Behind the White Coat

No Limit Texas Holdem

That's right folks, it's the new craze: No Limit Texas Holdem Poker. If any of you even flip through ESPN or ESPN2, you have undoubtedly come across the hottest craze in competition, and that is Poker. I think ever since The World Series of Poker started getting a lot of airtime on ESPN, everyone and their mother has started playing. Our games began a few months back, when some dusty poker chips and a deck of cards came out as we watched Moneymaker take down Farha in the 2003 World Series. After that, our tradition has been playing our 50$ buy-in, 4-6 man game of Texas Holdem while watching the world series of poker or popping in Rounders DVD (which I have seen a shit load of times by now.) Anyway, a slew of our friends have their own games going on now, and we play at least 3-5 times a week. (If you don't know the rules, bare with me or quickly read this.

Last week we discovered that the local bar across the street from our med school, Gleasons, just started a tuesday night Holdem Tournament. 50$ buy-in, top 3 players will get paid, and with 30 people, first place rolls in about 800$--not too shabby. So about 4 of us go on Tuesday and sitdown amongst 27 other local Bronx heads. The scene was pretty interesting, you got your local bronx guidos with the whole gold chain and "howyadoin" look goin on, we got the couple of fireman with their cigars, the one real fat italian guy who we have labelled "Goose" as in Tony Siragusa, and some other random punk-kids and low-tier Bx thugs. Hardly professional pokers plays I should say. Anywayz, there was maybe 5 or so people left on our table, I was short-stacked with about 150$, the blinds were 20-40 (meaning 40$ to stay in the hand), I was holding a King - 4. Flop came out, and I flopped trip 4s. The guido next to me bets big, so I'm confident enough and go all-in tasting the money already. The pot had about 500, I flop trip fours, and so does my friend. Shit. Well at least we'll split the pot. The guido has pocket Jacks (holding 2 jacks), only a jack could help him. What are the chances? Of course the river card--a Jack. He wins. I sat down with the mad guido, and he emptied my pockets.. Son of a bitch! That goes to show, in the amateur world, it's all luck baby. The Goose ended up winning that night (hello Sizzler buffet.) None of us got to the final table, and I didn't even stay in long enough to catch the free hot-dogs. Oh well.. Until next week!

Beyond the White Walls

Today I walked into pathmark, and this girl looks at me and is like "doctor... doctor..." I looked around, wondering who she was talking to.. Then I looked again, and she looked kinda familiar. Then she's like, Dr. Haider! You are my dad's doctor! Then I recognized her.. It was this young girl in her 20s, who I spoke to last week about her father, who is still on my service (until today when my sub-I ended), bedbound ridden with diabetes, hypertension, bad foot ulcers with osteomyelitis (infection in the bone) and blood growing out methicillin resistant Staph Aureus (basically very bad). I stood there for a minute shooting the shit, telling her about his MRI and progress and what his progress was as I looked around in the vegetable section of pathmark, with random people shopping for groceries as I stood with my english muffins and beer in my basket. It was the first time I realized that what goes on in the hospital is really just an everyday thing for people in the real world. People go to work, come to pathmark to buy some bread, visit a family member who is sick or even dying, and when they get a few minutes from the doctor to fill them in on what tests and drugs and procedures are being done, and go home to continue their day. It's amazing that doctors are actually normal people, as are patients and their families.

In the end, it's that measely 5 minutes u spend explaining to someone what the hell is going on to their father/sister/daughter in the hospital makes a huge difference, and their "thank you" actually is quite gratifying... I proceeded to walk out of the pathmark, as Raven (that's her name) stood out smoking a cig with her co-workers with a big smile saying and waving goodbye, have a nice day, thank you so much..... "Isn't that funny, that's my dad's doctor," I overhear... "He's really cool."

Accomplished

One more day left for the end of my Sub-I... It's crazy that 2 long-ass months of being a pseudo-doctor is coming to end... That is being a doctor transiently without the MD. But I gotta say, I have enjoyed it. Despite the chaotic call days, piles of paperwork, long hours, I have learned a lot, and become quite efficient, competent, and knowledgable in the field of medicine. You really do learn a shit load in only 2 months when you are given the responsibilities. In terms of basic types of admissions, I can do everything and manage the whole case on my own--Be it from heart failure, chest pain, infections, pneumonia, alcoholic withdrawal, strokes, seizures, COPD, etc. I am also a master at reading EKGs, and I know what test to order, and how to interpret it. In terms of procedures, before when I was barely comfortable drawing blood, I can now draw blood when no veins are visible, put an IV in a foot if I have to, draw an arterial blood gas, put in a femoral line central catheter, I've even intubated and done a laryngoscopy to visualize vocal cords! Quite amazing I gotta say. I got along so well with my team and residents, its gonna be sad to leave. Even the nureses will miss me!

Most of all it is the ability to interact with patients and their families that I really gained experience in. Before I'd be shit scared to confront someone's family. I mean, they would ask me questions about this person's life, and I am supposed to answer them?? Now I don't even call my resident, I just go, explain the situation, and stick to my words. I am shocked that patients and families don't ask why something is happenign, or what is going on. A lot of times they just accept what is happening, and don't really care to ask, or are intimidated to ask what is happenign to their dying family member. They simply trust the doctors. But I've learned--trust no one. So show off what you know a little bit and givem the lo-down. The families are so greatful when you take the time to explain why your sticking her father with a needle, or putting a tube down his mother's throat, or pushing 10 different medications through their IV, and why it would save their lives. After the nod, the smile, and the 'thank you doctor,' you definitely feel accomplished.

Deserter?

Man, I was reading about the American Soldier named Wassef Ali Hassoun who was captured. Now all these soldiers become POWs, and of course America gets very concerned and wants her boys back, and is very emotional about the whole ordeal--as we should be. Now why is it when a Muslim American Soldier, whose name is also Ali, gets captured, they label him a deserter?... Now that's fucked up! Of course it was later proven by a videotape with a sword to his head that he wasn't a deserter-- What the hell is that? How about proven by videotape that the kid is still alive! Most soldiers who have been in custody and go free to come home get a freakin welcoming on the runway, glorious praise, and a boost of our nation's morale. This poor bastard got beady eyes and backdoor whispers. You would think the Iraqi rebels probably decided he was useless to them and just let him go! Or of course he could have convinced them he was a double agent, working secretly for the Iraqi rebels, I mean his name was Wassef Ali, the perfect cover. Truthful or not, it didn't matter now. Perhaps he did what he needed to survive. That's why one must be careful no? He must be closely watched in case a deal was made. Hah, Puhleez! Send that nigga some scotch and strippers!

Friday at Vela

This weekend I'll be lookin forward to my "golden" weekend... that is the one weekend per month when I actually get saturday and sunday off, it will be quite the amazing event for me. I had Sunday call this past weekend, which wasn't bad, because I had Saturday off, and could go out fri night. I think I worked every night for 2 weeks until this past Saturday. But now I end the week, discharging all 6 of my patients on Friday (Amazing), and go into the weekned with a clean slate--Zero patients! Good stuff. It's always nice to discharge patients, knowing you have presumably 'cured' them in some way. And I got a lot of gratitude and thanks from family members on Friday as well, which despite the piles of paperwork I had to do, made me feel pretty good and appreciated--It's those little things that count sometimes. So I enter my day off in high spirits. Granted my plan of getting sleep was replaced with a night partyin in nyc, but with Sunday call and one night off, you gotta make use of the time no?

Friday after dinner, stopped by Delft in the East village for a drink early in the night around 11pm. A nice cozy east village bar/lounge for a drink and some tunes. They play hip hop upstairs and usually house downstairs. Good stiff drinks, and usually a nice mixed crowd to start off the night. My sister's friend was djing that night so we swung by to say hey. Apprently I am supposed to spin there when I make my 'comeback' sometime in the next month or two, so that should be fun if it ever indeed goes through. Granted i've been on dj-sabbatical for the past 1.5-2 years given my slave labor to the health care profession, but djing is like riding a bike--you don't really forget... Or so I hope..

After that my friend was havin her bday at this new place Vela. It's a Japanese-Brazilian fusion restaurant if I'm not mistaken, and a lounge by night. I met my friend there at about 12:45ish, but of course there was a group of guys in the front, and nobody was getting in. So we were like fuck it--we'll get a bottle and a table. In new york, if you cannot get in somewhere, and you really want to get in (and really want to spend all your money) Just buy a bottle and theyll hook you up. I figured since I hadn't really gone out in a few weeks, I can spend a little more today, I mean a night in the city ends up being at least 100, 150 as it is. So a 300$ bottle of Goose it was! (Yikes.) Anyway, we got escorted in to the tight packed lounge, a bar on one wall, seats and tables against the other. Pretty small and narrow, or so it seemed by the packed crowd, but the place was jumping. Lotsa cute girls, pretty good music, and very stylish decor. Drinks were steep as one would expect from a new trendy lounge in nyc, but at least we had our bottle-o-Goose to get us through. I finally found my friend who's bday it was, and a few of her friends who she was with. I had already had a few drinks before I got there, so a few more from the Goose and I was happy. I lost track of time in the end, and ended up not going home till the morning--all signs of a night well spent I should say. Though driving home in the glaring heated sun of 9am with a bad headache wasn't ideal, sometimes you just gotta do what ya gotta do. Saturday's plans of galavanting and shopping were replaced by sitting on my ass at home playing poker with the guys. We felt we should maybe enjoy the day at least, given how nice it was, but we were all so hurt and tired. Though one of us did suggest -- "Why don't we just go and play poker outside?" Brilliant.

Call days and Codes

So how do you usually spend your weekends? This weekend I was on call today, Saturday. Which basically means I have to go in on Saturday and Sunday. Yup it sucks. Saturday call days are the worst to have. This was the first call day with the new set of interns--July 1st is the magic day that the new round of 1st yr residents begin, so we are 3 days into the life of the new MDs. Luckily things have calmed down substantially since my previous post. My new interns, though in some ways lost they may be, are very nice and very competent. In a week's time, they'll be quite functional I am confident.

Now tell me why is it that every time I am on call on a weekend, it is the night that everyone I know goes out? Here I am back in my room finally at 12am. I check my messages on my cell phone - 6 missed calls. I had these girls coming from DC who I never get to see, coming to party in nyc and wanted me to come out--but alas I could not. I have a friend who is moving to Buffalo and wanted a bunch of us to come and hang out, but of course, I could not. My roomate is out paryting with some peeps somwhere in nyc, I have one friend who ran into some other friend of mine, and they both called me and bitched me out for not coming out. One girl I know called me to come out with all her girlfriends, who were supposedly hot, and I can't even come out for a drink!! I mean it doesn't end. What the hell? Half the time on a weekend I am wondering what the hell to do because nobody is around, nobody calls, and the minute I'm on call the whole night, "hey let's call Ali!!" Perfect. Even my friends who live upstairs and never go out went to see Spiderman 2. That's all I really wanted man. A freakin movie. Is that too much? Damn the man.

So tonight as I'm working on an admission I hear on the overhead "Code 1-2-6. 6 East, medical ICU" A few weeks back when I heard this I kinda looked around in confusion wondering what the hell it meant, but now, I dropped what I was doing and ran towards the 6th floor. Code 1-2-6 basically means a code has been called--that is a patient has "coded," "crashed," or what have you--pulseless, breathless, or something of the sort. I managed to arrive on the scene early. Dead weight. on the bed. no pulse, no breaths. Nothing. I quickly jumped in relieving the new intern, a short petite asian girl who was struggling to pump the chest of this 64 yr old black guy after a few minutes of pounding (hey its pretty tiring.) I got into position and started compressions, getting the sternum to push down into the heart, feeling and hearing the crunch of the ribs snapping at the sternocostal angles during the first 5 or 6 compressions, and then freely pumping his heart for him, sending enough oxygenated blood to his brain to survive. My back hurts. we rotate. I have been in like 6 codes since I got on the wards, but nobody has ever survived. There was even a code 4 days ago on my last call, on the same ICU bed, but he didn't make it either. Today, it looked grim. No pulses, compressions going, no rythm on the ECG, and there was problems getting the guy intubated. Everyone is doing something.. Compressions, ventilating, pushing meds, drawing labs, feeling pulses, gettin ECGs... We put on the defib pads (the handheld paddles have been outdated by stick on pads now for ease and convenience) and shocked him... 150 Joules. A quick jerk of the body. But nothing. Push some epinephrine.. Push some atropine.. Shock again.. 200 this time. twice.. I see the rhythm strip and he goes into Vtach.. ventricular tachycardia.. dangerous rhythm, but a rhythm nonetheless. more epi and a shock.. I feel the groin, i felt something.. I scream out "Pulse!" We had a pulse. Suddenly the QRS complexes on the ECG get narrower... A good sign.. He is out of vtach.. sinus tach now... Better. Much better. Heart rate is 162. He has a blood pressure. They got the tube down his throat and into his lungs, he is intubated. The rhythm stays. Heart is pumping on its own. The ventilator is in. We step back. He is alive. As I leave I see his lips movin and his body react to the ventilator trying to breathe on its own. He's back. Back from the dead. Relief. Exhiliration. Morbid satisfaction. My hands helped save a life today.

A long day on call, 3 admissions, cross-coverage, lots of paperwork--but one adrenaline rushing session makes you remember the moments that make you feel somewhat useful in this world.