Friday, July 29, 2016

When in doubt, just blame your parents?

My plan was to take time off from blogging, but I'm faced with a bit more idle time on my hands than that on which  I had counted. (I know it would sound more natural and, for that matter, better, to have written "time on my hands than I had counted on' but I'm still stuck in the Dryden-inspired rut of written and spoken English and of not ending sentences in prepositions; someday I'll blog about it.) I'm away from home for a time, and while I do have one musical instrument with me, it can only consume so much time. I picked an outdoor venue for playing it - it's a brand new instrument with which I have virtually no playing experience or technical knowledge beyond that which comes with having reasonable mastery of a  related instrument, which, in the grand scheme of just how pleasurable the sound would be to the ears of listeners, helps very little. I wanted to spare others the agony of my trial-and-error phase of learning the ins and outs of this new instrument.

Nature's elements provided just enough noise cover that my practice wasn't as easy for other to hear as it might have been -- a tornado and its usual preceding storms might have provided a bit more sound camouflage -- but it at least didn't sound quite as though  I was deliberately performing a very public concert on an instrument on which I had no qualifications whatsoever to be performing said concert. I should be clearer here. The quality of my play very strongly supported the fact that I have yet to acquire the skill level normally required to play for the ears of anyone other than immediate family or a music teacher who has been compensated for the obligation to  remain within hearing distance of my playing. 

The sounds of nature, though, muted my poor musicianship just enough, i hoped,  to dissuade anyone who might otherwise have heard me clearly from wondering  whether the sheer desperation emboldening me to expose my obvious lack of talent in exchange for whatever cash passers-by might have dropped near me was borne of homelessness and hunger or of a drug habit controlling my actions to the extent that my next step, had playing for tips failed to provide the means to fund my next fix, would have been a bold attempt in broad daylight to sell my body to the highest bidder. Recent weight loss caused by minor illness, overwork, and a difficulty to eat that I typically experience when my life is disintegrating around me did little to dissuade casual observers from the conclusion that I was either homeless or strung out.  it's an eclectic community where I have holed up for the duration of this forced vacation, though, and  few either unprecedentedly generous or especially musically challenged vacationers wandered over to where I was seated  and dropped enough cash on the ground near my instrument case to pay for both my breakfast and lunch. While busking was obviously not my intent, neither was I too proud  to turn down a free meal or two in light of this unscheduled and therefore un-budgeted-for vacation. if I'd thought this through more carefully, I might have toted along my violin, for which I possess a reasonable degree of mastery, and turned this into both a fund-raising expedition as well as an escape of sorts.

This is turning out to be one of the more difficult blogs I have written. It's much easier for me to look at another person and to analyze what in that person's life experiences might be either so lacking or so excessive as to have screwed him or her up to create in him or her such a disaster as to provide a source of amusement to the rest of us. It's practically second nature for me, and even somewhat enjoyable, to hazard guesses as to  just what has gone awry in someone else's life. Applying that same level of scrutiny to myself, however,  I find almost unbearable. I don't in any way enjoy the self-analysis involved in looking inward to determine causes of my own failings and frailties. The simplest way for to me to face this discomfiture is not to face it. Furthermore, in not facing it, I'm doing a humongous collective favor to anyone who might show up to read this blog. It's much more interesting, we can agree, to most who turn up here either regularly or on occasion, to hear me snipe away about just how screwed up  cognitively and/or psychologically almost everyone with whom I come into contact is than to have me prattle away incessantly with the same information pertaining to myself. 

Beyond that, I'm a proponent of the philosophy that, for the most part,  what has been done is done, and that there's little point in over-analyzing a whole lot of what already has happened. Sure, history should be studied for the obvious reasons that failure to do so promotes cultural ignorance. Beyond that, we've all heard the proverb, to which a ring of truth may be associated, that those who fail to heed history are doomed to repeat it.  We have much to learn about how best today's society might be governed by looking at ways in which things have been done in the past. Still, it's always been my perception that this idea of the exigence of the study of  history pertains to the study of history on a regional,national, or global basis, and not of the personal history of a middle-class twenty-one-year-old student. It's safe to say that the world at large, or even the world at small, has little to learn from the study of my personal history.

I can sum it up briefly (summing anything up briefly is a thing I rarely do), by stating that I am a most flawed individual. I have achieved minor successes in a tiny corner of my own world in spite of my obvious flaws. In some respects, what I have achieved is as much because of my flaws as in spite of them. My success or lack of it as well as the contributions of my weaknesses to any personal successes as well as to obvious failures I have experienced as well came up in a recent discussion with my friend Becca. Interestingly enough (to me; not much of anything appearing in today's blog is going to be of any particular interest to anyone other than to me and perhaps to a few people extremely close to me, but I won't even take for granted the interest in most of today's blog to friends and close family members) the bulk of the comment I made to her that alluded to my flaws and from whence they sprung was lost by an inadvertent keystroke. I was too tired at the time to retype what I had lost, but after the fact, I decided that for my own benefit, it would be worth re-typing the essence of what I had attempted to convey to Becca.

What I was relaying to Becca was that I had been in contact with my shrink. I received intensive and regular therapy following a crisis in my mid-to-late teens. My primary therapist was a psychiatrist who was and is a friend of my parents. Such wouldn't typically be any mental health professional's first course of action. Personal and professional distance is usually considered beneficial both to the patient and to the care provider. Nevertheless, my parents and the psychiatrist, to whom I shall refer  as Chairman Mao, as that is the nickname I gave him when I was receiving treatment as an inpatient in a facility he directed and continues to direct (I'm told that three years later, patients, none of whom were present when the moniker of "Chairman Mao" was given to this doctor, as still referring to him as such. I consider it part of my legacy. It's more than just a tad pathetic, I concede, that even a portion of my legacy is tied to of a nickname I coined while I received treatment as an inpatient in a mental health facility. It's almost akin to sitting at the cool kids' table at band camp) decided that the comfortable rapport he and I had established overpowered the negative aspects of familial connections and potential drawbacks in a patient receiving counseling and cognitive therapy from a family friend. In regard to the weak or lame  nature of any present legacy,  I am young and haven't yet been blessed with am abundance of time in which to create a memorable and significant legacy. Some at my age or even younger have, I readily concede, managed achievements of which they and their parents could be proud and which make my meager accomplishments at my age appear insignificant or worse, but for me, the best with which I have been able come up in my 21.5 years , in addition to the not-entirely-serious distinction of providing my shrink with his nickname, is to have completed my undergraduate education and to have exceeded the halfway-point through medical school. I acknowledge inferiority to many age- level peers.

The topic of my psychiatrist came up in discussion with my friend Becca. My shrink had telephoned me during my most recent time of difficulty. Much of what he told me that I relayed to Becca was lost into the ether. Many relatives would suggest that the disappearance of the content I relayed to Becca was an act of God Himself. At the the very least, they would insist, the disappearance of the text was no loss to the world at large.

Chairman Mao, my psychiatrist, in our recent  telephone discussion, was expounding on the idea that it has been popular for decades in the world pf mental health, particularly in northern North American Society,  for patients to cite their parents as sources for anything wrong in their present lives. This, for the most part, is silly as well as pointless. Some parents have mistreated their children in most egregious manners. Most parents, however, provided  the best parenting of which they were capable of providing. They, the parents, were themselves often damaged goods -- the result of a generation of parenting even less enlightened than the parenting to which they subjected their own offspring. In many cases, they learned from the error of their own parents' ways and endeavored  to raise their children differently than they had been raised -- to, in effect, end the cycle of abuse where it was present. In other cases, children were not quite so fortunate, and cycles of abuse perpetuated themselves. For the most part, though, parents tried hard to do better jobs than their own parents had done which, in the grand scheme of all things related to parenting, was just about as much as could ever be asked of any parent.

My own parents were, for the most part, cautious (excessively so), concerned, diligent, and loving parents but who, as individuals, were human. Issues in their own lives and baggage from their own upbringings inevitably wormed their way into the child-rearing practices of my parents. I say this with clear  knowledge that the perfect parent is nothing more than a myth. My parents did the very best they could with the resources available within and to them. Any single act of less-than-stellar parenthood of which I was the beneficiary would surely have been countered by an excess of one hundred examples of kind, gentle, nurturing and in all other ways exemplary parenting. It is with reluctance that I share a few of the examples of which my parents must surely be less than proud. I share them now, at the risk of hurting my parents' feelings but hoping that I do not do so, as a way of clarifying through my psychiatrist's perspective  how a few of these incidents have combined to influence who I am and how I react to stimuli as an adult.

My mother battled early effects of Graves' disease when my brother and I were toddlers. Graves' Disease usually appears gradually. Its effects had been present for at least a year or two before the diagnosis was even suggested. One symptom of Graves' Disease is that a patient is running with most body systems on overload. The heart beats more rapidly than it should. The digestive system runs rapidly as well; metabolism is at a jack-rabbit's pace. A diet that would sustain a normal person with calories to spare barely keeps the body of a person suffering with the hyperthyroidism of Grave's Disease alive. Kidneys, liver, skin, and the endocrine and pituitary glands are adversely impacted. Heat intolerance is normal Sleep quality is poor. Despite the jumpiness and appearance of excessive energy, fatigue is a constant presence. Anxiety is, for many Graves' sufferers, at an all-time high.

For my young mother with toddler and later pre-school-age twins, the anxiety manifest itself in many forms. The house in which we lived could not be maintained cleanly enough to ease my mother's concerns.  A spilled glass of water was almost enough to send her into hysterics.  A broken glass was even worse. I told in an earlier blog of a time I severed an artery by attempting to push  the pieces of a glass I had broken far down enough into the kitchen trash receptacle that it would escape my mother's detection. I might have been successful at hiding the broken drinking glass from her had I not severed the artery in the process, sending blood spurting all over the kitchen and later the living room. My mother's  reaction (not one of anger at me but one of sheer terror at seeing her seriously bloody three-year-old) in response to a child's severed artery sent her into the hospital for treatment of anxiety right long with me for treatment of a severed artery, loss of blood, and shock. My mom meant no harm, and the anxiety with she lived on a daily basis for the better part of two years before receiving the testing and diagnosis for Graves' Disease, occurred through no fault on the part of my mother.  It did, nonetheless, cause my brother and me to figuratively walk around on eggshell, afraid of doing the slightest thing to set her off, for the better part of two years. Our young minds learned that mistakes were not acceptable.

My father's situation was different. He was considerably calmer in the face of children being children, of spills of water, milk, juice, or other drinks occurring from time to time, of childhood boob-boos -- even those sometimes drawing blood -- inevitably happening. He was calmer in the face of standard childhood misbehavior  as well. My father's Achilles heel as a parent, which, at least as I see it, impacted me to a far greater degree than it ever did Matthew. 

My father was cognitively and academically gifted. Such became apparent soon in his life from a very early age. My father's mother was proud of her little boy and of the age at which he read, wrote, and calculated, possibly almost to the point of being ever so slightly boastful of her child's early abilities in academic areas. My father's father might conceivably have been proud as well, but if so, he had a very different style of demonstrating it if it was pride that he felt at his eldest son's early achievement. My father's father was very quick to point out any error in his son's work or in his son's manner or thinking. Whether this was his father 's way of assuring that his son's ego remained small enough to continue to fit comfortably inside his head, or whether it was my father's father's way of dealing with jealousy that his son was rapidly out-pacing his father's academic achievements can only be surmised. The end result was that my grandfather  took every chance to call attention to any error his young son made, and to poke fun at anything he perceived as cognitive weakness on the part of my father.

Sometimes when children are abused in any way, including psychological abuse  (the corporal punishment doled out by my grandfather would, at  least by today's standards and likely even by the standards of the generation in which he raised his children, cross over the line to what would be identified as physical abuse as well) they respond by raising their own offspring as they were raised by their own parents. My father seemed to recognize the physical abuse he received at the hands of his father as such. He was able to break the cycle in that regard. His use of corporal punishment, as I perceive it as having been on the receiving end, was almost a textbook example of how to use corporal punishment effectively. It happened seldom (six times exactly to me; possibly a few more times to Matthew, as boys can be more difficult in the early years). My father never seemed angry or out-of-control when he swatted me.  It was always a carefully considered option. It happened for direct defiance or for serious violations of safety issues. Even as the recipient, I would not change anything my father did in that regard.

My father, in my opinion, did not do quite so well in managing the academic progress of a child whose cognitive development may have been above average as he did with general parenting and discipline. I certainly don't think anything he ever did would have been motivated by jealousy, as I do not believe that I was his academic or cognitive equal at equivalent ages. Nonetheless, I was clearly the brighter of my parents' two surviving offspring. There were times when I felt that I was not allowed to be a 'normal' child and was held by my father to  ridiculously high standards. For purposes of illustration, and because I believe these actions of parenting on the part of my father have contributed to my excessive expectations of myself and my sometimes malignant self-expectations of myself for perfection, or, at the very least, my inability  to make even a single mistake and forgive myself, or accept that others will forgive me, for it. Again, I share these two incidents (there were others, but these two were particularly flagrant and stand out in my mind as such) because, at least in my mind, they have shaped the person I grew to become and how I live my life from day to day, but my father was so much more than these two incidents of parenthood. He was, for the most part, a fairy-tale parent in more ways than I could ever count, and I would not trade him for anyone.

My brother and I entered kindergarten at the age of four years, eight months. The kindergarten cut-off date for the state of California at that time was December 2, which was our birthday. Had it just been I and not a twin brother involved, my parents might have held me out of kindergarten until the following year just because of my size. My medical physical form that was completed a week before the first day of kindergarten listed my height at 34 inches  and my weight at 23 lbs, 8 oz. Checking size reference, my height would have been average for a little girl of roughly 2 years, 2 months. My weight would have been on par for a nineteen-month-old toddler girl. My size was already of concern to pediatricians and I was already being seen by a growth specialist. Yet I was already reading without anyone having taught me other than to read to me, and we did have letter magnets on our refrigerator. My brother was on the tall end of average for his height. He was beginning to read prior to entering kindergarten, as well, though his reading and math skills were considerably behind mine. Our pediatrician said there was no right answer as to whether to start us in kindergarten or to red-shirt us. He [the pediatrician] offered his opinion that since neither of us was experiencing academic deficits, whatever one child did in terms of starting or not starting kindergarten, the other child should do as well. 

We began kindergarten as four-year-olds, as the very youngest children in our school eligible to attend. (Catholic schools have the right to set different cut-off dates than what the state has established, but the school we attended did not.) Had Matthew and I been born six hour later, we would have missed the cut-off date and would have. by default, entered kindergarten the following year.

For the first week of school, I believe I did the standard kindergarten curriculum. It soon became obvious that, while my printing was barely legible because I had difficulty with gripping a pencil correctly ( I fisted it), and my coloring was abysmal, there wasn't a point in my sticking with the kindergarten curriculum, yet moving me to a classroom of older students would probably be a bad idea, as even the kindergartners tended to treat me as a baby; older children would have done so even more.  It was decided that curriculum material would be sent down from higher-grade classrooms. Literature came from a variety of sources, and math curriculum was from an advanced fourth-grade series.

During almost mid-year, I recall working on a page of long division problems. As I recall, the page consisted of ten problems of four-digit dividends divided by two-digit divisors. I recall that the teacher required that I show my work either on the page itself or on a separate sheet of scratch paper, which was to be stapled to the actual paper. the math pages were in a consumable workbook in which the sheets were perforated, with problems on each side. I remember my teacher would punch out each day's pages for me to do. On that particular day, my answer for one of the division problems was incorrect. I recall not thinking a great deal about the red check mark made next to one of the problems, and the 9/10 score written at the top of the page.

After dinner, my mom asked us to remove work, included homework and graded papers from the day, from our backpacks, which we did. She glanced at my paper and saw that I had done a problem incorrectly. My father overheard and came into the dining room where we were preparing to do our homework. He seemed quite agitated that i had missed a long division problem. He looked at the work I had done, and saw that the problem occurred when, at one point, I had calculated 6 times 7 to be 43. He was baffled. "Alexis,' he demanded, "how could 6 times 7 possibly equal 43? When you multiply any even number by any other number, what will the answer be . . . an even or an odd number?"

I thought for a moment, hoping I answered him correctly. "An even number?" I answered more as though I was asking a question.

"Yes. Of course," my dad answered himself.  "An even number multiplied by any other number invariably equals an even number . . . so how did you end up with 43 as your answer? Come on! Show me the math! I'm practically  dying to see this. Show me how it is that you got 43 out of 6 X 7?"  He was practically foaming at the mouth.

I didn't have any idea what he wanted me to say. "I don't know," I answered probably with tears rolling down my face.

"What you did was stupid, Alexis," he shouted. "Don't make stupid mistakes. You're too smart to make such a stupid mistake." I know he told me I was smart, but all I really heard was stupid.

From that point forward, if anything was marked as incorrect on any of my papers, I carefully tore the paper or papers up and placed the pieces into different wastebaskets at school.

I wonder how much it all got to Matthew, as he was clearly the less cognitively talented of the two of us. I think my dad just sorted of expected it of Matthew, though. I can remember hearing whispered arguments after Matthew missed a freaking sample question on the annual state test. (Sample questions are written with the intent of having the test-takers practice the bubbling procedure. The degree of difficulty of the content of sample questions is typically such that a trained chicken could correctly answer the question.) My dad was blaming Matthew's flat-line status on my mom's contribution to Matthew's genetics.  "Your sister Kara may be hot," my dad opined,  " and she certainly married well [to an oral surgeon who was also an MD and board-certified anesthesiologist], but she's not exactly rocket scientist material. She's not exactly even a rocket scientist's pencil sharpener material."

"John," my mother countered, "You could add up the full-scale  IQ points for all seven of your sisters and not possibly reach a sum as high as five hundred, so I'm not exactly sure why you're blaming this one on my family's DNA."

Another time that sticks in my mind happened when I was a six-year-old second-grader. It was in the early part of the year, before Matt and I had our birthdays. It was the second of the two years Matthew and I attended parochial school. That year, the second-grade teacher decided it would be a good idea for me to spend half of each day in the school's fifth-grade classroom. The fifth-grade teacher, whose name was Mrs. Rutherford, wasn't an exceptionally mean teacher, but, looking back at the year and at some of her actions, she may very well have been bi-polar. Now she'd be diagnosed and put on medication. Back then, she just took it out on the students. For the most part, she wasn't unkind to me, though.

Early in the year -- before Back to School Night -- the class was making a large timeline on butcher paper. The timeline  -- sort of a review of the previous year's social science curriculum, highlighted the white man's takeover of California. Everyone had to participate. My role was to print "1841 : John Sutter bought Fort Ross" with Magic Marker onto the butcher paper. Instead, I wrote; "1841: John Sutter built Fort Ross." When Mrs. Rutherford caught my error, she turned  a color somewhere between purple and blue. I was seriously afraid she might be having cardiac arrest, as I had seen my grandfather  when it happened to him, and his face had looked a lot like hers did. He couldn't shout during his cardiac arrest, though. Mrs. Rutherford was able to shout quite well. She acted as though someone had been killed as a result of my horrible mistake. Now she would have to cut a smaller piece of white butcher paper and glue it above where I had made my most grievous error. Then someone else would have to print "1841: John Sutter bought Fort Ross." This time it would be someone with at least half a brain who was smart enough not to commit the grievous sin of writing, "John Sutter built Fort Ross. "  The real fifth graders who were mostly ten years old, seemed to take delight in taunting  poor little six-year-old Alexis about her stupidity. (In fairness, though this might not have had anything to do with my error, John Sutter did actually build a fort in northern California. He built Sutter's Fort in what later became Sacramento, in either 1839 or 1841, depending upon what source one chooses to believe, but that's neither here nor there.)

Back to School Night rolled around about a week later. I tried to talk my parents into skipping my fifth-grade classroom after visiting Mathew's and my second-grade classroom, but they were determined to go there. Almost the second we walked through the door, Mrs. Rutherford approached them and walked them to the wall with the mural. She showed them the place where the mural had needed to be papered over because I had been so lacking in intelligence as to print "1841: John Sutter built Fort Ross" instead of "1841: John Sutter bought Fort Ross."

My dad glared at me and asked, "Really, Alexis?" incredulously.

My mom made some benign comment about how mistakes happen and that if the paper cost the school extra money, she'd be happy to pay for it. Nothing else of mine posted in the classroom seemed to matter, though.

Once we got into the car, my dad started what would have been a fifteen-minute tirade about how stupid my mistake had been that probably would have lasted the entire fifteen minutes from the school to our home had my mom not finally told him to shut up. I remember crying in bed until I finally fell asleep that night. Matthew told me the next day my dad had wanted to make me write '"1841:John Sutter bought Fort Ross" five-hundred times but that my mom told him not even to think about it unless he wanted her to spray paint "1841: John Sutter built Fort Ross" with red spray paint onto his white Lexus. (I think it was something like an ES 300, and it was a fairly late model.) My mom won that round.

I tell this story not so much to make the point that my father was a psychologically abusive parent, which he could be at times, though probably unintentionally. My point was that my shrink thinks my parents, with probably the best of intentions, or at least not the worst of intentions, helped to create in me a mindset that mistakes are never OK.  Maybe that's why I overreacted so strongly to accidentally dialing Judge Alex's phone number well after midnight.
That's my shrink's take on it, anyway, and I'm sticking with him on his story.

The good news is that I chose a profession where mistakes, for the most part, really aren't OK. I'll make a few in the training phase, for which I'll be yelled at, but someone will be overseeing my work to the degree that I shouldn't be able to kill anyone. Once I'm no longer under direct supervision, mistakes need to be somewhere between few and far-between and non-existent. A doctor can, once in a great while,  make the sort of mistake in which a condition is one of two, if you teat for one, you kill the patient if he has the other, ad vice versa.  You have a fifty-fifty shot either way. The truth of the matter is, though, that such cases happen a whole lot more in TV programs such as House, MD than they do in real life. Mostly you just need not to make mistakes that kill your patients or cause them to lose vital organs are limbs. I'm not sure that counts not butt-dialing people after midnight, though I intend to try extremely hard NEVER to do that again to anyone.

Now I've been told not to report for work until Monday, August 8. I'm cool with that as long as they're not just stalling me and they're not eventually going to tell me not to show up at all. My cold is finally getting a little better. My viola playing still sucks, I can play lots of songs. They all sound like shit when I play them.

Monday, July 25, 2016

The Rest of the Story: It Gets Better

It was a wild and crazy day.

I'm filling in the blanks here with the some conversation that took place in the O.R. on Friday. I was reluctant initially to include all of it, but have since been told that absolutely nothing can happen to me by virtue of my sharing it. I am including it because I suspect some of my regular readers would find it intriguing.

Directly following the dropping of the clamps (not be me), the f-bombs shouted at me, the hurled insults indicating that my head contained shit where brains should have been, and the reference to me as an anorexic and a Baby Bimbo, the conversation took a turn for the worse in the direction of sexual harassment.

The lead surgeon opined more than once on my need for breast enhancement if I wanted to be taken as a serious contender on the pageant circuit. "Although I'm not sure if it's legal yet at your age," he added. "Ah, hell, legal, schmegal, I can hook you up with a guy in Mexico who'll fix you up real nice." He asked if I'd been perfecting the pageant wave, and if I'd though of any answer more original than world peace when the pageant emcees asked me what would be my platform if I ever actually won one of the contests. He asked what my talent was. "I'll just bet you're a clarinet player, aren't you?" he answered his own question [with another question], winking at me. "All that extra lip and tongue action you develop from playing the clarinet comes in handy for other things, too, you know . . . but I'm sure you already knew that. . . And those thing can help you advance in the pageant world, too, if you use them right, but I'm sure you already knew that, too." Again, he winked at me.

"Shut the hell up before you get yourself in even more trouble than you're already in," the anesthesiologist demanded.

"I'll begin taking my orders from anesthesiologists just as soon as anyone comes up with the slightest evidence that any of you are one whit smarter than trained monkeys," the surgeon answered.

I stood wordlessly through more comments from the lead surgeon in regard to my qualifications as a beauty pageant contestant. "You're not as attractive as you think if you really analyze your facial features, though I guess some of those judges are partial to  anorexics, and we know how they love their blondes, real or from a bottle." 

For the record, I've always considered my looks to be average at best on a good day. This stems largely from the way I was raised. My parents wanted me to look inward for more important qualities than external beauty. In retrospect, they now realize that with the best intentions, they probably erred too far in the direction of de-emphasizing what to me should have been be the importance of my physical appearance, and now are constantly trying to build my self-esteem in regard to my looks. Each time I see either of my parents, they give me compliments regarding how pretty I look. It's all water under the bridge now, but the bottom line is that I certainly didn't need to hear from Dr. Lead Surgeon that I'm walking around harboring highly inflated views of the stunningness of my physical beauty.

Dr. Lead Surgeon's comments caused me to stare up at the ceiling momentarily. I'd never tried to hide the role of chemicals  in my blondeness. I had been blonde as a child, but childhood blondeness rarely holds, and I  frequently joked about the effort required in maintaining the hair shade of my youth, though not with the lead surgeon, as I'd never before had as much as a conversation concerning the weather with him.  I'm not sure what he saw of my face under the mask and goggles, particularly as I was making every effort to offer as little visibility as possible to him. "You look quite a bit like that little girl who got raped [sic; there was some evidence if penetration with a paint brush, possibly after the fact in order to disguise the event as a sexual assault gone to far. but the attack was not clear-cut rape] in Colorado. What was her name? Help me out here, somebody." No one helped him with filling in the missing details of Jonbenet Ramsey's name, instead mostly staring icily at him. 

Tears could be seen through the lenses of the surgical resident's protective eye wear as she continued suturing. Though nothing had been directed at her and, up to that point, she hadn't been part of any conversation in the O.R., the depths to which the discourse had sunk were clearly distressing to her. "Is this all really necessary?" she finally chimed in as she made the knot on the final suture. "I'm not comfortable with any level of sexual harassment in the workplace, and what we're all witnessing here is far from the minimal distinction of sexual harassment. It's  all the worse for me as her direct supervisor in the O.R. at this time. I can't let this go."

"So you're letting yourself sink to the level of the workplace snitch?" the lead surgeon sneered at the chief surgical resident. "Congratulations, and good luck in securing any recommendations from anyone around here," he added.

"I assume she has the recommendation of everyone here," countered the anesthesiologist. 

"And everyone up here, too," chimed in the voice of God from the intercom providing sound from the viewing area.

The patient, blessedly unaware of the degree to which the quality of her surgical care was compromised by the pathetic display in the O.R. was moved to a recovery area.

Personnel exited the O.R. and removed protective gear. The anesthesiologist voiced his desire to kick the lead surgeon's ass (his words, not mine). He indicated that he would refrain from acting on his desire this time as he didn't need the formal reprimand that would result no matter how deserving the lead surgeon was, but that if anything like it happened again, anyone who handed out a reprimand could take it directly to hell. 

Then the lead surgeon turned to me, pointed his right index finger at me and said  and said, his voice growing higher in both pitch and volume with each proceeding word, "You! Yes, you . . .  in addition to being an unprofessional little bitch with shit for brains,  are a first-rate trouble-maker who has a chest measurement that would embarrass a thirteen-year old girl with any self-respect." 

The anesthesiologist doubled his fist. A male RN who probably weighed two-hundred seventy-five pounds stepped between them. Security was called. 

I moved on to the women's locker room, to where the chief resident had already retreated. She was seated on a bench in front of her locker, and she was silently crying. one of the nurses was patting her shoulder.  Both of them turned to me. "You handled that really well," the rN said. "You know that none of that was your fault, right?" she asked.

"I assumed. . ." I answered.

"Lisa, the O.R. tech walked in. "Have you ever even worked with him before?" she asked me.

"No, " i responded. "I've never even met the guy. I couldn't figure out where it was coming from."

Another RN walked in and started to ask me something, but I quickly excused myself and bolted toward a stall. Once inside, I opened my mouth and allowed the comments of my stomach to escape with a level of force that surely would have impressed the member of The Exorcist's  special effects crew who were charged with coming up with Linda Blair's infamous barfing scene.  

The surgeon in charge of clerkship surgical rotations drove me to my apartment in my car as someone else followed her in her own car in order to drive her back to the hospital.

I thought the incident was over as far as I was concerned, but I ended up with hours of meetings and physical and psychological examinations the next day. All's well that ends well, though, at least for me, anyway. I've been given a free week to recover from my cold and from the effects of abuse-induced stress, of which, to be perfectly honest, is not all that much. When we're all telling stories of our med school experiences someday, hardly anyone will be able to say much of anything to top the story of my day in the O.R. with the surgeon who is almost certainly the single greatest asshole ever to wield a scalpel.

In Partial Defense of My Brother (sort of a back-handed compliment)

This is obviously not an actual photo of my brother because, for one thing, my brother would kill me if I posted an actual picture of him on my blog, but it's a reasonable facsimile except that my brother has blue eyes.

The central topic of this post is my brother Matthew. Matt merits frequent incidental press time in my blog, but seldom if ever has he been the prime subject of a blog post, or at least I don't recall devoting a blog post exclusively to him. The reason I'm writing about him now is in part because of a recent telephone conversation I had with a friend,  and also because of comments other friends have made to me about my brother recently.  

I may have created a few misconceptions concerning Matt. A friend once commented that from the way I speak of Matthew, it seems rather dubious that he is able to dress and feed himself independently. I've shared an abundance of stories about stupid things Matthew has said and done. Matthew believed until he was over six years old that a person could be sucked into a sewer or septic system by standing too near a toilet as it was flushed. I once convinced Matthew that by planting Cheerios into the ground, a person could ultimately produce a plant that bore doughnuts. As recently as three years ago, Matthew did not believe that there were such actual beings as pygmies; he thought they were Hollywood creations synonymous with "Oompa Loompas."  I've shared a few stories about stupid things I personally have said and done as well, but in general I'm much more open to the idea of talking about Matthew's acts of brain-deadness than about my own. It helps that Matthew gives me so much material with which to work in this regard, but still, I am guilty of sometimes fanning the flames of what sometimes seems to be the vacuousness of the inside of Matthew's head. I haven't been entirely fair in doing so.

By way of evidence that Matthew's EEG may not be entirely flat, I'll briefly discuss SAT scores -- Matt's, not mine, because my scores are not relevant here. He took the test twice. His first attempt was a bit mediocre, but he then went through the Kaplan course. His second attempt yielded him a combined score of 1890, which wouldn't necessarily have landed him into the thick of Ivy League contention, but still the score was nothing about which to be embarrassed. He was young when he took the test, I might add. Matthew and I each completed high school at the age sixteen years, six months and eight days, which would have necessitated early SAT dates. 

Matthew completed his Bachelor of Science degree in three years, just before hitting the nineteen-and-one-half-year mark. We both had the advantage of multiple AP courses in high school, and he took summer school courses in university as well. He didn't complete multiple majors as I did, but finished his degree early while spending two of his three intercollegiate years as a Division I baseball player. (His freshman year he red-shirted.) He would never have made it into the major leagues as a baseball player, but had a ninety-four MPH fastball with decent control, which for his relative lack of bulk was impressive. I don't think it was ever Matthew's goal to play pro ball, or at least it wouldn't have been his goal much after the age of thirteen or so, but he was a legitimate contributor to his university team's pitching staff. Matt's weakness as a pitcher was that he didn't have a great deal of versatility in terms of pitches other than his fastball. In order to be highly effective, a pitcher needs to have a variety of pitches in his arsenal, causing batters to wonder what sort of pitch might be coming up next; if batters know for certain that the next pitch they'll be facing is a fastball, too often that fastball will travel equally fast in the opposite direction, sometimes even over an outfield fence. Matthew had his impressive fastball, but the forkball that someone with vision corrected to a maximum of 20/400 could have detected before it left his hand wasn't sufficient backup for his fastball, however impressive and reliable  it might have been.

Matt's pitching performance is in some ways a relatively representative metaphor for his life. He has limitations, but what he does, he does extremely well. He works hard both at the things he does well and at those things that do not come so easily to him but that he knows are important. He may not learn as quickly as some do, but he's willing to put in whatever time is necessary to master a concept. 

And he cares -- not just about himself and his own performance in various areas and how his performance makes him look, but about others. When Matthew is a doctor, he will care about his patients.  If he becomes a surgeon as planned, he will probably visit patients more often than most surgeons visit their patients in hospitals. This may lead him to become aware of post-surgical problems or complications that other surgeons might have missed simply because he will be attentive and observant, and he will be there. Then again, perhaps the extra time spent at the hospital may just cause Matt's wife to divorce him due to the resulting neglect and/or cause his children to forget what he looks like. Only time will tell.

Matthew is typically calm in crises. This will work to his favor as a doctor of any kind, but particularly if he works in trauma or surgery.  Matthew learns well what he is taught and remembers it even in heated situations.

Matthew's Achilles' heel as a surgeon may be that once or twice in a physician's and particularly a surgeon's career, he or she will probably come across something he or she has never before seen or been taught about.  Not everything about the human body can be anticipated, and not every eventuality can be covered in medical training. If anomalies present in the course of a physical exam, a physician can consult resources. When it hppens in surgery, if someone in the O.R. doesn't know what to do, the results can be devatating. An organ may fail or an artery may blow out in the course of  a surgical procedure during which  the apparent impetus has never caused a similar failing in recorded medical history. In the occurrence of such an instance, a patient's chances of survival may be linked closely to a surgeon's ability to synthesize quickly and to instantaneously create out-of-the-box solutions to such crises. Matt may be handcuffed in his ability deal with such phenomena. In many of such instances, the patients won't survive no matter what heroic measures the attending surgeon comes up with, regardless.  In Matt's case, however, were the very same thing to happen to a patient under his care a second time, he would have as good a chance as any surgeon of beating the odds and saving the patient the next time he encountered the phenomenon.

I've never been known for possessing excessive humility, and I have a great deal of confidence in myself in terms of my eventual ability to practice  medicine and to perform surgery if that's the specialty I happen to choose. If I did not have such confidence in myself,  I would seek another line of work. Assuming Matthew and I both followed career paths leading us into surgery, my honest opinion at this point is that if a person were forced with the choice of going under a scalpel wielded by me or one wielded by my brother, I would be the safer choice. I'm speaking as who I am, a person who is perhaps a bit conceited but also honest with herself. On the other hand, I've seen many both  future surgeons and surgeons currently in the practice whom I'd trust far less with a surgical procedure in which my own life were on the line than I would trust Matthew. He will earn his right to practice medicine. He will do so not without good looks, charm, and a small degree of sweet talk to those in important positions, but in even greater greater measures he will do so with perseverance, diligence and devotion to the field, and with adherence to the Golden Rule.

Saturday, July 23, 2016

Take This Job and Shove It Except That It's Not a REAL Job in the Sense That I'm Unpaid Plus I HATE Country Music

Yesterday was a long and rough day at work. It didn't begin with the presage of being unduly lengthy, as the first surgery for which I was to be in attendance wasn't scheduled to begin until 6:30 a.m., which meant I could show up at some point between 5:00 and 5:30, which I did. Matters were not helped by my having picked up a cold at some point during the night, but such is life in the world of medicine. You don't skip surgery for a mere cold. You keep your stinking mask on all day even when you're not in surgery, but you show up and you stay there until you're kicked out of the hospital or surgical center by one of your superiors.Then some lady's fallopian tube exploded, and the surgeon who was to lead the surgery previously scheduled for 6:30 was suddenly out of commission. All of the other surgeries that were scheduled still happened -- just later than they should have started. I finally got away from the hospital at 8:05 p.m. 

I arrived at my condo to find Matthew at home with our living room full of his buddies eating pizza and watching -- of all things -- some ESPN program about how the 2016 NFL draft picks would fare in the upcoming fantasy football season. Jesus fucking Christ! Why doesn't ESPN just televise ants carrying food across kitchen counters? It would be a hell of a lot more relevant and equally entertaining.

I left to get an ice cream cone and briefly texted a friend, but almost as soon as I was handed my ice cream cone in the drive-through lane, I was overcome with violent gastric symptoms. I pulled my car far enough from any other cars in the parking lot so that I could drop the ice cream cone onto the pavement (I'm not usually a litterer, but I made an exception) and could empty the almost nonexistent contents of my stomach in relative peace. I then drove home, plugged my nose so that I wouldn't smell the pizza and beer as I walked though my living room, not that I could have smelled it anyway with the nasal congestion of my cold,  and put two towels at the bottom of my bedroom door so that the smell of the pizza wouldn't pervade my bedroom and make me sicker than I already was.

Work itself was less than delightful. One cannot expect it to be fun when experiencing cold symptoms, but a scratchy throat, headache, and sinus pressure were to be the very least of my troubles. During an exploratory laparotomy, the lead surgeon dropped a clamp. There wasn't another identical clamp on the tray, so he (the lead surgeon) hurled a few choice expletives as one of the nurses quickly hurried to grab another from an already sterilized set of surgical implements. The nurse handed the clamp to the surgical technician [who technically must be the one to hand every instrument, sponge, towel, or whatever piece of equipment is used in a procedure to the surgeon, and then must take it back if it is not something that is to remain inside the patient, because he or she is responsible for accounting for every piece of equipment and for ensuring that nothing is left inside the patient that isn't supposed to be left there], who inadvertantly dropped the second clamp. I was standing slightly behind and between the nurse and the surgical technician but had no physical contact with either, which made it most puzzling when the surgeon hollered, "Goddamn faecal encephalopathic!"

The O.R. tech gave him an ugly look, or as least as much of an ugly look as one person can give another with two-thirds of one's face covered by a surgical mask, and  commented, "You could have just said 'shit for brains.'  Everyone here  knows what faecal encephalopathy means. You weren't impressing anyone or sparing anyone's feelings, not that that you've  been known to spare anyone's feelings before." She paused for a breath, then continued. "And so I dropped a damned clamp. You dropped one before I did. No one felt the need to spout f-bombs when it was your fault."

"I wasn't directing anything at you!"  the lead surgeon retorted.

"So I'm the one with shit for brains?" the nurse who had retrieved the second clamp chimed in. Meanwhile, someone else had grabbed a third clamp and handed it to the O.R. tech, who wordlessly handed it to the lead surgeon, who miraculously managed not to drop it.

"Did I expressly identify you as the faecal encephalopathic among us?" he asked her, looking up briefly from the patient's open abdomen. (Radiological reports were unclear as to precisely what was amiss with the patient's organs, necessitating a full laparotomy as opposed to the less invasive laparoscopic procedure.)

"I handed the clamp to Lisa [the O.R. tech]," the nurse responded. "It fell to the floor. I handed off poorly, or she flat-out dropped it. You seem to be the self-proclaimed official scorer here, not that we've ever needed one before. If you weren't yelling at her, it must have been at me." 

"Try Option 3," the lead surgeon spat out.

"And what might that option be?" asked the assisting surgeon, a  third-year resident, an ordinarily soft-spoken woman.

"That would be Baby Bimbo standing right there between Thing 1 and Thing 2 who couldn't quite keep her hands to herself," the lead surgeon answered. My jaw dropped almost to the floor, though no one could have observed it through the surgical mask.

The O.R. tech and the nurse who handed the clamp to her both began heated responses to the lead surgeon when a voice came over the intercom. 'You have a patient on the table, Dr. ********,"  said what sounded like the voice of God through an intercom, but was actually the voice of the doctor charged with supervising surgical clerkships and residencies.  (Some surgical suites have viewing areas above them, which this one did. Those in the surgical suite cannot hear anything from the observation point unless someone presses the intercom button.  As often as not, the viewing areas are unoccupied, but a relatively  high authority stopped by to observe at a rather timely point in the procedure.)

The surgery proceeded in virtual silence, interrupted only by requests for instruments as needed. As the senior resident was making the final closing sutures, the lead surgeon looked up to ensure that no one was in the viewing area, then looked directly at me. "You cannot tell me, Princess Anorexia," his voice heavily laced with sarcasm, "that you didn't reach for the clamp and cause Ms. Herman [the O.R. tech; though she was known by "Lisa" to everyone in the room, I was, it seemed, unworthy even for a reference by her first name to be directed at me] to drop the clamp?"

As I was pondering the specifics of my answer, Lisa answered for me. "No, she didn't touch the damned clamp. I dropped it, it as you dropped the one before."

'What's this?" the lead surgeon countered.  "She can't speak for herself? Do you even have a voice?"

"Is this really necessary?" the senior resident asked as she made the knot on the final suture. "And by the way, things you've said in here have been precariously close to sexual harassment."

Peronally, I'm not overly concerned with verbal sexual harassment. For the most part, if they keep their hands to themselves, I don't care what questionable things they might say along the lines of sexual innuendo. I draw the line, however, at false accusations of any nature.

"I just want to know if she's capable of speaking," the lead surgeon continued. "I've heard no evidence that she has a voice."

"What do you want me to say?" I asked him, making direct eye contact.

"Anything!" he shrugged.

"Anything,' I responded.

Laughter broke out in the room as the lead surgeon rolled his eyes and muttered, "How intelligent!"

I made it out of the room and out of the scrubs and paraphernalia in record time. I didn't want to talk to anyone. Another surgery, thankfully with another surgeon, was scheduled for less than fifteen minutes from the time I made it out of the partial hysterectomy, and I would need to rush to be  scrubbed and ready in time to be allowed to be present for it.

My next and final surgery for the day -- a thyroidectomy -- went without incident. I just felt sorry for the patient for having to wait so late in the day for the procedure. Few things are more agonizing than waiting as a patient for a surgical procedure. Fortunately, it was short and to the point, everyone inside the O.R. behaved professionally, and the patient came through recovery with minimal discomfort.

So I made it through an especially arduous day, made all the more difficult with the symptoms of a cold, only to be hit with a gastric illness, and, unless someone else who lives in this condo has acted in a most uncharacteristic manner, a messy living room and kitchen with which to deal. Matt will likely pull the martyr act and say that because he is on call for Saturday while I have the weekend off, all the clean-up chores should fall upon me. If I open the door this morning to find the downstairs area not cleaned to my specifications, I will telephone the complex's on-call cleaning crew and arrange to have the entire downstairs area  be made spotless at Matthew's expense. If he doesn't fork over the money willingly, I'll call my dad and rat him out, and the money will be deducted from his next month's spending allotment. It shouldn't be a problem for him, as my grandmother sent him a hefty check for his half-birthday (?!?) last month.

P.S. I received a text message at 1:06 a.m. from my preceptor telling me that I am to meet her at her office at an early time this morning. (She indicated the time, but for security reasons, I can divulge neither the precise time nor the specific location.) She mentioned the importance of punctuality, as others besides her self may possibly be present as well. I didn't see the text at the time it came, but I checked my phone just while ago when it dinged for another reason, and then I saw her message. I've never been asked to meet with her except  regular scheduled-well-in-advance meetings, and certainly never on a Saturday. She's a psychiatrist and almost never works Saturdays.  This cannot possibly be good. I suppose I may as well give up on the idea of sleep for the rest of the night.

Thursday, July 21, 2016

Life sucks, and then you die.

Work  is good now. Everything else pretty much sucks. I could blog about the sucky stuff in my family. Most of it, for the benefit of anyone who really cares, is not my immediate family in particular. They're peripherally involved and I don't necessarily appreciate the ways in which they're dealing with it, but neither my parents nor my brother are the direct impetus.

I'm choosing not to air the specifics of my family's dysfunctionality as it relates to me in this particular instance primarily because any discussion of it in this forum would be a source of mirth to some of my least favorite relatives. While it might seem as though I have delusions of grandeur (and perhaps I do to an extent, but I'm not exaggerating in this particular context), extended family members who dislike me would be amused by the knowledge that my feelings have been hurt -- perhaps carelessly but perhaps intentionally, and even if it wasn't intentional, the person most certainly should have known that his or her actions would have been perceived as hurtful -- by a member of the family. Some would say that I'm harming myself more than I have been harmed by the person whose actions have offended me. This may or may not be true. Nevertheless, I refuse to deny my feelings at this time. I won't bury them and go along with the good old Mormon adage that all is well when all is not presently well with me.

The surgical rotation is fascinating. I learn several new things each day, which is as it should be. Were I not learning new things on a regular basis at this point of my career, something would be seriously wrong either with me or with the system. Those I am working with are, for the most part, decent human beings. Such will not always be the case, but it's a blessing that for the present, I don't have to deal with a-holes at work.

I'll have at least the next two weekends off. It sounds somewhat contradictory to say that work is delightful and then to express my gratitude at having weekends off, but I've found that almost nothing is made better by sleep deprivation. For now, I'll take every weekend off that I can get, and I'll be happy about it.

I'm sorry to come across as such a Negative Nancy right now, but it's not the most joyous time of my life, or at least I hope it is not. If this is as good as it gets, I'm not sure what is the point of anything.

Tuesday, July 19, 2016

Families are Forever, Fools Rush in Where Angels Fear to Tread, and Other Cliches That I Hope Have No Basis Whatsoever in Reality

Right now my life is in the midst of its own sort of "horse latitude" cycle. The doldrums have struck, and have done so in a rather cataclysmic and convergent fashion. My description is metaphorical, of course. I'm not on a ship, and the ship that I'm not on is not stuck in one of the Intertropical Conversion Zones of low pressure and calm winds -- either the calms of Capricorn or the calms of Cancer. Furthermore, I am privy to the knowledge  that the idea that horses had to be thrown overboard for the purpose of preserving ships' rapidly dwindling water supply -- hence the sobriquet horse latitudes -- is largely a term borne of folklore, which is not to say that there was never even a single instance of a horse being thrown overboard when water supply diminished rapidly during the calms of subtropical latitudes. The point here is that I took the same undergraduate physical geography course covering weather and climate that nearly every other university student did. No one needs to feel obligated to consult Wikipedia, then to use the "comments" section of this blog to "educate" me or other readers concerning the particulars of atmospheric circulation, disambiguation, and other features of the Intertropical Conversion Zones. Most of us already know as much as we care to know about the topic.

The one bright spot in my life, thank God,  the Flying Spaghetti Monster,  the Great White Blood Cell, or whomever is responsible, is that my personal issues are not interfering with work, and that work is continuing to move along smoothly. My supervising attending physicians and residents  have thus far liked me and have been pleased with my work, as have the interns supervising me. The word on the street is that the surgical rotation is the one in a which a third-year medical student  should not begin his or her clerkship. Nonetheless, someone has to start out here, and I figuratively drew the short straw. The work is physically demanding, and that's the very least of the drawbacks associated with the surgical rotation. Through a combination of over-preparedness and sheer dumb luck, I've been able to overcome most of the stumbling blocks of having gotten stuck with surgery as my first clinical rotation. For that matter, I'm finding it fascinating and am having a blast with it. 

After an organ that is not to be transplanted is discarded, third-year students often get to use it to practice incisions and sutures. This probably sounds bizarre and disgusting to anyone not actively involved in the allied health fields, but it's an excellent way to get the feel of incising and suturing live tissue when the stakes are very low. The organ is useless, so we can't do any harm. We've all done our time in anatomy lab, but cold, embalmed bodies have a much different feel to them than do living (or recently living) tissues. I've done well enough with my discarded organs that three of my supervising surgeons have allowed me to do just a bit of work on the actual surgical patients. The real surgeons are right there on the tips of their toes, poised to jump in and to repair anything that I might screw up, but thus far that hasn't been necessary. Knowledge of this has to be far from comforting for anyone who is or whose loved one is facing surgery at a teaching hospital in the near future. Still, training must happen, and until someone comes up with a mannequin remarkably similar to the human body, we doctors-in-training must practice on actual patients. If whoever operates on you or your loved one hasn't had adequate training and practice, the surgical patient is in a world of trouble.

Unfortunately for me right now, life consists of more than just work.  My family hates me. Okay, that's probably an overstatement. Most members of my family are angry with me. I shall not air the dirty laundry in this forum. I initially messaged a friend with the details, but then thought better of it and erased the messages. We all have problems. My friend surely has issues of his own with which to contend. Probably the very last thing he would choose to do with his finite free time is to read about the dysfunctionality surrounding my family. Even if he read about it, what could he really do? I can't exactly see him calling my relatives and telling them how wrong they are even if he did agree with my points in the dispute, which isn't necessarily a given. 


On top of everything else, I'm dealing with a bit of a situation in the domain of romance. While I'm in the league of neither Tesla nor Einstein where raw intelligence is concerned, I'm not so lacking in gray matter as to believe that now is a good time to involve myself in any sort of affaire de coeur. Lamentably, these things sometimes happen anyway, even to otherwise intelligent, or at least otherwise not overwhelmingly stupid people. The upside to the situation is that it is temporary. This, too, shall pass, and probably sooner rather than later. In five weeks the subject of this relationship and I will be in different rotations and may not meet up again in another rotation for a long time if ever.

The family situation will not likely work itself out with quite such ease. Blood is thicker than water (and speaking of blood, some blood types stain clothing more persistently than do other types; some things one has to learn the hard way, and I will never again wear non-hospital-issue scrubs into surgery), and these things usually eventually work themselves out, though not always without resultant scars. All I can do is stand my ground where I think it is absolutely essential that I do so but not be so stubborn as to hold out in ways that hurt myself more than anyone else solely for the purpose of making a point. 

Sayonara, and I hope that your summer is sailing along more smoothly than mine is.

Wednesday, July 6, 2016

Nurses vs. Doctors

I've observed something in the hospital setting that will come as no surprise to many of you, which is that many doctors and nurses don't like each other. Part of this can be explained simply with the suggestion that some doctors are pompous a-holes, while some nurses (male and female) are bitches. These particular doctors and nurses probably don't get along well with their bank tellers, their children's teachers, or the people who are unfortunate enough to inhabit residences with them, either. It's not surprising that they would have trouble getting along with one another.

I've written before about the hierarchy that exists in hospitals. In practice, we third-year medical students are on the lowest part of the bottom rung of the hierarchy. Theoretically, we outrank nurses at least in terms of orders concerning a given patient. If we give an order, in theory a nurse needs either to abide by the order or to contact an intern, resident, or attending physician to override the order given by us. In practice, third-year medical students usually want the input of nurses before even doing so much as turning light switches on or off, much less in formulating patient orders. 

In my current surgical rotation, I have fewer opportunities for conflict with nurses than I will have in most settings of my career.  A substantial portion of my time is spent preoperatively, in surgery, and in in post-op. I don't have to make much in the way of decisions concerning patient care. I talk to patients, record vital signs, insert IVs, and observe surgical procedures.  It's not an environment conducive to conflict with nurses. For this I'm grateful. While eventual conflict with a nurse is an inevitable part of this job, neither do I look forward to it.

My brother is in a pediatric clinical rotation. A nurse derided him him because he left her to clean a bed of a patient who had defecated. Because I'm a total wimp and I want the nurses to like me, I probably would have stuck around and helped the nurse to change the bedding and clean up the patient. My brother chose to alert a nurse and to move on to his next patient.  He was within his rights to act as he did. Cleaning up patients and changing bedding are duties of nurses, not of physicians, except in the most extreme of situations. Would there have been anything inherently wrong with my brother helping the nurse with the rather unpleasant task? No. Was he obligated to don his rubber gloves and clean up the mess. Again, no.

The nurses in the hospital make a monthly "Shit List" (no pun intended) of med school students and interns. Matthew would have had an excellent chance of making the list for the month of July had his conflict with the nurse happened later in the month. As it is, he still has three weeks to flash dazzling smiles at the nurses, most of whom will think he is a reincarnated Ben Casey, assuming either the fictional Ben Casey or the actor who played him have moved on. Chances are that by the end of the month, even the nurse he left to deal with the soiled patient and bedding will have forgotten all about Matthew having been less than chivalrous.

Meanwhile, I'll toil away and try as far as possible without surrender to avoid offending anyone.

Saturday, July 2, 2016

The definition of minor surgery is surgery that is happening to someone else.

I don't have to be at work quite so early today, so I've had the luxury of playing musical instruments, reading, and watching a little TV. Falling asleep quickly is an art I haven't quite mastered, but I've been so exhausted from the 13.5-hour workdays beginning early in the day that most days this week I've been lucky to have made  it home without having falling asleep on the five-minute drive to my condo. Having yesterday and today to catch up on sleep has been like a gift.

I've scrubbed in for a lot of surgeries this week. The surgeries I've seen thus fafr have been abdominal surgeries. Most of what I'll see in this rotation will be abdominal and lower thoracic surgeries, though I'll have a  week each of cardiac and neurosurgical procedures. If I'm interested in more, I'll need to request elective rotations in those sub-specialties.

I scrubbed in for a procedure that I won't see much of in this rotation, which was a c-section. C-sections are normally performed in the surgical suites in the maternity wing, but all four were in use when membranes ruptured in an expectant mother of twins with placenta previa. The OB-GYN wanted to get the babies out sooner rather than later. The babies (boys) were big as twins go - 6 lbs, 3 oz. and 6 lbs.10 oz. They were in separate sacs, which could mean dizygotic (fraternal) or monozygotic (the OB-GYn predicted monozygotic or identical, but said it would take further testing to determine with certainty) and have the same blood types. The delivery proceeded with no complications. I would have liked to have followed one of the babies, but the intern supervising me wanted me to see the entire surgical procedure. When I have my OB-GYN rotation in a few months, I'll get to see lots of deliveries and will have opportunities to follow the babies as they are evaluated. 

Personnel in surgery risk being sprayed or dripped on with every body fluid. I wear goggles even if I'm told there's no chance of being near enough to be doused, because there's never any guarantee of not being hit; the human body has amazing ability when it comes to expelling body fluids. I put double plastic bags over my shoes before covering them with surgical booties because I know too many people who have had perfectly good shoes ruined. It's not even the expense of replacing shoes that would bother me; I don't have the time to buy more.