22 September 2009

bad taste

in one room at cooper green hospital lies a patient with end-stage renal disease who undergoes dialysis. he is an illegal immigrant to the US, and in light of this fact, no outpatient dialysis centers will take him (because they will not be compensated for his care). he is a quiet, respectful man who speaks good english. without this dialysis 3x a week, toxins will build up in his blood and he will die.

in another room at cooper green hospital, shackled to a bed, lies a woman in her late 20s. a police officer sits in the room. she has a history of iv drug abuse. she developed endocarditis (an infection of a heart valve, a common complication of iv drug abuse) while in jail and was brought to us. this is not her first episode of endocarditis. she is generally respectful and well-mannered. she might receive surgery during this hospitalization to replace the recurrently infective valve, but the surgeons are requiring some type of word that she will quit iv drugs afterwards before they proceed.

although both of these patients are receiving the optimum medical care we can give, the attitude with which some of the doctors approach each of them is embarrassing.

although i have neither the energy nor knowledge to launch into a discussion on illegal immigrants, i know this: it is my duty as a doctor to care for my patients' health. where these patients come from is of no consequence to this duty. i sat in shock this morning as two interns discussed how we should just "put them on a bus back to mexico." if that's your personal philosophy - believe as you like - but leave it at the door when it's time to take care of people. i think what confused me the most was the treatment of the second patient i described. although she has an extensive history of things she could be judged for, no one seemed to judge her. i'm not asking people to judge her, by all means, but i am befuddled.

how is it that we socially condemn a man who has entered our country illegally, probably to get a job and earn money to send back to his family, yet we allow grace to a woman who has made recurrent decisions to use drugs, ending up in jail? is it that we're incredibly selfish, and this man's ingenuity threatens us? i don't know. maybe the fact that the woman is young and white factors in. i have no way of knowing. it just saddens me.

and that's how i feel now: sad. sad that the first patient i described will die somewhere in america, soon, with failed kidneys. sad that my second patient will have her heart valve replaced, subsequently relapse into iv drug use (mean number of relapses before getting clean: 7) and die from complications. and ultimately sad that somewhere along the way some of my colleagues think that they can judge who is worthy of their treatment... with no semblance of common sense being applied to that judgment.

i hope i never lose the sense of moral responsibility i have today. if you're a praying person, that's what you can pray for me through this long journey in becoming a doctor.

16 September 2009


so the end of this week marks the halfway point in my internal medicine clerkship... and time to switch to a new hospital. i'll be heading to cooper green on monday. i've really enjoyed my time at the VA - even more than i thought i would.

there's no way to encapsulate how much joy my patients have given me. in an attempt to try, here are a few memories i've collected:

after questioning my 'un-American' last name and launching into a discussion about where I'm from: "so you're from pennsylvania, then? you know those steelers beat my titans last weekend. damn steelers. hey! you see this thing on my finger?" my patient winks and points to his middle finger holding a pulse ox monitor... which he promptly lifts in the air.

78yo gentleman who always introduced himself as private so-and-so reporting for duty: "listen, doc, you've got to get me out of this hospital. i have this lady friend i like to see from time to time. she's probably as ugly as me, but i like her company all the same."

trying to perform a mini-mental status exam on a patient with altered mental status. didn't get very far, but did find out about his unconventional pet: "y'know, when i'm at home, i have this chicken. it's true. it sits outside my window and knows when i'm in bed and when i'm not. when i'm there, the chicken sings to me. i miss my chicken."


i get this weekend off since it's 'switch' weekend, so henry is taking me to atlanta! we got inexpensive tickets to the braves-PHILLIES game on saturday night. i'm so pumped to get to see my phillies play! we'll also be hanging out with our friend mario (who went to undergrad with Henry). definitely on the itinerary: dim sum. my mouth is already watering. it'll be a great change of pace, at least for the day, and i'll hopefully come back next week refreshed and ready for four more weeks of medicine.

i don't know that i'll ever catch up on all the sleep i've lost over the past weeks, but i'm sort of starting to understand that's part of the cost of having such a satisfying, challenging job. it will all be ok. i'm sure of it.

04 September 2009

call room proselysation

so i'm on call overnight at the VA tonight for medicine, and i just hopped in a call room to take a quick nap before getting back up at 5 to check on my patients (it's 3 now).

upon entering the call room, i was pleased to discover how much nicer it is than the ones in university. clean sheets on the beds, a computer built/manufactured sometime after 1998, and gigantic windows (which will be of no use to me from a waking standpoint because the sun won't be up yet) that remind me i still belong to the world beyond the hospital.

also -- there is a copy of harrison's principles of internal medicine on the nightstand/desk. if you haven't seen this book, i shall describe it for you: it's about 4 inches thick and chock full of blahblahblah about diagnoses. it's excellent, don't get me wrong, but it'd probably knock out an insomniac. (random tidbit: the "harrison" of harrison's is tinsley harrison of the one and only UAB. gotta represent.)

but so the presence of harrison's just cracks me up. it's so cute. it's like the internal medicine docs are the gideons of call room proselytizing. i suppose they think in the short nap i'm about to get i may wake up with a genius idea about a patient's diagnosis - and then, hey! harrison's is handy. could be. we'll see. i'll probably wake up to the sound of my pager and want to throw it across the room... maybe harrison's will follow suit. i'm sure a gideon bible or two has met this fate?

in any case, i'll be post-call tomorrow. a day of disorientation and stomach aches to look forward to. on call again monday on labor day. such is the life. < /end > playful cynic

02 September 2009

homemade sushi

this past weekend, henry and i decided to roll up some sushi. ! we had rice preparation instructions from henry's mom, and we've made sushi a few times before... but this time was very obviously our tastiest.

we sliced up cucumbers, carrots, and green onions. we scrambled an egg and sliced up nova salmon and crab meat. we also had a jar of tiny salted fish from taiwan that we added to our rolls. yum yum YUM YUM YUM. (we also sliced up a few Asian pears from henry's mom.) it was positively delightful. can't wait to make it again.