humiliation

i avoid it if I can, but sometimes I just can't. So today i had to go to our annual graduation ceremony of our 3rd year residents. some of the 2nd years asked me to sing with them for this "tribute" to the third years. PUH -leez.

i only agreed to it cuz it was going to a be a parody song like how weird al yankovic sings madonna songs. so we practiced once when I was on call and then we were supposed to practice agian 2 h before the graduation. but we didn't b/c things were not set up. So 10:00PM rolls around and the audience is tired and just wants to get out. ME included, BUT no, the group decides to go up there and i just want to call the whole thing off since we didn't even practice, no sound check or anything.

to make things worse, we made the crowd wait for about 10 minutes trying to do mic(rophone) checks and such. TORTURE I TELL YOU! And then we finally had to sing. I knew it would be bad. So the first verse went to the 2nd year resident whose idea this was in the first place. she sings well. then I had to sing with the other 2nd year BOB who doesn't sing very well. anyway i couldn't hear myself and I just didn't have the heart. Finally, when that verse was over, I was relieved to say,"take it away BOB!'

we could have joined the worst of the worst of american idol. why did i agree to do this to myself????? my husband told me it was bad cuz we made them wait and then BOB sang bad and so in reality, we as a group, we're B-A-D. ugghhh.

I just had to write this. I can not go to sleep without venting.

home remedies

in texas podiatry residents can't write prescriptions other than antiobiotics and fungal cream. whenever they admit someone the family practice inpatient service "co-admits" the patient. We deal with the ankle up which always ends up being diabetes, hypertension, hyperlipidemia. In other words, syndrome X. the diabetics with foot ulcers who end up in the ER arrive with out of control diabetes and thus, malodourous gooey ulcers.

I am amazed at the different types of home remedies people try for days before getting help. one man put onions on his lesion, another soaked his feet in warm water. the funny thing is, in non-diabetics, these lesions would heal DESPITE these home remedies but the home remedy would get the credit. In diabetics, though, those "fixes" don't work.

Here is the story of a diabetic foot in our system. The great toe gets amputed, a week later, the metatarsals are amputated, then midway (lisfranc), then up to the navicular (choparts) leaving the heel, and finally the good ole BKA (below the knee amputation). The good thing about a BKA is that the patient can get a prosthesis and can still walk around. The process, however it just torturous. A slow death.

Denial
My patient and her girlfriend are finally realizing how dire the prognosis of her disease. She arrived with metastasis all over her body and I guess i just assumed she had to know it would be difficult to cure. ALL OVER. Haven't you heard stories of other cancer patients who had it ALL OVER? But they thought she could be cured if we could only hurry up in our quest to procure that elusive pancreatic tissue and get started with the chemotherapy.

But I couldn't rain on their parade of denial. I couldn't say YOU HAVE CANCER THAT HAS BEEN KNOWN TO BE INCURABLE. I did reiterate every day about its every location--read between the lines--please. Her partner kept saying, "but it hasn't gone to the liver." BUT it's EVERYWHERE else.

tissue is the issue as the pathologist said. you can't diagnose really until you have tissue and you can't start treatment until you have tissue. and so we play this game even though there's evidence of cancer clinically. Weight loss, bone pain that wakes her up at night, abnormal activity all over the bone scan.

cancer everywhere

The first two weeks back on wards has flown by me. We've already had one death and at least 5 patients with cancer--and with each of these comes consults out the whazoo. In the university based residency programs, interns act like secretaries. We run up and down stairs, are on the phone consulting specialists, and are faxing requests for stuidies. We can't just write orders and expect them to get done. We have to follow them up.

"Did you receive me fax?" "Did you give so and so his potassium?" "Did so and so ever get his XR?"

Patients probably wonder what we do all day and why we only see them about twice if they're stable. They have no idea.

spurs fever

these games have given me anxiety attacks. what in the world is up with these low scoring games???!!

nieces

My two 8 year old nieces visited us the other week and I watched them amuse themselves by smelling each other's breath.

80 hour work week

so even though I'm going to be a 2nd year, it looks like I'll still be like an intern. Now that residencies are moving to the 80 hour work week including the "go home after call" policy, second years will most likely pick up the extra call and extra hours that the interns would have done. If they had done this when i was an intern, it would have been great, but oh well.

2 1/2 more weeks till i'm a 2nd year!