her (PS great answer… completely appropriate).
• Dan: (Dramatic Pause… wrinkled brow… pursed lips)… Steve… (another dramatic pause… apparently nothing says ‘I want this exchange to be uncomfortable’ like a good dramatic pause) If it’s real… (dramatic pause... clearly Dan is the Michael Jordan of dramatic pauses) It’s not cheesy…
• Steve: Afraid to answer….
• Awkward silence…
• More Awkward silence…
• Dan: Alright (dramatic pause… really driving his creepiness home)… who’s next?

After this and a few other awkward exchanges, we went to a ropes course that involved walking on a cable that was 30 feet in the air. This particular cable had another cable 10 feet above it in the air (for heaven knows what purpose)… they asked us get into groups of two and help each other across the cable… My partner and I had the ingenious plan of using our belts to make a zip line out of the higher cable (we of course would spring this Tango & Cashesque plan on the group once we got into the tree). As we’re about to ascend to the tree tops, Dan notices our belts hooked together in my partners pockets. Dan realizing what a liability this would be immediately makes belt-zip-lines illegal in this particular activity. As we protested Dan reports to us that it would be too much of a liability.

I responded, “Ummm… (dramatic pause) Dan… it’s ok for us to climb 30 feet in the air? But not use a zip line?... what kind of s@#$ is this?...”
Puzzled by my inquiry Dan responds with, “Shut the heck up and climb....”

OK, he didn’t really say that… but I didn’t ask him that question either… So I guess it's a wash. The good news is that I’m loving residency so far, and the people I work with seem to be amazing and I couldn’t be more excited about them.