Part II

As promised, here are my remaining words of wisdom:

3) Own what you know. This and #4 are products of my own experience. After following rules #1-2, you are self-equipped to make your own decisions. Frightening, yes, but true. Trusting your own judgment is tough stuff. Don't assume someone who disagrees with you knows better just because he/she is older or has reportedly been in this situation before. You will regret making an error based on someone else's judgment or knowledge so much more than if you'd trusted yourself but been wrong. Getting punished in the morning (as in after your night on call) for someone else's mistake is an unpleasant scenario indeed. Don't get high and mighty, but for the sake of many tears and restless nights, please, oh please, stand up for what you think is the right thing to do. I wish I had last February, but that's a story for another day.

4) Never ask a patient a question to which you don't already know the answer. (AKA: Trust no one.) You are taught in med school to always believe what the patient tells you, but patients lie. All of them. Some mean to, some don't. Because I think it's discriminatory to choose how much I believe of what you say based on appearances or first impressions, I employ a blanket policy to trust no one. To keep myself from operating on false information, I verify to the extent possible the data I seek through objective means (old op reports, clinic notes, etc). Then, akin to a lie detector test, I ask a few non-important questions to see if the patient's answers line up. Drug screens are my favorite; urine doesn't lie (you can quote me on that). This then determines how much I trust your other answers. Next time you end up in the Vandy ER, consider yourself warned; there will be a pop quiz.

Words to live by

I know it's been a few weeks since I posted, but this one's worth the wait!

Every med student who rotates on service with me learns to live by my four pillars of medicine, which also apply quite well to life in general. Today, you lucky, chosen souls, I share them with you...

1) Fake it 'til you make it. I can't entirely take credit for this one. I owe this motivating pearl to my high school band director. People often misinterpret this one; I don't intend for you to lie or attempt procedures for which you are not qualified. I simply mean to say that if you act confident, people will have confidence in you, which in my opinion dramatically impacts what you actually are able to do.

2) Never guess, look it up. I have Mom to thank for this one, who passed it to me from her elementary school spelling club. (I know, my mom is cooler than your mom.) You won't regret going back to double-check a dose or side effect before you order a med, but I bet we can all think of a time that made us regret not doing so. You also significantly decrease the risk of making yourself look like a horse's hiney when you verify the op note (record of procedure) or MRA (medication administration record) before yelling at the surgery resident or nurse. Frequent employment of this principle also obviates the need for Pillar #1.

That's enough wisdom for today. Tune in next time for the life rules #3-4.

Is there a doctor in the house?

My Friday night went a little something like this... I was minding my own business, sitting on a plane headed to Tucson, where I would spend the weekend shopping for wedding dresses with my sister. Then with a crackle and hiss of the overhead speaker, a quavering voice cries, "Are there any medical personnel on board the aircraft?"
Oh no. My heart starts tachin' away (medical slang for beating uber fast); I am medical personnel. What could it be? Fatal exsanguination? A woman in labor? Sudden cardiac death? An older gentleman leaps up and bounds toward the back of the plane. Maybe I can just stay where I am; that other guy got up. But what if he's just an enthusiastic radiology tech or retired pathologist? About 10 seconds have elapsed at this point as I stand up and head for the guy laying down in the back row. The flight attendant says, "Oh, do you need to use the bathroom?" After offering my assistance, she explains that a man felt queasy in his seat and then felt as if he were going to pass out on his way to the bathroom. Really? That's it? Mind you, he hadn't actually puked or actually passed out. I head back to my seat; the other guy is obviously more impressed than I am.
A few minutes later the flight attendant approaches my seat and asks 1) if I am a nurse (really?!) and 2) if I will examine his heart as the other guy (neurologist it turns out) can't hear anything. Neither do I, but as his blood pressure and heart rate are fine and he feels better, I don't entirely care.
Feeling very much like I'm dealing with the ER, I sit the guy up and take off the oxygen (running through one of those little plastic yellow emergency masks). He is not in the mood to go the ER upon landing. I inform him that we can't make him do anything. The other MD and me keep checking on him, and there is no further adieu.
Do you think the CEO of Southwest will send me a handwritten letter of his personal gratitude for my heroic services?

Oooohhhh, halfway there

January 1st marked the halfway point of my residency. I thought I had a fair idea of what to expect when I started that fateful July 1, but I could never have predicted and still can't quite describe my life over the last 18 months. The glass half-full way of putting it is to say that my experiences have made the first season of Scrubs a lot funnier. There's lots of glass half-empty days, too, when I can't remember the last good day or why I got myself into this in the first place. I wish I could tell you I have enough special, satisfying moments with my patients to keep me going, but that's just not true. If you require gratitude of patients or success against disease and dying to keep you trucking, I am fairly confident my line of work would beat you down and then kick you in the head for good measure.
But I believe God put me here and that He gave me the rest of my life to keep me where He put me. My sweet Nick, for example, regularly cuts me off from checking patient charts at home and meets me with hot chocolate at the end of a long day. And who can stay angry with the world when three waggily tails greet me at the door every evening?
We recently had an ethics lecture in which a silver-haired doctor told us stories to illustrate how being a compassionate doctor makes you a better spouse, parent, etc. I frankly disagree. Maintaining my non-work relationships allows me to be a doctor (hopefully a good one) without completely losing my mind and my cool, not the other way around.
But that's enough of my heavy heart for one day. Until next time, I'll be oooohhhh, livin' on a prayer.

A not-quite-silent night

I was among the privileged few to take call on Christmas night this year. Everyone says how quiet Christmas is because no one wants to come into the ER. Blah, blah, blah. Lies, lies, lies. Any night on which the rads attending calls you to say, "That's the biggest cecum I've ever seen" is doomed to be a long one. Said cecum hit 18cm and after much agony and debate went to the MICU around 1am and ended up getting urgent decompressive colonoscopy. I'm just glad it wasn't my cecum.

The day was not a total loss, however. My sweet Nick played St. Nick and brought a little Christmas to me. He cooked a full Christmas dinner, turkey and all, and brought it to the medicine lounge. I rounded up the other bedraggled, on-call souls, and we had quite a time. I had even invited all the surgery residents I ran into that day (think Joyeux Noel); however, no surgeons took me up on my offer. After dinner I admitted two people who were both so nauseated they couldn't eat; I found it quite amusing that I had quite the opposite problem in which I ate so much I was nauseated.

The best Christmas present of all? I realized roundabout 4am as I was admitting patients #5-6 that this was my last call for 6 weeks!!! Nick is going to start wondering who the stranger in his bed is...

Feels like home

I'm on call today and have a little lull, which is the perfect opportunity to tell you this story.
The fellow called me with a mundane elective admission, and she told me, almost apologetically, that this man is primarily Spanish-speaking. Those of you who know me know that I once upon a time spoke excellent Spanish, but I now consider my vocabulary sub-par. I trotted downstairs and completed my interview and exam. For a few minutes, you would have thought I was back at the Taub; this too-familiar encounter made me miss Texas even more than usual today. I thanked my patient for his patience with my almost-decrepit Spanish, and he told me he speaks a little English but that he wishes he could practice more. I informed him I would be happy to speak English with him to help him practice.
He said, "But then how can I help you practice your Spanish?"

Pick me, pick me!

I certified my rheumatology fellowship application December 1. Since then I've been trying not to think about the whole process since I heard rumors that no one really offers interviews until January. But I got my first interview offer today! This first brought a sigh of relief that I actually submitted my application properly without too many typos. I next moved into the dancing, singing my own praises phase. UT-Houston, here I come!
Then I went into strategic planning mode. The e-mail arrived 11 minutes ago. If I reply now, will I look enthusiastic or desperate? I told myself I would wait until the afternoon before replying. But what if the date I want is filled by then? (Really? Did I really think that? Like all 14 of us applying for rheum in the nation are really going to fight for that one day?) So I held out for 2 hours and then replied.
Next came the anxiety over when the next offer might come. It was easy when I could tell myself there would be silence on the line until January 1; now, however, I wait with baited breath for new messages from myeras. It almost feels like junior high gym class all over again, hoping I'll get picked soon. This anxiety is partly assuaged by my awesome interview suit; I mean, who wouldn't want me to be their rheum fellow in my perfect Ann Taylor tropical wool single-button grey suit with the cranberry silk button-up that I will alternate with the lavender rough silk ruffle-front shirt?
Anyway, if you see any rheumatologist around over the next few weeks, put in a good word for me.