Life is like wrestling a gorilla

So we had a crazy busy day on Tuesday, got a lot of consults, including one patient who's been in the hospital since December. It was 8:30pm and I was exhausted, my brain hurt, my stomach was rumbling and I was not looking forward to the next day because I knew I'd have to come in pretty early. As I was driving back to my place, I was reminded of a quote that one of the attending physicians told me is posted in the transplant clinic office:

Life is like wrestling a gorilla - you don't stop when you're tired, you stop when the gorilla stops.

His lips are moving

We were seeing a patient today on the consult service, a good-natured fellow whose brother was in the room. The patient, unfortunately, has metastatic cancer but was in good spirits despite his prognosis. After making some small talk, his brother said, "well doc, it's always been easy to tell when my brother's lying - just look for when his lips are moving."

We all broke out in laughter...it was nice to see such a well-knit family in the face of such a difficult circumstance. I hope we are able to provide our patient with the best quality of life in his remaining days...

Screeech, or what would MacGyver do?

So, about a week and a half ago in Milwaukee, I was warming up my car when I started my windshield wipers to wipe off some snow and ice. The driver-side wiper was apparently frozen in place with ice and eventually broke free but with a loud crack and as the wiper started moving across the windshield, it made a scratching sound, so I stopped the wipers and manually scraped off the remaining ice and snow.

I was running late for work, so I hopped back into the car with the thought, in the back of my mind, that I should replace the wiper soon. Time passed, without much snow, rain or ice, and the wiper never got replaced. This past Friday, it started to snow heavily in Milwaukee, with about 3 or 4 inches of accumulation and there was a lot of snow slush being thrown up from the road as well as falling from the sky.

I switched on the wipers, and upon hearing the back-curling screeching of the wiper on the windshield, added yet another reason, to my already long list, of why procrastination was evil and made my way to the post office by only occasionally switching on the wipers.

When I left the post office, I realized that I had a long drive to Chicago ahead of me and I couldn't possibly drive safely without a functioning set of wipers. It was too late to get it replaced at an auto shop and I didn't much feel like replacing it myself since it was night and cold.

So I looked around my car and thought to myself, "What would MacGyver do?" Surely, I could jerry rig a solution out of the random odds and ends in my car. I surveyed the interior of my car and saw that I had a small roll of floss. I instantly realized that I could use the floss to tie down the ends of the wiper so the rubber edge of the wiper would make contact with the windshield and the exposed metal part of the blade would be kept safely out of the way.

I tied the ends of the wiper blade down using surgical knots I learned during medical school - after all, if they are good enough to hold organs and blood vessels together, they should be able to hold a wiper down - and jumped back in the car to see if my little experiment would work.

Snick-slop, snick-slop the smooth sound of success - the wipers worked perfectly all the way home and the knots never came loose. Floss, not just for your teeth anymore...

Brilliant! ...or yes, water still freezes at 32 degrees...

So earlier this week, I drove into work and had a ton of snow sludge thrown onto my windshield thanks to the horrific job of snow clearing in the greater Milwaukee area. People here are so laid back and in touch with nature that the municipalities feel no need to clear the snow when it falls. I imagine the contingency plan is for everyone to take their dogs, hitch them up to sleds and just mush their way around...

...so anyway, by the time I get to the parking lot of the VA, I realize that I am all out of windshield wiper fluid and that my windshield is just filthy. I was wondering what I would do when I realized that if I kept wondering any longer I'd be late for work...

Around lunchtime, I bought some bottled juice, I think it was Nantucket Nectars, pomegranate pear. I was about to throw out the bottle when I thought - hey, why don't I save it, fill it up with some warm water and clean off my windshield at the end of the day...

So the end of the day comes, I grab the empty glass bottle and try to fill it up with hot water. Of course, at the VA, the water only comes out lukewarm, if that. I still think it's warm enough, grab my coat and head off to the parking lot.

I should mention, it takes at least 3 minutes to walk out to your car at the VA, by which time my lukewarm bottle of water wasn't so lukewarm. I, of course, being warm in my coat didn't think that the bottle of water should be any less warm and just poured the water all over my windshield and watched it run down.

I ran into my car, started the engine, and by the time I looked up at the windshield, realized the water wasn't running down the windshield, washing off the snow sludge, it was frozen, forming a layer of liquid ice all across the windshield...

Wow, I, thought to myself, I guess water still freezes at 32 degrees, and, for that matter, temperatures colder than 32 degrees...so, I spent the next few minutes scraping the ice off of my windshield, covered with snow sludge and wondering how in the world it is that people trust me with anything more than taking out the garbage...

Every bearded man...

So there we were having another fine day at work, our attending going through a complicated EKG with us, and finally saying at the end, "so you see, every bearded man is not your grandfather."

We all laughed at this unusual turn of phrase and he enlightened us that this was a popular saying in Turkey. Useful tidbit if you should ever be wandering the streets of Istanbul, looking for grandpa...

We're all the same

It was late afternoon, and we were making rounds, working our way down the list of patients that needed to be seen. This afternoon, our team had 6 people, the attending, a fellow, myself and three medical students.

We reached the next patient room and our attending introduced himself to an 89-year-old female patient who was in with some heart trouble. After discussing her medical issues, she gazed out at all of us and asked our attending (who is ethnically Korean), "Are these all your children?"

We all laughed, as our group is something of an ethnic rainbow, consisting of heritages ranging from German to Pakistani. About the only thing we all had in common was the color of our coats. That seemed good enough for our nice little old lady...

Internship, Interred

So this week I started running again, figuring it was time to undo the damage from the internship-induced atrophy. When I first hit the pavement, I picked a brisk pace, thinking I would spontaneously regain my high school cross-country athleticism.

My muscles allowed the fantasy for about 1 minute and 30 seconds, which is precisely when they went to politely saying, "ow, ow, ow" to "OUCH MAN, I'M NOT PLAYING, SLOW DOWN OR YOU'RE RIDING A CHARLIE HORSE ALL THE WAY HOME." At which point, I obliged by slowing to a walk, heart pounding, all out of breath.

As I half-jogged the rest of the way (I figured a minute thirty doesn't count as much of a work out), I had some time to think about the past year and how draining it's been. By draining, I don't just mean physical, you can get through that with coffee, Snickers bars and energy drinks (though it does add up over time, as the adipose starts to settle).

The real challenges are mental, emotional and spiritual. Can you keep your cool with an unruly patient at 4:00 AM on a night with no sleep? On call nights, do you take a few precious moments out to pray, or do you go straight to the call room to veg out? Do you get upset when a nurse bugs you about something unimportant in the middle of a rough night? And in the flow of the regular day, do you remember to pray for the health of your patients, no matter what they are like?

Physicians seem to be losing the mantle of "healers," and with it, its connotations of confidant, of high character. Instead, we are "service providers" giving our "customers" the best service experience. The problem with a service model is that one's character is valuable only while a service is being provided. So for the 15 minutes you're in clinic, you're entitled to my "professional code of conduct" but the second you step outside the office (or the second you can't pay for the services); well, don't let the door hit you on the way out.

When physicians were healers, their role was not limited to the walls of a clinic or a hospital and you expected them to have high moral standards. How many people today would use the words "integrity" or "kind" or describe their physician? The most popular doctor on TV is "House," a guy with no personal morals but excellent technical/diagnostic acumen. Is this really the new incarnation of the modern physician?

At the end of the day, I can only hope to keep pushing myself forward, to not only be a knowledgeable "provider" of health care but to also develop the characteristics of a healer, no matter how backward that seems today.

Go Getta!

The legions of CMM (Chronicle of Mundane Misadventure) readers have clamored for an end to the inexplicable five-month silence, they want to know what's on the mind of this original go-getta and read the pithy ponderings that can only be found here.

Well, fans, and I mean all five of you, the silence is shattered, and I bring you forthwith, and with much ado about nothing, the following insight and introspection:

Man, I've been busy.

I'm in the fourth of five months working what we call the "floor" or the general medicine wards. While those who trained before the 80-hour work week was mandated will tell you we have it easy, it's still draining. Plus with only 4 days off each month, you just feel tired all the time - it's work, sleep, eat & repeat.

All of which takes a considerable toll on one's desire to blog away. But, I'm back, for now at least, because the inertia of not writing was starting to become too much and I felt like if I didn't get back into it, I may forget how to write altogether.

So, a couple of posts coming your way, dear readers, and the internet is fresh and new once more...

Discovering the fishies

So, I just came back from the annual holiday party at work. Now, I usually avoid things like holiday parties, for no real reason other than social ineptness. But, I figure, it is a bunch of medicine geeks and, in that setting, I'm actually pretty hip. Anyway, my real motivation was that it was held at Discovery World, a museum/aquarium in Milwaukee. I was excited at the prospect of checking out the aquarium, in particular, and I figured the science wing would have some cool things to check out too.

So I get to the party, do a little meeting and greeting, and then head over to the aquarium as soon as I am able. The aquarium was sort of small at first glance, but I thought what they lack in space they may make up in quality.

As I walk to the first exhibit, I can feel the adrenaline flowing, it's game time, my neurons firing in anticipation of all the exotic fish-related trivia tantalizingly dangling before me like a worm on a hook. And then I'm there and I look into the tank and I see...

Brown trout. Perch. Groupers. Yes, the same fish that are featured on dinner plates across the country were on display, swimming around the tank with a certain smugness that comes from knowing that they, at least, were not going to end up on your dinner plate. In fact, much of the display, featuring fish of the Great Lakes, could have easily been called instead, "It's what's for dinner." I half expected the little displays that provided information about the fish to say something like, "brown trout is best served with a lemon sauce and french fries."

What more can I say? They're trying to make downtown Milwaukee more of a cultural attraction and it clearly needs more work. Thank God Chicago is so close...