my patient's patience

"we should get those results to you today"

as soon as I heard those words from another resident, I knew it was too late. we were explaining some test and the approximate time frame when the results of said test would be known. I turned to my med student.

"today! you realize that we have just doomed ourselves to finding out those results and letting them (family) know. actually, I think she just doomed you, because that kid is your patient."

and they say I'm too nice to my med student... In all reality, it really sucks that we setup these unrealistic expectations once a patient is admitted to the hospital. I thought for a second during my own medical school that such practices were limited only there, but it was really an afterthought. After all, what patient or parent would NOT want to be given the answers and solutions to everything once they set foot and set up camp in a hospital bed and room? after all, you are now in the big great academic hospital (which shall remain anonymous).

this sort of reminds of the movie Sicko, where one explaination I read somewhere suggested that our insane health costs are partially to blame on the expectation that the American people demand and our own culture of fast food medicine. we want answers to everything, and we want them fast. if we are discharged from a hospital stay, we damn well better give them a magic elixir to solve them, or else ligitation reigns supreme.

unfortunately, medicine is very much the opposite. in many cases, we are trying to undo the years of bad health and this is only where we know what is going on. many other times, we have no idea what the hell is going on with our patients. We rule out all the immediate badness like cancer, infections, vascular abnormalities, cardiac oddities, and other quick kills, and discharge you home to follow up with your general practitioner and specialists. if it's something possibly rheumatologic, then it will show itself in a few months, or maybe not. lab tests are sent out and if they miss a courier time, then it's another day wait. our lab vampires suck out several tubes of blood and leave the patient's arms and legs all bruised, yet no one gets a chance to fully explain that some of those tests may have to be redrawn tomorrow.

I'm still learning, but I do know what my expectations should be now. Fortunately for that patient, the MRI results came back later that evening. I think I'll start setting up false expectations now though. it's like the directv guy telling you he'll be there at 3pm and showing up at 2.

my workout

there's something to be said about a good day in clinic. unfortunately, those usually come later in the year; later, when I know where stuff is, how charting is performed, and what things to expect from the patients. the good thing is that I didn't screw up, not much at least.

the first day of medical residency is the start of many firsts. it's the first day after a tiring orientation, first day of the medical profession and practice, first day of doing something closer to what you ultimately like, first day of being paid, first day of calling yourself "doctor" and having it literally carry some weight, etc. although we still report to a higher power, being the attending, we do make judgements and decisions. this brings a new definition to the words "scary fun". unless you know the inner workings of the medical hierarchy, or follow one of the medical dramas out there on the tube, you may not be aware of the environment a intern faces. the worst of it can be comparable to being tossed in the deep end with a number of fresh cuts and bruises from before (medical school), while the opposite side is just a mild workout. fortunately, the institutes we work at have mostly gone the way of the latter, largely due to demands of a more humane working environment. I can take a mild workout, maybe some unblocked kidney punches and a handful of good uppercuts. after all, bruising is just bilirubin. bad pun indeed.

I started out in gen peds clinic, which is an awesome way to start, no sarcasm intended. I got another orientation of the clinic, a light load in the morning and a medium one in the afternoon. Best of all, a small flock of medical students were there to lighten the load. and did I mention pediatrics, which is somewhere on the opposite end of satan, er, surgery. along the middle of the day, some twins came in, identical in all aspects including chief complaint, history and exam. names differed in only a letter, and rhymed as well. oh, and other difference was slightly more severe otitis media, requiring a new antibiotic since the first line course had failed. Outcome? I wrote the script for the wrong twin. In the end, I tried to call the mom, but succeeded in talking to voicemail several times. she had a great metallic voice and I left her a message. To quote a great attending, a little bug juice never hurt and if the other kid was worse, they would come back anyway. Hell, there's still a chance it could be viral.

I don't think my jaw is too sore, besides, I have another 8 hours tomorrow and 40 opponents.

my "n"-th attempt

once again, I will attempt to chronicle mild bits of life fused with bits of comedic fiction and sprinkles of fact. while this will serve to help others who know me to keep in touch, it is primarily a selfish act to keep a digital version of my life. I've tried it in the past and now it serves to give me a good guffaw every time I read it and realize how much I've learned. Yet everyday of work also reminds of how much more I still should know.

enjoy this semi-updated blog.