the glory and the horror

So Kristen made a comment below wondering about doctors changing diapers. I just wanted to respond so that everyone could hear the answer.

Kristen: Doctors change diapers?
Phil: Yup. The rule is that when we’re doing newborn exams in the newborn nursery, if we find it, we change it.

This applies to residents and even attending physicians as well. It’s a great leveler in the world of medical heirarchy. Everyone gets peed on the same in the newborn nursery.

The end of 3rd year has come. My last clinical day as an MS3 was today, and it’s over. It was over fairly early, even, since a couple surgeries got moved up on the schedule.

There is so much to say about the process of third year. You see so much, you learn so much, you hear so much, and there’s not much time or energy left to process. There aren’t many opportunities to talk and discuss what happened before it’s time to do the residency thing.
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I didn’t even get to finish that blog post when I meant to. It’s now Thursday, almost 48 hours since I started this blog post.

So to continue, the 3rd year of medical school can be so many things. It can be the first time you’ve ever changed a diaper (which you get to do on pediatrics). It may be the first time that you’ve ever really seen a dying patient up close and personal. It may be the time when you learn to hide from dying patients for any number of reasons. It may be the first time you’ve ever stepped foot in an OR, for any reason (it was for me). It may be the first time you’ve ever felt the exhiliration of really making a difference for a trauma patient. It will almost definitely be the first time that you write orders for a patient, and actually know that what you wrote will be followed (assuming your resident cosigns it). It will almost definitely be the first time you are there for a delivery, not as an observer, but to actually deliver the baby, clamp and cut the cord, and be the one to show mom that she has a new child. It may also be the first time you see REALLY sick children, which can be very hard to deal with. It can challenge your notions of what is good, what is just, what is right, what is fair, what is really important in your life. It can make you resent medicine, and make you begin to see the patient as the enemy. To borrow from a pediatrician I spoke to several days ago, you might learn to see the patient as your enemy, the enemy of sleep, the enemy of eating, the enemy of vacation, etc. It will force you to make decisions (if you haven’t already) about certain parts of your life that will have to die. There will be times when you will just have to decide, because of medical school, that you will not be able to go a certain place (like church, a wedding, or home), do a certain thing (like sleep or eat). At the same time, you may also learn that there are more important things than medical school, and you may learn to make time for the truly important things. And all along the way, you’ll make mistakes, and screw things up with your friends, family, with God.

These are the things of 3rd year. These are the beauties, the intricacies, the joys, the warts, the nasty crap.

BBC NEWS | Europe | Crucified nun dies in ‘exorcism’

I’m pretty sure I’ve mentioned this before (I’m too lazy to search my archives right now), but I’ve wondered about the link between psychiatric illnesses such as schizophrenia and demon possession. I haven’t had much time to do much research, but there are supposed to be some resources out there dealing with this question.

Here is a real-life example of the question answered, with apparently tragic consequences. Note the priests response – “God has performed a miracle for her, and finally Irina is delivered from evil.” What is the appropriate response to this incident, and to his theology?

Trying to get this loan consolidation business done is annoying, especially since I don’t have much time during business hours to make phone calls and so on. Lovely.

Heard while at a private pediatrician’s office, mom speaking in reference to the doctor’s suggestion to admit her child at Children’s Medical Center in Dallas:

“You’re not going to send me to THAT Calcutta, are you? Seriously, with the masses?”

Cautious welcome for G8 debt deal

Finally!

CNN.com – State seizes cancer-stricken girl – Jun 9, 2005

Unreal.

Now, I’m not privy to the details, but that something would come to this… Come on. The doctors and the family really need to sit down and talk through this more.

As I progress in my medical education, I am convinced that these situations should almost NEVER have to be taken to the courts/civil resolution. Most “ethics” consults are already less about an ethical quandary and more about communication between the health care team and the patient/patient’s family. It seems to be the same thing here, just from this outside observer’s point of view.

Some background
Place: ER
Time: Late at night. Or early in the morning. Your call.
What: Intern attempting to do a sono on a trauma patient to check for internal bleeding

Conversation
Intern: Ok, sir, now I’m going to put some cold jelly on you so we can look at your internal organs.
Belligerent, drunk patient: I don’t want you to do that. Don’t make me kick your ass.
I: Sir, I’m not going to hurt you. I’m just going to look.
BDP: Get that thing away from me. I’ll kick your ass.
I: Sir, please, calm down. We’re just trying to help you.
BDP: I don’t want your help. Get away from me. I’m leaving. I’ll kick your ass if you don’t stop.
I: Sir, it’ll only take a minute, and it’s for your own good.
BDP: No! Stop it. I’m gonna kick your ass, you stupid punk.
I: Look sir, here’s some cold jelly, and it’ll be over in a second.
BDP: I’ll kick your ass.
I: Cold jelly, cold jelly
BDP: I’m not gay!

At this point, everyone in the room except for the patient busted up laughing.

Maybe this doesn’t work as a blog entry, but it sure worked that night.