Oh, readers. Is there anything I can say that will appease you? Thank you for the inquiries, the orders, and the pleading tones. I swear, I'm alive; medicine is still interesting and worth writing about; and although Scienceblogs.com may eventually lose patience with the intermittent nature of my writing, I haven't yet lost interest in writing intermittently. Soon, I'll tell you about the things that have happened since November. (November! I'm going to blogger hell.) I'll tell you about running codes by myself; about coming as close as I've ever come to saving someone's life; about the…
I've been away from the blog for a while, working on fellowship applications and riding the wave of the ICU. Thank you for your patience, as ever. As you might remember from my days as an intern, I used to love the ICU. That love is no longer: doing procedures to people whose fate is inevitable isn't as much fun as it used to be, and I feel powerless in the face of a culture that doesn't exactly embrace the avoidance of unnecessary intervention. This most recent time in the ICU, I worked with an intern who seemed to me less eager than some to take on the burden of her responsibility. About…
It's October 1st (well it was yesterday, anyway), and I'm pretty excited, because this means it's the start of another DonorsChoose challenge. For those of you who weren't around at this time last year, DonorsChoose is an organization that pairs up your ka$hmoney with educational projects in public schools. You get to choose the project your money goes to fund from an enormous range of schools, subjects, and students. It's sort of like what tax dollars are supposed to do, only it actually works. Last year, I set what I thought was an ambitious fundraising goal for Signout's readership, and…
Courtesy of the excellent bioephemera's Jess Palmer comes this item of news, which concerns photographs of patients taken at the University of New Mexico Hospital and posted to a website. The photographs were reportedly close-ups of injuries being treated--no faces or patient-identifying features were shown. The employees who took and posted the photos have been fired, and several others have been disciplined as a result of these events. My initial response to this was, "What's the big deal?" The implication of the firings is that taking someone's picture--even if it's not possible to…
From the Department of the Maximally Self-Righteous comes this delightful little piece of scholarship, a letter to the Journal of the American Medical Association (JAMA) that describes a survey of internal medicine interns on the subject of professionalism. In it, participants were asked to rate their participation in and perception of "unprofessional behaviors" related to residency. The survey* was created based on the input of third-year medical students, residents, and faculty, and was administered in the first three months of the subjects' intern years. Among behaviors rated as most…
While I slowly scrape together some original Signout blather on one of my favorite subjects, please to enjoy this terrific post by Dr. Rob about why much of the crap patients go through is not the fault of their providers. When you're done, read PalMD's interesting piece that follows up his first answer to "Would you do it all over again?" (See also the comments section in Orac's pointer.) Then, as a snack, go here for some outstanding fashion photography. After which you may enjoy this week's Change of Shift. Also, my heart goes out to those memorializing loved ones lost on this day in 2001…
There was a very nice piece in the New York Times yesterday about an oncology nurse's first code. Go read!
Anyone wishing to consume some tasty medical writing around the theme of "education" should have a peek at this week's Grand Rounds at A Chronic Dose. Laurie has kindly included not one, but two of Signout's snowflakes in her recent flurry of activity. Speaking of which, this daily-plus blogging thing is exhausting. I need a vacation.
You heard it here first: John McCain got Sarah Palin's daughter pregnant. You think I'm kidding? John McCain has repeatedly voted against legislation that would have prevented unwanted pregnancy by providing insurance coverage for birth control, programs to increase access to and awareness of emergency contraception, and biologically-based sex education. He has repeatedly voted in support of abstinence-only sex-education programs, which don't work to prevent teen pregnancy. He also voted against laws requiring that they be vetted as medically accurate before being used. He voted to earmark…
Every now and then, I get email from pre-med types who are having a lot of trouble deciding whether to go to medical school. Dear Dr. Signout*, I was supposed to start medical school last week, but [I've deferred for a year to figure things out.] I guess the thing is, I like living so much, and medicine seems both incredibly in line and at odds with that--you give up everything you've ever been passionate about to live, to the extreme, one particular passion. I know that what-ifs are horrible exercises of futility, and that denial and self-rationalization are crucial elements of happiness,…
One night last week, with not a whole lot going on, I strolled into the MICU to say hello to my friend Tom, who was working overnight. "Wanna go for coffee?" I asked. "Can't," he said, leaning against the nurse's station. "Probably gonna code the lady in room five sometime in the next half hour." I thought he was kidding; people anticipating an impending resuscitation are usually too preoccupied to lean on things. He saw my raised eyebrow and explained: the woman had been terminally ill for months. At her daughter's insistence, she had had every life-prolonging intervention, even beyond the…
It's been an exciting week here at Signout. Now that I am back from my unannounced sabblogtical (yeah, I made that up), I've tended to some much-needed housekeeping. To wit, the blogroll has been pruned of defunct and outdated links. Now you may futz around all up in the sidebar without fear. Futz, I say! Speaking of, and not to nag or anything, I kind of wish you'd give a little more click to the DonorsChoose link I posted last week. Every single visitor to that site can raise up to 10 bucks by voting for each of the 10 video profiles listed. With two minutes and a little back-button savvy,…
Last week, I got invited into my program director's office for a little chat. My previous week's attending had emailed him about a complaint made by a family with regard to the way I'd handled an event on the general pediatrics wards. The exact events don't really matter: all you need to know is that I made the mistake of relying on second-hand information while something fairly concerning was evolving. Although nothing untoward came of this, the perception of a delayed reaction on the part of a patient's family was enough to provoke a complaint. And another thing, said the email. For part of…
Yesterday, when I was on overnight call, something truly astounding happened: the hospital ran out of coffee. By which I mean, there was no coffee available all day, nor all night. To quote one of my favorite ScienceBloggers, what the fucking fuck?! Seriously, what kind of hospital runs out of coffee? Doesn't that violate some kind of accreditation requirement?* I had intended to write something thoughtful on my arrival home, but I'm too inadequately caffeinated to put a coherent thought together. Instead, you get the following link, which certainly benefits humanity far more than my usual…
You know how, when you squint at a colorful tree, the borders disappear, and all the leaves merge together into one big mass of green? Turn that inside out, and you have my relationship with The Hospital. At times--especially difficult times--all the departments and interests and people in that place start to merge. Their demands and rules start to become one entity's demands and rules, and their borders disappear. I have to squint hard to separate the strands that come together to form the rope around my neck. My friend Jack was in a terrible accident last week. I heard about it the evening…
Praise be, and hallelujah! That is all.
Let's say, for the sake of argument, that my first name is Trixie. I spent most of my first year of residency introducing myself as "Trixie Signout, the junior resident on the team." I got called "nurse" a lot, then started introducing myself as "Dr. Trixie Signout." I wanted people to feel comfortable calling me by my first name, I said. I didn't want to seem classist, or superior. Most of my patients ended up calling me "Doctor," anyway. During most of my intern year, it felt like a joke. But over the past half year or so, I've started to feel like that's really what I am. I finally feel…
I love to cook. I have a blog. Today, and probably a few more times in the future, I will post about cooking on my blog. Questions, concerns, and hangups may be directed to the management. I once had a friend who didn't understand the fetishization of chocolate. He so resented its common acceptance as The Best Sweet that he systematically avoided it in almost all of its forms. For this, I thought he was a fool. We argued about it now and then. I'd sulk whenever he ordered apple crisp; he'd turn up his nose at my black-bottom pies. Then, for his birthday one year, I got him a pile of premium…
"What I want you to do," I said, "is breathe in deep, then blow it all out like you're blowing out birthday candles." He focused his eyes in concentration and blinked a few times, then did as I'd said, aiming for the finger I held in front of him. I listened to his back with my stethoscope. "Again," I said. "Again. Again. Good job! Again." His mother sat forward in her seat and breathed in sync with her boy, her face softened from the suspicious glare she'd trained on me a moment before. After I'd listened to every part of the kid's chest, I put my hand up for a high five, which he gave me…
A few months ago, a new patient walked into my clinic at four o'clock on a Friday afternoon. She was a fiftyish woman who had recently moved to the area from a different state. On the plane ride up, she had developed a fever and cough, and the day after arrival, had been admitted to the hospital with a huge, cavitating pneumonia. She was seeing me in follow up to her hospital stay. Her hospital discharge, which I had skimmed earlier in the day, detailed an extensive past medical history including sarcoid disease and drug abuse. That afternoon, when I walked into the room where she waited for…