Behind the White Coat

Sub-I Round 2: Jacobi

I hate Medicine. This week I reached the threshold of my tolernace for some of the crap we have to go through as interns (even though I'm techincally a sub-intern, my responsibilities and duties level that of an intern at this point). I almost made the serious decision to fuck it and go back to radiology. I've treaded the dirty puddled potholes of the health care world, and it ain't pretty my friends. Hopefully it can only get better from here right? Someone give me some positivie motivation here.

I started at Jacobi Hospital on Monday. My first month was at Einstein-Weiler Hospital. A nice clean relatively new building, with a lot of private attendings and private patients as well as the service medicaid and uninsured population. Now, I am in the city hospital. This hospital... Is dirty. They told me it was dirty, but I never realized it until I actually got on the floors. At one point, I was walking into a female room. There are generally six patients per room... SIX! That is a lot. Old dirty floor, the walls are this pale, stained, off white chipped paint, the old windows creaked open, the beds separated only by a jamaican-yellow and orange designed curtain that probably hasn't been changed since the hospital was built. There is mostly old, demented people who say nothing, delerious ladies in a vest restraint babbling on and on about her imprisonment, ghetto family members, poor lighting, and blazing heat. It feels like some community hospital in the depths of south america, especialy since nobody speaks English.

Of course I start 3 days before the next set of first year interns start, and it so happens one intern left early, and our resident is out for 2 days. So the last 2 days, it has been me and my intern, who granted is about to be a resident, but that leaves me and him with 2 3rd yr students to handle the whole team's patient load. I know nothing about this hospital, I cant find anything, and I have no idea how to use the computers (and everything in this hospital is done on the computers.. everything). Oh, and I was on call my second day, so 3 admissions for me, home at midnight (only 3 hrs after im 'supposed' to leave).
Then there is my current patient load. I have two demented ladies, one just stares into space mumbling, the other has this face droop and thinks its 1988 and yells at me. The third is a demented lady status-post stroke, who can barely move her left side. The next lady only speaks spanish and I don't. My last guy, a white guy who is bright and happy, is a schizophrenic. Oh yea, and he's a deaf mute. You can imagine my doctor-patient interaction, let alone 'relationships' with these patients. I actually have the most productive and satisfying conversaiton with the deaf mute--at least he knows who I am and what I'm doing.

Anyways, It has been hell. Tomorrow the new interns come, and I'll have a full team. Hopefully things will change. Oh yea, and the chief residents asked me to present one of my cases at the resident morning report on friday, in front of all the house staff and some faculty. I have to present the spanish lady I have, who has this bad anemia, and nobody knows really from what, but maybe a combination of iron deficiency, Bone Marrow suppression from her rheumatoid arthritis drugs, anemia of chronic disease, and hemolysis from her mechanical mitral valve. Great. Oh and she may have pulmonary fibrosis from taking the anti-arrythmic drug, amiodarone. I know about as much about that stuff as you can understand what the hell it means. Oh lord let the month end so I can at least have my weekends back! Saturday call... can't wait.

Tribeca Grill

Talk about a hectic week... and it's only Wednesday! I am so bitterly exhausted I just have to sit here and bitch. I guess that's what I get for going out the last few nights and staying up late when I know I have to wake up at 6am to face another grueling day on the wards. But shit, you gotta live a little right? Am I gonna pay the price when I have to prepare my supposedly grand presentation on Diastolic Heart Failure for tomorrow's attending rounds? Probably. But at least I ate well last night...

This is a joyous week in new york city... That's right folks.. Restaurant Week--2 weeks out of the year where all the top notch, bling-bling, suck your corporate account dry restaurants will offer special menus featuring 30$ prix fixe dinners, and 20$ prix fixe lunches. Considering the normal prices of meals at many of these joints, that is a bargain. (Though you get sucked into thinking your getting such a deal, and after ordering the wine and drinks, it don't really make much of a difference in the end. Such suckers we are--but rule #1: never turn down an excuse to have a good meal!) Last night we went to Tribeca Grill. Co-owned by Robert De Niro, this place has been around for a while. It is a giant room with high cielings, where no agrophobic would feel safe. With a huge banquet hall upstairs for, I'm guessing, banquets, and a hallway to the bathroom ridden by Bobby D's movie posters. Serving up enticing nouveau-American fare, with a wine list that needs a table of contents, it is great place for a loud, spacious, happening spot for dinner with some friends if your in the Tribeca area. The square bar sits in the center, making it a nice spot for some pre-dinner drinks and conversation. There are also some tables outside to catch some summer air on Greenwhich street. Though we stuck to the restaurant week menus, they were straight from the normal options--and all tasty. Your standard array of steak, fish, and what not, but solid and served in a lively scene. They also had some of the best dinner rolls I've had in a long time! Try heading to Dylan's down the block for a post-dinner martini. The St Croix martini makes you feel the carribean-nyc fusion like you're sailin on the waves down fifth avenue.

1:30am and I have finally finished my exciting presentation. (Hours after starting this post). Tomorrow is my last call day at Weiler Hospital before I head over to Jacobi. Godbless a Golden Weekend (our term for the weekend of the month where we don't have to go in--that's what we have to look forward to each month.. Sad isn't it?). Hopefully there will be some stories to tell!

On Call Musings

It's hard to find time to actually have fun when you workin like an intern. Call every 4 days, leaves you tired as hell the remaining days, but I manage to maximize the free time that comes around every once in a while. And perhaps one day during the week when I'm not sleeping, in the Hospital, or out and about, I'll sit and write another aimless musing of my life from... behind the white coat.

I got paged the other day right before I left the hospital on a seemingly efficient day at around 4:30pm. The nurse informed me that one of my patient's fell. It was this pleasant, 84 yr old lady with heart failure on my service. She was about to go home the next day, except she decided to get up and close the curtains because the storm was bothering her. Of course she had to be a hero and do it herself, and lost her balance, and fell backwards, banging her head on the corner of the bed. "We just heard a thud and found her on the floor." I went to see her and lo and behlold was a huge gash on her head. Great. I aint ever getting home. My resident suggested calling surgery, but I'm like, forget that. I remember when my friend Puneet fell and cut his head one night out in the city (see this link), and they had irrigated and stapled him up. So I got myself some saline, hunted down a staple gun and some lidocaine, and stapled up her head. See, I did manage to retain some knowledge from surgery. Six staples later, the bleeding had stopped. Of course she began to get some weakness in her lower right leg. Not a good sign. Still gotta see the final reading of the head CT to see if there is a bleed or not. Next time you little frail old ladies, call the nurses, because nobody likes a hero, and nobody like an increased length of stay.

On a brighter note, I was sitting in the Einstein Hospital cafeteria eating dinner with my resident and intern the other day while I was on call. They ran off to do something for a few minutes, and I was left alone eating my meal. In the table next to me sat down this cute girl I've seen around with a couple of med students doing cardio consults. I started chattin her up, and learned (from the accent before she even told me) that she is a visiting med student from Hanover, Germany. Of course in the middle of my conversation, my resident returned, as did a friend of mine who decided to have a seat. Clearly they saw I was talking to this girl, but they came and cockblocked me anyway. So I pretended I was paged, walked to the phones, and then went and sat next to her on the way back, and got her number. Pretty smooth. You gotta maximize your time I say, even when you're on call, sitting the hospital cafeteria. One old lady down, one young lady's digits--all in a day's work. Now I'm about to go to my 24 hour call Sun overnight, 5pm to 5pm. It's gonna be a long night, hopefully something interesting lies in store tonight!

Overnight Call and Smith Girls

It is now almost 12 midnight on the night of my first overnight call--what a way to spend a saturday. You arrive at bout 5pm and take all the "sign outs" from other members of the team, that is the information on their patients so that you can handle anything while they are at home. So far it hasn't been too bad, especially since I discharged all my patients on friday, so I have basically have been just ordering motrin for aching patients who I am covering. I just finished my first admission which came in at about 10pm--sweating and dizziness, probably because her BP was 220/100, but nothing too difficult really. But alas, one of our team's patients had to go in for a bleeding scan for a rectal bleed--which is when they inject you with nuclear labelled red blood cells and after 2 hours take pictures to see if that labelled blood shows up anywhere it shouldn't be, like in the bowel. So now I am sitting here in the nuclear medicine resident's reading room, as the tech is across the hall eating a snicker's, and the fairly cute PGY2 resident has pulled in a cot in the corner and gone right to sleep. Now I must wait here for the scan to finish, 2 hours, and I don't even have my book to read. Thrilling. But I can recount my adventures from last nite--and boy it was a good one.

Last night I managed to go out and reak some havoc in the city. I got my Saturday daytime call swtiched to overnight (because day call would be 7am till 9pm and then I'd come in Sunday from 7 to 11, but overnight is from 5pm to 11am, so at least I could go out on Fri and Sat!). We went to Suba to eat dinner, this tapas place in the east village. Very sexy decor, especially the downstairs. The menu looked fantastic, too bad we just ended up drinking there for 2 hrs because we had almost 15 people and never got a table! I even ran into 5 kids from my med school there, who said the food was quite good. But I trust no-one, so I'll have to go back to taste the food one day. After dinner we head to The Park, my friend Manoj is leaving for Ohio soon so he told all his girlfriends to come out before he leaves. It actually kinda worked, because we had a good ratio (and quality) of girls who came out. Manoj and I headed over a little later because we were talkin to these 3 girls--one was a friend of his, the other 2 a cousin and a friend from Smith... Little did I know I was going to find out later on how Smith girls really party.

By the time we got there, we were already drunk. The Smith girl promptly started grinding with both the other girls, of course we had no problem with that--the grinding later progressed to blatant lap-dancing and groping on the dance floor, and man they were really getting into it (I think they even pulled a Janet a few times). A lil while later, amidst all the grinding and booty shaking, we somehow ended up, the 5 of us, with our feet in the jacuzzi, as the girls started hookin up with each other--which later progressed into more fun for all of us. I won't go into the smutty details, but let's just say it was definitely a fun, interesting, and quite entertaining night for all--even all the patrons at The Park who pretty much got themsleves a free show. By the end of the night, our group of 15 was down the two of us and the three girls, but hey who's complaining?

We've had some crazy nights out in the city, but fri nite was legit... The best change in my call day I have ever made.

Late night, after a stop at Neilav's to regroup and refresh, I got home at around 5:50am, and slept at 6:30am, waking up at 4pmish, an hour before my call began. The idea was to sleep all day so I could be awake all night. But here I am, only 12am, and I am ass tired. I guess when you are doing jack-shit, and it's late, you just get tired. Though I should be careful what I ask for... Any minute now a patient is gona crash, they are gonna call a code, and I'll be running upstairs, pumping chests, and cracking some ribs.

Bring it on...

I See Dead People

Week one has come to an end of subinternship. Two more months of my life as an intern to go, and boy did I ever get a taste of what is to come. As fourth yr students, they pretty much give us full autonomy in carrying our patients, except that our orders have to be cosigned by a resident (thankfully) since we aint exactly MDs yet. The week started off ok, I had about 2 patients I was carrying, and was just learning the ins and outs of the hospital and how things run. Then came Friday, my first call day. That is when the training wheels came off, and I was throwin into the fire like a piece of raw tenderloin, and sizzled and crackled in the flames until i was burn to a crisp. Let the games begin.

The day began pretty normally. In at 7am, get updates on my patients, work rounds with my resident and interns at 8am, and then round with the Attending at 9am. Around 11am I still was carrying my 2 patients, and I worked to get one of them discharged, and then my intern signed out her 4 patients to me while she went home until 9pm. (Since she was on overnight call, she could go home and sleep until 9pm, I guess that is supposed to make a 24 hour shift OK, but who can sleep between 12 and 8pm??). After that the chaos began to ensue.

After noon conference which ended at 1pm, my pager would not stop going off. When you first get the pager as a med student, nobody ever pages you, you just carry it around hoping to get pages to seem like ur important. Not anymore. Now, since I'm cross covering patients too, and these patients are sickly ill, I get paged by the nurses for every little thing. It never ends. And since this is my first week, and I'm suposed to be acting like an intern, I really don't know what the fuck I'm doing!! It's kinda scary at first, you're just throwin in there and they are like, "Go getem tiger." I'm like... "uhh grrr?" It is pretty pathetic. Lucky for me my resident is real nice and helps me along with what I need. So my integration has been pretty smooth. And now people start calling you Dr. They are like, Dr. Haider, blah blah blah... At first I'm lookin around like, who? Dad? Ohhh.. I mean.. yes.. that's me. Now I don't even say "Hello, this is Ali Haider, Subintern." I started saying "This is Dr. Haider, SubI." But now, it's just. "Hi. I'm Dr. Haider." Has a much better flow to it, and it rids me of the demoting suffix of "SubI." Good enough for me.

So until about 4 or 5pm, I was running around drawing bloods, checking labs, calling consults, following up on consults, checking on patients, and what not. The hours really go by fast when your running around without a moments rest, not really knowing what the hell your doing. Finaly I get my first admission at like 7pm--real late considering I'm supposed to be on call until 9pm. So I go see this guy, and I say "what's wrong," and he tells me in broken English and a spanish accent: "Doctor, I see dead people," I let out a sigh. It would be a long night.

You learn to deal with many of the basic complaints people come in with, but then you'll get this guy with a hudred problems, and stuff you just can't figure out. This guy had hypertension, coronary artery disease, history of strokes, and now he is in atrial fibrillation (an abnormal heart rythm), and he is having visual hallucinations. He really was seeing dead people, the way they died, just like in Sixth Sense. It was pretty freaky. I was like, the guy is on acid or something, but he was like that for weeks! That's pretty fucked up. Well I spent hours working him up, ordered him a slew of tests and the whole nine yards. I even ordered a Brain MRI--that made me feel pretty hardcore. You see how easily we are amused?

I got a call for the next admission at 8pm, but of course we didn't get to it until around 10:30, 11 after the first guy and doing all this other shit for the patients I was covering. My next poor old lady was diagnosed with lung cancer 3 weeks ago. She is deathly ill coughin up blood lying in bed. Very sad sight sine she will probably die in a month. Of course a slew of medical problems, and I ended up finishing her at like 12:00am. The night was sl0wly coming to an end, but after being in the hospital since 7am, having a tunafish sandwhich for dinner, I was losing it. I really think I was the one now who was seeing dead people. My resident and I started becoming a little delirious, but of course there were still a few bloods to be drawn and tests to be ordered. Delirious residents and interns at 12:30am trying to save lives. That is reality baby.

Finally I got home at like 1am, 4 hours past my intended time. Of course this was the night every friend I knew was going out to party. I had about 10 missed calls, and all over the city my friends were having fun, and here I was. I had to go hom and sleep, and wake up at 6:30am to come back to the hospital to present my patients. We rounded, presented, wrote notes, ordered consults on all the new patients, and took care of the ins and outs and what nots. I finally got home at 330pm, exhausted. Ahhh the life of an intern!!

Thankfully I went out sat nite to APT to meet some friends and managed to have a good time. You learn to appreciate free time a shitload more I'll tell you that much!