DYING TO DIE

I could write a whole blog about end of life. Was on palliative consults this week, and can't believe how many families are like, "when God is ready to take him/her, that's fine, but until then continue to aggressively treat them [with painful, futile, inhumane procedures that only extend their suffering]."

I just want to scream and pull out my hair!!

Modern medicine allows us to extend life indefinitely with tubes and machines and chemicals, but these people are already dead, for all intents and purposes. I know it's enormously difficult to let a loved one go- but at some point you have to realize how selfish it is to keep them suffering because YOU can't let go.

Waiting for God to "make the decision" will NEVER HAPPEN. That's because it already happened, when we put the tubes in, turned the machines on, and started dumping the chemicals into them.

TGIF

Another great thing about consult months: Fridays are really Fridays! And no worrying about patients over the weekends- their primary team can deal with that mess.

'ROID RAGE

Don't consult a team for a question if you're not planning on listening to them at all.

Ask about giving steroids, and then give them even though we said it would be inappropriate?

Fastest way to get us to sign off.

CONSULTING FIRM 2

Love those 4:45 pm consults.

Sir, your patient will be seen in the morning.

CONSULTING FIRM

First month of consults. First off, I don't have to be up at 5 or stay late. In fact, since we didn't have any patients for the first two days I got to leave by 3:30pm!!

Consult months = weekends off, no prerounding, no hand offs!

COUNTRY GRAMMAR

Love that I write up the whole case report and everyone else wants a piece of that pie. I asked them to at least add SOMETHING and all I get is "I'll email you a few grammar suggestions." Not sufficient people!

(By the way no one ever emailed me those grammar suggestions. Hope it wasn't too bad because I already hit the submit button!)

SHORT COAT ENVY?

Finally the sense of terror is starting to recede, no longer craving my short coat like a passifier.

WAKE UP CALL

I've now pushed 2 patients who thought they were years away from dialysis over the edge, and both are now on dialysis...so sad. (Hey neither were ACTUALLY my fault.)

BITING THE HAND THAT FEEDS YOU

A patient called me a dumbass today. I interpret that as him being ready to leave...except he has to go to a homeless shelter.

PULLING (PURSE) STRINGS

Patient's wife: "How much pull do you have to get us a different hospital room?"

Me: ..."I can't even get a tech to get VITALS on a distressed patient!!?"

Ok I didn't really say that but it was something a tiny bit on the sarcastic side.

....AND PLAY HARD

Day off! For the first time since July 1 I am essentially caught up on paperwork (there's always little stuff, and ill never get ahead), but hooray! Called for a celebration dinner at Bessingers BBQ. Otherwise I enjoyed just sitting around doing nothing, for the first time in a while.

IN MEDICINE, WORK HARD...

Sad day, one of the team's med students dropped the course for some remediation. I completely disagree about the decision and am frustrated that one person's opinion can have such severe consequences. Goes to show that even enthusiasm, hard work and exceptional intelligence doesn't always cut it.

DON'T JUDGE A BOOK...

Cross cover score! Several sequential nights with only 1 call for all of my patients!! It's my new goal, to not have any, ever. I actually enjoy cross covering...you're the only one there to make decisions. And most of the time they're easy fixes, like pain or nausea. Quick fix and you look like a hero!

A PAGE FROM THE BOOK OF A NEW INTERN

Disappointed to learn today that you still receive pages even when the memory is full (almost as disappointing as finding out- NOT from personal experience- that pagers float so there is no use throwing it in the toilet). First Gen Med call today and it was full by 1pm.

THE REAPING (...AKA MATCH DAY)

Match Day. It's a 50-year-old tradition that defines the transition between being just another person and a doctor. (Yes, hint of sarcasm, because it's downright crazy that one day you're nothing and the next day you're an M.D.)  I'd been planning on doing a short piece about the nuts and bolts of the Match (and a few personal opinions and grievances) and had an epiphany in the shower. (TMI, sorry!)

Forgive me for the frequent references to the Hunger Games when trying to describe medical school- it has just been such a great analogy.  If you haven't read it, shame on you. You won't get most of these references. And seeing the first movie doesn't count; it didn't do the book justice.

HOW THE RESIDENCY MATCH IS BASICALLY THE HUNGER GAMES' REAPING

• The reaping (Match) is an annual event that takes place in each district (medical school)

A TASTE OF YOUR OWN MEDICINE

We all go through it at some point, thinking we have Guillain-Barre or diabetes or the plague. We even know those thoughts are irrational...but then something actually happens.

About two months ago, while wrapping up interviews, I noticed a prickly, tingling sensation in all 10 toes. At first I brushed it off- maybe my hose or heels were too tight, and I had been sitting for extended periods of time on airplanes. But it never went away-it was constant and in both feet.

My first thoughts, of course in panic, were diabetic neuropathy, a spinal cord lesion. Statistically, I knew that diabetes is extremely common, but I didn't have ANY other symptoms. And not only is my BMI a nice 21, I had recently started eating more healthily, nearly eliminating simple carbs and fats completely. I considered stopping by student health to have my blood sugar checked.

Stupidly, I googled it. I knew very well I'd run across crazy, rare diseases and freak out. Multiple sclerosis kept coming back up, and that almost seemed more likely than diabetes at one point. A resident I know was diagnosed recently and I couldn't get that out of my head.

After two weeks of parasthesia that quickly spread throughout both feet, I finally called my mom, a pharmacist. She quickly recommended getting some B vitamins in, because apparently oral contraceptives are associated with that (I had no idea, and have taken them awhile without problems). I had actually considered a vitamin deficiency early on and took them for a week or so without improvement so I stopped.

After about a month of vitamins, it finally went away. I guess between my "healthy diet" and OCP, I became a statistic. And I learned a really important lesson.

You can't objectively assess yourself. Going to the doctor sucks, but sometimes it's better than the alternative of getting much worse. I am even cautious about discussing medical issues with close family, because the closeness still impedes objectivity.

Also, healthcare professionals should take their own advice and not google their own symptoms.

GRANDE SKINNY WHIPPED UPSIDE DOWN MACCHIATO PLEASE

I think I had a coffee revelation today. I've never really loved coffee. Growing up, my idea of coffee was a 1:1:1 mixture of coffee, creamer and sugar, which I would prepare myself as a 5-year-old at the Fresh Market. (Just a tiny cup, of course, in my mom's defense.)

I prefer the caffe mocha- almost the perfect ratios.

As you get older, it isn't really socially acceptable to be seen putting that much cream and sugar into your coffee. Acceptable colors are black, and "really close to" black.

At first I tried to hide the color in a lidded coffee cup, but the sweet syrupy smell gave me away every time. So I started thinking, how do I get the caffeine, without the coffee? (Even better, without the calories?)

I first came across caffeine supplements like NoDoz during my paramedic days, when I had to stay up for 36 hours at a time. So, for the past few years, I've been taking a quarter of a caffeine pill (that's less than one cup of coffee, but enough to prevent withdrawal headaches because I can't seem to completely wean off of it.)

IT'S A NICE DAY FOR A WHITE [COAT] WEDDING

My personality has changed a lot during medical school.

(Or so I hear.)

In my opinion, I just have a lot less patience in general. Grocery store lines, traffic– I just can't handle it as well anymore. My mom says I'm just more concise and to the point (much like the doctors she works with), and I agree. Why use 20 words when two will suffice?

Even conversations have become more like patient presentations. You better have a point, and get there quick.

So when it comes to planning a wedding, the same rules apply. If someone asks what kind of glassware to use at the reception, I want a limited number of discrete options.  Even better, a well-formatted comparison table in Excel with bullet points. Which one is more expensive? Does the other one contain lead? Are plastic cups couture yet?

Don't get me wrong. Like every other engaged female, I want a perfectly-executed (down to the second) beautiful wedding that people talk about for 10 years.

The wedding industry is a well-oiled machine. They've got things down to a science. Why isn't there any initiative to streamline the process?

My humble hypothesis is that it has something to do with bridal hype- TV shows like Bridezillas (guilty pleasure), huge bridal shows, magazines and now websites and Twitter accounts. Being a bride has become a 1-2 year marathon (Miss America?) rather than a one-day sprint. If the process was streamlined, brides AND planners would be out of business. (I now wonder if the articles, dresses and "new" DIY projects are just cataloged and recycled every 5 years.)

I kind of get it. It's fun to flip through a wedding magazine and rip out pages of ideas. But in the end, society had still allocated only one "official" day for us brides to temporarily sabotage everyone else's lives, and no one else- not even the groom- will remember much more than the food (and if the dress was hideous or not) ten short days later.