On a lighter note...

Makes ya laugh out loud, right?

B

Working Abroad...

Last week I found myself on the defensive. I was kind of caught off guard. How, I was asked, can I justify wanting to work outside of the US when there are people in America who lack healthcare. To me, this isn't an "either-or" situation, but a both. I was pretty annoyed at the time. And today, I read this passage from the book "Not On Our Watch: The Mission to end Genocide in Darfur and Beyond." It's graphic, and very disturbing.

". . .we met a woman, Amina, cooking on the ground. She had fled her village during an attack. Her husband had been shot as soon as he left their hut. She had two of her children on her back and the other two in her arms as about twenty Janjaweed chased her on camels. First they ripped her five-year-old, Adom [sic], from her, and when she stopped running and begged for her child, they told her they would shoot her. So she continued running away from her village that was up in flames. The Janjaweed then tossed Adom into the fire. He was screaming and calling her name, but she just kept running. Despite her speed, her seven-year-old, Asam Mohamed, was then taken and shot, once in his side and once in his back. She was never able to bury her children."

I wish I could have had that passage on hand when I needed to defend my desires to work in these environments. We have healthcare, and basic rights in this country. There are people who have neither. Tell me they don't need some help from us...

Argh!
Brian

Doing "Research"

I'm going to play hooky today. Technically I have a "research day." So I'm going to run to clinic, drop off the project I've been working on-making reference binders, and then am going to go to Pediatric Grand Rounds, and then I'm calling it quits for the day. Well, I mean I am going to do "research." I'm going to research what's been going on with a friend, while we have ice-cream this afternoon. I'm also going to research which coffee shop has the best java-this is actually on-going research, I know which ones I like best thus far...

By the way, this is my horoscope today:
Is your career growing the way you want it to grow? Or is it taking away from the rest of your life? It's time to re-examine your priorities. If your career has been taking too much of your attention, then today you need to schedule a day off or take a long lunch. If you haven't been giving it enough attention, then today you should investigate new ways to jazz up your office routine. You won't be able to change everything, so focus on the things that you can change.

Off to do some research

Random Dream #1

I wish I could take a year off to travel the world. Part of this desire is biased in light of having just read "Three Weeks with my Brother," where Nicholas Sparks and his brother spend 3 weeks on a package tour around the world seeing the great sites. Sure, obviously I wish I could spend 3 weeks traveling with my brothers. But in my fantasy of a year off, I would spend that year traveling from friend/family-to-friend/family.

Somehow I have managed to amass this beautiful collection of friends, and somehow they have become scattered all over the world. 5 continents. Too many states to count. I wish I could leave tomorrow, drive up to Burlington, Vermont and start there. No specific plan, just a goal to move from there and work my way across the US & Canada, end up in Hawaii/Alaska, and then board a plane and go from there. Maybe spend a few days with some people, weeks with others.

I've hit that point in residency where my day-to-day existence passes by, and I know that I'm moving, but it happens so fast that it actually seems slow, and seems like nothing changes. Every day poses new things to learn and new challenges, but the overall day-to-day is the same. And I don't even know where I'm going in the long run. I'm tired of guessing where I'll end up in 2 years--those plans change regularly. And then I catch myself wishing that I could just meet up with old friends, drink coffee in Denver, or grab a pint in Dublin, and discuss dreams for the future.

Holy shit, that future is rapidly approaching, and it's going to be time to make a decision about what I want to do when I grow up. And that's when I wish I could escape from my life for a year, re-connect with the people whom I have known since those days when the "future" was so far off in the distance, that it seemed like it would never get here.

"Not all those who wander are lost." -JRR Tolkien

I may wander for a while...

Cheers,
Brian

Back Home

Falling off the grid meant a quick, under-the-radar trip to Colorado. Spent a somewhat-lavish-but-modest weekend in Aspen with a great friend, then hung out with the family for a few days. I'm telling you, being in Maroon Bells, the only thing that kept coming to mind was how I was ever able to leave such a great place...

It's kind of good to be back now. I've got a few projects to get cracking on...

Cheers,

Brian

You know you're a resident when...

...when being awake for 24 hours doesn't seem like a big deal. The other morning I got up at 9am, knowing that I wouldn't nap before working the overnight shift, and that it would be well past 9am the next day when I went to bed, and the thought of being up 24 hours seemed REASONABLE? Is that normal? 30 hours make me cringe a bit, but 24 hours...

I have finished my long 6 week stretch. I'm a bit shattered, I must confess. I enjoyed the work, and would have to say that I am definitely leaning toward a hospitalist position down the road. Looking back, the hours were long, but the hospitalists at our hospital work 40 hours a week. Residents hit 80/week. Hospitalists make more than triple what we make. I think I'd maybe prefer a week on, and then a week off. Ideal would be a week of adult hospitalist, a week of pedi hospitalist, and then a week of walk-in/urgent/inner-city clinic, followed by a week off...

My brain isn't functioning, my sleep cycle is out of whack (it's almost 1:30 and I'm wide awake), and I have let a ton of things slide in the past month. I'm going to "drop off the grid" for a bit to relax. Am looking forward to getting out of dodge for some serious R&R.

Cheers,
Brian

Best for Last

I saved the best for last today. At my 86th hour of work this week, I walked into Ms Js room, flopped down in a chair by her bed, and just listened...

I expected to coast through today. But then I had a ridiculous number of admission overnight, and realized that my plan for finishing work by noon, or even two was fucked, and I was pissed. Couldn't even fake a smile, so I saw intoxicated and demented patients first. They wouldn't know I was in a foul mood, or, at the very least, wouldn't remember.

A few hours later I peeked in on Ms J. "I'll be by in a few hours, just wanted to make sure you were doing ok." I had already looked at her labs, talked to the night nurse when I got to work and knew that she was doing well, but I knew she would expect to see me in the morning. I hoped I had been able to pull off a half-decent fake smile for her...

I went about the day. And then settled myself in Ms. Js room. For a hour I just listened. This woman is amazing. Hearing her stories, listening to her talk about raising her children; I sit there and look at her and get caught up in her life. I believe her. She isn't going to die. But then I am snapped back to reality, and I know that best case is she makes it til Thanksgiving-Christmas would be a miracle. Does she really know that. Just when I think she doesn't she says something like, "when I'm gone.." or how easily and comfortable she uses the C work. I am drawn to this woman and her family, and I don't know entirely why. Or maybe I do...

It has been a long week. I think it has been rewarding. I think I have probably learned a fair bit. But I am spiteful of the long hours I have had to work. Tomorrow is my day off. And then I work 8 days in a row... what the hell?

Grumpy Point

I've hit that grumpy point of the month. I hit 40 hours today. I have 4 more days to go til a day off, which includes being on call on saturday. I worked 86 hours last week. I'm annoyed with a few of the residents I am working with, but then again am working with a few (sadly fewer) stellar residents. I'm just tired. Coffee doesn't even make me feel happy right now, and it barely gives me the buzz I need to keep moving along.

Blah.
B

Palliative week

Mrs O died last night at midnight. That pretty much summarizes the week.

It was a long, grueling week, but probably one of the most rewarding weeks thus far. This week was essentially a learning experience in palliative medicine. I had one patient go home with home hospice. Took another person off of supportive care and started comfort measures (meaning controlling pain, taking them off of the ventilator, stopping dialysis and medical care), and then the bombshell was making Mrs O comfort measures yesterday. I spent hours with these families each day, and it was such a privilege to watch them go through the process of accepting the terminality of their family members... I realized, in the process, that a few of the docs I work with, suck at helping families in this process.

I'm starting a 7 day stretch, have one day off then have a 9 day stretch..

Catskills

Friday morning, Mrs O asked me what I was going to do with my weekend off. I wanted her to know I wouldn't see her again until Monday. "I hope you are doing something enjoyable." To me, sleeping all weekend sounded enjoyable. Sure, I had been planning on going for an overnight backpack trip on Saturday. My 2 day trip was squashed due to a work retreat on friday evening. But on Friday, I was wiped out. The thought of packing my bag, and hiking seemed like too much work. Maybe a day trip instead. And looking at Mrs O, I felt this urge to enjoy myself this weekend. No responsibility. No Errands. This is my golden weekend, damn right it should be enjoyable. Almost exactly a week ago at this time, the medicine service was asked to provide care for Mrs O. Her attending is an oncologist, and she was unwell, and wanted the residents to cover her, meaning we would coordinate her medical care at all hours. After an hour trying to sort through her complex medical history, talking to her family (Mrs O was barely conscious then), I explained that I expected Mrs O would end up in the ICU, on a ventilator, and that I wasn't sure how this would play out. I re-visited the expectations for medical care, which were to "do everything possible." The oncologist had been trying to get the patient and family to consider Do Not Resuscitate and I wasn't going to get them to change their mind at this moment. I thought it our care was bordering on frivolous that night. I was pessimistic, at best. 2 hours later I transferred her to the intermediate level ICU, aggressively treated her issues. And on Friday (she is back on the regular ward, and doing well, albeit with still undiagnosed/pressing medical issues), when she told me to "do something enjoyable," it dawned on me that she was living on borrowed time. How could I even fathom letting a free weekend pass without getting into the mountains and going for an overnight trip. In 30 years, I'm not going to regret sitting around doing nothing on free weekends, but I will regret not making use of free time to get out and enjoy life. This is the view from my tent last night. I sat here and pondered many things, but kept thinking about Mrs O. She may not be alive in 1 month, or 6 months, or 1 year, but she has been able to enjoy 7 more days of life, so far, with her family. And today, she is celebrating mother's day.

So often it seems we press code status with families. There's a slight sense of relief when complicated, or sick patients are Do Not Resuscitate. But maybe sometimes we're wrong, and not really wanting to face the challenge, the fight to help keep people live. I have thought long and hard about my own wishes if I became unwell, and it's not even clear cut to me, and I think I have good insight into the issues.

I think I'm rambling at this point.

A weekend away, hiking in gorgeous mountains, driving through small mountain towns, it's been an enjoyable weekend.

Cheers,

Brian

Med Wards

Week one: not too bad of a week. Pretty long hours though, just taking some extra time to get acquainted to my new patients earlier in the week. Kind of nice to be taking care of adults, in the sense that the medicine is a bit more complex. After my month in the emergency department, medicine is beginning to feel a bit more comfortable.

Not much going on aside from work. I am off next weekend, and am thinking about making a overnight or tonight backpacking trip to the Catskills. Would it be nice to explore some real mountains. Cheers!
Brian

My Day Off, and Green Eggs

So, I had yesterday and today off. Made a break for the mountains yesterday. Packed about 8-9 miles and camped over night. Weather was perfect. Hot yesterday (sunburned arms), and perfectly overcast and cool today. Was nice to get away, and the trail was mostly empty. I realized that I really need to move somewhere that had good mountains.

On my way back home I stopped at a brew pub. I was sitting next to the owner at the bar. People kept coming in and saying hi to the guy. Nice local place. And no shit, this guys brings a carton of eggs (god love a local place), and opens them up, and they are, in fact, GREEN EGGS! I guess they come from some kind of Peruvian hen.

Back to clinic tomorrow. And then I'm back to the ER this weekend. Tuesday will be starting back on Medicine wards. May is going to be a busy month...

Cheers,

Brian

Trauma: A Spectator Sport

I was a spectator, today. My patients were stable, it was too close to shift change to start seeing new patients. We'd had 7 "trauma" patients in 2 hours, and 3 more (all of whom had been shot), were rolling in the door, so I decided to go in the trauma room to be a spectator. I wanted to take in some coffee and popcorn, maybe heckle from the back of the room ("Hey Doc, ya gonna stop the bleeding sometime today?"). . . but didn't think it would go over well...

What a mess... I think every ER resident was there, plus god knows how many surgeons/surgical residents, plus 2 ER attendings, a dozen nurses, and some xray people, security guards, police, and us gawkers at the back. In fact, I think at one point the hospital operators put on the answering machine and popped by to watch the action. Needless to say, it wasn't pretty.

While I watched the trauma-drama unfold, all I could do was think back to the surgical pit at Bara (South Africa). Simplicity. Good care. People lived. 3 guys in Bara, showing up at the same time who had been shot, taken care of by a grand total of 5, maybe 6 docs/nurses. Surgeons without ego. People who had seen so many trauma patients that they could do their job in their sleep (In fact, I fell asleep standing up in surgery there). This "third world" hospital was delivering superior care to what I was watching.

I am closeted in the ER. I don't let them know that I worked in an ER during college. I don't let them know that I probably saw more people shot in my month at Bara than these residents will see in their entire residency. Instead, I'll happily tend to the patients that the ER residents find boring. I like the elderly folks who have fallen. I like the kids with coughs. I like the suicidal teens. I like the guy with HIV and kidney failure.

I like being an internist and a pediatrician.

Going to work, knowing that I am in my ideal profession (even when residency makes me fatigued, depressed, angry), makes me feel damn lucky.

That's what ran though my mind as I watched the trauma team. And then I left, I had better things to do than be a spectator.

I may not enter the trauma room again.
Been there, done that.

Life and Death in the ER

Not in the dramatic sense.. but last night was really life and death in the ER. One minute I'm telling a 19 year old that she is pregnant (surprise!) and then 30 minutes later I'm asking two women if they want us to continue doing CPR on their father. That was the spectrum of my night last night. You might be picturing lots of tears and hysterics, but in reality the 19 year old took the news well, as did her parents, and the sisters had been expecting their dad to pass away soon, and they were well prepared.

I'm off today. And sadly I need to finish a presentation that I have to give tomorrow. Nothing worse than having a "day off" and spending all day doing stuff for work.

B

Unlucky Socks

I wore my unlucky socks yesterday...

You see, I was on Jeopardy call yesterday. And Friday I knew I would be on the pedi ward in the morning. But I figured I would be done by noon, or 1 at the latest. I figured wearing my unlucky socks, which are these striped multi-blue socks and are fun to wear with scrubs, would be harmless.

So, at 5:45 when I finally was able to leave the hospital, I was 5 minutes out the door when I got paged back to go on a NICU transport. And of course, what should have been a simple scoop and go transport took way too long, and I finally left the hospital at 9:15 pm.

I don't mind that I spent most of my jeopardy day working. Sure, the selfish part of me really wanted to have the day free to run errands, maybe socialize, and sadly I work at 3pm today so don't really have much of a weekend at all. I took care of cool kids and nice parents yesterday, got to work with a good friend during the day, and even went to dinner in Amherst (dinner at 10pm?) and got to see some friends (work/non-work) whom I hadn't seen in AGES! What I do mind, though, is what to do about socks that I like, which are unlucky? I hadn't worn them since July, when I had an ugly on-call shift on the pedi ward... I'm guessing that they will live, forever, in my sock drawer, but it'll be a while before I wear them again.

Today is April 1st. Am starting in the Adult ER tonight at 3pm. I'm looking forward to the educational opportunity to brush up on some adult medicine topics, but have a serious mental block when it comes to thinking good thoughts about the ED in general..

Cheers,
Brian

Balcony Day

Balcony Day. Number One.

Today was quite possibly the first official balcony day of the year. A few Sundays ago might have counted as a balcony day, but you can't really have a balcony day on a weekend, or vacation day. You know the days I am talking about...

I'm walking down the hall, and I look outside and I can see the beautiful blue sky, and I just know that the weather outside is perfect. And the day is going great. Things make sense. I'm taking care of neat kids, caring parents, my attending is in clinic in the morning, so I get to round on all the kids, see a new kid, and have a little autonomy in the morning, before he comes for afternoon rounds, agrees with my plans from my morning notes, and then he even takes the time to take me down to the hematology lab and review some slides under the microscope. I still manage to sneak away from work at a decent time, and all of a sudden I feel like a kid who has a half day. And all I want to do is sit on my balcony, send a text message to my flatmate saying this is a balcony afternoon, which mandates that we will take our kitchen chairs and sit out on the balcony drinking beer and listening to our balcony CD. Of course, I don't have a balcony anymore. I don't have that cool flatmate anymore. But that's ok... The important thing is realizing that sometimes, ya just gotta stop and admire the moment.

I know, you're wondering why can't you have a balcony day on a weekend. Think about it...

Ok, it's way late, and I have to finish up a presentation for tomorrow.

Cheers,
B

PS-Hope you have a balcony day soon.

Dinner for 20

I went to see family in Chicago this weekend. (Not Chicago proper, about an hour south of the city). It was really a much needed trip. It was great to see my grandparents (who will turn 85 and 90 this summer), and the rest of the gang. "What are you going to do?" Nothing I told people. Absolutely nothing. Spend the day with my grandparents, the afternoon with my godfather in the bar, and then dinner with whomever shows up. It was exactly what I needed. 48 hours away from my life. Away from Springfield. Away from my apartment. Away from the cold. Away from work.

I had been in a bit of a rut. Just kind of going through the motions. Complacent. Status Quo. I've just been a bit unsettled. But things were brought back into focus recently. And my trip to Chicago solidified that. There was something special about sitting down to dinner with 20 family members last night to remind me that I have great family in Chicago (and Denver). And of course, great friends, from coast-to-coast, and sprinkled around the world. And while I do have good friends here, it's just not the same. And recently, that's what I miss the most. The people who I've known for ages, aren't here.

Anyway, just some recent thoughts.. I should clean up the kitchen now. I've cooked enough food (lentil soup, sweet potato samosas) to have wonderful dinners all week long.

I'm wrapping up pedi heme/oncology this week. I'm switching back to Adult-land after that, and will be in the Adult ER in April. I have really enjoyed my past 3 months in pediatrics, and it's going to be a bit of a transition back to adults...

Cheers,
Brian

Yemen Week...

Like the good cup of Yemen coffee I posted about on Sunday, this week has been the shake-up I really needed.

I've been in the pedi heme/onc clinic most of this week. Have seen a bunch of really cool kids (and parents). It's really nice to be in unfamiliar territory. I know very little about the heme/onc world. As a future practitioner in rural areas, I don't want to be the guy who misses the kiddo with leukemia, or the guy who has to send a family to a specialist 5 hours away if I can get the work up done myself.

What's made this week really good though, have been some simple reminders of how wonderful it is to be a doctor.

I volunteered in a free clinic Wednesday night (now that I have some free time this month). It's ENTIRELY volunteer. This clinic is getting meds to people who would otherwise not have access to meds. The crowd falls mostly into the under-insured category. It runs out of a private Ob-Gyn office. Very cool. Very simple. It's my cup of tea.

Then, today in clinic I saw 2 of my favorite patients, and one of my most complicated patients who is non-compliant-generally-drives-me-crazy-but-has-really-grown-on-me patients. I also saw 1 really cool kid, and one of my cool teens who we're starting on ADHD treatment. It was one of those days where I didn't care about running on time (and my patients didn't care either). It was just great to take the extra time to talk to patients. Amazing what you can learn in a few minutes. One patient and I talked about what his life was like before his health deteriorated, and for the first time I saw how much his life has really changed. One patient and I talked about his recent cruise with his partner, and their evolving plans to retire to Florida. One patient (a woman in her 80s) told me about one of her trips to London, and how having grown up in Jamaica she was able to visit all the places she had learned about as a school girl, and how one afternoon as she was taking the escalator out of the tube station one of the security guards stopped her, and it turned out to be a classmate from primary school some 30 years previous. Is that cool or what!

I don't know how doctors see 20-30 patients a day. What's the point? If you don't know who your patients are, why bother?

Maybe I'll write a few scripts for a good cup of Yemen Coffee. Free Refills, of course.

Cheers,
Brian.

Not Settling...

I was deathly low on coffee beans. Tomorrow is Monday morning. Obviously, you see the problem. I swore I wasn't going to spend any more money once I got home from brunch this morning, but this coffee bean thing was an issue.

I decided to take my pediatric heme/onc book to Barnes and Nobble and read and get some coffee beans. I'm a huge Sumatra fan. It's my go-to. In a pinch, I can count on it. But I was saddened to see that they only had ground Sumatra. I really wanted Sumatra, but I wanted whole beans. I couldn't settle. So I decided, what the hell, might as well go get some freshly roasted coffee beans (which made me realize I really need to start roasting my own regularly) and went to Rao's Coffee in Amherst. Yeah, it's half an hour away, but it's one of the best coffee shops in these parts... and I got me a pound of Yemen coffee. This stuff ain't no Folgers.

My most favorite coffee in the world is the Yemen roast from Bluebottle Coffee Company. This is how Bluebottle describes their Yemen: "One more thing: you might not like it. Lovers of clean, snappy Costa Ricans, or Colombians might consider drinking a cup of Yemen uncomfortably similar to being picked up by the lapels, shaken, then tossed into a grimy Manhattan snow bank. But for some of us, this is the most complex and desirable cup in town." And this is what Rao's has to say about their Yemen: "Yemen has not, for the most part, modernized it methods of coffee cultivation. The result is an unwashed coffee with subtle complexity: wild and exotic with flavors of berries, nuts and chocolate. Yemen’s simultaneous characteristics may take a whole cup to really grasp. "


In life, some things are worth settling for. But other times, ya just gotta go out of your way to get what's really important. Tonight, it was good coffee.

Shaken. Desirable. Unwashed. Wild. Exotic. Grasp. Sounds like the swift kick in the ass I need after recent events, and the perfect way to start a new week, a new rotation, a fresh outlook. I'm not going to settle...

A month to forget...

This month started out well, but has crashed over the past 2 weeks. . .

One of my rocks-(a stable NICU kiddo) started to get sick on presidents day, and just tanked. He died 2 days later. It was a tough few days, and in the end we withdrew care so that he could die in his parents arms--the first and only time that they would ever hold him while he was alive.

Patrick and I also decided to stop dating. This has been the most difficult decision I have had to make in years. He is a wonderful guy, and I am hopeful that we will remain very good friends for a long time.

I'm looking forward to March. . .

B