redemption

     My pediatrics grade is essentially divided equally between three parts - first month evaluation, second month evaluation, and the exam.  For the first time in my life, I received a "Pass" as an written evaluation for my performance.  Now, I've gotten "pass" on plenty of tests.  I know I'm not the strongest test take.  But in the real world?  Never.  I felt a lot of things but pissed off was probably the strongest one.  I was told to be happy for it given all of the stress I've been under for....I can't even recall anymore.  First my brother, then my dad, and finally my son.  Somewhere in there, I went to medical school but I'm not quite sure I recall it.  So I was supposed to be grateful that I passed given the circumstances.  Pardon my language but $*%^ that.

     So the second month of pediatrics rolled around in February.  Different location, different attending, different everything.  And the stars aligned just right for me to be in the type of situations where I do best in.  Lots of work, an attending willing to let me take on as much responsibility as I wanted (and actually listened to my plans), and it was outpatient.  I was going to be damned if I let another month of "Pass" come across my ego.  I put my head down and plowed on handling things as simple as well baby checks to rather complex patients.  And my performance was not undervalued.  I redeemed myself and got "Honors" with rather good comments on the written part.  Those are actually probably the most important part.  At the end of your med school career when you apply to residency programs, probably one of the biggest thing besides your first licensing exam score, is the Dean's Letter.  On the letter goes ALL of your comments from Every.  Single.  Rotation.  I've known a few students who apparently didn't play up the resident's ego enough and got a bad comment on the review, despite passing the class.  I knew the students.  They were not slackers.  But doctors can be assholes just like any other profession.  And that one comment can tank your application.  No one wants to have to explain in an interview the comment "student was disinterested" or "lackadaisical in their approach" even though the rest of the comments were good.  You want to spend your limited interview time talking about other things because your letter has line after line after line reiterating "hard worker", "will make an excellent clinician", "was able to handle the most complex of patients", or my personal favorite "functioned at the level of a resident."  And then there's that one that matters more in Family Medicine than other specialties, "great at developing relationship with patients."

birthday

A happy belated birthday to my dad.  It was two years ago yesterday that he received his stem cell transplant.  It's a birthday that means much more to him than his classic birthday.

chief complaint

     Whenever one makes an appointment with a doctor, they ask for a reason for the appointment.  Everybody's done it.  The person then booking appointment, enters into the electronic medical record what the patient is being seen for.  This is supposed to help us.  Before we go into the room, we like to know what we're walking into, at least I do.  But on my last rotation - pediatrics - the chief complaints were written as if the person entering them had no medical training whatsoever.  Rather than get irritated, I started keeping a running tally of them so I could laugh at them.  But really it is a sign of driving down the cost of healthcare with foreseeable consequences.  Less trained people are replacing those with more training.  PAs are replacing doctors.  LVNs are replacing RNs.  Psychologists are replacing psychiatrists.  But I'm not going to get into that right now.  I'm just going to use my list to laugh.

1. Thrash in mouth - I think you meant thrush in mouth.  Thrashing in the mouth would be quite a terribly different thing.  And I wouldn't know how to treat it either.
2. Swollen right tisticle - Seriously?  We can't get testicle spelled correctly either?  And it was the left tisticle, by the way, but I figured it out.
3. Lump near head - Do you mean the neck?  That thing that the head is connected to?
4. Rash on bottom - Bottom of what?  Bottom of the hands, feet, etc?  It is appropriate to use buttocks in the medical field.
5. Rash in private area -  Oh, good grief.  Can't you use at least the diaper area?  Or, groin?  Or, God forbid, the anatomically correct term of perianal area?
6. Pain - Help me out here.  Pain where?????  Believe it or not, it makes a BIG difference where the pain is.
7. Fever - Again, help me out here.  Fever in and of itself is not a reason to bring someone in (unless it's a newborn).  Fever and what?  Cough?  Abdominal pain?  Those are very different things.

So if ever your doctor walks in and has no clue why you're there or they are running late, it may not be their fault.  They may have quick tried to see a patient with a run-of-the-mill headache and it turned out that the kid could hardly breathe for the wheezing and obvious new diagnosis of asthma.  We can't exactly just let that go.  We've got to try to get the kid stabilized and then decide whether they need to go to the ER.  So the next time you're making an appointment, do everyone a favor and be as specific as possible.  If you have three separate problems, tell them that.  Don't do the infamous, "oh by the way..." as we're trying to walk out the door having solved one problem.

A very bad case of gastroenteritis (I won't speak of the horrors of that disease) and an impending exam tomorrow have made writing rather low on the priority this week.

i've got friends in low places

     "That'll be $1.55.  How you doing?"  Every single morning for a month it was the same.  While waiting for the attending to show up for rounds, I'd run down to the cafeteria to grab the largest iced tea possible for my source of caffeine.  And every morning, I'd reply "alright, how about yourself?"
     "Good, good," was her unwavering reply. 
     For reasons that are still unclear to me, I decided to challenge her.
     "You say you're good every morning.  Nobody can have a good day, every day."
     "I wouldn't tell ya, even if I was having a bad day.  Nuh-uh.  No sir." she replied with a mischievous grin.
     "I'm going to catch you once."
     "I'd lie to ya, even if I was having a bad day," she laughed.
     I was amazed at her willingness to engage every single person.  Was it just politeness or was it real?  One morning I decided to challenge her again because I believed her to be sincere.  When she gave her usual greeting, I replied "I ain't doing so good this morning."  And I absolutely meant it.  Hell, I hadn't been doing well the whole month.
     Sure enough, she looked sad and replied, "I'm sorry honey.  Things'll get better.  Things'll get better.  You just got to be patient and have faith."
     "Yeah, but they can get worse, too."
     "You sure right.  Uh-huh.  They CAN get worse.  And that's where you just got to keep trying."
     She was so sincere and so we played this same game for the entire month.  I got to the point where I deliberately chose her checkout line, even if it was longer.  To be quite honest, it was pretty much the highlight of my day at that particular rotation.  She showed more empathy and sincerity than many of the medical staff.  And the very last day of my rotation when I kept picking at her, she said in almost a whisper, "maybe next time I'll tell ya when I'm having a bad day."
     "Ahhh, it's my last day here for this month," I said with some disappointment.  "But I'll back at the hospital another month."
     "Alright, you can get me then."

pain

     Historical diagnosis of what afflicted a famous figure is a dicey proposition at best.  But I read of an interesting theory surrounding Ernest Hemingway's death by his own hand.  He had suffered multiple traumatic injuries leaving his body a shadow of its former self, and this from a man who was known for his daringness and bravado.  His pain left him unable to do the things he loved and that included writing.  So one theory hypothesizes, guesses really, that had medicine been able to treat pain better half a century ago, perhaps he might not have taken up that shotgun.  It's an interesting theory in that I can relate to my own life.  My physical pain has been tormenting me of late to the extent that it's limited my ability, even my desire to write.  Being in pain is exhausting.  It saps your physical energy, your emotional energy, your very will.  When I get home, my mind is not on how I want to enjoy my evening.  It's not even spent on how to make the pain go away.  It's spent on how to get the pain down to a tolerable level.  So it goes with chronic pain.  I can't remember the last time I've been pain free.  As I've said before, I have developed a very deep empathy for patients with chronic pain.  It's hard to treat and most doctors don't want to touch it or even know how to do it properly.  My family doc, fortunately, has done right by me for which I am infinitely grateful.  He tolerates a lot of my self-diagnoses (we usually agree so that helps) and experimenting with different modalities.  I can only hope that I will do the same down the road with my patients.  But it explains my lack of writing lately.

wrestling the rooster

Some times I come across other's writings that are near identical to the type of practice and doctor I wish, nay will be.

http://acountrydoctorwrites.wordpress.com/2014/01/26/wrestling-the-rooster/