Web-headed happiness

Things I Love about the Spider-Man 2 Game for PlayStation2 (in no particular order):

* Jumping off the top of the Empire State Building, free-falling until the closest buildings are low enough to shoot a web at, and then swinging out over Fifth Avenue.

* Approaching a citizen in distress and hearing Tobey Maguire's voice say, "Hi, my name is Spider-Man, and I'll be your superhero today."

* Bruce Campbell as the game's narrator/ tutorial voice. Helpful, yet sardonic.

* Knowing it's possible to stick a web to the bottom of a helicopter and hitch a ride out to Liberty Island (and I shall, oh yes, I shall).

* The unexpectedly poignant videogame moment when I went to the financial district and saw a big vacant lot with a dozen big spotlights pointing straight up, at the site of the World Trade Center towers.

* To buy upgrades for Spidey's web-slinging and combat powers, you walk into what is pretty obviously the Midtown Brooks Brothers. And all the little virtual people go about their business as if it's completely normal. Heh heh.

* Hot dog carts dotted around the island, including one in Battery Park. (Game designers missed an opportunity to make them do something, but that's okay.)

* They named the neighborhood with the fictional Daily Bugle building "Flat Iron."

* Random New Yorkers shout out to Spidey as he swings through the city. About a quarter of them say something obnoxious.

* The digital Guggenheim confirms my long-standing suspicion that the thing is right at home in a comic-book world. I fervently wish that at some point in the game, it's revealed that there's some arch-villain's secret base in there. (The game's been out most of a year, and I well know there isn't, but a guy can dream.)

* And finally, here's a game with the expansive open-endedness of the Grand Theft Auto games (which I also dearly love, don't get me wrong), but without the misanthropy and nihilism.

* Swingin' on a series of webs, you can get from Harlem to SoHo in, like, five minutes.

Mortality and morbidity, with garlic bread on the side

On a recent weekday, I had the day off from the office job, so I went to the 7:30am trauma room conference. The conference is a review of a handful of the more interesting critical cases that came through the most acute part of our emergency department over the most recent week, grouped around a theme -- one week there will be two different head injury cases, for example, plus maybe a seizure case or another "altered mental status" case, if the general theme is level of consciousness. Conference takes place in a basement room that is all very hospital-white. There's coffee, and bagels show up at some point during the hour.

I like going when one of the a cases covered will be one I worked on, partly because I like to know how things came out for the patient. This can be good news or bad, of course. Speaking of head injuries, I'll never forget the one where someone I'd been there for was presented, and after the head CT and a report from our EM resident (assigned to Neuro at the time) came autopsy photos of the same massive brain clot, this time frankly visible within the exposed top of our former patient's cranium, with a report from the medical examiner.

I also go to conference because it's a chance to feel connected to the learning part of the process; to take advantage of the fact that I work at an excellent academic center, and I am encouraged to attend. I also like to imagine being able to call on these experiences later on, as a helpful memory. Not so much for clinical info, although surely I'm picking some of that up, too. I like the idea that because I have the chance to do this now, settings and situations like the conference won't ever be foreign to me, and thus less intimidating. It's part of the whole 'non-traditional' student thing. Many staff physicians are close to my age, but the residents are only younger than me by a factor that's about the same as how far behind them I am in education. Thus, I tend to gravitate to the resident part of the room.

Today I also stuck around for the med student lecture, something I do most days I attend the conference. As I said to the 3rd-year resident I was sitting next to, this is an unusual time in my training -- there would be no consequences at all if I decided to ditch the lecture, since I am "invited" and "encouraged" to attend the conference, but the lecture is pure bonus material. Somehow, this seems to work out to having the kind of attention span for medical education I fear I might be lacking later on, when things are going to get a lot more compulsory and/or graded.

It helped that while this lecture was unusually well-organized and presented in a more academic, true lecture-style way than some of the lectures I've attended, it was also really good. It amuses me to think that if I am asked to strap a blood pressure cuff to a patient's ankle in the next few weeks, I'll know exactly what's up. (Actually, I would have been able to suss it out on my own, strictly in terms of "what does that tell us?" But this way, I'll know it's because the resident and I attended the same lecture.)

Something I've never done was hang around after the lecture, for the Mortality and Morbidity conference. Having checked my voice mail, and knowing that lunch with the gf was not happening as planned, I was curious about what's next. The residents were not entirely sure at first, so I soon found myself with a very narrow window to decide if I would stick around. Turns out it was indeed M&M.

Would this be interesting? Totally. Educational and helpful? Sure. Would I just be there out of prurient interest? Not at all. Would it be okay for me to be there, or was this a doctor-only kind of thing? Uhhh.... well, I took a look around. The RN's had taken off already after conference, since they tend to have, y'know, lives, and of course nobody from other services was still around. But med students were still there.

One of the big things I've learned is that med students are nothing special. And I say that even as I make huge personal sacrifices in the fervent hope that I will be granted the opportunity to be one.

Some are of course wonderful, and brilliant, and it's obvious to see the future doctor just beneath the surface. Many are studious, well-intentioned young people, who with some time and effort will be great. Many are exactly what you'd think, if you watch a lot of Scrubs. Seriously, I have never had what I've felt was the requisite awe and respect for medical people; that's one factor that kept me from joining up earlier. But most of my experience has not yet shown I was wrong. Students are just regular ol' people... some moreso than others.

So it was staff, residents, med students, and me. But what the hell. The boss-doc who was running things saw me, we made eye contact, he gave no indication it was weird or inappropriate for me to be there. And it turned out to be really fascinating. For those who are unfamiliar, the "M&M" is the big meeting where we talk about what went wrong.

First was a discussion of things that get screwed up, in general, in the practice of medicine. There was a big long list that the group had been working its way down, over several weeks or months. The boss-doc presented some examples of issues culled from several years' worth of cases, pointing out where studies that had been read as normal were truly not, asking difficult questions of the residents, and applying hindsight to point out things not to be fooled by.

Then, specific stuff from the week at our hospital was presented, by various people who had been connected with the issues. None were huge problems, most were not even noticed by patients, but all were important because the team chose to make them important. Here's the situation, here's how it might have been prevented, and here's how we make sure it doesn't happen.

How come every industry, business, and institution doesn't do this?

From TV and film portrayals of the M&M, you'd think it was a big auditorium with stone-faced old guys frowning down at a trembling young doctor in the hot seat. It's actually a discussion peppered with horrifying but comical stories from 25 years ago, when the gray-haired sage who now runs the show was a skinny little geek prone to rookie mistakes just like anyone, and chances for newbies to demonstrate the ability to learn from mistakes during, and even prior to, their commission. It's the healthiest, most honest, most real-life-no-BS-helpful way to make things better I've seen.

And that's sad, because I've been in the business world for what, 12 years? "Continuous quality improvement" sounds great, guys. Thing is, we've been doing it since Hippocrates. (I commented to GeekSpice once, more than a few months ago now, that I had found the word "we" coming out of my mouth when referring to medicine, and the way things work in that world. I did it again, just a couple of paragraphs ago, when I said "our hospital." Yep, I'm committed, now.)

As M&M wound down, food was brought in. I was ready to go home, and really, the next thing on the agenda was prep for board exams. If all goes well, I'll be getting ready for my USMLE Step I board exams at this time of year... six years from now. So, not so practical. But hey, free food. So I stood in line, where I talked a little with some staff docs about an issue that the M&M had addressed, then ladled up some ziti that had a nicely zippy sauce, one good-sized meatball, and then sat back down. Dammit, board prep started immediately. I was trapped.

And then came the best surprise of the day. The way the oral part of the boards is done is extremely similar to the way my EMT class had been run, as we practiced cases for patient assessment. There is an examiner, who guides you through a scenario, and you need to verbalize what you would do, what you would look for, etc. Bedside manner counts, following the standard of care counts, doing the steps in the right order counts. There are things you need to do and things you should not do, to earn full points or avoid failing the scenario altogether. The scenario is timed.

One first-year and one second-year resident were being quizzed by a third-year, in front of the group. Staff offered comments and gave pointers about the way things are structured. Sitting in our seats, my friend the third-year and I whispered about the food and he (correctly) diagnosed the problem in about 15 seconds. Me, I wasn't ready to go that far, but I knew what to do. I was shocked to find that not only would I probably not kill this imaginary patient, I might actually get a decent score on this scenario.

Now, this in no way means I would not wet my pants (figuratively or literally), if faced with a real situation. It doesn't mean I'm as smart as an intern. It just means I am on the right track, and the preparation I have done so far will directly relate to what I will be doing later. As someone who is racked just about daily by a very reasonable-sounding inner voice that questions the wisdom of all this, I appreciated the boost.

This is long enough, so I'm signing off, but that reminds me -- sometime I need to talk about that EMT class, and the imaginary patient I killed in one of those scenarios. She's the only one I've lost so far.

And I still think that even if I had asked about it, she might have denied taking the damn Viagra.

Surgical Deep Thoughts, part 1

The femoral head is the round bit at the top of your thigh bone, your femur. It's the ball in the ball-and-socket joint of your hip.

In a total hip arthroplasty (a hip replacement, in other words), a titanium rod gets inserted a little ways down the center of the femur*. That part is meticulously measured and the rod is planted solidly. After the rod fits and the artificial socket up on the cup-shaped hip bone fits (that's the acetabulum, by the way), then the last bit in is secured to the top of the rod; this is the artificial dealio, made of titanium or ceramic or some other space-age material, that will become the de facto femoral head.

The femoral head is (on most adult people) slightly larger than a golf ball, smaller than a cue ball. Sitting there in a little metal tray, it can look awfully bewildered. Even, dare I say it, a little sad. A minute ago, it was an important body part, and now it's been replaced by some fancy-schmancy bionic thing. It's suddenly become medical waste. Hard to preserve your dignity in that situation, but the femoral head is nothing if not practical. It does retain some of its natural poise and beauty, despite being totally irrelevant at this point in the operation.

I thought it was sort of like the way a pitcher looks, when the manager walks out to the mound in the bottom of the fifth, with only one out and two of their guys on base, and says "nice work today, kid, but we need more juice out here right now. Hit the showers, willya?"

Except with more awe and respect. Not enough awe to make my brain seize up, though. Too much musing on the thin gossamer thread of every human's mortality, or the sacred yet profane work of we the blessed healers, can get in the way of people doing their jobs. And people doing their jobs is worthy of respect and awe, right there.

So, uh... yeah. I've had the chance to do some shadowing. Surgery is very, very cool. It's interesting to be aware of myself as someone barely scratching the surface. I know the names of most of the parts, and I understand much of what's going on. Yet outsider-style ideas and observations still bubble up. I'm hoping that I can hang on to some of that, along with all the actual knowledge and skill I'll be needing, when I'm standing in one of those other spots.

Total hip info (complete with gory photos) can be found here:
http://www.wheelessonline.com/05/4971.htm


* Some marrow gets sucked out to make this work properly, and for some reason that part wigs me out more than all the rest of it -- including the part where the surgical team gets to be standing there in the first place, looking down into an open wound at the bones of a live person, like a bunch of guys eyeballing the half-disassembled transmission from a 1993 Ford Escort. And also, shaping the bones so they'll fit snugly with the implant. Shaping them with a saw. And a hammer and chisel. Ortho is cool as hell, and that's partly for the way it is not at all glamorous. It's clearly science and art, and one of the specialties that can make a person perspire from the physical effort of practicing it. As an Emergency kid, this is something I can respect.

Welcome to the Backwater

I recently commented at SpaceWaitress' place about blogs, and how they provide a skewed prism of a person (a persona, really). There's a discussion there about people "in real life" who get ahold of one's writing, or stumble across it subsequent to the ending of the actual acquaintance, and use it to build a mental bridge that allows them to think they know the writer. Not unlike fans who have "connections" with famous people.

Sometimes readers actually do know the writer, so friends and family who read a blog can participate in one more way in that person's life. This is undeniably cool. We've learned that Spacey's mom is even cooler in her head (and via her keyboard) than she's always seemed at those brief times when we've talked in person. We've seen evidence of why people are such good friends to one another, and it's always heartwarming (or, since it's kind of an intellectual thing, maybe it's "brainwarming") to see an affirmation of people who get one another so well. I had been impressed by Spacey's group of friends, and their loose-knit ability to stay connected and in synch, but now I have another view of that quality, and I have a sort of observer's affection and respect for it.

My contribution to the thread over there was the awareness that as I plod through the process of various applications -- to postbac (done!), med schools (the plan is for the 2007 app cycle) and eventually, residency programs (2011, god willing and the crick don't rise), I'm going to be asked to write and talk about a lot of stuff... which in many ways, I am thinking and writing about now.

Part of being a good tech is anticipating the need, and having the whoosit ready by the time it's asked for. The ambulance is due to arrive in five minutes; we're all gowned up standing around the cart and saying hello as though it's the first time (which it sometimes is). We're looking at each other's name tags. The ultrasound is right behind you, doc, and it's booting up now. The nurse's documentation sheet has the Hollister sticker and my signature on it, and it's in the bin ready for other paperwork to join it. Empty blood tubes are arranged like a multicolored pan-pipe by the phone, and my gloved finger will jab any speed dial you need. We're all set.

So, okay. Is this mental processing here at the humble little pseudo-blog going to be useful later on? Or will it just be one more thing I can be evaluated on later? And, if it makes me look like a clueless tool with delusions of competence, wouldn't that evaluation actually be more like what in the liberal arts we like to call "judging?" Ay, there's the rub.

But you know what? This is public, but it's primarily for me right now. Convenient, that, since almost no one else comes here. Still, that may change with time. The work so far is not on my own C: drive because I do want some elements of a conversation. I don't want to talk only to myself. And in the long run, even though it might bring some of the complications that Spacey notes now, giving over the ability for people to jump in to this place from various points in the future or past, I think it's worth it. There could be value in helping other non-traditional students get on the road. It might be amusing or interesting. There could be some worthy insight. And best of all, there's the chance that it might help establish a pattern that corroborates something positive a decisionmaker thinks they see in me at some point.

And really, everybody else has a blog. Maybe in the 2007 application cycle, it will be weird not to have one. And you gotta believe that a person's true colors show over time. Whether this is a footnote or the Lake Itasca of one segment of my eventual doctorhood, welcome to it. It might provide clues about letters to the editor I'll write in 2024, or things I'll argue about at national conferences, or how I'd give feedback as chief resident.

At the very least, yeah, it proves I am actually like this, and not just at interviews.

If I'm quiet...

...it may mean that things are going on which will make awesome stories, but not yet.

Because things are too fresh in my mind, and need to be processed; because I need to think of cool pseudonyms for people I'll need to talk about; because I need to obscure identifying details; or maybe because I've been too dang busy to write.

The urge to blog is not insignificant. Someday this will be a sort of a record of selected impressions, opinions, and reflections from this particular part of my ongoing drama. And it will be a depository for amusing and maybe even interesting stories. Plus, it's practice for me, as I learn to formulate thoughts about these topics in a way that holds together.

But the urge to sleep is stronger, dude. No contest. So I'll just say I recently met some cool people, and I did some extremely cool stuff.

Hey, and I left a message for Turk. They need techs on that show, truly. Sassy, intelligent people who describe themselves as "low-life-techs," but who in reality make the place run well and help docs to be on their best game. It's TV gold, I'm telling you.

things that make me laugh, with glee, on the bus

1) "Indie RnR" by the Killers came up on my iPod. I'd never heard it before, and it was awesome. It helps that yesterday, I read the essay that Rivers Cuomo wrote when he re-applied for admission to Harvard.

(to be continued)

tonight's dinner

Just as a glimpse into the way I live these days, let me describe dinner for ya.

Arrived home a little after 5, already starving. Munched Corn Nuts while surveying pantry and fridge. (Side note -- Hanukah gift from mom was a giant bucket full of foodstuffs. Quite the care package. More of that when I go to school next year, plus some time in the Fitness Barn, and I'm in good shape).

Contents of fridge include skanky au gratin potatoes made from scratch four to five weeks ago, in need of disposal. Milk, past expiry date by more than 10 days, in need of disposal. Film on bottom of pitcher where sugarless "-aide" style drink evaporated. Rice and beans, made from scratch like the potatoes, and similarly skanky due to dearth of preservatives, plus lots and lots of time. Eggs, reading 'Sell by Oct 5.' Mushrooms, fresh two days ago. Shredded cheese, fresh two days ago. Onion, sorta fresh, sealed in zippy-bag. Leftover salmon-in-phyllo-dough deals made-- hm. Over a week ago.

Oh, and wait, some of mom's turkey-and-stuffing (another thing that I hauled home from the Open House of Lights this weekend), a goopy and delicious concoction that is more souffle-like than many other, inferior stuffings. But at the moment, I was not thinking of it much. It just sat there, looking bored. Also, jaunty seafoam green boxes containing vials of Enbrel, plus syringes for reconstituting and injecting the drug. Much as I'm pleased with what recombinant live cells derived from Chinese hamster ovaries can do for me, a dose costs my HMO like $200 to $400. So that's more a specialty item, not part a wholesome winter meal.

Pantry: pasta, instant brown rice, popcorn. Mac & Cheese mix, but that would mean going out for milk. Did I mention at this point it's about 15 degrees Fahrenheit outside? The guy from the TV Weather said (by way of the phone recording one can call) "Wind chill, 4 degrees." Four flippin' degrees. As I walked home from the bus, about 10 minutes previous to this, I had decided I'd be staying in for the night. If I'm going for milk, I may as well go to the airport and fly to a hospitable part of the world.

Inspected coupons for local chicken/pizza joint. Yes, I'm curious about the broasted chicken, but keep those eggs long enough and maybe I can broast one here. Feeling like cooking, dammit.

Inspiration: olive oil plus 'shrooms plus onions, over rice, little shredded cheese, there we go.

Checked freezer. One pork loin, frozen. Hallelujah. (Yes, I did say "Hanukah" earlier. Also, "cheese" and "pork.")

So, when all was said and done, I carbed it right up by oven-broasting the pork at 400 degrees for 35 minutes over a pile of the stuffing, which gave a nice moisture to the meat. I stirred the stuffing back together, the crunchy bits and the juicy bits, together with some of the sauteed mushroom/onion mixture, the rest of which adorned some rice. With cheese on top.

There are times, usually those rare occasions when I bring lunch in to work, when people talk as though I was a good cook. Maybe there's something to it. I really could use a bunch of steamed broccoli, I don't mind saying. And a tall beer.

But it is freakin cold out there.

CALL-TURK update

I actually got through last Friday, and was able to leave a message. We shall see.

Also, I worked in the trauma room over the weekend. Just apropos of nothing at all, if ever I'm feeling weird and sort of dizzy, and a head CT at my friendly, competent, perfectly good small-town hospital shows nothing wrong but I'm admitted to the hospital anyway for other sorta-related neuro reasons... please make sure the staff doesn't let me sleep for like 10 hours straight without waking me for vitals, talking to me, or doing a crapload of neuro exams. Because, while I do like helicopter rides, and I love to take naps, I also like waking up.

DISCLAIMER: I actually don't know how this patient is doing today. Could be anywhere on the spectrum. Plus, there's not a lot of info about what happened in the case before the patient's arrival, and I may not have seen the whole chart. This is more a story about how things might go, sometime, somewhere... but back to our story.

Preferably, if I'm checked in with a nonspecific problem in the noggin, you'll room me with a noisy 8-year-old insomniac who is not actually all that sick. I say this because either playing Ratchet and Clank or plotting revenge against a tiny tormentor would be a higer brain function, and in times of neurological distress, I'll want a reason to practice those.

Like I said, the facts of the case are admittedly a little sketchy (which by the way helps me to obscure the identifying details; convenient!), but the principle here is like I was taught: "if you don't put it in the chart, there's no way to know it happened." And we know that the scan done less than 24 hours previous, at PGSTH, was read as normal while ours was really, really... not. Whatever the specifics, my part of the story ends with a CT control-room-ful of EM and Neuro docs anxiously watching successive slices of brain imaging come across a monitor screen, like really shitty cards being dealt, and going "arrrgh" in unison. That's just never a good thing.

One resident commented, later, that the systemic kind of bad luck is the kind that can sometimes really screw a patient. Hospitals with sprawling residency programs training new doctors, and with med students rotating through, sometimes get scoffed at. Sometimes the scoffing comes by way of well-fed, comfortable small-town docs who work in hospitals with fewer than 50 beds, and sometimes by way of their patients. But it's a fact that some poor schmuck intern who has to come see you at 11pm, then 1am, then 3am could be the one to notice something that, if noticed soon enough, might not kill you. Food for thought. And when the day comes when I'm that poor schmuck, I guess I've learned a little something about being glad I'm there.

Things That Have Actually Happened To Me, and Which Would Fit On "Scrubs," Part One

INT. SMALL HOSPITAL ROOM - EVENING

(FEBRIFUGE enters. He's decked out in maroon scrubs, and carries a clipboard. The PATIENT is a middle-aged man, propped up in a mass of blankets, waiting calmly.)

FEB

Hi. How are you feeling now?

MAN

Ehh, you know. Not good. Not terrible. Kind of bored.

FEB

Well, you'll be a lot more comfortable upstairs in the main part of the hospital. (he lowers his voice, and sing-songs a little) Cable Tee-Veeee... (and he's back to being all-business) So, one of the things we do, when someone is being admitted to the hospital, is make a list -

(he indicates the form on the clipboard)

- of all the personal property, the clothing and whatnot, that a person has with them when they come in. That way, when it's time to check out, we know and you know that nothing got left behind. Okay?

MAN

Yeah, okay.

FEB

So I just start by looking around the room, and seeing what you have with you; here's a pair of jeans (he writes), here's a shirt (he writes), I see you're wearing eyeglasses, so those go on this blank here, I see you've got a ring on your right hand there. Cool ring, by the way.

MAN

Thanks.

FEB

Any on your left hand?

(The man smiles and holds up his left arm. It's been amputated just above the elbow. Probably a long long time ago.)

Okay, so I'm gonna say no to that one...

If I can get real surgeons to call me back, maybe it'll work on Dr. Turk

By now, you've probably heard that you can in fact call Turk. Which is to say, the mobile number that the fictional Dr. Turk obtained on last week's "Scrubs," 916-CALL-TURK (actually, said the character, "...it's CALL-TUR. But I'm hoping people will dial the K anyway").

So it's a real number. The people who make the show bought the phone, bought a mobile contract with the number, and the phone sits on the set, taking messages. Cast, crew, and production staff will pick up the phone and chat with fans, if the mood strikes. If I were less lazy and more Blog-smart, I would link you some examples of the hilarity which has already ensued. Somebody got "Ted, the lawyer." Somebody got the guy who plays Dr. Kelso, also in character. Apparently it's a fun diversion, and a chance for actors to screw with the minds of their audience. From first-hand experience, I understand how deeply amusing and satisfying this can be.

Between this and an NPR "All Things Considered" interview I listened to recently, where show creator Bill Lawrence and star Zach Braff spoke for like 25 minutes, I had to call Turk my own self this morning. See, Lawrence has a good friend who really is named Dr. John Dorian, and really did go through training as a student and a resident, all the while remaining (from his friend's point of view) essentially the same lovable goofball he always was. The interview was great; at one point, Lawrence summed the whole thing up by saying that the real JD was this guy he'll always remember with an empty cardboard beer case on his head, and it's a special kind of horrifying to imagine being wheeled in to a hospital and having such a person be the one telling you, "don't worry about a thing, sir. You're in good hands."

Lawrence claimed in the interview that the show has yet to do anything medical, any little workaday moment that touches on the hospital/ doc/ nurse experience, that is not directly derived or distilled from somebody's real-life experience. The real-world medical community has embraced "Scrubs" like no other show (I can vouch for this myself), and there's some kind of an informal deal going where show-creator-people's doctor friends, family, and random party guests can submit ideas and anecdotes to Lawrence and the writers, often times having a character named after them for the trouble.

Obviously, the combination of my performing/writing background, coupled with my love of the Internet and new modes of communication and community - not to mention my gigantic ego - make it seem to me like a great idea for the show to have some minor, one-episode character just like me. Hey, I see Internal Med and Surgery docs all the time, when they have to come to the ED for a consult. They may not see me, but still...

I envision a few different scenarios that could work, and one or two of them don't even require building a new set. (Although, they might have one. In season 1 or 2, they did a five-second cutaway to the ED at Sacred Heart. There was a hippie surfer with a tie-dye t-shirt and long white coat, giving a differential with more hedges than the Queen's garden. That was funny.) Anyhow, you could call somebody down, or a tech scutmonkey like me might come up to the floor or the ICU, with a bag of personal belongings for a patient. Or a patient. Hilarity might ensue.

So this morning, I parked my car near the hospital, and started walking toward Day Job (I work in the ED later, from 5pm to 11pm). Once I was off hospital grounds, I no longer felt quite as funny about calling a fake doctor at a fake hospital. I expected to leave a message. I was prepared to talk to a live person, should anyone be up and on set at 5am Cali time.

But the mailbox is full, or vm has been turned off. Dang.

However, it said I could leave a call-back number. Hmmm.

So, what the hell. It's not the trauma pager, but it'll do.

Patch Adams Can Bite Me

...however, I do tend to get chatty with patients. I crack jokes when it's not horribly inappropriate. I acknowledge the absurdity of situations. I play with kids. Last night, I asked a 14-month old child what 15 times 6 is. When he told me "baabwoooo," I agreed he was probably right, and thanked him. Then I wrote down "90." This all happened after I'd plugged my stethoscope into my ears, listened to the frame of his stroller, listened to the top of his head, listened to my arm, and then finally listened to his little heart. 30 seconds earlier I had been approaching the kiddo's personal space with a foreign object of nefarious design, and now we were burbling about math. The parents appreciated it too... or at least put up with it.

People need to understand what you're doing, and why you're doing it. If they're drugged to the gills, in severe pain, can't breathe well, really anxious, or 14 months old, this may not be possible. Still, it's better for them and for you if they know you're not a sadistic equipment-weilding boogeyman. At the very least, they should have some indication that you're someplace in the neighborhood of okay, and at the very very least, they should be distracted and confused, because the process of trying to decipher "what the--" can be enough to lessen pain and fear, for a moment.

I also had occasion to meet a grownup or two on last night's shift (see below). I mentioned that the patient in that story served in WWII, and this information came out during small talk while he was on a gurney having a heart attack. This may seem odd, but trust me, this is the thing that "ER" the show lacks most egregiously, in my opinion. There is some sparkling conversation and dramatic opposition that happens in those rooms. The bongo drums are a cheap way to inject tension that could be there tenfold, if the situation were presented well. It's mind-bending and sublime, the mingling of the mundane and the literally life-or-death. I'd be riveted by a scene where a patient chats about some random quotidian thing while people, machines, and drugs that come out to several thousand dollars in hourly costs did their work.

But here's the thing about why I like to chat so much: talking to people is a great way for me (and the half-dozen people in the room with ten times the education I have) to assess their airway, their mental status, and their pain level. Also it's friendly, and a nice thing to do. Not least of all, if I were the patient I'd be reassured by the idea that the painful scary crap that's going on with me is also, on some level, just a normal day at the office. If something that is rocking my world in a bad way is no big deal to some group of people somewhere, then I want to be with those people at that moment. I never want to be an "interesting" case, much less a stressful one, for people whose job is to save lives.

If I'm ever lying there, having my clothes cut off and my circulatory system temporarily reconfigured with the help of needles and plastic tubing, I want to hear some chatter from the team. I don't want to hear clenched jaws and see beads of sweat on foreheads. I don't want terse commands and silence puncuated by beeps. I want to hear about restaurants and car payments and kids' baseball. I want to hear people giving each other crap. If a vein should blow and a nurse says whoops, that IV needs to be re-done, I want somebody like me dabbing blood off an arm like it's not a big deal, because it's really not. It's all good. It's under control.

in which I slip away for five minutes to thank a Veteran

The work at Day Job is well under control (my team kicks ass... plus it's generally slow at the moment), and so I had time to call the hospital switchboard and get up to the team station in a particular unit. There's a gentleman under their care, around 80 years old, and I met him last night. I was helping out in the trauma room, since it was one of those moments when we had two unstable patients at once, and my counterpart who was assigned to the room was occupied. We were "up" at the moment - I was extra, in other words, and was assigned to float to wherever I was needed most. And so I was there when this polite, dignified gentleman was brought in, in the midst of a heart attack.

The only-sort-of-"ER"-like whirl of stuff got done, he got somewhat better, and about 30 minutes after arriving, he was on his way upstairs, where he rests comfortably right now. I called back today to speak to his team because as we were all talking, it came up that this gentleman fought in Germany for the Allied side in 1945. I called the team station to make sure the people taking care of him take a minute to say thanks today.

The RN I spoke to was really glad I called. So was I.

Yeah, war is dumb. But soldiers are professionals, and their job is harder than most of ours. If you've ever been impressed by or grateful about the fact that the really violent and unstable things that happen in the world, within and between political entities, usually don't happen here; if you've noticed that they usually don't interfere with our going about daily life, the people who serve in the military have a lot to do with that. Veterans especially.

the inevitable post-election post

I've been doing a fair bit of participatin' over at New Patriot -- and since Blogger has eaten this post at least once, failed to acknowledge it, and then spit it out twice in two minutes, prompting me to trash one of the copies... well, anyway I don't want to lose this idea.

I'm responding here to someone who argues that the Left has been bitching about joblessness and the decay of the support network all his/her 31 years, and it's a big turn-off. In responding, i may have accidentally said something cogent and helpful about what I think the left side of the middle ground is about.

Anonymous 5:17pm, I hear what you're saying -- that message sounds a lot like "wolf" to most people, as long as the cable TV works and there's a paycheck coming on Friday. But it's amazing how little there really is between any one of us and poverty. Think about where you'd be, if two paychecks in a row failed to arrive, and there wasn't unemployment to work with. Or if you needed a $2700 visit to the emergency room, with insurance paying for only $1800 of it.

Nobody wants to be reminded of the gloom and doom crap, and if we really did live in a world where people really did get to keep what they earn, where they used only what they paid for and only paid for what they use, then there might be a position to defend there. But the fact is, things might be fine right now, for you, but there's a lot more to it than that.

They used to make fun of the Left by saying, 'a Conservative is a Liberal who's ever been robbed.' Well, these days, a Liberal is a Conservative who's ever been sick. Or had an accident they couldn't sue somebody over. Or lost a job and been unable to find another one. Or had to work way below their training level. I sincerely hope you don't have to understand any of this first-hand, but it really does happen, and it happens a lot more than it used to. It just happens to, you know, OTHER people.

Conservatives like to talk about the politics of self-sufficiency. I got mine; you go earn yours. Which, again, WOULD be fine... if everyone who could earn a living actually had a shot at a job someplace near their skill level. If getting sick or getting hit by a car wasn't an instant ticket to financial ruin. If the arena where talent and hard work are all you need wasn't so damned hard to get into in the first place.

If random bad luck ever tosses you on the scrap heap, with the teenage moms and the homeless vets, the people who get sicker because prescriptions cost more than rent and the families declaring bankruptcy without being able to shake the credit card companies, I guess you can keep on espousing that message of "just one more day, one more lottery ticket, and I'll be back on top." You can keep on voting like people who have enough money they don't need anyone else's help... but it won't ever help you become one of them.

what the-- ?

How are y'all finding this place, anyhow? This blog barely exists. Never mind; I know how. Clicking on my little name on some other Blogger board. I even know which ones: I finally registered with Blogger so as not to have to leave "anonymous" posts at Velcrometer and NewPatriot. (I'm so new here that I can't even make those into links yet. )

So I guess my question is, gosh, why? There's nothing here yet.

I hypothesize that the advent of the Blogosphere was inevitable, because people are naturally social. And as my grandfather and Trash from Velcrometer make abundantly clear, some people can literally start (or induce others to start) a conversation anywhere, anytime. About anything.

Discuss.

(not that I have to say it)

a note about the ER

From time to time, I will talk about what I saw and did while working a shift in the Emergency Department. I wanted to say a couple things about how I do that. The following applies in perpetuity, since it's my standard practice in person, out loud, in text, in public and in private.

1) Patient confidentiality is so important that it actually trumps a good story. There will be things I just plain can't write about. When this is the case, I'll talk about something else that's approximately (...and this is a goal, not a promise...) 75% as entertaining. That's my pledge of quality to you, the reader.

1a) There will be no real patient names used. If a patient's name is so cool I have to talk about it, I'll make up a name that's 75% as funny or interesting, in a germane and similar way. A patient named Blender DuPree might be changed to SaladShooter Delacroix, or maybe I'll save that analagous name for some other story. Remains to be seen. (Okay, suddenly I need to go write a hard-boiled mystery novel set in a Baton Rouge Appliance Mart.) Any name you see in a story is so totally fake. Don't worry about who's who. And anyway, I change identifying details all the time, unless they're vitally important to the story and keeping them specific and correct doesn't identify the patient.

2) I tend not to talk about exactly where I work. I don't like to name people, buildings, streets, or areas of the hospital that might have catchy names. Not that it's a big secret, but I am by no means a representative of the hospital in any real sense (unless of course you're a patient; if that's the case, then I'm the human face of the organization, I'm an ambassador, and because I want for you to understand how much we appreciate and value you, I'd like to know is there anything else I can do to help you today?).

And frankly, I don't ever want to have to have a conversation with a lawyer about something I once said on the Internet. That would be a really nonsensical way to mess up my career before it ever starts. Telling a story (or even arguing) years from now, about a decision I made as a resident, which I thought was right and best for a patient in my care? Well heck, that's compelling drama. Not being able to do residency at all because I alienated, mis-quoted, or accidentally annoyed someone would be crushingly stupid. And avoidable.

3) After all the above, believe me: it can still be funny. And close observers (or people who know me outside of here) will be able to piece together the not-too-subtle clues. I'm not relying on a cloud of secrecy. But I'm not speaking in any capacity other than my own personal view. That's bigger than one job at one hospital (since I plan to have many of them, in many places). At the same time, it's much much smaller, and more specific.

Capisce? Okay, then.