Separating the boys from the men...girls from the women....whatever

It's kind of funny. A whole year has gone by since I've started working in the hospital, but I'm not sure things have changed all that much. I'm still trying to figure out my role in the team and I'm still not sure what my patients should be doing aside from using a little breathing machine and getting out of bed.

As a med student in the hospital, you look around and it becomes really clear. There are students that are thriving, and then there are students who are just barely getting by. I'm in the latter category, and despite the encouragement from everyone around me, I definitely feel that way. I wonder what it is about other students that make them thrive, that makes them get out of bed in the morning.

blah...too lazy to blog

I'm just tired of playing the game. I've gotten surprisingly quite good at it. The world is a stage...

-bender

It is done...

Kind of a dramatic quote to borrow from. Anyhow, I finished my last day of my AI in urology on Friday. I worked hard, learned a lot and the staff and residents like me to boot. As an AI, I learned a lot more about what it's like once you're actually in the residency. You work late hours, you're gonna miss a lot of dinner that you "promised" you could make. There are times where you've been gone for so long that you don't really have much to talk to with your significant other aside from work. Long awkward silences that weren't there before. On the plus side, you're doing what you love, learning a lot and get to do cool procedures like cutting off necrotic penises and fixing ruptured bladders.

I think I've kind of seen both sides of urology. It's full of intense people. Our chairman wakes up at 4am every day to go bicycling, on top of all the other stuff that he does. Sometimes I wonder if I could keep up the lifestyles...after a month on, I slept 20 hours yesterday, those other 4 hours were spent eating or going/coming back from eating. It's really hard not seeing your family/friends. For surgical subspecialties, you can literally be on call every day of the month. That means no drinking and often times it means coming into the hospital at the middle of the night every day, especially in July, because some intern blew up the catheter balloon in the prostate and now the guy has hematuria. It's true what they say...don't do medicine if you don't love it. I can't see anything who does not love this surviving 6 years of this. Sometimes I wonder if I could survive it...oddly enough, I can't see my self doing anything else.


It's been an interesting month. I've seen people pushed to the edge and seen what happens when you're really tired and your patients aren't doing so hot. In med school, we talk about being "on." To be on, you need to be alert, read up on all the latest research/data and know your patient cold. In reality, you can't be on all the time. In fact, there are long stretches where you're not gonna be on. What one chooses to do on those days when you get yelled at and feel inadequate...that's what defines the type of doctor and person you will ultimately become. Will you throw in the towel and try to "wing" the patient's operation so that you can get 1 more hour of sleep? Will you make up that one lab value, however nominal it seems at the time, so that you can look good in front of your attending? Ultimately, it comes down to how much are you willing to sacrifice for patient care. There comes a time when you need to let a few labs go so that you can be sane, and other times you need to be hyper vigilant. I haven't made it to the point where I know the difference and I'd rather error on the safe side. Sadly, I've found myself falling asleep a lot...at home, during my study breaks and even while standing in the OR.

I don't understand how doctors can be arrogant. Every day I am reminded that there is so much that I don't know. Often times I'm left wondering if I'll ever get it all. Therein lies the beauty of a hyper-subspecialty. Know something cold. Unfortunately, there are so many more factors involved...what about the patient's health insurance, what about his diabetes, access? Do I care? I'd like to think that I do, but I'm finding that I need to be selective who I put myself out for or else patients will step all over me. Intern year is going to be a very interesting year.

Guys, if you talk to me later next year and find that I'm changing into a monster, please let me know. At least blog about it and refer to me as "that guy." It's hard to police yourself...

-bender

A fine line indeed

It's hard not to see things from your own point of view after you've been constantly drilled to approach things from a specific perspective...the relationship between doctors and patients is often a fine line between love and hate.

Perspective. So a guy came in this morning to the ER. His history.
40 something year old man with a 4 day history of right sided flank pain and nausea. He was seen in the ER 4 days ago when the pain began and was found to have a kidney stone. He was sent home with pain medications and an appointment was made for further workup in the outpatient setting. Anyhow, it appears this morning the pain was no longer controlled by his vicodin. He starts yelling at me saying he wants immediate treatment. We offered to place stents as a temporary measure to alleviate his symptoms. The OR is booked, so a definitive treatment cannot be offered at this time, but stents can be placed as a temporary measure until we book his case in the OR. He went off about how he works in the health industry and that I'm full of shit. He demanded definitive treatment and would not sign a consent for stent placement. I had 5 minutes until I had to meet up with my team for morning rounds. Sorry buddy. No stents for you.

Patient's perspective. He has had excruciating pain for the last few days. Every time he comes to the ER, he has to wait 6-9 hours until he is seen. Even then, nothing is done and he is sent home until his pain and nausea gets out of control and he has to return to the ER. The doctors don't care enough to stay a little later to fit his case in because they need to go off and play golf.

I talked him down, but I don't think I'm going to have time to do that later in my career. There are many patients to be seen, none who are more important than any other person. It all depends on how you look at things. Patients can be really annoying. A lot of them have psych issues and have personality disorders, which make them hard to treat and require lots of time to work with. Some are downright stupid and do things that get them back into the hospital...things that people within reason would not do. Each patient on your list means 15-20 minutes of less sleep each night. After a month of sleeping 3-4 hours every night, some times I wish these patients would just piss off. Some patients just never get better and are stuck in the hospital. It sucks for them and for us.

Obesity

Damn it Joe. You're making me fat. haha
NY Times Article

Health

Find Yourself Packing It on? Blame Friends

By GINA KOLATA

Published: July 26, 2007

Obesity can spread from person to person, much like a virus, researchers report.

-bender

The nature of good and evil

So it has been a really brutal month. I made a lot of stupid mistakes and most of the heat and yelling that I received was well deserved. In the beginning, I was worried about working with a gunner that lonecoyote and I had talked about. It turns out that he is actually a really nice guy, albeit socially awkward. I think most people are actually really nice if given the chance. This past week in particular was especially brutal. Due to scheduling problems and unforeseen accidents, we were pulling 4am-8+pm days across the board without any days off for the past month. Tensions ran high and there was a lot of anger going around. On Friday, I made a stupid suggestion and one of the residents exploded at me in the MICU. Gunner boy was the first one to come to my aid, put an arm on my shoulder and let me know that everything was ok. He stood up for me and as far as I'm concerned, he is ok in my books. I think he might have been difficult to work with on internal medicine because he wants to go into heme/onc and probably felt threatened. I'm not justifying his past, just giving credit where it's due regardless of past behavior. As tired as I am, I have no complaints. I love what I do, it's just the hours. I've seen the hours turn really nice people into monsters, but it has brought out some of the best of us on the same occasions. I know most of you guys aren't religious, but I attribute all that is good to my creator. There is a lot of shit going on in this world, but times like this I'm reminded that we are all created good on the inside.

-bender

photos

So I guess it's official. I finally got a digital camera. A few years back when I was an idealistic SLR camera carrying wanna-be-artist, I swore I'd never join the digital bandwagon. Anyhow, I'm starting to play around with color and lack thereof.


-bender

Death by Vagina

Today was one of the most surreal days I've ever had in my life. I had to tell a guy we were going to cut off his penis. It was funny, but not really.

It started out about 3 weeks ago in clinic. A guy came in with a penile infection that had been raging for the past 6 months. Most people would've gone to have this checked out earlier. It was beefy red, swollen and just oozing pus out of his urethra and a couple of other pus pockets. The whole time, he was eating peanut M&M's. One of the residents actually took a few steps back and leaned against the wall when he took a look at it. Yea, it was that bad. Anyhow, we ended up giving him antibiotics and sending him home. About a week ago, the guy came back to clinic with pus oozing out of his penis again. We drained his corpora cavernosa, only to find it pus filled. We sent the cells in for cytology and this afternoon, the reading came back as squamous cell cancer of the penis.

Fast forward to later in the day. One of the 4th years and I went to go tell this guy that he had penile cancer. The guy fumbled around with peanut M&M's wrapper for a while. The shits and dammits were later followed by the quote of the day, "I never thought my dick would do me in." We just had to laugh at that. I mean, come on...anyhow, we're gonna cut off his penis. He had palpable inguinal lymph nodes...might be infection...might be cancer. Got chills writing the order to check his serum calcium levels.

Here's the kicker. It turns out, the guy's wife's former husband passed away from penile metastatic cancer after the docs had cut off his dick. What are the odds of that. Penile cancer is even more rare than breast cancer in men. Anyhow, our guy is having his penis cut off next week. Let that be a warning to all you straight men and lesbians out there. The vagina can kill you, literally and figuratively.

-bender is out like greg oden

Lame Ass Stu's Wedding pics...

The lovely couple

Me and the puto


The Wedding reception


Take care my friend...

-bender

DIY

It's funny how your pet peeves change as you get older.

1) Now I understand why people like to live in secluded houses when they get older. To all the do it yourself, fix everything with your own hands kind of guys. Seriously, more power to you. The caveat is, when I only get to sleep 2 hours a night, and DIY man decides to hammer and drill during that time. I fucking hate you. I really do.

2) False advertising. I just spent the last 20 minutes ironing my shirts for the week. Normally, it wouldn't bother me, but I made it a point to go out and buy several wrinkle-free shirts before my rotation, specifically so I wouldn't have to do this. Ross, you let me down.

-bender

Urology AI

So I'm halfway through my urology AI at my home institution. I've gotta say, I'm pretty freaking tired, but I'm having a good time. I'm finally getting used to the hours again after being on Psych for my last rotation. The bitch about surgery/medicine/etc is the transition period. There is a period of about 1-2 weeks where you need to get used to not sleeping/eating/shitting when you want to. Basically, during that time, you think about wanting to sleep for almost every second that you're awake. After you get through that and your body finally accepts that it's going to be tired and hungry all the time, things start getting interesting again.

Yesterday I saw my first real code. A 20 year old cholo looking kid was in the passenger's seat when his car got T-boned on the passenger's side. The kid didn't look too hot when he rolled into the ER. Urology was called because his pelvic bone was fractured and it had ruptured his bladder. This guy was bleeding out 5 liters of blood roughly every 10 minutes. The trauma team threw fluids and blood at him as they worked to figure out where the bleeding was come from. Once the trauma team thought they had him stabilized, urology stepped in to stitch up the bladder temporarily so that the other teams could finish stabilizing him.

It really was like a scrubs moment. The chief resident, 2nd year resident and I were chilling in the recovery room eating cheez-its when the kid crashed on us mid-snack. It was the kind of thing you see on TV. Chest compressions, mad fluids and the grand finale of us ripping open his chest, only to find that he had no blood in his heart and aorta. Flat line. Time of death, 16:15. Some of the nurses were crying. Others chose to tell jokes. Whatever it takes to get through the day. We all wanted to get the fuck out of there. The whole day, all we could think of was this kid who coded on us. There really was no time to decompress. We had to put on our smiles, tell our other patients how well they were doing, discharge other patients, hunt down nurses to get tests ordered and call up family members of our other patients to keep track of how they were doing. We all walked away feeling a little numb that day.

Rest in peace John Doe.

-bender

clipping fingernails

So Bender, I have a major announcement...

I love the cock...

Hehe, just kidding... but uh, on the serious side. I'm moving to Seattle in september, transferring to the AI there and saving about 40 grand for a better program that actually will give me more baking experience and a better business plan prep work.Also I will be able to purchase a home for it's appropriate price and not 300-400K more than it's not worth. I won't deal with asshole immigrants(wetbacks) and people actually talk to you when you say hello to strangers on the bus. You know what I'm talking about, you got out of LA, and now... so am I.

You are welcome to come visit anytime you want, and we'll always have a room for you whenever you need it. Even if you want to bum it there for a year, you are more than welcome to. Just don't eat all my sunflower seeds and drink all my coke and we're golden.

Their are lots of reasons for the move... if you get some spare time, give me a ring and we can discuss it if you want to, if not, that's cool.

I'll still be down here when you come down to do your USC rotation, so we'll hang out if you can fit it in your schedule.

joe out

MJ

Truehoop is one of my favorite basketball blogs that recently went live on ESPN.

Here an excerpt from a great recent entry.

Michael Jordan: Still Not Piping Up

July 3, 2007 2:53 PM

On ESPN's Page 2, LZ Granderson tackles a favorite conundrum of sports -- when is Michael Jordan going to put his celebrity to work for a cause beyond making money?

Granderson quotes the mayor of Newark, Cory Booker:

"I cannot discount the inspirational power of just seeing Michael Jordan or Tiger Woods achieve athletic greatness and the positive effect it has on the black community. But while it's true we live in a free democracy, we have to understand this democracy was born out of incredible self-sacrifice. It wasn't even a generation ago that you saw the extreme sacrifices made by people whose names we don't even know. Now we're in a state of crisis, and black athletes can help change that. The call is out there, but I can't be frustrated by those who don't answer the call."

But I can.

In 2005, we cheered Kanye West for saying George Bush didn't care about black people after he bungled Katrina relief efforts. Yet less than two years later we're wondering whether New Orleans is going to have enough police to contain all the violence and ghettofabulousness for next year's NBA All-Star Game. With disconnects like that, who needs the KKK? We're eliminating ourselves from the equation, and it seems as if our elite are too busy to care. I now understand what Marvin Gaye meant when he said "It makes me wanna holler and throw up both my hands."

I wonder if Jordan is ready to holler yet.

And if so, why can't we hear him?

-bender

Happy 4th!

Happy 4th of July. The further along I get along in my education, the more and more this comic resonates with me.

-bender

Personal Statement

So I'm having a bitch of a time getting my personal statement done. There are only so many academic ways of stating that I want to be a pee doctor. Anyhow, in truth, there is nothing quite as superficial, but glaringly revealing as a personal statement. I was talking to a resident in psych the other week and she said for their graduation speech, Dr. Servis basically took a compilation of people's personal statements and read bits and pieces to the audience. Then he stated, these are the reasons why we came into medicine...hold onto these reasons as you go out into the world to practice medicine. A little sappy, but poignant nonetheless. Anyhow, I was looking over my personal statement for medical school and thought it'd be fun to read y'alls' personal statements if willing. I don't want to post on an open forum because there are some shady ass people out there, but let me know if that's something anyone might be interested in.

-bender

Embracing my inner kid

I start my AI tomorrow for Urology. In short, that means that for 28 days I will be busting and kissing ass. I'm nervous, but I think it's gonna go well. So far, the resident and faculty like me. I'm not a great medical student, but I'll try my best and see how it goes.

On a sidenote, things have changed in my application. UC Davis traditionally takes one of its own. I thought I had a decent chance of matching here, but I heard from the staff one of the new students who joined my class will be doing the urology rotation with me. I'm a little concerned in that he didn't strike me as the nicest guy. From my one conversation with him, he basically told me nothing about himself and grilled me on my research and why I liked urology. It turns out he did a PhD in the chair of urology's lab. His application is definitely in another league and that's fine. I only hope that he isn't a competitive jerk. I'd love to get through the month with him, sharing the load and making each other look good in front of the staff. I'll openly admit that he is a shoo-in candidate for the program and that he doesn't need to feel threatened by me...gunners make me nervous.

On to more pleasant things. Some bastard stole the tires and rims off of my bike. If I had caught him in the act, I would have beaten him down...I like my bikes. Anyhow, hopefully he is using it to deliver papers in the morning to help pay for his sick mother with cancer or something like that. Anyhow, I needed to get a replacement bike, so I went out and bought a kid's BMX bike. I barely fit on the bike and the most I can extend my knees is 90 degrees. Either way, I'm pretty happy. The GT performer was a childhood dream bike...this thing looks pretty similar and I feel like I'm living out a childhood fantasy, despite how ridiculous I look on this bike outfitted for people who are 4 feet tall.

In terms of other pleasant surprises, I've been in the market for a propane grill. While walking Rabbit's dog, I found a pretty nice grill that had been left out for abandon by someone who had moved out. I'm pretty excited to get my grill on after I finish my AI.

-bender