I had the day off today, but was several weeks behind in preparing a presentation for Grand Rounds, which is taken quite seriously here.  I used up the best part of the day in the resident’s room at the hospital getting it done.

Afterwards, having had the foresight to bring my camera, I went exploring around the recesses of the hospital and the campus grounds.

This was my favorite shot of the day.  It’s a label on a crane attached to the ceiling at the top of some stairs.  The stairs lead to a large metal door that opens onto one of many roofs.  I’ve been trying to figure out what the crane is for, but nothing makes sense.

I added some sharpening, luminance correction, neither of which I’m sure makes any difference, and the vignette.

The day is long but too short by a lifetime. 

You work ceaselessly but only accomplish the minimum of daily tasks.  Greater pursuits are shelved for later.  Long-term projects never get started.  Family time is the few minutes between dinner and bed.  You anxiously wait for a change, hopeful that this will not persist longer.

Victories are small unimportances: setting a date for Lasik, an offhand compliment from a supervisor, an delicious dinner from your wife. 

But, the end of the day leaves you feeling empty, tired and cold.

You tell yourself, tomorrow will be better, knowing it is a lie.  Tomorrow will leave you just as exhausted and delinquent as today.

Still, you are gorgeous, talented and humble.  That’s got to count for something.

***

Your interns are not doing well and you have yet to show adequate leadership.  They come to rounds without the basic data expected of them–vitals, labs, telemetry.  They seem to think being flustered and offering apologies is acceptable.  You fight your inner demon down who wants to tell them when I was an intern I came in at 4 in the morning, hand wrote my notes by 8am and attended an hour conference before rounds started at 9am and you can’t even get your vitals and labs written down by 9am when all it takes is printing out the “physicians progress note template” in a batch for our team list?  A whole 5 minutes of work?  Seriously?  You get three more hours of sleep EVERY DAY than I did and don’t even have to answer your pager at night.  And then you have the audacity to ask me to help with your notes?!

You wish you had the cojones to tell them how badly you think they are doing, but somehow are afraid they’ll break down and cry on you, quit the residency and/or suicide.  You can’t seem to find the right words to scare but encourage, to reprimand but give hope.  You actually look forward to them not being around so that you can work quickly and accurately with a modicum of refinement and skill.  You wrack your brain trying to remember if you were at all like this as an intern, but remember only the choking fear of failure driving you beyond reasonable expectations. 

Worst of all, you feel like a failure for not being able to make them better.  You have failed to inspire, failed to teach, failed to make them better. 

You may have fixed their mistakes behind their back and kept the patient’s safe, but you have failed to train them. 

The stench of failure is suffocating.

If you use flickr, get PicLens.

It’s free, so just get it and go to flickr.  Don’t ask questions.  Just go.

I got a business related email today with the following signature:

Dale Eisenheart BS, RT(R),CT,CV,MR

Not only is that way too many characters after a name, but I only know what one of them means. 

The signature was then followed by their job title, their department, their company, their building wing designation, their phone number (sans area code oddly enough) and their email.

It made me think of this article that stated that the more important you are the shorter your signature.

I’m not very important so I have my name and mobile number:

Nuclear

443-4993

Sometimes I throw in my full name/title if the recipient might not know it and it might be relevant (as in I get a reply email saying “only doctors can do that” or “your physician needs to email us that request directly”:

Nuclear

Nuclear Fire, MD

443-4993

As always:

What a crazy, busy, month it’s been!

We moved, finished another year of residency and survived the 500 year flood.

We didn’t have a lot of time last year to find a place to live.  Also, as Ikuko reminds me, we weren’t sure if we’d be living together so I had insisted on finding a place in IC with a rent of only $500 in case we’d be paying on a mortage too.  That left us living in the ghetto of IC with open drug dealing, shootings, no heat or AC, mold growing on all the walls, etc.  Ikuko would have booked soon after moving in, but being a tightwad and too lazy to move again, she suffered for a year.

But now we have a new apartment (I’m still too tired to buy another house) and it is fantastic.  Location is perfect as it is right across the street from our daycare and local coffee shop.  Parking is excellent with a covered garage, which we’re using for storage.  The appliances are all brand new and high quality from the fridge with built-in ice cube maker to the ceramic top stove to the in-apt washer and drying.  The AC and hot water work perfectly.  It’s clean.

This last month the Iowa River overflowed its banks drowning many cities in the area.  IC was only partially flooded (and we were completely spared) but many people lost their homes, a dozen university buildings were closed and at one point only one bridge across the river was open and was under threat of closure.  While many people suffered greatly (one resident had no flood insurance on their new home), we only had to endure detours and traffic jams.

Finally, we’re finishing another year of residency.  For me, this means moving onto my final year with only two months of call.  I will be losing a lot of elective time as the program is changing the curriculum and the seniors will have to suffer to help with the transition.  Still, one year left is quite a milestone.  Ikuko has finished her preliminary medicine year and will be moving on to her first year of pure neurology.  I expected her to be happy, but she seems more apprehensious about the amount of work she is expecting on her call nights.  She will have to cover all neurology consults at both hospitals, manage stroke codes, field outside calls for help and requesting transfers and generally attempt to survive.  Their program also lost an intern (and his replacement) so she’ll end up being on call every 4th night instead of every 5th for the year.

Time marches on, but it just keeps getting better.

It’s an eneffable quality of immense worth. 

At my intern program, whenever a patient started contacting lawyers or a case developed such that a lawsuit was not an unlikely possibility (an admittedly rare occurrence) the attendings would have the residents stop taking care of the patient and do all the work themselves.  In essence, they were protecting us from future litigation and showing that the buck stopped with them. 

Yesterday, I saw for the first time how my current program handles the situation.  After a complicatedly long procedure, a college student woke up from anesthesia with excruciating leg pain and lack of ability to move the leg.  The procedure was performed by an attending and the patient was supposed to be handled by the attending-directed service (no residents).  Instead, after finding out about the complication then placed the patient on the resident’s service.  When the family then contacted lawyers, they decided to transfer the patient to the ICU, without a medical reason, onto my resident service.  Rather than insulating residents from further lawsuit, they just dragged two sets of resident’s names onto the chart who had nothing to do with the original complication.

There are some cardiologists at the University of Iowa Hospital and Clinics who are seriously lacking in class.

As if today couldn’t get much worse (and I mean that in the totally blessed middle-class lifestyle way):

Hello Dr. ******,

Thank you for contacting Online Support.  Unfortunately, there are no plans at this time to produce the Kelley’s Textbook of Rheumatology in an eBook form that is compatible with the Kindle.  I would not be able to say whether or not this may be a decision in the future, but at this time there are not any plans to release it in that format.

We apologize for any inconvenience.

Please let us know if you have any other questions.

Thank you

When replying to this email, please include a copy of the original email.

Jeff Vordtriede
Online Technical Support
Elsevier
11830 Westline Industrial Drive
St. Louis, MO 63146
1-800-401-9962

“What is that?”

It’s a question I’ve been asked repeatedly of late. And also the biggest drawback of Amazon’s new ebook reader, the Kindle.

The Kindle is basically a really nice screen designed for reading text. Sounds boring, right? Pretty much.

Unless you happen to spend the vast majority of your time reading. Maybe you read a lot of books and articles for your job. Maybe you like to read a lot of magazines and newspapers. Maybe you like to read a lot of novels and history books. Maybe you do all of the above and don’t like the inconvenience of having so many books that it takes up half your house, you can never carry what you want with you, your eyes get screen fatigue by 5pm, etc. In that case, an e-ink ebook reader complete with an added 2 gig memory card is exactly what you want.

The screen is so gentle on the eyes you forget you’re reading from an electronic device. You can easily bookmark or highlight passages. You can switch between books at will with your place automatically saved and opened right back to the next time you select that reading. You can look up the definition of words inside the text using the built-in Oxford dictionary. You can carry your entire personal library with you all the time.

I’ve been putting a lot of medical material on it that I’ve gotten off the internet. I have access to several excellent resources like Uptodate and used to print out reams of paper for learning, reference and teaching. I now port it over to the Kindle so not only can I read it repeatedly without it getting all wrinkled and coffee stained, but I have it with me wherever I go. Journal articles are a little harder to port easily and in a readable format but really anything with text (and most pictures) is fair game.

There are other ebook readers out that, but one thing that Amazon added was a wireless radio, the same kind that is in my cellphone, and provided free access with it. It has a built-in portal to Amazon’s store whereby you can browse and buy your books anywhere Sprint has cellular service. You can also subscribe to newspapers (and magazines) and have them wirelessly delivered to your Kindle each morning. I tested out a free 14 day trial with the Wallstreet Journal and it worked amazingly. You can look up things on Wikipedia and even use the vast majority of the internet (text and basic pictures mostly).

The Kindle bestows +30 nerd points when equipped. e.g. Dr. V, my program director, future fellowship guru and at-that-time rotation attending kept telling me about this book The Tipping Point. So as we’re walking down the hall to see a patient, I took Akako (Amazon encourages you to name your device and given my fancy for Japanese females…) out of my white coat, downloaded it and started reading it before we even got to the patient’s room. Tech Nerd Five!

Overall, no matter how cool a device is, if it isn’t functional it isn’t worthwhile. At the end of the day, the Kindle has made my life much easier.

And why is that question a drawback? Because people only see Akako when I’m reading, which means I keep getting interrupted when studying.

Substory, my editor removed from the above: My whole family is full of avid readers. My brothers and I have whole walls covered with books. I owned over 200 books by the time I was 12. I used to get a kick out of people asking me “how many of those have you read” and seeing their bug-eyes at the reply “all of them, of course.”

My least favorite month this year–the cardiovascular intensive care unit. 

Actually, it’s hasn’t been that bad so far.  I’m learning much on a subject I was not very familiar with previously.  Unfortunately, it’s also one of those rotations that are so busy I have little time to read independently which is one of the integral aspects for concrete learning.

Rounds take forever–several hours for only a handful of patients.  The nurses, pharmacists and nutritionists don’t round with us, which is unusual for an ICU. 

The attending is intense, probably a vixen in her younger years and likely a little crazy.  Her empathy for her patients is unmistakable. 

The nurses are as bad as ever.  I thought a hospital with Magnet status would mean a hospital with excellent nurses.  Instead, I think it really means nurses are in enough positions of power so they are able to make sure they never have to do any work or take any responsibility for their mistakes.  Drugs go unadministered.  Orders are missed.  Patient’s complain that they are treated like unwelcome guests.  Weights and I/Os are not done or obviously wrong.

The patients are nicer than on average.  Most of them are living pretty shitty lives confined to wheelchairs due to their lungs and heart failing them.  Many will be dead in less than a year.  One decided to stop coming to the hospital and just be treated symptomatically by hospice.  She wanted a beer.  So I had the privilege of pouring her a cold one in a frosted mug in bed 9 of the CVICU.

I have never felt so bad on a good day as yesterday.

Our team got its ass handed to it on call the night before with quite a few admits and sick patients. I was already dragging hard when I left post-call, but instead of being able to crash into bed, I had to take my son to his three year checkup. I’m sure I must have looked psychotic continually contorting my face to keep my eyes open and myself awake. I felt that awful kinda crap feeling you do when you’ve been awake way too long, but with a child to watch over, all that takes a back seat to responsibility.

We got a cookie and milk then played on the playground awhile. Then we headed to the opposite side of the mall and rode the merry-go-round, first on a horse and then on a dragon. That was followed by some OJ for the little one and Moroccan Mint hot tea for me.

At home we made pasta for dinner and watched Harry Potter and the Sorcerer’s Stone before putting him to bed early so I could finally enjoy the restful sleep of the weary.