Behind the White Coat

Back Pain and Cooking

Interviews Requested:5

Rejections: 4

 

It's nearly February, and I'll admit I'm a little nervous.  I think (hopefully) in the next few weeks we (myself and colleagues) will start hearing from more programs.  I know a lot of them are just taking their sweet damn time, but it is a little nerve wrecking.  The biggest problem is scheduling these damn things.  There are usually only 1 to 5 days of interviews offered by many programs, and since for the next 2 months I am on call every 3rd day, it is seriously a biyatch.  So the new places that I got were UCLA and USC.  How am I getting such So-Cal love?? I have no idea. Clerical error or not, I'll roll with it for now.  I'm still waiting for the NYC progs to hit me up, so far I only have the Mount Sinai Community program (which is like the affiliate of the main one).  I also got a rejection from UT Southwestern in Texas.... Did I even apply there?!

 

My back is killing me today.  Being that this month, I am the only man on my pulmonary medicine rotation aside from my attending (seriously, all 6 of my co-residents, all the nurses, even the fellow, are women!!), I was asked by one of the nurses for some "strong hands" to move this guy up the bed (he was about 300lbs).  Me, knowing I have my herniated disc, decided I could handle it.  Since then, I've been in pain non-stop.  I gotta learn my own saying--nobody likes a hero. Thankfully I don't have a foot drop or haven't lost sensation in my feet, or (get ready) lost control of my bowels. I know, ew.  But damn that shit hurts.  I had to get a script of percocets from my preceptor, who probably now thinks I am an addict like Dr. House.

 

The nurses do love me on the Pulmonary floor though.  Probably because I am the only man around, and I throw them some nice comments about their hair, and a few ghetto slang words to go with it, and they love it.  One of the evening Jamaican nurses tells me, "you don't look like a doctor.  You look like a movie star!".  Maybe it's the beard I am growing?  Just call me Amitabh Bachchan.

On a more random note,  I been cookin up some serious dishes lately.  I rarely cooked last year, but this year I've stepped it up.  Maybe its my recent addiction to Top Chef on Bravo, (the finale is tonight, I can't believe they kicked off Michael!!).  I've also tried to perfect my shabby knowledge of Paki cooking... Despite the glorious cooking at the 'rents place, my skills are limited to basically chicken karhai (cooked in a wok with ginger and garlic), daal, kebabs, and a feeble attempt at aloo keema.  I am far from creatin a lustful donga of nehari, or payas that would tickle the palate of the likes of Samosa, but give me time...

Jungle Lady

So as the responses start rolling in (good and bad) from the programs, I figure It's time to start the interview season updates.... It is early in the game, but the count stands as follows:

Programs Applied to: 54 (I know, don't ask)
Interviews Requested: 2
Rejections: 4

Mass General Hospital and Brigham and Women's hospital responded today made it the third and fourth one (those are the Haaarvard programs). But that was expected. Unless I had a PhD or discovered a new organ, I probably had no shot. The interviews I have gotten are at University of Rochester (I don't think I can handle 8 months of snow), and a crappy program which I refuse to go to (always shady when they request green card or visa status). So I'll keep y'all updated on what my future holds (not that anyone necessarily cares, but too bad).

In keeping up with my invincible heart, I went home today to see the 'rents and eat some good food. Damn is the food good. I don't know why I don't go home more often, cause I certainly eat well. Today was payas (like a stew made from lamb ankles... believe me, its amazing), and some kick-ass palau (rice w/ meat), and some yummy daal. I honestly believe the food in my house is amon the best in the tri-state area. Guests of our many dinner parties will attest to that, as well as the last three Prime Ministers of Pakistan, who know never to miss a meal at our house. Sure I'm gloating, but if only you could taste it.... Mmmmm...

To touch on some recent stories, I'm sure some of you have heard about the Jungle Lady. Yes, I'm ta'lkin about the recent story about the Cambodian village girl who has been misssing since 8 years of age. Now 18 years later, they found her, as she was trying to steal food left out for animals. She has been living without human contact in the jungle for years! Crazy.. Her only words she knows is Mother, Father, and Stomach Ache. Apparently she wants to go back to the jungle.. A real live tarzan! Though I doubt anybody elses but a Cambodian villager or Vietnamese village person could survive like that (my Vietnamese friend agrees by the way). So give them some credit, sometimes those who are most simple and deprived of any sort of luxuries are the ones that possess the most incredible survival instinct... Me?  Forget about looking for food, I wouldn't have made it 3 days before succumbing to some terrible infectious illness, or being consumed by a predator.

Interviews and Lipids

It's freezing cold.  Actually, it's close to what it should be for a normal year, but I, like many other New Yorkers, have been spoiled by this somewhat mild winter we have had.  We did get our first snowfall on Friday though.  Granted it was but an hour or two of light snowfall, it managed to briefly whiten the branches and the grass to remind us that it is indeed the dead of winter! I may be super lame tonight and stay in for the second wknd night in a row!  I hope nobody finds out...

So I mentioned a while back that I was either going to apply for a Cardiology fellowship this year, meaning I would start in 2008 after my 3rd year of residency, or I was going to do a chief residency year.  After some debate, I decided that I did want to accept the offer for the chief year.  AFter a somewhat complicated sequence of events, as it turns out, they gave it to somebody else (who they wanted as the clinic chief at first, but he wanted the other job).  Anyway, it was a difficult decision to begin with, but now I have to say I am happy that I am not doing it.  There is just way too much shit-work you have to deal with, and less academic stuff.  Not to say that I am not upset, my desire to be chief was there, but my desire to move on to cardiology was greater.  So it worked out to be a blessing in disguise.

Now it is interview season, and sit here awaiting interviews.  Cardiology interviews somewhat late, so we start hearing about interviews end of January, and we go to interview in Feb and March.  So far, I have gotten 2 rejections and 2 interviews.  None of them are really places I care much about. I ended up applying to a shit load of programs, partly because I was nervous, and partly because it was just so easy to click them and apply.  Everything is done online using the ERAS system (for those who have used it), so it makes it easy.  I figure keep my options open, and figure it out later.  Now I have to start preparing for interviews so I know what I am talking about when I go.  I haven't thought about it much as yet, because I figure I'll have plenty of time to stress out in the coming weeks.  Add to that the fact that my next 2 months will be spent in pulmonary intensive care, and the medical intensive care where I will be on call overnight every 3rd day.  I can't wait...

In some good news (for me at least), I got my blood tests done, and my lipid profile (or cholesterol)  is fantastic.  I have a total cholesterol of 167, an LDL of 54, and an HDL of 106.  The LDL is the "bad cholsterol", and should be below 120 in normal risk people (lower in people with risk factors), and the HDL is the "good cholesterol", which should be above 45.  My numbers are frankly outstanding - I've never seen a man with an HDL as high as mine.  I guess all the wine and olive oil I have been consuming the past few years have done me good.  Now I feel invinsible, and have been eaten the fattiest, and most unhealthy foods I can find.  I figure, better get my fix now while my heart can't be stopped!

Clinic Stories

Ok... So my last post brewed up some excitement it seems.  Well, it was solely by the mis-interpretation of one individual, but I think myself and my readers said whats need to be said... Anyways, I think it's time to move on, and I exercised my veto authority and unpublished Jeff's last comment (sorry Jeff, my blog, my decision), because frankly I was sick and tired of the whole argument, and it was going nowhere.  I suppose everyone is entitled to their own interpreatation of things (as misguided as they may be), and to their own opinions, and I think they've all been put on the table twice over.  Though I must admit, the lil blog-battle got me riled up for a bit, good to see I have people who actually read my blog, whether they like, me or hate me!

I'm halfway through my Rheumatology elective this month.  You do see some interesting stuff, mostly in the outpatient clinic setting.  I was hoping to get a lot of joint taps (when you stick a needle in a swollen joint to get fluid for analysis), but so far, I have had only one attempted and failed needle aspiration of this 85 yr old lady's painful swollen finger joint (MCP if you are curious), as she screamed in pain, "Lord Jesus take my hand!".  (The hand joints are real difficult to tap). 

I had an intense encounter this week in the clinic.  This 45 yr old woman who came in with her 20 something yr old daughter for evaluation of joint pains and lab values that were suspicious for lupus.  As I began asking her questions, she seemed somewhat uncomfortable when I cautiously brought up alcohol and drugs, and I suspected it was because of the daughter.  When I asked the daughter to step out, the mom started balling in tears.  She told me about her ex drug habit, she was a huge user of both heroin and cocaine (you could never tell by looking at her).  She proceeded to tell me she has been clean for 14 years, and recently even completed a TV special about drug addiction (I won't mention specifics to protect identities).  She keeps tearing and tells me her ex-husband was parolled from prison last week after 12 or 13 years, and while she was with him, she succumbed to curiosity, and ended up usin again for the first time in 15 years.  She had never used IV drugs before, but this time she injected the cocaine.  She pulled up her sleeves to reveal a resolving cellulitis she even got from the injection site.  She also has no idea how clean those needles were.  She begged me not to say anything to her daughter, who has no idea she used again, who is also a police officer.  (And by law, we are bound to keep her info private of course). The whole purpose of her visit was forgotten, and it was just me with this distressed woman in tears.  I spent a while listening to her, talking to her, and trying to console her.  I think she had so many feelings of shame, distress, and helplessness, because after being so good, and being an advocate against drugs, she herself succumbed to temptations.  It was of course all the fault of her ex husband, but I really felt sad for her.  She just wanted to tell her story, and confide in someone, and that someone just turned out to be me. 

I don't think her joint paints were anything but a little arthritis, and an abbarently positive lab value (+ANA) that through off her primary doctor.  It could have been a bone infectionr from the drugs, but the symptoms started before that incident.  However, her true issue was revealed during that visit. I made sure she got tested for everything, including hepatitis B and C and HIV.  I hope she doesn't contract something after this, it would be tragic.  I don't think I did much medically for her (except to tell her she didn't have lupus), but she seemed so greatful and happy, probably just because she got it all out, and protected her daughter at the same time.  She found me before she left and gave me a big hug and a kiss on the cheek.  It was a nice feeling.  Sometimes all it takes is a conversation and a set of ears, instead of fancy tests and drugs to help a patient in need.

Savior or Swindled?

You be the judge... So I am walking to the library of my hospital today, which is right near one of the main entrances.  As I turn the corridor, I hear a voice in Urdu stop me "Excuse me sir, doctor-sahib."  I am met with a slightly restless Pakistani man, probably in his mid to late 40s.  He was in a shirt and tie, an old dark jacket, an oldish bag, mildly disheveled looking given his imperfectly combed hair and the anxious look about him, but it did seem like he had gotten somewhat "dressed up" from his normal attire.  He seemed greatful that he had met another Pakistani, he clearly (and correctly) profiled me from a distance, as he was more comfortable speaking in Urdu, though he spoke English well.  He explained to me he needed some help and proceeds with his story.  He came down to NYC from upstate for a job interview at a company, whose name he did mention, but I forget now, and it seemed he is a recent immigrant.  He said he was making a phone call at a pay phone, and left his wallet on top of the payphone as he left.  Of course, the wallet was gone when he returned a few minutes later.  I asked him if he filed a police report, he said he just did that.  He came over to Montefiore to look for a doctor he knew in the area, a "Dr. Nawaz", who he then discovered had moved his practice from the old location.  So now he finds himself in the doorway of Montefiore, with no money or ID, and no way to get home.  He is very respectful, and I could see the hint of despair in his eyes, as he comes to me to ask for $38 for bus fare to return to upstate New York where he lives.  He swore to me (and to Allah) that he would pay it back.  I told him to have a seat for a minute in the lobby, and I said I would be right back, and I took a walk to size him up real quick in my head...

Now first off, was he legit, or was he trying to swindle me? He had a pretty convincing story, and by looking at him, he definitely fit the part of what he portrayed.  Now I'll admit, the fact that he was Pakistani, and speaking to me in Urdu, I felt more of an obligation to help him.  If he was a random white or hispanic guy, I'll admit I would probably not have even stopped to talk to him for so long, and gone on my way.  That's not even in a racist way, but you always have somewhat more of a bond and cultural obligation to at least give "your people" the benefit of the doubt--swindlers or not.  Now I lost my wallet recently, so that definitely made me think about his situation, which worked in his favor.  Moreover, this guy is far away from home, and nobody to go to for help, so I felt his pain.  I mean it was only $38, and I doubt he developed such an elaborate scheme for just a few bucks.  And the amount was precise, he didn't ask for 20, 50, or anything, it was $38.  I consulted with a coworker who agreed that he is likely telling the truth.  And I mean, what is $38?

So I exchanged address and phone numbers with Mr. Abdul Aziz, took out $40 from the ATM, and he was on his merry way.  He said he would need 2 to 3 weeks to send me the money, as he was waiting to hear about this new job, and would get money soon.  I almost told him to "pay it forward", but he'd likely look at me wondering wtf?  Now I give it a 30% I get the money back, and even if I don't, I don't think I would care. In the end, I feel good about myself, because I have done my good deed of the day. Even if there is that small chance that I have indeed, been duped.

72 Degrees in January

I haven't seen the documentary with Al Gore, "An Inconvenient Truth", as yet, but after this weekend, it has made the top of my netflix queue.  Yesterday, January 6th, it hit a record high of 72 degrees!!!  As amazing as it is, it's almost frightening.  This should be one of the coldest days of the year, with the cashemere sweaters and scarfs, the down jackets and peacoats, gloves and hats, and maybe even the long johns!  Instead, we found ourselves in central park, with nothing but a t-shirt.  The park was packed on Saturday.  The trees were bear of leaves, but the air was warm and the breeze was refreshing. Everyone was out and about, families with the kids, drummers and musicians doing their thing, tossing of frisbees, throwing of footballs, and just an aura of joy and a tad bit of shock.  I mean it was 20 degrees warmer than it was in LA!  Sure they say it is an el nino season, so the southern winds are influencing the temperatures, but you know the whole "global warming" issue is playing a role here.  To mention another record, the latest a flurry has ever been seen in NYC is this year!  Prior to this, it was sometime in the late 1800s January 4th, as the latest date of a confirmed flurry.

I actually enjoy the winter.  You get to bust out a whole new wardrobe.  Layering up with the weaters, jackets, cashmere scarves, hats, and what not.   Sometimes that cold crips breeze that catches you in your uncovered face is refreshing.  Then of course there is the snow.  You gotta love snowfall, it is part of the character of New York.  Then you have skiing and snowboarding, which is the best, though I have been off the slopes since the damned herniated disc!

Anyway, having said that, I cannot say I am not enjoying our abnormally warm weather.  Especially since I was off this weekend, and could take it all in... Here's a shot from my phone of the park in the promenade just behind summerstage:

2007

Happy New Year!!  Welcome to the year 2007.  So how did you spend your new year's?  I ended up going to a lounge in the lower east side, not too big of a place, top shelf open bar for 90$ all night, quite the deal. I'll leave the details out, but I'll just say we had a super fun time bringing in the new year! 

Nothing else to say today. Gonna go watch the end of season 5 of 24.