Last Words(?)

This may be my last post. I'm thinking this because of the following reasons:

1. What little spare time I have, I should be reading.
2. The quality of my posts have generally sucked for some time now, and I don't anticipate a reversal in that trend, and
3. I think writing about every single notable event that happens to me during intern year/residency is a tiresome exercise for both me and what remaining people visit here, anyway¹.

Instead, I'll just sum up some things that may have happened in the last month-and-a-half:

• I moved.
• I independently made medical decisions.
• I let the nurse make a decision.
• I bonded with a patient.
• I wanted to throw a patient out of the hospital.
  
• I saw someone else's patient 'code.'
• I saw my patient code².
• I was the first doctor to the code and hesitated to go in.
• I was the first doctor to the code and started compressions.
• I got yelled at by an attending physician.
• I got yelled at by an attending physician for someone else's error.
• I carried four pagers at once.
• I wanted to throw each of them into the Schuylkill River.
• One day I didn't have time to eat until 9pm.
• I discovered that dried apricots, mixed nuts, and diet soda make an easy, convenient dinner.
• I didn't get enough sleep.
  
• I did nearly nothing, and my patient loved me.
• I did everything I could, and my patient hated me.
  
• I felt competent.
• I felt like an idiot.
• I took a fellow intern out for a drink because he felt worse about internship than I did.
• I wished someone did the same thing for me a week earlier.
• Someone lived.
• Someone died.

In short, life happened. Same as anywhere else.

*******

¹ For an accurate depiction of residency life, just watch Scrubs.

² I think 'code' is one of those words that loses its meaning once you say it enough times. Like 'cow' or 'Bracken.'

You know you've made it when...

What did I do during my first official day as a physician? Why, more orientation in my new hospital, of course! Still, a few things happened today that made me feel a little closer to being a real doctor.

• Receiving my stack of prescriptions for narcotics.
• Getting arterial blood from one of my patients, first try, first stick.

But most of all, I know I've arrived because I've got my very own personal bottle of developing solution for the fecal occult blood test. Now if only they'd give us some gloves.

The Orientation Express

AWRIGHT, YOU MAGGOTS!!! EYES FRONT!!! I WANT TOTAL SILENCE FROM HERE ON OUT!!!

My heart sinks. The brochure for the residency program gave a different impression - the Swedish Bikini Team was supposed to greet us with a smile, putting leis around our heads as we enter a sunlit forest glen surrounded by palm trees somewhere in downtown Philadelphia. The room falls quickly into silence as ordered by the Drill Sergeant Chief Resident. The room is well cooled on this ninety-plus degree day, but you can see beads of sweat form on the foreheads of most of the incoming interns.

YOU!!! WHEN DID YOU GRADUATE???
About three weeks ago?
WHAT!?!?!
About three weeks ago, Sir!?!
ARE YOU ASKING ME???
About Three Weeks Ago. Sir!!!
WELL!!! YOUR THREE WEEKS OF FEELING IMPORTANT ARE OVER!!! I DON'T CARE WHERE YOU CAME FROM!!! I DON'T CARE IF YOU GRADUATED THE TOP OF YOUR CLASS!!! FROM NOW ON, YOU ARE INTERNS!!! YOU ARE THE LOWEST OF THE LOW!!! BUT I GOT GOOD NEWS!!! WE DON'T DISCRIMINATE ON THE BASIS OF RACE, COLOR, OR CREED --- YOU'RE ALL EQUALLY WORTHLESS!!!

His eyes narrow.


YOU!!! WHY ARE YOU TWITCHING???
Can I go to the bathroom?
YES!!! YOU SEE THAT STYROFOAM CUP??? FROM NOW ON, THAT'S YOUR BATHROOM, DOCTOR TINKLEBELL!!!!

ANY OTHER REQUESTS!?!?!

The rest of orientation went by with nary a peep. They covered so many invigorating topics, such as Joint Commission Regulations, Stress Management, Health Information Management, Compliance Issues, Medical/Legal Issues, Autopsy Procedures, Resuscitation Orders, Adverse Drug Reactions, and Sleep Deprivation.

I do my part to fight sleep deprivation by dozing off several times during orientation.

First official day tomorrow. Mood: Slightly panicky.

Help

I may be preaching to the choir here, but just in case this happened to miss anybody:

An acquaintance of mine was recently diagnosed with leukemia^*. His story is here. In brief, he needs a bone marrow transplant. If you aren't already registered with the Bone Marrow Registry, please consider doing so.

^* This is the second friend of mine to be diagnosed with some form of leukemia. I'll also pin Joe's blog to the right, as their plights are frighteningly similar.

I can't recommend Away From Her highly enough, a picture about a married couple dealing with Alzheimer's Disease. Julie Christie is great in her performance as the woman afflicted with the disease, while Gorden Pinsent plays her husband who has to watch somewhat helplessly as her dementia progresses. It is all at a once warm, tender, infuriating, and heartbreaking.

Giddiness/Creepiness

I just mailed my first letter regarding a professional matter, and I signed it with all those letters after my name. I didn't celebrate aloud, but I have to confess that I did do a little internal tap dance. Then I felt like a bit of a creep for feeling all excited about it.

Argh, the conflict!

Graduation

Favorite memories from this past graduation weekend:

1. The greatest gift of all, of course, being my family traveling from near and far to be with me this weekend. (Honorable mentions go to the personalized Steelers travel coffee thermos from Mom, and Peter's general bad-assness this weekend).
2. Finally getting up on stage and getting the diploma.
3. One last hurrah with my now-former classmates. I'll miss you guys.
4. Our commencement speaker was fantastic, probably delivering a speech that was instantly more memorable than those in recent years. He read a passage from his book, that really communicated his emphasis to the graduates that we remember humanity in our practice of medicine.
   
5. Sleeping in the day after graduation

Created with Paul's flickrSLiDR.

Some not-so-great moments:

1. The night before graduation - I had one too many. Again, Peter and Jocelyn came through for me here.
2. Reading this new version of the Hippocratic Oath. Granted, the classic version necessitated an update as the mores and ethics of modern culture has evolved, but there are a couple phrases in the modern version that seem like they were written with a medical malpractice lawyer looking over the writer's shoulder, and diluting the lyricism of the original:

"I will hold myself aloof from wrong, from corruption, and from the tempting of others to vice.

I will exercise my Art solely for the cure of my patients and the prevention of disease, and will give no drugs and perform no operation for a criminal purpose, and far less suggest a thing...

In proportion as I am faithful to this oath, may happiness and good repute be ever mine; the opposite if I shall be forsworn."

I think even the dean of the medical school read these passages with a little bewilderment. Kinda reduced the impact of the moment.

We graduate on Sunday!!!

And, a pleasant surprise: we got our class yearbooks at a graduation rehearsal yesterday, and my yearbook picture doesn't suck too bad! Woo Hoo!

Tagged

Curse you, Sonny Morningstar. Yesterday was my last day of medical school, and now I have all the free time in the world to run my errands, pack, or just laze about. And he tags me with a meme. Curse you. I don't do memes. Actually, that's not true. I do do memes, I just have no desire to let my personality be reduced to a simple character, like:

You Are Cookie Monster

Misunderstood as a primal monster, you're a true hedonist with a huge sweet tooth. You are usually feeling: Hungry. Cookies are preferred, but you'll eat anything if cookies aren't around. You are famous for: Your slightly crazy eyes and usual way of speaking How you life your life: In the moment. "Me want COOKIE!"

The Sesame Street Personality Quiz

Still, Sonny's meme is pretty interesting:

The rules:
1. Add a direct link to your post below the name of the person who tagged you. Include the state and country you’re in.
2. List your five favorite places to eat (locally) - any kind of food, whatever you like.
3. Tag 5 people (preferably from other countries/states) and let them know they've been tagged.

The Restaurant Reviewers so far:

• Nicole (Sydney, Australia)
• Velverse (Kuala Lumpur, Malaysia)
• LB (San Giovanni in Marignano, Italy)
• Selba (Jakarta, Indonesia)
• Olivia (London, England)
• ML (Utah, USA)
• J (California, USA)
• CuriosityKiller (Hong Kong, SAR)
• Shelli (Minnesota, USA)
• Bluepaintred (Saskatchewan, Canada)
• Avitable (Florida, USA)
• Diana (Singapore)
• Jessica (Missouri, USA)
• Not That Desperate (Minneapolis, USA)
• Sonny Morningstar (Cambridge/Boston, MA, USA)
• Mikey Mud (Brookline, MA, USA)

How I made my selections: I decided to only list places that I've eaten at more than once. This excludes restaurants like The Federalist or Chez Henri. It's pretty obvious these are amazing quality restaurants, which I think defeats the purpose of this meme. I also avoided restaurants that are too expensive - fine dining is great and all, but you shouldn't have to mortgage your house to eat there (Locke Ober). Franchises or chains were a bit of a stickler. I thought that excluding chains was a good idea, places like TGI Friday's, The Olive Garden, or Chi Chi's (all of which should be struck from the face of the earth). However, I've also had fantastic meals at small chains like Boca Grande, so I'm thinking chains are okay, as long as they're small. Okay, that's enough. On to the restaurants!

Indian: Udupi Bhavan, Ashland, MA. This Indian restaurant is really not a secret. It's a hike from Boston, however. This restaurant was my introduction to South Indian cuisine - I could go on and on about the dosa, uthappam, etc. but their sambar is unparalleled, no question. Actually, I have to eat here one more time before I move. Any takers?

Korean: Cafe Han River, Brookline, MA. This is counter to Sonny's pick of Fugakyu for his favorite Japanese restaurant. I admit I was a little annoyed that he picked Fugakyu, but then I just felt sorry for him. I mean - it's a pretty obvious pick. I expected more from you, Sonny - I thought you'd find awesome sushi in some mom & pop place, tucked away in Billerica. Anyway, Cafe Han River is a wicked small eatery, that serves some of the best Korean food I've ever had. The menu isn't extensive, but that's not a problem. The kitchen is small - it really looks as if you're getting Korean home cooking. The rice cooker is not much bigger than my own, and, better yet, the rice is sticky, as it should be. The meals come with kimchee and a few dumplings, which round out the main dish.

Comfort Food: Zon's Restaurant, Jamaica Plain, MA. Comfort food done really well in an intimate setting. Was on my list of places to visit before the move, and I was able to cross it off a couple of weeks ago. The ice cream sandwiches using freshly baked cookies as the sandwich for the ice cream makes this place worthy of this list. My only regret is not getting to try one of their several versions of macaroni and cheese.

Pub Food: Matt Murphy's Pub, Brookline, MA. God, I'm going to miss this place. The look used to be really authentic - wooden tables with people carving their names or some crude message into the top, chairs that didn't look like they could last the night. They've made some decisions lately that are questionable - one long cushioned seat along one side of the pub. The removal of Guinness draft from their selections. Still, the food and the service remain stellar. My favorite dishes are the shepherd's pie (I think this is the more authentic version, not the brick you see in the hospital cafeteria), the steak, and the fish & chips.

Chinese: Ocean Wealth, Boston, MA. This is a tough one. First, the progression of Chinese cuisine in Boston, in my opinion, has stagnated. Yeah, Ming Tsai's Blue Ginger is local, but that's more like Chinese-French fusion. Second, to get the good stuff at Ocean Wealth, you have to ask for the special menu. And even if you know to request the special menu, you should be able to read Chinese characters, and order in Cantonese. I don't go here without a Cantonese-speaking individual in my group. I don't know the names of my favorite dishes: there's a lobster scallion stir-fry that makes my mouth water as I type. There's a deep-fried taro-duck dish that is artery-clogging amazing. The best thing is that, for dessert, NO FORTUNE COOKIES. Depending on the season, it's either tropical fruit or some Chinese tapioca thing that, again, I have no idea what it's name is.

Okay, now the tagging. I've decided to tag couples and count them as one - I hope some of them are still reading, despite the fact that I've slowed down with the updates:

• Jocelyn and Peter - Because any good restaurant that I've eaten at lately is probably from Peter's recommendation.
• Cathy and John -
  
• John and Jill - because I want to hear about the foodie life in Hamilton, Ontario.
• Rebecca and David - Because I want to hear about the foodie life from some parents.
• ThaJinx - Because I want to hear that Idaho isn't just about potatoes.

Have at it!

*****

Right now I'm listening to: Written in the Stars, The Bill Charlap Trio

Life Support Training

Prior to starting my intern year, I have to be certified in Advanced Cardiac Life Support (ACLS). A good idea, you would suppose. You are tested for knowledge via a multiple choice exam, and for skills, which supposedly simulate someone going through various forms of cardiac arrest.

None of this, of course, is a substitute for real life experience. Just to give you an idea, one of the multiple choice questions is: "What is the proper sequence of events for use of an AED¹?"

The answer: "Turn the AED on. Attach pads. Check rhythm. Shock if indicated." (emphasis mine).

Which is something like handing a multiple choice exam to a photographer if you were to hire one for your wedding: "What is the proper sequence of events for use of your camera?"

Answer: "Take the lens cap OFF. Point camera at object. Focus. Click."

In short, yes, I am certified in both BLS² and ACLS.

BUT...

Don't you dare go into cardiac arrest anywhere near me. At least not until the end of summer.

¹ Automated External Defibrillator
² Basic Life Support