I can’t decide whether the years have made Richard Butler more measured, more mature, more poignant . . . or simply more tired.
Psych Furs, Pretty in Pink, 2007.
Was reminded of this while reading an old, old post of mine on loss of innocence. Here’s the coherent part:
Maybe we focus on the sexual angle because that, at least, is a pleasant (or at least humorous!) memory. And, maybe for some people, the loss of virginity does equate with the loss of innocence. But for me, and I suspect for most people, loss of innocence meant coming to terms with the real world. I wouldn’t take that innocence back no matter how much you paid me — because it would only mean having to lose it all over again.
This commute is really wearing me down. It’s bad enough that to some small degree, I find myself liking call because it means I don’t have to make the drive home.
Today, on a stretch of two-lane highway with no chance of passing (no dashed white line) for about 8 miles, I found myself sandwiched with a tailgater behind me, a slow person in front of me. I should have pulled over and gotten myself out of the sandwich, I know, but I wanted to get home.
After a while, there’s a long, straight bit of road with the dashed white line. There was no one ahead in the oncoming traffic lane — no one — so I passed. Safe, legal pass. I didn’t cut off the person in front of me, I just passed, but you would think I had run over her cocker spaniel. She honked and flashed her brights at me for the next minute. She didn’t speed up and tailgate me, but I found myself wondering if that was next.
I don’t know why stuff gets to me, but it does. My son says I stress out too much.
Pop-up that appeared when I tried to sign my new contract:
Please confirm that you agree to the contract and that your signed name is Baculum P. Walnut. By clicking on OK, you will have signed the contract. Once you have signed the contract, the contract is signed. Click on Cancel to stop this process.
I learned a lot of things in training. Learned to develop a thick skin, for one thing. (Interesting how it protects me from the outside barbs, but not the inside barbs.) Learned how to function on two hours of sleep or no hours of sleep. The worst, by the way, is one hour of sleep. I would rather have no sleep than one hour of sleep. One hour of sleep is an absolute misery.
Someone told me on my first or second day of internship that I would learn to get blood from a stone, and it was true. “Stones,” in this case, are IV drug abusers who have shot all their peripheral veins. I could always find the femoral vein, of course — that was my preferred last resort, since I never was too comfie with subclavian sticks. Not to mention jugular lines — Yeesh! But I always tried to find a good peripheral vein, because the big ones are riskier and they bleed like stink if the patient yanks it out.
Veins do seem to roll away from you, and they also seem to go into spasm and disappear altogether. I say “seem” because who knows what they really do. One minute they’re there, the next they’re not.
Those first few days on Urology were brutal. To the patients, I mean. (Never get sick in a teaching hospital in July. That’s when all the noobs come on board.) Couldn’t do much but practice on patients until I got it right. I remember the learning curve being pretty quick, though; my first day, I turned an old Hispanic guy into a pincushion, but I don’t remember too many traumatic sticks after that.
Infants and children are a different world. The stress on the doc, me anyway, is indescribable. The tissues are pristine, but the vessels are tiny. I guess the worst case scenario would be an 18-month-old IV drug abuser, but fortunately I didn’t meet too many of those.
In med school, I learned how to do arterial punctures and set arterial lines. Most people would consider these to be more difficult procedures than drawing blood or setting IVs, but for me that pulse had become a beacon. Back again to my first day on Urology: I remember thinking, “How do I find it without a pulse?”
I wonder if I would have made it through internship if I’d had any idea what I’d gotten myself into.
***
You learn, too, that your patients are forgiving. People forgive a lot when they know you’re trying your best.
It’s that magic time again, Weekend Call, and have I pulled a doozy. Between the two hospitals we cover, there are nine patients on our inpatient and/or consult service. Three of them could easily get worse and become OR cases.
I told the Chief of Service: “Well, if I’m busy, the weekend will go faster, right?”
“Your weekend is going to go VERY fast,” he said.
Another doc (the former Chief of Service, another guy who has been around a while) called me to commiserate. “I think this must be some kind of record,” he said.
I don’t mind working hard. Really, I don’t! The main thing that stresses me out is when things are more than I can handle. I can’t do everything, after all, and I can’t be in two places at once. In residency, there were always three of us in house (plus med students, plus a chief you could call in, if necessary) so there was little risk of having to be in two places at once.
My Chief of Service tells me that in the ten years he’s been here, only once has he had to be in two places at once. He called in one of the other guys and they dealt with it. So, yeah, there’s backup if I need it — but everyone here figures this should be RARE.
Let’s hope it is. Stay tuned.
D.
P.S. It’s been a grueling week, by the way, which is why I haven’t been around much. The upside? Once I’m through with this weekend’s call, it’s mostly downhill from here. Not too many bumps in the road between here and Bakersfield.
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.
That’s the name of a place on Highway 199 that sells, you guessed it, burls. Burls are redwood tree tumors — um, I think. I never did find out the skinny on that. They’re hard wood, they take a nice polish, and folks love to make tables out of them. They’re not common, so they can be expensive. Anyway, I figure It’s A Burl would appreciate this dream I had last night.
Karen and I were back up north, and we had decided to look at the most expensive home on the market. (We did that for real once. The home was on the market for something like $1.2 million, WELL outside of our comfort zone, but the realtor didn’t know that. Everyone thinks doctors make a fortune, so this guy must have assumed we were qualified buyers. The home wasn’t much except for the view, which was about as dramatic as 270 degrees of California oceanfront can get, on a “little” 10 acre spit of land which, for $2 million, would come included with the house. Great investment, if we’d had the money.)
You know how the asking price on overpriced homes will sometimes drop like a rock? This place (in my dream) was doing the opposite. $1.2 million initial asking price . . . then $3 million . . . now $5 million! We had to see what was so damned special; I figured the house had to come with its own harem.
What it had was burls. Each and every cabinet was a polished burl, the counter tops were burl, the island was a burl.
I thought, that’s a lot of burls.
And I thought, maybe too much of a good thing.
Sometimes prices don’t have much correspondence to reality. That’s one of the things we’ve noticed while looking at Bakersfield homes on the internet — the same quality home might sell for $150/square foot as a foreclosure, $400/square foot as a new offering. We’ve discovered that “pricier” does not necessarily correspond to “better.”
Oh, well. We don’t want burl-fronted cabinetry. All we want is our killer kitchen. And our killer master bathroom. And a large master bedroom. Oh, and a harem. Can’t forget the harem.
I might as well start getting psyched up for it, right?
1. Worst air pollution in the country (for particulates). What does not kill us makes us stronger. So if the Bake’s air doesn’t kill us, we are going to be amazing.
2. We’ll be only two hours away from Angeleno food. I’m looking forward to eating, once again, the best Chinese food in the world. Period. Chinese people fly from China just to eat this food. And no one makes Mexican food like the people of Los Angeles.
3. Old friends. Thank Facebook for that — I’m starting to hook up with a lot of people I haven’t heard from in 30 years or more. Lots of ’em still live in L.A. One writes an LA blog.
4. My sister lives down there, too.
She’s grown up since then.
5. A big house. Cheap real estate in Bakersfield, don’t ya know, and we’ll be buying into the low (or near-low) of a buyer’s market. I won’t surprised if we can have a whopping huge guest room, one of those “mother-in-law” thingies. Hint, hint. What, not obvious enough? COME VISIT!
6. Financial security. Yes, this is a long-term thing. I mean, I have to put in my time, right? I’m not gonna be instantly secure all at once, RIGHT? But at least now I’ll be on the road to a secure future. Not like in Crescent City, where we were treading water most every year.
7. Familiar turf. Being the only ENT for a particular population is comfortable territory for me. (Yes, there are other ENTs in Bakersfield, but I’ll pretty much be the only one for the Kize.) There are certain advantages and disadvantages to that situation, and while it’s a mixed bag, it’s something I know very well.
Yeah, I was kind of hoping for a Thirteen, but I’m fading fast. Seven down, six to go.
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!
