Tired of tired

When I was too young to remember and fussy, my dad would put me in the car and drive around the block. He said it never failed to put me to sleep. To this day, I still have trouble staying awake in cars.

Later in Grade 1, my French teacher used to call on me all the time when we were learning vocabulary. One reason was because she said I used to know the answer all the time. The other reason was because I was asleep for the entire vocabulary session, and she was trying to embarrass me into staying awake.

In high school and undergrad I had endless trouble staying awake during classes, and during movies. None of this was due to sleep deprivation, sleep apnea, or any of the other usual suspects. It wasn't just the usual after lunch nodding off that everybody else gets. I fell asleep in almost every class, but more easily in those classes I found boring. I could tell the exact moment I fell asleep in class, as my notes would gradually get more illegible, wavering above and below the ruled lines, and to cap off le fait accompli, the perfectly curved penstroke right off the side of the page and onto my neighbor's notes as I completely lost consciousness.

I wasn't trying to sleep through class; I'd be fighting to stay awake all the way through the hour but I would invariably lose the battle and nod off. It would annoy me when I did nod off, because I was doing my best to stay awake but it clearly wasn't good enough. It frustrated me further when someone would comment on it. God dammit I was trying to stay awake.

I tried everything, from going to bed early and regularly, stimulants in the mornings and none in the afternoon... nothing was working. I started having trouble keeping my marks up, as I would invariably fall asleep during some crucial moment of the lecture. I got in trouble at work because I fell asleep at the company social outing planning meeting. I got in trouble for falling asleep during RA training.

I continued my somnolent ways right through med school. If it wasn't for some excellent notetaking from friends, I'd have been lost. I started wondering if I had something a little more serious than simple daytime fatigue. None of my symptoms seemed to fit with any syndrome in the literature, much less any syndrome that wasn't laughed at behind patients' backs.

Most recently I got ousted from resident rounds because I was nodding off. Being bitched out for falling asleep was nothing new to me, but what bothered me more this time was how the staff talked about it like I was too stupid not to know sleeping during rounds was wrong, and how I "needed more sleep" or should try "drinking coffee". What a bunch of asswipes. I wasn't about to explain to them my chronic problem with sleeping.

When they condescended the way they did, it hurt more than that time I fell in the cotton candy machine. It hurts to have a problem that people don't believe is real, or don't understand. It's even worse when they punish you for it.

So I have a little more sympathy now for people with weird conditions. Narcoleptics, you can crash at my place anytime. You my boys, chronic fatigue syndrome sufferers. Restless leg syndrome, let's go cut a rug sometime. And everyone else who's just bored easily by boring people and unengaging teaching, don't let the man get you down.

PS: Morgellon's? No sympathy. You guys are just plain crazy.

Foot in mouth disease

Requisition History: Hirsutism.

I remember writing a while back about how patients talk too much. I'd like to eat those words tonight please. No, the specials will not be necessary, thank you. A house salad will be fine, vinagrette on the side. And a bottle of your second cheapest wine, mon sewer.

So what happened? Did my patients read my post, huff indignantly and organize covertly to begin a health care system wide silent treatment? Fortunately, my readership is limited and this was not the case. No one's talking to me because right now I'm in radiology.

Whenever I wrote up a radiology requisition, I never bothered putting much information on it for the radiologist to read. I always figured that whatever the problem was, their well trained eyes would pick it up and find it anyway. Since I've started though, there have been no shortage of instances when I needed any kind of clinical information at all to help me figure out whether or not this patchy crap in the patient's lung was something to worry about, or whether there even was any patchy crap there to begin with. But those xrays won't tell you anything that you can't already figure out from the look on their faces.

I guess that's part of the reason why radiologists become radiologists; they don't have to deal with people. In radiology you'll never have those patients that can't answer a simple yes or no question without an A&E Biography style retelling of their life. At the same time, you'll never know anything important or interesting about the people under your care. Every person you see is going to be as informative as the unconscious drunk, the frontal lobe stroke, or the parentless 6 month old.

I realized that talking to people was a big part of the reason why I liked suturing so much. You get to sit down with someone for a good 10 minutes and chew the fat, find out who they are, where they're from. I met an Afghani refugee the other day with some pretty crazy stories about Afghanistan. I never would have known by looking at his CT scan.

So radiology's not for me. I like talking to people. I hope this rotation ends quickly. I don't envy that luminescent pearly white sheen everyone seems to acquire after their patients stop talking to them.

American I-bull sh**

I just finished up a month in emergency medicine, and while en route to another educational locale I got together with CLL and 888 and a few other friends for lunch. Naturally, all we talked about was medicine. One of my lunchmates is not a medical student, and as I listened to myself go on and on about the different things I've seen and done so far it suddenly dawned on me that I must sound incredibly boring.

To someone who's not a medical student, being privy to our mealtime exchange must be as stale as astronaut food. I imagine sitting at that table was something like judging a miniature painting contest, or making a Hinterland Who's Who funded documentary about muskoxen, or somehow poking yourself in the eyeball with your other eyeball.

Most of what I talk about is medicine. Most of what I think about is medicine. Pretty much everything I do is somehow medically related. People told me when I started that I would work non stop, take no vacations, and run away with the secretary, but nobody warned me that it would swallow my life to the extent that it has. Even when I make a conscious effort to try to talk about something else, invariably I find myself talking about another medical school related issue or anecdote. Is there no way out?

Well, I think I've started taking steps in the right direction. I've recognized that I need to shut up more about work/school, and do more that's not tied to medicine. I've been trained for many years to convert all my free time into more work time. It won't be easy to break free of my Pavlovian conditioning, but now that I've made my career choice, hopefully it won't be impossible. Here's to the work free weekend, and keeping it that way.

Learning the hard way

"Doctor I think there's something in my eye..."

I'd just put the finishing touches on my first 6-0 facial stitches. My preceptors had been harping on me for a long time about how hard it was to use 6-0 stitches (it's not), and how important it is to stitch properly on a face (it is). My job today was made slightly more difficult because my patient was a 19 year old girl who had previously had an injury to her face that had not healed well.

So when I'd closed up her forehead and sent her away with the right instructions I was feeling pretty good about myself. I'd done an impressive job in my opinion, I'd properly disposed of all my sharps and strode out of the surgery room a little more confident in my skills and a little less inept.

Five minutes later the ward clerk chased me down and gave me grief because I'd sent my patient home looking like she'd walked off an excerpt from the next Fox special "When Prison Riots Go Wrong". In my excitement over another suture technique to add to my arsenal, I'd forgotten to wipe off the excess blood off the patient's face. For some reason, foreheads bleed like stink and the nurse wasn't going to let me forget about this one.

Such is learning in clerkship, at least for me that's how learning is done. I don't know the answer to a question, or I don't know how to do a procedure, and I go look it up later. I get chided for doing something improperly or I nod sagely through a conversation that's completely over my head, and I go look it up later. The path to enlightenment appears to be littered with those times when you fall flat on your face with everybody watching. Shamed into learning! It's the best way to remember your lessons. It's embarrassing, but it works.

It's so easy to identify the people who are going to be star doctors someday, catering to Bill Clinton's quadruple bypass, Kirstie Alley's stomach stapling, and when the other shoe drops, Britney Spears' medically supervised methadone usage. Those clerks are the ones that know the answers before the questions are asked, the ones that never have to be bailed out of a jam, the ones that seem to never have to study. I don't know how those people learn, unless it's direct download into the USB port they have secretly installed in their rectums.

Learning. Digital, or humbling.