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! 

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...

Another Catch-Up Post

Well it has been a while since my last post. I've been busy lately, and last night I happened to check out my blog and realized that I'd 'left' on a very sad note. Sorry about that!
So what have we missed? One relationship anniversary, one uneventful new year's eve, another goodbye to another good friend leaving the country, another monumental governmental failure (but we're used to those), another stupid Internal Medicine rotation, a few breathtaking days on the Faraya slopes. All these, among other things I've meant to blog about that would have kept my readers busy/amused/annoyed. No such luck; instead, here I am, once more, overwhelmed by my flying ideas, frustrated by my tantalizing muses, pressed for time (but we're used to this one, too), and struggling with my vocabulary trying to make something out of this heap of interweaved trains of thought.

Let's start here. I am happy. Happy, of course, being a word surrounded by a cloud of relativity, and perhaps a few drops of evanescence, but for the first time in a few long med school years, I can really say that I am happy. Happy with the way things are going in my life. Happy that I'm just starting to peer through that window onto the next steps in my life and career. Happy with my lovely L. Just overall, in a good moment I guess, the likes of which I haven't seen in a very long time.

Trying to pinpoint it is hard. but I think what has drastically changed my outlook on things is the fact that I'm done guessing what I want to do with my life. Over the course of one day, my career path has become clear to me; I am to become a surgeon, people, go crazy. There has never been a specialty better suited for me, I've always known it, and since I've applied to a surgery residency at AUH for next year, things have been different. It takes much more to worry me, I am more relaxed in my work, I'm optimistic and feel so hungry to take on this next chapter that I don't even feel like a med student anymore. Med IV is almost over. A few months ago I was excited at the prospect of beginning my last year of med school. Time flew, that's all I can say. and if you've read that post, you'll understand why I'd be keeping with the continuum if I say, Bring it, Surgery! Bring it, Residency, Bring it, long on call hours! I want to work my ass off in something that fascinates me, instead of sitting around the morning rounds in internal medicine for 5 hours wondering what the hell I'm doing there, trying hard as I can to stop my eyes rolling into the back of my head from boredom!

Did I mention I hated internal medicine? Well I'm sure it's obvious now! (Some other post, for sure)

So there you have it. The main update and now we can look forward to my admission (wish me luck) and to my Surgery internship next year which I'm sure will bring you many long posts.

Will keep you posted!

The Bitter End

They called me to your room, I saw you for myself

I saw you, and my self was torn

Who you remind me of, I dare not say

The consequences I dare not see

Your habit, got the best of you

But you of it, have the worst end

And they will be there, to hold your hand

Your loved ones, till the bitter end

Themselves miles more torn than me

Written for a dying mother...

It all starts with a nodule...

We are taught by life to greet people with courtesy; always smile and say something nice, always ask how people are doing. You enter a sick patient's room on the morning rounds and say something like: "Hello sir, how are we doing today?", and hope for some optimism and a smile in return. Try doing that on the oncology wards. On a few of my first patient visits on the oncology floor, I was caught off guard by a 38 year old patient with a body torn up, on the inside, by a uterine cancer. Now in the terminal stages of her disease, N. answered my question in a way I was never ready to handle.
- Me, entering the room for the first time, smiling: "How are you today Mrs. [...] ?"
- Her, stating the obvious, pointing at her distended, asymmetric, diseased abdomen: "Well, how do you think I'm doing?"
Realizing the retrospective absurdity of my question to a woman with a mass the size of a basketball inside her, and many other little ones scattered around her frail and broken body, I froze for a second, and nodded, with my stupid, embarrased smile still stuck to my face, and proceeded to interview and examine her, gathering a few pieces of information to write my stupid little note in her chart.
How? How can you be pleasant to a dying person? I'm still learning here... perhaps learning that oncology is the single most impossible specialty for me to work in. Oncology, cancer, that indiscriminate, slow killer that catches persons and tosses their bodies around for seeming ages.
Cancer means you see your patient on Friday and think he's doing a bit better:
- Mr. H, a nice and unfortunate old man: "Thank you doctor for coming to see me, it makes me stronger"
and then you go away for the weekend and on Monday you hear the news that Mr. H passed away on Saturday, his son's wedding day. They tell you that Mr. H's son had been pushing since thursday for a discharge so that his father can die in his hometown, and to kindle a glimmer of hope that his father would get a chance to see his son get married, even if he has to feel this fatherly pride in a wheelchair. No such luck.

It's too much for me to handle. Too much to see this losing battle day in day out, too much to see so much suffering. Too much to see so much harm coming from what started as a small nodule, a small blip on a chest radiograph... Not for me.

Hey what's up??

What's going on? I don't understand... Why is it that one day everything in your life is going wonderfully, just to turn completely around the next day without you having the slightest clue that anything has happened?

Why is it that those things you are completely oblivious to one day seem like insurmountable obstacles the next morning?

What happens to people overnight?

What in the world gets into people sometimes?

How do you manage, for the first time in your life, to end up alone at some random bar on a Thursday night, sipping on a glass of scotch and asking yourself all these questions?

I wonder...

Why am I so disappointed?

What Happens to Time?

When Monday morning kicking off another day's work seamlessly morphs into a Monday morning kicking off another week. And while you're trying to think about it, why not? another month flies out the window and next thing you know you're left sitting on a metaphorical curb, head cradled in your hands, wondering what you've accomplished, if anything, during that hectic October you've just leaked ever so unsuspectingly.

Or when you meet your new pediatrics resident for the night's duty and realize that his father was actually the pediatrician who followed, treated, and probably terrorized you through the better part of your childhood, 0-18 years of age. In a puff of smoke.
Such a shame how far that apple falls from the tree... but I digress...

People are always afraid of losing time. Time, time, time.
"We're late, we need to hurry!" Of course. Time is gold.
"I'm growing old, look at these wrinkles" says she, in her mid-late 20's, dripping of youth and beauty as she speeds down a wrong way road to her plastic surgeon's office, stone-coldly ignoring all pleas for a healthy and graceful maturity that's still far far away.

But why? Why should I be so preoccupied with time, when the harder I try to save it, the more acutely aware I am of my helplessness toward it? Why can't I be less attached to that Monday? or to that October, or to that year that October has ruthlessly dragged down with it for the 28th time? And why can't I look back at my great 28 years in this world and smile, instead of looking just ahead, terrified of turning 30 in 2 years?
2 years. More like 2 Mondays, 2 more weeks, 2 more Octobers; it's all the same. Maybe that's why...

Meet me back at that curb...

Days in Memory...

August 13, or the last of it was

In a fortnight, let there be life!

And I can't help it, but I ask

What if this had been let unroll

It is but today, that I realize

What you and I have brought to bear

What you have given me

No other has

And for that indeed

I love you more

For L.

Glass Inferno...

Faqra, Lebanon - July 2010

There's something mesmerizing about glassware photography. I find wine glasses to be a beautiful object to photograph, especially in a dark environment.

This unedited picture was taken on a beautiful windy night in Faqra, Lebanon; a half-empty, half-full glass of wine, backlit by a raging barbecue fire. With the aperture wide-open, a slow shutter speed of some 2 odd seconds allows the wind-stricken flames to merge together in an apparent explosion, and leaves the core of the fire appropriately overexposed. It could be criticized for hand shaking during the exposure, inevitable at these slow speeds, which is evident from the smeared contours of the glass and reflections.  Sure, a tripod would have made this a better picture,strictly technically speaking, but as I've learned, it is photographic imperfections such as this one that so often seem to add a little something to a photograph. Something raw and unexpected, something beautiful. In this case, a nice snapshot of the way I was seeing that night after the few watered down glasses of wine that preceded this one...

Is it just me, or...

Well it is obvious that everything in this country is getting more and more expensive by the day. Restaurants, Pubs, Night Clubs, Beach Resorts, nothing is spared from exorbitant prices rising at exorbitant rates. But what's been pissing me off lately is that as this happens there seems to be a concomitant slow but steady decline in the quality of all services provided! Here are a few things off the top of my head:

- The beiteddine festival: Have you ever bought a soggy, hyper-salted, minuscule Saj man'oushe for 7,000 LBP [~5 USD]? if you haven't, please take a long drive to Beiteddine and do so at the entrance, where the monopoly of saj has blown the prices right off the chart. And whether you like it or not, and no matter what you order, you are getting the "Amira" specialty man'oushe because the lady who makes them will MAKE you. just go there and you'll know what I'm talking about.

- Beach resorts: Jiyyeh and Jbeil alike, the amount that a nice enjoyable day at the beach will set you back is sizable! 20-30 $ entrance fee, 15-20 $ for a quick bite at their restaurants managed by some of the most incompetent people on the planet, you're talking at least 40 $ for some sun! More if you feel dehydrated and feel like getting a cold drink. Sun beds line the pools in almost all resorts and renting one will set you back another 20-30 $. Oh and did I mention the "bouncers" at the entrances? apparently they're concerned about the male:female ratio and won't let single or groups of men in... PLEASE! It's a !@#$ing beach resort!

- Restaurants: How much profit do you want to make? selling a 500 LBP bottle of w ater for 5,000 LBP is just ridiculous. Selling teabags for 7,000 LBP is even worse! We had dinner last night at Beib el Mina at Byblos. Some of the nice usual Lebanese mezze like Tabboule, Hummus and Baba Ghannouj, followed by fries and 3 fish dishes, with a few cokes and glasses of wine. Good food, good times, crappy service as usual. The bill? 850,000 LBP [566 USD] for 16 people. I didn't even feel like I'd just had a meal. Ridiculous. And it's like that everywhere.

- Pubs, Night Clubs: Always with the 30 - 40 $ minimum charge. Always with the dinner requirement to get a decent table. And most of them do not inform you until you receive the bill and can't believe your eyes because you've just had a 35 $ glass of Red Label, a 750-cL bottle of which costs no more than 13 bucks at your local minimarket! Did I say a glass of Red? I meant a glass of ice, with a scent of whiskey for you to fantasize over. That's not a night out, that's a JACK!

It seems to me that going out in Lebanon, especially this summer, has become more of a hassle than a pleasure. Factoring in the indescribable Lebanese traffic and all of its associated road rage, or the heat if you're unlucky enough not to have A/C in your car, followed by the ridiculous return you get on your hard earned money, I'm becoming more and more of a fan of house parties and dinners, and I cannot stand the sound of the word Jemmayze when my friends call me up to go for a drink...
Going to the beach is no better.