medical

  • How not to communicate Scientific Findings

    Things at work seemed to have settled back into a routine for now. Few interesting patients here and there, but I am still am not quite up to sharing stories and experiences yet. That said, one of the reasons I continue to maintain this site at all is to communicate, to learn, to teach, and just to have fun. It's strange how I go through waves of activites. Some months I will write everyday, others I wont look at the computer, instead doing yoga, or playing video games until I simply get bored and return to one of my other hobbies for a while. I think however that it is time I start trying to write more again, because I miss all you guys and gals. We communicate only through comments and messages, with the rare exception of some of you who I have been fortunate enough to meet in real life, but that makes you no less a friend, and in some ways, you all still know me better than your real world counterparts, because I have the illusion of anonymity here.

     

    Enough drama. On to something fun, (YAY! SCIENCE!) : the following is an excerpt from a BJU article about a lecture given in the 80's on treatment for erectile dysfunction, long before the day and age of viagra and spam mail about penile enlargement.

    http://onlinelibrary.wiley.com/doi/10.1111/j.1464-410X.2005.05797.x/full

     

    "In 1983, at the Urodynamics Society meeting in Las Vegas, Professor G.S. Brindley first announced to the world his experiments on self-injection with papaverine to induce a penile erection. This was the first time that an effective medical therapy for erectile dysfunction (ED) was described, and was a historic development in the management of ED. The way in which this information was first reported was completely unique and memorable, and provides an interesting context for the development of therapies for ED. 

    Professor Brindley, wearing a blue track suit, was introduced as a psychiatrist with broad research interests. He had, he indicated, hypothesized that injection with vasoactive agents into the corporal bodies of the penis might induce an erection. Lacking ready access to an appropriate animal model, and cognisant of the long medical tradition of using oneself as a research subject, he began a series of experiments on self-injection of his penis with various vasoactive agents, including papaverine, phentolamine, and several others. His slide-based talk consisted of a large series of photographs of his penis in various states of tumescence after injection with a variety of doses of phentolamine and papaverine. After viewing about 30 of these slides, there was no doubt in the [audience's] mind that, at least in Professor Brindley's case, the therapy was effective. Of course, one could not exclude the possibility that erotic stimulation had played a role in acquiring these erections, and Professor Brindley acknowledged this.

    He indicated that, in his view, no normal person would find the experience of giving a lecture to a large audience to be erotically stimulating or erection-inducing. He had, he said, therefore injected himself with papaverine in his hotel room before coming to give the lecture, and deliberately wore loose clothes (hence the track-suit) to make it possible to exhibit the results. He stepped around the podium, and pulled his loose pants tight up around his genitalia in an attempt to demonstrate his erection.

    At this point everyone in the room, was agog. But Prof. Brindley was not satisfied. He looked down sceptically at his pants and shook his head with dismay. ‘Unfortunately, this doesn’t display the results clearly enough’. He then summarily dropped his trousers and shorts, revealing a long, thin, clearly erect penis. There was not a sound in the room. Everyone had stopped breathing.

    But the mere public showing of his erection from the podium was not sufficient. He paused, and seemed to ponder his next move. The sense of drama in the room was palpable. He then said, with gravity, ‘I’d like to give some of the audience the opportunity to confirm the degree of tumescence’. With his pants at his knees, he waddled down the stairs, approaching (to their horror) the urologists and their partners in the front row. As he approached them, erection waggling before him, four or five of the women in the front rows threw their arms up in the air, seemingly in unison, and screamed loudly. The scientific merits of the presentation had been overwhelmed, for them, by the novel and unusual mode of demonstrating the results.

    The screams seemed to shock Professor Brindley, who rapidly pulled up his trousers, returned to the podium, and terminated the lecture. The crowd dispersed in a state of flabbergasted disarray. I imagine that the urologists who attended with their partners had a lot of explaining to do.

    The rest is history. Prof Brindley's single-author paper reporting these results was published about 6 months later [1].

     

    ---

    Yes, people, I did in fact make my grand return to xanga by returning to my old staple of dick and fart posts. I may have lost my GI fellowship for now, but not my scatalogical and juvenile sense of humor.

     

    -Dr J

  • Resolutions

    My first post of the new year. And my 11th straight year of xanga posting. So In that I am moving forward at least.

    2011 was simultaneously one of my best and worst years. It began with a reconnection with an old friend that blossomed into a relationship, a lightening of my work schedule, and best of all, acceptance into one of the most competive fields in internal medicine, gastroenterology at a location I had wanted, cook county in chicago, where I had lived for 5 years during med and grad school.

    It ended with remediation and loss of the fellowship, extension of a 3 year residency by a 4th year with the accompanying self doubt and humiliation, and the impending end of a relationship that for a number of small reasons that have continued adding up, simply did not work out.

    I fought the good fight, in both work and love. And in both cases, sadly, the end result was a polite announcement that while my efforts are impressive, the end result is the same and I cant continue on. The fellowship advised me to re-apply, but will not allow me to defer. The gf notes that we simply are not "best friends" merely boyfriend and girlfriend, that we dont share enough of a connection to build any kind of lasting relationship. I am encouraged to reapply if our friendship deepens, but barring a few remaining social obligations, I need to gracefully let go and allow her to find the happiness I simply cannot provide. She hasnt said it in so many words, but even someone as dense as me cant fail to pick up on signals and subtext repeated often enough.

    So Where am I in the beginning of the new year? Where I was three years ago...older, hopefully wiser, but kissing ass working like an intern who has just moved back to the state as friends deepen their careers and achieve financial comfort and stability, single as I continue to receive announcement after announcement, and watch my friends slowly drift away into weddings and family planning, living at home when people I know are all buying houses.

    It's not a good place.

    And yet, I still try and find the small things that can keep me going from day to day. Relearning the piano, to give myself some creative outlet while the comedy is on hold. Using my large amounts of isolated alone time at work to catch up on my reading, both fun and study. Trip planning the upcoming vacation with my usual travel friends.

    Have I been defeated? absolutely. But this merely goes to show what I have known all along-medicine is not my life. It's a job. A fascinating and challenging one to be sure, but not who I am. And while I will reapply, I dont hold out too much hope of achieving the same position twice with this albatross around my neck. At least I know I was capable of it...unlike when I applied for optho as a med student, I WAS accepted...I WAS good enough, and the horrible political scapegoat environment at my residency is what cost me.

    I dont get a choice. I have to complete residency no matter what I do after, whether fellowship by some miracle, or some outpatient/hospitalist job to pay off my loans.

    I cant think about the future, because I dont have one. I can only focus on one day, then the next.

    New Year for so many people is usually a time of resolutions. For me it is a time to be resolute.

  • Medical Comics strike again

    Cyanide and Happiness, a daily webcomic

    I love puns. So much.

    Cyanide and Happiness, a daily webcomic
    Cyanide and Happiness, a daily webcomic
    Cyanide and Happiness, a daily webcomic
    2011, both the best and worst year of my life to date. Here's hoping 2012 sees more ups than downs, more smiles than frowns, good friends, good food, good health and good times.
     

     

     

  • Favorite mastectomy breast prosthesis idea: a fake boob containing a spare rechargable battery, accessed via a nipple USB port. Complete with a ring of LED charge indicators in the areola!

     

    Plus they take like 9%.

     

    Seems Archaic, indeed.

     

  • Christmas Eve

    Christmas Eve.

     

    Peace on Earth, Goodwill toward men. Ghosts of Christmas past, present, and future abound in the hallways of the hospital. As doctors we treat disease, but the building is impregnated with the memories and feelings of the people who have passed through it's doors.

     

    In the corner of one patients room stands a small, sad, Christmas tree. The kind you might see in a Charlie Brown special. The Patient has been in the ICU for 45 days, unconscious for the last 10 of them. Intubated, with enough tubes and wires coming out of him, and monitors hooked up to him that he could be a Christmas tree himself.

     

    7 other patients reside in the remainder of my half of the ICU. A veritable menorah of the critically ill...only its not the lamp oil everyone is hoping will last out through the night. 

     

    One patient's church group came by to sing Christmas Carols. Most of my patients are unconscious or sedated, but I think the doctors, nurses and ancillary staff appreciated the gesture. Nobody wants to be in the hospital during the holidays.

     

    And like the ghost of Christmas future, I go from room to room, showing the families a glimpse of what is to come. Up to my old tricks, I have held palliative meetings with 4 families in the last 2 weeks, changing the code status to DNR sometimes mere minutes before the patient passes away. I'm not doing it because I dont want to code somebody, but because I have learned to recognize when the battle has been lost, when aggressive resucitation would serve no purpose to anyone, least of all the patient. 

     

    The internal medicine department can say what they will about my medical knowledge or professionalism, but apparently I am still good at convincing people to die. I second guess or doubt most of my decisions, I overdocument every thought process I have as if a trip to the bathroom could land me in court, I still have little to no interaction with any of my former fellow residents or attendings, and I am fine with that. But at least the ICU attendings recognize that I have an ability to relate to patients and their families.

     

    I may be stuck here, with no light at the end of the tunnel, but that's no reason to take it out on those for whom I am supposed to be caring. If I can focus on that, and getting my license, maybe I can forget that unlike Ebeneezer Scrooge, I wasnt given a second chance to change my future.

     

    Merry Christmas to All, and to all a good night.

  • It begins

    Probation begins Tuesday.

    I had almost forgotten that I had to go back to work. The week I was on leave to consider my decision was so nice and unrelated to medicine at all that I didnt even have much time to feel sorry for myself. There were birthday parties, ceremonies, days at the museum, even mundane things like getting my oil changed to take up my time. And then Tuesday begins my year of shit. Starting back in the ICU, so at least not working with any of the hospitalists who forced me to this course initially, but among people who had certain knowledge that I was finished rotating through that department.

    I understand the rationale. If there are all these supposed concerns about my ability to treat critical situations, it makes sense for me to repeat my training in critical units. Nevermind the fact that those were some of my highest evaluations the first time around. I have accepted the fact that I am going to be eating a lot of shit sandwiches for the next year, and there is nothing I can do about it.

    The program director and administration are still looking for ways to remind me how serious this case was, you know, in case I forgot somewhere along the way of them ending my career, or maybe in case I am not appearing appropriately contrite enough.

    People portray doctors as being arrogant or uncaring. It hurts. A lot. You do your best day in and day out, and feel awful when things go wrong. And now someone is accusing you of having committed malpractice in your efforts. 

    So why did I take the probation? Why havent I fought this harder, or "lawyered up" if I really feel I am being that unfairly treated or targeted? Because I dont have documentation to prove that I am being picked on, and it is easy for my accusers to say they have been concerned about my knowledge all along because residents make mistakes. And a single one here or there in an evaluation no matter how good can always be pulled out, and used to show in court that there were supposed doubts about my ability all along

    It kicks the shit out of you. You lie awake at night wondering if you're going to lose everything you ever worked for. You cry. You think about quitting, but have to go on because you're in too deep not to. With this sword of Damocles hanging over your head, you still have to go to work every day, and do your best for the patients who still depend on you. Some days it's pretty damn hard NOT to start drinking.

    And, deep down, you wonder: Am I really incompetent? You question your own judgment. Suddenly every headache patient needs a brain MRI. Every person you see is a time bomb. You start to view them as the enemy. People use the phrase "defensive medicine" in a derogatory fashion, meaning unnecessary testing doctors order to prevent themselves from being sued. But after something like this happens, you don't give a fuck how much money the "unnecessary" tests cost. You'll order anything to cover your ass.

    And, regardless of the case's outcome, it will forever destroy the beliefs that once drove you to dream of being a doctor. Even if new reasons are found later on down the road, you will never trust or have the faith in your colleagues that you once did.

  • Resolution

    I will fight this. At least, I will try to fight it. There isnt much I can do, but I will go down swinging.

     

    Should I make it through, I will add another tattoo to the collection.

    Should they win, I will stick around only until I can pay off my loans. And accept that I wasted 13 years of my life on something I wasnt meant to do.

     

    And they thought I had an "attitude problem" before...

  • One Mistake

    One Mistake. That's all it took.

     

    One mistake, and a committee came down to a split vote on outright dismissing me from the program, versus ultimately deciding to graciously allow me to continue, should I so choose, under probation. Demotion to r2 status with an extra year of residency. Guaranteed loss of the fellowship I spent months, if not years competing for. 

     

    One mistake, and I reap a year of humiliation and condescencion. Having to tell all my friends I'm not moving, then explaining why. Having to work side by side among the current second years who will be talking about how badly I screwed up. Being made "the example" for the hospital. Having to stay in the same situation while everyone else moves forward.

     

    One mistake, and one that more likely than not would have been treated more favorably had I not already been on remediation.

     

    I have spent the last 6 months arriving at work, waiting for the day to end so I can go home, telling myself I could put up with any of it as long as I had my fellowship waiting for me at the end.

     

    But now?

     

    Do I really want to put myself through that? An extra year, to what purpose? I am burned out. I'm done. Even if I decide to graduate, I would be in medicine only as long as it takes to pay back my loans, and then I would quit and go back to enjoying my life again.

     

    I should never have gone to medical school. But I guess that was just one mistake as well.

     

     

  • Brand Names

    Written on cute ''Groceries!'' stationery.

     

    I wish this comic was less true. But for many families, being involved doesnt mean weighing the options and heeding the advice our education has given us, but dictating care according to what they think the patient wants or needs.

    I find myself dreading my upcoming wards month...I dont want any difficult families. I cant afford to have anyone evaluate me as anything less than perfect. The human body was not meant to undergo these levels of stress for this long. And yet, here I am still plugging away, still hoping against hope that despite all evidence to the contrary, something, anything, will turn out right. I guess that is the difference between hope and faith...with faith, you dont have this kind of anguish, you simply know. With hope, you keep waiting for something to be snatched away.

    I dont know why I keep recording this whole episode. Is it for you, or for me? If I make it through this, is it something I really want to remember? Will I one day look back on these posts and tell myself, oh right medicine isnt always easy, but you have been here before...or will I reread this and be like, this was your tipping point, when you had all you could stand and left a career that was doing nothing but breaking your spirit

    I dont want to know the future, I just wish I didnt have to keep anticipating it.

  • Teach a Fish to climb a tree

    Everyone Is A Genius - But If You Judge A Fish On Its Ability To Climb A Tree - It Will Live Its Whole Life Believing That It Is Stupid - Albert Einstein

     

     

    ''I love you with all of my vestigial organs.''

    I havent done a comics post in a while. Figured I would intersperse it with some personal thoughts. I think I am beginning to see the writing on the wall with my current relationship. Nothing is specifically wrong, it just seems that whatever I do will never be good enough. As per the excellent quote by @suuperstar in the last post, at a certain point you cant keep trying to change yourself especially when it doesnt seem appreciated or if the other person is willing to change for you. I like who I am, or at least I used to, and I dont want to lose that. Apparently relationships can fail simply from holding different viewpoints on life. Who knew?

    Cyanide and Happiness, a daily webcomic

    I feel like this a lot at work lately...like somehow, I just dont get it. Like no matter what I do, it's not good enough, and even when I do something right, someone is there to point out how obvious the solution was and how I should have gotten it sooner. 

    Cyanide and Happiness, a daily webcomic

    I know this too shall pass, but I wish that i didnt have personal and professional drama going on at the same time. I guess it's just because November is sweeps month, I am pulling stunts like this to garner ratings...

    oh well, better than being canceled.