Charleston

So the first weekend of October, I went to Charleston, SC with some friends from work. The weekend went like this... This is a picture I took of Charleston from the top floor of a hotel we stopped at one night.

I was on-call on Thursday. Meaning I work up at 4:30 AM, and work from 5:30AM to 11:30 AM on Friday (30 work hours total). Get home, pack, finish some work from home. Leave for Charleston at 4PM (~36hours awake)... I sleep for the first 2 hours. Arrive at Charleston at 8:00PM on Friday, go out with friends until 3:00AM on Saturday. Get up at 9:00AM Saturday and go to the Beach until 4:00PM. Head downtown for dinner, go on a walking tour of the city. Go out with friends again until 1:00AM, then drive four hours back to NC so that I could go to church and my buddy could be on call. I drove while my friend slept so that he was as rested as possible for call (you have to make sacrifices to have fun.... My youngest brother can tell you all about it... he’d sacrifice ANYTHING for fun).

Story.... We decide to take a walking tour of the city of Charleston, that supposedly details haunted buildings in Charleston. What better way to kick off a night than heading out at 9:00PM and hearing scary stories. Here’s how I envisioned it... a guy looking like Vincent Price would take us around scary buildings in Charleston, as we jumped every time we heard an ominous board creak. However, in reality... our tour-guide (Stew) was more like Matt Damon from the Informant
dressed in khakis shorts, a khaki shirt, and (you guessed it) a khaki hat. The outfit was topped off with copious amounts of sweat, and the tour consisted of walking past (not into) “haunted” buildings, as Stew told us 3 historical stories and 1 anecdotal story (that was originally past on by none other than Stew Jr.).,

Stew’s story telling ability also consisted of the recitation of these stories complete with awkward, forced pauses for dramatic affect. (Note: these pauses were often ill-timed and just long enough to be annoying). Let’s just say, it wasn’t exactly “enthralling.” In fact, it was boring enough at certain points that, believe it or not, my friends and I become... ummm... disruptive?... Literally, I think it took about 2 minutes before my first obnoxious comment. It went something like this...

Stew takes roll of all the people who have paid to be on the tour, and the following exchange occurs (a picture I took during the tour of the renovated basement of a building 2 stories above where a pirate dungeon used to be).

Stew: I would like to welcome you a tour of historic Charleston. Charleston was founded in 1670, and consists of (rattles off statistics about the number of original buildings that exist from the 1700’s, 1800’s and early 1900’s). Do any of your have any guesses about what the most historical city in the U.S. is?
Simultaneous - Everyone in the group with a pulse: Ummm... Charleston?...
Simultaneous - The Lady without a pulse: Ummmm....
Stew: I’d also like to remind everyone of the city of Charleston’s motto, Aedes Mores Juraque Curat (She cares for her temples, customs, and rights), but she does not care for her sidewalks, roads, pavements, alleys or paths. And believe you me, this tour is a lot better vertically, than it is horizontally. So please be careful as you walk this evening, and watch your step so that there aren’t any injuries due to stumbling or falling.... (one of the soon to become patented pauses)....
Me: Wow!... That’s a long motto...
Everyone but Stew: Laughing....
Stew: Still pausing...

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...