signout | September 22, 2007Much as activism kind of annoys me--I blame my polite mother--I am fairly solidly behind the woman who's fighting facebook for banning pictures of her breastfeeding. Breastfeeding is really good for babies,* and I'm all for making it as easy for moms to do as possible. That might mean overcoming our discomfort at viewing the breasts of women we don't know.
In the U.S., it's normative to find female breasts sexay. I'm not sure why; they have a pretty clear function, and it's not reproductive. Lots of people in this culture get a little shifty-eyed around breastfeeding mothers, and although…
signout | September 17, 2007Over the weekend, I got an email from Thomas over at Hope for Pandora. Thomas blogs about science and society from a lefty point of view. Now that he's about to start in on clinical medicine, he's hoping to blog about his patient experiences, too.
Not without reason, he is fraught with panic (OK, it's really just mild anxiety) over the potential for disaster:
I was wondering if you could offer me any suggestions about blogging experiences on the wards such that I am not out of compliance with HIPAA, but more importantly, I respect patients' privacy.
He has some of his own ideas, to which I…
signout | September 15, 2007I spent the afternoon today in the office of Dr. Leaky, a neurologist who takes care of people with movement disorders. One of the patients we saw was a man in his late fifties with amytrophic lateral sclerosis (ALS, otherwise known as Lou Gehrig's disease). ALS is a devastating illness that slowly drains muscle strength until a person is unable to feed themselves, bathe themselves, or even breathe for themselves. The course of the illness varies, but affected people usually die of respiratory failure within five years of the diagnosis.
This patient had been seeing Dr. Leaky for a year, ever…
signout | September 10, 2007Seen taped to the cover of a large emergency medicine text:
Sick --> admit to medicine or surgery
Not sick --> Vicodin, generic discharge paperwork
Not sure --> admit to neurology
signout | September 6, 2007See, this kind of shit makes me crazy.
There's a press release floating around about another study that demonstrates that women and men are, well, you know. The way they are.
It should be noted that this report will appear in the Proceedings of the National Academy of Sciences (appropriately, PNAS), and is made of SCIENCE, so it's definitely true.
The study reports differentials in the importance of a potential date's physical attractiveness among male and female speed daters--I mean, among the general population. In their sampling--according to the press release--men went for the most…
signout | September 6, 2007How could I have been such a fool?
It's been two months since I started feeling empty at work. It started with anger toward some bad systems at my institution. Lately, I've started feeling some resentment toward colleagues who ask for help--a bad sign--and even occasional resentment toward patients who ask for help--a worse sign. Although I usually manage it professionally, it's only a matter of time, I think to myself, before these feelings affect the way I take care of people.
The hospital has started to feel like a prison. I've been walking around the place without any joy and just doing…
signout | August 29, 2007A friend of mine who finished her residency in June just took a job in a non-medical field. I talked to her over the phone last weekend. She is so happy in her new position, she said, so happy.
Sure, I said, who wouldn't love a 9-to-5 job after what you've just finished?
You know, it's not even the hours, she said. It's the respect.
See, apparently, when you're not a resident, people sometimes appreciate the time you spend at work. People consider your feelings when they respond to your ideas. When you do something well in the real world, sometimes you even get praise. Praise!
Apparently,…
signout | August 27, 2007For those of you who check regularly for updates, my apologies. I have been far too angry with absolutely everything about my shitty, shitty job to write anything but screed for the past couple of weeks. And no one comes here to read screed.
Please hold while I attempt to develop a new coping mechanism.
signout | August 15, 2007I was in the olive department at the local market a few weeks ago, when I heard a voice from in front of the Cerignolas. "Dr. Signout? Is that you?"
At one look, I knew who it was--the father of a girl whose forehead I'd sewn up months ago, near the middle of my intern year. I smiled, made chat, inquired after the girl, and cooed appropriately about her impending entry into kindergarten. All the while, I fought the overwhelming urge to bolt, because moments prior--seeing only the rear view of the father and son--I had cursed them under my breath as I'd impatiently maneuvered my shopping cart…
signout | August 8, 2007Running a resident team on the general medicine wards is not a simple thing, especially at this time of year. The medical students are new to clinical work, and are painfully self-conscious. The interns are new to the hospital, and are scared of their own shadows. The upper-level residents are new to running teams, and are not completely sure what it means to be in charge.
That's not to say we don't understand our responsibilities. As one of those upper-levels, it is my job to set the team's priorities, which means I determine the order of rounding and delegate work to different members of…
signout | August 3, 2007As part of my efforts to multitask, I read while I work out. It works well for me: if the reading material is interesting, I hardly even notice I'm schvitzing while reading. An unfortunate consequence of this habit is its magnification of my tendency to talk to my reading material, as when I yelled "Oh, no you didn't!" at the article on workplace discrimination against caregivers in last Sunday's New York Times Magazine. I was provoked by the part where the author, Eyal Press, unflinchingly writes that "becoming a parent is a choice."
Let's be clear: In the United States, half of all…
signout | July 31, 2007P.S. I love Highly Trained Monkey, and consider myself extremely remiss for not posting the link to the latest Change of Shift at her blog. Enjoy!
signout | July 31, 2007We're not supposed to pick favorites among our patients, but I have one. We'll call her Brenda.
Brenda heard about our clinic through a friend of hers, a guy she used to smoke crack with. She'd been off drugs and booze for almost a year when she came to see me. Now that she was sober, she said, she realized she had "normal-people problems"--joint pain, high blood pressure, obesity--and needed a normal-person doctor. She had anything but a normal-person mouth, however, and from the moment I met her, said anything she wanted to, any time she wanted. She never held back the many, many things…
signout | July 22, 2007I stayed in the hospital late last night to finish some paperwork. As I was nearing the end of the pile, the code bells went off. I didn't have to, but I ran, anyway, and when I got to the room, I was the first one there.
I took a deep breath. "I'm with internal medicine. How can I help?"
I'm an upper-level resident now, and that means that when I find a situation requiring resuscitation, I'm expected to know how to manage it. A nurse practitioner holding the chart looked up and recognized this, and me. "Signout! She just went unresponsive. They were concerned she was brewing sepsis earlier…
signout | July 17, 2007It's unbelievable, the company I somehow manage to keep in this blog neighborhood: Rob Knop of Galactic Interactions is one of the cosmologists today awarded a portion of this year's Gruber Prize in Cosmology.
Since pretty much the second he hung out his ScienceBlogs shingle, Rob has regularly been served a pretty good helping of shut-the-fuck-up, just because he's into God. And yet, he still bothers to educate readers--often with surprising gentleness--on the ways in which faith can be constructive. Although I've never met him, his blog shows him to be a principled, reasonable, and…
signout | July 12, 2007For those of you craving more more more on the origins, hangups, and favored afternoon activities of the Signout, hie thee over here. Although the ScienceBlogs interviewers call me elusive, I insist that I really am slow-moving, easy to spot, and marvelously accessible, as demonstrated by the thirty pages I received while my intern was in clinic this afternoon.
Slow-moving, I say! Unless good pastry is involved, in which case, get out of the way. I am not even kidding.
signout | July 12, 2007About a year ago, when I was an intern in the throes of my first medicine ward rotations, I got a compliment that shone in my memory for weeks.
We had a rather complicated patient on our team. Her case was such that she often required several family meetings a day, and because I was busy with checkyboxen, those meetings were usually attended by my senior resident, Dr. Tremble. Of a certain afternoon, Dr. Tremble was in clinic, and I attended a meeting in his place. Afterward, the patient's husband followed me out of the room, and asked me--in front of the medical students, no less!--whether…
signout | July 7, 2007Every now and then, I get email from young aspiring physicians who wish to drink from my fount of wisdom with respect to Choosing a Life Direction. I find this hilarious, seeing as my path to where I am now has been of the relatively winding variety, and that even on the best of days, I still see myself as a seeker. Although I am honored that these bright stars look to me for suggestions, they really could do better.
And do better, they shall! I'd bet that at least a couple of the medical types that read this humble blog could offer guidance greatly exceeding mine on multiple levels. To them…
signout | July 4, 2007I've started my second year of residency with a rotation where I don't really function that differently from an intern. Our job descriptions are almost exactly the same: arrive stupid early, gather data on several sick people, round with our moody attending, and run around following up on details for the remainder of the day. The care of most of the patients on our ward is pretty specialized; under the fellow's supervision, I play at subspecialist-style management, but my actual decision-making is limited to basic inpatient medical issues.
Most of the time, I feel just like an intern.…
signout | July 2, 2007I have a secret crush on one of my patients, an 85-year old man who's recovering from a bad pneumonia. After a weeklong stay in the intensive care unit, he has recovered at a remarkable pace: the day after he was extubated, he was out of bed with a physical therapist, making his way slowly around the ward with a walker and a big smile.
What motivates him to work so hard at recovery, the nurses say, is his love for his wife. They have been married 60 years. She comes in to see him every day, wheeled around by their daughter. The whole time she is there, they say, he holds her hand as if it is…