Inspired By A True Story

Checklists and then some

There've been some omissions on my part. Sue me! 

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Was that you or me?

I've been mulling over whether I should write about this for the past few weeks, simply because it doesn't show my clinical skills in the best light. Some may even say I need to go back to first year and work out my problems.

Since the blog is somewhat anonymous, I thought I'd share anyway. 

So, I've been told I have a nice high volume pulse, and I'm a thin guy. It just so happens there're times during ABGs when I need to concentrate real hard to avoid picking up on my own pulse in my fingertips. So, a couple of weeks ago, I had a couple of polytrauma patients who weren't doing so well. They required daily blood tests, so it had become a routine for me to get blood via the femoral vessels; God forbid I try to extract it from the central lines and mess up the Dopa-drips.

Was just another morning, me with my needle and syringe, hunting for a femoral pulse that I knew is usually feeble seeing how critical the patient is. I was just about to prick him, when an anesthesiologist asked what I was doing. "I need to run some tests". "He's gone. Didn't you know?". I was just left standing there, wondering what needed to be done next; a little befuddled and upset at thinking I'd found the patient's pulse. And when all the thoughts of my stupidity had ceased, the flatline pulse oxymeter, the ominously still functioning ventilator made me feel sorry for the man who'd just passed. 

My obsession with "Anal People"

Worry not, this isn't a rant about how I like to deal with difficult people, I don't! It just hit me yesterday when I was going through my posts from August, that I've been using this label for my posts a lot. So, what's changed?

Have I just become unluckier with my colleagues? Am I an "Anal People" magnet? Do Aliens really exist? Have I grown spiteful & vengeful with time? Who killed Michael Jackson? Is internship turning me miserable?

The answers to these and many more questions will be coming up in future posts. For now, at least, I hope to write a few cheerful posts, get back to those notes I took during surgery & give those ideas some life & of course get back to cartooning. I can't believe I gave up on that mid-way. Maybe it's because I only happen to know how to work Paint on my computer. Photoshop is like a Whipple's to me; I'm eager to try it but don't know shit about it! 

Someone come forward and help poor SS out.

& sorry, but this post will also have to be labelled with... You guessed it!

The Dilution Disparity

So, I've been working under the most difficult head, once again! Is it just me, or am I really turning into a bad superiors magnet? Remember what happened in Pediatrics? Tsk Tsk, a recap: here, here & here. Thinking back about it, those losers inspired my best work. Thank you fuckers, sincerely thanks.

So, there was this one particular day on-call, didn't get a wink of sleep, finished off everyone else's work because people were too busy in surgery or were out sick, skipped breakfast for rounds & am then abused by the head about how this one nonsensical clerical job, that wasn't mine to begin with, wasn't done & that he'd told me the previous morning! 

*Blink *Blink.. Did I hear that right? Am I asleep? Did he really shoot down all that I had managed to do over the past thirty hours because of that?!? This wasn't the end of it, "Things usually get done NO thanks to YOU. When I say something, I expect them to be taken care of before I happen to ask. If you can't even manage such a thing, someone ought to remove you from the hospital!" 

I can't even describe how I felt at that point. It was a sad mixture of desperation, irritation, PMS, aggression & surrender. I had my senior resident gesturing vociferously behind the head's back for me to not say anything further. And not surprisingly, I'm handed another piece of work, that isn't mine to start off with, isn't in any way related to surgery, or medicine, or the hospital! Somehow I manage to get this piece of crap outta my way, only to be shown false concern by the asshole. How selfish can you get?!? 

Spoke to my resident about how crappy all this made made me feel. He could only introduce me to what he calls "The Trickle-Down Effect". Apparently, since an intern is at the bottom of the medical pyramid, all the crap, bullshit, nonsense that anyone generates above him trickles down to him eventually. Sadly, there's noone below him/her to vent out this frustration. Thank fucking god I have a blog!

So, here's my corollary to the Trickle-Down Effect: The Dilution Disparity

No matter how much an intern works, the efforts and accomplishments get progressively diluted until the news reaches the top of the pyramid; so much so, that eventually the head just acknowledges the presence of this sad soul!

What was his name again?

I'm this close (holding index finger and thumb 0.5mm apart) to calling up my nerdy engineering friends & having them calculate the probability of what I'm about to say. My surgical unit has the worst luck with patients, they all have the same freaking names! I mean all of them. You may wonder what difference that may make to me, but it really does. Leads to a bucket load of problems with their paperwork & guess who gets blamed. 

There were two ABCs when I joined and this last night on-call, another one joined in. The worst part, I had no idea about their diagnoses, so I had no idea whose files I kept looking at. Next thing I know, I happen to wander into the female ward & there're two PQRs there too. Haven't ever been so relieved to see someone's discharge card being filled; one less confusion to deal with. 

But this next one just had to take the cake. We have two guys with severe head injuries currently on ventilators in the ICU on adjacent beds. Both were brought in by the police, without any relatives, so were labelled "Unknown" until someone came forth to claim them. Thankfully, a couple of days in, Unknown #1's family showed up and changed his name in the papers to XYZ. And considering the ongoing trend in my unit, not surprisingly, Unknown #2's name also turns out to be XYZ!! 

So, back to square one. "Excuse me, which head injury was this one again?"

Sister or Sistah ?!?

Dear Nurse,

I hope this letter of mine reaches you in the best of health and happiness as the same deserts me here. You may have seen me around the hospital. I'm the friendly guy with the friendly face, with friendly words. I'm usually too harrowed to worry about the blood on my hands, running from pillar to post to get work done on time. I'm also the one who asks with a smile and ends with a "Thanks". Remember me now?

I've worked in this place (and others) for long enough to get a vague understanding of where everyone stands and how things work; everything except for the nurses. You go from being kind and gentle to fire-breathing dragons within seconds. I have to listen to long lectures at the end of which I have no idea what the mistake was. I've been told I speak disrespectfully by people who should be shown the "NO HONKING" signs outside hospitals. I mean, if you had to PMS so often, why join medicine at all? And while I'm at it, I need you to know, I don't run a private practice of my own. Those syringes, needles, blood bulbs, catheters in my pocket aren't brought back home. Neither do I sell them in the black market. I carry crap around in my coat because it saves me time and effort. By far the heaviest thing I've been lugging around is this rude nurse who follows me wherever in the ward, making sure I don't pocket anything that's the hospital's property. I never knew I needed a security guard. Can you please look into what this nice nurse does other than stalk me? 

I know I'm a hindrance to your work, maybe I come in your way at times. But, honestly I don't think I can be that irritating! If I ask for help, it's because I need it and you happened to be around. What about all the times that I helped out and taught those nursing trainees? And what about when you come to me in the clinics asking what this drug does and which resident is good to consult? Let's accept it, you didn't want me to become a doctor. I swear, if I was in media instead, I would've come up with a sizzling hot rap video with all the nurses scantily dressed, teasing doctors, shaking booty and what not! Sing with me "I need you Sistah!"

Melodiously yours,

Rap Master S.S.

Disclaimer: I know I'm gonna get crap about this post, but, once again this isn't me generalizing. Been having a torrid time with a couple of people at work and this is addressed only to them. I've been lucky to have met some great nurses in my rotations, the best at my sister-hospital. I miss them terribly, now more than ever! That being said, that music video idea wasn't half-bad was it?!

Indecision Conundrum

"He's the best of the lot. He sees things others don't or at least things that others ignore & takes the final call." I heard a resident speak of a junior surgeon in my hospital the other day. He also commented on how others are scared of committing themselves to a line of treatment. Fellow interns, how many times have you gone through a file and read, "Dr.ABC has assessed the patient and suggested continuing conservative line of management with review if any change in condition"? It's definitely easier on the surgeon, it's easier on the relatives, but most importantly, quite often it's easier for the disease. 

Every few weeks, each hospital holds a Mortality & Morbidity meeting, to reassess what went wrong with the selected cases for review & offers advice on how to best manage similar situations in the future. I am yet to attend such a meeting, but have been told that every care is taken to be sympathetic to the state of the presenting doctor & avoid such terms as "accuse" and "blame". People die, that's the harsh reality of our profession, it's worse when they die due to human error; and mistakes do occur regularly. The worst errors are those of omission. But, sadly these are seldom discussed at these meetings. Not operating is often the easiest choice that a surgeon makes. This is most true when a problem is often complex and survival considered bleak. His morality rates are kept in check, he goes on perform surgeries where the prognosis is optimistic and everybody goes home happy, including the patient, albeit not for long. 

From what I can see, some of these surgeons ought to grow a pair. If they were so interested in watching from the sidelines, they should've become physicians instead. There's no sense of discovery, no enthusiasm of finding the unknown. What's so great about opening a patient for an appendectomy & finding an inflamed appendix? Nothing! Ever been in a massive surgery where they operated for something else instead? It's magical. You hope for a fruit and find a fruit tree instead; every surgeon's dream, or at least I used to think so. And while I'm at it, people need to stop treating the pancreas like it's the fucking plague. I agree it's insanely difficult, the protocols aren't well-defined & predicting a prognosis is often more difficult than the surgery itself; But, still! I'm sick of hearing people go on about what "should have" been done two, three weeks ago and how how the patient is now inoperable. This rant is dedicated this awesome surgeon who joined us at rounds today. I wish he'd come 10 days earlier, I would've witnessed one awesome surgery!