She tapped her pen on a legal pad, briefly stopped and motioned for me to take the seat opposite. Maggie was a psychology intern. She was about 25, tall and wore her blond hair long and straight. She was trim with a nice figure; she almost certainly went to the gym on a regular basis. Today she wore high heels and a black suit jacket underneath which was a sheer white blouse. She sat with her legs crossed. Her matching black skirt came down to about the mid thigh.
At the conclusion of the standardized patient interview, Maggie's job was to review the video footage with the resident and give him or her feedback on how he or she handled the actor who had been pretending to be a depressed patient. Maggie looked at me through her dark-framed glasses. I wondered whether or not they contained prescription lenses. "So, how do you think you did with this patient encounter?" She sat about 3 feet away, facing me with her legs crossed. Her long, white legs seemed to go on forever. I pondered this while allowing her to induce me to manufacture some feedback on my performance. Feedback on one's performance within a patient encounter, whether real or simulated, is entirely subjective and largely bullshit. As far as I'm concerned, an encounter with a patient is either successful or unsuccessful. It is successful if a plan of action is developed that everyone is on board with. Sometimes a plan is developed, but only partially implement or sometimes the plan represents a compromise between what the doctor recommends and what the patient is willing to do. In these cases I would call the encounter partially successful. Better doctors are the ones who facilitate the most successful patient encounters. I pondered this as Maggie leaned forward, uncrossed her legs and said something about "eye contact" and "empathy."
"What do you think you could improve upon for next time?" She leaned back as she asked me this and I took note that there was just enough separation between her knees at this angle to make visible the shiny, white panties she was wearing. She crossed her legs again as I said something about being "patient-focused" and asking open ended questions.
There was nothing noteworthy about the rest of our exchange and I left the interview hoping to get "feedback" from Maggie again sometime.
BEEP! BEEP! BEEP
My pager had been quite all night. The sinking feeling that happens in the pit of your stomach whenever your pager goes off is typically pretty well ingrained after a week or two of intern year. And it's no wonder. Every time an intern's pager goes off, something bad inevitably happens:
BEEP! BEEP! BEEP -> Dr. Logan, there's a family member at the bedside of the cancer patient in Wonderland. They have questions and need you to come talk to them...(heart palpitations) BEEP! BEEP! BEEP -> Dr. Logan, there's someone having trouble breathing in Purgatory. You need to talk to them, examine them, figure out what orders you need to write, write those orders and then write a 2-3 page note about them - hopefully finishing all of this before you get paged again. By the way, don't forget to go talk to the family member of that cancer patient when you're done...(heart palpitations) BEEP! BEEP! BEEP -> Dr. Logan, there's a patient on the 8th floor of the Fog wing having chest pain. You need to go assess what's going on and maybe save her life. And you need to be pretty quick about it because there's still that patient in the ER and that family member waiting for you...(heart palpitations)
BEEP! BEEP! BEEP...(heart palpitations, in the absence of initial stimulus) I pick up the phone and dial a number I don't recognize.
ME: Hi. This is Dr. Logan, returning a page.
VOICE: (snorting and heavy breathing)
ME: Hello? (Dr. Logan wonders if he's just been paged by a wild boar)
VOICE: Hello.
ME: Who is this?
VOICE: (deep throated laughter) I'm surprised that you don't already know.
ME: What's this about?
VOICE: (chains clanking, snorts) We've met once before.
ME: You live under the hospital?
VOICE: (snorts now loader and shorter, more nearly resembling angry barks) I don't live under this hospital, I am this hospital. I am the irate family member in Wonderland; I am the old man who can't breathe in Purgatory; I am the diabetic lady having a heart attack on 8 Fog. It's all ME.
BEEP! BEEP! BEEP
I had set my pager to go off at 6am so I'd be able to get ready for 8am rounds. I recalled the events of the previous night:
1. Calmed a nervous daughter who demanded to know when her father with metastatic esophageal cancer and severe anemia secondary to a bleed at the surgical reanastamosis site was going to have radiation to the lesion in his brain.
2. Admitted a man with a COPD exacerbation.
3. Sent a woman with an ST elevation MI (heart attack) to the cardiac cath lab for emergency revascularization.
After that I had been able to sleep for about 45 minutes and seemed to recall having had the strangest dream. Upon getting home to my own bed in the late morning, I would halfway recall my attending having congratulated me for winning "...The battle."
I just found out about a network of underground tunnels that connects the various buildings on the Medical Center campus to one another.
The pager had been quite all night. In order to break the monotony and do something good for my body, I decided to walk over to the Dark Tower section of the hospital. While most of our hospital is a sprawling mass of mismatched construction projects, each one successively glued to the previous one over the decades, the Dark Tower is the oldest and tallest part of the hospital standing at 17 stories. The seventeenth story of the Tower consists of offices and the two floors below that are filled with ICU and CCU beds. But, the family medicine service does occasionally have a patient on the fourteenth floor - DT 14, we call it. Whenever Dr. Hertz is on service, he insists on making the entire team climb the stairs up to the fourteenth floor. Then we listen to the sweaty intern try and present her patient.
"Mrs. Jameson is 49 year-(gasps for air)-old female who came in with 2 days of (gasps, puts hand on counter to steady herself) fevers, cough and (takes off her white coat panting heavily)..."
So, in the absence of pages, admissions or phone triage calls, I thought I'd get some exercise by taking the stairs up to the seventeenth floor and back down a few times. Our call room is on the 3rd floor of the Enchanted Wing. I walked over to the Dark tower, made the climb from DT 3 to DT 17 and then back down past DT 3 to DT 1 and down 2 more flights to DT Ground. At DT Ground, what I thought was the lowest level of the hospital, I noticed that the stairs continued downward. In order to make my climbing as continuous and uninterrupted as possible, I'd have to start my next run from the lowest level. So, past and unlocked wrought iron gate, I continued my descent. The stairwell had become noticeably cooler and the steps led me to a stone archway flanked by gargoyles holding torches. I couldn't see anything past the 2 gargoyles at the gate, only blackness. But, deep within the blackness I could hear what sounded like the heavy breathing and snorting of an animal. Then, a louder snort and the distinct clanking of chains being dragged along the ground. I listened at the blackness for 60 seconds as the clanking and snorting slowly but perceptibly increased in volume.
I took the stairs back up to DT 3, forgoing the remainder of my workout, and then made the walk back to the call room in the Enchanted Wing. I'm not exactly sure what I discovered down there. If tomorrow night is equally quiet, I may investigate further.
Just checking in to let any readers I have know that I am still alive. Although, I am on surgery right now, so just barely.
I just started watching the This American Life TV show. There is a fascinating season #1 episode about a guerilla theater group who "pranks" an obscure local band into thinking they have fans by going to one of their concerts.
Think about that for a minute. Charlie Todd, the organizer of this group, got 35 people together in order to make a showing at this new band's second concert. The 35 people in question are part of an urban theater network called Improv Everywhere. The 35 people downloaded the band's music, learned the lyrics and made t-shirts. Then they came to the concert and rocked out with the band. My question is, in what sense does this constitute a "prank?" This is just life. I can't figure out how this is any different from the "prank" I once pulled when I went to school for what will be going on 25 years now and worked hard and got good grades. Hah (slaps knee)! All my teachers thought I was a good and diligent student! Man, I really pulled one over on them. Or the one where I visited my girlfriend in the hospital when she was sick with appendicitis. I brought her flowers and balloons and everything. Man you should've seen the way her face lit up! She thought I really cared about her.
My point is that our entire lives are, in some sense, a "stunt." The mission statement of these 35 was to give this band "the best gig ever." Maybe some of them were also there to achieve some notoriety or maybe they enjoyed being a part of something bigger than themselves. Maybe some of them genuinely were fans of the group. But, when one of the band members found out that these so-called fans where there as part of an urban theater performance, he was devastated. He's being short-sighted. Here's why.
If you take the view that your performance is meaningless despite the crowd of people jumping and singing to your music, what meaning does anything in life have? What you see, hear, touch and perceive is as real as anything gets in this world. Don't think too hard about it - you'll drive yourself mad.
Housestaff members of the MICU team at University Hospital are slowly beginning to rebuild in the wake of attending physician, Marshall. Pulmonary and critical care specialist, Hugo Marshall, who reached an unprecedented level five on the malignancy scale, caused general devastation to University Hospital MICU service leaving behind broken dreams, flooded hopes and dashed egos. As no such attending had struck University Hospital since 1977, the residents and medical students in his path found their emotional infrastructure was not sound enough to withstand the torrents of sarcasm and belittlement that characterized Dr. Marshall's two weeks on service.
"It was horrible," recall internal medicine intern Amelia Cruz and family practice resident Michael Silverberg. "We lost everything - our confidence, our desire to learn, even our will to live. It's going to take months to rebuild our sense of worth and to start functioning effectively as doctors again."
Attending physician Marshall could not be reached for comment, but forecasters predict he will continue to move eastward across the hospital where he will strike the pulmonary clinic sometime early next week. Many housestaff in the area have no means of evacuation and have been sighted employing strategies such as barricading the call room doors and laying stronger emotional foundations.
My girlfriend and I watched the movie The Pursuit of Happiness tonight. Grossly overrated movie but it does include a really nice version of Simon and Garfunkel's song, "Bridge Over Troubled Water" sung by Roberta Flack from her 1971 album Quiet Fire. Here's YouTube clip from one of Simon and Garfunkel's live performances:
I really love that song. I would kill to be able to sing it the way Art Garfunkel does. I really would. Most of the time, when people say they would kill for something, it's just a euphemism, "I'd kill for a doughnut right now, I could just kill someone, you kill me...etc" But I really mean it. I would actually commit cold blooded murder in order to be able to sing like that. I mean, I wouldn't kill my sister or my parents. In fact, there's a pretty long list of people whom I would not kill no matter what I would get in return. But the guy who gave me a parking ticket last week, the woman at the DMV who wouldn't give me my plates, Anne Coulter... I would truly consider killing one or more of these people in order to be able to hit some of those high notes in a song like "Bridge Over Troubled Water."
What a great song ;-)
I love the new incarnation of American Gladiators almost as much as the 1990's original. But, to the AG producers, please indulge me as I voice one small bit of constructive criticism. Your female gladiators - Jet, Venom, Phoenix, Siren - all get to wear dead sexy outfits that expose lots of abs and are tight enough to give us all the information we need about the size and contours of their thighs and of their respective gluteal regions. So, what's the deal with Helga's outfit?
Helga is your HOTTEST gladiator! And just like in all the later seasons of Xena, Warrior Princess (the ones where Xena was really buff), she has to completely cover up the midriff and she has to hide her legs and butt with some frilly skirt-like thingy. American Gladiator producers, take my advice; put the skirt on Jet - she's an amateur and there isn't much there anyway. If there's anyone whose costume should come in two pieces, it's Helga. You guys clearly are not shy about showing off the human form; let's see Helga's beautiful physique!
