Letters From a Young Doctor

We found this sweet dog on Sunday. She only had a rabies tag and it was from a vet clinic in Missouri(!). They are working on searching through the records but are taking their sweet time. Can y'all put the word out? Seems crazy but if a Missouri dog can end up in Texas, who knows where her people really are? She was found near Fincher and Belknap street. We were on the way to pho. We never did get that pho...



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Me? I'm okay. Been really busy at work. I'm on, like a thousand committees now because I decided to undertake my own version of health care reform. You know me, always doing it my own way: vigilante style.

I'm reorganizing my stuff-I know it never happens, but believe that it is happening now. In one of the strata that makes up my room, I came across a note that I wrote during my first internship. It was to my program coordinator. I wrote her to plead that she do something about the pest situation in the call room. I spent the night on call the night before being awoken not only by my pager, but also by ROACHES CRAWLING THROUGH MY HAIR. EWWWW.

It was hard enough pulling 36 hour shifts without having to worry also about creepy crawly shit eaters in my hair. But I guess I knew where I was on the food chain. My call room today is much nicer--almost like a hotel room. My students are amazed when they see it. they are often shoved into rooms with multiple bunk beds. It sounds like fun until someone else's beeper goes off while you are trying to sleep. Of course, I have a theory that the nicer it is, the rarer you get to see it. I haven't been able to see mine in quite some time...

It seems that H1N1 isn't as virulent and deadly as people initially posited. Thank goodness. Still, over 1000 people have hit the ER in the last three days with coughs and runny noses. They wanted to be checked out "just in case". Of the 600+ flu tests that were done, NONE were positive. My ER doctor friend looks very tired.

I'm glad that is wasn't as bad as people thought and I'm still wondering why such a hullabaloo was made in the first place? Did I miss something? Perhaps I'm too jaded and cold blooded from seeing far worse on a daily basis. I don't know.

I'm just glad it'll be over soon and the kids are going back to school. Still, I think I pulled a hang nail. Perhaps I should be tested too...better not, as I might be positive and won't be able to see NIN with M, pixielily0323 and superrice. Now THAT would be a tragedy!

I'm stuck on jury duty today. My case assignment isn't until one, so I'm wandering aimlessly around downtown until then. I tried visiting the library as I had spent so muah of my childhood there, roaming the stacks.

Unfortunately, they rebuilt it in an expansion move. Instead of preserving the architecture, which was a forward looking and modern underground facility, they chose this garish neoretro pseudoclassical affair with fake columns. It's so gauche I can't stand it. You really can't go home again.

So I'm back to wandering, waiting and hoping that this case, if I'm selected for the final cut isn't protracted. At least it gets me out of call this evening. Hope it doesn't extend to my days off next week. That would just be perfect.

The best part of being an adult is being able to eat a fried chocolate pie for breakfast whilst listening to Nine Inch Nails full blast. It's the best. The best!

So far there aren't any confirmed cases of Influenza A H1N1 S-OIC-just a handful of suspected cases. I hope it stays that way for my call tomorrow night.

I posted this from my phone so there.

this swine flu thing is getting totally out of hand. the school system in this area decided to shut down through may 11th. wtf.

people, let's get this straight. swine flu (H1N1) is just a fucking flu virus. true, we usually do not contract this particular strain, but it's the flu all the same.

there are less than 100 confirmed cases (91 so far) in the ENTIRE UNITED STATES OF AMERICA. there has only been one death thus far. more people get chlamydia. more people get HIV. every day.

please, please, please do not flood the er or clinics with every little cough and sneeze. practice good hand washing and general hygiene. don't bother with the surgical masks, it'll make you look silly. or japanese.

eat a bowl of rice then, wash the bowl. it will be okay.

Going to Philadelphia tomorrow. Plan on spendin' the week getting my learn on at the ACP conference.

What should I do while I'm there besides eat cheesesteaks and no get mugged? I have no idea.

I have never been to Pennsylvania so much in my life, since I lived in Hershey.

Texas Lawmaker suggests Asians change their names to make it easier for Americans to deal with.  so okay, i've transliterated my name before, it's true.  i did it because i wanted to get on about the business of communication, instead of wasting time explaining the nuances of vietnamese phonetics.  the mind wobbles.  she should be getting on about the business of familiarizing herself with the new face of her constituency, the new face of america.

also, i once had a teacher try to tell me that i spelled my name wrong.  i didn't care for that, either.  come to think of it, her last name was brown too...

so my aunt took a road trip to houston to meet the guru. the long and the short of it, he promised that he could cure her without surgery. this of course feeds into her baseline desire of not wanting surgery in general.

this whole situation has the family in an uproar and i'm in a quandary as to what to do. they (her brothers and sisters) want me to "do something about her", like i have any pull. besides, she is an adult and is competent. her fierce resistance speaks to the anti-paternalist in me to let her do what she wants.

still, i'm not quite ready to be an orphan. this unwillingness to do surgery also flies in the face of her past wishes "to do everything possible" to treat a person. i suppose "everything possible" is whatever she arbitrarily decides? i don't know.

what to do?

what to do?

I get to spend it making rounds and taking my stubborn mom to her surgeon. Woo Hoo.

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edit: it's not officially unitl 30 march, but there was a luncheon and such today, and i got over excited. mmm luncheon and stuff...

Mom has another round of imaging and perhaps a biopsy today. Really, this is a stalling action for the definitive action: surgery. This was the best compromise that I and her surgeons could come up with to bring her back to the table.

She still doesn't want surgery, and told my brother as such today. He didn't take it well and blew up with her on the phone. Not the best of moves, but he's always been a bit of a hot head.

It's worse than I thought, her recalcitrance. Instead of a "couple of months," she wants to do the herbals for six months(!). Whatever this guru of hers is telling her, it is really playing into her fear/avoidance. I think a face to face with him is overdue.

I'm not quite at my wit's end but close. I've been using my position to the best of my abilities to maneuver behind the scenes to get things done that she refuses to do (such as pick up her XRAYS). It has been quite distracting since I have my own patients to care for. I can't take too much time off as we're short handed already and I believe now that I have to save my days to look after her later.

I can't do this alone anymore. I need help, but I don't know how to ask for it without sending huge shock waves throughout the family (I don't she's told any of her siblings). I will tell them but I hope that they surprise and panic dies quickly so that we can get to it...

The preliminary results are in. I say preliminary because very few LJ'ers bothered to answer, but here are the results anyway:

Of the medical types (physicians, students, physical therapists and the like), an overwhelming majority said not only "yes", but "HELL YES". This is like 10:2 in favor. Reasons cited range from "time is of the essence" to "it makes it quicker and to the point when they're on the pot." One practitioner even cited the training he received in the art of "The Toilet Interview" from a mentor. The two who answered "no" are still young in their careers and I wonder if they won't change their minds in a few years as they progress in their training.

On the patient side, it's a mixed bag. Of the four who answered, the universal initial answer was "no". However, there were a few caveats, those namely being "if I can't see the doctor any other time" or "I was too tired to care" and "if I'm in the bathroom, yes, but if pottying in the bed, then NO."

I find it quite interesting, this divide. On the one side, the practitioners are eager to forgo the usual social norm of private potty time, in the interest of time efficiency and perhaps because they're desensitized to it. On the other, patients--especially ones without chronic diseases--tend to hold their potty privacy time dear.

This question was directed towards the hospital setting. I wonder what the results would be in the office setting. I bet they would be different, except for perhaps in the case of Urology or Proctology clinics!

Patient doctor interaction/conversations while the patient is on the pot: yes or no?

Please register your opinion in the comments. The results will be tallied in a future entry. I already have a fair number of the medical community I know weighing in. Now I want your opinion.

In other news, I seem to be bracketing a small, yet very important chapter in many people's lives as of late. I am uneasy about this due to recent, personal events.

I know when death's a comin', it is a common theme in this journal. I don't, however, speak of life much. It happens, from time to time, as you well know.

I saw this lady the other day who was found in a pool of her own vomit. Two hospitals and a helicopter ride later, she was diagnosed with a massive head bleed. The usual things were done and the prognosis grim. She was good and had an advance directive in place, stating no artificial life support and feeding tubes and such.

We extubated her off the ventilator and she breathed. The other day, she managed to yank her feeding tube out* and she now tolerates spoon feedings. She is non-verbal but it almost looks like she wants to say something.

I spoke to the family and despite earlier plans palliative care, it looked like she would live longer than expected--indefinitely, really. Now we are looking into placement and perhaps even therapy, but I'm cautious.

I'm not sure where she'll go from here, but I've said it over and over again: if it's not your time, it's not your time. Color me fatalistic but you will live until your turn comes. I do.

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* i am constantly amazed how comatose/near comatose patients can perform such feats, but it happens.

The awards went as expected last night: someone else got it.  More importantly, that particular doc parks on the other side of the hospital, in the another parking garage.  YES.  My precious slab of concrete is once more free from the clutches of its current master.

It's mine, well almost.  The slot is up for grabs for the first one to arrive and claim it each day.  Ah the free market, it can be your friend or enemy but at least it's a level playing field.  I wouldn't have it any other way.

i'm going to my hospital's holiday party tonight.  the food is fair, but there's an open bar and really, that's all that matters.  even more important than that, they'll announce the physician of the year tonight too.  the winner receives their choice of parking spots for a year.  i could care less about winning but i want my parking spot back. 

last year's winner took the spot that i and others fought for every day.  it's closest to the door and has a wall on two sides, so only exposing one side to door dings and the elements.  for a year we've circled and waited patiently.  tonight we all have chance to compete for the prize once more.  i meet with destiny and win, lose or draw, i'm gonna get my spot back!

I'm on my way again to the American College of Osteopathic Internists meeting.  It's the right day and everything.  Hopefully, they'll have some exciting breakthroughs and I can get my learn on.

No one I know is attending this year, but I wonder if I'll be pleasantly surprised.  It would be nice and I could do some recruiting too.  If you're interested in doing hospitalist work, hit me up here or at the convention.  Hmmm, I think that I better swing by the office to load up on business cards...

I'm not sure what my internet connection will be like and will be mostly on Twitter, if you're interested in the happenings at seminar.

I'm a big sky, grandiose concept kind of guy. I revel at taking in the big picture. Minute details? They are necessary I suppose, but I oft get lost in that forest. Although I'm obsessive, I'm not entirely compulsive and my eyes glaze over, if there's too much minutia. This is why I'm not a pathologist.

I've always said that I need a personal assistant. Today, I proved it: the convention that I thought was beginning tomorrow won't until Thursday. My flight is today and I'm not supposed to check into the hotel until...tomorrow. D'oh. Good thing the company is paying for (most of) this as I'd be just a wee bit pissed about paying for the flight change. I'm still not happy about spending more dough on something I don't even want but at least it worked out for the best.

So, I think it's best I get someone to else to handle the details. After years of trying diaries, PDA's and other organizing tricks, I think that I need a more human solution. I hate giving up control but I think it's for the best...

We spend our lives scheming, organizing and seeking order. Great amounts of energy are spent on these pursuits, some knowing that the efforts are moot.

Really, it is not the way of the universe; entropy rules here. Chaos, disorder is the true way. Everything seeks its lowest level of energy, the laws of thermodynamics dictate this. Thus, plans are meant to unravel, arrangements disrupted and bonds broken.

It has been a tumultuous few weeks. Life, my life has entered a phase of upheaval. Life as I've known it is turning on its ear. Tomorrow, the dissolution continues. Tomorrow, I lose my mom as she has decided to renounce the world and become a (Buddhist) nun. She'll assume a different title and I can't call her "mom" anymore.

I know this has been a long time coming. I know it's what she wants. I know we disagree on most turns. I know she'll still be my mom, but still...

Well, it was a disaster as I thought. No one listened to me until it was too late. Oh well.

I'm prepared today: brought my laptop bag, iPod, headphones, PDA and condoms.*

It is a unique and rare opportunity to be able to follow my coworkers and seeing they way they work and their thought processes. They are so individualistic yet conservative, so rebellious yet protocol driven. It's fascinating, just fascinating.

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*it's more symbolic than anything else--protection in case we we're going to be fucked by the computers again. they're expired anyways. /sad/

the last several weeks have been a whirlwind of change. both personal and professional final common pathways have come or will come online soon. i am entering the end-game of many scenarios begun many many moons ago. it is both exciting and stressful at once.

today, i embark upon another adventure at work: it is the first official day of our new electronic health record. they say in medicine, never be the first nor the last to do something. i see the wisdom in this tidbit of knowledge now: as the first to be fully versed in this system for my group, i've been pressed into service as a point of impact contact for any problems. only thing is, it's my one weekend off i get every month. good thing they offered money because i have a feeling i'll be earning it...

i haven't been around lately, but have been trying to keep up. what's new with you?