I recently watched The Hangover, a hilarious comedy about a bachelor party gone awry. There was a scene in which Zach Galifianakis was ridiculed for carrying a satchel by his friends. “You’re carrying a man-purse!”

That brought back some memories of my experience during my family medicine rotation during internship. I had carried a nylon briefcase from the AAO 2008 meeting to work and one of the FM sub-i students remarked, “Is that a man-purse? Whoa!”

Mind you, the AAO briefcases do not even compare in quality or in metrosexuality as the Timbuk2 messenger bag above. If I had my way, she would have gotten an “F” for insight. Clearly the philistine doesn’t know the difference between a briefcase and a messenger bag.

medicine medicine, rant

For the second time this week, I saw a sports vehicle with a handicap parking tag. It always amazes me that a disabled person can be capable of driving a fast sports car. Perhaps this is a reflection of my narrow-mindedness, but doesn’t it seem odd to see a Nissan 300Z (manual transmission) sport the universal man-in-wheelchair logo on its plates and rearview mirror?

While the rules that govern distribution of the handicap permit vary by state, the general qualifications are similar. I believe that you must meet one or two of the following criteria:

• Inability to walk at least 200 feet without stopping to rest
• Use of portable oxygen
• Diagnosis of NYS Class III or IV heart failure
• Diagnosis of COPD, either end-stage or severely limiting.
• Wheelchair bound

The list continues with about a dozen more criteria, but I don’t believe that any of those disabilities actually prevent you from being able to work a clutch on a fast car.

The driver of the Nissan 300Z was a middle-aged man wearing thick-cut jeans and a flannel shirt. He didn’t seem like the heart failure type, and he wasn’t obese either. He did, however, light up a cigarette on his way out of the car to the Papa John’s pizza store.

Ah, the luxuries we have in the U.S…

medicine medicine, rant

Bad outcomes do occur on the roadway. Several weeks ago as I was driving to the airport on I-95 around 3:30am, a white Infiniti I20 whizzed past me on the left lane. The roads were slick from a constant torrent that had been ongoing from the night before. I was cruising around 55mph–I’d say the guy in the Infiniti was speeding closer to 80mph. About 15 minutes later, I approached a police and ambulance barricade. The Infiniti was upside down, with its front hood smashed in the concrete barrier on the left lane. A Cutlass station wagon was adjacent, with its driver’s side door crumpled.

I could hear the siren of an ambulance wailing off in the distance. I wondered if the driver was dead, but I supposed the ambulance would have kept kept its siren off if the patient were definitively dead.

While I don’t who is at fault, this is yet another reason why you shouldn’t drive 80mph in foggy, rainy weather with 50ft visibility ahead.

misc life, rant

I hate the post office. Unfortunately, it is my only means to send mail economically. There is nothing wrong with the post office itself, only the experience of being there. Back in NYC, the post offices rarely make any of their supplies available–no delivery confirmation stickers, priority mail envelopes…anything. You usually have to wait in a line the length of the Great Wall just to get any assistance. The postal employees are unlikely the ones at fault; it’s a fact that most governmental offices are understaffed.

I religiously use the automated stamp dispenser to avoid the dreaded line. Today I scurried off early to the post office to brave the early crowds. At 8:30am (the post office opened at 8am), the line was already to the doorway, with only two employees. Fortunately I was mailing a flat-rate envelope and did not require human assistance. As I smugly deposited my letter in the bin, I caught eye of a customer at the counter epitomizing the cause of long post office lines.

She was attempting to mail a poorly sealed cardboard box while claiming that the automated stamp dispenser ate failed to print out her postage. As evidence, she displayed a crumpled receipt of dubious origin. The postal employee was kind enough to dispense new postage AND correct the erroneous zip code marked on the box. Ironically, the customer scratched out the corrected zip code and rewrote the original one, seconds after being told that the zip code did not correlate with the destination city. I could sense the frustration exuding from the rest of the crowd. I ducked out before I became visibly irritated from the scene. Good grief.

How difficult would it be to package your missive properly before leaving home? Is it too much to ask to KNOW where you plan to send your letter? Postal workers are overworked without having to deal with incompetent customers.

I dream of the day I have postal pickup in my office. That would be paradise. In the meantime, I guess that the automated stamp machine will have to do.

misc life, rant

Illness drives us to illogical decisions, and that’s one of my pet peeves in medicine. As doctors, we think that we know what’s best for our patients and frown when they disagree with us. We are even trained in medical school and residency to put ourselves into their shoes to help guide our decisions. Yet with such extensive preparation and almost a year of clinical practice behind me, I still am unable to rationalize some of the decisions my patients make.

Last evening I was paged by nursing that one of the asthmatic patients demanded to be discharged from the hospital, at 10:45pm. She was taking multiple anxiolytic agents, along with sedatives. She complained that her wheezing had not improved since admission, and that she “needed” to leave. Earlier in the evening outside of visiting hours, she had a visitor who demanded to meet her in the hospital lobby. When security denied their rendezvous, she threw a fit.  I gave her a standard discussion about leaving against medical advice, and that I did not believe it would be ideal if she left in the middle of the night while she was ill.

Over the next hour, she demanded to speak to me over 5 times. I presented the AMA form that relieves the hospital of any wrongdoing if she left and told her that she could even die with untreated asthma. Around 2am, the nurse notified me that the patient had left the hospital.

I guess she was probably withdrawing from some illicit substance, like a third of my patients predictibly do (I am working at an inner city “Outside Hospital”).  Afterward, I felt disturbingly relieved that my patient had left–I wouldn’t have to write a progress note on her in the morning.

medicine medicine, rant