Behind the White Coat

Day Float

I sit here now at 315am sat nite/sun morning, as my pre-partying power-nap has gone horribly awry.  I was so tired from going out last night and working all day today, that I just couldnt make it!  Alas I awoke to a slew of text messages wondering where I am.  Oh well.  It actually feels good to stay in and save money on a Satrday--even though nobody will believe I simply felll asleep.

Today I was on dayfloat all day at Weiler Hospital, part of my duties during my new rotation for the next 2 weeks.. A pretty slow day for the most part.  I only got paged a handful of times, and the most work I did was put in an NG tube.    Although we did have one code, which was actually my first code as intern. If you don't know, a "code" is when a patient goes into cardiac or respiratory arrest.  Unlike as a med student, since I took the ACLS (Advanced Cardiac Life Support) course, I actually knew what was going on as the code-leader was calling out the shots.  The patient was already intubated so you know she was already quite sick, but before the 3 epinephrine and 3 atropine brought her pulse and rhythm back, she was pulseless for about 15 minutes, and when you pass 10 minutes, it's never a good prognosis. The patient was almost certainly going to code again, so the intern taking care of the patient (luckily one of the 3 interns I wasn't covering for) had to ask the family to sign a DNR (do not resusciate) form in all the midst, since she would go peacefully next time her heart stops, otherwise if she did survive after all the efforts, she would most likely have some degree of brain damage and a poor quality of life to say the least.  It looked quite intimidating as helpless little Christina broke the reality to the 5 family members as they pointed towards God seeking the power of Jesus.  She almost cried (and I mean Christina), but she did good--one of the tougher parts of our job.

Tonight we went to have a drink at Bar None, which was empty, except for a guy at the end of the bar with a chick, and it turns out he was Finch from American Pie. That's right, that guy who fucked Stifler's mom.  He was also in Harold and Kumar (Jason Lee's roomate). How funny is that? We all had a good stare until we probably freaked him out as he bounced with his chick (who was only semi-cute I must add).  I still don't know that guy's name...

ER and Lawsuits

So my last ER shift was actually quite fun.  I had amazing attendings and great cases.  I realized most ER attendings are real chill, and very easy to work with, and like to teach for the most part.   I had a bunch of abdominal pain cases, which I for some reason love.  Appendicits, Colitis, and gallstone pancreatitis in a 25 yr old who we discovered had sickle cell trait (not dz).  Quite cool stuff.  Then we had the guy with a week of fever, negative blood cultures, and then developed a bad headache.  Of coures that meant it's time to tap him.  It was my second Lumbar Puncture, and I got it with zero help from the attending!  The guy didn't even jump once.  Damn I'm good.  It was great, and the attending commended my good work. Turned out he had an aseptic meningitis, so lucky for him he didn't get admitted.

On another note, did I mention the lady who I got into the accident with where I totalled my car because she made an illegal turn into an intersection where I had a green light, is sueing me?   I got a fuckin letter from Jacobi and Meyers.  Can you imagine!!! Bitch was watching late night TV and actually called that goddamn number for a personal injury claim.  Unbelievable.  The worst part is nobody can still prove it wasn't my fault, and she didn't even give a statement because she "didn't remember."  So I am only gettin 50% of liability claim.  HORSE SHIT.   The system sucks.  This is a travest-sham-mockery!!!  Fuckin legal system.  I'd like to see that woman come into my hospital one day.....

Drug Reps

You gotta love drug dinners.  You know some docs are all about "No free lunch", and oppose the idea of drug reps coming into the hospital, handing out free pens, serving us food, taking us out to nice restaurants, and things of the sort.  They feel it is an unethical practice, and that they are using methods to 'buy' the doctors into selling their product.  I say the hell with that, bring on the free shit!!!  I for one love food, and will never say no to a free night of drinks and food on a drug rep.  I mean shit, we prescribe their drugs all the time, be it a Merck rep, Pfizer, GSK, or whatever, at some point or another you have prescribed their drug.  And if your argument is that because they are taking me out, I am going to prescribe one statin (anti cholesterol drug) over another, I say kiss my ass.  I just want to be fed and quenched baby!  I mean us doctors make jack shit money, the pharmaceutical companies are the ones that rake in all the dough, selling a drug for like thousands of percent times the cost of making it, and we are the ones who prescribe it making their money for them!  So naturally they will try to 'take care of us', and I say it should be an obligation.  And for those who feel we are unfairly persuaded and bought into prescribing their drug inappropriately, I simply laugh. It's usually the lovey dovey idealist primary care and social medicine people  Me? Regardless, I am going to prescribe the drug that is the best for the patient, be it for effiacy, side effects, price, or whatever.  And if the drug reps wanna come take me out to a night of dinner and drinks and try to get me to prescribe their product, well then I welcome their efforts.  Sign me up baby!

One more week of clinic.  I am going to miss it.  I think the nurses and the staff love me.  They even say I should be chief resident, in front of the current chief resident and the medical director of the clinic!  Wow.  I must have made a good impression.  Well I guess the pressure is on me now, but I'd say Im off to a good start.

Night Float

So Friday night I had my first experience in the inpatient world.  I was night float coverage for the medicine wards from 5pm Friday until 8am Saturday.  Now I have been on clinic month, so I have been working in the clinic and had a few ER shifts.  So I was somewhat nervous going into the night being responsible for covering about 30-40 patient, but there were 2 other residents floating around that I could page if I needed help.  It was better since one of my friends was on with me so we kept each other entertained.  Night float is hit or miss - it could be a visciouis night of endless pages from nurses for everything from putting in IVs, medication issues, low or high blood pressures, low or high sugars, fevers, etc.  Lucky for me the night wasn't too bad at all.  My first page was to put an IV in this lady's foot.  One arm was in a cast, the other one had no veins left, and only one, edematous, ulcerated foot was free.  Miraculously I found a vein and got it in.  I had to do only one fever workup, which entails drawing 2 sets of blood cultures, (which is the most annoying part)  and getting a x-ray and sending a urinalysis to find the source of the fever.  A few other pages for sugars and blood pressures which weren't very serious, and of course some patients crying in pain begging for their percocets.  No patients crashed, no codes, and no serious issues.  I spent most of my time chillin or napping in the conference room.  Definitely a bad night at all, and got me kind of refamiliarized with the inpatient world in a way.  If I go by the laws of averages, next time I should be worried.

Week one in Medicine

I've been a doctor for 9 days.  I've decided to make an effort to try and post more frequently, just shorter and more random posts, since thats really all Ill have time for.  I also realized I can at least keep the name of my blog the same, for the white coat only differs in length.  How convenient...

<this may get kind of disgusting.. in a medical way, so be warned>

If you don't know what a decubitus ucler is, you probably are better off.  But I'll tell you anyway. Patients who are bedbound or parapalegic spend most of their time lying on their backs on a bed. As you lay there, the pressure on certain areas of the back start to build up, especially when you don't move much..  Lie there immobile long enough and shit begins to break down.  The skin first, then deeper to the muscle, and even down to the bone.  Sacral decubitus ulcers.  Right on the ass.  I know.  It's disgusting... But you don't know till you've seen one.  And I mean a BIG one.

The surgeon looked at me with a look of awe as he mutters, "Holy shit you see that thing?"  This guy had a an ulcer right by his left buttock and thigh.  Now decubitus ulcers can get pretty deep, if it's big enough you can even slide your finger in to see if it hits the bone.  Now this mother was the grand canyon of decubitus ulcers.  It was may have been bigger than my hand.  You could see the white of the pelvic bone jutting out amidst the eaten away skin, flesh, and muscle.  It was fucking disgusting.  The Grand Canyon of decubs.  And it didn't help that his anus was right next to it, because the diaper the poor parapalegic wears only facilitated shit (and I mean feces this time) into the ulcer.  Guess that explains his sepsis..  Just picture the size, color, and smell.   Oh lord the smell...  He'll be in the O.R. the next day.

Needless to say by my first patient I see my first E.R. shift was interesting.  Despite being totally lost for the first 2 hours, I finally got the jist of things.  Things in the ER run a lot differently than in the wards.  Oh lord the wards.... I await in fear.

I'm looking for a new car.  I was liking the Jetta. . Hmmmm...