Saturday, July 28, 2012

Ready for the End

This is the last weekend of my first block. It was challenging. 319 hours in 4 weeks, just one short of a violation. Over 400 pages for services to the floor. Untold number of scut monkey activities and moments of potential humiliation by upper class folk and attendings sprinkled with a solid 1/2 dozen moments of amazing connections with family and/or patients.

And it's those few moments that fuel my love for what I'm doing and yearning for more. I think I can put up with almost anything as long as those moment continue. And I know that that part of the equation is up to me. Because I know I have little control over any of the rest of this madness and mayhem they call residency, filled with strange rules, hours, notions, myths and activities.

Yet at the end of any brutality is the notion that one can survive almost anything. And then onward to the next block of work, education and hopefully more time for me. Remarkably, I am about to survive and this is my last weekend. And, I think I'm ready!

Let the games begin

I think medical education is constant search for diversion and distraction punctuated by the complete lack of sleep. Let the games begin!!

Love the Ralph Lauren USA garb, made in China :)

Friday, July 27, 2012

Dragon Speaking

"ice on a dill" = lisinopril

Voice recognition dictation can be so so entertaining

Wednesday, July 25, 2012

Loving what you don't like

It's inevitable. Experiences in medical education, or in life for that matter, that you file away in "I'm sure I don't like that". And then you set about a way to avoid it, to the best extent possible. But still staying politically correct, snuggling to the correct person, and stating the most obvious sarcasm you can muster... "I love this [thing you really hate]!" Although hate is a strong word, certainly something you will try to avoid. It just feels wrong.

But somewhere in the political correctness, the lies about what you say you like but don't, is a spiritual nirvana and real message in the "hate". We learn what we don't like but still take away a greater knowledge, experience and appreciation for that thing or experience.

And so is the life of an intern. Moving through the motions of learning so you can be a working physician, figuring out what you like and what you don't like, but still learning...always. Every skill, every nuance, every opinion, every fact; Adding to the knowledge base that is your toolbox for the future practice of medicine and patient care. Always with the knowledge that there isn't anything that they can do to me in one rotation that I can't get over. But a positive lesson on something, even if it's negative, every single day.


There is no way possible to fix the current medical system quickly and easily as long as it's core is made up of professionals that believe that the old way is the only way. Sadly it's those old ways that have brought us to this broken, unenviable place in U.S. medicine.

Wednesday, July 18, 2012

Cost of doing bad business

She said "I ran out of my medications" and couldn't afford to get them.

Cost of medications for the month not covered by insurance, $85

Cost of the Emergency room visit for the hypertensive crisis plus the ambulance ride in, $2800

Does this make any sense to anyone?

It's not mine

There are few things that are more disturbing than to hear those words from physicians who are in the business of attending to and working with patients..."It's (referring to a live, breathing patient) not mine"

Let me get this straight. The patient needs your services, but "it's not yours?" And the it, ...that's Mrs. Bernstein. I know you are tired, so am I. I know your reimbursement won't be maximal, but who's is. But she is yours. You are a neurologist with expertise in meningitis, you are on call, and she does have meningitis.

So it, her brain and it's surrounding meningeal structures, are yours.

Tuesday, July 17, 2012

Healing in the modern era

This has gotten so complicated. Financial issues prevent or alter access. Why not use the ER for your primary care. They can't turn you away, even if you don't have the co-pay. So, so broken...

Monday, July 16, 2012


Nothing too good for our residents. I have the luxury top floor penthouse suite

Letting Go

Medicine is a strange training ground. So much pressure to compete. So many lost opportunities for real collaboration and real team work. Mix that with sleeplessness & stress and you have a potential challenge.

Letting go of the tendency to hold ourselves up to other people’s standards, and letting go of the belief that we need to compete and win, doesn’t mean we don’t believe in doing the best job we can.

I love baby Pandas.
But I digress.

Friday, July 13, 2012


The hospital ED has a way of dealing reality to both patients and providers.

Reality: that which you were formerly clueless on, becomes clear as a bell.


Without good teaching and teachers the process of learning in residency can become disheartening and destructive. But with good mentors and teachers, it holds promise and value to be both gratifying and productive. We shall see.

Tuesday, July 3, 2012

First Days of Residency

The first days of work were a little challenging with the hours, demands and (most of all) the reactions of the patients. Do you think it had anything to do with my shirt?


Monday, July 2, 2012


First of anything are usually a challenge. It certainly was my first night on call as an intern. They said it wasn't too busy, but it felt like an avalanche to me. Fortunately all the patients did well and the only faux pas on my part...walking into a "isolation" room without a yellow gown. I learned to read door signs more carefully.

Of course the patient load/calls were compounded by not knowing how to get places, how to use the electronic medical record, or the "norms" of the hospital and staff. It was challenging to integrate medical school and my experience into the work of getting through the night. But I survived. Barely. I fell asleep after my 14 hour shift during morning report before going home.


And so it begins. The residency learning process in the face of overwhelming responsibility, not enough time, not enough staff and a learning curve as steep as Mt. Everest. But I'm determined to make the climb, one step, one day, one patient, one decision, one new EHR skill, one nap, one admission, one order at a time.