Sunday, February 3, 2019

Back to the World of the Living for Now

I love this picture so much that I use it at any time that it is even marginally applicable.

Readers shall be spared all the gruesome details, but I've been quite ill for the past few days.  I'm returning to the world of the living, though I can only work a light schedule this week.  Not being able to work at all would be a problem for me, but working a light schedule is akin to having the best of both worlds. 

This week I am beginning a pediatric rotation. i've enjoyed pediatric work in the past, and I expect the same will be true this time. i will be mostly hospital-based for this rotation, though I will spend some time in a clinical setting under the supervision of an attendting pediatrician, and this time without a supervising resident.  While I harbor no particular ill will toward residents,  I've thoroughly enjoyed and have found most productive the times in which I've worked directly under attending physicians without the interference of  residents.  The duties delegated to me in such situations are typically the most interesting and the best learing experiences. If a resident is involved, he or she often takes the more interesting cases himself or herself, leaving the more menial or unpleasant tasks for underlings.

I don't mean to complain about inheriting menial and/or less pleasant  tasks. I try hard to cheerfully complete whatever assignments I'm given. Not long ago a resident assigned to me a manual extraction of fecal impaction.  Fecal impaction is akin to constipation on steriods. It most frequently occurs when a patient  unaccustomed to the constipating effect of opioids has been injured or has undergone surgery, and fails to take due heed to instructions regarding prevention of constipation. The patient is usually getting very little exercise at the time, further compounding the problem. There's a false perception that constipation will always right itself eventually. Such is obviously not always the case.

Fecal de-impaction or extraction is arguably one of the more dreaded tasks in medicine, but when it has to be done, it simply has to be done. A medical practitioner would do well to remember how much worse it is in every respect for the patient than it is for the medical personnel, with regard to the gross-out factor, the embarrassment, and the almost incomparable discomfort. It's rare that a physician has such an overt mode of offering a patient instant relief. If a practitioner is compassionate and humane throughout the patient's ordeal, most patients respond with extreme gratitude. It's really not all that difficult to to be compassionate and humane. A physician or other practitioner needs merely to put himself or herself in the situation of the patient, and to apply The Golden Rule.

In any event, the patient with fecal impaction was, unbeknownst to me at the time,  the husband of someone prominent in our community.   If a physician is the sort of person who is professional in every situation and treats all patients with respect, often it's better not to know that a patient has particular wealth or influence. I might have been nervous had I been aware of his standing. As it was, I didn't know, yet treated his wife and him  with the empathy I would have appreciated under similar circumstances.  After the fact, the patient's wife wrote a letter commending the nursing staff and me.  The resident who assigned the task to me was slightly chagrined with the way things worked out. Had she known the patient had connections, she probably would have taken the case herself. The problem with being a resident or intern is that we work so many hours that we spend little to no time in the community outside of the hospital. We have no clue as to whom the connected and socially prominent members of the community might be.

Yesterday my dad called when I was sick. He grabbed his guitar and played/sang a few of the songs I used to ask him to sing when I was very young. One song he sang was a song I hadn't head or even thought about in years --  "I'm Easy" by Keith Carradine. I've mentioned before that either my mom or dad sang to us every night when Matthew and I were little. We could each choose one song for whomever was singing to us that night. "I'm Easy" was one I requested several times. i think I liked the chord structure and Travis picking more than the actual song itself, but I remember my dad complaining to my mom that it was a rather strange song for a four-year-old to like. My mom responded to my dad that I was a rather strange child, and that I had inherited my strangeness from him.

"I'm Easy," written and performed by Carradine, was from the movie Nashville. At the time I would not even have known of the exstence of the movie Nashville, but I've since seen it.  I'm not sure what its rating is on Rotten Tomatoes or any similar site, but I'd have to say that it might be among the worst movies ever made. Still, the scene with "I'm Easy" was rather cleverly directed. The character portrayed by Carradine was something of a player, and he performed the song, announcing that the person to whom it was dedicated might be in the audience. It was amusing to watch the expressions of all the women who thought the song had been written for them.  Even occurring in such an abysmal movie, it was ingenious direction on the part of Robert Altman.

 I do not own this video. I express my appreciation to the rightful owner for allowing me to use the video on my blog  for however long the video is allowed to remain here.


  1. Yay! Missed you. Pee Wee is always pertinent. laperla

  2. Bill was once so constipated that he had to have an NG tube passed up his nose. Then he drank Go-lytely until his colon pretty much blew up.

    I have never forgotten that... especially since it happened after he took Immodium. Got to keep the bowels moving.

    1. A little over hree weeks ago I had to help when a nurse was having trouble inserting an NG tube because of bowel obstruction. The obstruction in that case also followed a single does of Immodium for killer diarrhea. My aunt developed ischemic colitis following a single dosage of Immodium that she needed due to acute gastroenteritis.

      Immodium is obviously sometimes necessary, but it too often does its job too well.

      And where Go-Lytely is concerned, I would honest-to-goodness rather drink toilet water than Go-Lytely. It gives me the shudders just to think about it.