Hippocrates In San Diego

Please, I implore you

When working in a nursing home, and encountering a little old lady who has fallen over and turned blue, please make sure she doesn’t have a pulse before you start pounding on her chest like a gorilla throwing a temper tantrum. She’s liable to break a rib that way!

Don’t make me twist your arm…

Don’t ever lie to your doctor. I can tell when you’re lying and I usually know why you are lying. There are few things that will make providing good care more difficult than a dishonest patient.

It can suck

You have to think about what you’re doing every single day. There’s rarely a time when you can be lax, or not care about the quality of your work, or ignore its results. And that is true whether you’re tired, ill, distracted, or bored. That’s why it can suck sometimes. Why somedays you wonder if people slinging coffee at Starbucks or fixing cars have to be on all the time, “bringing their A Game” every day. I’m sure most do routinely, but do they have to? Do they feel the same obligation? Right now an occasional day requiring only my B Game sounds fantastic. I’m envious.

I refused someone shelter tonight

It’s been raining steadily for the last two days. Today has been especially wet, and (for San Diego) cold. It’s pretty typical to get a prolonged winter rain like this, but this year’s storm is especially rainy.

Yesterday, one of my patients, a homeless woman in the hospital only so she could be placed in a care facility, got tired of waiting and left “Against Medical Advice.”

Continue reading I refused someone shelter tonight…

Gettin’ wonkish…

My friend David emailed me today, asking if I had any interest in working to arrange a local, small scale discussion group on healthcare reform, as part of a call from President-Elect Obama’s healthcare advisory team. I think the idea is to have grassroots groups discuss the local conditions, and to provide some sort of input so that a national discussion can be had. This is exactly the type of discussion that was missing the last time Democrats tried to bring healthcare reform to the national stage: the Clinton plan was ill-timed (in the midst of an economic boom, with sharply decreased numbers of uninsured due to low unemployment) and poorly executed, politically. It wasn’t in the national consciousness like it seems to be now.

Continue reading Gettin’ wonkish……

The zeal, bravery, and good behavior of the officers and men on the night of June 30, and during July 1, was commendable in the extreme. — John Buford

I’m just finishing another two-week shift at our smaller boutique hospital in the north of the city, covering the final week of the last academic year and the first week of the current year. This is always a challenging time to be on the wards; fresh med school graduates are starting their internships the last week of June so there is a lot of learning happening. And a lot of stress — the interns are stressed, I’m stressed, and the patients are stressed because one day their doctor changes from a confident, knowledgeable and efficient first-year resident to a scared, sheepish, quasi-medical student who suddenly has a long white coat, two new letters after their name, and the power to make serious decisions. If there’s anything I can pass along to you, dear reader, is the advice that you never, ever, EVER get sick enough to require hospital admission around the first of July. The risk of badness happening is several orders of magnitude greater during this tenuous time.

Continue reading The zeal, bravery, and good behavior of the officers and men on the night of June 30, and during July 1, was commendable in the extreme. — John Buford…

Loss of Sensation

Some people still are impacted when they encounter death or other morbid events in their lives. In medical school they beat that feeling out of you. They start you early, doing anatomical dissections of donated cadavers at the beginning of the second year. I think everyone who has been through it remembers the feeling of that first day, when we were introduced to the people that would become our anatomy “partners” for the next several weeks. I remember walking down the hall outside the anatomy lab, seeing one of my classmates running for the bathroom with her hand over her mouth. My own heart rate was rapid that day - a strange combination of anxiety, anticipation, and fear. I remember seeing the phrase painted on one wall of the lab — some saying by some old Greek physician that escapes me now. I remember the stink of formaldehyde, how my scrubs reeked for weeks, how my skin was scrubbed raw trying to remove the smell. I remember those damned exams - one nerve buried deep in a limb or cavity somewhere was tagged with a piece of string — give the name, the insertion point of the muscle it innervates, and the name of the nucleus that modifies its function. Huh?

Continue reading Loss of Sensation…

Art. 25, Gen. Assy. res. 217A(III) of 10Dec48

I deal with the consequences of our healthcare insurance system every day. I work in two hospitals: one is a large urban public hospital that takes care of a large portion of the county’s uninsured, including homeless people as well as the working poor without adequate insurance; the other is a private hospital that is more like a hotel, with wealthy patients who have private insurance as well as Medicare or MediCal, California’s state insurance program.

Continue reading Art. 25, Gen. Assy. res. 217A(III) of 10Dec48…

Whew!

If you are looking at my posts closely you’ll notice that it’s been quite a while since my last (thanks for the nudge, joe positive). I just finished a 14-day stint on the wards. I’m still surprised how my life continues to revolve around an artifical lunar calendar. As a resident, my assignments always depended on the month. My schedule might have included spending July in the Intensive Care Unit, August on the General Medicine wards, September on the Nephrology consult service, etc. I lived and breathed by the month. This month was hard, that month was cake. I thought that would all come to an end when I finished my residency, when my “normal” life was all set to begin.

Continue reading Whew!…

Veteran’s Day Blues

I spent the better part of an hour watching “Combat Hospital” on CNN. I could barely choke my pizza down past the lump in my throat. This was hard for me: although I had seen similarly gruesome visual images in medical school, the context of the images on the screen made them intensely powerful. Every one of the patients brought into the Combat Support Hospital (CASH) was under the age of 25, with the exception of a sergeant who collapsed from emotion after transporting two of his wounded troops to the hospital. American soldiers and Marines as well as Iraqi civilians of all ages were treated by the doctors and nurses. It seemed like an incredible waste of youth. To be 18 or 19 years old, given a powerful weapon (and often becoming a powerful weapon), to be taught unending discipline, all for the end result of a mangled limb or shattered psyche — this was the opposite of everything that I had been taught or trained to do in medicine. We are taught not to think of disease as the enemy, because that dehumanizes our patient, turns them into a battlefield rather than a person. “The War on Cancer” or “Assault on Diabetes” sounds antithetical to what I’m trying to do — improve the quality, and frequently the quantity, of life. Where in these soldiers’ field training manual is the quality of their life mentioned? Is it only addressed after a lucky, but incomplete, survivor leaves the CASH?

Continue reading Veteran’s Day Blues…