Sunday, October 26, 2008

Superstitions

I was oncall last week. Needless to say, it was busy (well, relatively speaking. It's not going to be as bad as residency anymore, admittedly).
It's interesting how many of us, even the super-scientific sceptics, get so terribly superstitious oncall.
Yea yea, I know. You'll say there's no such thing. I know about the studies people have published showing no increased patients to the ER on nights with a full moon. While we often consider ourselves scientists and put a lot of weight on published research, good luck finding a doctor who believes that article.
A few interesting observations:


When asked how your call is going, NEVER say "Oh, it's pretty quiet so far". That's almost like placing a special order for 3 simultaneous ST-elevation MI and 2 DKA and 1 elderly-man-needs-digital-disimpaction patients


Full moon= sleepless night with plenty of calls from crazy patients (and nurses)

Friday the 13th. Bad. I was the senior in the medical ICU on a Friday the 13th, and it was a full moon that night. Needless to say, we needed ethanol therapy post-call the following day.

I had a classmate who would never have sex with his wife the night before call. Never. He said it brings bad luck. (No wonder they're still childless).

Another buddy always wore his green boxers for call. Not that I ever checked to see if he was making that up. Considering we were oncall every 4th day I never did ask if he did his laundry that frequently, or simply 'recycled'.

I had my pair of lucky shoes. Not that they worked. But I felt comforted and reassured wearing that pair of torn Nike shoes for call. Perhaps the sweetly-sour stench would ward off admissions? I still have that pair of shoes. Hole and all.

I've also learnt that things come in clusters. Eg. if your first admission was afib with RVR (atrial fibrillation with rapid ventricular response) you can bet your next 4 will be the same. Or if your first admission was an 'chronic abdominal pain, needs demerol' then you're fucked. Same still applies now. I had been seeing a lot of diabetes and thyroid patients of late. And happened to mention to my medical assistant that I hadn't seen a hyperparathyroid patient in a while. Next thing I knew I saw 5 parathyroid patients that day.

And so, if you're going to be oncall, and happen to break a mirror in the bathroom, and then see a black cat cross your path while not noticing that you just walked under a ladder, better call in sick and forget about going to work that day.

What about you? Any superstitious beliefs/practices for call?

Sunday, October 19, 2008

Sometimes you get a reminder of how fragile life is.
I know I'm still somewhat in shock over what happened.
I saw Mr. K in consultation for his diabetes, while he was admitted for heart failure. He was a man with type 1 diabetes, looking a bit older than he was. Balding, thick, wire-rimmed glasses, with a moustache and what looked to be a permanent grin.
He was in pretty good spirits, and we joked about the hospital food and how it was bad intentionally to discourage patients from staying too long. I must have seen him at about 3 pm.
The next morning, my resident calls me up at 7:30 am.
Mr. K coded (had a cardiopulmonary arrest) and died at 1:00 am. While the cause is still not clear, it was probably an arrhythmia. Apparently his automated implantable cardioverter defibrillator was firing several times a few days before.
Nonetheless I'm in a bit of a disbelief. I mean, he looked great just a few hours before. And now, he's probably in the morgue? His family mourning?
It's a reminder to not take life for granted.
Wherever you are, Mr. K, I hope you and your family find peace.

Friday, October 17, 2008

Doggy Urges

Yes, I think you could say our dog's going through puberty.

video

While humping anything that moves is normal doggy behaviour, what I can't understand is why our FEMALE puppy is humping my dear sweet wife. Gender identity issues?

We're gonna have to get her fixed real soon.

Thursday, October 16, 2008

It was a mixed kinda day.
I'm oncall again, and not enjoying it too much. Rounds were busy. Patients were sick. We just sent a patient with newly diagnosed anaplastic thyroid cancer to hospice. Just imagine; 3 weeks ago he was blissfully oblivious that so soon would he be facing a death sentence. And I had a ton of clinic phone calls to return. And I had to break rounds to come see a couple of afternoon outpatient consults. So naturally, I came in to the clinic pretty frazzled, uptight and grumpy.
And then I see the note on my first patient's chart: "Patient will not see anyone but Dr. V"
Oh great, I tell myself. Sign of a demanding patient, perhaps?
Surprisingly, she was a very pleasant lady. Just out of morbid curiosity I asked her why she had asked to see me. Maybe we had met before? No, she says. It seems that two of her friends had independently recommended me to her. By name, moreover.
And the second event occurred a few minutes later when I had to call another patient telling him that because his tests were normal there was nothing I could offer him in terms of treatment. I expected him to get disappointed, or worse, pissed. After all we did just order half a dozen blood tests. But no. He thanks me. And follows that with "You are the best doctor I have ever worked with."
Not because I had all the answers. Not because I was smart. Or that I cured him of his ills. But just because I had taken the time to explain things to him, and to listen.
It's no big deal, I know. But I have to say that felt pretty good. Considering I've been working here only 2 months. My feet felt light when I left work, and walked with a bit of a bounce.
Yes, it felt pretty darn good.

Monday, October 13, 2008

How to tell you're an Asian driver

  1. You drive with the air conditioning off to increase mileage and save gas
  2. Your modified exhaust pipes are large enough to fit a watermelon
  3. You keep a box of Kleenex tissue in your car (probably in the back where the rear speakers are)
  4. You drive with the music (probably techno) on so loud that people hear you coming from a block away. And you leave the windows down.
  5. You have at least 5 sporty decals on your car. MOMO, Falken, K&N, Ralliart or something similar is a given.
  6. Your car has a rear spoiler that totally obscures the view from the rearview mirror. After all, aerodynamics is more important than safety (then again, the spoiler probably is just for show)
  7. Your suspension is so low that driving over a pebble causes your car to scrape on the ground
  8. Your lights are tinted
  9. You have a Buddha charm hanging from the rearview mirror
  10. Your car has neon lights illuminating the undercarriage

Yes, I know generalizations are often incorrect. But we love them coz they're funny, especially if you're talking about yourself.
Driving back from MN over the weekend I drove past some such cars. While I had the air conditioning off.

Wednesday, October 08, 2008

Things that frustrate me

As an endocrinologist, there are some things that frustrate me. Yes, yes, I know, you have your reasons, and perhaps I'm just being unsympathetic, but allow me to vent:
  1. Patients with diabetes on complex insulin programs, who come for their visits not bringing their meter, logbook and have no foggiest idea how their numbers usually run. I know, to forget is human nature, but really, if you're coming with no numbers for us to go over, then you're just going to be wasting your time. I'm going to be billing you anyway, but you're likely not going to get much out of our meeting simply because I would not be able to give you any firm advice on insulin adjustments
  2. Patients with a list of symptoms and another list of normal blood tests, who come to be because they're obsessed that despite the normal values, "their hormones must be imbalanced to cause all their symptoms". And those symptoms range from weight gain to fatigue to knee pain to an annular rash on their right shin. I wish it was that simple, but often, it isn't. And while I'm not downplaying anyone's symptoms and I know it's bothersome, I'm sorry, if your TSH and T4 are normal then it's not your thyroid. I don't care what Oprah says, but until research proves that earlobe itchiness is a hormonal disorder, don't expect me to have all the answers to your problems. I'm a good listener, yes, but I'm not going to have all the answers.
  3. Patients who don't show up for their appointments. My time is just as important as yours. If you're not planning to show up, don't make the appointment and keep other patients waiting. I'm due to see Mr. T tomorrow who has no-showed 3 previous times. I'm fully expecting him to not show up again tomorrow, and if that's the case I'm going to refuse to ever see him again.
  4. Patients who come late. Our appointment cards tell them to come 15 mins early. And so if they're 15 mins late to see me, really, they're 30 mins late for their appointment. I'm going to contradict myself, I know, but I do sometimes run late myself. I try not to, but sometimes patients are more complex than expected and you end up starting on the next one 5 minutes late. But, on the flipside, if each of my 12 patients were to come 15 mins late, then the last patient of the day's going to have to bring a sleeping bag for his visit. And it pisses me off that you make my other patients suffer and wait just because you decided to pick up a lattĕ on your way here.
  5. Patients who lie. Yes, lie. Not about simple stuff like eating a Big Mac last week. We all do that sometimes. But like the patient I saw yesterday who is trying to file a lawsuit against someone else, who suggested I 'tweak' my notes and make the other party seem more guilty. You know, the very manipulative kind of person. In a nice way, I basically told him to go to hell. And dutifully documented the request he made of me. I'm suspecting his lawyers won't be asking me to be his expert witness.

Thankfully, the majority of patients I see aren't like that. And most of those who sometimes break the above rules often are not malicious about it, and are no repetitive.

Saturday, October 04, 2008

Updates on Claudia

So many have asked me:
How's the car?
Well. The suspension is stiff and the ride bumpy.
It's a manual transmission, so my left foot's been feeling tired from working the clutch.
The mileage is nowhere near my late-Veronica's (my Accord).
And the Boxster, after all, IS the cheapest Porsche. Doesn't get half the respect the 911 does.

video

But man, Claudia's one swell car to drive. There really isn't anything like driving a Porsche on the highway with top down. With the plexiglass windstop, even 70 mph, the wind buffetting is minimal, and you can have a fairly normal conversation.
I'm finding that I'm making the smallest excuses to go out and run errands, just so to drive. And at work (pathetic, I know) I'm wanting to get done early not to get home fast, but just to be able to drive home while the sun is still up, just so I can drive with the convertible top down. I'm trying to make the most of it, before I have to put the hardtop back on.
And though the mileage is worse than the Accord's, I'm still getting about 25 mpg city and 29 mpg highway. And on the midrange super-unleaded (yea, I know premium's recommended, but the Porsche has a knock sensor, and many others have used this with no problems). So it's actually not bad.
And the egomaniac in me is saying this: I love how this car turns heads. People gawk and point. Just do not stall the car when working the clutch. Trust me. It's happened once.
I hate to appear shallow and seem to derive so much pleasure from a material thing, but really, I just love this car.
(ask me again in 3 months when the snow's here)

Friday, October 03, 2008

There is just something about being in bed with a naked female, that just makes you melt inside....
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And no, Chloe doesn't usually sleep in our bed. But that was a weekend, so we made it an exception.