Behind the White Coat

The Missing Shirts

So if you read any of my previous posts, you may remember my incident with the dry cleaner (see prior post).  Basically this dry cleaner lost my laundry saying someone else picked it up for me.  So I had left him that day, pissed as hell, basically telling him to get my goddamn shirts back....  Meanwhile I figured he either lost it, or there was some sort of inside job, and my beautiful shirts (really my best shirts actually) were jacked.  What could I do?

So one week later, I head over to his store.  In my mind I had my whole argument ready to go.  I was going to insist on reimbursment, and I was ready to file complains, mention getting my lawyer involved, and threaten goin to small claims court.  I was heated and ready.  So I roll into the store, a sneer of determination and anger on my face.  I give him a look so he knows I mean business.... "So my friend... The shirts..."  I was expecting some sort of evasive answer, or even fear in his eyes when he saw the look on my face....  Unexpectedly, he tells me, in his broken Korean accent, "Oh.. I make mistake... I have your shirts."   Then he whips out my ticket, and another one that says "Muhammad," and he tells me "I got confused.. Another guy, named Muhammed, looks just like you... You Ali... He Muhammad... Mistake."   Hah!!  Can you imagine?  I was too relieved and happy to get my shirts back to even say anything to the regards of "You racist," or "What we all look alike?" .... Lucky for him that I know him, and hes a nice guy, and I suppose he made an honest mistake... Confusing Ali with Muhammad. Wow..  So I gave him a sock on the shoulder and said that I came in here ready to seek his blood.... He felt pretty bad, but I was just happy I got my damn shirts back, nice and clean and pressed.... Whatta country.

Tomorrow I got clinic... My medicine service is actually not too bad right now.. The interns are a little more proficient and efficient in their work, and we have new med students who seem eager but perhaps a little over-zealous (i.e. kiss asses).. We got some interesting cases though, everything on the spectrum including alcohol withdrawal, a Bengali guy with elevated liver tests and negative viral serolgies who we are convinced has Hepatitis E, a guy with sarcoidosis of the liver and now probably the kidney, Tropical Spastic Parapesis (look it up), our lady who has been comatosed for 20 days from  prolonged hypoglycemia, and our latest patient who I am convinced has Giardia....  One more week of Jacobi left!  Just when things got smooth and I was beginning to enjoy myself!

Do Not Resuscitate

So can someone tell me when life as a 2nd year resident will get easier??   Ok, granted I started off rough, but the rest of the months cant be as bad.  I gotta say I enjoy it though... Since the interns are all new, they look towards me for guidance and questions, and I am forced to teach and learn and be independant... Especially at the city hospital, where I make most of the managment decisions on a day to day basis.  Despite the painful hours and workload, its a good experience....

Today we had the first fatality on our service.  This guy was admitted maybe the first day I was on call in the beginning of the month.  He came in with swelling and increasing abdominal girth, and we diagnosed him cirrhosis, the result of this his many long years of drinking.  He proceeded to get worse, became encephelopathic (a result of cirrhosis when the toxins make you confused). He eventually had an intestinal bleed, got intubated, went to the ICU for a few days, and came back to us a week ago.  He stabilized for a bit, but then got much worse, his kidneys failed, and we soon learned he actually had advanced liver cancer, a result of the cirrhosis.  He basically reached a point of no return.  The family had it rough--a presumably healthy man with no problems one day, 2 weeks later he is on his death bed.  I sensed he could crash and decompensate at any moment, so I tried everything I could to convince the family to make him "DNR"-- Do not Resuscitate.  Meaning in the event his heart were to stop, or he would stop breathing, that they would choose to do nothing instead of having us perform CPR, press on his chest, shock him, and give strong meds to "restart" his heart.  People this sick who crash, rarely make it back, and all we end up doing is mutiliating the body.  If they make it back, they will probably crash agian, or be brain dead.  Anyway, the family chose to do everything.  This morning, his blood pressure dropped very low. He responded to some fluids, but not for long.  Then one minute he was talking, and suddenly became unresponsive.  So we reintubated him, and managed to get his BP up.  We think he had an infection in the fluid in his belly (SBP), so we started antibiotics.  I tried for the femoral line blindly, but could only hit the artery.  After 2 hours of working on him, we walked away to see our other patients.  2 minutes later we hear the announcement "Code Blue."  Shit...  Of course, he "coded".  We walked in, he was getting CPR, and epinephrine through his IV.  He then started spewing blood from his mouth and around the tube.  His liver was so bad, his blood lost all its clottin factors and he was bleedin everywhere.  I've never seen so much blood sucked out of someone's mouth, it kept pouring out, as we hammered his chest and tried to revive him.  20 minutes of arrest in PEA (pulseless electrcial activity), and we failed to revive him.  He was dead....

It was probably better off for him to go, but it could have been more peaceful if he was DNR.  Sometimes families dont understand what it really means to code someone so sick, and we say "what are they thinking?".  Although from their eyes, in a matter of 2 weeks their family member went from walking around seemingly normal, to a horrible death.  However, it probably takes a while for the truths to really be accepted, and some random doctor telling them to let him die may not be so easily accepted at the time.  Nevertheless, I urge everyone if your loved one is severely ill, or dying of cancer, or is extremely old... I would make them DNR.

Being a Resident.... with no shirts

So.... I am now a second year resident.  They told me things would get better, but I beg to differ...  Granted I have my first month as a second year stuck on the wards at Jacobi (the "city hospital" program where we rotate through at some point in our residency).  My interns are brand new, and in many ways, clueless, inefficient, and overwhelmed.   I suppose it is July (their first month), so they aren't expected to be super stars... On top of that I have a subintern, and 2 medical students, whom I I have to teach and keep on the ball so that I am as good a resident as I can be, because when I was in their position, that was all that mattered.  It is a rough life.. With like 15-18 patients on our service on many days, and admitting 7 patients on my call days, my hours are probably worse than my intern year calls.  I think one of my interns has already broken down and cried, and the second one almost hit that point today.  Goodness... Thankfully we are halfway through the month.....

Anyway... I'll save the stories for later... On a sadder note, I went to get my dry cleaning the other day (6 of my favorite, and most expensive shirts), and my dry cleaner, who knows me, and who I have used all year, says that my "roomate" picked them up... I was like... what the??  I have no roomate.. In fact nobody knows i use that dry cleaner!!  So he claims someone came in saying that they were my roomate, and took my shirts... I think he is a goddamn liar!!! Unless some big white guy is stalking me and my shirts, something is awry. . Bottom line, my six fuckin shirts are GONE..... And what can I do? He aint gonna pay me, or reimburse me... I have no proof or evidence...I am screwed.... What a crock eh?  Now I got no clothes to wear, and no money to buy new threads.. I am not a happy man right now...

Thats all for now.. more later...

Ulodeniz and Pammukale

So finally I'll be posting the last few select pics from Turkey.... Yeah I know, almost 2 weeks later.... But life as a resident has been busy, so seep it up before you start hearing more stories from the depths of the medical wards of my month at the city hospital!

So..... From the town of Selcuk, in addition to Ephesus, we made our way to the calcium laden springs of Pammukale... Very cool landscape of what nature can do and create!  Natural hot springs with streams of water creating natural warm pools, abutting a mountainside of white rock... Just above is the ruins of the city of Hersepolis, the Romans sure knew how to choose locations...

The last leg of our trip to Turkey took us to the Mediterranian coast, to the beautiful beach town of Ulodeniz.... What a fantastic beach it is... Just at the foot of the hilly terrain behind, the beach loops around to form a calm serene lagoon opposite the mediterranian coast.  One can lay by the sea or by the lagoon, depending on your fancy, and rent kayaks, boats, swim, etc.  The town has a lot of stuff going on too, but none of the buildings are tall or gaudy to keep the feel less commercial... It is also hoarded with Europeans!  Tons of English and Germans go there it seems, since everything was priced in pounds as well as Lira!  Anyway, take a look..

Me and Puneet against the Mediterranian

Nagrila on the beach... I love it.

tip of the beach joins the lagoon and sea

Turkey Continued

The second half of our trip took us to the town of Selcuk, where we stayed in a great little hotel with a lovely rooftop to sit, chill, eat, smoke hookah, and mingle with other visitors.. We made a few friends, and it was probably one of the nicest parts of our trip.... From there we hit up the ruins of Ephesus (amazing it was!), and the surroundings which included St John's Bascilica and other "old buildings" if you will....

chillin with the hotel owner and a Colorado couple.

birds nest outside the window, in front of St. John's Bascilica

Ephesus

Nike, the Goddess of wind

When you gotta go....

The town of Selcuk

Puneet gettin baptized at St. John's

Uh oh... Run Pun, Run!

In front of the Coliseum at Ephesus