Monday, March 3, 2008

My month in Kenya

Just some reflections on my month abroad to the mountains of Kenya taken as part of an elective. As you may know I hate residency and my program in particular so my month abroad was a breath of fresh air. This was in spite of the fact that 1000+ civilians were killed just for belonging to the wrong tribe and I had to ignore an evacuation request from my overseas coordinator. So I either hate my residency so much that risking my life in a dangerous country was a needed break or the thrill of being in a volatile third world country, "got my juices flowing". The answer is obviously a combo but mostly the second.

So just a couple of blurbs noted from my particular region, the mounatins of western kenya; No electric, no TV, no landlines, and no cold beer.

Firstly while there were none of the obvious amentities noted above there was no shortage of smiles. This is on stark contrast to all the grumbling going on in our hospital myself included, which reinforces the expression, "money doesn't buy happiness".

Secondly there is no stopping soccer internationally. The children would wrap up discarded plastic bags tie them into a ball and you have 20 beaming children playing a competitive game of "football". This goes to such an extreme that even without formal electric some entrepreneurial individual bought a satellite dish, generator, and (warm) beer from some distance away and beamed in soccer games and news charging 7 cents admission to hopefully eventually turn a profit.

Thirdly people do not play the sick role as they do in the US of A. Everyday in the morning all the patients would walk or would be assisted into our field, hang out in the sun, and socialise until evening when they would return to the ward and retire for the night.

Sickness witnessed: Malaria, typhoid, dehydration, gun shot wounds.

Not witnessed: Fibromyalgia, irritable bowel, diabetes, or heart attacks.

Which country would I rather live in? Kinda hard to choose but I would be lying if I said I wanted to leave, almost cried when I left.

Friday, November 9, 2007

ICU attendings Who the F--- do they think they are ?

Doing my MICU month now as a resident. I am lucky in the fact that my intern already finished a speciality in his country so HE knows what to do in case of emergency. What I noted though in the ICU is the God complex these attending's have. We had a case this week of a very sick patient. She was on a ventilator because of a pneumonia and her kidneys shut down. The only way for her to survive and possibly recover was dialysis. That's where our attending's and "ethics" panel come in. The husband married to her for 50 years wanted everything to keep her alive, she wasn't some demented Alzheimer like patient, but was alert and oriented with her mind functioning perfectly. Our Ethics panel though thought differently. They wrote in their opinion that she was a sick lady and dialysis would be of little benefit because of her age and illness. Now I don't disagree that this women was ill and a few months or years later would not return with another pneumonia but it would have made a world of difference for him to have his totally functioning wife back for any period of time. Instead we let her lapse into a coma and die.

Monday, October 15, 2007

My month in the ER -get the drunks and homeless their own place

So I spent the last month in the ER. Unfortunately as medicine residents they dump the worst possible shifts on us, IE I had overnights for almost all the weekend nights and was placed in our level 2 and not level 1 trauma center. All in all though it was quite an enjoyable experience. The ancillary staff (for the most part) are not lazy, the nurses flirt a little more, and things run a little smoother. Not in the least bit you also get a little more respect due to the glamorization of ER by the media". One of my last nights I saw these two drunk (and quite beautiful) girls come in after a nights of drinking and flirting (she was getting divorced) and one of their first comments was "this is nothing like ER we had to wear breathing masks after being placed next to the homeless guy". I guess the ER is the great equalizer.

Looking back on this month there were some memorable moments. Things were generally quite busy since in NYC they closed down many hospitals in our area so we must absorb all the excess. In addition our shortsighted and cheap ass administration never added any new house staff to accommodate the new influx so spending our short staffed resources on drunks and homeless that just wanted a warm bed was a bit on the frustrating side. Don't get me wrong I feel bad for the homeless and do not want to throw them on the streets but there must be another way to help them out rather than wasting our time medically evaluating someone who clearly just wants some food and shelter. My beef with the drunks is that these bums come get evaluated fed and accommodation and never pay a dime. Why can't we charge these guys in some way for example, for every visit they must commit some community service to pay off their debt, medical care may be a right but what these people unfairly due is not.

On the lighter side they do provide the occasional entertainment, like the guy who starts peeing in middle of the patient care area and the hostile drunk that starts punching the wall (he broke his wrist) before threatening us (we call security who come running down after him). My life has already been threatened a few times, so I hope I don't meet them in some dark alley drunk.

Thursday, August 23, 2007

two month's down ten to go

Getting through 2nd year now. Just finished floors, really tough, managing 20 patient's isn't so bad but learning 5-6 new patient's a day is. Fortunately no one died on my shift though I must admit to two "casualties" both whom were leading relatively normal lives prior to arrival. One of those is now questionably permanently demented and the other is so weak she had to go to a nursing home upon discharge (also hopefully temporary). 80 hours a week also is bullshit though it is without a doubt easier now with the new laws in place than it was 20 years ago where 100 hrs plus were the norm.

The big thing with our hospital is that it is run corporate like. Unfortunately the corporate honchos in our facility know little about business planning or what the world calls foresight. Therefore instead of hiring more staff we are woefully overworked and people are dying as a result of it. One lawsuit can easily pay for the staff necessary to have prevented the problem in the first place.

As for me, still pondering fellowships. In the meantime looking forward to an out of country elective most likely Africa for 5 weeks but can't shake off the desire to experience Baghdad.

Till next time Tada

Wednesday, July 11, 2007

My new life as a resident, Let's save some lives!

Finally done with Intern year, it didn't end soon enough. Now I have the glory of minimal scut work but real responsibility. Stuck with responsibility of peoples lives vs making the interns life hell. Trying to save the night float intern last night from scut almost ended in disaster, so much for compassion ......I guess you must be cruel (to the intern) to be kind (the patient) as the song and Shakespeare lament.

I have also reconsidered my thoughts on eugenics (vis-a-vis survival of the fittest) and now believe in saving lives. Not that I no longer believe in the theory but now I realize that saving lives really does support the theory in that those with better genes will more likely seek out and receive health care.

All that is left is for me to justify an upcoming medical trip to rural Africa I plan on taking in wintertime.

PS Update on my personal life free again after 2 1/2 week relationship 4 weeks accd to her. BTW why are men expected to move for their GF can't they just yank a friend that is free and that lives nearby? What am I some cheap ass mover with nothing to do with my free time that I should shlep across town for work that can be done in 1/5 the time by anybody else. You need not fear I refused.


Wednesday, June 6, 2007

Where have all the hot women gone?

Just got dumped by some blind date that I was set up with. I wasn't upset that I was dumped by someone that I loved as obviously I wasn't since it was only a second date and we really pretty much disagreed about everything. The thing that upset me was that she was pretty , or at least pretty to me, so I tried my best to get together with her even though it meant arranging my schedule to see her on HER spare time which in hindsight I feel like a real sucker and really "whipped".

She had every right to dump me but I hated the reason, "we are very different". For me different is something to be cherished it gives you something to talk about and discuss, that is how we learn, I was truly interested in her rather non medical profession which was very non high power anything and political views as simple and unsophisticated as they were. She considered me opinionated. Well if having opinions is a crime, your honor, I am guilty.

I really wish I could be attracted to all the 35 -40 year olds usually divorced that write to me on line. I feel cursed, in a way that I am attracted to pretty women. Who is attracted to the older unsexy women? Do they just date them because they can't get who they really want. For now I will hold off on dating the ugly "chics", at least until Sat night.

Sunday, June 3, 2007

Stop the FAT people !!!

As I slave away sacrificing my life to medicine I would like to think that I am actually doing something good at the expense of my own personal loss, though I have have always had this nagging question in the back of my head.....Am I actually helping society?

There are a few reasons I question if it is actually so. The first is from an evolutionary perspective. If evolution is so efficient, which it is as you marvel at the perfection of the human body and nature in general, who am I to interfere with its own "weeding out" process of those that are sick as representative of a genetically inferior class? How can we do better than nature running its course with "survival of the fittest"? (This only applies to those of reproductive age as those that don't procreate anymore i.e.those post menopause and ill will not contribute genetically inferior offspring, and keeping these sick people alive may actually represent the altruism "gene" which is advantageous to the species in general.)

Secondly I question if medical treatment is actually beneficial to those sick in general. There has been much research in general about iatrogenic (phyician induced) morbidity and moratlity. If taken as a separate disease it would rank as the leading killer. I have seen firsthand that these numbers are certainly underreported. I would say that at least half of the people in the hospital are admitted for reactions to medications such as rebound hypertension (the blood pressure shooting up after somone forgets to take his medication) or hypo/hyperglycemia (too much or too little sugar in the blood almost always induced by either taking too much insulin or by stopping abruptly their diabetes medications.)

I personally am a big believer of evolution and believe (with many others of course) that the route cause of illness is the rapid progress society has made without the ability of the body to adapt genetically. Therefore we have too much food and we still have the appetite "genes" that remain from when food was scarce (see Time magazine dated this week)hence the rampant obesity. This imbalance has contributed to the greatest cause of not only mobidity but certainly mortality as well. Every one of the leading killers can directly be linked to obesity. WE NEED TO FOCUS ON CEASING TO TAKE THE SHORT TERM APPROACH OF MEDICATING OUR PROBLEMS AWAY. We need to eat less and exercise more if we really want to improve our health.