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.

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.

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

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.

sayanora

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.

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.

why the f#$@ do you have that cap in your throat?

Survived the first round of nights, I was pretty lucky no one died on my watch. You must be humble as the reason no one dies is rarely related to you. A really busy night last night. There were three "Rapid Responses", the emergency level right below a "medical code" (what you see on television). Regardless with only four doctors managing the hospital you must run for these as well. The first was a "GI bleeder" she was bleeding from her mouth and rectum. She looked like death but medically speaking she was boring, not much to do since she is DNR (do not resuscitate ) and is not a surgical candidate so I called the daughter and told her her mom may die tonight.

The next two rapid responses were for an alcoholic recently arrived from the ICU (my co-interns patient) who was having difficulty breathing. I actually didn't hear the overhead the first time it was called as the overhead system isn't very good and I was either in the ED or elsewhere. They gave him nebulizers hoping he gets better. The next overhead for the same guy I came running. This guy looked like he was having a tough time I reckoned. We check the vitals Blood pressure OK but for some reason he kept getting worse so we prepared the patient for "bagging" and imminent intubation( putting a tube in his throat and hooking him up on a ventilator). As this was going on his oxygen start dropping precipitously, we are about to start bagging (helping him breath by blowing air in with a large balloon) him when the respiratory therapist goes, "first take out that thing in his mouth" ..........what did she say ?......Thing in his mouth ? Holy Shit I quickly yell to the nurses to get a spoon as my friend and co-intern turns him on his side and starts wacking him on his back. Fortunately the nurses bring me instead of a spoon a pair of tweezers. Not having done any practice in surgery or stitching in some time I was a little concerned with my hand-eye coordination, one wrong push and this is down his throat and he is dead. My first try was unsuccessful but on the next try I succeeded. The pt may now be brain dead but alive.


One other quote from a guy with a skin infection last night . "When was the last time you used drugs"?
"A few days ago I put cocaine on the infection to kill the pain, pretty dumb huh"? I told him "Well I don't know I have not heard of that before ". In theory though maybe it does work, not so dumb after all.

Beer goggles

Now that I am on night shift and can't really go out much I have noticed some nurses (I strss some see other post ) are getting more attractive, is it the late nights in the hospital or lack of any other choices all week long or maybe they are actually attractive. I really need to know before I make any choices I regret.

Nurses, are they brain dead?

My only free night here as I am now on nights, which really means the night and half the next day. All I can say is WOW! Working my ass off running around covering 8 lists following up labs and admitting 5 new patients. So I get pretty frustrated about incessant dumb pages from nursing, Examples from last night 1:00 AM "Doctor, the patient is coughing can I give him cough medicine?" I say, "sure do you need an order for it?", "No I just wanted to know".

Fine, stupid is one thing. I then get 5-10 pages between 1 and 3 am about a patient (who is a drug seeker) who wants more medication but who is under strict parameters because of his drug seeking behaviour by the day team. "No, tell him he can't get, he is over his alloted amount", click, 10 minutes later again I get paged same thing. Each time I run to answer it because it can be an emergency requiring my immediate response. The nurse tells me "but he is standing on top of me what should I do?" Call security I tell her after the 6th time what the fuck ( i didn't actually curse to her) am I supposed to do? She wants me to get the patient off her back so she can go back to her relaxation. As I go running around like a chicken without a head all I see on every floor are the nurses sitting on their chairs some sleeping, some yucking it up some talking about their next break, but one thing is clear....none of them are working. Not until 4 AM that is...

Nursing has alot of work after 4 am (meds, bp, and other real stuff) so obviously I get paged again...alot. 6 AM is my first "real" page of the night, this time 2 in a row and an overhead page within 5 minutes (I was in middle of a procedure so it took 5 minutes to return the page), it was regarding a patient who was real sick. I quickly run upstairs and start assessing the situation, I ask the nurse for an ECG as this patient was in bad shape. The response I get is, "Does that need to be done stat?" I already know where he is going, (officially nurses don't perform stat procedures). YES it needs to be done stat (you fuck) the patient is very sick, "Oh, we don't do stat procedures" I was gonna kill this guy, here I am alone trying to save this patients life and all this fuck cares about is to finish giving out his medications so he can leave on time. Where are his priorities, why is he nurse then? I myself left 2 1/2 hrs late. .....The patient died.


PS just to qualify the above, I do not feel all nurses are like this, just the ones at my hospital that share night shift with me.

Just how busy is the rest of the world?

Just to get this off my chest.

Was just cancelled on by my semi-blind date. You see this is my only free night for the entire week, not because I am going to the beauty parlor, but because I must work 15 hours a night, overnight, for the entire week. So I am a bit confused when I call this girl for a second date and tell her I can meet anytime arond the 24 hour window that I am not working and told that she is so busy she only has one hour available. Regardless I say fine and arrange my schedule and rush so I can meet at the specific hour that is conveniant for her. She then cancels at the last minute but would like me to call because she would "love" to go out again.....I don't think so

The Dilemma Part 2

Here I am, on vacation. The first few days were spent catching up on much needed sleep. But here comes the question, Do I just chill out for another week with the likelihood of being bored part of the time or do I push myself to go away just for the sake of getting away and come back to work (night shift no less) exhausted? As I ponder my question in bed the answer is coming to me by default.
tada

The Dilemma

My apologies to any of the recent comments, I haven't been on this blog in a while to comment or publish, your thoughts are appreciated though. Two issues I have been troubled with recently. The first I will discuss here. If as the expression goes, "don't s--t where you eat" applies in the hospital setting and I have witnessed many poor results (though I must admit it is always from the girl end) then who are you supposed to be physically intimate /date? Our exposure to the outside world is severly limited by the hours and schedule we put in.

I myself am lucky enough to have social networks outside but even with that I spend sooo much more time with my co-workers. In addition to working together we also all live in the same building, so if you are tired and bored you call a co-worker and not someone living 35 blocks away to hang out. So I guess I am answering my own question and you must only hope to not catch any fecal oral diseases.

The second issue will be in my next post

Why are older women less attractive?

As I was off most of the day today I had time to reflect on matters related to my personal life. This topic is not new in my head as it has been troubling me for quite some time.

"Why are younger women more attractive?" It would make more sense if we are attracted to women our age since those are usually what we get anyway. This is not a problem when we are 22 but how about if you are in your late 20's, early 30's, or even older.

From an evolutionary viewpoint it is understandable, men and women look to mate with those that will benefit themselves and the species. Younger women mean more childbearing years as well as the physical ability to assist in home building, physical labor, and protection of the young. From a woman's perspective a younger male means greater strength, this translates into having a better ability to protect the woman and her offspring, as well as a greater ability to hunt and gather food.

In our times a woman's biological clock, though improved, still exists. The ability to protect the young and home building are likely less relevant. The hunting gathering benefit of a younger male though is arguably non existent. The ability to bring in food, build a home, and protect is now related to financial security which invariably is inversely related to age.

So why can't I get a younger woman. The answer must lie in the fact that our genetic makeup hasn't caught up with society, and in the meantime I am left without a (good looking) date.

Bored at 4:55 AM

Sitting here at the above noted time. I guess I can watch Scrubs or Curb on our "multi-media" in the library but I get paged so frequently. But is sounds better than writing this blog. Fortunately nothing too exciting aside from the anxious Russian who "desats" (breathes fast with her oxygen levels dropping to dangerous levels) with her nightly anxiety attacks, and the dying black man who can't breathe and coughs up blood. We decide to give her, anti-anxiety meds, and to him some "nebulizers" to help him breathe and some pain meds. Technically speaking they are both on their way out. You see the the goal of night float is to prevent them from dying on your shift. As the adage goes "Our job is not to save lives but rather to prolong death". Till the next journey
G'night

attendings suck

just got a call today from one of the chief's , apparently the effeminate attending wanted me to cab in from across town last week and use up 1/3 of my days salary instead of taking public transport during the snowstorm. This way I get to face a room full of empty chairs earlier of the patients who themselves could not show up to clinic due to the inclement weather. It sounds like he wanted me to apologize for my tardiness instead of using my logic. What an ass. He called the chiefs on me....don't they have better things to do.

euthanasia

Let me ask you.... what is the line between killing someone and withdrawal of care. I understand the idiom of respecting a patients wishes, but how do you know that the wishes remain the same until the end.

My experience is drawn from pt "K", an individual that did not want medical intervention for his terminal illness but was completely lucid and communicative at first. What transcribed was so depressing. First he becomes DNR (do not resuscitate), then we dope him up, stop blood draws, d/c the anti-biotic, and finally stop IV fluids and feeds. The moment he would groan the family would interpret this as a sign of agitation so we slosh him again by knocking him out with more fentanyl (stronger narcotic than morphine). Maybe his groans were wishes that he wants us to save his life or at least feed him. I will never know....he passed away this past Friday.

Since when is a "respecting a patient's (initial) wishes as noble as saving a life", as my attending tells the family. This is not what I signed up for.

the ease of death

3:30 AM here so close this week to a patient dying on me. 28 year old women apparent allergic reaction . So close yet so fortunate for us both. Though I am quite certain it was a correct decision on my part man will I be more careful next time when I suspect allergies.

my first post