Tuesday, November 29, 2016

working insane hours with equally insane people in order to attend an even less sane Portuguese rosary

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I need to be up and at work very early because I will leave work early to attend a rosary for which I will play piano or organ. I'm already at the hospital. Probably the very last thing I should have been doing, other than shooting up heroin or something along those lines, was staying awake and blogging. I'm sure most people understand, on the other hand, what it's like to really need to get to sleep. Sleep is often a most elusive commodity under such circumstances. It's pointless to lie awake in bed trying to sleep. It only makes sleep even harder by which to come. Blogging is more productive than staring at the shadows on the ceiling.

Matthew will be with me on the travel to the rosary, and he will drive. The drive there, even though we're leaving mid-afternoon, will be a bit of a bitch because of traffic, but the drive back will be quick and painless, as we won't be dealing with traffic late at night. Matthew is probably still sleeping (he doesn't need to be at work quite so early today; he worked late last night) as though he's Michael Jackson after a dose of "warm milk," known in the medical community and by virtually everyone other than the late Michael Jackson as propofol. I should probably clarify that Matthew is sleeping as Michael Jackson did following the intravenous hits of propofol that were not his ultimate shoot-up of the drug. Matthew is still very much alive and well. I opened his door an hour or so ago to let the cat in, and could hear him breathing.  Matthew sleeps like a heavily sedated person even without the benefit of drugs. He falls asleep within five minutes of the time he first attempts to sleep, and wakes up whenever he wants, usually without benefit of an alarm clock. It's a fantastic trait for a doctor to have, and he's very fortunate that both sleeping and waking come easily to him. 

I will be on duty shortly after 5:00. I typically would not attend hospital  rounds on a Tuesday, but since I'm making up time that I will miss at the end of the day, so the most logical use of the time is for me to participate in hospital rounds for internal medicine patients. I will be the only med school students. The interns will likely pull rank and will ask me every question that is in the book and many that aren't, which is why I plan to start reviewing charts almost two hours before the scheduled start of rounds. It's a chance to look really good or really bad. I'd prefer to look good. It's also a chance to make a few interns resent me if the residents ask them questions to which they do not know the answers, and then refer the questions on to me if I happen to know the answers. Often the attending stands back and observes the drama without saying much, though occasionally he will ask questions of the residents, and God help the residents if they don't have the correct answers. I won't volunteer answers but if I happen to know and am asked questions directly, I'll either answer or apologetically admit that I don't know the answer. The very worst thing is to try to fake it when one doesn't know the answer. It's OK to be wrong once in awhile as a med student -- though not too often -- but bullshitting gets a prospective physician absolutely nowhere except in deep doo doo  during rounds. 

After rounds, I'll have time for a very brief break before office hours begin. Because I will have shown up substantially earlier than everyone else in order to review charts and talk to the patients, and for the simple reason that the lower one is on the food chain in this business, the earlier one is expected to be on the job, I won't be expected to find ways of making myself appear productive because I will have been working long before the rest of them and will be entitled to a bit of a break. That is, unless I screw up on the question/answer sessions of rounds, in which case I will be expected to make it very obvious that I am studying the material of which I demonstrated non-mastery during rounds. If I handle rounds acceptably, I'll make a few quick notes for studying later, go back and bid the patients farewell and wish them a good day, and find out if they have any immediate needs that aren't being met. I don't HAVE to do this, but it's a nice touch, and I would appreciate it if I were stuck in a hospital as a patient. I will then have a bit of time to myself.

I have protein bars, chocolate milk, and a travel toothbrush with toothpaste packed in my car for when I leave the hospital to go to the internal medicine office. I also have a five-hour energy drink in case I cannot get by without it. Those things are supposedly really toxic for one's kidneys, which is why I avoid them on normal days, but after  sleepless night (though I did have a 50-minute nap when I first arrived home from work), I cannot be yawning in patients' and physicians' faces. I may have to sacrifice a day of the life span of my kidneys in order to avoid appearing highly unprofessional.  I try hard to limit myself to no more than one of those energy drinks per month, but at those rare times they're necessary. If I yawn too much on the job, am excessively sluggish, or fall asleep, my reaction to the reprimand that I receive -- the obvious degree to which it would upset me -- would cause far more damage to my health than would the 5-hour energy drink.

The piano is still in the waiting room of the internal medicine practice at which I am now working. It will remain there until December 10, at which time it will be moved to the floor where it will be housed semi-permanently, which will allow it sufficient time to settle before being tuned on the day of the 16th in anticipation of the holiday function for physicians, administrators, board members, benefactors, and others. I still have no idea if I'm expected to play it that night. Perhaps it's presumptuous of me to think it could even be a possibility. On the other hand, it bothers me a bit that if those organizing the event are expecting me to show up to play the piano at their event, they think they can wait until the very last minute to let me know that my services are needed. The bottom line, however, is that they can.  They may very well be waiting on an R.S.V.P. from a more esteemed musician. If such is the case, they are sparing my feelings by not letting me know that I'm their second or third or fourth choice, but that I should keep the night open. I would prefer to think that it's their knowledge that they can expect me to be on call at any time without notice even though playing piano isn't really part of my scope of duties, and even if it is rude of them not to let me know further in advance, and even if it's not part of my job. My dad disagrees about the "not being part of my job" thing. He says that as a med student or intern, if one lists a skill on his or her resume,  he or she may expect to be called upon to perform that skill if it in any way benefits the program to which he or she has been accepted whether or not it has anything to do with the practice of medicine.

My only issue is that I need a play list, and I'd rather, if the event coordinator is not going to provide  the play list, come up with it at my leisure, as opposed to spending every spare minute on the day of the event trying to figure out what to play. Christmas music is the obvious choice unless someone in power suggests otherwise, but I'd like to know if it needs to be almost exclusively holiday music with as many non-Christmas-specific seasonal selections as possible out of respect for the many doctors who do not celebrate Christmas, or if they're looking more for light classical music, piano standards,  or easy-listening-type fare. My mom says I should have this list on hand anyway. I asked her if she had such a list on hand. She said no. Why would she think it was so important for me to be prepared in this way if she is not? 

In any event, I'm probably flattering myself to think whoever is in charge of procuring a musician for the affair  would even consider using my musical services for this event.  We're not far from one of the major cultural centers of the world.  There have to be many known artists on whom the event coordinator could call for this event, though the services of the well-known pianists in the area would not come cheaply.  I am not in a position to demand a cent.

At least I won't have to worry about what to wear if my services are requested. Male professional musicians wear black tuxes to such occasions. Women wear black clothing - usually dresses, but nice slacks and relatively elegant tops are acceptable as well. My closet is one-third filled with professional musician clothing. I could always drag out the cute little ensemble I wore for my senior piano recital. It was black, but the style was something like one of the Von Trapp girls would have worn. I thought it looked a bit silly, but my mom was in love with the dress. I considered telling her if she loved it so much she should order one for herself and wear it at her next appearance, but I know what she would have answered, which was that the dress was for a person my age and not hers. I have few opportunities to make my mom really happy, so I wore the dress she wanted me to wear.  

No one minds (or has expressed it to me, anyway) if I play the piano in the waiting room either before I'm on duty or after the work has been done prior to the start of the day and it's not yet time for patients to appear. I don't invite myself to play the piano if there's work to be done. Yesterday I could tell that the noses of three of the other four med students assigned to the practice were slightly out of joint when I played the piano. (They were already on vacation when I played in the days before thanksgiving.) Late yesterday afternoon, when one of the attendings mentioned that the doctors wanted me to play a bit more while the piano is still in the waiting room, I  voiced my concerns about it possibly causing hard feelings among my peers. He almost exploded. I was glad they had already left for the day, as he might have said something to them, which would have been awkward. He said that he is going to ask them if any of them proficiently play the piano or any other instrument that would be easy on the ears in an office setting, and to invite them to have a turn at playing if anyone answers affirmatively.  He said if he notices anyone even looking at me cross-eyed when I'm asked to play, he'll call the person in to have a chat. He said it's none of anyone's business what he does with the time of the medical students assigned to him as long as it's both legal and ethical, and he won't have med school students deciding what anyone else's duties are while they're in his office. He also said that my knowledge and skills are superior to those of the medical students assigned with me (I disagree where one of the other students is concerned, but it's not my place to argue with a doctor; I'll try to put in a good word for him later before final grades for this rotation are issued) in this rotation to the extent that none of them have any cause for complaint that I'm not carrying my share of the workload, because they need far more practical experience than I do, and  because I accomplish twice as much in half the time as most of them do when I'm on the job. That isn't not as much of a compliment as it might seem to be. With one notable exception (who is also the one who has neither complained nor given me the stink eye when I play the piano), the weakest links in our cohort are assigned with me right now to this section of the internal medicine rotation.

I suggested to the attending physician that people get tired of Christmas music if it's played too early, and that it might be good to wait until the first of December before dragging it out. He said that for now he plans to have me play for roughly an hour in both the morning and the afternoon. I can play what I want unless he or one of the other doctors thinks of something they want to hear, but if a patient requests a holiday song, I should play it. He said he happens to like the sound of Christmas music. He's Hindu, so if he's willing to listen to Christmas music , I suppose I should humor him.

Today is going to be a very long day, but then we'll be back to business as usual. I'm already at the hospital, and it's time for me to begin reviewing charts and waking patients to talk with them. They so love it when I wake them early in the morning to chat. 

P.S. Cousin Dan has arrived in the chaco, or el chaco, in Uruguay, to determine if the Mennonites there are indeed of the House of Israel, and, if so, from what tribe. I'm not sure what he'll do if he realizes once he gets there that the indigenous people are of the house of Israel, and not of the tribe of Manasseh, as interpreters of the Book of Mormon, or the Book of Morons if you prefer, would have you believe.

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  1. Most patients probably don't care if you wake them. They weren't likely to be sleeping very well anyway.

    1. No one has actually been rude to me when I've woken them up, so you may very well be right.