This week, things keep chugging along for HankMed. We got some very MacGuyver medicine, a new batch of PDBs who are deep down very cool people, and one sexually-frustrated hospital administrator.
Not a lot that adds to the cause of PA awareness, but some nice Divya moments regardless.
A much longer review to follow.
Wednesday, July 15, 2009
Wednesday, July 08, 2009
Royal Pains, ep. 4: "TB or not TB" (but definitely PA-C)
It's been a big week in the Febrifuge household. Of several new developments, perhaps the biggest was that the household moved 400-odd miles. So, in terms of my own convenience, USA picked a great week to hold off on airing new episodes of Royal Pains. It took me a while to get to it, but I was rewarded with an overall good episode, featuring several refreshing bursts of Divya being awesome. It actually appears to be an intentional story arc that the PA is established as more than "doctor's little helper." Also, I got a job, and as recently noted, I passed my board exam and earned certification not long before that... so it's a good week to be me.
But enough yappin'. On to the show. As always, I'll try to concentrate on the medical stuff, with what I'm sure will be mixed results. Bullet points are for organization, but + means [yay!] and - means [meh.]
* Is it just because I'm watching on Hulu this week, or is the funky underwater title sequence really gone? That was cool, dang it. Okay, we're in a kitchen, people are busy, this one lady is really intense... oh, I see, somebody here is going to be the patient of the week. The head chef is too obvious, so I bet it's the tall skinny guy.
Oh, wait. This only looks, sounds, and feels like House. My mistake. It's Alison, the restaurant owner, who has weird neuro symptoms. She hallucinates that the high-end Italian food in her restaurant is something that Chef Boyardee made yesterday... or no, that's just what it looked like. Looks like there's a prop master out there whose employers need to pay for a few good restaurant meals. For research, y'know? Honestly, the blurry effect really was low-rent House stylings. Better-done, I would have called it an homage.
Medically, they had her experiencing blurred vision, and using the word "pizza" when she meant to say "pasta," then not realizing she'd done it. Actual word salad tends to be much weirder. My good friend M. Giant has had attacks where the language center of his brain crapped out on him as it's suggested Alison's has here. Since he's a writer, you can check out his description, for a more appropriate level of oddity and fear. In an otherwise healthy, young person, these symptoms are very scary indeed.
Since this isn't actually House, Alison's spell resolves, and rather than the sound of Massive Attack, there's another scene or two. The HankMed crew come in to administer PPDs to the restaurant staff.
+ Here, we have some impressively accurate medical procedure. Hank and Divya are both using the correct, 0.5ml syringes, placing little blebs of the solution right into the skin on the forearm, and telling people what the test is, and how it works.
- This week, the one conveniently overlooked part of the process that would obviate an entire plotline is not asking the patients about previous exposure to TB, previous positive tests, or previous immunizations. Especially given that more than a couple of the people working in this particular restaurant are from the old country, where the BCG vaccine is used, you'd think that would have come up. Huh.
+ Later, Hank is speaking privately to Alison about her freaky symptoms, and does some excellent doctoring in the way he counsels her. Sometimes advocating for the patient's best interests means getting in their face a little. And anyway, Hank's such a nice guy (I am 1/16th culturally empowered to call him what he is, a mensch) that he barely seems to be harping on Alison. Honestly, I'm ready to see the character turn the frustration up a notch, and be a little less perfect.
+ No wait, the title sequence is here after all. The show is just messing around with the best place to put it, and seems to be studiously avoiding the most House-ian possible placement, immediately after the 'tease' in which someone gets ill. (And thanks to the CG guy who was nice enough to post a comment saying he'd created it. Yes indeedy, the use of clozapine, an anti-psychotic, on the label was cute. There is no version that comes with APAP - which is acetaminphen, or Tylenol - but I agree that the guy who added that was on to something. I'm all for creative license.)
+ Just after we're back from commercial, Divya delivers a lecture to Evan that is music to my ears. After Evan makes the fatal mistake of calling her "doctor's little helper," she unloads on him with a combination of the "What is a PA?" text off the AAPA website, and a beguiling mix of excellent diction and attitude. "I am a certified Physician Assistant," she says, much the same way one might say "I am going to stomp your smirky face into chunky salsa." I stop to wonder if because she's in New York, she might not want to say "Registered Physician Assistant," instead of the "certified" that is standard everywhere else in the US, but give up the thought as she rolls on.
"That means I practice medicine. I prescribe medications. I order and interpret tests. I assist in surgery..." And then Hank strolls up, having figured out he can't be there in three days to collect results on all those tests, so asks her to do it solo. He delegates that part of the practice to her, having her do it independently, conferring his legal and clinical authority to her.
+ And I pretty much faint, because that's exactly right. That's what it is, that's how it's done. I've been worrying about how the PA will be portrayed in this show, and whining about the "Screw the Midlevel" moments I saw in the first episode or two, and here the show is saying almost exactly what I would tell them they should. And since this is only episode 4, surely this scene must have been written - and filmed - before the pilot aired. So, nice work, show. I feel much better about this whole Divya the PA thing.
- Later, there's a level of product placement that is impressively tricky: advertising two different car brands at once. I applaud at the TV, sarcastic clap style.
+ Paulo Costanzo continues to walk away with all the Evan/Hank scenes, despite an alarming trend toward overly broad, buffoonish moments. Driving a golf cart across town? Ehhh. Maybe not. But Costanzo's tirade against brunch, and especially his delivery of the phrase "french toast salad," are comedy gold.
+ I was impressed by the way that for once, a TV doctor's blunt declaration "she's had a stroke" made some kind of sense. Given that Hank had spoken to Alison previously, and being a kick-ass doctor, it made sense that he could be so sure in his diagnosis so quickly. This was refreshing.
Hey wow, what a concise and timely explanation of thrombolytic therapy. Dr. Exposition, please report to Act Three. Doctor Exposition, Act Three. And I suppose it's cool to show that Hank doesn't get to go wherever he wants inside the hospital, even if he is dating the administrator.
Someone who works in NY state tell me if the short white coat is really what MDs wear in the hospital. I saw the 40-something guy rocking the short lab coat and thought, "huh. Another non-traditional student." And I still say people look like steakhouse waiters in those damn things.
Um... why does Boris need a tiger shark? Who is Katie, and why does she need to be called right away now that he has one? And holy crap, tonic immobility is a real thing, although no way does it last 20 hours. Looks like I must have missed a couple of Shark Weeks.
(Total and utter tangent: this week I also saw an amusing signature line on one of the medical forums I visit: "Live every week as if it were Shark Week." Inspirational, isn't it?)
Wow, they must be rich in the Hamptons, because Dr. Short-Coat responds to Hank's request "Can you get me some thrombolytics" with "sure." Not with "don't you mean tPA, Dr. Slick?" and not with "you mean the package that has to be back in the fridge in half an hour if it's not used, and costs like three thousand dollars if you so much as peel back the foil?" nor with "you don't have privileges here, and can't walk past the yellow line, and I'm going to hand over super-expensive drugs? You want a fistful of Perocet too, you delusional weirdo?"
But then again, not having the magic meds (which looked amazingly like a 10ml saline flush, and apparently didn't require mixing or prep of any kind) would have robbed us, the viewers, of another MacGuyver medicine moment. The DIY Bair Hugger (which in the medical world is essentially what they made: a blanket made of hollow baffles, through which warmed air is pumped) was pretty cool, I'll grant them that. And presumably Divya established two really fast IV lines, with that pimped out SUV kit of hers.
Speaking of which, Mac-compatible, portable Xray? Damn. Notice too how the readout had Hank's name on it; the PA-MD team very often puts the MDs name on stuff like that. The team's medical decisions are ultimately the MDs responsibilities, but the PA has as much latitude and independence as the MD wants to grant, so presumably the practice agreement says that Hank is totally comfortable with Divya's ability to read a chest x-ray. Maybe she'll ask him to check it out later, as a quality measure, but when she says "it looks good," that's the same as Hank saying it.
The episode winds up with what I take to be a future plot point: who was Jill formerly married to? My money's on Boris, actually. If not him, then a new character, played by Ted McGinley.
Overall, I have become very impressed with some of what's coming out of the writer's room on this show. Not having viewership numbers handy, I can't say for sure but they have done more for the public's understanding of the PA profession than our actual professional association has, in my opinion. If only they would add a layer of quality control to the plotting, and stop letting conflicts arise via series of events that would be rendered moot by the same common sense the characters show except when the plot demands they be dumb. That's the kind of story-craft that makes Three's Company plots work.
A- for the episode as a whole. Some good doctoring from Hank, some silliness over poor Italian translation and a critical question never asked in any language, tempered by Divya-liciousness. The minus is for Divya knowing the BCG produces false-positives, but only knowing it in Act Five.
A+ however for what's going on with Divya's character progression. If I find out the AAPA is connected to the bracingly clear way this show presents what a PA is and does, I'll take back most of the things I've said about them.
But enough yappin'. On to the show. As always, I'll try to concentrate on the medical stuff, with what I'm sure will be mixed results. Bullet points are for organization, but + means [yay!] and - means [meh.]
* Is it just because I'm watching on Hulu this week, or is the funky underwater title sequence really gone? That was cool, dang it. Okay, we're in a kitchen, people are busy, this one lady is really intense... oh, I see, somebody here is going to be the patient of the week. The head chef is too obvious, so I bet it's the tall skinny guy.
Oh, wait. This only looks, sounds, and feels like House. My mistake. It's Alison, the restaurant owner, who has weird neuro symptoms. She hallucinates that the high-end Italian food in her restaurant is something that Chef Boyardee made yesterday... or no, that's just what it looked like. Looks like there's a prop master out there whose employers need to pay for a few good restaurant meals. For research, y'know? Honestly, the blurry effect really was low-rent House stylings. Better-done, I would have called it an homage.
Medically, they had her experiencing blurred vision, and using the word "pizza" when she meant to say "pasta," then not realizing she'd done it. Actual word salad tends to be much weirder. My good friend M. Giant has had attacks where the language center of his brain crapped out on him as it's suggested Alison's has here. Since he's a writer, you can check out his description, for a more appropriate level of oddity and fear. In an otherwise healthy, young person, these symptoms are very scary indeed.
Since this isn't actually House, Alison's spell resolves, and rather than the sound of Massive Attack, there's another scene or two. The HankMed crew come in to administer PPDs to the restaurant staff.
+ Here, we have some impressively accurate medical procedure. Hank and Divya are both using the correct, 0.5ml syringes, placing little blebs of the solution right into the skin on the forearm, and telling people what the test is, and how it works.
- This week, the one conveniently overlooked part of the process that would obviate an entire plotline is not asking the patients about previous exposure to TB, previous positive tests, or previous immunizations. Especially given that more than a couple of the people working in this particular restaurant are from the old country, where the BCG vaccine is used, you'd think that would have come up. Huh.
+ Later, Hank is speaking privately to Alison about her freaky symptoms, and does some excellent doctoring in the way he counsels her. Sometimes advocating for the patient's best interests means getting in their face a little. And anyway, Hank's such a nice guy (I am 1/16th culturally empowered to call him what he is, a mensch) that he barely seems to be harping on Alison. Honestly, I'm ready to see the character turn the frustration up a notch, and be a little less perfect.
+ No wait, the title sequence is here after all. The show is just messing around with the best place to put it, and seems to be studiously avoiding the most House-ian possible placement, immediately after the 'tease' in which someone gets ill. (And thanks to the CG guy who was nice enough to post a comment saying he'd created it. Yes indeedy, the use of clozapine, an anti-psychotic, on the label was cute. There is no version that comes with APAP - which is acetaminphen, or Tylenol - but I agree that the guy who added that was on to something. I'm all for creative license.)
+ Just after we're back from commercial, Divya delivers a lecture to Evan that is music to my ears. After Evan makes the fatal mistake of calling her "doctor's little helper," she unloads on him with a combination of the "What is a PA?" text off the AAPA website, and a beguiling mix of excellent diction and attitude. "I am a certified Physician Assistant," she says, much the same way one might say "I am going to stomp your smirky face into chunky salsa." I stop to wonder if because she's in New York, she might not want to say "Registered Physician Assistant," instead of the "certified" that is standard everywhere else in the US, but give up the thought as she rolls on.
"That means I practice medicine. I prescribe medications. I order and interpret tests. I assist in surgery..." And then Hank strolls up, having figured out he can't be there in three days to collect results on all those tests, so asks her to do it solo. He delegates that part of the practice to her, having her do it independently, conferring his legal and clinical authority to her.
+ And I pretty much faint, because that's exactly right. That's what it is, that's how it's done. I've been worrying about how the PA will be portrayed in this show, and whining about the "Screw the Midlevel" moments I saw in the first episode or two, and here the show is saying almost exactly what I would tell them they should. And since this is only episode 4, surely this scene must have been written - and filmed - before the pilot aired. So, nice work, show. I feel much better about this whole Divya the PA thing.
- Later, there's a level of product placement that is impressively tricky: advertising two different car brands at once. I applaud at the TV, sarcastic clap style.
+ Paulo Costanzo continues to walk away with all the Evan/Hank scenes, despite an alarming trend toward overly broad, buffoonish moments. Driving a golf cart across town? Ehhh. Maybe not. But Costanzo's tirade against brunch, and especially his delivery of the phrase "french toast salad," are comedy gold.
+ I was impressed by the way that for once, a TV doctor's blunt declaration "she's had a stroke" made some kind of sense. Given that Hank had spoken to Alison previously, and being a kick-ass doctor, it made sense that he could be so sure in his diagnosis so quickly. This was refreshing.
Hey wow, what a concise and timely explanation of thrombolytic therapy. Dr. Exposition, please report to Act Three. Doctor Exposition, Act Three. And I suppose it's cool to show that Hank doesn't get to go wherever he wants inside the hospital, even if he is dating the administrator.
Someone who works in NY state tell me if the short white coat is really what MDs wear in the hospital. I saw the 40-something guy rocking the short lab coat and thought, "huh. Another non-traditional student." And I still say people look like steakhouse waiters in those damn things.
Um... why does Boris need a tiger shark? Who is Katie, and why does she need to be called right away now that he has one? And holy crap, tonic immobility is a real thing, although no way does it last 20 hours. Looks like I must have missed a couple of Shark Weeks.
(Total and utter tangent: this week I also saw an amusing signature line on one of the medical forums I visit: "Live every week as if it were Shark Week." Inspirational, isn't it?)
Wow, they must be rich in the Hamptons, because Dr. Short-Coat responds to Hank's request "Can you get me some thrombolytics" with "sure." Not with "don't you mean tPA, Dr. Slick?" and not with "you mean the package that has to be back in the fridge in half an hour if it's not used, and costs like three thousand dollars if you so much as peel back the foil?" nor with "you don't have privileges here, and can't walk past the yellow line, and I'm going to hand over super-expensive drugs? You want a fistful of Perocet too, you delusional weirdo?"
But then again, not having the magic meds (which looked amazingly like a 10ml saline flush, and apparently didn't require mixing or prep of any kind) would have robbed us, the viewers, of another MacGuyver medicine moment. The DIY Bair Hugger (which in the medical world is essentially what they made: a blanket made of hollow baffles, through which warmed air is pumped) was pretty cool, I'll grant them that. And presumably Divya established two really fast IV lines, with that pimped out SUV kit of hers.
Speaking of which, Mac-compatible, portable Xray? Damn. Notice too how the readout had Hank's name on it; the PA-MD team very often puts the MDs name on stuff like that. The team's medical decisions are ultimately the MDs responsibilities, but the PA has as much latitude and independence as the MD wants to grant, so presumably the practice agreement says that Hank is totally comfortable with Divya's ability to read a chest x-ray. Maybe she'll ask him to check it out later, as a quality measure, but when she says "it looks good," that's the same as Hank saying it.
The episode winds up with what I take to be a future plot point: who was Jill formerly married to? My money's on Boris, actually. If not him, then a new character, played by Ted McGinley.
Overall, I have become very impressed with some of what's coming out of the writer's room on this show. Not having viewership numbers handy, I can't say for sure but they have done more for the public's understanding of the PA profession than our actual professional association has, in my opinion. If only they would add a layer of quality control to the plotting, and stop letting conflicts arise via series of events that would be rendered moot by the same common sense the characters show except when the plot demands they be dumb. That's the kind of story-craft that makes Three's Company plots work.
A- for the episode as a whole. Some good doctoring from Hank, some silliness over poor Italian translation and a critical question never asked in any language, tempered by Divya-liciousness. The minus is for Divya knowing the BCG produces false-positives, but only knowing it in Act Five.
A+ however for what's going on with Divya's character progression. If I find out the AAPA is connected to the bracingly clear way this show presents what a PA is and does, I'll take back most of the things I've said about them.
Thursday, July 02, 2009
A week off
Looks like the nice people at USA are skipping an episode of Royal Pains for the holiday weekend. This is nice for me, as I just moved 400 miles, and I'm taking off for the holiday to a place where there are no Internets.
So watch next week for my write-up of the fourth episode broadcast.
So watch next week for my write-up of the fourth episode broadcast.
Friday, June 26, 2009
'Royal Pains' review delayed
Episode 4 aired last night, and ordinarily I'd have watched it by now, but Monday is moving day, so we're up to our necks in boxes and things to do. Early next week should be about right. Take care!
Thursday, June 25, 2009
The Fun Begins
As I said a while back, I had to take, and pass, my national certifying exam before I could call myself a PA-C (for 'certified,' as though that were not already obvious).
The test was Monday. I answered my 360 questions in under four hours; hey, I was on a roll. And this morning I got my results. I'm official.
The test was Monday. I answered my 360 questions in under four hours; hey, I was on a roll. And this morning I got my results. I'm official.
Friday, June 19, 2009
'Royal Pains' ep. 3: Strategic Planning (but not very much, or very well)
Okay. So, the pilot was enough to get me interested (well, that and the marketing assault on Facebook and Twitter). Last week, there were glimmers of hope in terms of how Divya, the PA character, would be presented. In this, which appears to be the second episode written/ filmed but the third one shown, there were several 'facepalm' moments. Consider it one step back after last week's two steps forward, which means in other words that I agree with the decision to show these out of order. Bottom line: if this had been on last week, according to my lovely wife, she might not have been watching last night. I would have, because I'm an old man and I enjoy yelling at the TV.
A + denotes something I liked, and a - is so much more than just a bullet point-style dash.
In the opening bit, Hank is trying to get Evan to go for a nice cardiovascular system-exercising run, while Evan is trying to a) scope chicks and b) get Hank to admit their new enterprise should probably involve caring about money, just a little. While trying to make a questionable point about how dogs and women are somehow the same, Evan causes a dog-walker, who is otherwise minding his own damn business, to be bitten in the hand by one of his charges. Rather than stomp Evan into a coarse paste of hair gel and poor judgement, the kind-hearted dog walker (whom I want to call "Benny," and will since IMDB is no help today) apologizes. Hank, being Hank, looks at Benny with soulful eyes, says "I'm a doctor," and mumbles physical exam findings. Yup, that's a dog bite, all right. Pretty crappy exam, though.
+ Hank quite rightly says Benny needs to get to the ER for 'a thorough cleaning' instead of stitches. We don't sew puncture wounds.
+ It's good that Hank pokes holes in his water bottle and squirts the jets into the wound to clean it (a little, anyway). Research shows that the two main things that prevent infection are 1) using A LOT of irrigation, and 2) having a little pressure behind it. So just unscrewing the cap and dumping it would be, according to some research, less helpful.
- On the other hand, there were like 8 or 10 holes in that thing, which means the effect is lessened... and lots of the water was nowhere near the wound. And of course, whatever's left in Hank's 20-ounce bottle is of almost no help. Would have been easier to just hold the guy's hand under a drinking fountain or a simple garden hose for a good 10 minutes.
- And the number one question Hank would ask, as a real-life Emergency doctor: "When was your last tetanus shot?" THAT'S the reason he needs to go to the hospital.
After this B plot is safely sailing, some more silliness occurs. Further evidence that this is actually the second episode comes in the form of a conversation with Boris. Later there will be scenes between Hank and Jill that completely ignore what we saw last week in the 'real' episode 3, and a conversation between Hank and Divya that bears (scrawny, shriveled) fruit last week, which would have been 'next week.' Honestly, I'd have preferred they leave this one in the drawer, show us Episode 4 now, and call it good. But I'm getting ahead of myself.
Hank and Divya arrive on the scene of this week's "Privileged D-bags Who Are Actually Not That Bad Once We Understand Them Better." I'm going to call them PDB's, for short. On the way in, Hank gets Divya to confirm the info I previously had as a rumor, which was that she somehow went to two to three years of PA school, for 8 to 12 hours a day, without her family catching on. Oooo-kay.
I can't decide if this is a Screw the Midlevel moment, because Hank recognizes Divya's smarts and talent, saying she's "qualified to work at any of the major clinics in Manhattan." Instead, I think this is meant to be her big defining conflict for the first season. I'm already looking forward to the scene where Brian George appears as Divya's strict and demanding father, whose heart melts when he realizes what a strong and capable woman his little girl has become. And sort-of-almost a doctor, too!
And then we meet the PDBs. Momma-PDB is a driven, icy matriarch who is focused with such laser-like precision on her family's success that she neglected to develop a third dimension to her character. Her offscreen husband is a former Fed director and current US Senator, but not the President, and therefore is a total failure. Good Son PDB somehow bears his mom's pathologic orchestrations with good humor, perhaps by doing drugs or appearing in drag shows in the city every few weekends (either of which would be far more interesting than what actually happens). Daughter PDB is as high-strung as Mom, as bland as Good Son, but is blonde. This must be offscreen Dad's contribution. That, and a slow-burning irritation with The Way Things Have Always Been that will result in a totally unsurprising confrontation later.
Seriously, the first time she tries to object to something, Mom lays down the law, and closes with her wacky catchprase "...is that okay?" we already know about 75% of the dialogue for that inevitable scene. Which will of course have to happen today, and which will of course feature Hank standing nervously nearby, because he needs to, House-like, catch the one key phrase that randomly blows the whole case wide open.
Okay, here's the deal. I have advanced training in medicine, but I also have a degree in theatre. And I'm here to tell you, this writing sucks. It smacks of unused bits from the pilot and random scraps from pitch meetings past. For the rest of this week, I'm going to try to stick to the medicine, so as not to get too depressed here. Oh, I'll be watching next week, and I'm sure it will be better. Because it can't help but be.
+ I was amused at the medical equipment in the PDBs' former 'game room.' Hank and Divya might have a clue how to operate maybe half of that stuff. Mostly, the 'executive physical' line made me smile (since I've been to two of the Mayo facilities, and that's kind of how patients are encouraged to think sometimes), and idea of a yearly head-to-toe physical done as an action montage! was loopy fun (for me, because I'm weird).
- Why the eff does a healthy 18-year-old need a treadmill stress test, or even an EKG in the first place? Must be a college athlete thing, hey? And what, no hernia check? That's easy comedy gold right there! An echocardiogram is always a nice visual. And sweet zombie Jesus, where did Divya learn phlebotomy? That looked like a two-inch, 18-gauge needle attached to nothing in particular she was jabbing into the patient's AC.
+ Need to check your patient's vision, but don't have a Snellen chart? Yeah, there's an app for that.
+ Later on, after Good Son PDB gets really sick, really fast, for no good reason, they'll do a spinal tap. He'll be in fairly poor position, and they'll take out a whole lot of fluid, assuming the vials we don't see are as full as the one we do. But props must go to the writers who refer to there being four of them, and which tests to do on each.
- And, um, -SPOILER ALERT!- part of that executive physical would be looking in the ears the way they checked the eyes. AUTOMATIC FAIL for not seeing the deer tick suctioning off Good Son's football awesomeness drop by drop through his ear canal.
- Wait. It would have been a good idea to get him to a hospital earlier, but now he's too unstable to move? What did you do in there, Dr. Hank? And in the pilot, after you opened up Tucker's pericardium with common household materials, you remembered that the helicopter is a flying ICU. What, now that you're staying that's not good enough? Wow. You've changed, dude.
- Divya. Yo, Divya! Hey! Look, thanks for pre-oxygenating the patient before the intubation (holy crap, you did have the O2 hooked onto that thing, right?), but now that the tube is in, it would be helpful if you a) checked the end-tidal CO2 thing, b) listened to make sure the tube is in the trachea, or at least c) BAGGED A LITTLE MORE SLOWLY. We're not trying to get this guy overinflated or alkalemic. Air has to go in and come out. Where did you go to school, again?
But eventually, the offending parasite (literally, not any of the PDBs) will be removed, and everything will be cool. And this being the Hamptons, Hank has not actually just wasted tens of thousands of dollars on a workup that would be obviated by looking in the patient's ear, because the money was already wasted when Momma-PDB bought the equipment. So I guess that's a win, in terms of the larger health care system.
I'm not talking about the fastest-developing case of hot tub folliculitis ever, because Evan was an embarrassing 80s-movie cliche horndog this week, and I'm not sure if those girls were supposed to be over or under 21. Everything about that plot was creepy and weird. "Hey, girls! We're hanging out with a skinny loser we just met, but his house is nice! Let's do body shots... off, um, each other maybe? I guess? I really didn't think this through, but don't worry because USA Network wouldn't make us actually do it, so long as we say 'body shots' a couple times! Wooo!"
+ Grudging props are however given for the line "I tried all day to convince these girls I wasn't a douchebag, and they all went home smelling of vinegar and water." I have an uncomfortable feeling that the entire plot worked backward from this line, but what the hell. It was funny.
At the end, there's a heartwarming scene where Hank earns a gold star for the first part of this exchange:
Hank: So we should talk about your title...
Divya: What's wrong with 'Physician Assistant?'
Hank: Well, people tend to just hear the second part of that.
My heart swells, I get a little misty, and I hug a throw pillow to my chest. "Oh my god," I think, "the writers of Royal Pains really understand me. And they... they like me." Hank continues:
Hank: I was thinking more like, 'Associate.'
And, y'know, fair enough. There are plenty of people who would prefer 'Physician Associate' to 'Physician Assistant,' and indeed back in the very earliest days of the profession, the former term was actually the one that was used. And people really do trip over the 'assistant' part. It's true that no, we are not independent practitioners (and don't really want to be), but we are professionals. We practice medicine too, and our job really isn't following the doc around, fetching stuff, or answering phones. It's practicing some of the medicine, so the doc can concentrate on his or her own part of it.
But for better or worse, Divya's license says 'Physician Assistant,' and so does her Master's degree. She can be "Hank's associate in the practice" and a PA at the same time. It would be far better if she would stop saying she's "Hank's Physician Assistant" (even to the point of inserting a word into the phrase "Hank's assistant") because that's just as confusing.
But whatever. They just started working together. As time goes on, he'll understand how well-trained she is, and how good her skills are. She'll learn (mostly medical) stuff from Hank; he'll learn (mostly Hamptons survival skills) stuff from her. Eventually, Divya will show up for calls herself, and get Hank involved on those cases where she recognizes she needs the backup or additional expertise.
Maybe. If the show turns into a more interesting (and more realistic) direction. I still have hope, but wow, this was not the episode to show to people who want to check it out for the first time. This one was a C+ all the way. It might have been a B-, but having seen what they can do, I know they either weren't trying here, or else they were trying and failing to illustrate some point about Hank being out of his element, the team needing to learn to work together, or something. The acting was fine, but writers just failed to have a decent plan.
A + denotes something I liked, and a - is so much more than just a bullet point-style dash.
In the opening bit, Hank is trying to get Evan to go for a nice cardiovascular system-exercising run, while Evan is trying to a) scope chicks and b) get Hank to admit their new enterprise should probably involve caring about money, just a little. While trying to make a questionable point about how dogs and women are somehow the same, Evan causes a dog-walker, who is otherwise minding his own damn business, to be bitten in the hand by one of his charges. Rather than stomp Evan into a coarse paste of hair gel and poor judgement, the kind-hearted dog walker (whom I want to call "Benny," and will since IMDB is no help today) apologizes. Hank, being Hank, looks at Benny with soulful eyes, says "I'm a doctor," and mumbles physical exam findings. Yup, that's a dog bite, all right. Pretty crappy exam, though.
+ Hank quite rightly says Benny needs to get to the ER for 'a thorough cleaning' instead of stitches. We don't sew puncture wounds.
+ It's good that Hank pokes holes in his water bottle and squirts the jets into the wound to clean it (a little, anyway). Research shows that the two main things that prevent infection are 1) using A LOT of irrigation, and 2) having a little pressure behind it. So just unscrewing the cap and dumping it would be, according to some research, less helpful.
- On the other hand, there were like 8 or 10 holes in that thing, which means the effect is lessened... and lots of the water was nowhere near the wound. And of course, whatever's left in Hank's 20-ounce bottle is of almost no help. Would have been easier to just hold the guy's hand under a drinking fountain or a simple garden hose for a good 10 minutes.
- And the number one question Hank would ask, as a real-life Emergency doctor: "When was your last tetanus shot?" THAT'S the reason he needs to go to the hospital.
After this B plot is safely sailing, some more silliness occurs. Further evidence that this is actually the second episode comes in the form of a conversation with Boris. Later there will be scenes between Hank and Jill that completely ignore what we saw last week in the 'real' episode 3, and a conversation between Hank and Divya that bears (scrawny, shriveled) fruit last week, which would have been 'next week.' Honestly, I'd have preferred they leave this one in the drawer, show us Episode 4 now, and call it good. But I'm getting ahead of myself.
Hank and Divya arrive on the scene of this week's "Privileged D-bags Who Are Actually Not That Bad Once We Understand Them Better." I'm going to call them PDB's, for short. On the way in, Hank gets Divya to confirm the info I previously had as a rumor, which was that she somehow went to two to three years of PA school, for 8 to 12 hours a day, without her family catching on. Oooo-kay.
I can't decide if this is a Screw the Midlevel moment, because Hank recognizes Divya's smarts and talent, saying she's "qualified to work at any of the major clinics in Manhattan." Instead, I think this is meant to be her big defining conflict for the first season. I'm already looking forward to the scene where Brian George appears as Divya's strict and demanding father, whose heart melts when he realizes what a strong and capable woman his little girl has become. And sort-of-almost a doctor, too!
And then we meet the PDBs. Momma-PDB is a driven, icy matriarch who is focused with such laser-like precision on her family's success that she neglected to develop a third dimension to her character. Her offscreen husband is a former Fed director and current US Senator, but not the President, and therefore is a total failure. Good Son PDB somehow bears his mom's pathologic orchestrations with good humor, perhaps by doing drugs or appearing in drag shows in the city every few weekends (either of which would be far more interesting than what actually happens). Daughter PDB is as high-strung as Mom, as bland as Good Son, but is blonde. This must be offscreen Dad's contribution. That, and a slow-burning irritation with The Way Things Have Always Been that will result in a totally unsurprising confrontation later.
Seriously, the first time she tries to object to something, Mom lays down the law, and closes with her wacky catchprase "...is that okay?" we already know about 75% of the dialogue for that inevitable scene. Which will of course have to happen today, and which will of course feature Hank standing nervously nearby, because he needs to, House-like, catch the one key phrase that randomly blows the whole case wide open.
Okay, here's the deal. I have advanced training in medicine, but I also have a degree in theatre. And I'm here to tell you, this writing sucks. It smacks of unused bits from the pilot and random scraps from pitch meetings past. For the rest of this week, I'm going to try to stick to the medicine, so as not to get too depressed here. Oh, I'll be watching next week, and I'm sure it will be better. Because it can't help but be.
+ I was amused at the medical equipment in the PDBs' former 'game room.' Hank and Divya might have a clue how to operate maybe half of that stuff. Mostly, the 'executive physical' line made me smile (since I've been to two of the Mayo facilities, and that's kind of how patients are encouraged to think sometimes), and idea of a yearly head-to-toe physical done as an action montage! was loopy fun (for me, because I'm weird).
- Why the eff does a healthy 18-year-old need a treadmill stress test, or even an EKG in the first place? Must be a college athlete thing, hey? And what, no hernia check? That's easy comedy gold right there! An echocardiogram is always a nice visual. And sweet zombie Jesus, where did Divya learn phlebotomy? That looked like a two-inch, 18-gauge needle attached to nothing in particular she was jabbing into the patient's AC.
+ Need to check your patient's vision, but don't have a Snellen chart? Yeah, there's an app for that.
+ Later on, after Good Son PDB gets really sick, really fast, for no good reason, they'll do a spinal tap. He'll be in fairly poor position, and they'll take out a whole lot of fluid, assuming the vials we don't see are as full as the one we do. But props must go to the writers who refer to there being four of them, and which tests to do on each.
- And, um, -SPOILER ALERT!- part of that executive physical would be looking in the ears the way they checked the eyes. AUTOMATIC FAIL for not seeing the deer tick suctioning off Good Son's football awesomeness drop by drop through his ear canal.
- Wait. It would have been a good idea to get him to a hospital earlier, but now he's too unstable to move? What did you do in there, Dr. Hank? And in the pilot, after you opened up Tucker's pericardium with common household materials, you remembered that the helicopter is a flying ICU. What, now that you're staying that's not good enough? Wow. You've changed, dude.
- Divya. Yo, Divya! Hey! Look, thanks for pre-oxygenating the patient before the intubation (holy crap, you did have the O2 hooked onto that thing, right?), but now that the tube is in, it would be helpful if you a) checked the end-tidal CO2 thing, b) listened to make sure the tube is in the trachea, or at least c) BAGGED A LITTLE MORE SLOWLY. We're not trying to get this guy overinflated or alkalemic. Air has to go in and come out. Where did you go to school, again?
But eventually, the offending parasite (literally, not any of the PDBs) will be removed, and everything will be cool. And this being the Hamptons, Hank has not actually just wasted tens of thousands of dollars on a workup that would be obviated by looking in the patient's ear, because the money was already wasted when Momma-PDB bought the equipment. So I guess that's a win, in terms of the larger health care system.
I'm not talking about the fastest-developing case of hot tub folliculitis ever, because Evan was an embarrassing 80s-movie cliche horndog this week, and I'm not sure if those girls were supposed to be over or under 21. Everything about that plot was creepy and weird. "Hey, girls! We're hanging out with a skinny loser we just met, but his house is nice! Let's do body shots... off, um, each other maybe? I guess? I really didn't think this through, but don't worry because USA Network wouldn't make us actually do it, so long as we say 'body shots' a couple times! Wooo!"
+ Grudging props are however given for the line "I tried all day to convince these girls I wasn't a douchebag, and they all went home smelling of vinegar and water." I have an uncomfortable feeling that the entire plot worked backward from this line, but what the hell. It was funny.
At the end, there's a heartwarming scene where Hank earns a gold star for the first part of this exchange:
Hank: So we should talk about your title...
Divya: What's wrong with 'Physician Assistant?'
Hank: Well, people tend to just hear the second part of that.
My heart swells, I get a little misty, and I hug a throw pillow to my chest. "Oh my god," I think, "the writers of Royal Pains really understand me. And they... they like me." Hank continues:
Hank: I was thinking more like, 'Associate.'
And, y'know, fair enough. There are plenty of people who would prefer 'Physician Associate' to 'Physician Assistant,' and indeed back in the very earliest days of the profession, the former term was actually the one that was used. And people really do trip over the 'assistant' part. It's true that no, we are not independent practitioners (and don't really want to be), but we are professionals. We practice medicine too, and our job really isn't following the doc around, fetching stuff, or answering phones. It's practicing some of the medicine, so the doc can concentrate on his or her own part of it.
But for better or worse, Divya's license says 'Physician Assistant,' and so does her Master's degree. She can be "Hank's associate in the practice" and a PA at the same time. It would be far better if she would stop saying she's "Hank's Physician Assistant" (even to the point of inserting a word into the phrase "Hank's assistant") because that's just as confusing.
But whatever. They just started working together. As time goes on, he'll understand how well-trained she is, and how good her skills are. She'll learn (mostly medical) stuff from Hank; he'll learn (mostly Hamptons survival skills) stuff from her. Eventually, Divya will show up for calls herself, and get Hank involved on those cases where she recognizes she needs the backup or additional expertise.
Maybe. If the show turns into a more interesting (and more realistic) direction. I still have hope, but wow, this was not the episode to show to people who want to check it out for the first time. This one was a C+ all the way. It might have been a B-, but having seen what they can do, I know they either weren't trying here, or else they were trying and failing to illustrate some point about Hank being out of his element, the team needing to learn to work together, or something. The acting was fine, but writers just failed to have a decent plan.
Friday, June 12, 2009
"Royal Pains" Ep. 2: There Will Be Food (and potential)
So, there's a new summer show on USA. It's on after the ridiculously enjoyable Burn Notice (which is itself kind of a mix of The Rockford Files and a Bourne movie), and worth checking out. But what's germane here is that Royal Pains features a PA character, the first on American prime-time TV since Jeannie Boulet on ER way back when.
Given the show's premise -- talented Emergency Med doctor's career goes boom when hospital beaurocrats throw him under the bus after a hospital trustee dies; he falls into being concierge doc to the spoiled rich in the Hamptons -- I was curious how a PA would fit in. The pilot showed us Divya Katdare, a sharp young woman from a wealthy family who apparently wanted her to be an MBA instead. This being New York, I'm assuming she's RPA-C (since they use both the R for 'registered' and the national standard '-C' for certified), but it's not like they're showing us close-ups of the characters' business cards.
Last night was only the second episode, so I have many questions, hopes, dreams, and fears when it comes to how this all might play out. It would be pretty sweet to have a PA as a major character on a popular hour-long drama. Likewise, considering all the annoying misperceptions there are about the career, this new show could wind up part of the problem. So I'm watching, carefully.
So much so, in fact, that I decided I'd take a page from Scott, MD over at Polite Dissent, and do a weekly write-up of the episodes, evaluating them for medical as well as narrative quality. He does it for House, and it's a great read every week, whether or not you are a medical person. Put a bookmark there, and check it out whenever you've just watched an episode and wonder "wait -- does it really work like that?" (The short answer is, probably not, but like I say, Scott's site is about enjoying the details.)
So I basically watched Episode Two in liveblog fashion: I fired up the DVR this morning, took some quick notes, and proceeded to pick things apart. There's good stuff too, so annoyances and errors are denoted with + or - for bullets.
* Hey, new pre-title voiceover to set up the plot. Wow, we really do love Burn Notice, don't we?
- Would it kill the producers to have Hank say "Emergency doctor" instead of "emergency-ROOM doctor?" Not that it's their job to correct every little misconception, but I don't see the benefit to perpetuating them. Whatever. Last week, he was not only EM trained but also did a fellowship in toxicology.
- Um, hey, you don't need an MD to examine a wound or take out sutures. Divya could totally handle that; but I see, having Hank present in that scene was important to the story, so that the crew could be invited to the party. I'm going to count these instances of "Screw the Midlevel" as we go on through the season. They could just as easily have had Hank walk up to Divya finishing the suture removal, with Tucker saying something like "naw, I just wanted to see if you felt like hanging out." This not only doesn't screw the midlevel, it fits the whole "Tucker needs a dad" thing.
- That wound looked okay, if a little too red at the medial aspect, but the sutures looked like crap. Apologies to the props person or set medic who gamely threw some stitches into a piece of moulage putty, but ya should have gotten some better reference photos. That looked like it was done by a Navy Seal under fire. On his own abdomen.
+ The actual title sequence, with trippy underwater stuff and backwards-cam, was pretty cool on first viewing. I wonder about all these cheap stethoscopes in the promo materials for the show, but maybe you'd have to pay 3M or something if everyone rocked a Littman like in real life.
+ Evan gets all the best lines. As a temporary Chicagoan, I laughed out loud at "ketchup is for dillettantes and three-year-olds." My wonderful, lovely wife puts it on everything, and I mock her for it.
+ "You need some blood work. I'd love to have my associate Divya do a full workup." Holy crap! They do understand what PAs do... unless they think she's a phlebotomist. But no, let's give the writers some credit here. Divya would, according to Hank, draw the blood, get the lab to do the appropriate tests, and then interpret the results. Which is true. But then, that makes instances of "Screw the Midlevel" that much more notable. Okay writers, you're officially having it both ways. (I'm doing that gesture where I point to my eyes with two fingers, then turn them around to point at you.)
- You do realize that 'I get blackout drunk on those rare occasions when I drink' is still kind of a red flag, right? I mean, nice plot device and all, but Hank is so concerned about everything, all the time...
+ Hey cool. Andrew McCarthy is Cary Grant as C.K. Dexter Haven from The Philadelphia Story. I love that movie! ...Oh, no, wait. He's an ass. And a very well-done "that guy is an ass" scene it is, too. Yowch.
+ I'm really enjoying not only Evan as a character, but what Paulo Costanzo is doing with it. The cooking/dancing went on a little too long, but it won me over. Although, how long did that food sit out if the ballerina wasn't coming over until after sundown? I also really liked when he admitted that NYC had gotten stale for him, which sheds some additional light on his drive to get Hank to the Hamptons last week.
+ The "Robin Hood of medicine" thing, as illustrated by Hank's speech on Bill's boat, is an appealing fantasy. Gosh, if only more of us could just draw fat checks from random rich people, and give our services away to the rest of our patients!
+ The running gag where Hank never, ever, gets to eat a bite of anything (until the end, sharing Chinese food with Jill) was cute. In the ER, nothing makes more work appear like ordering or heating food.
+ Hey, House writers: see how it works? A character who understands physiology sees a patient go into shock (shock being defined correctly as "perfusion insufficient to meet the metabolic needs of the patient"), looks at the heart monitor, and then identifies it as 'cardiogenic shock.' A little clunky and over-exposition-ey, because 1) who really cares at that point, and 2) duh, but still. Divya clearly knows medicine. This is nice, because as of now I trust the writers to know she's not a medical assistant, even when they treat her as one. (Caveat: I haven't seen this reaction to gluten, and I'm a little skeptical it would clear that quickly. Also a three-lead portable monitor isn't a Holter, and come to think of it I never saw them put pads on the patient, but since so much of medicine is boring we give some slack on these matters.)
- People, we never shock a flat-line. That TV trope has to go. Draw up the epinephrine or atropine, but put down the paddles and back away.
Overall, this was a nice solid A- of an episode. I'm feeling generous since while things are still very new, I'm seeing more to like as more is revealed about how the writers and producers approach the characters and the medicine. The show is finding its equilibrium between commenting on how "the system is broken," presenting its version of what's both cool and important about the practice of medicine, and keeping the story moving for its characters. My PA-touchstone character got zero development in this episode, but on the other hand she displayed some competence and knowledge. I'm feeling a Divya-centric B plot coming soon, if not a main story. Let's hope I'm proven right, and they do a good job.
Given the show's premise -- talented Emergency Med doctor's career goes boom when hospital beaurocrats throw him under the bus after a hospital trustee dies; he falls into being concierge doc to the spoiled rich in the Hamptons -- I was curious how a PA would fit in. The pilot showed us Divya Katdare, a sharp young woman from a wealthy family who apparently wanted her to be an MBA instead. This being New York, I'm assuming she's RPA-C (since they use both the R for 'registered' and the national standard '-C' for certified), but it's not like they're showing us close-ups of the characters' business cards.
Last night was only the second episode, so I have many questions, hopes, dreams, and fears when it comes to how this all might play out. It would be pretty sweet to have a PA as a major character on a popular hour-long drama. Likewise, considering all the annoying misperceptions there are about the career, this new show could wind up part of the problem. So I'm watching, carefully.
So much so, in fact, that I decided I'd take a page from Scott, MD over at Polite Dissent, and do a weekly write-up of the episodes, evaluating them for medical as well as narrative quality. He does it for House, and it's a great read every week, whether or not you are a medical person. Put a bookmark there, and check it out whenever you've just watched an episode and wonder "wait -- does it really work like that?" (The short answer is, probably not, but like I say, Scott's site is about enjoying the details.)
So I basically watched Episode Two in liveblog fashion: I fired up the DVR this morning, took some quick notes, and proceeded to pick things apart. There's good stuff too, so annoyances and errors are denoted with + or - for bullets.
* Hey, new pre-title voiceover to set up the plot. Wow, we really do love Burn Notice, don't we?
- Would it kill the producers to have Hank say "Emergency doctor" instead of "emergency-ROOM doctor?" Not that it's their job to correct every little misconception, but I don't see the benefit to perpetuating them. Whatever. Last week, he was not only EM trained but also did a fellowship in toxicology.
- Um, hey, you don't need an MD to examine a wound or take out sutures. Divya could totally handle that; but I see, having Hank present in that scene was important to the story, so that the crew could be invited to the party. I'm going to count these instances of "Screw the Midlevel" as we go on through the season. They could just as easily have had Hank walk up to Divya finishing the suture removal, with Tucker saying something like "naw, I just wanted to see if you felt like hanging out." This not only doesn't screw the midlevel, it fits the whole "Tucker needs a dad" thing.
- That wound looked okay, if a little too red at the medial aspect, but the sutures looked like crap. Apologies to the props person or set medic who gamely threw some stitches into a piece of moulage putty, but ya should have gotten some better reference photos. That looked like it was done by a Navy Seal under fire. On his own abdomen.
+ The actual title sequence, with trippy underwater stuff and backwards-cam, was pretty cool on first viewing. I wonder about all these cheap stethoscopes in the promo materials for the show, but maybe you'd have to pay 3M or something if everyone rocked a Littman like in real life.
+ Evan gets all the best lines. As a temporary Chicagoan, I laughed out loud at "ketchup is for dillettantes and three-year-olds." My wonderful, lovely wife puts it on everything, and I mock her for it.
+ "You need some blood work. I'd love to have my associate Divya do a full workup." Holy crap! They do understand what PAs do... unless they think she's a phlebotomist. But no, let's give the writers some credit here. Divya would, according to Hank, draw the blood, get the lab to do the appropriate tests, and then interpret the results. Which is true. But then, that makes instances of "Screw the Midlevel" that much more notable. Okay writers, you're officially having it both ways. (I'm doing that gesture where I point to my eyes with two fingers, then turn them around to point at you.)
- You do realize that 'I get blackout drunk on those rare occasions when I drink' is still kind of a red flag, right? I mean, nice plot device and all, but Hank is so concerned about everything, all the time...
+ Hey cool. Andrew McCarthy is Cary Grant as C.K. Dexter Haven from The Philadelphia Story. I love that movie! ...Oh, no, wait. He's an ass. And a very well-done "that guy is an ass" scene it is, too. Yowch.
+ I'm really enjoying not only Evan as a character, but what Paulo Costanzo is doing with it. The cooking/dancing went on a little too long, but it won me over. Although, how long did that food sit out if the ballerina wasn't coming over until after sundown? I also really liked when he admitted that NYC had gotten stale for him, which sheds some additional light on his drive to get Hank to the Hamptons last week.
+ The "Robin Hood of medicine" thing, as illustrated by Hank's speech on Bill's boat, is an appealing fantasy. Gosh, if only more of us could just draw fat checks from random rich people, and give our services away to the rest of our patients!
+ The running gag where Hank never, ever, gets to eat a bite of anything (until the end, sharing Chinese food with Jill) was cute. In the ER, nothing makes more work appear like ordering or heating food.
+ Hey, House writers: see how it works? A character who understands physiology sees a patient go into shock (shock being defined correctly as "perfusion insufficient to meet the metabolic needs of the patient"), looks at the heart monitor, and then identifies it as 'cardiogenic shock.' A little clunky and over-exposition-ey, because 1) who really cares at that point, and 2) duh, but still. Divya clearly knows medicine. This is nice, because as of now I trust the writers to know she's not a medical assistant, even when they treat her as one. (Caveat: I haven't seen this reaction to gluten, and I'm a little skeptical it would clear that quickly. Also a three-lead portable monitor isn't a Holter, and come to think of it I never saw them put pads on the patient, but since so much of medicine is boring we give some slack on these matters.)
- People, we never shock a flat-line. That TV trope has to go. Draw up the epinephrine or atropine, but put down the paddles and back away.
Overall, this was a nice solid A- of an episode. I'm feeling generous since while things are still very new, I'm seeing more to like as more is revealed about how the writers and producers approach the characters and the medicine. The show is finding its equilibrium between commenting on how "the system is broken," presenting its version of what's both cool and important about the practice of medicine, and keeping the story moving for its characters. My PA-touchstone character got zero development in this episode, but on the other hand she displayed some competence and knowledge. I'm feeling a Divya-centric B plot coming soon, if not a main story. Let's hope I'm proven right, and they do a good job.
Wednesday, June 10, 2009
Oh, and about those extra initials...
You'll note that for now, "I'm Febrifuge, MS, PA." I can say that much because I got my diploma; the MDs who graduated at that same ceremony are MDs as of now, as well. None of us can actually get a license, hospital privileges, or prescription rights until we pass our respective Board exams.
Actually, there's more to it. The MDs have residency spots lined up, which gives them a sort of blanket license to practice in their home hospitals and any affiliated sites. Me, I need to sit for my national certifying exam (which I'm doing later this month), which when passed lets me apply for all that stuff you need to practice.
At that point, having passed the test, I get to be "PA-C" for certified. That's when the fun begins.
Actually, there's more to it. The MDs have residency spots lined up, which gives them a sort of blanket license to practice in their home hospitals and any affiliated sites. Me, I need to sit for my national certifying exam (which I'm doing later this month), which when passed lets me apply for all that stuff you need to practice.
At that point, having passed the test, I get to be "PA-C" for certified. That's when the fun begins.
Tuesday, June 09, 2009
Febrifuge, MS, PA
Hey! I graduated!
The law of inverse blogging, or whatever it's called, was in full effect this past couple of months. (Seriously, is there a name for that? The more stuff that happens, the less you feel like/ have time for blogging about it?) Rotation #6 was back home at the very ED where I was a tech, but now I was treating patients and doing the same job as the residents. #7 was an elective in Trauma; I had such fun working my ass off in Michigan that I thought of trauma & critical care as a career option.
Turns out I was a genius for picking this elective, because nothing clears up the rosy glow of a great rotation like doing something similar in a crappier environment. Compared to the group of highly-skilled, generally pretty happy surgeons and kick-ass PAs I'd worked with in Flint, the West Side Chicago crew was overworked, overextended, territorial, and maybe shouldn't have had students around in the first place. It was not awesome, but I learned a ton about the work environment I don't want, and how to recognize it.
Oh. See how much more honest I can be now that I have my diploma?
My final eight weeks was in the suburban ER. I liked the idea of this, because whether it was back home prior to PA school, on my EM rotation, doing surgery in the 'hood, or the Trauma elective, all my ER experience has been in the grim n' gritty urban centers. And the jobs really tend to be in the suburbs.
Again, there's a lot to be gained from seeing things from the other side. I liked the work, and I was pretty good at it. The skills I've developed over this whole thing are the ones that sort of have to come to you organically; one preceptor said I have "street smarts," which I loved to hear. And in the 'burbs, those come in handy, if not very often. Maybe I'll tell you the story about the guy who, no kidding, said "my father is on the board of this hospital." I'll definitely be talking about the TV show that reminds me of.
So I don't know. I love emergency med, and I'd bet I'll wind up there for a long time... but maybe not quite yet. I want to do other things too, and maybe for that all-important First Job After School, I should start in an area where I can do more general, hospital-based work. More on that as we go, too.
The law of inverse blogging, or whatever it's called, was in full effect this past couple of months. (Seriously, is there a name for that? The more stuff that happens, the less you feel like/ have time for blogging about it?) Rotation #6 was back home at the very ED where I was a tech, but now I was treating patients and doing the same job as the residents. #7 was an elective in Trauma; I had such fun working my ass off in Michigan that I thought of trauma & critical care as a career option.
Turns out I was a genius for picking this elective, because nothing clears up the rosy glow of a great rotation like doing something similar in a crappier environment. Compared to the group of highly-skilled, generally pretty happy surgeons and kick-ass PAs I'd worked with in Flint, the West Side Chicago crew was overworked, overextended, territorial, and maybe shouldn't have had students around in the first place. It was not awesome, but I learned a ton about the work environment I don't want, and how to recognize it.
Oh. See how much more honest I can be now that I have my diploma?
My final eight weeks was in the suburban ER. I liked the idea of this, because whether it was back home prior to PA school, on my EM rotation, doing surgery in the 'hood, or the Trauma elective, all my ER experience has been in the grim n' gritty urban centers. And the jobs really tend to be in the suburbs.
Again, there's a lot to be gained from seeing things from the other side. I liked the work, and I was pretty good at it. The skills I've developed over this whole thing are the ones that sort of have to come to you organically; one preceptor said I have "street smarts," which I loved to hear. And in the 'burbs, those come in handy, if not very often. Maybe I'll tell you the story about the guy who, no kidding, said "my father is on the board of this hospital." I'll definitely be talking about the TV show that reminds me of.
So I don't know. I love emergency med, and I'd bet I'll wind up there for a long time... but maybe not quite yet. I want to do other things too, and maybe for that all-important First Job After School, I should start in an area where I can do more general, hospital-based work. More on that as we go, too.
Saturday, March 14, 2009
Febrifuge's Eponyms, part I
Last week down in the ED, we consulted on a 40-something gentleman who had been smacked with a baseball bat and had a goose-egg so big it looked as though he was working on a second head. His initial CT scan was negative (well, as negative as it can be with a depressed, nondisplaced skull fracture). We wanted another one in the morning, after he chilled out in the step-down unit. He was advocating for the position that he get back outside and go about his business. The one thing he'd said that made any sense was that we should call his emergency contact, his mom.
Signing out AMA is no big deal, so long as you're competent to do so -- which is a legal question, and one we don't want to get into. We're concerned more with the medical question of whether you have capacity to make the decision. (If you don't see the distinction, then you're probably a normal person, and not someone who could be called to a courtroom to talk about something somebody else said or did several years ago.) If you're drunk or high, it's an easy call to make. If you're calm, reasonable, can count backward by sevens, and remember what you had for lunch yesterday, it's likewise pretty easy.
If you're acting like a tool, you're a little drunk, and you've been hit in the head recently, the way you're acting could be due to any possible combination of columns A, B, and C. So that's a little trickier.
The ER folks, with the patient's mom in agreement, decided that holding this guy against his will, for his own good, was the way to go. He naturally disagreed. So what I learned, and what I'm taking credit for naming here, was something I'll call Febrifuge's Equation.
I'll have to work out the specifics, but on one side we have all the factors that identify a person as medically obnoxious, and increasingly potentially dangerous to self or others: their blood alcohol level expressed as a percentage by volume, their body weight in kilograms, the number of security personnel needed standing around their gurney to approach an equilibrium. On the other side of the equation, balancing everything out nicely in this guy's case: his mom.
The equation would have to work such that "mom" (M) comes out to either a positive or a negative value. So long as M is a positive number, the person is able to be persuaded to stick with the plan. The values on the other side of the equation can adjust downward so long as M is still enough -- the number of guards can be reduced; with time the ETOH level will decrease; and everything will stay cool. But if M becomes a negative number, then not even the patient's mom can help. This is when things get tricky.
Signing out AMA is no big deal, so long as you're competent to do so -- which is a legal question, and one we don't want to get into. We're concerned more with the medical question of whether you have capacity to make the decision. (If you don't see the distinction, then you're probably a normal person, and not someone who could be called to a courtroom to talk about something somebody else said or did several years ago.) If you're drunk or high, it's an easy call to make. If you're calm, reasonable, can count backward by sevens, and remember what you had for lunch yesterday, it's likewise pretty easy.
If you're acting like a tool, you're a little drunk, and you've been hit in the head recently, the way you're acting could be due to any possible combination of columns A, B, and C. So that's a little trickier.
The ER folks, with the patient's mom in agreement, decided that holding this guy against his will, for his own good, was the way to go. He naturally disagreed. So what I learned, and what I'm taking credit for naming here, was something I'll call Febrifuge's Equation.
I'll have to work out the specifics, but on one side we have all the factors that identify a person as medically obnoxious, and increasingly potentially dangerous to self or others: their blood alcohol level expressed as a percentage by volume, their body weight in kilograms, the number of security personnel needed standing around their gurney to approach an equilibrium. On the other side of the equation, balancing everything out nicely in this guy's case: his mom.
The equation would have to work such that "mom" (M) comes out to either a positive or a negative value. So long as M is a positive number, the person is able to be persuaded to stick with the plan. The values on the other side of the equation can adjust downward so long as M is still enough -- the number of guards can be reduced; with time the ETOH level will decrease; and everything will stay cool. But if M becomes a negative number, then not even the patient's mom can help. This is when things get tricky.
Sunday, February 22, 2009
Hi, My Name Is ___ sleep deprivation ___
I know there is probably already a documented "law" that states the more one has going on in one's life, the less time and energy there is to blog about it. If anyone knows of such a thing, please let me know what it's called, so I can chuck it into the memory banks with all the other stuff named after people.
Beck's Triad; McBurney's Point; Morrison's Pouch; Murphy's Sign; Colles' Fracture; Boxer's Fracture, Pugilists Nose; Swimmer's and Wrestler's ears. Someday it's my hope to identify something or other that's unique and useful, and stamp it Febrifuge's _____.
Sorry I've been so silent. All that time I spent back home, in the very Emergency Department where I used to work. In my defense, we stayed at Jonny's otherwise-uninbabited house; we paid stupid-cheap rent and kept the place occupied, but there was no Internets. And as we all know by now, I only add to this blog at weird times of the day and in short random bursts.
Emergency is still awesome, even now that I've actually done it, with some responsibility. I can see the career going ahead as planned. Currently I'm back in Chicago, and back in Trauma. Aside from the nasty commute and the 4:40 wake-up time, it's pretty sweet.
Since a couple of weeks ago, I've had a special hatred for pulmonary emboli. More than that, I don't really feel I can say. I can't do justice to it. Suffice to say, everyone is someone's family, and the thing for people in my position is to remember that, but still be able to think, and act.
Last week I renewed my disgust for handguns, in re: what they do to people's bodies. The surgeon I was with said, "most people never get the opportunity to see this." True... but being part of my educational experience probably doesn't help make anyone feel better. Anyway, another random bullet in the big city, another stupid exchange of words, another overreaction, another kid who won't graduate high school. I guess if I can continue to love humanity in the abstract even when dealing with this kind of thing, I must be in the right place.
Beck's Triad; McBurney's Point; Morrison's Pouch; Murphy's Sign; Colles' Fracture; Boxer's Fracture, Pugilists Nose; Swimmer's and Wrestler's ears. Someday it's my hope to identify something or other that's unique and useful, and stamp it Febrifuge's _____.
Sorry I've been so silent. All that time I spent back home, in the very Emergency Department where I used to work. In my defense, we stayed at Jonny's otherwise-uninbabited house; we paid stupid-cheap rent and kept the place occupied, but there was no Internets. And as we all know by now, I only add to this blog at weird times of the day and in short random bursts.
Emergency is still awesome, even now that I've actually done it, with some responsibility. I can see the career going ahead as planned. Currently I'm back in Chicago, and back in Trauma. Aside from the nasty commute and the 4:40 wake-up time, it's pretty sweet.
Since a couple of weeks ago, I've had a special hatred for pulmonary emboli. More than that, I don't really feel I can say. I can't do justice to it. Suffice to say, everyone is someone's family, and the thing for people in my position is to remember that, but still be able to think, and act.
Last week I renewed my disgust for handguns, in re: what they do to people's bodies. The surgeon I was with said, "most people never get the opportunity to see this." True... but being part of my educational experience probably doesn't help make anyone feel better. Anyway, another random bullet in the big city, another stupid exchange of words, another overreaction, another kid who won't graduate high school. I guess if I can continue to love humanity in the abstract even when dealing with this kind of thing, I must be in the right place.
Thursday, January 08, 2009
Just a quick thought for the day
It's true, there is no such thing as a free lunch.
However, having already paid my $23000 for the year's tuition, I cheerfully accepted a box-lunch turkey sammich and Diet Pepsi today, as we students attended all the same lectures as the Emergency Med residents.
And although the academic part of the day means I have some down-time before I see sick people from 3 to 11pm, at least I can stop by here and say hi.
So... how are you?
However, having already paid my $23000 for the year's tuition, I cheerfully accepted a box-lunch turkey sammich and Diet Pepsi today, as we students attended all the same lectures as the Emergency Med residents.
And although the academic part of the day means I have some down-time before I see sick people from 3 to 11pm, at least I can stop by here and say hi.
So... how are you?
Tuesday, December 30, 2008
Fun, and Not Fun
I love vacation. Partly because I get to reflect back on the accomplishments of the past seven months (we haven't had a significant break since the wedding), and partly because... well, because it's vacation. I can drink beer and play video games at 3 in the afternoon if I like. And, people: to a certain point, a point which represents admittedly more than Teslagrl might be hoping for but much, much less than it would have been not so long ago, I like.
It's been a very good year overall, and the clinical phase of school has been different in ways that are almost entirely good. If I made New Year's resolutions, I'd think seriously about promising to 'splain some more about how this phase of my education works. Now that time has passed, it's probably safe to jumble up patient-specific characteristics and tell some stories about each rotation, to give a sense of what this is all about.
But for today, I'm talking about video games. There's a really cool discussion going on at a blog I read called Twenty-Sided, where Shamus the host put up a ten-minute YouTube video he made, for discussion and comment. The video itself is a commentary, wherein he asks deep questions about the nature of games (he's a programmer himself, as well as a creative-type). He wonders how come some of them are no damn fun to play. A related question is about why there are so many folks, even in the age of Wii, who can't or won't get into games that don't involve bowling and whatnot. If this sounds even remotely interesting, and you have ten minutes, you should check it out. He's a smart guy, and knows what he's talking about.
Like everything I see on the Web and then run back here to write about, it got me thinking. And I've formed kind of a wobbly early version of a Unified Theory of Fun. But before I go spewing my opinions and deep thoughts about the subject, see what Shamus has to say. I have a hearty handful of readers. A few might have a little time to kill. I'd like to see how his arguments sound, to gamers and (maybe especially) to non-gamers.
It's been a very good year overall, and the clinical phase of school has been different in ways that are almost entirely good. If I made New Year's resolutions, I'd think seriously about promising to 'splain some more about how this phase of my education works. Now that time has passed, it's probably safe to jumble up patient-specific characteristics and tell some stories about each rotation, to give a sense of what this is all about.
But for today, I'm talking about video games. There's a really cool discussion going on at a blog I read called Twenty-Sided, where Shamus the host put up a ten-minute YouTube video he made, for discussion and comment. The video itself is a commentary, wherein he asks deep questions about the nature of games (he's a programmer himself, as well as a creative-type). He wonders how come some of them are no damn fun to play. A related question is about why there are so many folks, even in the age of Wii, who can't or won't get into games that don't involve bowling and whatnot. If this sounds even remotely interesting, and you have ten minutes, you should check it out. He's a smart guy, and knows what he's talking about.
Like everything I see on the Web and then run back here to write about, it got me thinking. And I've formed kind of a wobbly early version of a Unified Theory of Fun. But before I go spewing my opinions and deep thoughts about the subject, see what Shamus has to say. I have a hearty handful of readers. A few might have a little time to kill. I'd like to see how his arguments sound, to gamers and (maybe especially) to non-gamers.
Sunday, November 09, 2008
Compare and Contrast
Hi.
For the past 6 weeks, I was someplace far from home, on my Surgery rotation. I was at a hospital where the PA service is run unlike almost any other, and I had an amazing experience there. I've never worked harder, or been better-educated. I like to learn by doing, and I was in my element out there.
Here's an idea of what I mean: 6 weeks ago I could suture, and tie a knot... but I wasn't making sugical incisions, I wasn't the first-assist on several different types of operations ranging from hernia repair to hand surgery, and I wasn't solely responsible for sewing up lacerations. I had full, unrestricted Internet access (including Blogger, which was blocked by the network), but I didn't need to use it to research the 20-minute talk I had to give on a new assigned topic each day. I was sleeping in my own bed, rather than crashing at the dorm-style 1970s-era apartment building a block from the hospital's Emergency entrance, but I wasn't working 80- to 90-hour weeks.
I'd watched brain surgery on the Discovery Channel, but hadn't observed an awake craniotomy live and in person. And I certainly didn't have to excuse myself to respond to a trauma alert. I've known folks who had gastric bypass, and god knows I've played some video games, but I definitely hadn't operated a laparoscopic camera (by the by, this is something I have now done multiple times -- by the end, the surgeons were requesting me, and it's possible I may have gained -- gasp! -- a lucrative, marketable skill).
I mean, I really like Scorcese, but let's see how Gangs of New York would have looked if all he had was a fiberoptic light source jacked into a glass rod as big around as a wooden spoon handle, and the whole thing had to be filmed on location inside the abdominal cavity. Right?
Okay, true, I'd been present for a few hundred trauma activations. So those were nice.
I can tell some stories and talk some specifics at a later date, but basically this rotation (#4 of 8) seems to have been some kind of a turning point. Long-time readers will recall how I struggled all through Post-Bac and the first year of PA school; basically there's been a conflict (internal, external, or both) between studying to be a student, and studying to practice.
This rotation was one where the accent is on preparing to do the work. And not coincidentally, it's the one where I've had the best success. Sure, there's a lot to know, and every morning I had to be ready to stand at a marker board and give a talk, proving I understood the concepts and memorized the facts. But as the veteran PA* in charge said, "you're standing there because medical folks think sitting down, around a table. In surgery, we think standing up."
It's good to be back, to be sure. And it's a new world for lots of reasons. Next up, it's Family Medicine on the West Side.
* literally; there are a few bona fide Vietnam-era Army medic/ Navy corpsman-type 1st-generation PAs at this place
For the past 6 weeks, I was someplace far from home, on my Surgery rotation. I was at a hospital where the PA service is run unlike almost any other, and I had an amazing experience there. I've never worked harder, or been better-educated. I like to learn by doing, and I was in my element out there.
Here's an idea of what I mean: 6 weeks ago I could suture, and tie a knot... but I wasn't making sugical incisions, I wasn't the first-assist on several different types of operations ranging from hernia repair to hand surgery, and I wasn't solely responsible for sewing up lacerations. I had full, unrestricted Internet access (including Blogger, which was blocked by the network), but I didn't need to use it to research the 20-minute talk I had to give on a new assigned topic each day. I was sleeping in my own bed, rather than crashing at the dorm-style 1970s-era apartment building a block from the hospital's Emergency entrance, but I wasn't working 80- to 90-hour weeks.
I'd watched brain surgery on the Discovery Channel, but hadn't observed an awake craniotomy live and in person. And I certainly didn't have to excuse myself to respond to a trauma alert. I've known folks who had gastric bypass, and god knows I've played some video games, but I definitely hadn't operated a laparoscopic camera (by the by, this is something I have now done multiple times -- by the end, the surgeons were requesting me, and it's possible I may have gained -- gasp! -- a lucrative, marketable skill).
I mean, I really like Scorcese, but let's see how Gangs of New York would have looked if all he had was a fiberoptic light source jacked into a glass rod as big around as a wooden spoon handle, and the whole thing had to be filmed on location inside the abdominal cavity. Right?
Okay, true, I'd been present for a few hundred trauma activations. So those were nice.
I can tell some stories and talk some specifics at a later date, but basically this rotation (#4 of 8) seems to have been some kind of a turning point. Long-time readers will recall how I struggled all through Post-Bac and the first year of PA school; basically there's been a conflict (internal, external, or both) between studying to be a student, and studying to practice.
This rotation was one where the accent is on preparing to do the work. And not coincidentally, it's the one where I've had the best success. Sure, there's a lot to know, and every morning I had to be ready to stand at a marker board and give a talk, proving I understood the concepts and memorized the facts. But as the veteran PA* in charge said, "you're standing there because medical folks think sitting down, around a table. In surgery, we think standing up."
It's good to be back, to be sure. And it's a new world for lots of reasons. Next up, it's Family Medicine on the West Side.
* literally; there are a few bona fide Vietnam-era Army medic/ Navy corpsman-type 1st-generation PAs at this place
Friday, September 26, 2008
What's in my open windows right now?
Wow, long time, sorry, etc. School does this to a guy.
I'm watching the debate live, and here's what's on the laptop:
1) This window, natch.
2) Facebook, where several of my peeps are being all political and clever.
3) FiveThirtyEight.com, so I can watch their liveblog.
4) The messageboard community I've been part of for several years, for more live reaction and discussion.
And I'm seeing the debate on CNN, where I get live info about how various voter blocs respond to what they're watching... which is what I'm watching. I'm struck by how just how much information is available at once. And the thing is, it isn't too much.
Is this because I have ADHD, or because this is a hell of an election?
I'm watching the debate live, and here's what's on the laptop:
1) This window, natch.
2) Facebook, where several of my peeps are being all political and clever.
3) FiveThirtyEight.com, so I can watch their liveblog.
4) The messageboard community I've been part of for several years, for more live reaction and discussion.
And I'm seeing the debate on CNN, where I get live info about how various voter blocs respond to what they're watching... which is what I'm watching. I'm struck by how just how much information is available at once. And the thing is, it isn't too much.
Is this because I have ADHD, or because this is a hell of an election?
Subscribe to:
Posts (Atom)
