Northern Exposure

Last night was extraordinarily painful at work. Part of the pain is that the fun of doing night admissions is long gone. Scrap that previous post of thinking the life of a nocturist would be enjoyable. Working the night shift, doing admissions and cross-cover is not as fulfilling as it had seemed. On top of that, the night float team works with everybody. So part of the lack of joy is having to clean up other people's messes. Kind of scary really. ER doing half-ass work ups for people who need to be admitted (if I see one more patient to be admitted with a blood pressure in the 200s!!! I may go on a rampage). Medicine residents doing half-assed job of tucking in patients at night so they can get out right at sign out time. Attendings doing a half-assed job supervising residents. I do like the autonomy of working solo at night, but picking up the slack takes a toll.. .

 

There were a string of shitty events last night, so that when this morning rolled around, I couldn't wait to escape from the world. Sadly, the residents were 20 minutes late to relieve us this morning (it's becoming the norm), and then I had a dentist appt.

 

I needed mountain air and solitude.

 

I slept about 2 hours (post dentist, which was nice because then I could feel my mouth and suck on my platypus bag when hiking), and then made a break for the hills. I can't use the term mountains, they really are hills. That being said, the towns leading up to my usual trail head are really cool. The kind of remind me of Colorado Mtn Towns.

 

Had I had my daypack already packed when I got off of work, I would have just left after work and slept on the way when I got tired, or slept at the trailhead, or slept while hiking. It was a PERFECT hiking day. Cool, in the 60s, cloudless beautiful blue sky. Part of me wished that I had my overnight pack instead of the day pack, and I'd be out under the stars right now..

 

Lots of random thoughts came and went during the 5 hours I was hiking. I kept thinking it's a damn shame to not be getting out hiking more. I realized I was wishing that some day (maybe on return in a year) I just keep a day pack and overnight pack in the jeep, and make use of getting to the hills as much as possible. Which lead to the thought that I wished I lived somewhere that had lots of desirable hills to go hiking in.. which lead me to think about where I would want to work, which lead me to think about small mountain towns in Colorado (but obviously towns with hospitals) which made me think about this rural loan repayment program in Colorado, which after damn near tripping on a rock reminded me I was actually hiking not day-dreaming about my future life, and then thoughts of Northern Exposure popped into my head. And I thought back to the time when I thought I'd grow up to be Dr Joel Fleishman working in some small mountain community. 

 

So, I made a mental list of what I want to do once I'm out of residency. These are in no order.

-Himalayan Base camp doctor

-Colorado mountain town doc, in oh say Telluride (aside from the lack of hospital)

-Med-Peds hospitalist at DG

-Cruise Ship doctor

-Repeated stints w/ MSF (aka Doctors w/o Borders)

-Be employed by WHO/UNICEF

-Take a tropical medicine course

-Spend time doing locum tenems

-Work 6-9 months a year in the US, and 3-6 months a year abroad

 

Seriously, I have not a clue what the hell I'll be doing, or where I'll be doing it.

 

It's probably a good thing I have an extra year to think about it.

 

So, back to the hike. I stopped in one of the small towns, picked up a bagel sandwich and a cold beer, and found myself enjoying dinner sitting on a rock, in the middle of a large stream, staring up at a waterfall. And all of a sudden, the bullshit of work was the furthest thing from my mind... 

 

Maybe I should keep the packs in my car...

 

[And for the record, in 1993 on a road trip, we went through the town of Roslyn's, WA where Northern Exposure was filmed, and watched then film part of an episode, as well as walk in the gift shop where you could buy, among other things, part of the piano which was flung!). Oh yeah, I was addicted to that show..

Party Antics..

Just keep this in mind while you view the following.. I was S-O-B-E-R when these were taken.. One of the pedi attendings had an annual party, and it was kind of fizzing, so "The Other Brian" and I tried to liven up the place...

Full Circle

Friday night I went to NY to hang out with Lucia. Sitting in the back of Queen of Sheeba, an excellent Ethiopian restaurant in the city, we discussed my impending departure.

 

It was 11 months ago, and we were sitting outside another restaurant when I first proposed this idea to go to Bara for a year. And now, it is a reality, and in 4 weeks I'll be arriving in Jo'burg. With some minor pre-departure jitters (or due to voluminous coffee required to stay up post-call) we discussed what a great opportunity this is going to be. It was also helpful to ask some last minute technical details, related to where I'm going to live and getting around the city. When Lucia went to Bara, she actually stayed where I'll be staying...

 

In some ways, it seems like there is still a lot to get done in the next few weeks. A few boxes of stuff to go through. Trying to read up on some pedi topics. Lots of people to see. I suspect that what'll happen is stuff to sort through will simply end up in storage, unsorted, pedi topics won't get reviewed, and I'll be on the plane thinking of the people that I didn't really get to hang out with before departing..

 

It's all good.

Getting Sued

This afternoon, in clinic, a patient handed me a crumpled business card of a lawyer, and he said he was suing me.

 

Ironically, this was the highlight of my afternoon.

 

I hesitate to write here how much I loathe clinic. I fear that there is some eager medical student who wants to go into med-peds and will Google and somehow come across my blog, read about how much I loathe clinic, feel it is a reflection of our program, word gets back to my boss, and then it gets all weird. If you're that person reading here, email me and we'll talk in private. Suffice to say I highly doubt I will ever practice outpatient adult primary care. Pediatric primary care, sure. Adult urgent care, sure. Pedi urgent care, sure. Free inner city walk-in clinic, sure. But adult primary care, not a snowball chance in hell. Med-Peds hospitalist, definitely. I've actually volunteered to cover some Cardiac ICU shifts this week to get out of clinic!

 

Anyway, I had just wrapped up seeing a patient brand-new to our clinic, who has some SERIOUS medical conditions (including possible new heart failure) who I was seeing without ANY medical records and trying to triage her medical issues, debating admitting her to the hospital so I can get a work up done that will take me 3-4 weeks in the outpatient world, and was suppose to do this all in 5 minutes. Well, I mean I should have had 30 minutes for the visit, but essentially since clinic was already behind schedule, I really had 5 minutes from when I entered the room, until I was scheduled to see my next patient (who wants to sue me-I didn't know that then), and the 4 patients after him. In reality, this new patient is complex enough that she should have had an hour or two to be seen...

 

So, I walk into GVs room. I'm seeing him for follow up. I saw him 2 months ago, referred him to a specialist to be seen, and gave him some meds to try and control his issue until he could be seen by the specialist. In talking to GV, he decided against taking the pills as I prescribed, and he is on the wait list for the specialist. So, essentially today's appt is a waste. Except, that I really like GV. I wanted to strangle him when I first met him since he was out of control (that'd be good ammo for the lawyer- You're Honor, He tried to STRANGLE my client), but over the 3 years I've seen him change and I no longer fear seeing his name on my schedule. So, he hands me a crumpled business card. I was hoping he hadn't crumpled my business card.. and I read it. LAW FIRM. Oh shit. Are you kidding me. I look to his family, and his relative says "He wants to sue you." Honestly, I wasn't too worried. I mean look, he hasn't even taken a handful's worth of the pills I prescribed 2 months ago.

 

I look GV square in the eye:

 

Me: You want to sue me

GV: Yes

Me: Oh really. What for?

GV: You had them put those sticky things on my chest last time.

 

We had to do an EKG to monitor for possible medication side effects, and he can't articulate that the sticky things were the EKG electrode patches.

 

I look to his family, as if to say is he outta his mind?

 

Me: Yeah, so?

GV: I had 4 chest hairs, and now they are gone, so I'm going to sue you!

Me: FOUR? I examined your chest when I listened to your heart, I didn't see them. How much money do you want?

 

I'm sure the hospital legal counsel wouldn't want me to bargain in the room, but I'm pressed for time..

 

GV: Five thousand dollars.

Me: Tough, I have 20 dollars til pay day.

GV: Holding out his hand.. Ok, give it to me.

 

Instead, I grab his head and give him a nuggie. Again, I am sure the hospital lawyers wouldn't think this is an acceptable solution to a pending lawsuit. But given that GV is 9 years old, I think it's appropriate that I use my bruit strength to remind him that I am in charge. His grandma laughs. I ask her to please give him his meds, tell them that I'll miss them for the year I'm gone, and look forward to seeing them in a year.

 

It's a small reprieve.

 

 

Websites

Here's a collection of websites that I've been following...

 

http://multimedia.thetimes.co.za/photos/2008/05/flames-of-hate/

 

http://news.bbc.co.uk/2/hi/africa/7407055.stm

 

http://www.nytimes.com/2008/05/19/world/africa/19safrica.html?hp

 

http://news.bbc.co.uk/2/hi/africa/7396868.stm
 
http://www.cbsnews.com/stories/2008/05/01/60minutes/main4063191.shtml
 
http://msf.org.za/PR/PR_SouthAfrica_MethodistChurchZimbabwe_050208.html

 

http://www.guidepostsmag.com/personal-change/positive-people-archive/?i=730&page=1

 

 

BPB

Nocturist

I spoke to one of the nocturist last night at work. He works 3 nights, a week, in a row. Admitting patients to the hospital, and providing cross cover on the already admitted patients. Sometimes, I really think this would be a great job. You get the challenge of creating the admission differential, you get to start the initial work up. Plus, the added benefit of having free time during the day. Hmmm

 

Pushing through

I am literally pushing through today. No thoughts of crashing. I was the night float/medicine admission resident last night, managed to not have any admissions from 2:30 am til 5:30 (slept poorly on a couch) and this am when I saw that it was going to be a beautiful day, the only think I could think of was getting into the mountains. Some needed trail time!

I have this secret fantasy of some day always having a day pack and an overnight pack (w/ 2-3 days of stuff) in my car at all times so that as soon as I leave work I can make a break for the hills and escape for a few hours, or a day or two.

Today was that day. I called Karin (who is on vacation) and we went to SW Mass and hiked for a few hours, then met up with Elsa for a divine lunch. I ended the evening by reading bedtime stories to Ian and Emily, then coming home and having a few glasses of wine w/ my flatmate. Such a great day.

I can't explain the mental fog that has settled on my brain. I am exhausted. Period. My bed is a few feet away, and I know the minute I lie down I will be out for the count.

Work Hard, Play Hard. There really is no other philosophy in life...

Off to bed.

Just Hanging

I haven't really mustered up the energy to post in a while..
 
Random things:
-stopped a drug seeking patient from getting more narcotics from the clinic yesterday, got to call security to the clinic to escort him out of the building, -THAT- was a fun time
-ran again along the trail I've been running a few weeks now. The leaves are finally out and the trail looks totally different
-no medical license for SA. And honestly, am thinking it won't happen until I get down there
-avoided going to Pride last weekend, kind of over the small town bullshit that goes on here. Think this is the first time ever I've intentionally skipped Pride
-Have found a vehicle to purchase in Jo'burg. A 1999 Ford Bantam. A UK doctor (friend of a friend) is leaving so it's convenient to buy his car
-Am really really really trying to find time for one last overnight backpack trip before I leave
 
That's about it really. All is just kind of status quo.
 


 

Denver Pics

Real Life Scrubs

I moved in with JW, who is a medicine resident in the same hospital. She is on-call tonight in the CCU (we worked together in the CCU in October) and I'm on night float, so it'll kind of me like Scrubs when Turk and JD.. 

 

I'm spending today, finally unpacking in the new room. Basically taking clothes out of trash bags, and separating out books and papers.