A Haunting Encounter

Today, I had a class on incorporating the humanities in medical education.  We were asked to write a short piece of prose or poetry on a patient encounter that haunts us.  Hearing what others wrote was way to much for my hormonal psyche.  I didn’t share mine because I was too busy trying not to let anyone see me cry about the ones that were shared.

I am not a poet, but it kind of has a poetic feel, I think… Here it is…

You did your best.  You knew something was wrong.  You were low risk, they said.  But, now, you are sit in clinic and don’t know how bad it really is.

You are angry and scared.  You cry when I review what is happening within your body.  I am gentle, but I am up front.  Medicine is so advanced, but so limited.  

Together, we bring you down off that ledge.  We have a plan.  You know what is likely to happen.  Then, I point out you need to meet my staff.  To keep in mind that a chance for second opinion isn’t gone.  

Gruff and curt, he approaches.  The plan changes and you are confused.  There is no explanation.  Just a closed door.

I try to help you understand.  I feel a sense of loss.  Like I am free falling in a place outside of my control.  It can’t compare to what you feel.

You don’t want another opinion.  You trust him.  Because you trust me.

In that moment, I don’t trust me.

I go home and review the literature.  I think and think.  I talk to another staff person.  I am right.  There may be more.  But, how does that get approached?  Who is willing to speak up?  

Everybody talks, but nobody deals.  That seems to be the way sometimes.  The questions are brought up, but I wonder if they were truly dealt with.  They get swept under rugs that some of us can’t help but look under.

This time, someone did say something.  This time, something did change.  Somehow, the suggestions were accepted.

I was relieved.  I want the best for you.  I want the best for all of you.  But still, the whole thing is unsettling.

In the long run, will it be enough?  Will you continue to get the care you deserve? 

If I hadn’t been there, if you didn’t trust me, would it be different?  Would you have made a different choice?

Maybe it is enough.  But, I wonder if we could do better.  I wonder if it is my fault.  That my being nice, that we “clicked” made you not question, not request that second opinion.

I won’t know.  I can’t help but wonder it is my fault.  And I’m not even sure what “it” is.

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Turning Tables – Treating Physicians

Today, one of the other residents and I had an interesting conversation.

Somehow, the topic of treating physicians came up.  And it is something that terrifies us both.  And not just for the reasons you might think.

I will confess, treating other health care people is always nerve wracking because you worry even more about saying something wrong or stupid because you always wonder if they are secretly judging your skills.

But the bigger thing is that when we see them, they are being faced with a cancer diagnosis.  And for some reason, most physicians and nurses get the bad ones and all the complications.   And that is horrible for anyone.

The issue is, they know too much.  Sometimes, having some uncertainty is a good thing.  But, when you have cared for people with the same thing.  When you understand the odds and get the treatments, it is a whole other level.  You know the worst case scenarios.  All of them. Sometimes the unknown bits of the known are the worst.  Especially when your whole world gets turned upside down.

That is the hard part.  The anxiety, the sadness, the anger and guilt.  The fact that sometimes, the person who knows too much coming in can’t be easily comforted.  That the numbers that scare everyone have too much meaning.

It also forces us to face our own mortality.

We both agreed that given we work in Oncology and given the odds in the world today, we will both one day have cancer.  And we will probably die from it.   Those are simply real odds.  And the “comedy” that is life.

And we know this and accept it.  In fact, we laugh about it in an uncomfortable kind of way.  Sure, I might have a heart attack or an accident, but it is more likely I get dementia or die of cancer… Or both.

Really, it is something I accept.  But, it is still something that is terrifying. And maybe that won’t happen.  Maybe I’ll just die in my sleep in old age.

Either way the reality of seeing people who dedicate their lives to healing others broken, afraid and unwell is terrifying.  They are “one of us” who became “one of them.  It is just too real sometimes.  Too close to home.

I just want to fix the hurt.  I want to prevent the hurt.  I want to be out of a job (kind of).

But I can’t.  So, we do the best we can.  With every person.  Because one day the tables will turn in one way or another.

How Did That Happen?: How to try to be a good resident

This is the first edition of “How Did That Happen?”stethoscopes1

The first topic in question given the droves of people freaking out about starting residency (and in my opinion, justifiably so) is how to try to be a good resident.

Clarification… Good does not equal perfect.  Perfect is not real.

I feel like most people want to be good residents. I sure do. And from time to time I have been told I am a good resident. And from time to time I work with good residents.

How the heck does that happen? What actually makes a good resident? Do you have to be the freaky genius kid who gets straight As all through med school and doesn’t sleep and doesn’t have a social life? I sure hope not, then 99% of us will never be a good resident. Ever. A textbook answer would be to refer you to the freaking CanMeds flower, but if you went through med school in this country, you have the sucker memorized.

So, here is what worked for me and/or for other people who have been told at one time or another that they might be a good resident or who worked with someone who was probably a good resident. Clearly, this is not a be-all end-all list and there are some details for different specialties that may vary.

  • Go in to things knowing you (and no one in this world) is a perfect resident.
  • Sometimes, no matter what you do, bad stuff still happens.  People still die, preceptors still won’t love you and that evaluation won’t be outstanding.  Life goes on.  You just have to keep trying.
  • Show up. I mean really show up. Go to work leave only when your work is legitimately done. Attend teaching and meetings and participate where necessary.
  • Be on time. Just because doctors are famous for being late and you magically (somehow) have that title in front of your name does not mean you should take up being late. People notice and appreciate when you don’t make them wait.
  • Be enthusiastic. I get that people don’t all have ridiculously high baselines. But, try to feign interest in what you are learning, even if it is a rotation that makes you want to gouge your eyes out with small needles.
  • Read. Read a lot. Learn about the main topics and objectives you have for a rotation even if it is something you don’t care about. You’ll remember that stuff when it comes time to prep for exams and it stops you from looking like an idiot.
  • Know how your specialty relates to the one you are currently working with (if you are off service).
  • If some asks you a question and you don’t know, say you don’t know. Then, look it up because odds are they will ask you again and if you don’t know that time, they will be less than impressed.
  • Know your patients, but also, know your team. Nothing is more annoying than when someone doesn’t know who is following who, where a team member is or what time to round.
  • Teach. It is as simple as showing someone where to find something in a chart or explaining the rationale for a test to as complex as preparing a lecture. Not everyone is good at or wants to teach, but everyone has to do their part. Remember what it was like to be a med student or more junior resident and help a person out.
  • Look things up. Don’t accept what someone wrote in one note as fact. Check images yourself, cross check medications with the patient or bottles or pharmacy. Confirm timelines with old records. Just because someone else wrote it down doesn’t mean it is true.
  • When you don’t know, ask or look it up and share with others. But don’t ask just for the sake of drawing attention to what you know… That is annoying.
  • Be nice. Seems simple, but some people struggle with it. Respect everyone, answer pages and questions and really listen to the nurses and patient service workers. Same goes with patients and families. Even the crazies need someone to be nice to them from time to time.
  • Care. Not the same as being nice, but in the spectrum.
  • Be organized. This is tough for some people. Keep track of meetings, projects and paperwork whatever way works best.
  • Volunteer for stuff. I’m not saying do everything because that will kill you, but offer to teach or do presentations or look up some articles.
  • Write good notes and try to be legible. Nobody is asking for perfection, but if you can read it and it contains enough detail that the on-call person can figure out what is really going on, then it is good.
  • Give hand-over. I can’t believe how many people are terrible at this. I think it is because we don’t really learn it in med school. If you have someone who is sick or who has potential to need something specific overnight or is just plain complicated, tell the on-call person who it is, what is going on and what you think they should do. Same goes for telling the day people if something crazy went down at night.
  • Help out others. They’ll help you in return.
  • Seek feedback. This terrifies me because I don’t want to hear bad things, but the only way to be better is to know what is wrong. Some people won’t tell you unless you ask.
  • Many of the above can be summed up with this phrase, “take initiative.” If something needs to be done do it or make sure there is someone who will.
  • Don’t get too cynical.
  • Don’t disappear. Seems simple. Some people have a gift for this.
  • Don’t go rogue and start making out of your scope of practice decisions and doing crazy procedures without staff (aka don’t pull a Grey’s Anatomy or House, MD).
  • Don’t become a hermit. Friends and family are good. They keep you “normal” and happy.
  • Don’t give up things like sleep or food for extended periods of time. I’m not saying it won’t happen, but if you have a choice, please choose these. They make people function better and keep people from being shangry (that is my new made-up abbreviation for sleepy hungry angry, something I am at about 8am after every in-house call shift).

What are your “how to try to be a good resident” tips?

CAPO Review

It is the first Monday of the month and the last Medical Monday until September. Whoo. Time to check out some medical minded/affiliated blogs at the link below.


I am going to use this as an opportunity to expose you to some of the awesomeness I saw and learned about at the conference I went to this past week for the Canadian Association of Psychosocial Oncolology.

All last week, while at the conference, I was so excited, I wanted to tell the internet world about it, but resisted the urge in order to keep people from hating a million small updates about things that may not be as thrilling to everyone except me. But now, I will give a digest of some of the cool videos, tools and ideas that captured my attention at the conference and that I think might appeal to a wider audience.

First of all, every single keynote speaker pointed out that physicians are burnt out and that leads to poor communication, missing compassion and other issues. They also all cited a study of Internal Medicine residents showing that 76% displayed symptoms of burnout or depression. This made me feel depressed. Mostly because I know it is true. Also because I wanted to know what information was out there. So, I found a decent review article (IsHak et al. 2009) on the topic citing burnout rates to be anywhere between 25-76% and that self-care, counseling and system changes might help the residents and in turn improve patient care. Fascinating.

We have a system of health care, but not a system of caring.

Dignity is huge. Studies have shown that the factor that was seen as the make/break point in maintaining dignity was how the individual thought they appeared to others. Feeling dignity is supported if they feel they are being seen as a person and as a WHOLE PERSON, not just a disease.

One speaker talked about a thing they were doing at their hospital where they asked new patients to the palliative care service an additiona question, “What should I know about you as a person to help me take the best care of you that I can?” It changed care for many people.

Breast cancer risk is increased by smokng. But, interestingly, that risk is most increased when people smoke during periods of breast development. So, a group in BC designed videos targeting teens to try to make a change in this behavior. And it is working!

ReThink Breast Cancer is a nonprofit all about young women with breast cancer. They have support groups and events and all that good stuff. They even have a blog.  They also promoted a super cool publication in the form called Cancer Fabulous Diary, which is a book with coping tips and musings for young some with breast cancer.  It is written with the blogger from Cancer Fabulous, which is basically the experience of a young woman named Sylvia Soo who is a breast cancer survivor diagnosed at the young age of 24.

The Canadian Cancer Survivor Network has a webinar series on Thursdays about things like advocacy, drug funding and really relevant political/medical issues. Who knew? They aren’t the only ones though. Lots of other non-profits in cancer care have webinars with relevant topics.

No man is an island.

I went to a series of talks on decision making in older adults with cancer. About how they make decisions, how people get information and how they enroll in trials. Many people factor in their age, even more than providers sometimes expect. Family members are often divided into two categories, the super involved and the not involved. Both can have their pitfalls. Also, subtleties in communication with the provider influence the decisions a great deal. Sometimes the appearance of interest of a physician in a clinical trial will convince someone who was on the fence. Also, older adults cope better with a cancer diagnosis and treatment decision making than younger adults.

I saw a really cool video documentary on sexuality in young adult cancer survivors that addressed a lot of big issues.  The maker of the video is designing a website and taking the show on the road.  Unfortunately, it isn’t up yet, so I can’t show you.  But, it was very real and honest and not sugarcoated like a lot of stuff out there these days.

Psychosocial oncology is cool!

Puffing

The first Monday of the month and the last Monday of Respirology.

Actually, I quite like Respirology. The consult service is busy, but I have legitimately learned a lot and am now less afraid to mess (constructively) with people’s puffers when they are admitted to me in the future.

I also quite like Medical Mondays. Check out other medically affiliated blogs at the link on the image below.

Since it is the second to last day of resp, I thought I would share this lovely image.

Image from pinterest.com.

I remember seeing this episode and laughing hysterically.

It is so true.

People have no clue how to use their puffers. And they think they do. And they often can’t figure out why they aren’t getting better. But it is often because something isn’t being done right. And often this is because nobody asked and nobody taught.

I know this from both sides of the hypothetical office.

I have been on puffers off and on since I was about 9. I am one of those weirdos that did not have childhood asthma in the wheezy since toddlerhood kind of ways. I developed asthma in my late kid years.

I finally gained control of my asthma when I was in my 20s.

I have CONSISTENTLY PROPERLY used my puffers never.

Okay, never isn’t a fair term. I have used them consistently and properly, but not for more than a few months at a time.

I had a puffer for the odd “chest infection” as a tween. I never had an aerochamber. We figured out how it worked by reading the instructions.

One time, I was prescribed a turbuhaler. That is a puffer that has a powder you suck in. There is no puff of aerosol. We couldn’t figure out why we couldn’t taste or see it (this is before the days of Google, boys and girls), so I took a good 20 hits of puffer before we figured it out.

Google would have shown me this… Instead of just the words on the tube. And helpful tidbits like you shouldn’t taste or see anything. Image from theasthmacenter.org.

I was first given an aerochamber at 14. By this point, my breathing issues were beyond asthma and got into this weird laryngeal spasm thing, so that not only did I wheeze, but I had stridor because I didn’t keep my airway open right any more for some reason that is still beyond me (and probably at least partly psychosomatic).

What 14 year old who audibly wheezes and hacks wants to add to her awesomeness by carrying an aerochamber everywhere?

Not this one.

So, I used it at home and no where else.

It took years of titrations, allergy shots and finally growing up enough to see the greatness of not being sick all the time to finally establish good asthma control. If I had actually used the darn puffers properly all the time, it might have been quicker. Maybe not because there was other stuff at play, but maybe.

Instead, I would take them until I felt well, then I would forget them most of the time until got a cold, which would then linger forever because my airways hated me. That is when I would start taking them properly again.

Now, I have an action plan. I have that figured out with lots of medical education, doctors orders and real experience.

I don’t always follow it. I miss days of my steroid inhaler sometimes. That usually comes back to bite me. I forget to restart my seasonal asthma/allergy medication when Spring comes (seriously, I just realized this now). My aerochamber (that I have had for an indeterminate period of time) has a crack in it (I will get a new one next time I see the doctor), so I confess, I haven’t been using it. And I also confess I never carry it with me.

So, if I, the doctor suck at managing my respiratory illness, I know that  most patients are probably kind of like me too. That being said, I think it is doable.

I mean, it is where your priorities are at…. Breathing is good. The problem is that when you feel good and a problem doesn’t flare that instant, you don’t always think (for instance, I would never skip my migraine prophylaxis because 1 or 2 missed doses and I am out for the count for a day).

What I am pointing out is that puffers are inconvenient. Moreso than taking a pill. If you have an aerochamber, they are bulky, need to be washed and don’t fit in a nice purse (especially if you are me and like to carry a book).

The directions for puffers are variable. Often, I see people who don’t understand why their directions are different from the ones on the bottle and different from their friend. They get mixed up. People don’t understand that one is to keep you well long term and another is for emergencies only.

And don’t even get me started on proper use.

One of the docs I work with said that he suspects 75% of people prescribed puffers don’t use them properly. Mind you probably 20 or 25% of those people don’t use them properly because they don’t actually need them (that is a rant for another day). I’d believe it.

Today, I saw someone grab their puffer from their bedside table and try to use it without the aerochamber with me, the resident working for the lung specialists, standing right there!

I put it together and showed her how it worked. She had never seen it used that way before. Mind you, it had a mask because this person had such bad respiratory distress taking a single deep breath and holding for 10 seconds was out of the question. But, until then, that is what the person tried to do, but couldn’t do.

Image from asthma.ca

That is why I ask how you use your puffers.

Because I don’t always do it right, but I want you to do it right. I like it when people show me up and do everything to a tea and rattle off the proper timing and dosing. But, when you don’t know, I show you.

You can’t get better if you don’t get appropriate drug.

That message is as much for me as it is the other millions of people with respiratory disease.

But seriously, if you would up here looking for advice on how to take your puffer… GO SEE YOUR DOCTOR!

Learning in Ultrasound: A Person is a Person…

I can’t believe how fast February flew by.  It is Medical Monday again, which means time to link up with some other lovely medically affiliated blogs.  Check them out at the link below.

As you may know, I am on a radiology rotation.

A few weeks ago, I decided it was time I go see some ultrasound imaging.  Other aspects of imaging are more comfortable for me (especially Nuc Med for obvious reasons), but ultrasound is my black box, so I figured learning is good.  So, I am doing ultrasound at the hospital where I usually work.  Lots of livers and thyroids and kidneys.

Then, up on the screen pops up a perfect looking 8 week embryo.  Cool, I think to myself, that might be my kid in another four weeks.

Image from babycenter.com.

I then remembered that all of the obstetrical ultrasounds are generally done at the children’s hospital unless there is someone in emerg.  I asked why this ultrasound was done at the hospital we were at.

Its for the TPU replied the fellow.

Termination of pregnancy unit.

My heart sank.

He said I could leave if I wanted to.  But really, this is part of my learning.  Part of life in a hospital and in this world.

I watched him read four ultrasounds of perfect little embryos between 6 and 11 weeks all with heartbeats and the works.  Perfect little embryos that might have otherwise grown up, although it is tough to say for sure because bad stuff happens.

I went home and cried to Patrick because it seemed so sad and so unfair that these babies had to die when maybe they wouldn’t.  It seemed so unfair that so many women want babies so badly and yet here are people who for whatever reason or circumstance don’t or can’t want their own.

Just over a week later, after losing my own baby, Elim, I sat in that department again.

Yet again, I saw babies getting their photo taken to confirm that they were indeed alive (because the procedure is different if they are alive or dead).  I saw one person who had terminated pregnancies 6 times.

I had an overwhelming urge to go in and yell at these people.  To tell them that I am here, working and trying to piece together what is left of my sanity because my baby died before it would have even been very visible on an ultrasound.  That I really wanted that baby.  That it isn’t fair that they get to choose, but I can’t.  To ask a big huge why.

But, I didn’t.

Because that isn’t fair of me (or very professional).

Their baby dying, my baby dying, really, it is all a loss.  Those kids are all with God now.  They all had potential.  They all died because they were made in a fallen world full of brokenness.

That mom may mourn the loss of her child like I do.  Everybody grieves differently.   Maybe not now, but maybe later.  I have heard of the struggles of moms who make that decision.  And maybe she won’t.  I can’t put myself entirely in her shoes.

We aren’t very good at putting ourselves in other people’s shoes.  We are, however, really good at trying to point out other people’s wrongs.

Image from chzbgr.com.

I’m not here to have the pro-choice or pro-life debate.  In fact, I don’t want to hear it because it is often hurtful, overdone and narrowminded on both sides of the coin.  Sin is sin.  Death is death.   Pain and anguish are universal.   We have free will.  That is all on that.

I read this blog post from The Lewis Note called “Why Miscarriage Matters When You’re Pro-Life.”   It was strangely timely based on the adventures of the last few weeks.  Check it out.

I read this post the night after my second day in the ultrasound department when I was really struggling with the value of life and how we see it as a society.

It rocked my world.  Because it is so true, especially in a Christian context, but I am sure it works for others as well.

I have already experienced both the good and the bad sides of this post.  Some people are really nice.  Other people aren’t.  And some nice people say stupid stuff (I sure do).

Thinking on how I responded to people who lost kids at the same point, I think I had empathy and sympathy for both.  I think I did place more value on the aborted baby.  I also think I had more sympathy for that child’s mother because there was action and potential.

Looking at scans, it is the same.  Already dead babies are already dead, so in a way, it seemed less sad than about to babies about to die.

That isn’t necessarily fair of me.

Both an electively aborted baby and a spontaneously aborted baby were both alive at one point and had potential and value.

And then, there is our approach to the mothers and fathers.

Don’t forget the fathers.  Many people do.

Everyone needs love.  It doesn’t matter how voluntary a loss was, it doesn’t matter how old the child was (although this does often impact they way people can grieve and what is considered “acceptable”).  You need people willing to live the grief with you.  To sit it out with you because that is what you might need, even when it is uncomfortable (just like sitting through scans that are upsetting helps us to learn and grow in a different way).

If you claim to care about a person, to care about life, then you should stand by the mourning no matter what they are mourning and no matter how long that what was alive.  If you want some practical suggestions and examples, check out that post.  I am the first person to admit that I tend to project my feelings on others, so if I think something would weird me out, I tend to avoid doing that for someone else or letting someone do it for me.  I’ve learned that I am often wrong and my assumptions were totally incorrect.  If you aren’t sure how to help or love someone where they are at, ask.

I guess I’m learning more than I anticipated on this radiology rotation.

Our New Friend (you just can’t make this stuff up)

Patrick and I made a new friend today.

We were on church set-up today, which is basically assembling the place to look like our version of a church (during the week it is a mission) and then cleaning up afterward.  Also, it involves the important task of going to the hipster hostel café down the street to pick up coffee and then return the containers afterwards.

On our way back with the coffee, we got stopped by a random man standing in the doorway of a closed shop.

Oh, I should probably mention at this point that we go to church in what is known as a super dicey part of town.

I like it.  It makes me feel at home (because at home-home, we go to church in a super dicey part of town).  You just never know who or what is going to wander in through the doors.  As much as I am terribly shy, I love some of the personalities and honesty that can come in the door in.  I also think that loving people where they are at is so important, just like anywhere else, but in this place, some of the people unfortunately don’t get as much love.

So, this guy who is kind of looking a bit in disarray stops us.  He has no teeth.  His beard forms a single dreadlock.  He has terrible leg swelling to the point where one shoe has no laces and his foot barely fits in it.  He has a lovely smile.

He tells us that he isn’t asking us for money or food or something because he doesn’t do that sort of thing.  He wants to read us a letter he is writing to his girlfriend.  His girlfriend of 25 years.  Who he dated when he was a teenager.

He hauls out a piece of paper.  On one side is a ton of numbers.  On the other is writing.

It is simply written in block letters.  Some of the tenses of verbs are wrong, some words are misspelled.  He reads us every word.   It is a slow go.  As much as the actual writing isn’t the best, it is pretty deep poetry.  The thought behind it is lovely.

He tells us he is going to make it into a song and chats with us about his blind and lame grandfather who was an amazing piano player and who he gets his musical ability from.  He talks a bit about love.

Then, he starts walking with us and eventually turns off down an alley.

We laughed because that is the beauty of this community.  We were stopped to be read poetry.  That’s all. Most people would have ran or kept walking for fear of what was going to happen.  But really, we got slightly more snowy and much more happy.

After church, we were returning the canisters the coffee was in and we passed the same guy playing a purple children’s guitar on the corner.  He sounded really good.  He picks with his nails, not with a pick (this always impresses the face off of me).

He spotted us and ran across the street to say hi.

Again, he told us he plays and sings for the love of it, not to make money.  He often plays at home on his own, but it was nice today.

He talked to us about his theories about music.  How instead of there being a bunch of (I think he said sixteen) notes in a scale, he feels there are really only four.  He then played us four chords.  The four chords that make up most songs.

He told us that the best way to learn to play guitar is on a children’s guitar like the one he has in an empty room, so you can correct yourself off of your own echos.  That you need to feel the music.  That you need to find your notes.

He sang a song to us and mixed up styles to show us how music is like a wave and you can change the flow.

While we chatted, people walked by.  Everyone seemed to know this guy.  He clearly isn’t just friendly with us.

Eventually he let us go and started talking to a lady waiting for the bus (who did not look as amused as we were).

I love that people aren’t always what they seem.  That someone who clearly loves music and poetry wants to share that with the world, in his own unique way.  That a neighbourhood that is “tough” is very loving and friendly to this unique soul.

Again, you just can’t make this stuff up.

ID compared to House, MD

It is Medical Monday, yet again.  Actually, I feel like it has been a long time since the last Medical Monday.  Either way, it is time to hook up with some other medical related blogs for some medical and Monday-ish goodness.

As some of you who read this blog regularly know, I am currently on an Infectious Diseases rotation and I have likened it a bit to the TV show House, MD.

I have been giving it some thought (and noticing the continued strange popularity of my post General Surgery Is NOT Grey’s Anatomy) and decided that it is time I both prove and dispel some more TV related medical show perceptions, this time referring to House, MD.

First of all, why House?

For starters, it is one of the other medical shows I watch(ed).  Also, when I think of real medical specialties that are kind of like “diagnostician” I think Internal Medicine and, more specifically, ID or Rheumatology because they get to see some of the weird and wonderful.  And I am sure in some big places, someone really is a diagnostician specializing in the really complex cases.  That being said, it isn’t a residency or a common position.  At least, I don’t know any, so this is my reasonable facsimile.

The similarities:

  • There really is a gaggle of people who deal with the complicated cases.
  • People do sit in a group and bounce ideas off of one another complete with internet and journal searches and a white board, or more commonly, a sheet of paper.

    Image from teichdoesmedicine.blogspot.com.

  • Someone who is generally much smarter than everyone else does lead the pack (and sometimes bosses people around).
  • Often times, much of the staff are not fans of the person in charge of the hospital.
  • Patients do lie.  For reals.

    Okay, not everybody. Image from Iamilliontrees.net.

  • The days can be crazy long and chaotic, but also interspersed with mind numbing waiting and boredom (or time for other antics).
  • When you just think you have someone or something figured out, there is a twist (sometimes).

    Image from eatliver.com.

  • Sarcoidosis, lupus and obscure infections are often somewhere on the differential.

    Or is it? Image from http://www.quickmeme.com.

  • You do have to work in places you don’t always like to or want to in order to keep the hospital running and such.

The differences:

  • Patients do tell the truth.
  • One does not generally have a team of fellows who were staff in every other area of the hospital.  Those people often just stick to their own jobs.
  • You can’t just go around running your own lab tests, diagnostic scans and procedures all willy nilly.  There are people specially trained to do all of those things better than the doctors on the show.
  • You would lose your job for screwing around with a clinical trial, stealing drugs, blatantly endangering patients, etcetera.
  • A good start to making a correct diagnosis is a good history and physicial.  They tend to skip that step.
  • A next important step to a correct diagnosis is doing the correct diagnostic test.  Most of the scans they do aren’t appropriate and then the images are not actually of the scan they claimed to order.  In fact, they often put the patient in the incorrect machine.
  • You can’t order everything STAT.  That would make “STAT” routine.
  • There are more staff in the hospital than the “Diagnostician” and a lone oncologist who happens to treat EVERYONE (including children) with cancer.

    I do quite like their bromance, though. Image from tinyobsessions.wordpress.com.

  • As a consultant, you consult, not make all the decisions.
  • People don’t code that often.  At least they don’t code that often and survive.
  • Patients die.
  • Sometimes you just don’t figure out the answer and the person either dies or gets better and you don’t know why.  That isn’t a failure.  Just life.
  • Breaking into someone’s home, car, workplace and so forth is a felony, not medicine.
  • It takes much more time to figure out complicated and novel cases.
  • You can’t just throw drugs at people (or take them away) and expect them to get better.
  • If it walks like a duck and quacks like a duck, it is probably a duck, not a zebra.  House almost always gets the zebra.
  • Sometimes, it really is lupus or sarcoidosis.

    Image from housemdconfessions.tumblr.com.

  • Nobody would let you practice medicine on that many drugs.  No matter how good you are.
  • You can’t just go taking over in the OR, bursting into the OR or really, doing anything in the OR if you are not currently practicing as a surgeon.

    No. Just, no. Image from housemd-guide.com.

  • There is a financial and ethical limit to how much you can and should do.
  • Doctors aren’t immune to whatever the guy in the bed has.

Learning Style

Yesterday, the Daily Post had a prompt called “Learning Style” asking about your learning style.

I used to cringe when people would pass out those learning style inventories and such.

I have never been one to really fit into one of the boxes.

And I suppose that is a good thing.

It is easier for me to say what I don’t learn well doing…

Group work.

I have never been a fan of the group work.

Sometimes I like to joke it is because I’m an only child and don’t play well with others.

But seriously, I hate relying on other people to get work done.

Plus, I was always one of those kids who would have a bunch of work dumped on them.  And I like to teach and help people, but I want to get to do my own work too.

So, group work is a big no!

I am also not the best at learning by doing.  I like to learn by doing… Otherwise medicine would be a big issue.  That being said, practical skills learning by doing takes me a long time.  Manipulative skills are not my strong suit.

I like to read things in books.  Or hear them in lectures.

And yes, I prefer them in print.  Or tables.

I don’t get mneumonics.  Pictures don’t stick in my head particularly well (unless they are hilarious and not fully related).

I work things out in my own head through research and note taking… Then, I can apply it.

My books are highlighted.  I make post-its to piece together concepts.  Sometimes, I make entire sets of my own notes.  I like practice questions.

The more real-life applications and examples, the better.

But I need to know the basic concepts and build principles.

That is how I learn best.

Some thanks

Some gratitude…

Thanks to the friend of the patient I saw today who bumped into me at the cafeteria and told me that I am nice and make a good doctor.  It had been an emotionally draining day, but nothing like what you are probably experiencing.  You don’t know how much of a difference it made to me to hear that.  

Thanks to the cat who usually bites and paws at Patrick in the middle of the night instead of me.

Thanks to my parents who are letting us make use of one of their collection of white Christmas trees.  I like that they are weird.  Plus, they are all I have ever really known.

Thanks to the nice person who chased me down the hall last week when I dropped my hospital ID.

Thanks to my husband  who finally dropped of the maintenance request form for the drawer that Jeter broke almost a year ago.

Thanks to the staff doctor who came in to help me when the work was piling up on call without asking and without piling on the guilt.  I got out earlier than I would have, I had way more teaching than I usually get and it saved a lot of phone calls.  

Thanks to Cineplex for buying out Empire Theatres and introducing us to the awesomeness that are Cineplex points and  our first free movie after only going to one before that.

Thanks to the people who read this blog even though sometimes I must seem absolutely boring or bizarre.

Thanks to one of my favourite coffee shops starting a buy 9 drinks get one free card.  

Anyone you want to say thanks to recently?