Well, apparently xanga has managed to survive. At least so I’m assuming from the fact that I can still log in. It’s kind of like coming back to a childhood home after a move away. Though I havent been gone that long, it seems ages have passed.

And I suppose that in some ways they have. I have no clue what my xanga friends have been up to, at least the ones with whom I communicate solely online. A few close friends and I elected to continue writing to each other via old fashioned letters. A step down in technology, but a grand return to interpersonal communication, something that despite my job, I still feel I sometimes lack.

And so, I putter about the place, sorting through old memories, wincing at pictures and posts of who I used to be, and enjoying the chronicle of whom I have become. 

There are so many stories still left untold.

The completion of the Peru trip-I have gone back to keeping a paper journal on travels, so something will survive another internet website ending

The completion of residency. I made it out, but what came next-the surprisingly difficult struggle to find a job despite, or perhaps because of my level of education and specialty training.

My locums work (think temping, but for doctors) experiences in a geriatric all spanish speaking outpatient clinic, and my rural/3rd world hospitalist time spent in Kona Hawaii.

My upcoming return to the Midwest for a permanent position as a hospitalist, at least for the next several years.

The return of my stand-up comedy career.

And all the stories of what you, my friends and readers have been up to in all this time I have been busily concerning myself with the outside world.

Everything Changes. That’s the adventure we call living. However, it’s nice to know that I still have somewhere I can come back to at the end of the day to call home. So in whatever iteration you return xanga, I’ll be right there with all my things set up just the way I like them.

After all, I’m still one of the 24 hour people

-Dr J

I’m not sure I want to do medicine anymore.

SHould I even be putting this on a public forum? Are you sure you want to know what goes on inside your doctors head during the training period?

Maybe it’s just the people I am working with, or the string of horrible things I have had to deal with at work since august, but I meet all the technical definitions of burnout. A recent quality review issue that came up during nightfloat was deemed to not meet the standard of care (i.e.-something went wrong, and a committee decided it was my fault) and as a result, I am waiting to see what the next step is.

The options are dismissal, which I have been told will not happen, further remediation (meaning more time spent with people i dont like, dont trust, and who have zero faith in my abilities as a physician, and probably as a person), or probation and extension (an extra 6-12 months of residency)

The best case scenario at this point is further remediation. My inner pessismist has been rearing his head and warning me to start preparing for probation or extension-after all n one has been there to offer help or support the rest of the time in residency, why would they start now? And it is practically a guarantee that if I am made to do an additional 6 months of residency, I will lose my fellowship position that I worked so hard to get.

Oh yeah, also the humiliation of telling friends/family/whoever about why I am still in residency, not doing fellowship, etc. Cant forget that

I dont remember why I wanted to be a doctor anymore. I know at one point I did, or I wouldnt have been able to make it through medical school. I can read over past entries and see I was still bright eyed, bushy tailed, and hopeful. Now all I can think of is what I have to do before I can leave the hospital for the day, and even when that is done, how long I will have to work before my loans are paid off and I can stop doing this. 

Medicine isnt fun anymore-I used to like teaching med students, educating patients, making people feel better, talking about interesting cases with colleagues. Now I avoid interacting with my peers for anything other than specific patient care issues. I find myself dreading my next r service and what else my superiors will find wrong, when I used to look forward to having a new med student to teach and morning reports to learn from.

And if they take my fellowship away, why force myself to stay in this environment? I find myself wondering what other careers I could pursue to pay off my loans, checking the forums to see what else is left for me. I invested too much to not finish residency, and I will have to stay in medicine at least until my loans are paid back, but then? DO I really want to commit myself to a career in which I am miserable, or at the very least, not happy?

I spoke with one of my friends the other day, who mentioned how he used to be much more up to date with his languages, he would always be studying japanese, but now he finds himself reading neuro journals and hanging out at work because he loves what he does.

…

I want that. I want to enjoy what I do, and not have it be just a job or feel like an excuse for a paycheck…but is medicine still the way for me to achieve that?

And maybe all the stress is temporary and if i can get out of this environment my opinions will change.

and maybe it isnt.

I’m counseling a clinic patient this afternoon about obesity and her high cholesterol, and as we’re talking she reaches into her purse…

And pulls out a hot dog. Wrapped in foil, but still… a hot dog. And she unwraps it and starts eating. While we are talking. About her eating habits.
I am literally dumbstruck. This does not happen often. I inform her that she can not have a hot dog in the middle of clinic. Doubly so while I am telling her to lose weight.

“I didn’t get a chance to eat lunch.”

That is entirely beside the point. you can eat before or after your appointment but not during.

“I didn’t get the french fries. I’m trying.”

There is a fundamental connection here being missed. I tell her again she will have to put it away, or throw it out.
And then she stuffed the entire thing into her mouth, chewed it up, and swallowed.

“You didn’t give me much of a choice.”

Ah, clinic.

A Question posed by fellow xangan GreekPhysique in response to his Ask YOU anything post:

“By the very nature of your field (and mine), we end up giving some of the very best years of our lives to hard work for little pay in exchange for a much better deal after 30 (or 40, depends). How do you feel about that trade you have made right now, and how do you keep yourself from thinking you made a bad deal?”

Well Greek, I would start by saying I disagree with your fundamental assertion. From a young age we constantly hear how whatever period we are currently in is “the best years of your life” whether it is elementary school, highschool, college, early 20′s, etc. Making the statement that something is the best implies that all the things following simply cannot measure up, whereas I find that each year my life just gets better and better. Not every moment is full of sunshine and lollipops but neither have I noticed a downhill trend as of yet

However, that said, I can appreciate that we do sacrifice a number of potential high earning years until later, while my friends who went into business or law started pulling down six figure incomes before I even was done taking loans or beginning residency. As to how I feel about that trade, I dont regret any of it. I chose to apply myself to medicine with full knowledge of certain aspects of what I was getting into, and I still feel that I would not have been nearly as happy or satisfied in any other field. My other interests, comedy and cooking, I have continued through residency, and when I finally retire from medicine I will pick up and develop those in further detail. So I keep myself from thinking I made a bad deal by continuing to enjoy my life and what I am doing

I have my own panel of patients now…which is kinda neat, admittedly.

To elaborate, every thursday afternoon, I have what is called my “continuity clinc”. It is supposed to teach you how doctors follow up their patients over the long term, providing continuity of care…one doctor, one patient, no illness left behind yada yada yada. What it has actually been for the most part is an urgent care center where once a week I see patients with simple complaints like pap smears or colds or medication refills because their regular doctor isnt available to see them.

But in the last month or two I have been starting to slowly get my own panel of patients, people for whom I am their primary care doctor, their gatekeeper to hospital medicine. If they need a referral, it comes through me…if they want to see how their blood pressure control is, I am the one with whom they make an appointment. It’s rather empowering, and makes me feel just a tiny bit more like a doctor having a group of patients to whom I can point out and say “these? they are MINE.”

And of course at least half that panel is spanish speaking only as I am one of only 3 residents and apparently only 20 some odd physicians in my hospital who speak enough spanish to carry on a conversation in it. Which I find staggering, as I work in California where white people are actually a legitimate MINORITY now. (and yet still no affirmative action grants and loan forgiveness for us, go fig.)

However, I like the added challenge of speaking with a patient in a foreign language. It turns even the most mundane visit (i need a refill of my blood pressure meds) into an exciting conversation and telenovela (PERO DOCTOR, NECESSITO LA MEDICINA POR MI CORAZON Y PRESION!).

——————————

Speaking of Mi corazon, i am going to go off on a brief tangent here about Valentine’s day. I am not super anti holiday, but neither is this my favorite holiday as I tend to spend it alone for one reason or another. However, several friends and I have a singles tradition as it were whereby those of us unable to secure dates for the occasion will instead stop by hallmark, pick up a nice, generic card and then bring it with us…

…to the local strip club. Where following several rounds of drinking and leering, we then each present a different exotic dancer with a valentines card to let them know that their hardworking efforts at putting themselves through school are appreciated by somebody.

I like to think that we help to improve their day just a little bit, like hugging your garbageman or leaving a surprise cupcake in the mailbox for your postman…it’s all about catching people by surprise.

Of course one friend who is new to this tradition called me up the other day to happily decry…”dude, I was in the grocery store walking past the card aisle for valentines and I started feeling all bummed that I didnt have a gf and then I remembered…strippers!”

And just like that valentines day will never be a day of misery/frustration/longing for a certain subset of the population again.

Okay, I admit it.

Much as I complained and whined about ccu, it has already made me a vastly better doctor in terms of my knowledge base and how confident I feel in dealing with patient medications. It happened so gradually I didnt even realize it.

Not even one month ago I would make a note about medications I though should be changed and wait til I could bring it up in rounds phrased as a “maybe we should…what do you think?

Now I am making changes as I see fit in the mornings, and present on rounds with here is what I have done in reaction to my findings. And if I erred (and sometimes I do, but less often than I was worried I might) I am corrected and learn something else from it. I am finally starting to stay ahead of my patient’s findings instead of always chasing after labs. I am beginning to learn to anticipate and develop my clinical judgement. Which is a nice holiday gift

Which is good because I am working on both xmas and new years. But at least I am back on R service and have once again found my small joys. It makes a difference

So xangaland…wishing you and yours a happy holiday season and a merry xmas full of all the small joys you can find. Hope they have added up to a great year!

-Dr J.

A short list of the people who helped influence my medical personality along the way. Even though I doubt any of them will ever read this, I wanted it set down somewhere so I dont forget. And now, in no particular order

Raj Kalsi: My resident during my 3rd year trauma surgery rotation at Masonic. Hated every moment of trauma, loved the team. Thank you for not only treating me like an equal instead of your scut monkey, but of showing me the importance of documenting documenting documenting everything you think say or do with the patient for a medicolegal standpoint, and of how to befriend the nurses so you dont get quite as many bullshit pages overnight. You showed me how to make even terrible rotations or parts of rotations fun, and are one of the residents who I have tried to model myself after

Jonathan Davidorf: Not only one of my wonderful physicians, but one of the ones who had a pretty significant amount of influence on my remaining determination as I powered through. You helped show me what the business and private practice side of medicine is like, and took a chance on a young college premed student looking for some experience, and turned him into a trained opthalmic surgical technician with a skillset and ability to learn from my mistakes and criticism. While you may not always have been the best boss, I would still send my family and friends to you as an amazing doctor

Michael Lotke: For a while you had me seriously considering pediatrics as a field because you made it so entertaining. You showed me that it was okay for a physician to have outside interests like performing, or cooking, or whatever else helped to keep me sane outside the job. Pimping was never about making the student feel bad, it was about engaging their curiousity and getting us to think before we acted. You were also one of the few physicians who took the time to teach us as students what to do when patients died: how to talk to the family, how to take some time for yourself to let it all sink in, and how to accept that it is going to happen and its just another part of the job

Charles McCormick: My first real medical school professor, you taught me physiology from the old school busting out a dry erase pen and light board while everyone else was in the world of powerpoint and electronic aid teaching. One of the few people who genuinely had an open door policy, I never felt any hesitation about wandering in and chatting with you if I had a question or just wanted to say hello. You helped show me that teaching could be as important as learning, and both could be enjoyable when done by someone interested in the subject material

Dad: One of the only non-medical professionals on this list, you supported me from the beginning without ever pushing me into medicine. I got the feeling I could have been painting on a street corner, making soup in culinary school or doing research to cure cancer and you would have been equally proud. While you did not live long enough to see me make it all the way into med school, you saw me slip in the back door and a desire to make you proud after your death continues to push me to constantly improve myself, and helps keep me honest. You showed through your action two of the most important lessons I probably carry around in my head as a doctor, that a person is only as good as their word, and just because you dont like someone is no reason to be rude to them, and if that doesnt sum up how I get through most days, I dont know what does.

The List goes on, and this entry was more for me than for anyone else reading, but in case you guys were wondering what shaped me, above is a brief but important subset of people who had a pretty big hand in it.

I am surprised at how much fun it is to have med students around, more confused than I am, making me feel like I’m a genius, or at least that I’m a doctor. Hey, after five months I know things! I know the abbreviations people use! I know what’s probably serious and what’s probably not! I know when to call a rapid response! I

I try and sit down and teach the med student when i can, even if its only for 5 minutes. I remember being a med student. I remember how awesome it was when the interns and residents helped me out like that, and it definetly influenced my decision to pick internal as a field. So I’m trying to be a good intern and help them feel not so lost. I’m actually starting to figure out what I’m doing and getting comfortable. It’s probably some of each.

My one complaint would be that is is kind of hard to make friends in the program. Mostly because there is no communal downtime. Everyone is on a different rotation, in a different part of the hospital or even a different hospital, and we never actually have a chance to get to know each other. In med school you have classes, you have lunch, you have extracurricular activities.

Not to mention there isn’t a lot of “not at work” time that people have in common and can make plans. My day off might not be your day off, my early night is probably your on-call night, you’re on days and I’m on nights… so even if I wanted to make plans with someone, it’s almost impossible. But bit by bit the five minute conversations add up. I just have to try harder to motivate people to go out, I suppose

Outside of medicine, I will be performing stand up comedy again in the next couple weeks at a relatively well know LA comedy club. Anyone in the area should swing by and check it out

So My first week on wards is finally complete, and I have to say, I like it. Sure, I work 12-13 hour days, but at even when i dont particularly like my patients, i still find them interesting. And for all my complaining about night float, it did a surprisingly good job of preparing me in developing my assessments and plans.

And as usual, after checking over past entries, its amazing how much i have learned in a short time. We have a medical student on our team who is a 3rd year and just learning how to do histories and come up with assessments himself. Admittedly, when we got a late admission, i was a bit frustrated with how long he was taking, and I stepped in to finish the case, because, hey, I wanted to go home. I can now only imagine how irritating my pace must have been to my residents now that I am in that position. Nonetheless, I try to sit down and teach the med student when i can and provide the same sort of positive reinforcement that i was given, because hey ultimately that was a large part of what made medicine so attractive to me in the end.

No new fascinating patient stories this week, but stay tuned, because much like myself, you never know whats coming up!