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?
Friday, August 22, 2008
For the Record
Every time Teslagrl gets a text message now, I have to ask if it's Sen. Obama. That right there is some pretty great politicking.
I think it would be cool if he takes the stage tomorrow in Springfield, and says "hang on a minute, I just have to send a quick text" before starting his speech.
I think it would be cool if he takes the stage tomorrow in Springfield, and says "hang on a minute, I just have to send a quick text" before starting his speech.
Wednesday, July 30, 2008
SOS
I'll have more to say about it later, but I saw Mamma Mia, it was partly-to-mostly awful, and I can't wait to talk all about why. A few key points:
1) Watching people act as though they are having fun is not the same thing as having fun. (I have a similar opinion, this one more controversial, about The Blair Witch, as regards things that are frightening.) Watching people screech like 9-year-olds and stomp around like giant city-wrecking monsters on Ecstasy is not the same as being a witness to ecstasy.
2) Salon.com's Stephanie Zacharek is spot on: James Bond can't exactly sing, but as an actor he GOES FOR IT, and god bless 'im for it.
3) Speaking of effective expressions from the UK, to review this movie in five words or less I found I had to go beyond American English and use British English, which in general is far better for the occasional verbal sniper-shot. It's not that the film was poorly made (which it was), or that it was not fun (which it wasn't, really, and certainly not as much as it thought it was). It's that, all in all, this movie is just utterly pants.
From http://www.peevish.co.uk/slang/p.htm:
Pants(!) Noun/Adj. Nonsense, rubbish, bad. From the standard British English of pants, meaning underwear; also a variation on 'knickers'. E.g."The first half was pants but I stayed until the end and it was actually a great film." [1990s]
Exclam. An exclamation of annoyance or frustration. From the noun, (above).
1) Watching people act as though they are having fun is not the same thing as having fun. (I have a similar opinion, this one more controversial, about The Blair Witch, as regards things that are frightening.) Watching people screech like 9-year-olds and stomp around like giant city-wrecking monsters on Ecstasy is not the same as being a witness to ecstasy.
2) Salon.com's Stephanie Zacharek is spot on: James Bond can't exactly sing, but as an actor he GOES FOR IT, and god bless 'im for it.
3) Speaking of effective expressions from the UK, to review this movie in five words or less I found I had to go beyond American English and use British English, which in general is far better for the occasional verbal sniper-shot. It's not that the film was poorly made (which it was), or that it was not fun (which it wasn't, really, and certainly not as much as it thought it was). It's that, all in all, this movie is just utterly pants.
From http://www.peevish.co.uk/slang/p.htm:
Pants(!) Noun/Adj. Nonsense, rubbish, bad. From the standard British English of pants, meaning underwear; also a variation on 'knickers'. E.g."The first half was pants but I stayed until the end and it was actually a great film." [1990s]
Exclam. An exclamation of annoyance or frustration. From the noun, (above).
Friday, July 25, 2008
Blogopenia
CC: "My blog sucks because I never update it."
HPI: 38yo WM with 3+yr hx of intermittent blog activity, ranging from thoughtful to snarky to extreme cheese-sandwichy. Last post about one month ago.
FHx: non-contributory.
SHx: ETOH 3-5/ wk, no cigarettes, no recreational drugs. Positive for PS2 with recent additions of Nintendo Wii (~2mos) and XBox 360 (~1wk). Works as scut-monkey scum, currently with urban Peds clinic, between 40-60h/wk.
PE: Lethargic subject in mildly poor physical condition, but in no acute distress. Personal hygiene WNL, but positive 1990s signs to some clothing. Cell phone, shoes, messenger bag, and PDA adequately cool.
A: Mild to moderate blog-malnourishment, secondary to lack of free time. Reduced motivation is a parallel problem worth noting.
P: Watchful waiting. Recommend shorter, more frequent posts. Hold off on initiation of Twitter or similar modalities until the situation is more critical. Short-range goal should be one post per week. Re-assess in six to eight weeks.
HPI: 38yo WM with 3+yr hx of intermittent blog activity, ranging from thoughtful to snarky to extreme cheese-sandwichy. Last post about one month ago.
FHx: non-contributory.
SHx: ETOH 3-5/ wk, no cigarettes, no recreational drugs. Positive for PS2 with recent additions of Nintendo Wii (~2mos) and XBox 360 (~1wk). Works as scut-monkey scum, currently with urban Peds clinic, between 40-60h/wk.
PE: Lethargic subject in mildly poor physical condition, but in no acute distress. Personal hygiene WNL, but positive 1990s signs to some clothing. Cell phone, shoes, messenger bag, and PDA adequately cool.
A: Mild to moderate blog-malnourishment, secondary to lack of free time. Reduced motivation is a parallel problem worth noting.
P: Watchful waiting. Recommend shorter, more frequent posts. Hold off on initiation of Twitter or similar modalities until the situation is more critical. Short-range goal should be one post per week. Re-assess in six to eight weeks.
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