Previously posted on October 30, 2005 at: http://spaces.msn.com/members/jodidodds/Blog/cns!1p1a54g1PSNkhyBLLbfi4i8A!136.entry
Previously posted on October 21, 2005 at: http://spaces.msn.com/members/jodidodds/Blog/cns!1p1a54g1PSNkhyBLLbfi4i8A!135.entry
Previously posted on October 20, 2005 at: http://spaces.msn.com/members/jodidodds/Blog/cns!1p1a54g1PSNkhyBLLbfi4i8A!133.entry
Previously posted on October 19, 2005 at: http://spaces.msn.com/members/jodidodds/Blog/cns!1p1a54g1PSNkhyBLLbfi4i8A!131.entry
Previously posted on October 19, 2005 at: http://spaces.msn.com/members/jodidodds/Blog/cns!1p1a54g1PSNkhyBLLbfi4i8A!130.entry
Previously posted on October 18, 2005 at: http://spaces.msn.com/members/jodidodds/Blog/cns!1p1a54g1PSNkhyBLLbfi4i8A!129.entry
- Gomers (an acronym for “Get out of my emergency room” – these are old, demented people who will sit on a resident’s service for weeks awaiting placement in another facility) don’t die.
- Gomers go to ground.
- At a cardiac arrest, the first procedure is to take your own pulse.
- The patient is the one with the disease.
- Placement comes first.
- There is no body cavity that cannot be reached with a #14 needle and a good strong arm.
- Age + BUN = lasix dose.
- They can always hurt you more.
- The only good admission is a dead admission.
- If you don’t take a temperature, you can’t find a fever.
- Show me a BMS (Best Medical Student) who only triples my work and I will kiss his feet.
- If the radiology resident and the BMS both see a lesion on the chest x-ray, there can be no lesion there.
- The delivery of medical care is to do as much nothing as possible.
I don’t particularly agree that the only good admission is a dead admission – I think he just means that, at 5AM when he is exhausted and an “interesting case” arrives in the ER, at that point there is no such thing as a good admission, because it is preventing him from sleeping.
Many of the other rules are hilarious, and shockingly, quite true. Take #2 – “gomers go to ground.” My first week on an oncology service one of my colleagues was paged because a demented patient got out of bed, fell, and broke his hip. Since that time, I have had three of my own patients fall out of bed in the middle of the night, fortunately not breaking any bones or resulting in any cerebral bleeds. BUT, I am currently on night float, and I am constantly paged because older patients try to walk around and go straight to the ground. In The House of God they lower the beds to the ground and it saves them a lot of trouble. I have started doing this, and it works beautifully.
It may seem crass to claim, as a physician, that the proper way to practice medicine is to do as much nothing as possible, but I have seen how many consequences can arise from a patient undergoing unnecessary procedures and taking unnecessary medications. Often aggressively interveing results in more (and worse) problems than what the patient was initially admitted with. I am all about doing nothing when nothing is appropriate.
Age + BUN (blood urea nitrogen content) = Lasix (a diuretic, aka “water pill”) dose is a nice one, and because it’s not scientifically proven, most of us start with a low dose of lasix and work our way up. What is scary is that once I give a dose that exceeds the sum of a patient’s BUN and age people who I thought would never pee actually surprise me with some urine.
And placement…ahhh, yes, placement is oh so important. I would say at any point 30 to 50% of the patients on my internal medicine service have no acute medical issues, but are awaiting placement either at assisted living, a skilled nursing facility, a drug and alcohol rehab program, a homeless shelter, a transitional care unit, a psychiatric hospital…the list goes on and on AND ON AND ON… When patients hang out in hospitals without medical issues, it is inevitable that they will acquire them. They are surrounded by sick people. They end up with staph infections or C. difficile diarrhea or a hospital-acquired pneumonia. Again, it may sound insensitive to focus so much on placement in this novel, but I can atest to the importance of good, early placement.
One recurring theme in the book I cannot relate to is having sex with nurses in the call rooms. I can’t exactly relate to all of the sex that goes on between residents and attendings on Grey’s Anatomy or ER or Scrubs either though. Medicine has become a profession of both men and women and the work environments are more respectful. We are constantly reminded about sexual harrassment and what it means. Plus, I see more residents in marriages and long-term relationships, and with work hour restrictions we actually have time to spend with our significant others.
Anyway, this post is growing much too long, so I will close. I am on page 209 of The House of God and expect to see a demoralized, cynical Roy Basch at its conclusion, questioning his decision to enter medicine. I am very grateful for laws that enable residents to maintain semi-decent qualities-of-life during their training (she writes, typing at her hospital computer at 8PM, three hours before her shift ends). I do not expect to complete my intern year as a demoralized, dejected person, but rather as a physician with a year of experience, prepared to move on to what comes next.
Previously posted on October 14, 2005 at: http://spaces.msn.com/members/jodidodds/Blog/cns!1p1a54g1PSNkhyBLLbfi4i8A!128.entry
- Tom Delay – indicted
- Bill Frist – subpoenaed to testify about his suspicious stock trade
- Karl Rove – in deep doo doo over leaking the Valerie Plame’s identity as a CIA agent
- Tom Delay – indicted a second time for money laundering
- Scooter Libby – may also be in deep doo doo for the same reasons as Karl Rove
- Never had the desire to do so while living with my mother as a child/adolescent.
- Lived in the college dormitories and was not allowed to paint the walls.
- Rented during medical school and, again, was not allowed to paint the walls.
Evan and I bought a condo in May, and after months of tormenting myself with questions such as – “What if I screw it up?” or “What if I drip on the new carpet?” or “What if I hate the color?” I have finally worked up the courage to try it. I have lived with white walls for too long (or, as my friend, Beth, has informed me, the current color is actually “bone,” even worse than “white”). My mother is in town from South Carolina and has graciously agreed to assist me, having painted numerous times and with a knack for decorating.
So here goes – hopefully my walls will still love me, and when Evan arrives home this evening, his home will not look the same. Hopefully I will not be convincing him that paint drips on carpet are all the rage and that it was supposed to turn out that way. Heh.
Typically $20/day is charged, but parkers start to see breaks if they have parked for 5+ days. We would have been parked for seven days, so that is $85 (at the discounted rate) we saved by taking the bus.
- Peace of mind in trying to find parking – a huge plus. In addition, I don’t have to PAY for parking either – another huge plus.
- It buys me sanity – I don’t have to silently scream at other drivers who cut me off – because I don’t have to drive.
- Less frequent car maintenance.
- Try this one on – my friends and family have heard it already, but it’s worth repeating: I last filled the gas tank in my car on SEPTEMBER 6, 2005. That is two days shy of a month ago – and I still have 3/8 of a tank of gas.
I will not even begin ranting and raving about all of the huge SUVs on the roads, so let’s just say – regardless of what type of vehicle you drive – try leaving it parked and jumping on a bus! For more information on the Seattle bus routes, click here, or here, or perhaps here.