ndab Ah Yes, Medical School

Thursday, May 17, 2007

A Step Down, A Step Up

As graduation rapidly approaches, I have felt this growing pressure to come up with some creative way to capture, summarize, and otherwise wrap-up my four years of medical school for you. After all the freaks encountered, bodily fluids sprayed with, and orifices probed, I figured it would be pretty easy to come up with something good for a grand finale. But then I realized that I haven’t actually worked up, talked to, or been within ten feet of a real patient, doctor, or classmate for almost five months, so my arsenal of pathetic real life experiences has been severely depleted (although as an aside, isn’t fourth year of medical school just the most amazing thing ever?).

Given this dilemma, I attempted to turn to other sources of inspiration in my quest to forever enshrine the experience that is medical school. At first, it seemed as if popular culture was going to make this really easy for me. Almost immediately after beginning my quest, I discovered that Keith Richards admitted to snorted his father’s ashes. A ha!, I thought. If snorting your own father’s remains in a drug-induced stupor isn’t what medical school is all about, then…umm…actually that’s just really fucked up. But after all, that right there is about as ridiculous as anything I’ve experienced these last four years, and if there’s one thing that sticks out about medical school, it’s the sheer ridiculousness of the whole process (for examples, see…the rest of this website). But then I realized that that makes absolutely no sense whatsoever, and I moved on.

Only moments after doing so, I was blessed with yet another pop-culture discovery that I thought could enlighten me on how to commemorate my medical school experience. Flipping through the channels one night, I happened upon ABC’s The Bachelor (“happened upon” or “lustly devoted to”, I’ll let you decide). At first nauseated by the profile of the bachelor and his freakishly tool-ish qualities, I soon discovered that he was a physician, which seemed to account for all of his forced, tool-like behavior. A tool doctor on a tool dating show, now that’s medical school! To my delight, the show turned from simple comedy to pure spectacle, for I would have never thought that this show could have encapsulated the true narcissism, comedy, and humiliation of medical school until I saw the distinctly familiar face of one of my classmates emerging from one of those limos they herd the women through during the introductions. What follows is a severely edited version of my stream of consciousness during this historic moment of television:

Holy crap, that crazy chick from my class is on The Bachelor.
Holy freaking crap, that crazy chick from my class just read the bachelor a fortune cookie note.
Holy freaking mother fucking crap shit balls ass fuck, that crazy chick from my class just sang the national anthem to the bachelor in front of millions of viewers.

Unreal. I was literally laughing on the floor for a few minutes, and I had the chance to see her sing over and over again (and subsequently roll on the floor over and over again) courtesy of my friend’s DVR. Un-freaking-believable. Did that really happen? Did she really sing that entire thing? Did she just provide one of the most awkward moments in television history? Seriously, if that isn’t the most ridiculous thing that has happened, if that display of shameless comedy doesn’t summarize the, umm, shameless comedy of medical school, than I don’t know what does. Yet, following her progress through the next few episodes, I couldn’t help but feel that while her hapless moment in the sun has provided my friends and I with a lifetime of unintentional comedy to bond over, this scenario is wholly hers, not mine, and that there was really no way to adapt some moment of hers to summarize four years of my misery.

Yet, just when I thought I was out of luck, that I would have nothing of substance to submit to you, the reader, that could fully capture the last four years of my life, that cruel, ugly bitch known as Fate intervened. For you see, I had the privilege of being in the wedding party for one of my best friends wedding last week (I also came to that city a little early to find an apartment). While not a best man, I was an usher and given the responsibility of reading a poem selected by the couple-to-be during the ceremony. I walked up to the pew, read the piece (a stirring rendition, I should add), and turned to my left to walk back down the stairs.

Except a funny thing happened while walking down the stairs. You see, I was wearing those shiny rental tuxedo shoes and…well…I slipped, fell, and tumbled down the stairs with a monstrously loud thud. During the wedding ceremony. In front of just about every single one of my best friends from college.

I immediately jumped up, ignoring the enormous welt I just delivered to my behind, and walked to my seat, my face now literally as red as my thunderstruck ass. I then had to hear about me being a monstrously large jackass for the next six hours at the reception (deservedly so, I admit). And, to top it all off, I returned to my car that evening to discover that someone had smashed my driver side window and stolen the GPS thing I bought from Costco to help me navigate the city while looking for apartments (which I of course was not planning on returning to Costco immediately after this trip, cough cough). Crap. Did I mention that I never even found an apartment?!? So the next day I had a six hour drive home with no driver-side window, no apartment, and a huge, painful bruise on my ass.

Ladies and gentlemen, that right there, that’s medical school.

Well, not entirely. The following day, I discovered that an apartment I thought I was aced out of had become available, so I snagged it. And my now-married friend thanked me for my tumble, because it made him feel infinitely less nervous standing up there about to get married. And, while I still had a massive, painful bruise on my backside, I took a picture of it and emailed it to all my friends to force them to at least share in my misery by having to look at a picture of my ass.

Now that’s medical school.

The frustration, the embarrassment, the comedy, the pain, the promise, the shared misery, the occasional burst of inspiration, that 24 hour sequence captured it all, and that is what I have been trying to convey to you these last few years. After all, the vast majority of questions emailed to me go something like “So what’s medical school really like?”, and my answer is simply:

Medical school is like falling on your ass at your friend's wedding in front of your best friends from college, having someone break into your car shortly thereafter, but having it all somehow work out for the best in the end.

I still don’t know if I am doing the right thing, I don’t know how long I am going to last as a resident, and I don’t know how much I am going to want to last as a resident. I do know that these last four years have been some of the most frustrating, embarrassing, funny, inspiring, and painful years of my life. So when I step up to receive my diploma in a couple of weeks, I’ll try to keep these racing emotions and memories in mind. Well, that, and not slipping and falling on my ass again. But I genuinely hope that I have been able to share some of what I have gone through with you, in a way that you can understand, so that perhaps you have a newfound insight into how the person responsible for making sure you are healthy, well, and fit becomes that person in the first place.

And, finally, I wanted to thank you for entertaining me with your comments, questions, and (most especially) hate mail, for pushing me to get off my lazy ass and whine on the Internet from time to time, and for maybe, just maybe, helping me remind myself why I keep doing this in the first place.

Thank you.






Oh c’mon, you think I was just going to end it like that? Gratuitous wounded Fake Doctor ass shot for everyone!!!


Oh, and just in case anyone was curious, I did reserve Ah Yes, Residency...

posted by The Fake Doctor at 4:02 PM 116 comments links to this post

Wednesday, April 11, 2007

World Tour 2007

Greetings. I just wanted to pass along two quick things:

1) I have been getting an inordinate amount of email asking me which speciality I have matched into. While I have previously discussed my interest in hematology/oncology, you can't match directly into that and have to do something else first. Rather than try to come up with another witty, hilarious romp through the medical profession as I try to pick a residency, I will instead point you to the post where I discussed this ad nauseum and let you go back to sending me plain old hate mail instead.

2) I will be out of the country for a little while, taking full advantage of the fourth year of medical school and all of its rigors (don't worry, I have a lot to say about this...and what this has to do with Keith Richards and The Bachelor...however, I don't have time to explain right now, because my plane is leaving in a few hours and I should probably start packing), but I promise to return with the aforementioned rant on fourth year and my need to complain about something even when I am on vacation.

posted by The Fake Doctor at 4:10 PM 21 comments links to this post

Sunday, April 01, 2007

Something Missing

A funny thing happened while my dad and I were moving my stuff out of my apartment this weekend. We loaded up a truck that, unlike a fine wine, has aged like Mick Jagger’s right testicle, to the brim with all sorts of big things that I own: a desk, a dresser, boxes and boxes (and boxes) of porn, and my virginal mattress and box spring. Since the mattress and box spring were the last things we took out of the apartment, they ended up on the top of my pile in the truck. We turned on the engine with a fiery switch of the ignition (at this point I would like to thank the fine craftsmanship of the Ford automobile company…circa 1954) and were off on a treacherous 10 minute drive to my grandmother’s apartment, where we would ceremoniously dump all this stuff in one of her unused rooms. We arrived at the apartment, hopped out of the truck, and opened up the backside. It was at this point that my dad made a funny look with his face that had nothing to do with the Pollo Bowl (without pollo, of course, because we’re such good Jews and we doubt the fine folks at El Pollo Loco carry Kosher chicken products) we had a few hours earlier. Naturally in my completely oblivious state, I started tugging at the mattress to pull out it of the truck and get the misery of moving over with. This led to the following exchange:

“Uhh…[Fake Doctor]?”
“Ya?”
“Umm…I think we’re missing something.”
“Huh?”
“Ehh…where’s the box spring?”
“Umm…”
(In unison) “Shit.”

An airborne box spring sailing somewhere on one of the major streets we had just driven past has made me a little introspective over the last 24 hours. I couldn’t help but feel that, during these last few months, I too had been missing something. I couldn’t shake the notion that there was something I was supposed to be doing, someone I was supposed to be talking to about something moderately important that had happened in my life, someone who was exceedingly thoughtful and genuine with concern for my future. What could it possibly be? Fortunately, I have you, the reader, to keep me in line in situations like this. For as I searched for this missing aspect of my life, I received an email with the subject heading “Fuckface”, by S.C., that went as follows:

“Did you match you fuckin’ cock sucker?”

Of course! After all this soul-searching, I knew that what was missing was…passion. Passion for the career-path that I am following. Passion for the study of medicine. Passion for a life that thousands of people work so hard to attain each year, a life that I have been trying to minimize during these last four years. In all seriousness, if I had the opportunity to look at myself as I was four years ago, I would have a hard time recognizing the idealism, hope, and excitement that I had within me throughout college and the start of medical school. At some point during the last four years, something started seeping out of me, slowly at first, but then quickly and ferociously, and it makes me sad that I have such a hard time reigniting that fire again. So it is with a mixture of excitement, trepidation, and somber realism (something I clearly lacked before embarking on my medical school career) that I have matched at my first choice institution. More importantly, I am hopeful that that missing element, akin to the joy that people who love their jobs and their lives display for everyone to see, will begin to reveal itself once again.

Wait, what was that? I have to work 80 hours a week? Christ. Well, on the bright side, my dad and I found the box spring resting comfortably on the side of a quiet street, far away from oncoming traffic, and in surprisingly good condition. Something is missing, no more.

Huh? Oh you want to know where I matched? Seems like there's always something missing, no matter how hard I try...

posted by The Fake Doctor at 11:09 PM 49 comments links to this post

Tuesday, January 23, 2007

Ask The Fake Doctor 6

Breathing out…now. Having just returned last night from my last whirlwind trip around America doing interviews for residency, I admit to achieving something pretty remarkable. After all, I did not think it was possible to watch Futurama on the Cartoon Network for 4 straight hours, but thanks to the groundbreaking satellite technology available in today’s planes, such things are now possible and can be realized, as I did last night. I’d also like to say that I have reached some grand epiphany about how to rank the programs I have seen, where I would like to go, and what I would like to be doing, but that would involve me actually having some clarity about my life which, as you might have already inferred, will not be happening anytime soon.

Since it is pretty clear that I have absolutely nothing interesting to write about these days, I figured I might as well turn the spotlight over to you, my glorious readers, and go through some of your delightful fan mail. Apologies in advance for the massive length of this post (it has been a while, after all), as well as to the letter-writers I have not yet had the chance to reply to. And if anyone has any bright ideas on where to go for residency, I’d really like to know.


So, I am 28, and all of a sudden I got the urge to go to medical school. I am a computer programmer, and I think that I’d be much better as a doctor. Do you think that 28 is too old? I found your blog when I googled medical school. I’d like to hear your opinion.
-M.

I have a few answers to this, and I’ll let you decide which one you prefer to take:
1) There is an adage that says “It’s never too late to start something new”, and that advice applies to medical school as much as anything. That said, you better be damn sure this is what you want. Lets ignore all of the other commitments you’re signing up for and do the simple math first (assuming you haven’t done any premed requirements yet):
Doing a post-bacc: 1.5 years
Medical School: 4 years
Residency: 3 years (minimum)
So that’s at least 8.5 years, which is an optimistic assessment, meaning you’re going to be 36 or so before you are even finished with your training. Now, for many people, including a fair number of classmates of mine who are as old or older (the oldest in my class was 37 years old when she started) than you, that is not too big of a deal. Personally, I’d be frightened by the prospect of not even being finished with training by the time I am approaching 40, but that is just me. So you have to just be honest with yourself and decide whether you really want it, and if so, then go for it.
2) If you start medical school at 28, that means you will not be able to wear your long white coat/chick magnet until you are at least 32, which seems like wayyyy too long for me.
3) Wait, you want to drop computer programming to go to…medical school?!? Having recently visited the Google campus, I strongly suggest you send them your resume and do the same before making this decision. Christ.

You get mistaken for Matthew Perry? Be still my heart! Not only a brilliant fake doctor, but good looking to boot! Natalie Portman doesn't know what she's missing.
-K.

OK, I don’t actually have anything to add here. I just wanted to make sure everyone saw this email. It’s a great thing that women out there think of me as such an amazing sex symbol, desired by women everywhere, the modern Greek God, exuding muscles and hotnes-wait, what was that? You want me to read the next email? OK fine.

Are you SURE you're not gay?
-Anonymous

That’s more like it.

Whoever created this site, or writes all of these things, the doctor, you're pretty pathetic. You spend your free time bitching about a "television show" or "Hollywood." It's a show. If they were to be realistic, that would be freaking boring! People don't watch shows like Grey’s Anatomy or the medical stuff.. well maybe some…apparently you do, just to bash it…but the majority of people watch shows because they like them, not to get "facts." You might as well bash every single show and movie then, saying those situations are unrealistic and fake, that this 'hollywood' stuff would never really happen.. lol it's television!! Get over it!! I probably will totally forget to check this site.
-Anonymous

Umm.. doctor?? Where do you get all this time to watch the show...and bash so much on it???? lol. If you're a doctor, then you spend your free time horribly…use your power to prescribe and prescribe yourself.. some uumm,, what's it called that we all have?? Oh, right, a life. It's TV Drama. Not reality TV. Ass. With all the med school, you sure as hell lack a lot of common sense.. No one watches TV shows for facts, we watch to be entertained. If you hate it THAT bad…why do you continue to watch it?? lol. NICE.
-A.

Wow. I seemed to have hit a nerve here, and this is just a sampling of the fair number of hate mail I have received regarding my take on Grey’s Anatomy. I never thought my innocent attempt to provide some mildly comedic observations about a show that I personally can’t stand would set off this degree of rage, hatred, and general contempt for my misery of a life. I’m reminded of a story that was told to me once, a story about two brothers. One was very serious and studious, while the other was somewhat of a trouble-maker. One day the two brothers were arguing about something non-trivial (the details of which escape me, and for that I apologize), when the serious brother started lecturing the trouble-maker about appropriate behavior and what is or is not acceptable for all. The trouble-maker countered about the necessity of comedy and humor in one’s life and the need to pick on third parties to make a point or just for laughs. This argument went on and on, until the wee hours of the night. After many hours, the trouble-maker shoved a pie in the face of the serious brother, who subsequently discovered that pie does in fact taste good, even when splattered on one’s face. Now, what is the moral of this story (a story, I should add, that I have spent a whopping 30 seconds concocting in my head)? It’s that you are a douchebag. (For a further elaboration on this idea, check out my response a few emails down.)

Someone should design a cardboard cutout of a porn-star bending over with a hole in it. You could place it over the patient and pretend you're examining Jenna Jameson instead of Old Man Winter.
-Anonymous

Holy crap, this is a brilliant idea. Even Jenna is giving it two fingers up! Or is she practicing her rectal exam technique? Let's go with this idea. I could open up an entire line of medical fantasy diagnostic tools. Instead of that sterile white paper that gets rolled over the exam beds, the paper would have pictures of naked women on them. Bags to place over the faces of ugly women before doing breast exams. Speculums shaped like-…hmm…why do I feel like I am already getting sued before even finishing that sentence?


Classic. I've never met a psychiatrist (or neurologist for that matter) who was balanced (insert Three Stooges noises here). Neither should be permitted to reproduce. Have you ever interacted with their offspring? One word - oy.
-P.J.

P.J. brings up a fascinating point about psychiatrists. I was fortunate enough to attend elementary schools, junior high schools, and high schools with a fair amount of doctors’ offspring, and after interacting with many of these kids I have come to a similar conclusion: it is virtually certain that all children of psychiatrists are fucked up in the head. This is a remarkably reproducible phenomenon. I have no idea why this is the way it is, but I would imagine that these children are predisposed to being weird simply by virtue of their having the genes of their freak parents. If anyone has any bright ideas about this I’m sure someone has a Nobel Prize waiting for you.

Got the MCAT scores back today... Went searching on google for "MCAT Retarded". Got this blog. Thanks for cheering me up.
-Anonymous

Since I’ve already said my piece about the MCAT, I don’t really have much more to add to this other than the fact that nothing makes me more proud than knowing that my blog is the first item listed when one googles “MCAT Retarded”. I feel like I have truly made it.

After reading through some more of your old posts and seeing that you put on tefillin, I realize that you might be able to shed some light on the challenges of being an observant (to any degree) Jew in medical school.
-S.A.

Sadly, it is not that easy to be observant and be a medical student (or resident, or even a real doctor for that matter). The first two years are no problem, as your schedule is just like it would be in any other graduate school that has class from Monday to Friday. Save for the occasional asshole that schedules a final exam on Yom Kippur, there are no major issues to be had. However, once you start third year and are expected to work in the hospital six days a week (at a minimum), finding time to put on tefillin in the morning becomes rather challenging, especially during some rotations when “morning” means 4 AM. While I do not keep Shabbat, I would imagine this is also a challenge since call schedules are constantly shifting and it is virtually impossible to always have Friday night to Saturday night off every week. That said, I am pretty sure there is some sort of Judaic teaching that involves the responsibilities of being a doctor, such that physicians are absolved of following the all the Jew rules as long as they are doing something to save lives, etc., although I could not find a good link to an article that explains this in more detail. Also, do not think that it is all bad, since being Jewish and in medical school has its perks. Namely that all Jewish girls have been bred for thousands of years to desire and mate with Jewish doctors, so you are pretty much guaranteeing yourself success in that department. Unless you are me and you have no game whatsoever…but hell even sometimes it still works out, so you never know.

Quit being a fag and get used to it. I hate the fact that you lost your humanity and are laughing at someone who undoubtedly is outcast by assholes like you. He is not a 'schizophrenic patient'...he is a human being who lives with the unfortunate affliction of schizophrenia. Dickhead.
affectionately,
F.U.
-Anonymous

Personally, I think my use of the phrase “schizophrenic patient” pales in comparison with your derogatory use of “fag” to denote my apparently obvious homosexual tendencies (obvious to everyone but me, it seems – see above) and your subsequent attempt to equate homosexuality with being an “asshole”, but can you really expect me to have anything intelligent to say when I have a penis on my head? And why am I trying to have an intellectual conversation with you when I should be spending my time playing with the dick currently resting on my head? These are the things that keep me up at night (whereas, it should be noted, my dickhead usually doesn’t rise until the morning). I think I’m done here. Wait…DICKHEAD! OK now I’m done.

"slutty nurse from peds?" Jerkoff.
-Anonymous
Oh, the humanity! Oh, the horror! How dare I generalize a legend about one incredibly slutty nurse from the pediatrics ward to the entirety of nursing? Where do I find the gall to even remotely suggest that I was laughing at someone less fortunate than I (ignoring the fact that if you actually read carefully, I am not doing any such thing)? I am so rude, so insensitive. In this tradition, let me also add bluntness to my list of qualities. What do I mean by this? Here we go:

IT’S A FUCKING JOKE, PEOPLE.

Man that felt good. If you’ll excuse me, I’m going to, as you so subtly recommended, go jerk off to the picture of the slutty nurse before laughing at a few retards and bashing formulaic televised medical dramas. While I’m away, will you people please do us all a favor and remove the rods from your asses? Thanks.


And, finally, speaking of rods, a tie for the last word…

Babes, no need for pliers. Men can usually extract anything from their rectums using their own bare hands and just a tad bit of lubricant. Um ... I mean ... not that I would know anything about any of that ... I've never shoved anything in any man's ass ... nor extracted anything ... wait a minute ... I'll just be quiet now ...
-F.B.C.

Hey,
Think yourself lucky, I'm a vet in England. A finger? Try up to your shoulder in cow! And humans don't try to kick, bite or gore you! Oh and on sheep we dont bother with gloves.
-R.

Cheers!

posted by The Fake Doctor at 5:20 PM 96 comments links to this post

Wednesday, December 27, 2006

Buy Me A Clue

Last month, I found myself among some of the elite young men this generation has to offer. All of us were there, at around 9:00 AM on a beautiful Sunday morning, with clear purpose and emboldened spirits. There were men of all ages, races, and religions present, standing together with a clarity of mind not seen since the glory years of our civilization (which, in case you are curious, began during my birth in 1981 and ended with the second half of the “Who Shot Mr. Burns?” episode of The Simpsons in the early 1990s). We braved the temperate weather and clear skies for one thing, and we would not rest until it was safely in our hands. We were all after it, knowing few would actually get it. Yes, ladies and gentlemen, for those of you who have wanted to meet me in person, your best chance at catching me in an impromptu public appearance already occurred at around 9:00AM on a Sunday at our local Circuit City, as I joined some of the other local nerds, rejects, and losers waiting desperately in line for the Nintendo Wii.

Please do not adjust your monitor. You read that right.

While standing in line that morning, after having stood in other lines for countless hours, coming away empty handed every time, I had a thought on how this relates to my other current pursuit, namely a residency program that does not make me want to throw up. This occurred to me in the context of some basic economic principles (basic because my career in economics began and ended with Econ 1), because it was clear to me that while the Wii is currently in a seller’s market, with demand so much stronger than supply that the stoner employees at Circuit City could have taken a dump on my forehead and I still would have waited in line, internal medicine residency spots are currently in a buyer’s marker, because why on Earth would anyone want to do this when so many other higher paying medical careers are available? Cue momentary existensial crisis…OK done. So with that thought in mind, and having been through eight interview days (with at least five more to go), I thought I’d use some basic economic ideas to highlight what it takes to make the sale for a residency program.


Principle #1: There Might Not Be Such A Thing As A Free Lunch, But I Damn Well Better Get One.
Perhaps some programs have forgotten this, or perhaps they refuse to acknowledge this, or perhaps they just don’t give a crap, but some seem to have neglected the fact that many applicants have traveled far and wide at considerable financial expense to interview at their programs. As such, these programs see no problem with providing simple snacks or crappy hospital food in lieu of a real lunch. This may seem like silly whining from a spoiled brat (which I clearly am), but it really doesn’t say much about your program if the best you can do is a bag of Doritos and a Diet Coke. Remember, this is a buyer’s market, and I ain’t buying no Otis Spunkmeyer.

Principle #2: Econ Lectures Are Boring.
No really, they are fucking boring. I still remember being bored, and I took Econ 1 spring quarter of my freshman year of college - that’s roughly 7 years ago. With that in mind, I’d like to point out that while it’s really cute that programs feel a need to bring applicants to noon conference and have us sit in on lectures like the real residents do (golly gee whiz!), it’s a fine line between being really cute and excruciatingly boring. And if the only thing I can remember about my interview day is falling asleep during a lecture I didn’t even want to go to in the first place, that’s about as cute as Nicole Ritchie after a weekend bender in Vegas.

Priniciple #3: Insider Trading Is Only Illegal If You Get Caught.
Let’s just say hypothetically that you go to a medical school that went through a lot of changes during your time there, and while it was often a rough transition and you were exceedingly frustrated much of the time, you made it through the four years having only lost your passion and desire to do good, while the people in charge kept saying things like “Don’t worry, you’re in good hands, just trust us, we know what we are doing.” Now, let’s say that same institution has a residency program, and during the morning presentation about the program the people in charge mentioned many big changes that are coming that would affect the incoming class (i.e. you), but that you should not worry because you are in good hands and they will take care of you. Knowing what you know, having experienced what you experienced and being the insider that you are, how confident are you in that institution’s ability to actually come through on their claims of a seamless transition in the wake of substantial changes this time around? That’s what I thought.

Principle #4: The Customer Is Always Right.
So I had this one interview experience that briefly went as follows: I, along with a visiting applicant, was scheduled for an interview at a certain time. The interviewer did not show up. We were told to wait for a replacement. A replacement was quickly found for the other applicant. I continued to wait. I waited through the lunch. I asked again and was told to wait. I waited through the afternoon question and answer session. I asked again and was told to wait. The interview day officially ended. I asked again about my interview and was told to wait because, per the people in charge, they wanted to take care of everyone else first. I continued to wait. I was finally brought to an interview. I was then grilled by some arrogant prick for 45 minutes. Check please.


With these simple principles in mind, you too can learn how to run your very own residency program. More importantly, you too can stand in line for hours with the faint hope of getting a Wii, much like I did not too long ago. I am pleased to report that on that glorious Sunday morning, I was successful in this journey, and I have been immersing myself in video game nerditude ever since. So whether it’s a good residency position, a Wii, or a dick in a box, I hope you got what you wanted this holiday season. Now if you’ll excuse me, I have to go kick my roommate’s ass in video game tennis.

posted by The Fake Doctor at 3:50 PM 34 comments links to this post

Wednesday, December 13, 2006

Excuse Me While I Whip This Out

Apparently, rumors of my demise have not been as greatly exaggerated as they should have been. Sadly, I have been holed up in my apartment for the last few weeks cramming like no other for Step 2 of the medical board exams. Well, that, and jabbing a pen in my eye and pulling it back out through my nose. As a result, I have not had time to reach into the eternal grabbag of shame known as my stream of consciousness and pull out some mildly comical and moderately depressing observation on the human condition as it relates to my self-centered life as a medical student. However, I promise that I will have a lot to say in the coming weeks, including my in-depth analysis of why interviewing for residency programs while studying for the boards is a really bad idea. In the mean-time, I thought I'd collect a few interesting articles for you all to read because it's pretty clear none of you have any lives anyways:

Groopman on Experimental Drugs

A Take On Apocalypto

Jews, Christians, and Values

And, finally, remember when I wrote up a post detailing my admittedly pathetic attempt at circumcision? When I made a concerted effort to remain neutral as possible regarding this topic, focusing exclusively on my incompetence, so as not to piss off any of the extremists on both sides of the argument? Except I was bombarded by a horde of anti-circumcision fanatics calling me a horrible person, Satan, and other such unpleasentries while suggesting that even the consideration of a itty bitty teeny weeny benefit to circumcision is undeniably wrong? Well, in response, eat shit and die, assholes.

P.S. Extra points if you know which movie has the phrase that inspired the title of this post.

posted by The Fake Doctor at 11:18 PM 34 comments links to this post

Thursday, November 09, 2006

ERrrrrrrrrrrr

A Pirates Guide To The Emergency Room

Editor’s Note: Two posts in one day? He must be mad! Not really, but I got so depressed writing the first post of the day I had to cheer myself up, and since I’m all out of alcohol and I’ve seen Erotic Survivor 2 about 46 times already (thanks Patty!), I thought I’d put this together. I hope you don’t mind. But if you do, please send me some new porn so I have something else to watch. And I hope you appreciate the irony of me putting in an Editor’s Note here, as if to signify that there are two separate people working on this. I’m losing my mind.

Ahoy pirates, welcome to the grimiest ship in all the sea, the emergency room. OK I’m done (for now). Rather than change the slogan of every ER (or every medical school, for that matter) to “Abandon all hope, ye who enter here”, I thought it’d be fun to recap some of the things I’ve learned about the ER from the pirate perspective because…well…umm…pirates are fun. I feel like that needs no further justification. So please enjoy the guide that follows, and if not, it’s off to Davy Jones’ locker for ye, arrrrrrr! (See how much fun this is? There’s no way I’m not starting a patient interview tomorrow by saying “How arrrrrrrr’ ye doin’ mate?”)

Most of ye patients, they not be chum free. Aarrr.
I’m sure the rules of personal hygiene apply to most people in this world, rules such as “Clean oneself once every two to three weeks at the absolute minimum”, but it seems to me like people who go to the ER actually know they are going about 4 months beforehand and choose to stop showering, shaving, brushing teeth, or doing anything that might resemble cleanliness before entering, almost out of spite for having to wait so damn long before we see them. I mean, we get trauma patients (who, presumably, had no plans of coming to the ER before being hit by a car or something) come in who are homeless who smell a hell of a lot more fresh than other housed people with less urgent problems who have no excuse. So, please, unless you’re being brought in by an ambulance, throw on a little deodorant before coming in. Or at least try wiping the urine off your pants.

Avast, ye silly tricks be too strong for a lubber. Aye!
People do the strangest things. In the ER, that means taking us by surprise and showing us things we never thought the human body was capable of doing. Whether that be discovering that a Johnny Walker bottle can indeed fit up ones rectum or that it is possible for one to squeeze skin near ones thigh and express a milky white discharge through a hole created by a botched hip replacement surgery 12 years ago, these tricks are simply disgusting. Next time, just say you can do it and not actually feel the need to show us, we promise to believe you.

Scraping barnacles off me rudder be worse than dropping anchor in a storm.
You haven’t lived until you’ve scraped a live cockroach out of someone’s ear. I have nothing further to add here.

Shiver me timbers, swabbie be bleeding more than a scurvy dog!
It never ceases to amaze me how many people show up to the ER teetering on the edge of death, bleeding out of all sorts of orifices most people don’t even know exist (except for those of you into the really cutting edge art-house porn – that’s two porn references in one post, I’m on fire!), and not having any clue how sick they are. No, ma’am, you shouldn’t be bleeding like that, the blood is supposed to stay…inside of you. But thanks for asking, and I’m really glad you are enjoying your fifteen hour wait. Please enjoy our complementary reading material, a 1985 Time magazine.

Everthin’ be faster than a wench on me jiggers.
I never really appreciated how fast one needs to work until I started my rotation in an ER. Everything has to be done at breakneck speed, from interviewing the patient, doing procedures, and shipping him or her off to somewhere else, because there’s another 50 people in the waiting room, two gun shot wounds coming in from ambulance, and one of the patients just crapped her pants all over the floor. In other words, it’s total chaos. It’s great that some people thrive in this sort of working environment, but me, I don’t think I function all that well after 7 straight hours of chaos, which is probably a big reason why I plan on staying as far away from the ER as possible in my future (assuming I haven’t managed to extract myself from the hospital in the near future – c’mon, someone has to want to give me some money for this crap?!). It also should be noted that I like my poop to remain in the toilet. But hey, that’s just me.

Not even the scallywag can see the end of a bilge rat.
Highlighting what I find to be the most frustrating part about emergency medicine, this bit of pirate wisdom points out to a key characteristic of the ER: no patient continuity. This means that the vast majority of the time you evaluate the patient, initiate a work-up of the problem, and then transfer the patient to home, clinic, or the inpatient ward for further investigation, often never really knowing what happens to the patient. Now, for people in ER this serves as one of the perks of the field, but personally it drives me nuts. It’s like only being allowed to watch the first twenty minutes of every movie you watch. Sometimes, as in the case of just about every piece of crap movie that came out this summer, this strategy works in your favor, as by minute twenty you are about ready to kill yourself anyways. However, every once in a while The Godfather comes on, and it would be a crime, a travesty, an affront to Al Pacino’s glorious overacting to turn it off after only 20 minutes. And that’s why I cannot be an ER physician. Aye, ‘tis true.

That be the last, me hope ye liked ye trip. If not, it’s the plank for ye. Aarrrr!

Seriously this is too much fun. And can you believe I made it through an entire post about pirates and didn't make attempt to combine the word "pirate" with the word "butt"? Me neither.

(I would like to thank the folks at talklikeapirate.com for enhancing my linguistic abilities in all things pirate. FYI, Talk Like A Pirate Day is September 19th.)

posted by The Fake Doctor at 11:04 PM 48 comments links to this post

Shande

Somewhere between Einstein and Gene Simmons in the list of Jewish contributions to mankind, Yiddish, a mutt language that is sadly fading away with each generation, is arguably one of the most fascinating and lasting because of its richness and knack for having just the right dour expression for any situation. I thought of Yiddish today, motoring around a packed county emergency room, because I cannot stop thinking about one expression in its repertoire: shande fur de goyim. Literally, this means “shame for the gentiles”. It is an expression used by Jews to describe a person or event that brings a collective shame to the Jews, something that makes us think the gentiles (that’s you people) will think less of us and, as was often the case not too long ago, proceed with a pogrom or other form of mass extermination to display their displeasure with our actions. For instance, Jack Abramoff is a shande fur de goyim. It is a sense of communal embarrassment, collective shame, for someone or something that makes us shake our heads with a combination of disgust, fear, and sadness.

I couldn’t stop thinking about that phrase recently, not so much as it relates to Jews, but as it relates to the health of our country. You see, I am about halfway through my emergency room rotation at an extremely busy county hospital in a very urban (i.e. poor) area, and I feel like I keep seeing the same thing over and over again. The typical patient encounter goes something like this:

Hi Doc, I’m here because I have chest pain. It started this morning, and it feels like an elephant is on my chest. What’s that? No, I don’t have a regular doctor. I don’t have insurance. What’s that? No, well, I had some medications given to me the last time I felt like this and came here, the doc said it was important I take it every day. But I ran out and each time I come to get a refill the wait is more than 12 hours here, and I can’t stop working for that long because I have to support my family, so I just kept putting it off. I mean I work 14 or 15 hours a day just to get by, I can’t afford to pay for the drugs. I have to put food on the table, doc. You understand, right? No, I don’t have a regular doctor, I can never get an appointment, and I can’t afford an outside one.

The story ends one of three ways:
1) The patient ends up being fine, gets a refill of his medications, and maybe fills the prescription before walking out the door.
2) The patient is having symptoms of a heart attack, gets seen early enough, has a corrective procedure done, and has a protracted hospital stay at an exorbitant cost to the taxpayer.
3) The patient has a massive heart attack and dies either in the ER or soon thereafter in the intensive care unit, also at an exorbitant cost to the taxpayer.

I bring this story up not just because it keeps happening over and over again, but more because I was thinking about it today in the context of how embarrassed it made me feel, how each day I come home and take a moment to myself to simply shake my head in disgust. Not for myself, or for the doctors, nurses, and other ancillary staff at the hospital. But for my country. See, just like all of you, I was brought up to believe that America is the greatest country in the history of civilization, the land of opportunity, of equality and freedom and on and on. While there is clearly a fair amount of jingoism going on with this sentiment, I genuinely believed in this concept in a general sense, especially after being lucky enough to travel around much of the world over the last 4 years and seeing what other “first world” countries have to offer in terms of basic transportation, amenities, and other basic societal services. (One need only compare the ease in finding a street sign at a random corner in a random city in the U.S. versus just about any other country to see the difference.)

This sentiment even extended into medicine. Much of my medical career has been spent seeing the cutting edge of medical technology (i.e. the most expensive new stuff out there), provided at both county and private hospitals. I presumed and initially observed that even the county system, with all its flaws, worked well enough to provide basic medical care for everyone at minimal cost to them and independent of the patient’s insurance or citizenship status. A noble effort, indeed, despite the obvious disparities between care provided to insured and non-insured patients, as all were treated adequately by competent physicians even if the hospital surroundings differed dramatically. Sure, things didn’t run as smoothly at a public hospital, but all patients were still given the care the needed when they needed it, or so I observed on various inpatient rotations, such as neurology or general surgery.

However, it has taken only about two weeks working in a county emergency room, at the front lines of medical care, for me to realize how ridiculously wrong I was, and I am astounded at myself that I didn’t fully appreciate this earlier. The one aspect of medical care I was not able to compare up until this time was the emergency room, and I was unaware of the magnitude with which people depend on the ER for the entire spectrum of medical care that they need. People go to the ER for everything from medication refills to heart attacks to the most obscure disease you could conjure up, the ER serving in place of having regular doctors. Regular doctors who would follow these patients and do their part to contribute to preventative medicine by providing them with cheaper earlier interventions that are easier on the patient and the system as a whole. But our system does not provide for such basic services at levels necessary to cover even a remote number of the people who need such services. As a result, people show up to the ER sicker, require more involved (and, therefore, more expensive) care, and have worse prognoses, all a drain on the patient, the hospital, and society at large.

Put simply, the American health care system is broken. But I don’t mean that the way people throw that type of phrase around, as it has been used for some time now and as I have joked about in the past. Not “broken” in the “we should probably maybe do something about it but it sort of works so it’s ok for now as long as you’re insured” way. It’s embarrassingly broken. Shamefully broken. Broken to the point where thousands of people are dying solely because as a society, the presumed greatest society, we can’t institute a system to provide basic simple preventative medical care for everyone. We’re not talking invasive neurosurgery here; we’re talking cheap blood pressure pills, quick clinic visits, simple follow-ups. It’s broken to the point where, for the first time in my life, I came home from a shift a few days ago feeling embarrassed. Not just for myself, or for the medical community, or for the vast amount of people waiting for ages in the emergency rooms across the country that haven’t been closed down yet begging for medical care…but for the entire country, for America, that we can’t do better than this. I know about the statistics, pointed out in a similar rant by Bill Maher on his cable show two weeks ago, how we rank somewhere in the 30s or 40s among all nations in terms of things like quality of care or infant mortality, but I never really believed it. I never saw this played out before my eyes this frequently to this level of magnitude before, and it is simply shameful.

Now before I get barraged with hate mail calling me un-American or a communist or whatever else you have in store, keep in mind a few things. First, make sure you have any clue what you are talking about before you start screaming at me, because I defy anyone who’s actually worked in this system to tell me it works. Frankly, it’s a miracle it works at all, and this is only because a few good doctors, nurses, and ancillary staff take significant pay cuts to work with the poorer segments of society in these crowded and understaffed public hospital environments. Second, know that it is actually painful for me to write in print that I’m embarrassed for my country, because despite all the crap our country has been involved with of late, I have never taken pleasure in it, never found any sort of joy in what I’m seeing, and never felt embarrassed enough to actually say something about it.

But most importantly, remember this: without enough people from all segments of society screaming about this, complaining, being ashamed, it is not going to change, because as this most recent election has demonstrated, things only changed when people get so dramatically upset about a unifying issue they find so repulsive that they decide to clean slate and elect new leadership that will presumably change things. I don’t know what would be better, whether we need a national health care system, whether we need more incentives for businesses to provide adequate insurance plans, or what, but it is painfully clear that something needs to change, because the system as it currently exists is a disaster.

So if we want to parade around the world telling everyone how amazing we are, how genuinely attractive a society we have built, how we are the greatest country in the world, we damn well better start acting like it. And one way to do so would be to not let this shande persist, because the whole world is watching, and they’re probably having a laugh at our sickly expense. Shame on you. Shame on me. Shame on all of us.

posted by The Fake Doctor at 11:00 PM 136 comments links to this post