my life as a filipino-american, newly graduated family med physician

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twilight zone

On my visit to one of my patients today at the nursing home, I felt like I had walked into the twilight zone. I had to ride the elevator to the basement and found that it fit in nicely with its surroundings--creeping down 2 floors and smelling like it had survived a century of floods. Coming out of this "casket," I was met with a sea of white hair and minstrel sounding music. All of a sudden, it was like everything was moving in slo-mo. A nurse was standing in the middle of a circle of elderly people in chairs and throwing a beachball back and forth between them. Before I knew it, a woman came up to me, looked straight at my face, but somehow past my eyes and touched my chin like I was her grandchild. "Preciousito." she said and walked away.

I found my patient so I could examine her, not talk to her. She was pleasant and loquacious as always. The thing was, she wasn't talking to me or anybody else I could see around me. She too looked passed me. IN a way, the fact that she "wasn't there" made the exam so much quicker--I hate to say it, but it did!

It's so weird that in this one room of the nursing home, you could step into 50 different places at one time depending on which patient you're interacting with. They all live in their own worlds, slobbering, talking, staring, gesturing, and pointing to no one.

posted by dinah 10:09 PM

last night
I worked my last night shift in the ER for the year. I still have day shifts to go, but those night shifts can be killer both from boredom and from lack of sleep. The last few hours of my shift these past three nights on the pedi side have been slow. I figure kids are fast asleep by that time and don't get into too much trouble.

A few shockers though on the pedi side. . .an 11 year old who has sex???!!! I don't know, I guess since I was not and am not well endowed, I never had that problem. I looked like a kid and basically was kid when I supposed to be a kid. What was more appalling in this case, h/w, was that her boyfriend looked like her father. Just shows you how the ER can resemble Jerry Springer.

posted by dinah 9:48 PM

eat to live

Last night I walked into an exam room expecting to see a typical little boy, but instead saw a long, curly haired child wrapped in blankets. For a second I was confused, but after introducing myself, the child's mother said "He's here b/c he has chest pains." Okay, so "she" was a he and the whole long hair and curled eyelashed threw me off.

When a child comes into see me, I usually direct questions immediately to Mom as I did in this case. Without dropping a beat, the 11 year old boy starting describing his symptoms as if he were an adult. I kept smiling to myself because he was so articulate in a half man/half rap meister lil Romeo kind of way. I was enamored by him. At one point, I asked him, "So, do you feel like you don't want to eat or drink." His answer,"I eat to live, I don't live to eat."

posted by dinah 4:48 PM

guitar

I'm starting to play again, but since I have no more calluses on my fingertips, my fingers are aching! I haven't learned a new song in a long while and actually, since I only know mostly Christians songs, I could get away with only playing 15 chords. Now, I'm trying to expand my repertoire.

posted by dinah 6:42 PM

a change of face

In the ER, we work 12 hour shifts and then pass off our patients to other residents for the next shift. It's funny how when people come into work their hair is nice and combed and their face is bright. When I come back after 12 hours, their hair is disheveled and all the color has drained from their face. I call it the 12 hour metamorphosis.

mr deeds

4 out of 5. loved it.

I hung out for the first time with some of the other interns who I have been working with in the ER. We're all girls and all asians. It's always interesting how asians always flock together. vietnamese, filipino, chinese, and indian girls eating out at a thai restaurant. I had a good time and felt very comfortable with them. I like these people. they seem "like" me. MOst of them, h/w are internal medicine residents so I wonder if we'll still keep in touch these next three years. who knows. It was also unbelievable that we all had the day off and we're all on the same rotation. It'll probably never happen again.

posted by dinah 1:02 AM

ER

The 12 hour shifts in the ER haven't been too bad especially since I've been on the pedi side most of the time. The patient turnover is fairly quick compared to the adult urgent side and the complaints aren't as long and arduous. Plus, the kids don't generally smell--not that I'm not used to that . . .

My only weird case of the night was a family who came in for med refills--at midnight!

sleep
I'm not sure if I'm getting adequate sleep. I feel like I'm dreaming about/thinking about my patients all the time--whether it be their meds or whether I managed them in the best possible way. Being a resident, h/w, is so much more fulfilling than being a med student. I so much more incentive to read up on my patient's diseases than I did as a student. Plus, I don't have some pending exam to study for so I can concentrate on my patients more.

Mr mom
thank the lord for my husband who has cooked for me this entire week!

posted by dinah 1:15 PM

and boy does she bark

so my clinic attending likes to throw her weight around and I've noticed she tends to do it about every minute. I shall vent.

in one ear, out the other
during the first year of med school I was taught to look a patient in the eye, listen w/o interrupting, and not write in my chart while they are talking. as a resident, I must throw all this idealistic norman rockwellism out the window.

my attending writes as she listens to the pt and interrupts often. in this fast paced economy, you have no choice.

today I had a patient with a thick chart and a problem list to match. As soon as I sat down with this patient and introduced myself, she said," are you a doctor who listens to a your patients and cares about what is going on with them?" Immediately I put down my pen and chart and looked her in the eye. This wouldn't be a patient I'd try to pull a "fast one" on.

So after listening to her lengthy story and going over her med list, I had to present to my attending. "That one took a while."
My attending: yeah, about an hour
me: well, she did ask me if I was a "caring" doctor, I HAD to listen intently and I thought I had the time [i had taken 25 minutes with this patient and I had no other patients to see that day and I only had 2 the whole afternoon--i figured I could take my time. My attending had told 2 days ago that I had been managing my time well compared to another resident. I'm an intern, after all and we're purposely given 40 min with a patient during this first month.]

my attending: that's what you all say and you DON't HAVE the time

so I began to present the pt" She's a 56 y/o black female with . . . ." I spoke for 10 seconds and she interrupted me. From then on she shot me down. Why is she on this medication?" "Why did you write down that she has coronary artery disease?" and finally, "that should have been a 5 min visit." I joked with her, cuz I'm THAT way, but STILL!

when we went back to the pt, i timed my attending and it took her 15 minutes to get out of there, NOT 5 minutes--and that's with me already telling her most of the story. I just had to prove to myself that I'm not that idiotic.

I mean, this attending belongs in SURGERY with her snippety attitude. I abhor when people act that way all the time and my personality does not strike back BECAUSE i don't burn bridges if I know I'll need that person in the future. She's is so labile, snappy one minute but smiling the next. really really weird.

just venting.

posted by dinah 5:11 PM

stopped up

No one can say I don't care for my patients. I stayed two hours longer in the ER just to make sure my patient got her spinal tap/lumbar puncture. I also stayed so that I wouldn't have to leave too much scut work for the next intern. I still have this unsettling feeling that I didn't do all I could for the patient though. I mean, if I were an attending, things would have gotten done. There are so many gaps in my learning process now. It's just frustrating.

I can't believe I survived the 14 hours w/o anti-histamines. My nose is so clogged, but I didn't want to have that groggy feeling while I was at work. I had drugged myself all weekend and felt extremely light-headed. I didn't want to be in dreamland during my shift.
Anyway, I've been breathing through my mouth all day w/c has made my lips dry. On top of that, my nose is rubbed raw from all the toilet paper I used to blow my nose. yuck!

posted by dinah 11:10 PM

Insomnia 3 3/4 out of 4 stars

Al Pacino doesn't sleep for 6 days in this movie and I literally "felt" it. I worked for the first time on the adult side of the ER yesterday and I had such a fun time. My patients were pretty straight forward cases, but nonetheless, I still didn't have time to eat. I also tend to get dehydrated b/c I forget to drink. By the end of my shift, I felt like I had to drag my body along with my brain. Still, when the offer to hang out w/ friends on a Friday night came along, I went.

clearing up?

The forecast calls for more rain in south/central Texas on Monday. I'm hoping it won't come true b/c every piece of land has been soaked to its limit. It was the first time that I experienced a fourth of July where there were absolutely no firework celebrations all over the city. We actually had to watch fireworks on TV in NY. It wasn't the same. All the theme parks were closed too and you can imagine the amount of money they lost on one of their usual busiest days of the year.

In New Braunfels, Shari Kasberg watched floodwaters swamp her home for the second time in four years. The water was up to the roof.

"My children are safe, my animals are safe; we'll be OK. It's just material possessions," Kasberg said, choking back tears. "But, you know, it is your home. It's where you have birthdays, it's where you have Christmas."Associated Press

___

posted by dinah 8:36 AM

High School Reunion

I can't believe it's coming up! I most likely will not go simply cuz I don't think high school was that big of a deal for me. I have no idea what became of my friends and I don't think they'd go either.

Disgruntled

Why wouldn't lavender flowers be considered spring flowers? A extremely naive cashier would not give us the advertised 50% discount on a spring flower arrangement b/c she thought only yellow "colorful" flowers were considered "spring-like." Needless to say, after paying full price and turning back around to customer service, we got our discount

MIB II 3 out 4 stars

break

The floods have been rather beneficial for me this first week of internship. Conferences have been cancelled and so have clinics! Today I just spent 3 hours reading XRays and listening to our attending talk about Vietnam.

eavesdropping
On the way to the VA (verteran's administration) hospital I overheard an older white male saying to a physician:"I shot down two snipers during the Kennedy administration . . .and I'm not a psych patient either!" Yes, many VA patients have psych problems, but many do not. However, we are so apt to categorize these patients as "loopy" especially when they start rambling on about their war stories. I sympathize with the guy whose story may be valid yet must contend with the fact that his peers can be a bunch of cirrhotic confabulating bafoons (sorry so harsh).

posted by dinah 10:37 PM

Rain, rain go away

Yet another flood. Luckily our house is away from flood planes and our roof isn't dripping!

posted by dinah 8:14 PM

Speedy Gonzalez

My clinical director intimidates me just a tad. She seems extremely nice (other residents say her bark is worse than her bite), but she sets her expectations high. For example, as soon as I saw her today she said,"Let me tell you about time mgt. I'm going to teach you to see patients in 10 minutes by the time we're finished with you." I am so accustomed to take FOREVER and a day with my patients b/c I let them talk. They always like me for that reason.

Patients always say they like it when their doctor listens. Now, how will I camouflage efficiency with care? How will I redirect a rambling patient so that I can get to the nitty gritty of their history and examen them in 10 minutes? Follow-ups are easy and so are colds. But when you have a female patient on the verge of tears, that's another story.

The cool thing my director did tell me was that I had to learn how to see patients quickly so that I wouldn't have to stay at the clinic too long. This, in turn, would allow me to have a life outside of medicine, spend time with my family, and not get a divorce. I'm surprised her reasoning was NOT "to make a lot of money."

posted by dinah 7:54 PM

First day

I introduced myself for the first time as DOCTOR yesterday and everytime I felt awkward. The ER was extremely slow on the pediatrics side b/c the floods kept everyone home. The adult side was pretty crowded and as the day progressed, the overflow eventually reached the pedi side. While I was glad for the slow pace in the beginning, I also WANTED a patient whether adult or pedi. I asked the attendings twice if I should take a patient on the adult side. After all, I felt like I was wasting valuable learning time. Anyway, I only saw 3 patients yesterday and so it worked out well as my first official day.

Nurse

The nurse I was working with yesterday was pretty cold towards me at first. Blunt answers and such. I made the terrible mistake of asking her if I should answer the phone (not b/c I expected her to answer it but b/c I wasn't sure about the protocol there). She said,"It's on your side isn't it?"

By the end of the 12 hour shift though she was a lot nicer. Maybe she realized I was no threat especially after I showed her how suggestible I was. She'd "recommend" pushing IV fluids and I'd sign the order.

MOral of the story: The best way to survive a rotation is to be nice to the nurses!

posted by dinah 11:36 AM