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

I just finished a week of night float at what is probably considered one of the “outside hospitals”.  The nursing pages are painful. I’d typically receive a page every evening notifying me that a patient had not moved his bowels in 3-10 days, and that the constipation protocol was just initiated. Other times, nursing would demand that I order Seroquel to knock out patients who were simply irritating. While I don’t mind constructive advice on patient management, I don’t appreciate illogical verbal pressure from unqualified people to medically subdue a non-hostile, non-psychotic patient who asks for ice chips.  These select ancillary staff workers leave a foul air that mars the reputation of nurses and techs, and I have to remind myself that not all nurses are lazy assholes. On weekends where I’m in the hospital for 30-36hrs, my pager goes berserk every 10 hrs with 10-15 pages within 2 minutes for inconsequential order clarifications–this corresponds to the nursing shift changes. They tend to forget that my shift spans four of theirs.

On Tuesday, my co-resident and I caught a rotund technician lurking around the resident’s lounge. He stated that he left a “paper” somewhere in the lounge and promptly dashed off. Later, we noticed that half of my co-resident’s iced tea was missing, and his sandwich was gone. We should have confronted the tech in the lounge, since all other staff is forbidden from hanging out in our lounge.

While hospital staff that outright harm patient care are terminated, the majority of the subpar group continue to maintain their duties without penalty even though the hospital administration is aware of them. It is unfortunate, but there is a shortage of qualified nurses in American hospitals. I believe that the shortage is expected to worsen in the next decade; it does not look good for inpatient medicine from this aspect. Hopefully, I will be out of the inpatient business by then…

medicine medicine, rant

I have been cycling through paperwork for my new residency over the past few days. The packet contains a mix of poorly photocopied forms, some of which is either illegible or completely cut off. The hospital also graciously included a photocopied Chase Bank flyer dated 2004, which offered $200 for opening a checking account. I called the graduate admissions office (GME) later to clarify some issues:

Me: Hi, I’m starting residency at XXX next month, and I’ve got some questions about some of the forms I received from your office.

GME guy: You need to call YYY.

Me: The forms came from your office, one of them is a verification of medical school training. I’m not…

GME guy: (cuts me off) And?

Me: I’m not in town, and I was going to fax in the form to the Registrar’s office to be stamped. Do you accept faxed signatures?

GME guy: It depends if you sign it. Up to you.

Me: It goes to your office! Ok, I’ll fax it over. I’ve another question: what time and where do I show up for the orientation in June? The forms don’t say.

GME guy: We don’t do orientation.

Me: The form says “Please show up to Occupational Health on time”, but it doesn’t say when and where.

GME guy: This is OHS. You said orientation, confusing me.

Me: (I was getting really pissed off at this point) Yea, OHS. Where do I show up?

GME guy: <paused for 10 secs> You got the green sheet? Read the top.

Me: <looking at the green sheet> It says ..ving Pavilion, and no address.

GME guy: Yup, call the number at the top for info. Irving Pavilion.

<click>

Apparently the address for Irving Pavilion was completely cut off the top of the page. If I didn’t already know where the buildings on campus were, I’d have no idea where to find it.

Ah yes. And now I am reminded why I left NYC…

medicine humor, rant