I'm gonna, gonna lose my baby / so I always keep a bottle near

Amy Winehouse died today, aged 27.  I think it's pretty obvious that it was from her completely unchecked alcohol and drug addictions, but I'm sad nonetheless.  Music got me through a lot of the very low points of medical school, and Amy Winehouse's music really expressed much of how I felt.  I know that she was often falling down drunk at live performances, so I'm including a clip here to show that she really and truly was a talented girl who just couldn't get it together in the end.

Amy, sorry it didn't work out for you.  We'll miss your voice and your soul.

Today's "Oh, crap!" moment of the day is brought to you by justthetip.com

Monday night, 10 pm, on call.  While rounding in another part of the ICU, my intern gets a page that one of our post-op patients is desatting.  She desatted earlier in the day, but we got her back with aggressive suctioning, so my intern leaves to try this out.  2 minutes later, I walk in.

Me: Whoa, she's down to 78%?  That's worse than before... and her pressure's dropped!
Intern: Oh, yeah.
*my friend E, the medical resident on that evening, walks in with his intern*
Me: E!  Oh, thank god.  Listen, she desatted earlier but we got her back with suctioning.  I'm going to bump up her O2 and attach this ventimask while I suction her.  Wait, that's not a ventimask... do we have anything else?
Nurse: Can't you see that I'm BUSY?!  (Gets back on phone)
E: Ok, let's get a second O2 sat monitor, this thing is jumping around and I'm not sure if it's working.
Me: Great idea.  Hmm, this really isn't getting better.  I'm going to sit her up.
Intern: She's only satting 60% now, on this new machine.  And her pulse just dropped to 50.
E: *listening to chest* Nurse, page respiratory - we need a proper mask.  She's not getting adequate ventilation here.
Me: *nearly hysterical* Holy shit, her sat's now 50%.
E: *silent*
Me: *silent*
Us: *simultaneous realization that two 2nd year residents are in charge and nobody more senior is coming to help us*  Uhhhhhhh.....
*300 years pass*
Respiratory: Did someone page respiratory?
Us: OH THANK GOD YES SHE NEEDS TO BE INTUBATED RIGHT THIS VERY SECOND OH GOD OH GOD OH GOD!!!
Respiratory: Ok.  Move.  *Intubates*
Me: Mrs. Jones?  Can you hear me?
Mrs. Jones: *big smile*
Sarada's Ass: Wow, I don't think I'm going to be able to pass stool for days now.

Samaritan Woes

I think it's pretty reasonable that, after awhile of training in medicine, a person starts to imagine scenarios where they get called in to serve.  Usually it's the airplane scene, where someone starts to have chest pain at 30,000 feet and the airline hostess gets on the intercom and says something like "Is there a doctor aboard?" or similar nonsense.  Most practicing physicians say they really dread these kinds of situations, because of the lack of equipment needed and lack of control over the situation.  (Not to mention, the extreme obligation it places on the physician who is escaping an insanely busy practice to get just a few days away with the family.)

It never occurred to me that there would also be an extreme sensation of terror upon getting involved with this type of scenario.

Last night, after lazily laying about all day and watching Hindi movies on Hulu, I got dolled up to meet a girlfriend for dinner and drinks.  I was already running late when I got out of the subway in the West Village and was walking briskly along when I saw a crowd of twenty people surrounding a body lying on the sidewalk outside a shop.  Getting nervous, I asked one of the women standing there what happened, and she said that they just saw this guy lying there and someone had called EMS.  I asked if anyone had checked him to make sure he had a pulse and was breathing, and she said no.

My heart dropped out of my chest.

"Are you kidding me?" was really all I could say.  I crouched down next to the guy, put my purse down next to me, and started getting my hands all over him to look for a pulse, breath sounds, responsiveness, anything.  Another woman asked me if I was a doctor.  "Oh shit," I thought to myself with increasing horror, "I am.  Oh, god."  I realized in a moment of further panic that I didn't even have a stethoscope, and just put my ear to his chest to see if his breathing was appropriate or junky.  I got lucky - he wasn't tachypneic or tachycardic, and sounded pretty clear - he seemed to really have just passed out.

He suddenly got up, and it became apparent that this guy was chronically intoxicated.  We sat him in a chair and I pulled off his hat to check for signs of head trauma, as he reached into his pocket to roll a cigarette (or "cigarette").  He was oriented but clearly confused, as he told me that he had simply tripped going down a few steps into the shop (but somehow fell on his back, above the staircase).  EMS showed up and pulled on some gloves before touching him, and a creeping grossness overcame me as I ran to the bathroom to wash my hands and arms, and soak a paper towel in rubbing alcohol to clean off my left ear as I tried hard not to think about scabies.

My friend showed up on the sidewalk, in the meantime, with a shocked look on her face as I came out of the store looking as though the world had just ended.  We walked away, while EMS tried to coax the guy into their truck so they could take his vitals, and went about our dinner plans.

On the way out of the last bar of the night, we passed an EMS team evaluating a young man completely passed out in front of a garden apartment.  I kept walking.

PGY-2

Things I have learned during my first week of being a 2nd year surgical resident:

1) Having an intern is like having a kid.  I'm just so anxious for how well they're doing.  I stay awake just thinking about it.

2) My residents were actually snooping behind my back when I was an intern and checking charts and stuff!!  No wonder they could always tell when I was lying.

3) Being a resident makes you feel POWERFUL.  Until someone asks you to do something and you remember that you don't know squat.

4) ...but the title sure does count for a lot, as snoop dogg intern points out (from 1:05)

Divine Secrets of the Surgical Sisterhood

When you choose to go into medicine as a woman, one phrase that you hear a lot is "old boys' club".  It's a reference to the fact that medicine, for centuries, was one practiced by men alone, a fact that was sharpened during the 1950's when the advances made by women were repressed in favor of a return to old time values.  It also references the fact that men, for centuries, have always formed fraternities in one way or another, a way to bond and speak as equals on subjects of substance and importance, and to form friendships, connections and networks for the benefit of all members.  Nowadays, the phrase "old boys' club" infers, due to negative connotation, a professional or social group into which women could be belong based on credentials but cannot because they are not male and therefore not welcome in the fraternity order.

It is a sad fact that women don't seem to have the same natural propensity towards fraternity as men, especially in fields that men have historically dominated.  Of course, the concept of sorority and womens' groups is an old one, but they typically form naturally for the benefit of social friendship, not professional advancement.  Those that exist for professional advancement often have a forced feeling to them, and the ones that have persisted through time exist only in reaction to a negative situation (such as being shut out of male groups).  One would think that, as a minority in certain professional circles, women would band together, help each other out, and act as mentors for each other.  One would especially expect that of the kind of women who have acted as groundbreakers, plowing a path for the rest of us to follow.  But it is not so.  

Dr. Karen Sibert is an anesthesiologist practicing in West Hollywood, CA.  She wrote a well-publicized editorial to the NY Times bemoaning the groves of women training in medicine, only to leave to devote time to family and lifestyle balance.  She includes a number of factual flaws in her argument (ex: she claims that residents don't pay tuition and instead receive a salary, but neglects to mention that repayment of medical school tuition starts in residency while being paid less than minimum wage for a 90 hour work week), and criticizes a pre-med college student for wanting to know about anesthesia as a specialty with regards to work-life balance.  She essentially argues that to be a doctor, one must commit to it to the exclusion of all else, as all men do, or society at large suffers the consequence.  She argues that women are selfish to enter the field and expect such things as time off, end of shifts or part time work, because they suck the precious national resources going into training doctors.

The undercurrent of this editorial is that women must suck it up, not complain, and not ask for anything different in terms of equity.  I am sure that, as a women who graduated medical school 30 years ago and had no other women to band with, this method worked for her.  She has become hard core and old school.  And, truly, I admire her for it.  I've met (heck, we've all met) tough-as-nails female physicians who trained when they had no other companions mentors or encouragement and threw themselves in head first to learn medicine for a higher cause.  It's something I could never do, and have undying respect for.  But there's a broader issue of humanity in medicine - I myself have encountered more than a few older female surgeons who do fantastic work but are a nightmare to be around.  They are, nearly as a rule, nicer to boys than they are to girls.  I never wanted to believe it, but I have encountered more manipulation, lying, sexist and judgmental attitudes at the hands of female surgeons than I ever have at the hands of my male surgical attendings (why by and large have been nothing but encouraging, patient and kind).  

The reason I feel that it's a time-related issue is that, when I look at my senior surgical residents, I don't see any of these traits at all.  I belong to a residency which is at least 50% female, and most of the other programs I applied to were similarly stocked.  The girls I work with are tough and smart, but also look out for me.  I don't get treated any differently than the boys, which is how I know that I am being treated the best I can be.  When I go outside of my residency cradle, I am always shocked at the slightest hint of gender discrimination because it's simply not how I was raised.  At the risk of putting all older female attendings in a box, I argue that the act of training in an all-male world has created a certain type of creature.  Brilliant, tough, smart, but also unable to trust anybody but men.  I believe that the female attending throws younger female doctors under the bus because she forgets her obligation to them.  She is jealous that so many things she had to fight for, her residents can take for granted.  The ability to even consider part time work as a doctor to be with her children?  That was a pipe dream in her day.  Having to be a thousand times better just to be considered at all?  It's the exception rather than the rule now. When she works with men, she's back on familiar territory, she knows how they will behave and react.  On some level, it probably even makes her feel special inside, to be above so many men who were once above her.  But female residents, they throw a wrench in that calculation.  And she forgets her obligation to mentor, guide and protect because she never had those things herself.

Like gay marriage and outdoor smoking bans, changes in this behavior will only come with time.  The female attendings like Dr. Sibert won't change their attitudes, they'll just retire at some point soon and be replaced by many more females who trained under more balanced circumstances, with respect and concern for each other.  Our network will come because we all worked with each other, remember our seniors with fondness and respect, and bond over a common experience.  As much as Dr. Sibert wants to flap her arms about the change in priorities in medicine, the fact is that, very soon, she'll be under our care and not over our heads, and we'll all be able to form the sorority we deserve without her stopping us.

Life as you know it

Hooray for vacation!!  I'm back in the states, after a week off in London and a few days off here and there at home.  I won't go on too much about the trip itself, except to say that there was lots of shopping, drinking and laughs.

Oh, baby.

But here's something that struck me - in the course of meeting many of my sister and cousins' friends, I wound up talking about my job.  A lot.  Probably a certain amount of that was just desperation and gratefulness at having the chance to get away that it almost seemed unreal.  A significant proportion was also residual pain from the way that I had been professionally singed on my last rotation, by some people who I had underestimated in their ability to put personal gain above team duty.  But the thing that drove it the most was the fact that I work so many hours at this one job, and so many people that I met just couldn't comprehend it.

It's a fact of life in the UK that work hours are very severely limited.  It's a culture that is hardly hedonistic compared to the rest of Europe, but by American standards can seem outlandishly fun-oriented at times.  To have several drinks with colleagues, to travel, to spend time together, to shop during the lunch hour, these are all things that are assumed by many to be a regular part of life on a weekly or even daily basis.  Even for doctors, the work-hour limit is about 50 hours per week, just over half of what American residents are limited to (and often work over).  So while discussing my job with people, the shock and horror I experienced at describing a standard 85 hr work week was overwhelming.

I used to encounter this sort of attitude years ago, when I was in medical school and dating around.  People would ask what I did for fun on weekends or holidays, and the response of "I'm studying" used to baffle people.  Later, when I started rotations, I would gripe about having to get up so early when the rest of the world seemed asleep, or having to travel so much in such an unpredictable manner.  But eventually, I took solace in knowing that I wasn't the only one.  It enabled me to get off my high horse when I realized that investment bankers work 90 hour weeks too, and while they have bonuses larger than my entire salary, they also have to do it all in a suit and tie, and deal with way bigger assholes.  Embarrassingly, it took me 3 years to figure out that the guy at Dunkin Donuts serving me my latte had to get up at 4:30 in the morning, too.  And my dad chided me for complaining about the frequent travel - nearly all consultants do the same, and they have to do it on planes.  I gradually started to feel that my situation wasn't special, and that allowed me to tone down the pity party I was throwing for myself at working so long for so little.

It is easy to feel jealous that I do not belong to a culture, or a world, in which lifestyle and experience are the focal points.  I certainly turn green at the thought of my friends, who casually meet up with each other with little notice and maximal enjoyment.  But, the fact is, to make those lifestyles happen, these people all picked jobs where they more or less sit at desks, deal with vague concepts and handle a level of office politics that I am, paradoxically, protected from in many respects because the people I work with just don't have time for petty grudges.  I would never be happy in those circumstances, and the few rotations I went through resembling such work had me bored out of my mind.  I didn't pick it because it didn't suit me.  I feel healthier in some ways, doing a job that keeps me occupied for the majority of my time.  I feel healthier in a job where I walk a lot.  If given the option of living the London lifestyle or not, I probably wouldn't pick it if I had to stay with it the rest of my life.  And that's just the way it is.

LDN

Things I have learned in the past 36 hours:

1) The aisle seat is NOT preferable when you are sitting next to a woman who ate NYC street food before getting on the plane.

2) They have Ben and Jerry's vending machines dispensing little mini-pints of ice cream at the Heathrow airport.  I live on the Eastern seaboard, how come we don't have that???

3) Gherkin is a far better name for this.

4) I am truly addicted to my Android.  Last night, I realized I was going to have to go a whole week without TMZ and I nearly had a heart attack.

5) I did not drink enough on Memorial Day, otherwise I would not still be feeling all that wine I had last night :/