Category Archives: The Barbarous Craft
Yesterday, somehow I managed to look at my schedule and not see that I was on call that evening. It was worse than not checking my schedule. I checked my schedule. I looked at the wrong week and thought, “No call until this weekend.”
Mind you, this took real talent. It’s not like the schedule was ambiguous.
I was so certain that I wasn’t on call that when the first ER call came, I felt a stab of righteous indignation. Dammit, how could they screw up something so simple as reading our call schedule! So then I set out to find out who really was on call . . . and everyone I spoke with said Yup, you da man.
So, dog tired from the drive home, I got into my car and took the 90 minute drive back to Antioch. In the rain. But what else could I do? As it is, I inconvenienced my department head big time, since he had to handle the phone calls while I got my ass to work.
I hate making dumb mistakes.
D.
It’s a funny thing, but I dread my 1 in 12 call more than I ever did my 100% call back in Crescent City. When you’re on call all the time, you come to forget about it. You know you can’t drink alcohol or leave town, but other than that, life goes on . . . until your phone rings, of course. Then things grind to a halt.
So y’all might think I’m not looking forward to Bakersfield, where I’ll be back on the 100% call schedule (or close to it — I’ll have one week and one weekend break from call per month until a second doc gets hired), but I really am. For one thing, I’ll be taking call from home. Because of the distances involved, I have to stay in a hotel when I take call for Walnut Creek. It’s kind of nice not having to make the commute, but I would still rather be home.
And I’m torn, as always, as to whether I want to get called in. See, I get paid if I go into the hospital, but if I don’t get called, I don’t earn any extra pay. I like an uninterrupted night’s sleep, but it’s also fun to earn some unexpected extra cash.
There’s a constant, low amplitude thrum of terror to call, too. Most every doctor must sense this, unless he’s in one of those non-life-or-death specialties like, I don’t know — are there any non-life-or-death specialties? Guess everyone has their own private nightmare scenarios. For me, it’s the fear that I won’t be able to perform up to the level required of me for some critical event.
Pager just went off. Business? Naw. Call from an advice nurse needing, um, advice.
My last call night, I slept straight through, drove into the office an hour early, and THEN the ER called with a couple of cases. They think they’re doing me a favor when they do that, but they’re not. (Hey guys? Call me at 6, not 7:30. I don’t mind. Really!) Because then I have to rush around to get things done before my patients start rolling in at 8:30. I hate rushing around!
Wish me luck . . .
D.
I had a nasty week, as some of you know, but here I am. I survived. That’s the lesson of life, isn’t it? You always survive these things. Until you don’t. I survived, and even if I didn’t solve every last problem, I took care of my people, and that’s what it’s all about.
Thursday night found me miserable and tired and stuck in Antioch. When I finally finished in the hospital, I should have done a quick google to find a hotel, but I didn’t. No, I had to drive around for 20 minutes to find some EconoHell, a $55/night crash pad with no end table lights, a broken toilet seat, and construction debris in the bath tub. The toilet deserves special comment. It was a steady state flush, which means that the bowl never really empties. So I called down the night manager and he “fixed it,” meaning now it didn’t flush at all. Fine. I was too tired to worry about the niceties at this point.
I had to go back to the night window to get a remote for the TV. WTF? Like people steal remotes? Not that I really wanted to watch TV, but I was too tired to sleep, if you know what I mean. Too wired, too annoyed with myself and with work and with just the general circumstances of life in general. Can’t reveal details about my patient, of course, but the take-home lesson from all of this? Chew your damn food.
Friday night, I was so tired that while Karen and Jake were watching Colbert, I fell asleep sitting up. I’ve never done that before. I don’t recall being that tired even in residency, which is bizarre since some of those marathon cancer cases led me into situations where I had been up 36 hours (or more) on only 1-2 hours of sleep. But it’s a different kind of tired, I suppose, when you’re The Dude and not just a 2nd year grunt, a warm body just awake enough to write notes and hold retractors.
A two-day weekend is not long enough to recover. I need a three-day weekend. Or a three-week vacation, but not a four-week vacation. In internship, we got two four-week vacation blocks, believe it or not. Four weeks was too much. By week three, you’re wishing you could get back to work because the sooner you started up again, the sooner internship would be over.
But this business of ours has no endpoint, does it? Except retirement, of course, but that’s 15-20 years away. So I have to focus on the short-term signposts: the end of this gig, the move, the adjustment to the new gig. Our 25th Anniversary is coming up, and we’re going to treat ourselves to some time on the coast . . . and maybe go back to Hoppe’s, site of our Best Meal Ever.
D.
I’m getting calls out the ying yang. I think Portland wants to interview me (or at least it looks promising). And perhaps Denver. And Alamosa Colorado! Any of y’all ever been to Alamosa?
Then I got a call from a recruiter responding to my query about a position in “the greater Seattle area.” Turns out this town is two-and-a-quarter hours’ drive from Seattle.
“Oh, the GREATER Seattle area,” I said, and made a crack about honesty in advertising.
But the best call of the day was this weird call from a recruiter representing two businessmen who were interested in opening a snoring clinic in Walnut Creek. I would be treating one thing and one thing only and by one technique only . . . some proprietary thing they wanted to promote (I’m guessing it’s the pillar procedure). They would pay me a sum that would make a lot of folks blanch, but I would be bored as hell, all of my other skills would get rusty, and I’d probably spend 90% of my time scratching myself and playing solitaire on the computer because THERE JUST AREN’T THAT MANY PEOPLE OUT THERE WILLING TO PAY COLD HARD CASH FOR THEIR SNORING PROBLEMS. Businessmen. Jeez.
Southern California went well, by the way (but I’ve thought that before, and been wrong). I’m hopeful.
D.
This made my day:
I recognized the accent of my nonagenarian patient, so I asked her where she and her husband were from originally.
“Poland,” she said.
“Hey! Half my people are from Poland,” I told her. “My mother’s half of the family. They came from Lodz.”
She brightened even more . . . a thing of beauty. “We are from Lodz!” And of course she pronounced it better than I had (“wooj”).
When she and her husband left, they wished me a happy Hanukkah. They may be in their 90s, but their jewdar works very, very well.
***
I couldn’t stand it anymore. So what if I’m the only one who cares; I broke out the menorah tonight and lit up the candles. I don’t have enough candles to last eight nights. Hanukkah miracle, anyone?
***
At Lodz Shetlinks, you can take a Virtual Tour of Jewish Lodz. This sounded like a lot of fun until I took the tour, which looks a lot like this.
Graves. Lots and lots of graves. Thanks for bringing me down, guys! But at least they have some photos of the sole surviving synagogue,
So how strange was it for me to run into a couple of Lodz natives? Not that bizarre, I guess; Lodz is Poland’s third largest city. That’s right — Poland’s Chicago. No big deal, right?
But it felt good, just the same.
***
My grandparents, if they were alive today, would be (as best I can figure . . . they lied about their ages and didn’t know their true birthdays) about 105. I miss them, even though they drove me crazy.
D.
Chapters I’m looking forward to:
6. Chronic Sleep Deprivation. We always like reading about ourselves.
7. Phylogeny of Sleep Regulation. Phylogeny . . . might that be code for evolution?
21. Host Defense. I’m hoping this chapter will explain why sleep isn’t horribly maladaptive.
25. Neural Mechanisms of Sleep-Related Penile Erections. We always like reading about . . . oh, yeah, I said that already.
47. Why We Dream, the last of seven chapters all about dreams. And that’s not even counting the section on parasomnias!
55. Sleep Disruption in Jet Lag and Other Circadian Rhythm-Related Disorders, which will likely be of great practical use.
77. Nightmares and Other Common Dream Disturbances (from the section on parasomnias).
80. Violent Parasomnias: Forensic Medicine Issues. I couldn’t have done it! I was asleep at the time!
Seriously, this book is huge, like nearly 1500 pages huge. If I carry it in to work every day, I may address both my continuing medical education and physical fitness needs.
D.
I saw my new primary care doc today. Admittedly, I only needed him to write my prescriptions for me, but still: whatever happened to the history and physical exam? He didn’t ask me any historical questions, unless you count, “What can I do for you?” And he didn’t lay a pinkie on me.
You have to understand that in med school, we’re taught to do everything. There’s a reason for that. When I did PCM (preparation for clinical medicine) at the VA, I once had to ask a guy in his 50s about his drug history. Here’s this vet who is only about ten years younger than my dad, and I’m asking him about marijuana! But he said yes, he did a little coke on weekends.
We were expected to poke and prod at everything, too. And we did.
The thing is, if you do a good history and physical, you will sometimes discover interesting things. Just the other day I looked up the snoot of a guy who saw me for a skin cancer. He has nasal polyps! He was unconscious of them, but it’s still a significant finding; some polyps behave aggressively, and can even become malignant.
I wonder if my doc adopted the hands-off approach because I’m a doc, too. Maybe he figures I’ve been feeling my own liver. Anyway, I’d be more critical of him except this has become a near-universal phenomenon. This is not the first time I’ve observed this sort of behavior (although Karen’s doc back in Crescent City used to listen to her lungs, and would do the occasional Pap smear), and I’ve heard it said more than once that today’s primary care docs diagnose by blood test.
So: whatever happened to the laying on of hands?
I’m a doc. I know better than anyone how fallible we are. I’m not too superstitious . . . and yet I must say it would be reassuring to have someone listen to my heart and lungs, prod my belly, and look up my snoot, and declare me Not Dead Yet.
Even a doc likes to hear he’s Not Dead Yet.
D.
A probing, prodigiously particularized post penned by your perennially puerile protagonist, um . . . Pwalnut.
This idea came to me in the wee hours of the morning. If my muse has found a topic which interests her, I’m not about to argue, even if the inspiration was painfully obvious.
Before we proceed, I have one administrative detail for you. Yes, the contest is still open. Scroll down, check it out. It’s fun! It’s easy! How can you not participate?
Onward to the Pee Thirteen . . .
(more…)
I’ve never before had to market a practice. This is not something you do in academics. Nor is it something you do in private practice in a community where you’re the only ENT for 70 miles around.
(Arguably, I should have done more marketing in Crescent City. There are no doubt LOTS of snorers up north whom I could have helped, if only they had known of my capabilities. Sorry, folks.)
This place is a different story. The HMOs have a big share of the commercial market, so the unaffiliated ENTs (those who aren’t part of Kaiser, in other words) have to fight for the community’s few non-Medicare paying customers.
(more…)
Back in Crescent City, every few months a patient would check out my diplomas and say, “What are YOU doing HERE?”
The implication was that someone with my background shouldn’t be practicing in a small town. He should be some big name somewhere. And that’s the nicest interpretation of “What are YOU doing HERE?” More than once, after I explained my reasons, the patient would add apologetically, “Well, you know how it is. We tend to get a lot of other people’s fuck-ups.” Or language to that effect.
***
Tonight, I had dinner with an old friend and classmate. We compared notes, and we decided that life isn’t fair. Life doesn’t reward you for how well you did as an undergrad, nor for the fact you passed your boards the first time through, nor for providing quality care to your patients. Who does life reward? A whole lot of shmucks.
There is no fundamental relationship between brains and success. (Okay, I just added “pointless whining” as a category for this post. I’m not taking myself all that seriously.)
I talked to Karen about this tonight. “Is it luck? Is that it?” I wanted to know. Or do my friend and I lack some je ne sais quoi?
Karen thinks it’s the latter, and she has a name for the nameless je ne sais quoi. Salesmanship. My buddy and I both thought we could become successful practicing ethical, quality medicine. Boy were we ever wrong. We forgot about salesmanship!
We’re looking forward to the day when Universal Healthcare hits. Then we can just be docs, and be content in the knowledge that that jackass down the street/upstate/across country who we know doesn’t give a damn about his patients but still makes a million a year? That jackass will be making the same salary we are.
There’s a problem with that fantasy, though. There always is. Two problems, in fact.
(A) That jackass will still be raking in the dough by doing botox and restylane injections.
(B) A doctor dies and goes to heaven. (Hey — it could happen!) He says to God, “Lord, I have one question. Will America ever have Universal Healthcare?” And God says, “Yes. Yes, it will.” Dramatic pause if you tell this joke out loud. “But not in my lifetime.” Ba dum dum.
D.
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