Doctor Psychobabble

It’s 9:00 p.m. I just got home from a 13+hour day on call at the hospital in neurology. I was incredibly, incredibly busy today. I did thankfully manage to cram one meal into my mouth today (my resident insisted on it). Actually, it was quite the multitasking meal, as I literally shoved food into my mouth with one hand while writing orders with the other, and stopped to push meds and discharge patients in between. I think the coolest thing about this past month of neurology has been finding my groove.

I’ve really started to understand how to get stuff done. Take a simple procedure like putting in a nasogastric tube (NGT). It’s a rather simple procedure, but involves finding the NGT, lubrication, and tape. It works much better if you position the patient correctly, and you have to remember to get a chest x-ray to check the placement before pulling out the guidewire and putting in the order to start feeding the patient through the tube. Again, none of this is that difficult, per se, but knowing where to find stuff, how to place the order, and when to notify the nurse are all mini-skills which, when added together, equal a major-skill.

Among many other tasks today, I assisted in a lumbar puncture, and then had to run the cerebrospinal fluid (CSF) to the lab. As I now have experience in doing just this, today’s adventure was much shorter and entirely less stressful than my previous attempt at CSF delivery.

Random list of things accomplished today:

1. Placed two NGTs.

2. Assisted in an LP and delivered the CSF.

3. Called several consults.

4. Obtained about 10 consents for various procedures.

5. Spoke with about 5 different families.

6. Calmed a very hysteric patient.

7. Discharged four patients.

8. Drew cardiac enzymes.

9. Ordered STAT EKGs.

10. Wrote 15 progress notes.

11. Got yelled at and belittled by the cardiology fellow (it actually didn’t upset me at all…)

All in all, it was a challenging and tiring day. But I knew how to do stuff. And I did all my work fairly efficiently.

It feels super duper to finally have my groove back.

Photos: 1. My awesome sushi dinner on Friday night. 2. My chocolate bunny s/p B/L ear amputation.

For all of you out there who think that being a doctor is similar to what you’d see on Grey’s Anatomy, Scrubs, or House, I thought I’d share a little secret.

Let me use an experience from today as an example.

An episode of Grey’s Anatomy would go something like this….Patient has some strange symptoms…close up to doctor performing a spinal tap…cut to doctor finding out that patient has some bizarre disease based on the results, which probably appear on a huge, flatscreen in front of them…shock and awe and excitement!

Now for my real life experience.

Patient has some not so strange symptoms. They need a lumbar puncture. I search for 20 minutes in the clean room to find the LP kit, sterile gloves, and other supplies. I find out from the nurse that I need to fill out 10 pages of paperwork in order to perform the procedure. The LP takes almost an hour. I find out that the spinal fluid needs to be hand delivered if I want it to get run correctly. I walk very far to chemistry. They tell me to go to hematology. I walk far to hematology. They take a sample and send me to microbiology. They take a sample and send me to parasitology. They take a sample and tell me I need to go back to hematology. They take a sample and tell me I have to go back to chemistry. I get lost outside for a while in the rain (carrying a biohazard bag with spinal fluid in it). I finally drop off the last sample at chemistry. I find out later that I need to fill out a special form to get one of the labs. I fill out the form but the fax machine isn’t working. I find another fax machine. Finally, labs sent. Then, hours later, I pull up the results on a not so fancy computer. Still, no finite diagnosis. I am tired.

That’s actually the short version of how things went for me today. Not that I’m really complaining. I’ve realized in my 8 months of being a doctor that my actual time spent with patients is minimal. I spend most of my time filling out forms and documenting.

Someone should really produce a show on TV about what it’s really like to be a doctor. But then again, I doubt anyone would want to watch it.

Photos: Taken on my walk to the hospital today. Also, not seen on TV.

Part of My “Trash Talkin” Photo Series

Please check out my latest post on “The Ink Blot” at Medscape/WebMD to read about how not to be a “bad” medical student.

Click Here to View the Original Post on Medscape

“There’s a lady who’s sure
All that glitters is gold
And she’s buying a stairway to heaven ”

- Led Zeppelin, “Stairway to Heaven”

I just got home from the hospital. I was on call today in neurology. It’s 9:00 p.m. and I am quite pleased to be home not too unbearably late. I’m tired, but not brain-life-sucked.

The interesting thing about being on call for the “floors” in neurology is that my duties mostly involve putting out fires and talking to families.

I ordered STAT doses of medications. I made sure patients had labs drawn and followed up with consults.

But perhaps most importantly, I talked to patients’ families. I plan on writing an actual post/article on this topic. And I promise to do so soon. But the gist is that I’m starting to realize the importance/significance of speaking to families. I had to answer questions tonight from family members such as:

- Did my father have a stroke?

- Will my mother ever awake from her coma?

- Why is my father choking on his feeding tube?

- What is a seizure? Will it happen again?

- Can you please get me diaper so I can change my sister?

- Is it cancer?

- Will my mother be able to walk again?

Some answers are obviously more difficult than others.

But I pride myself in answering the questions of loved ones succinctly and sensitively, no matter what they are.

I’m in love with the challenging yet delicate nature of my job as a doctor.

I really am.

Part of My “Trash Talkin” Photo Series

“Since the invention of the kiss, there have only been five kisses that were rated the most passionate, the most pure. This one left them all behind.”

- The Princess Bride

Photo: Rainbow and Pepe, my mom’s horses.

I am a self-proclaimed obsessive compulsive person. I have always been a neat person. And, I have an obsession about things being correctly aligned. A crooked picture on a wall causes me anxiety. Crooked rugs will drive me up the wall. Literally.

Not only do I need to have a clean apartment, but the process of cleaning is in itself a therapeutic experience for me. I’m happy to say that since I had the past two days off in a row (eat that, residency!), I’ve been able to clean my apartment, do all my laundry, and organize my life, in general. In addition, I had the time to add two “extras” to my usual cleaning routine. I cleaned out my refrigerator and microwave. Now I no longer have to wince with anxiety every time I go to grab orange juice from the fridge or re-heat my leftovers.

My planets are aligned!

Photos: My sparkly clean fridge and microwave! (Yes, I’m a dork!)

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It’s Friday night at 10:00 p.m. I just got home from being on call today in neurology. I’m tired and hungry, as always, but incredibly happy and satisfied, not as always.

There are two good reasons for my current state of bliss. The first one being that I have what I named a “platinum weekend” starting tomorrow. In medicine, having both Saturday and Sunday off is a rare occurrence. Us med folks term this wonderful event a “golden weekend.” I’m happy to announce that I not only have Saturday and Sunday off this weekend, but I also have Monday off, as it’s a holiday and I’m not on call. I have decided to call this most pleasurable of events “platinum.” I seriously could not be happier.

The second reason for my joy is that I realized today that I really like being a doctor. While physicianhood and residency are intensely challenging and endless sources of stress, being able to care for my patients is a privilege, which I cherish.

I broke the news to a family today that their mother had a massive stroke, which she would likely not recover from. I was called to sedate a demented patient who was attacking their one to one. But I ended up using words, not meds, to calm him. I pushed two amps of D50. I used phone translation services to clear my patient for an MRI. I consulted gastroenterology for a PEG placement. I convinced the MRI tech to perform an emergent full spinal MRI on my patient.

I did a lot of doctor stuff.

I actually really enjoy doing doctor stuff.

Last night, I went to the pre-opening of an exhibit at the Cooper Hewitt Museum, which my partner Micah works for. I wore an awesome dress and heels. I drank free wine and mingled with artsy fartsy folks. I never used the words “NPO” or “bowel preparation.” I had a blast.

I really enjoy doing non-doctor stuff.

I am actually looking forward to cleaning my apartment, doing laundry, going for a long run, and all kinds of other stuff this weekend.

And I might just even sleep in.

Life is good. Very good.

Photo: My arm from last night. Hopefully I will have more photos to upload later. (Come on Vanity Fair photographer!)

Please check out my latest post on “The Ink Blot” at Medscape/WebMD to read about the Youer than You.

Click Here to View the Original Post on Medscape

I’ve been tired out of proportion for the past week and I’m not entirely sure why. I’ve actually been getting “reasonable” amounts of sleep lately. And I eat. But I still find myself nodding off during morning rounds. I think I’m developing a tolerance to caffeine. It’s difficult for me to make it through the day without 3 large coffees.

As I sat down at my computer just now to write, I realized that I had nothing new to say. But decided to post anyway.

So, in light of words, please accept these two trashy photos taken on my walks to the hospital.

The first one is what happens when a huge pile of snow melts in Brooklyn. The second one was taken the day after Valentines day. Enjoy.

Part of My “Trash Talkin” Photo Series