There are no sick days in residency

Of the numerous sucker punches residency has to offer, I think the most baffling is the way we deal with falling ill. As in, the residents themselves being under the weather.

I know! That happens? Bunch of pansies...

It's okay for our patients to get sick, I mean, they kind of have to in order to eek a living out of this popsicle stand, but we, as care providers, can not. 

Our daily zigging and zagging of snot is irrelevant. Our very job description of promoting health, wellness, and recovery, doesn't apply to us. We must defy the principles of communicative disease, be the commander of our own physiology, make ways to rest/hydrate/exercise within our 80hr work week, and not get sick.

Okay. Let's be fair. That might be a bit extreme. There is a contingency plan in place if you are delirious or in a coma. 

Or, if you are a weakling who doesn't want to bring your virus laden wet rag of a self to the oncology ward because you're "concerned" about the "vulnerability" of patients "without an immune system," then you can fall back on the a fore mentioned contingency. It's called Jeopardy.

Jeopardy. Sure it may refer to the Alex Trebeck themed monologue running through your head -  "You chose this career you nincompoop for 100", "Nut jobs in charge of scheduling for 200," or, today's daily double, "Schadenfreude," - but in reality it refers to the word's dictionary definition:

Jeopardy [jep-er-dee] noun 

1. harzard or risk of or exposure to, loss, harm, death or injury

2. peril or danger

3. the danger or hazard of being found guilty, and of consequent punishment, undergone by criminal defendants on trial

Synonyms: See Danger; menace, threat

Antonyms: Security

So, see? You're totally covered! 

Vomiting, immobility, fevers, explosive uprisings of rebel recruits in your sinuses? Nope! Doesn't sound like death to me! Walk if off you whiner.

If you really are in peril, you can call in a jeopardy person. Go ahead. See what happens.

Who is the jeopardy person, you ask? One from a shiny cavalry of good hearted souls on call to be our back-up? Close... it's a fellow resident.

365 days a year there is a resident on jeopardy call. Actually, three. One for each year -- there's an intern jepo person, a 2nd year jepo person, and a senior jepo person. If you can't come in on a given day -- your grandmother died, you're in a car accident you can't leave the scene of, you've just found out you have two months to live -- then you call the jepo person in to cover whatever shift you're going to miss. 

Am I the only one who finds this sketchy? Cause, I mean... yeah you get a break, but you're screwing over your counterparts by succumbing to your body or circumstance, you lame-o.

It gets lamer.

If you DO call somebody in to cover your shift because you're dying, what do you get in return? Sympathy? Chicken soup? Nah, how about a healthy serving of guilt and immediate e-mails asking when you're going to PAY THAT PERSON BACK.

If you're sick, and someone has to cover for you, even though you're miserable and are making what is probably a considerate decision for anyone working with you who might pick up what you've got, you need to pay whoever covers you back.

Not with money, mind you. With another, comparable, shift. 

Last February I was hypoxic (low oxygen in my blood) and dyspneic (short of breath) and physically unable to walk from my couch to the kitchen (sooooo sick). I'd worked four 12hr ED shifts in as many days with a waning voice and a progressively looser grip on reality, taking care of angsty teenagers and snotty kids who weren't half as sick as I was, and finally said, ENOUGH. 

Well, my husband did. He said enough. He thought I was dying and forced me to stay home.

I had to jepo someone for the first time in 22 months of residency. Because GOD FORBID the ED would be down one resident for 12 hours (when there are always at least 3 residents in addition to 2 mid-level providers and 2-3 attendings)(plus med students).  

While it was great not having to go in that day, and probably best for the health of everyone involved, I then had to work with the covering person to find a time when I could cover a 12 hour shift that they had in the future. So I ended up covering the PICU, NICU, and peds ward at the city hospital overnight on Thanksgiving, because that's the only time we could find that jived.

Be ye warned. There are no sick days in residency. And in fact, you get insult to injury by having to cover another shift for that person in the future.

While I get that the payback expectation is largely to discourage people from abusing the system, why on Earth isn't there a better way? A medical diploma didn't make us superhuman. Why does the system expect us to be? 

Just... what?

This bonanza over birth control makes as much sense to me as Chris Brown still being on the airwaves.

How is everyone not looking at each other, aghast, wondering, “Uhhh... hello? What’d I miss?” Birth control is responsible. Chris Brown is abusive. Done and done, right?

Well, interesting.... The Right. Yes. That is where a lot of this seems to be stemming from. The masochistic, inane, completely flabbergasting rhetoric being thrown around by some of the presidential candidates and their party cronies is just... I don’t even know a word that would properly encompass my feelings.

Pitiable? Infuriating? Stupid?

Do they not realize that without the use of and access to birth control they’d have a pied piper following of illegitimate children all their mistresses would produce? Show me a politician who hasn’t had an affair. It’ll probably be easier to find a frat boy who’s never tasted beer.

Oh, I’m sorry, are those broad sweeping generalizations not even remotely based in fact? Guess where I learned to do that?

The idea that the government, the GOVERNMENT, is making inflammatory decisions about women’s health care based on moral rationalization rather than, oh I don’t know, legitimate data outlining how this issue is even remotely relevant, makes me livid.

Hi, you’re not doctors.

The short sightedness and... I don’t know, again, stupidity? that’s not even a strong enough word... of these people truly makes me want to... vomit feces, I guess. I can't think of a bodily function repugnant enough.

If you’re really so concerned about lost souls or innocent children or whatever the hell you’re calling zygotes these days, DO SOMETHING WHEN THEY’RE ON THE OTHER SIDE OF THE UTERUS.

You don’t want to imbue public education with any funding, you don’t want to expand social services, you’re cutting down on the already scant mental health resources available, you’re ignoring the reams of scientific literature linking unwanted children and risk of abuse, and you’re making statements outside the realm of your expertise.

Unintended pregnancies know no socioeconomic limitations, but the resources available for them once they slide down the chute are obscenely imbalanced amongst societal stratification.

I see the evidence of this every hour of my 80 hour work week.

How is birth control viewed as anything but preventive medicine? Pregnancy is not a benign condition. Women shouldn’t have to be penalized (HA!) for choosing not to put themselves at high risk for medical morbidity.

It’s on par with refusing to pay for someone’s statins because they CHOSE to eat all that McDonald’s and trans fat and blahbity blah - insert any American cuisine - and have a massive heart attack. In covering their anti-cholesterol, anti-inflammatory agents aren’t I just giving them carte blanche to go eat willy nilly whatever the hell they want? Veritable permission to go be junk food whores? (I'm looking at you, Rush Limbaugh.)

Why does everything change when you substitute in “birth control” for statin and “pregnancy” for myocardial infarction?

If you’re thinking of an argument that involves Jesus, then it should be off the table. Pretty sure there’s separation of church and state. Pretty sure that the justification you’re providing, that your God says it’s bad (paraphrasing), is completely unrelated to the governance of our country.

I could bring out Harry Potter and tell you what Dumbledore tells us to do. Would that be useful? Then at least I’d be speaking on your terms. Oh, going through Platform 9 3/4 is impossible is it? So is walking on water.

Believe what you believe. I don’t care. Just don’t make it law to believe what you believe.

There is absolutely nothing in these campaigns or in these politician’s track records that smacks of God’s love, forgiveness, justice, equality, unconditionality, concern for the least of us, on and on and on... so quit using it as an excuse. Walk the fucking walk, boys.

While studying for the Primary Care shelf

"What are the four classic presentations of tinea capitis?
1. Blah
2. Blah
3. Blah
4. Favus (oval patches of alopecia with a golden crust)"

Doesn't it sound like they're describing a fancy dessert? Perhaps one of those ones that arrives with a tableside flame thrower?

Or they're describing treasure. Treasure obtained after an epic adventure.

THE ALOPECIA WITH A GOLDEN CRUST!

You'd get all excited if you read that bit about what you had -- so fancy! But no no. No no. In real life? Just fungus hanging out on your scalp.

Awakened to the Night of the Living

I've spent one day a week for the past six weeks at a nursing home facility in the city. It's been... interesting. It's certainly raised a lot of issues for my own life in terms of what I'd like my end of life care to be like and the fact that I need to sit my parents down and talk to them realistically about what they'd like done.

Somehow I don't think my mother's "If you're thinking of putting me in a nursing home just tie me to a tree instead," is going to work as well as she thinks.

How do you even broach a conversation like that though?

Mom, Dad, hey, let's talk about what you'd like while you're dying.

I'm so in denial about that even being a possibility. I mean, they're my parents. My PARENTS. They're such a constant. A constant source of bickering, passive aggression, angst and grudges? Sure, but... they're my parents.

Today I was speaking to a patient who has had an incredible life. He was a former show business guy and has met some of the most prominent figures throughout the industry from Billie Holiday to Michael Jackson. But now he's in a nursing home. And he's not leaving until he dies.

How does one even begin to reconcile that kind of life change? I mean, I even wrote "has had an incredible life." Like it's already over.

He told me he's just a zombie. "You know, a zombie. The living dead. I just haven't stopped breathing yet."

Scarier than the prospect of such a ghoulish image was the fact that I couldn't disagree. Scarier still?

He's somebody's parent.

Gesundheit, America

There are few things that chap my ass as much as the notion that health care is a privilege, not a right.

I stayed up last night watching the obscenely long votes via "electronic device," made by the House of Representatives on the bills aiming to start what can only be a long, long road for health care reform. I just couldn't believe the drivel being thrown around in the discussions.

I mean, fine. I understand that everyone has different opinions about abortion. I have my own. I may spout them off vehemently since this is my little space of the Internet. But now is not that time.

What it apparently IS time for is to remind people, specifically those Republicans and select Democrats unwilling to understand the notion of doing something, ANYTHING, right now instead of proceeding with a letter perfect bill, is that there IS assurance of the sanctity of life in this bill.

Now all people in the United States have a better shot of caring for their health and therefore saving their lives.

I just can't stand these garbage assertions of no respect for life, baby killer and what not. HI. HOW ABOUT THE LIVES OF THE ALREADY EXISTING UNINSURED.

Or, if the lives of the living breathing people of the United States isn't enough, what about the fetus that isn't aborted who is born into a family WITHOUT HEALTH INSURANCE? Sure it's alive and apparently sanctified, but maybe it'll be born with intestines outside it's abdomen. Maybe it'll be hospitalized with pneumonia. Maybe it will just need a check-up and some freakin' vaccinations. Without health insurance that baby would've been better camping out in its host uterus forever.

I was developing a tick last night and as I sat with Irreverand Boyfriend and his family (who are, as he pointed out, a family who yells at CSPAN the way Midwesterners yell at Monday Night Football) just DYING for someone to point out that this bill IS all about the right to life.

HELLO. HEALTH IS LIFE.

I'm not saying that anyone who is ill isn't living or is subhuman or something. But I think it's a universal agreement that in order to function at full potential and embrace the best version of one's self, it's easier to do so when you're not debilitated than when you are.

I didn't have to go to med school to learn that one.

Of all people I never thought I'd find Representative Stupak (a pro-life Democrat from Michigan) voicing my concerns from the couch on the floor of the House, but he shocked me and did. And thank God. Yes he's anti-abortion, be he also recognizes that this bill is about so so much more than a campaign bolstering buzzword. It IS about life.

It's about American life and I can't wait to see how this historic event enables us to progress forward so that we can ALL live it to its fullest.

Matchmaker, matchmaker... made me a match

Today really is the first day of the rest of my life. I've finally decided what I want to be when I grow-up: happy.

Four years of college, four years of medical school and an innumerable, INNUMERABLE, number of nervous breakdowns... and it's finally paying off. Well, sort of. I still have to you know, actually graduate and move and yadda yadda big girl stuff like find a bank, organize loan payments, get a car? Yikes. Okay. Too much reality.

All across the country fourth year medical students found out where they're going to be for the next 3-7ish years of their life.

This morning my roommate's girlfriend woke up, declared "HAPPY MATCH DAY!" and made steak and eggs. Clearly, it's a day to celebrate.

Irreverand Boyfriend wore matching clothes for the occasion and woke me up with Fanfare For The Common Man followed by the title theme to Star Wars.

Irreverand Boyfriend, my roommate Mean Bean Greene, her girlfriend Chefy and I clicked our heels and skipped to a big fancy room in the medical school where a large table held individual envelopes for every match candidate. Inside the envelope was where we each were going for residency. End of story. Binding contract. We are going there.

I was blessed to get my first choice.

I'm moving Out West.

And I'm going to be a pediatrician. So we begin.