Thursday, November 22, 2007


You always see the doctors on TV saying "We did everything we could...but..." and it seems so easy.

We told a family that same thing last week, and it was the hardest thing to be a part of. I was on trauma call when Mr. X came in. He'd been hit by a car as he was crossing the street on his way to the grocery store. He came in a little hypotensive, so we pumped fluids into him and tried to get X-rays and the FAST scan to see what was going on inside of him. We assumed that the major injury was his open head wound. Things were going well...he was still hypotensive, but hanging in there...and then all of a sudden he bottomed out. COMPLETELY bottomed. BP was not palpable, pulses were not palpable, you name it. We activated ACLS protocol and got to work. I have never worked so hard or had my arms hurt as much as they did while doing those chest compressions. After about 10-15 minutes, we gave up and called it. We stripped off our gowns, threw our gloves away, and called it quits. And then...from the monitors...the faintest "blip...blip blip...blip" sounded. He was back in the game, and so we were.

The story could drag on, but the bottom line was that the guy coded twice more,once on the CT scan table and once in the OR before cardio even had a chance to crack his chest. We lost him.

It's hard for me on different levels to accept this. It's hard because I'm a perfectionist. I'm used to things working out. I'm used to trying my hardest and getting results. It's hard because I feel like I let myself down. It's hard when your best simply isn't good enough.

It's hard because I went into medicine to be a positive change in the world - to save the lost, heal the sick, piece together the broken. It's hard to come to terms with the fact that you can't save everyone. Knowing that you can't save everyone and having that fact shoved in your face are two separate things.

It's hard for me because I forget that life really is just a few precious moments on this round piece of real estate. When they are gone, nothing can bring them back. It's hard to be reminded of something so simple: that we all die. And truthfully, I am finding that remembering the inherent mortality of a human being is very hard.

Wednesday, November 7, 2007


As much as I enjoy learning...

As much as I enjoy the challenges of medicine...

As much as I love medicine (good days and bad)...

I'm realizing that there are depths to human beings that I will never understand and situations that will drain me in every way a person can be drained.

I'm learning that sometimes what I see day-to-day has the power to break my heart into a million pieces.

Today was one of those days. I can't go into details because the case I was in on has gotten some news time and you can never be entirely sure who reads your blog. All I can say is that it's amazing to me how medicine can blow your mind and break your heart at the same time.

To be quite frank, I'm worried that one day something I see will break my heart so completely that there are no pieces left to put back together.

What then?

Tuesday, October 2, 2007

HealthCare Rant

ne of my attending physicians on the ENT service chatted a bit the other day about the sad state that our country's medical system is in (among other topics). It's a discussion that I've had more than once with a variety of people and even though it's a repeat conversation, I still am very bothered by it.

I am bothered by the fact that what I see across various specialties and subspecialties is this sense of entitlement and a misguided idea of fairness. To a lot of people, they are "entitled" to low-cost/free health care. They want major operations that take 8+ hours for next to nothing. They complain about the high cost of health care and bitch about the "disgustingly high" doctor's bills that they get in the mail without even realizing that doctors don't see the majority of the money on that bill. For example, depending on reimbursement rates for the INSURED (and that's the INSURED, mind you...) if a patient receives a bill for $5,000, the doctor might only receive $1,500. The rest goes to corporate america and the CEOs and other middlemen that have infiltrated the medical profession at the behest of the government.

Part of the problem is that people are willing to pay top dollar for what they consider necessary. People pay huge amounts of money to plastic surgeons so that they can have those butt implants to ensure that they'll never find a pair of pants that fits correctly again. They pay to suck fat from their upper arms that could have been removed by a $50 gym membership. They want collagen in their lips and silicone in their chest. They'll happily pay $20,000 for a few minor procedures that leave them looking like they've decided to go as Joan Rivers to the company Halloween party. And yet, when they find out that their unhealthy life styles have made a coronary artery bypass necessary...they don't want to pay. They think it should be free. In the minds of many people living in this country, it's more worthwhile to pay $25,000 for an endoscopic brow lift with laser resurfacing and a touch of lipo than it is to pay $25,000 to fix their heart and buy them more time on this planet. It's frustating.

I look at it this way. I love my car. I love it for a variety of reasons, not the least of which is that it drives me around and gets me to places I need to go...such as work, so that I can pay for the roof over my head, the food in my belly, and the clothing that keeps my out of shape body covered. If I were driving along on the freeway one day and my car began to sputter and jerk before descending into the final death throes that cars will randomly engage in from time to time for no discernable reason, I would be unhappy. In fact, to the repair shop I would go posthast. I might balk and gasp when the mechanic announces that there are problems with the engine/transmission/fuel pump/etc that will cost me roughly $4,000 to fix. I might think very rude and unlady like thoughts in my head. But the bottom line is that my bank account will become $4,000 lighter, not because I truly want to pay the mechanic that much, but because it's my car and I need it. I don't bicker with the mechanic. I don't tell him that I am somehow entitled to free car service. I don't refuse to pay him the $4,000. He takes my money, spends an hour doing whatever it is that he does to the innards of a car, and I drive away in a car that once again does what it is supposed to do.

My point is this: we don't hesitate to pay the mechanic to fix our cars. We'll pay obscene amounts of money just to get a fuel line fixed. We'll do whatever it takes because it's important. We'll wait hours and hours for the TV repairman to come fix our televisions so that we don't miss the Thursday episode of Grey's Anatomy. Yet when it comes to our healthcare, we expect it for free and we get mad and refuse to pay "on principle." WHAT PRINCIPLE IS THIS? You'll pay the mechanic to work on your engine/TV repairman to fix your LCD flat screen TV...but you won't pay the doctor that grafts a new vein into your heart so that you can be around to watch your son play his Little League game or walk your daughter down the aisle. Help me to understand how my time is less valuable than the time of a mechanic and how my daily activities are less important than making sure ABC comes in clearly on your television.

Understand this, people: NOTHING IS FREE, and healthcare shouldn't be any different. I do keep in mind that healthcare costs are too high. That's not the fault of doctors, it's the fault of government created middlemen that have changed the way medicine is practiced. If government had less influence in medicine and middlemen weren't paid so much to sit behind their desks, medicine might very well be a cheaper undertaking. I don't have any easy solutions to the problem. Actually...I don't have a solution period, because I'm busy. I've been busy for the last six years and I'll be busy for at least the next 40. I've been busy learning how to be a good doctor - the kind I'd want my parents to go to. I've been busy spending 10 hours a day studying for the last couple years. Right now, I'm busy working almost 80 hours a week, sometimes nearly 30 hours straight, so that one day I'll be able to save your sorry butt. I see my family for maybe two weeks out of each year because my schedule is a little full and if you don't think I miss them, you're sorely mistaken. I'm busy enough that conversations with my best friends are limited to messages sent through MySpace, because I just don't have the time for phone conversations. I spend 12 hours a day wanting nothing more than 30 minutes to visit the loo and the cafeteria, and at night when I dream, I dream about sleep. I lose sleep and I stress out and sometimes I cry from exhaustion and despair, sure that I'm never going to be the kind of doctor worth having. I'm busy caring about you, even when YOU don't care about you, and to be quite frank with you, I get quite disgusted when you throw a hissy fit because you don't think you should have to pay me. If you refused to pay the plumber, you'd have to figure out an alternate method of showering because he doesn't work for free. If you told him "I know you asked for $1,000 but I only feel like paying you $250" he'd laugh all the way out of your front door and you'd still have a broken toilet. Yet when you do the same thing to doctors, you walk out of that OR with a new heart. You want the latest, greatest technology for pennies on the dollar, and that is not fair. It's not fair to us, and it's not fair to you. People complain that the standard of medicine has fallen even though costs have risen, and some who receive low-cost/free healthcare complain that they get sub-standard care. It's trite but true, even in medicine - you get what you pay for, and when you pay for a lower standard of care, that's sometimes what you get. The impetus for something better is missing. I'm not saying that things should work that way; I didn't go into medicine to give shoddy care - nobody does. But it's happening all over the replace, so I'll repeat myself: this current thinking pattern is not fair to us, and it's not fair to you. In fact, it's so not fair that America currently has only 75% of the physicians that it needs, and it's only going to get worse. Medical school enrollment rates are starting to drop. Not all those who start medical school finish, and not all those who finish decide to practice medicine. There are a variety of reasons for this, but I would be remiss if I didn't say that the current state of medical affairs wasn't among those reasons.

I think it's about time you get your priorities straight, people, or one day there won't be a surgeon to fix your heart or a pediatrician to heal your child's ear infection. You'll be up a creek with without a paddle - and don't expect your expensive tummy-tuck to pitch in and row you to safety.

Friday, August 3, 2007

Oh my, Mexico!

In the GYN clinic, I was handed a chart and was sent to evaluate a patient, Mrs. X.

Walking in, I could see that Mrs. X definitely had some problems. She had some balding and a slight moustache going on, but that wasn't what she was coming in about. She was coming in to complain about the size of a certain part of her nether female had started to grow increasingly larger and larger.

Hello, virilization!

As I sat there taking a history from her, I thought it odd that she kept referring to Mexico, as if there was something there that might be important. I figured she kept going there to visit family...after all, the vast majority of patients that I see in the clinic or the hospital are from Mexico or South America and have family there. I didn't think much of it and kept asking questions on my list for the express purpose of figuring out just why she, a 50-something woman, was starting to look more and more like a man. She kept on mentioning Mexico. After awhile, I asked her what she was doing in Mexico. She was visiting family (big surprise...) and taking some medications. Medicine? From Mexico? Now, I try not to be jaded/prejudiced, but if I had a medical problem and needed medication, Mexico sure wouldn't top my list of places to aquire help.

Turns out she'd been bothered by hot flashes and a doctor in Mexico was giving her some medication to get rid of her symptoms. After a blood test, the answer was immediate. Her testosterone was elevated into the "Macho Man-Mr. Universe" level.

She also let it slip that she'd been very itchy "down there" lately, and no vaginal creams had worked so on a whim, she tried using her foot cream down there. To her surprise, it made her feel better.

Tx: We gave her prescriptions for Premarin and lotrimasone and told her to quit going to Mexico.

Saturday, February 17, 2007

you know you are a medical student when...

I found this on the internet (yeah, while I was supposed to be studying....). It's sad how true each of these actually is. There were actually more listed, but I didn't feel like listing every one of them. Even I don't slack THAT much...

-You have named a dead person and talk to them about your stresses while finding their lumbar plexus.

-When you go out with non-medical students, you're abnormally quiet because you don't know what to talk about besides medical school.

-You've heard the phrase "You must be smart - you're in medical school" and want to vehemently disagree.

-You can't remember the last time you did anything spontaneous.

-You know that, in theory, you really do have family and friends but you can't place the last time you saw them.

-You know countless dirty mneumonics for parts of the body but couldn't tell anyone what the the front page headline in the news was today.

-You know that there is such a thing as studying too much and that after you reach that point, further study will only bring your grades down.

-You know that even with residency hour restrictions, you'll still be making less than the secretary when you finally graduate.

-You've done physical exams on your boyfriend/girlfriend/close friend/roommate.

-You think it's "AWESOME!" if someone keels over in front of you

-You're pretty sure you used to be normal in social situations but now you can completely stop a conversation by recounting the time the that some guy peed and bled all over you during a code.

-You've thought something like "What's another 10,000 in loans?"

-The word holiday means the weekend after exams.

-You have a non-medical student in your life that either elbows you or says "Forgive her, she's a medical student" when you say socially awkward things.

-You've thought something along the lines of "Why couldn't my grandfather/brother/sister/best friend have waited until AFTER exams to die/get married/graduate."