signout | December 15, 2006I just started a rotation on the adolescent wards, and about half of our patients have eating disorders. They are all girls, and they range in age from 12 to 17 years old.
Every day, they have group therapy meetings in the recreation room at about noon. They file by our work area in flannel pants and pony tails, wearing shirts from cross-country teams and field hockey teams and basketball teams, slapping their slippers on the floor. They are all somewhere between 60 and 80% of their ideal body weight for height.
As they walk by, I think to myself, "Man, they are so pretty." And I am not proud…
signout | December 10, 2006Today, in another of her cantankerous and directionless "interviews," Deborah Solomon of the New York Times at least got something right. This time, the subject of her bullying is Louann Brizendine, a professor of neuropsychiatry at the University of California, San Francisco (UCSF). Brizendine, who in her picture insists on the heeled ankle bootie, just came out with a book about why all women are catty bitches. (Finally!)
Near the end of the interview, Solomon notes that while Brizendine draws on other scientists' research in writing her book, she hasn't done any research herself. In…
signout | December 4, 2006During my first week of medical school, we watched a video that documented the life and death of a child diagnosed in utero with neurologically devastating spina bifida. The girl's parents had been aware of her prognosis long before her birth, but chose not to terminate the pregnancy; they cared for her until her death at 8 years of age. Speaking several years afterward, they regretted nothing. They saw her, and the opportunity to take care of her, as a gift from God.
I distinctly remember sitting in the lecture hall and thinking to myself, you people are out of your fucking minds. I grew up…
signout | November 21, 2006I was drinking my coffee unawares the other morning when I somehow got roped into a rather unpleasant exchange.
"I don't know if anyone's told you yet," said the blonde-haired senior resident who comes from money, "but your role in the NICU is to stay awake. Don't ever, ever go to sleep when you are on call. You need to be available to answer questions about the patients you're covering."
"That's bullshit," said the brown-haired senior resident with the eating disorder. "It's not like anyone ever comes to us with questions about our patients--they go straight to the nurse practitioners, who…
signout | October 28, 2006The other night, I started writing about one of the things I hate about the NICU, which is that no one there talks about death. I didn't finish it, so I didn't post it, thinking I'd get to it the next night.
The following morning, instead of our usual attending rounds, we had a "debriefing," which is basically a meeting of everyone in the NICU involved in the care of a patient who has died. As these things often are, it was a lovely example of the support that people can show for each other at moments when they question their own actions and motives. But beyond that, the session helped me…
signout | October 24, 2006These days, I snicker a little when I hear doctors say it's a privilege to take care of people. If it's a privilege to submit to this shitty schedule, that crazy attending, and those revolting bagels, I sneer, I don't want to know about the punishment. But in clinic the other day, I actually understood what they meant. All it took was a fat kid.
She was 13 years old and quiet in a sweet kind of way, and she weighed 250 pounds. "I've been fat all my life," she said, "and I just want to lose weight." On the parental questionnaire, her mother had written only, "I am concerned about my daughter's…
signout | October 21, 2006Today, I admitted a week-old baby whose mother didn't know she was pregnant until she gave birth to him.
Let me repeat that.
Today, I admitted a week-old baby whose mother didn't know she was pregnant until she gave birth to him.
When her contractions started last Friday afternoon, the 13th of October, she ran a hot bath to soothe what she thought were cramps, but leapt out of the tub when she saw a head appearing between her legs. She cut the umbilical cord with a pair of kitchen scissors, but because she hadn't clamped it first, she bled extensively prior to delivering the placenta.…
signout | October 19, 2006It is 1 a.m. on a Thursday night, and the only light in my apartment is coming from the laptop that sits in front of me in my bed. In four hours, I'll begin my third day of a monthlong rotation through the neonatal intensive care unit (the NICU). I normally do not have trouble with sleep, but every night since starting this rotation, I've laid in bed awake for hours, my thoughts coming fast and strange. Although I eventually sleep, I wake up in the middle of the night unable to rest for hours at a time. The only dreams I can remember are about being lonely and scared.
I'm not sure why this…
signout | October 15, 2006When I started medical school, I was not into kids. It was partly a matter of principle--I didn't want to do what everyone else was doing, and everyone else was loving kids, so it became my business to not like kids. Another part of my distaste was the spectacular humorlessness of so many people in pediatrics, their overall trend toward an inauthentic kind of hokey-jokey smileyness and their tendency to stare blank-eyed and confused at sarcasm. I was also rubbed wrong by the unspoken ethic--and not just in medicine--that kids deserve more care, more love, more forgiveness, more everything,…
signout | September 26, 2006Although I more or less like all little old ladies, there's a certain subset of the genre that I love. The ones who are over 80 with the skinny bodies and the voices creaky like rocking chairs-they completely do me in.
When I go into their hospital rooms early in the mornings, I watch them for a moment before I wake them. I love their little heads drooping to the side like heavy blossoms while they sleep. I love the curls their skinny hands make around the covers. I love their little bellies, soft and round like puppies'. God help me, if it's wrong to love an old lady's belly, I don't want to…
signout | September 24, 2006This month, I'm rotating through a small community hospital that is affiliated with the academic center where my residency program is based. For residencies based in well-staffed, well-resourced academic centers, the point of having their residents rotate through a community hospital is to expose them to the real world of medicine. A significant proportion of the hospitals in this country are community hospitals, and because these facilities have little to none of their budget devoted toward research, they often have far fewer specialty services and facilities than academic hospitals do.
This…
signout | September 16, 2006"Is someone down?" asked T., who was driving. We were on our way back from an intern retreat day in the mountains, and while stopped at a traffic light, we had noticed a cluster of people standing in the oncoming lane of traffic. Looking out my door into the dark, I could make out three people looking down at a black umbrella. Under the umbrella was a body. "Yeah," I said, "someone's down."
I got out of the car, crossed the street, and ran toward the umbrella. S. was close behind me, and T. got out of the car and followed him. A young woman was lying down on the ground with her legs bent at…
signout | September 7, 2006On my first day as a medical resident in clinic, one of the patients on my roster was listed as having a chief complaint of "genital rash." No big deal, I thought to myself. I am a young, progressive, body-positive doctor. Everyone has genitals! I am unfazed by genitals! Let there be a genital jubilee in my clinic! I'll make s'mores!
But when I walked into the room and saw the patient-a 24-year old guy with not-small shoulders and a great big smile-a policeman, for the love of God-my hands got clammy. I was torn between the urge to flirt and the urge to bolt. But I am a doctor now, so I faked…
signout | August 20, 2006Today has been an unbelievably frustrating day in the hospital, but I don't want to bring anyone down. In an effort to promote peace, harmony, and blogular happiness, I'm going to instead write about something everyone can get excited about: the patriarchy.
Earlier this year, the venerable American Medical Association (the AMA) put out this press release, which describes the findings of a recent study of young women's behaviors on Spring Break and their subsequent gnawing regrets.
I found the press release appalling. For starters, by leaving men out of the story, it tacitly sent the message…
signout | August 16, 2006I have heard through the grapevine that certain people are not so interested in reading what I write here because it is, and I quote, "too sad."
It's never occurred to me that my job is especially sad. Yes, I'm surrounded by sick people, and yes, most cheese danish to be found in our hospital is abysmal. But by this point, most of my colleagues and I have created so much distance between ourselves and our patients that it takes a lot to really make us feel sad about our work. Plus, we can always bring in danish from outside the hospital.
With the exception of the occasional paperwork…
signout | August 13, 2006Since I came on the medicine service, my team has been taking care of a man who because of one of his unfortunate afflictions I will call Mr. Scrotum. Mr. Scrotum is a 70-something man who came to the hospital with an infected prosthetic knee joint. He had surgery to clean it out, then came to our service to get medically stabilized prior to beginning physical rehabilitation. Unfortunately, Mr. Scrotum had some post-operative complications, including some wacky mental status changes and a fairly reversible kind of kidney failure.
Mr. Scrotum's medical course, while not ideal, is a fairly…
signout | August 8, 2006It was bound to happen sooner or later: I finally broke someone.
Last Thursday, we admitted an 84-year old lady with bad disease of her kidneys and their vasculature. Her kidneys were too sick to make urine, making her a good candidate for hemodialysis. (In hemodialysis, a patient's blood is circulated through a big machine that sucks waste and excess fluid out of the blood-sort of an out-of-body kidney).
The goal on admission was to manage her acute issues, find her a slot for long-term dialysis as an outpatient, and send her home. Her most acute issue? Her very high blood pressure: she…
signout | August 1, 2006On Sunday, we admitted a new patient to my team, a young, kind of hip lady with an 8-month history of progressively worsening abdominal pain, fever, night sweats, and weight loss. All signs pointed to pancreatic cancer, which generally has a very poor prognosis. So it was a little confounding when the initial CT scan failed to show a pancreatic mass.
My team spent about an hour and a half discussing her differential diagnosis-the list of diagnoses she could possibly have-with two different attendings. It occurred to me at a certain point that I so badly wanted this woman not to have cancer…
signout | July 31, 2006I got a spot of blood on my dress today. It happened as I was on my way out of the hospital and heard the code bells ring. I ran, cursing, past two women clutching each other in a hallway, into a room where a man was lying unconscious in a chair, blood trickling from his mouth. He was a pre-transplant patient-a man about to get a new liver.
Ideally, a code is a carefully choreographed disaster. No one expects the outcome to be good, but everyone expects the process to be organized.
This code was a disastrous disaster. I didn't participate this time-just tried to stay out of the way. The…
signout | July 27, 2006As a brittle, childless spinster, I don't have child-rearing experiences of my own to draw on. Yet every day in clinic, I make reassuring eye contact with haggard looking, applesauce-spattered people, and explain to them how to raise their children. I have no data to back me up-only snippets I've overheard from people who actually know what they're doing.
This is not evidence-based medicine. This is fraud. As someone who has never had the pleasure of ignoring a breath-holding spell or a tantrum, I feel like a total jackass telling parents to do it. But what's odd is that when I speak as if I…