Gone too long

So my friends and fans, has absence made your hearts grow fonder? Have you found yourself pining away for a new post of the mundane misadventures that fall my way?

I didn't think so either, but, after a trip into the ether, I'm back. Where I've been, now there's a tale. Like Mr. Baggins, I feel like I've been there and back.

When you first put on the long white coat, you feel like a superhero donning his new supersuit. Like the Prince of Gotham, your utility belt is equipped with pager and PDA, a stethoscope hangs over your shoulders like nunchuks and you walk with a just a hint of a swagger (that is totally unearned). Bring on diabetes, you think, it's game time.

Of course, the bubble is quickly burst once you actually start seeing patients. The "simple" diabetic now shows up with a sky-high sugars, dangerous levels of potassium and dehydration. Now you can't just say, "give him insulin." You gottta figure out what kind of insulin, how much and for how long. Back-seat driving, as pleasurable as it was as a student, just doesn't work here.

One of the things I was least prepared for was the physical and emotional drainage of internship. Especially nights when I was on call, it felt like being given the steering wheel of the Batmobile in the middle of a car chase. All you really hoped to do was avoid crashing...

Of course, it's not so dire - you do have senior residents and attendings for help and guidance. Plus I have this tendency to stay and stay until I think everything's done, which makes for some super long days. I've learned that "signing out" (giving the on call person tasks to follow up on) is not a sign of weakness, but rather of sanity.

There are a couple of memories that stick out in my mind. One is the first time I had to pronounce a patient's death. The patient was 41 years old and was diagnosed with melanoma (a skin cancer) this past April. Unfortunately, the cancer had spread all over his body, and there were metastases in his heart, liver and brain. When he came to the hospital, he knew that he didn't have much time left. What he needed from us was placement of a catheter to drain fluid from his belly (ascites secondary to malignant effusions in medical jargon).

I did an initial tap of the fluid in the patient, to relieve his symptoms, until a catheter could be placed by radiology in the morning. The next morning, however, things had changed. His kidneys were shutting down, his heart was going into dangerous rhythms and it became clear that the end was coming sooner than later. The patient did not want any heroic measures taken, something his family was in agreement with, and asked only to be kept as comfortable as possible.

When they paged me to come and pronounce his death, his entire family was at his bedside, his wife in tears and young children around the bed. He was diagnosed with melanoma in April and dead in August. I remember feeling clumsy while examining him for signs of death. It sounds strange to say that, but in medicine, death is still a clinical diagnosis. There are a series of things you look for on exam to confirm the patient's death and then you "pronounce" them.

But more than that, there is an emptiness you feel, no matter how many people are in the room with you. The same person you were talking to earlier in the day now lies before you, lifeless, and there is no more you can do.

Death lives in the shadows. We fill our hospitals with gleaming electronics, bright lights and windows as though we can drive out the shadows, drive out the only certainty there is in the world, that we too shall pass.

As difficult as it was for me to deal with, I cannot even imagine how it must have felt for the patient and his family. How does one wait for death?

On those weighty words, I leave you to your thoughts. Until next time friends...

Life in the Not So Big City

So people want to know what it's like in Milwaukee, especially as an expatriate suburban Chicagolander. The first thing that strikes me about the place, at least in the hospital, is that there actually are a lot of other expatriate suburban Chicagolanders around here.

You often discover this secretly, in a discussion on sports, for instance. If the other person doesn't talk about the Green Bay Packers with a reverential deference, you begin to wonder...if the person doesn't know anything about the Badgers, you become almost certain, and eventually they'll say something that will seal the deal - "didn't the Bears have a great season last year?" Of course, as turncoat Green Bay fan, I just nod and smile.

Many of us in this secret society of people from Chicago often refer to Milwaukee as Chicago's northernmost suburb, a designation not really favored by the locals here for some reason. Some people I've talked to here think of Milwaukee as a big "small town" but it seems to me the people running Milwaukee are more interested in making it into a "New Chicago" than a charming bucolic throwback to the days of yore.

One thing everyone can agree on: don't speed in Milwaukee, or Wisconsin generally. If you do, you will get a big, fat ticket. This fact is so well known and understood, that I routinely see people driving the speed limit. This is an unheard of practice in Illinois.

In fact, on Illinois highways one can safely go 70-75mph despite a speed limit of 55mph. In Wisconsin, with a speed limit of 65mph, people drive no faster than 75mph. The daring few in the left lane may push it to 80mph but even then only when safely out of the stretch of highway between Kenosha and Racine, which is one giant speedtrap.

There are even billboards that advertise this fact - I saw one that said, "Speeding is a Big Ticket Item" and another one for Cousin's subway sandwiches that says, "It's worth its weight in speeding tickets."

So I guess it's safe to say that life is slower here...

There are also some random connections back to Chicago even up here. News Radio WBBM 780 from Chicago comes in quite clearly up here and I often listen with special delight when they give the rush hour traffic reports in Chicago.

There is no such thing as 50 minute delays here in Milwaukee. Even with a massive highway construction project, it takes no more than 15-20 minutes for my commute, a blessing I can hardly describe to you in Chicago.

But there are prices to pay for this life of ease. We do not have nearly the selection of relatively cheap, but good, Indo-Pak or Arab restaurants out here. One place that is pretty good that I've been to is called Ujala, which makes some great naan and chicken karahai.

That's it for now on my notes on M-town...if I get time, maybe some stories from my month in the ER...

Crisis in Lebanon

"No one can for one moment accept rockets in Haifa, Nazareth, or anywhere in Israel. But demanding that the Lebanese government rein in Hezbollah while bombs rain down on a variety of targets, some civilian, is not the answer.

Widening the war will inflame tensions, increase casualties and decrease any prospect for a permanent peace. The United States can best support Israel and the Arab world by vigorously pursuing an end to the violence, the resumption of a peace process and a commitment to unite the region to isolate terrorist groups and all who oppose a just and lasting peace for all people."
-Representative Jim McDermott, Washington State

"The Lebanese people, who had hoped that their country's dark days were behind them, have been brutally dragged back into war. Already, over 300 Lebanese have been killed and over 600 wounded. And the casualties are mainly among the civilian population, about one third of them children. Much of the infrastructure in Beirut and around the country has been destroyed. Lebanon remains under an Israeli military blockade, imposed by sea and air."
-Kofi Annan, UN Secretary General

"In Lebanon, from a humanitarian standpoint, we are witnessing a tragic, downward spiral. We already have a crisis with rapidly growing unmet needs. Every day the fighting continues takes us closer to a human catastrophe."
-Louis Michel, the Commissioner for Development and Humanitarian Aid (European Commission)

"Call for an immediate cease-fire in the region that would allow the rapid deployment of the international humanitarian aid effort and the return of international law;"
-Conference of the Presidents, European Parliament

My latest addiction

I absolutely love the game, "Pac the Man X" developed by McSebi.  It is based on the old PacMan arcade game and is really well done.  My high score is over 56,000 and my goal is to erase Imran and Ejaaz's high scores from my high score list. I think they only have one score each on the list now.  Soon, my precious, soon the list will be all mine...

Hey, so there's not a whole lot to do in Milwaukee, okay...

What's Happening Now?

So it's been a while since I've posted. Much has gone on in the world, Dwayne Wade turned out to be the real maverick, the Mets have been making the Wright moves, and there are some Tigers that need to be muzzled by the White Sox before things get out of hand.

I've also finished school, mash'Allah, and am counting down to July 1st when I get to trade in my short white coat for a long one. I imagine it will be a momentous occasion, held the evening before we start, with the red carpet rolled out in front of the entrance to the emergency room. As the lights glare and the cameras flash, I'll walk in and the hallway will be lined with hospital staff and papparazzi. The lights will be dimmed and then the soft, subtle music that is played when the Chicago Bulls enter the United Center will be piped in over the hospital PA system. Someone will say, "And now, ladies and gentlemen, announcing your new house interns!" And with that the audience will break out cheering and clapping. "Coming in at a little under six feet tall, the only brownie that won't melt in your hands, Uuuuuu-mar!" Of course, the crowd goes wild...

If only the long white coat imbued you with new superpowers, x-ray vision would be particularly useful, to match the great responsibility wearing it entails. Like a butterfly fluttering on the winds of change, one cannot help but feel trepidation and exhilaration, along with the great hope that God is guiding you to ever better things...