Cowboy MD

"I promise I'll never break your heart."
"Awww that's sweet."
"But I will sedate and paralyze you so you suffocate on your own saliva."
"What?"
"I love you."
"Awwww that's sweet."

I have a few rules which have served me well in the past. They've never let me down, and I don't expect them to let me down anytime soon. I shall share them with you in the hope that you too, may someday benefit from their wisdom.

1) The authenticity of a Chinese restaurant is directly proportional to the number of spelling mistakes in the menu.


2) The authenticity of an Italian restaurant run by Chinese people is inversely proportional to the number of spelling mistakes in the menu.

3) Put on a shirt before you fry bacon.

4) Don't get anesthesia from Dr. S.

We were providing anesthesia for a healthy young patient who had come in for some elective surgery. Dr. S. had left me alone for several periods lasting 15 minutes at a time, which in retrospect, really shouldn't have been allowed. What the hell do I know about resuscitating someone? Or maintaining a proper state of anesthesia?

Beans. That's what I know.

At the end of the surgery, the patient was breathing on her own, so I decided to take the tube out. After the patient was extubated, I checked to see if breathing was still going on. "Come on, let's move her over to recovery." Dr. S said. I didn't move, still checking to see if the patient was going to take a breath. The patient hadn't taken a breath since I'd taken the tube out.

"Is she breathing yet?"

I looked a little closer. Come on, breathe dammit. My boss is hassling me.

"I don't think she is."

"Come on let's go."

I was surprised, but hey. He's the anesthesiologist, what do I know? I helped slide her onto the gurney and off we went down the hall.

I wasn't thinking about it but the whole time we were sliding her onto the gurney, cleaning up the OR, pushing her down the hall to recovery, the patient wasn't breathing. This took maybe 5-6 minutes. Try holding your breath for 5-6 minutes. I bet it's hard. I bet it's not good for your brain too.

So when we got to recovery, Dr. S told me to hand over to the nurses, because he had to make some important business phone calls. He left before the brakes were even put on the gurney. I started handing over but in the middle, I heard the oxygen saturation drop. A good oxygen saturation should be above %94. Hers were now 47. A code blue was called and everybody came running. The nurses were managing the airway and everything was being taken care of. All I could do was stand there and wonder to myself whether or not this was my fault and whether or not this patient was going to a) die b) have impaired brain function c) have some other complication I'm sure I'm not aware of yet.

I wondered if all this could have been avoided if I'd spoken up a little louder to make sure Dr. S had known the patient was breathing when we left the OR, so that we could have stayed and managed her airway properly before she started desaturating. I wasn't feeling very good about myself.

Later on, I heard from a few other clerks that that's just the way Dr. S operated. He doesn't perform up to the standard of care, and certainly doesn't do what was in the patient's best interests. I felt a little better hearing that. He would have been cavalier with her airway regardless of what I'd said.

The point of the story?

There are good doctors and bad doctors. Get the good ones to do your surgeries and anesthesia. And look for typos in your menus.

In case you didn't hear the first time

I don't get smoking.

Well, maybe I do get smoking. I guess it's not hard to see how some misguided insecure teenagers in poor company could get started on something stupid. It's the people who are going to die who keep on smoking that I don't get.

Patients have lost their legs because they smoke. They lie wasted away on hospital beds because all their fat and muscles have been cannibalized for energy, except for their massive neck muscles that work overtime just to keep them breathing. They've lost their fingers because they smoke. They can't even hold onto their cigarettes anymore because all they have are either sutured stumps or black shriveled stumps.

And they still won't quit. They bitch about how none of the smoking cessation adjuncts worked, how they tried 300 times and still can't shake the habit. What kind of lame ass excuses are those? If I was in a steel cage slowly filling up with water, and I'd tried to pick the lock 300 times already, you could bet your last breath of air I'd be still trying to pick the lock until the end.

While these patients die, they suck up money. They need to be fed, oxygenated, watered, cleaned, drugged, monitored, fussed over by doctors, nurses, and surgeons. If these patients leave the hospital, the government will have spent thousands upon thousands of dollars on their care. Not only that, but those patients occupy valuable beds that could be used to treat other patients who have medical issues that don't result from smoking.

And it's my money. It's all of our money. Instead of buying myself a new park, a better school, a space program or whatever, I bought myself a dying patient who can't or won't stop smoking long enough to realize that it's not his health I really care about when he says he wants a smoke. It's already too late for this one. I care about everybody else's health. The money this patient uses on cigarettes helps get other insecure teenagers smoking someday down the road, and before long they'll be in here just like this guy.

God dammit. Stop smoking! You're pissing me off.

Work crisis

Am I cut out for this?

How do these psychos keep getting up at 5 something in the morning to get to their jobs? Do they really love it that much? I certainly don't. There isn't a lot I get up that early for, and after I graduate I certainly don't expect work to be one of those things.

I'm sure I'm not the only one who feels this way. Maybe everyone else denies that they're not sure. Maybe they don't talk about it out loud. Maybe it's embarrassing to admit that maybe after all the money, time, education and jumped hoops, medicine was the wrong choice.

Maybe everybody else is sure of what they're doing.

I'm just not that interested in these things. Other people seem to be excited when they talk about new meta analyses or how interesting they find SKIN or LUNGS or CANCER. I certainly don't feel the same passion about anything I've learned so far.

So maybe I'm weird. No, I'm definitely not weird. THEY'RE weird. Maybe I'm just not the right kind of weird to be a doctor.

Maybe I'm too normal for this job.