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Friday, February 25, 2011

Of Seaside Mornings

Beirut, Lebanon - February 2011

There's something about the sea during the morning hours. 
If you're a morning person - or an insomniac, of course - then I suggest a nice cup of coffee at the coast. 
Nothing better to clear your mind and get ready for an anticipated stressful day at work!


Saturday, February 19, 2011

A Physician's Closest Enemy...

... is actually the patient's lifeline. That brilliant little invention called a Beeper or Pager that's designed and built to keep you alert and reachable,  and without which the phrase "on call" would have no practical meaning whatsoever.
That's all very nice. I mean it's really hard to conceive of a hospital functioning without pagers. Every single attempt at communication would invariably take longer, cost more, and be more burdensome on staff and patients alike. So here's how it should work:

1- Patient need something
2- Patient calls nurse
3- If nurse can handle it, stop here.
4- If nurse can't handle it:
5- Nurse picks up a phone and pages Dr. Fixit
6- Dr. Fixit shows up happily within minutes and sorts things out.

Great stuf right? 6 easy steps towards better patient care! Right? Well, only when it works!

BUT... (hehe) what happens when you mix needy and naggy patients, an incompetent nurse, and a doctor worn out by 14 hours of floor work during the day, and 3 hours of the same after sleeping hours? well things turn out a bit different... like so:

1- Patient needs attention = Patient nags about the lighting in the room
2- Patient calls nurse
3- Incompetent nurse prances in and freezes at such an impossible task as putting the patient to ease
4- Incompetent nurse freaks out, picks up a phone and pages Dr. Wornout at 3 AM
5- Dr. Wornout is bummed that the stupid pager's ringing again but humbly picks up a phone and responds
6- Incompetent nurse tells the story
7- Dr. Wornout cannot believe he's been woken up for such a lame story
8- Dr. Wornout screams and cusses out incompetent nurse
9- Dr. Wornout still might have to come over and talk to the patient or prescribe sedatives across the floor to get some peaceful sleep.

Ah, yes! This is perhaps a more accurate description of many of the calls we get on a night's duty. Thinking about it is funny. It really is! I can remember being paged for the dumbest stuff! And I swear all of these are true stories!

BEEP! 2:00 AM, 10 South: Doctor, doctor! The patient in 1026 refused to wear the face mask that was keeping him alive. He says it's too bulky, and his oxygen saturation went down to 70. But don't worry I called Inhalation Therapy and they convinced him. - "Wow good job, stupid male nurse! Thanks! "

BEEP! 5:00 AM 8 North: Doctor, Doctor! The patient in 823 Just called me and said she just had her period. - "OMG are you really calling me at 5 in the morning for this?! What do you want me to do, bring pads!?! Is this an emergency? Is she hemorrhaging?! - No - Well?!!? - ok thank you Doctor.

BEEP! 12:00 Midnight 9 North: Doctor the patient in 922 is ready for his blood transfusion, if you could bring up that unit? - Ok on my way - I get to the floor - Here's the unit, start the transfusion - Oh but Doctor the patient was taken down for his CT scan. - Is he coming back soon? - We don't know so we can't keep the blood unit here, in case it takes longer than expected; you have to take it back to the blood bank and check it out again when the patient comes back. - !@#%#$^$%&*^%$#!@#$#$@%@# You stupid MORON!!!!!!

BEEP! 1:00 AM 10 South: Doctor? I was wondering why the patient in 1036 is taking Methotrexate? - Ok I'll go along with this, He has scleroderma, to satisfy your hunger for knowledge at this hour of night... - Ooh ok, and Why are you giving him Tazocin? - For his pneumonia honey what's up? - Oooh true but why not Tavanic? and since he has pneumonia, why didn't you order him an incentive spirometer? - Hmm are you really calling me to suggest medical management is incorrect? Can I !@#$ing go back to sleep now?! Promise we'll talk in the morning!

No disrespect to nurses, but please help us out with our crazy duties! There are things you can handle, and things you can't, know which is which!
It's funny remembering all this stuff and I'd like to take a moment to say that not all nurses are like this! I've worked with a few nurses who had excellent judgment, knew how to talk to patients and resolve issues like lighting and air conditioning, but also comforted their patients for a peaceful night's sleep without the need for Lexotanyl! Some admittedly knew more about medicine than I did and they have my full respect and admiration. You make our lives easier.

Cheers to a completed Internal Medicine rotation! 

Sunday, February 13, 2011

Of Friendship and Lack Thereof

What happens when you run out of outlets? What happens when your friends are leaving, one by one, caving to the attraction of a random civilized country with hope for a decent and secure future, and you're left counting how many of them you have left? Two or three? Or is it one? Shit I don't know anymore!
I'll tell you what happens. You're left with two or three mindsets that cooperate or take turns tearing your sanity apart, each one taking partial or complete precedence over the others depending on your mood and how your day is going.

On the rare but welcome good day, you'll feel optimistic about present and future -like I felt when I wrote my previous post-, and keep thinking to yourself, "staying here isn't so bad! I've almost got it figured, and it feels good to be home!" Expected, from someone who's already failed -miserably- to capitalize on the golden opportunity of a medical career in France due mostly to nostalgia.

On the more common average day you tend not to think about it too much. Because on the average day you have a lot keeping you busy, and there isn't much time for thinking and musing about life and its roller-coasters. You do catch a few ideas flying by, but these don't tend to materialize into something meaningful by the time your attention is caught by something else.

We're left with bad days. It is on those bad days, those days when you just can't seem to find anything to do with your time, or when you just seem to have woken up on the wrong side of the bed, that these thoughts go wild. You feel stranded, isolated, wondering what the hell you're doing at home or wherever you are. Your outlets are numbered and each has his/her own set of problems and obstacles. They're busy. You don't really feel like their gossip, trivia, and pettiness, even though you love them. She's unreachable! S. is in the U.S. B. is in the U.K. N. is in Kuwait, K. in Dubai, R. in France... I could go on...
And this is when it gets to you the most. Because what are you left with, if not memories of good times and intrusive thoughts and feelings of all sorts that make you question your own sanity sometimes? or a bad mindset and ensuing reactions and overreactions that can ruin friendships and relationships? And what can you do with these thoughts? Well you can either swallow them, or throw them in someone's face. I tend to do the latter, often with bad consequences, but that's another thing I never seem to learn.

But you know what? All that's about to change. I'm done. I feel like I've been changed. Yes, BEEN changed, by these circumstances. I've let them get the better of me, something I don't usually do.
I've gotten a few remarks which I admitted to, again, something not everyone around me is used to seeing. The changes are in motion, things will be different from now on.

Here's to not keeping all your eggs in one basket.

For those of you who know what I mean...