Oh, neurology

August 28, 2007 at 8:23 pm (Clinical rotations)

During the height of the Greek and Roman eras, the celestial bodies were worshipped as gods. Good citizens fervently prayed to Apollo and Zeus to grant them good travel and healthy families. Christians who refused to believe in the gods were fed to lions and crucified for their defiance. Eventually, science took over and astronomers demonstrated that the stars’ paths could be predicted-that the heavens above were nothing more than soulless bodies of fire that traveled around the sun. All of that dedication played no role in the day-to-day random events that made people healthy, rich, or fertile. What’s worse, the pagan priests, despite all of their years of training to accumulate such a vast amount of knowledge, now were useless because they could not influence the results of people’s lives by praying to the gods. In a similar fashion, neurology has plenty of highly trained physicians whose knowledge will play no role in how their patients fare.

After coffee hour this morning, my team met with the attending to discuss the previous day’s cases. We spent ten minutes debating whether a patient’s disease was located in the nerve’s cell body or in the axon. Finally, after much deliberation, we concluded that the lesion was in the axon. All I could think of was the absurdity of the conversation. Our patient couldn’t walk. Even after we figured out where the lesion was, the patient still couldn’t walk. In fact, there is no treatment for his paraplegia. Much like the pagan priests, we wasted all of that time getting worked up over nothing.

Don’t get me wrong. I think that neurologists are very intelligent and are experts at treating some of the most debilitating illnesses in America such as stroke and headache. However, so much of what I’ve seen over the past week has been consults where we confirm that yes, the AIDS patient does have a degenerative spinal disease that is slowly leaving him without sensation in his arms and legs. And you know what? There’s nothing we can do about it. I wonder why four years of residency is required to learn the neurological exam only to tell families that grandma won’t be able to eat in the future without drooling on herself.

So much of my day is spent shaking my head and saying, “Oh, neurology,” as if I were watching my cousins expound upon the benefits of astrology and the importance of following the daily horoscope. Maybe I’ve just become jaded too early in my medical training. However, I got into the field because I actually wanted to do things for people. I wanted to serve as a healer. If neurology can’t grant me that, I’ll gladly wait until the donut of misery rounds another next full circle and move on to the next rotation.


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Neurology: the anti-surgery

August 21, 2007 at 8:13 pm (Clinical rotations)

I started neurology this week; and if today is any indication of how the rest of the month will go, I’d say I have a pretty easy rotation ahead of me.

8:00AM — arrive at the neurology room. 4th-year medical students who know that they’re not going into neurology eventually trickle in. Our future radiologist comes in 40 minutes late. Residents come and go, discuss the previous day’s patients, and ignore us students in the corner.

9:00AM — the stress of discussing patients amongst themselves is too much. We all go for coffee.

10:00AM — meeting with the attending to discuss the previous day’s patients. The attending regales us with tales of patients he saw during the Nixon administration.

11:00AM — see the first patient of the day. The resident finds unique ways to avoid seeing consults from other services by saying, “You haven’t given us the baseline,” or, “The patient was in the bathroom when I stopped by.”

11:30AM — lunch

1:00PM — time to return pages from the emergency department. While we’re there, I jump into a code and start doing chest compressions on a patient in asystole. My resident surfs the Internet. The 4th-years make dinner plans.

3:30PM — seeing these five patients has got me exhausted; time to go home.

Mind you I didn’t actually talk to any patients myself. I got to watch the resident do a few abbreviated physicals, but never touched the patients. Apparently, my responsibility during this rotation is to gain an appreciation of the field. All I can say is that I certainly appreciate getting a vacation after surgery.

While I know that neurologists really do work harder than what I’ve presented here, I’m still a little surprised that the residents don’t want us doing anything. They don’t even have us doing scutwork. I looked up the vital signs for one patient, but my resident later told me not to even bother with that. While I enjoy the break, I certainly want to get something more substantial done this month.

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Second impressions

August 8, 2007 at 8:12 pm (Clinical rotations)

As I close in on the final week of my surgery rotation, I’ve had several realizations:

1. Cell phones and cable TV are more important than health insurance. The combined cost of watching MTV while sending text messages to friends will run about $80 a month. Similarly, joining an HMO will cost about $80 a month. When given the option of choosing the latest cell phone or health care access, my patients will always pick the Razr. Nothing’s worse than seeing an unemployed patient in clinic who pulls out a better cell phone than the one I own, and then demands to speak to a social worker in hopes of finding a job. But what does he care? We’re going to see him for free anyway. So long as the students get to experiment on him, the hospital will let any abusive, drug-addicted, baby daddy walk through the door and receive free care.

2. Morbidity and Mortality conferences are the medical version of the whipping boy. In Medieval society, the discipline of royalty involved punishing a pauper for the actions of the prince. If a prince disobeyed his parents, instead of spanking the child, the king would have a substitute whipped in hopes of scaring the prince into behaving. Similarly, morbidity and mortality conferences seem to serve the same purpose in the medical world. Every week I have to watch residents get pummeled by dinosaurs for the screw-ups of the attendings. During an M&M conference, a resident will present a case of patient who comes in and receives some kind of mismanaged treatment. The poor resident then has to answer questions regarding such topics as the standard of care, recognition of treatment, and the year particular journal articles were published. Meanwhile, the attending—the person who was really responsible for the mistreatment—gets off the hook. I witnessed one case last week where the resident was continually asked why a patient was scheduled for a particular operation. How the hell would the resident know? She didn’t schedule the procedure.

3. I’m a genius compared to the people I work with. During my trauma rotation, a man came into the trauma bay for minding his own business at a party. He was shot, suffered bilateral collapsed lungs, and needed resuscitation. My intern inserted a chest tube to reinflate his lungs. A few days later, we noticed that there was a leak in the tube, as indicated by the collection box. My attending yelled. The intern wrapped petroleum jelly around the entrance site of the chest tube to seal off the wound.

Still, there was a leak. My attending yelled. The intern removed the chest tube, cut open the patient’s skin, and inserted a new chest tube.

Still, there was a leak. My attending yelled. The intern tried his hardest to wrap the entrance site for the second tube in petroleum jelly.

Still, there was a leak. My attending yelled and threatened a third chest tube. On rounds, I noticed that the tube leading to the collecting box had a tiny hole. I put tape over the hole. The leak stopped.

4. Surgeons intentionally try to be jerks. During some downtime recently, I got on a computer at the nurse’s station to read from The Washington Manual of Surgery. A resident came over to computer, said, “Move! I need to use the computer. And to show you what a dick I am, I’m going to browse away from the website you were using.” He finished his work, closed the web browser so that I would have to login from scratch, and then walked past three empty computers on his way out.

He once mentioned that he isn’t married. I can’t think of a reason why.

5. If I don’t take the initiative, no one will. I was in line at the cafeteria one afternoon trying to get lunch before the next marathon surgical case. I heard a commotion behind me and turned around to see a woman lying on the ground in the middle of the snack bar. I watched as several people walked by her, including one resident. I got out of line, grabbed a wheelchair, and then ran the woman to the emergency department. There are multiple instances of healthcare workers turning a blind eye to helping others. Naturally, I’m not going to give the homeless people outside of the hospital my loose change, but if a patient needs genuine help, I’ll be the first to jump in. I’m really saddened to see that so many of my colleagues—regardless of their stage of training—are not willing to do the same.

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