Monday, January 11, 2010

House sucks

I joined the rounds this morning where 8 residents and four specialists, and me, if you can count me, that took upon the cases from the weekend. For those of you who like House: no one looks glamorous at the butt-crack of dawn and when they have stayed up all night working on a patient's case. House sucks.

Doctors love to laugh. We love to enjoy the crazy nuances of our work. But there are days when we just can't laugh. Today was one of those days.

One day you can be talking to a patient about their children and the next you walk in to find them, writhing in their bed completely gone to the world with encephalopathy. Then you watch as they ship the patient down to shock trauma.

One day you see a happy mother talking about what she is going to name her child and the next, she's crying over the body of a still born child.

Today left me exhausted. There was no way to laugh and there were too many ways to cry, but in the end, we know that there is always hope for a better tomorrow.

Saturday, January 9, 2010

Run Residents, Run!

In a world operated by pseudo-geeks, the last thing a patient wants to be called is "cool."

You remember when 'bad' meant 'good,' and 'cool' meant 'hot'? Well, that's not the case in doctor-talk.

is bad, very bad. In fact, it is the worst thing to be called. Cool means that a hundred white coats stand around your bed ogling you like you're a laboratory specimen from the planet Plutarkion. Cool means that your disease is so rare that it probably doesn't even have a name yet. Cool means that you're two steps away from meeting St. Peter at the pearly gates.

So basically, if you look in the English to Physician language dictionary, cool translates into big-paycheck. In the medical student handbook, cool means the patient is has more medical problems than Tiger Woods has girlfriends. Not a good thing.

Today, we had a cool patient... poor guy. Worse was that he was 'cool' while in the intensive care unit (ICU). Now that is a pretty bad situation to be in.

Let's just put this in perspective: We had a cirrhosis patient whose skin was so yellow that she looked like she had been attacked by a mob of highlighters. She wasn't considered cool.

Another patient was coughing up enough mucus to lube six semis. He was not cool.

Third one bleeding out of several orifices. Still not cool.

Train wreck as in 'does hamburger mean anything to you?'. Nope, not cool. Considered a total yawner.

This poor man was cool. Now this is not to say that being designated cool does not mean that all compassion for you is gone from the medical community. It actually means that you become the major focus of the day. Physicians work extra hard to keep you alive and even harder to make you feel better fast. But I won't say that your situation would not be a teaching tool for years to come; patient privacy be willing.

And the doctor that I was working with, recognized a good learning experience when he saw one. He knew that the patient needed round the clock care and no one else could do that better than the residents. Bwahahahaha!

Residents are a different breed of medical professional all-together. Physicians balance patient care, politics, and paychecks. Medical students are wide-eyed and excited about everything... we don't even have a chance to think about paychecks. Heck, we don't even know what a paycheck is.

We think that making $40,000 a year is an amazing salary, because we're living off of top ramen and Fruit Loops (refer to last blog on the dietary demands of the medical student). We spend to much time being worried about tests and graduation to even think of anything else.

Residents, on the other hand, worry about three things: sleep, sleep, and sleep. If you read any 'how to survive residency without going insane' book, the first instruction always given is: sleep when you can, eat when you can, and pee when you can. Words to live by.

So here, my good preceptor talked with the resident's head Attending (refer to physician language dictionary under 'clinician professor that runs residents ragged' ) about adding the cool case to their list of patients. I stood outside the Attending's office, while they talked.

The residents appeared out of the shadows one by one cautiously, looking like wide eyed, unshaven, starving wild men. I thought for a moment that I should throw them a piece of meat, but there was a sign behind me that said, "Don't feed the residents."

Then like all creatures of the wild, their ears perked up and they caught wind of the conversation.

As soon as they found out that they were being given another patient, panic ensued. It was like I was on the Serengeti and a lion just jumped into a herd of gazelle. They scattered to the four winds. A couple of them even ran into each other, trying to scramble away for safety.

Seriously, that is how it went down. My jaw dropped. I've never seen sleep deprived, starving people run so fast in my life.

The attending and my preceptor came out of the office, happy. It was set. The patient would not only be followed by my preceptor but also several of the residents. My doctor looked around. It was as silent as the grave. I think a couple of tumbleweeds blew by.

He looked around. "Where did the residents go?"

"They ran." I said, the disbelief still acute.

My preceptor laughed. "Nah. They probably just had work to do."

"No, they ran." It was a flat statement.

My preceptor decided that he could find at least one of them at the respiratory ICU (RICU). When we arrive in the RICO, no residents. Not a single resident to be found.

Just so you know, there are around 40 residents. That's a lot of bodies to hide.

My preceptor asked the nurses, "Where did the residents go?"

The nurse replied. "They heard you were coming and ran."

He just blinked at her surprised then said, "Oh they're probably just in the Shock Trauma Unit (STU)."

The nurse lifted an eyebrow knowingly, and said, "Mmmhmm."

Another lap around the gia-normous hospital and also at STU the residents were no where to be found.

My preceptor looked around, scratched his head and asked the head nurse, "Where are the residents?"

The head nurse replied with a dry expression, "Someone said you were heading this way and they scattered like rats."

My preceptor dropped his head, feelings hurt. I patted him on the shoulder, "Don't worry, you can still catch one." I smiled at him soothingly. "They can run, but they can't hide. You have their pager numbers."

He looked at me with an evil grin. There have been many scary things in this world: Jason, Freddy Krueger, Hannabal Lector, the Ring, King Kong. But nothing compared to that grin.

Glee in his eyes, he dialed the pager number. He had one. The lion had caught its prey and went for the juggler. The poor resident came back in dragging his feet, head bobbing as if he was thinking to himself, "oh alright, I'll do it."

To be continued....

Tuesday, January 5, 2010

Waiting in Exile...

There is nothing worse for a medical student then having time on our hands.

You'd think that we'd enjoy doing absolutely nothing and use the time to sleep. But, heck no! We're freakin' wired like robots to go 24/7.

The only time we sleep is the moment when we crack open a text book. (image from

Vacations to us are like emotions to that Star Trek's android Data... we have no idea whatsoever to do with them.

To many medical students, vacations are scarier than The Shining movie: "What?! We don't have to study for tests?! Nooooo!" It's like we become like pariahs. Other medical students run from us as if we're lepers about to drop a toe on them.

And we get the awkward phone calls from our med school buddies. "What? You're not on rotations?" The other end goes silent as if they're expecting the Psycho theme song to emanate from their cell phone. Then the conversation ends quickly with a "Uhhh... hey, man I got to go," as if they're trying to crawl the walls to get away from talking about vacations.

Medical students are an odd bunch, and I can say that without bias because I am one. I gave up normalcy when I got my acceptance letter. It should have been in the fine print: warning, attendance here may turn you into someone who talks about eating while cutting open dead bodies and whom says, "cool" when the grossest diseases are presented to you.

As medical students, we live an odd lifestyle. We eat, sleep, and drink medicine. Our social life consists of our medical textbooks and talking about tests.

We like getting no sleep, not exercising, getting fat, becoming overstressed, and ingesting insidious amounts of sugar, top ramen, and caffeine just to become better health professionals for you. (Image from

As for you our patients, we nag you about being healthy. As for ourselves, that's a different story. We believe that physicians are super humans that can live off sticks and excessive amounts of caffeine. Oh, and doctors don't get sick--except while on pediatric rotations: those are our Kryptonite. One pediatrics experience can take down the most powerful of all physicians faster than a speeding bullet. Our enemy: children, the adorable little out-break monkies. (Note: I love pediatrics and kids.)

There's a cosmic law out there that states during the exam block weeks that we affectionately call "Hell Weeks" --that's an endearing designation of love if you hadn't already guessed -- medical students must refuse to bathe the entire seven days. It's initiation. No personal hygiene allowed while taking tests. Bathing is vorboten!

Yeah, you can only imagine the smell of more than 300 medical students at a single school with humming armpits and having been eating only bean burritos and noodles all night long. Let's just say that Professors own gas masks.

If a student walks in dressed nice, makeup done, and smelling like a poached lily during block week, the Bugler starts the funeral march, "Ich hatt einen Kameraden," and offers them the Final Salute. (Images of club and stressed students from

I know that all too well when the coffee-blooded zombies that were once my classmates hissed at me every block week because I just had to look like a sparkling, prissy chic when taking exams. It was my good luck ritual: there's was snarfing down keggers of Starbucks. Everyone had their "good luck charms." Some people wore their lucky underwear; I chose to Tyra Banks myself.

Then again, I'm not your average med student. I kind of got the Legally Blond motif going for me.

So here I am, in exile from rotations during the holiday break. Soon, I start my next rotation in Intensive Care---which doesn't get it's name of "intensive" for nothing--- and yet, I've got vacation-cabin-fever and can't wait to be back in the hospital to work the long hours and back breaking shifts.

Enjoy your vacations, eat right, and change your underwear. Words to live by.


P.S. This is my relaxing blog about my medical school and soon-to-be Internship experiences.

I also have another blog at It is an educational blog dedicated to wilderness and disaster medicine.