After an interesting and very, very early day in the Emergency Department, I made my way back home. As I waited for the bus to get to the Metro, a couple approached me, which bus to take for the Red line. They were in luck as I was heading to the Red line. Their little girl sat there beside her mother, cute as button and very inquisitive. Today, she would see the circus, lions, tigers, and bears, oh my! She confronted me on my PJs, and rightfully so, scrubs must look quite funny if you are not used to seeing people wear them. Her mom repeatedily told her that I was working, but she knew better...how could it be work? My day was coursed with fun stuff and good people helping me along the way. Caring for people always makes me feel good, and generally I enjoy myself in doing so. Although, missing an IV stick due to a history of drug use is not fun. I guess a body covered in track lines spelled out a little bit of a hint of my impending failure...maybe not so fun.
I savior my time traveling on the buses and the Metrorail. I see it as a time to reflect on the day and to interact with a wide variety of people. Today was extra special. As I sat at the Dupont Circle D6 stop, I watched people and the occasion happy dog walking his/her owner. Time kept on spinning by. I started to grew a little curious as to where the bus was, but I didn't pay it much attention as I sat there completely content, just happy to be. Out of what seemed nowhere, a gentleman younger than myself, seemingly recently from Mexico, approached me. In broken English but with much resolve, he asked what bus I was waiting for. I told him the D6 bus. Excitedly, he said I need to get to Mass. Ave as the D6 bus ran out of a completely different stop despite bus stop sign. After a couple rounds of "Are you sure," it sunk into my thick skull. The guy must have thought I was crazy. I thanked him and took off toward the bus stop labeled for a completely different bus. A minute or two later when the D6 bus arrived at the 'wrong stop', the man's words rang true. Plus, he saved me from a rather long stay at the original bus stop and from eventual long-winded cursing of the D.C. transportation system.
Wonderful to think, salvation links us. A myriad of individual events throughout the lives of many crisply flows as one interdependent course of action. We need each other. It is just that simple...we need each other.
Saturday, March 24, 2007
Sunday, March 18, 2007
Ravage
We live in a ravaged world. Our songs echo pain as much as they do joy. Why is this? Why is it we allow ourselves the misfortune of drowning in a sea of troubles? Why not oppose them? Here we sit on this rock. Depending on perspective, we are the most advanced, most adapted creatures on the face of the Earth. We have surpassed the gauntlets of most terrestrial environments and furthermore look to the stars as our next great adventure. Some might say space is it, but think for a moment. How could we be so bold, so arrogant to believe it ends at space? No my friends, space is not it. Space is just another chapter, another wonderful, daunting chapter from the sea of our birth. The adventure resides not just in where we are and where we are going but more completely also inside, i.e. in the nuts and bolts of who we are and who we want to become. I believe many of us have forgotten this aspect of the adventure. We are more concerned of greed. Now, although I can take this commentary to places that I would rather, I will not. In lieu of my favorite topics, this time it is health care policy. Before you run away from this commentary, read the next few sentences, and then do as you wish.
In our country, roughly sixteen percent of society has no insurance; moreover, every one in ten children does not have insurance. In an elementary school class of thirty children, as they exist in every state, country, city in this country, three children oppose a great wall, a lack of health care as you and I know it or should know it. We have let them down. We have always let them down. So I ask of you, the reader, as I ask of myself, let us find the solution. Leave it not to politicians, for such vehicles care more of themselves than those they serve, although I will admit exceptions here and there. I shall present two views as headings, then I will very briefly tell you why I believe one has extreme ethical issues at its core and why the other, although ideal, has it downfalls. Our goal should be universal coverage. Simple, right?
An economist’s approach to solving the aforementioned health care problem: Take the government complete out of the financing, let them regulate, but leave them out of paying for it. In this view, insurance companies are the vehicle of payment and coverage. They would compete with each other over plans and payment systems, coverage systems could be completely different from each other. All Americans would be covered by law. My question for the economist: Is health care a basic human right or is it a privilege? You may ask yourself, “How does the writer’s question have anything to do with this approach to solving the problem?” Simple: justify an ethical standpoint allowing for insurance companies to make a buck off of caring for someone. Still not clear? On average the overhead of Medicare (funded primarily by tax dollars) sits at about three percent; however on average the overhead or ‘administrative’ costs of an insurance company can be around twenty percent. In the case of the private sector what constitutes ‘administrative’ costs? Let’s say they that private insurance companies for some reason or another are less efficient than the government at covering their true administrative cost. I’ll give them five percent of their budget. What is left of the pie? Fifteen percent is profit, money in their pocket. Money spent by you and it to make sure we have health insurance that goes right into their pocket. I wonder if we could at least cover the children who live everyday without healthcare insurance with the money insurance companies place in their pocket. It is all about greed; never mind denying healthcare to our future.
The utopian solution to our health care problem: We all (i.e. those who can afford to pay) contribute funds to the government. Everyone is covered, no matter their employment status, their health state, their ability to pay. Is it possible? Ask the U.K. Oh and by the way, their per capita spending on health care is about 1/6 of our spending on health care. Do they have the best health care system in the world? No, apparently Canada owns that title, according to the W.H.O. Don’t ask where the U.S. resides on that list. The U.K. takes hits for queues (lines for care or elective surgeries) and lacking the latest and greatest technology, but then again, remember right now we spend six times what the U.K. spends on healthcare…surely we could ensure shorter lines and the latest and greatest technology with such spending. My challenge for you the read is: can you deal with paying the health care bill of others? Oh and by the way, we already pretty much do. I’ll leave this perspective with two reasons why and one food-for-thought. Reason 1: About half of the bankruptcy cases in this court are attributed to paying for healthcare. People still need to get paid. Guess who foots the bill in these cases…the government, but more importantly you and me. Reason 2: Medicare and Medicaid are primarily government funded entities. Food-for-thought: About half of the uninsured people in this country have jobs.
Please feel free to challenge my views or statements. In the end it is all about learning and getting it right. A bruised ego heals.
Cheers.
In our country, roughly sixteen percent of society has no insurance; moreover, every one in ten children does not have insurance. In an elementary school class of thirty children, as they exist in every state, country, city in this country, three children oppose a great wall, a lack of health care as you and I know it or should know it. We have let them down. We have always let them down. So I ask of you, the reader, as I ask of myself, let us find the solution. Leave it not to politicians, for such vehicles care more of themselves than those they serve, although I will admit exceptions here and there. I shall present two views as headings, then I will very briefly tell you why I believe one has extreme ethical issues at its core and why the other, although ideal, has it downfalls. Our goal should be universal coverage. Simple, right?
An economist’s approach to solving the aforementioned health care problem: Take the government complete out of the financing, let them regulate, but leave them out of paying for it. In this view, insurance companies are the vehicle of payment and coverage. They would compete with each other over plans and payment systems, coverage systems could be completely different from each other. All Americans would be covered by law. My question for the economist: Is health care a basic human right or is it a privilege? You may ask yourself, “How does the writer’s question have anything to do with this approach to solving the problem?” Simple: justify an ethical standpoint allowing for insurance companies to make a buck off of caring for someone. Still not clear? On average the overhead of Medicare (funded primarily by tax dollars) sits at about three percent; however on average the overhead or ‘administrative’ costs of an insurance company can be around twenty percent. In the case of the private sector what constitutes ‘administrative’ costs? Let’s say they that private insurance companies for some reason or another are less efficient than the government at covering their true administrative cost. I’ll give them five percent of their budget. What is left of the pie? Fifteen percent is profit, money in their pocket. Money spent by you and it to make sure we have health insurance that goes right into their pocket. I wonder if we could at least cover the children who live everyday without healthcare insurance with the money insurance companies place in their pocket. It is all about greed; never mind denying healthcare to our future.
The utopian solution to our health care problem: We all (i.e. those who can afford to pay) contribute funds to the government. Everyone is covered, no matter their employment status, their health state, their ability to pay. Is it possible? Ask the U.K. Oh and by the way, their per capita spending on health care is about 1/6 of our spending on health care. Do they have the best health care system in the world? No, apparently Canada owns that title, according to the W.H.O. Don’t ask where the U.S. resides on that list. The U.K. takes hits for queues (lines for care or elective surgeries) and lacking the latest and greatest technology, but then again, remember right now we spend six times what the U.K. spends on healthcare…surely we could ensure shorter lines and the latest and greatest technology with such spending. My challenge for you the read is: can you deal with paying the health care bill of others? Oh and by the way, we already pretty much do. I’ll leave this perspective with two reasons why and one food-for-thought. Reason 1: About half of the bankruptcy cases in this court are attributed to paying for healthcare. People still need to get paid. Guess who foots the bill in these cases…the government, but more importantly you and me. Reason 2: Medicare and Medicaid are primarily government funded entities. Food-for-thought: About half of the uninsured people in this country have jobs.
Please feel free to challenge my views or statements. In the end it is all about learning and getting it right. A bruised ego heals.
Cheers.
Saturday, February 24, 2007
The Red Line To Our Personal Hell
I spent last night working at Washington Hospital on the northeast side of the city. In doing so, my travels took me aboard the red line Metrorail. I have found my time on the Metro to be an opportunity to reflect on the day. Grant it on the way back from the hospital this morning my time was mostly spent just trying to stay awake...I stood and watched the buildings in the crisp morning's sun. Irony of Washington Monument being in the same field of view of run-down housing can really put a spin on your day if you let it.So last night I worked in the Emergency Room (ER) or Department (ED) (pick your poison). Now that the shift is over I can say this, it was a surprisingly, relatively quiet shift. I worked with a really cool attending physician. The guy sincerely cares, which tends to be the theme around here, mind you. He and his staff worked hard to teach me, which was great in itself. He allowed me to do as much as I want to do, so I was prepping patients in no time flat. Fortunately, I will be working with him throughout the rest of the semester. Last night, I saw a lot of different diseases. What sticks with me through all the minutia is mostly the images of scared patients. Fear rests on our shoulders and grabs at our throat, perhaps one of our most important signs of humanity. I feel as long as I can identify with the fear associated with each patient, whether he/she be conscious or unconscious, dead or alive, sick or healthy, I will be guided. Things become complicated when drug addicts faking pain looking for a score, child/spouse/elderly abusers, individuals trying to get out of work, or looking for a reason to sue, etcetera enter the mix. Patients can have 10 of 10 pain no matter how bad it really is, which is frustrating but also very enlightening. Patients can be extremely scared despite what their disposition 'looks' to be, and fear can drive a person to do many things they normally wouldn't do. The patient with the perirectal abscess in Room 10 may be a jerk to everyone. He may be homeless. However, he needs help, so you jock up, try your best to overlook the fact that he is practically screaming at you, because he has had to tell the same story 4 times in the last 4 hours. By the way, waiting times of four, five, six, seven (you get my point) hours are the norm for non-immediate life-threats in major city hospital ERs. The truth of the matter is that he has probably lived with a bleeding abscess for quite some time, but last night was pretty damn cold. So you tell me, if you were in his shoes, which would be an extremely difficult image to picture, then what would you do...cold night out with a slow bleed in the area where sun doesn't shine or a warm Emergency Department with a bunch of questions thrown at you after a 4-hour wait followed by some medical student sticking you, swallowing some barium filled cranberry-like juice, and then being taken off for an image study and a likely surgery to fix a persistent abscess...oh yeah did I mention receiving a few meals. So, the Emergency Room is a place of battles. Some battles are fought and either won or lost in minutes, while other battles are almost purely ethical. The fact remains: people need help.
Tuesday, February 13, 2007
I Just Want To Be A Doctor.
I Just Want To Be A Doctor.
When standing face to face with a demon many thoughts may surface once you get over the whole shock and awe factor. I found my Achilles heel thus far on my journey through the world of medicine. Apparently, biochemistry takes the helm of this demon’s ship. Undoubtedly, another beast will replace this sinister creature, but for the time being biochemistry will do. After just barely passing the first exam as did most of the class, I stood there face to face with this vile gatekeeper. In all its wicked breath, it haunted me through the winter break, through January, and into February. Over a slow course consuming the last two weeks, the beast lies still, slain at its throat. Unfortunately, this story does not hold true for many of my fellows. The beast won many times over, a sad fact of the matter. I’m left with distasteful thought. At times when I can reason no rationale behind some of the necessary conquests on the horizon of a medical student or resident, a few thoughts come to mind. Most presiding of which remains to be: “I just want to be a doctor.”
I just want to be a doctor. At three A.M. with my notes and flash cards spread out all over my desk and highlighters gone wild, I just want to be a doctor. Spending an entire day in the same lecture hall listening to lecturer after lecturer speed through their bit, I just want to be a doctor. With my arms shoulder deep in somebody’s bowels, I just want to be a doctor. At eight in the morning running off of 5 hours or less of sleep for the sixth day in a row, I just want to be a doctor. As I slowly accrue more debt than I care to admit, I just want to be a doctor. While I put my life in a holding patter at 10,000 feet, I just want to be a doctor. Watching my friends, at times, struggle right along side of me, I just want to be a doctor. Damn it you wretched demon, don’t you get it…it’s going to tell a hell of a lot more to get me to even budge.
I’ll leave this commentary with one final thought. Why is it that we allow some of America’s brightest and finest students to walk such a gauntlet? These souls live so that they may make the lives of others at least just a little better, so why is that we try to bury them along the way? I just want to be a doctor.
When standing face to face with a demon many thoughts may surface once you get over the whole shock and awe factor. I found my Achilles heel thus far on my journey through the world of medicine. Apparently, biochemistry takes the helm of this demon’s ship. Undoubtedly, another beast will replace this sinister creature, but for the time being biochemistry will do. After just barely passing the first exam as did most of the class, I stood there face to face with this vile gatekeeper. In all its wicked breath, it haunted me through the winter break, through January, and into February. Over a slow course consuming the last two weeks, the beast lies still, slain at its throat. Unfortunately, this story does not hold true for many of my fellows. The beast won many times over, a sad fact of the matter. I’m left with distasteful thought. At times when I can reason no rationale behind some of the necessary conquests on the horizon of a medical student or resident, a few thoughts come to mind. Most presiding of which remains to be: “I just want to be a doctor.”
I just want to be a doctor. At three A.M. with my notes and flash cards spread out all over my desk and highlighters gone wild, I just want to be a doctor. Spending an entire day in the same lecture hall listening to lecturer after lecturer speed through their bit, I just want to be a doctor. With my arms shoulder deep in somebody’s bowels, I just want to be a doctor. At eight in the morning running off of 5 hours or less of sleep for the sixth day in a row, I just want to be a doctor. As I slowly accrue more debt than I care to admit, I just want to be a doctor. While I put my life in a holding patter at 10,000 feet, I just want to be a doctor. Watching my friends, at times, struggle right along side of me, I just want to be a doctor. Damn it you wretched demon, don’t you get it…it’s going to tell a hell of a lot more to get me to even budge.
I’ll leave this commentary with one final thought. Why is it that we allow some of America’s brightest and finest students to walk such a gauntlet? These souls live so that they may make the lives of others at least just a little better, so why is that we try to bury them along the way? I just want to be a doctor.
Saturday, November 11, 2006
Now what...
Twenty four hours ago I asked myself what the hell I was thinking…medical school…I must be out of mind. All week I recited the same line over and over again from time to time. Examination time always makes a person reevaluate decisions. Today I completed an examination of the entire body. The rules were quite basic: 1) Anything regarding the HUMAN body goes and 2) Gray's Anatomy textbook is the bible. Needless to say, the conditions were ripe for people to fall into the grips of panic, anger, panic again, more anger, and ending with the final statement of 'Oh shit what is that test doing in front of me.' So far in life I've learned a few powerful lessons:
1) If you don't know where to start then just start.
2) Hard work pays off.
3) Don't be afraid to get dirty.
4) Believe in yourself.
These four lessons helped me tremendously during the 500 lb gorilla of medical school, Gross Anatomy. Something in me changed during the course of that class. I don't know when or where it happened, but something changed. Socrates' famous quote makes me smile. "All I know is that I know nothing" could never be more true than to the field of medicine. In a way, Gross Anatomy sobered me up more so than any other time in my life. I learned how impossible it is to learn everything about the human body much in the same way clinical cases relate to medicine as a whole. I now have in me a body of knowledge that could make me quite dangerous. Or should I say, the potential of this acquired body of knowledge makes me dangerous. The true irony of medicine is the more you know the more dangerous you become. It is the 'sober' physician and surgeon who make the best doctors, i.e, the ones who know they do not know everything and will not know everything. No wonder why Gross Anatomy remains the hallmark of a medical education...
I wonder what med school will be like now that I'm not elbow deep in a cadaver every Monday, Wednesday, and Friday afternoon (at least).
1) If you don't know where to start then just start.
2) Hard work pays off.
3) Don't be afraid to get dirty.
4) Believe in yourself.
These four lessons helped me tremendously during the 500 lb gorilla of medical school, Gross Anatomy. Something in me changed during the course of that class. I don't know when or where it happened, but something changed. Socrates' famous quote makes me smile. "All I know is that I know nothing" could never be more true than to the field of medicine. In a way, Gross Anatomy sobered me up more so than any other time in my life. I learned how impossible it is to learn everything about the human body much in the same way clinical cases relate to medicine as a whole. I now have in me a body of knowledge that could make me quite dangerous. Or should I say, the potential of this acquired body of knowledge makes me dangerous. The true irony of medicine is the more you know the more dangerous you become. It is the 'sober' physician and surgeon who make the best doctors, i.e, the ones who know they do not know everything and will not know everything. No wonder why Gross Anatomy remains the hallmark of a medical education...
I wonder what med school will be like now that I'm not elbow deep in a cadaver every Monday, Wednesday, and Friday afternoon (at least).
Saturday, September 9, 2006
I was pimped twice this last week.
Pimp (verb): to make use of often dishonorably for one's own gain or benefit. –Merriam-Webster OnLine
I was pimped twice this last week: once during lab and once during lecture. Pimping is an unwritten passage that ALL student physicians must come to terms with early on in their careers. Call it an initiation. But, also, understand, pimping makes physicians better physicians. Pimping is sort of a one-sided dialogue, a barrage of questions directed from the senior to the newbie or rookie or underclassman all the while putting the student on the spot under a floodlight in the stark of night. These questions are designed to find the edge of student's knowledge and then push the envelope a few notches. The effects are two-fold: 1) reminder of humility and 2) reinforcing continued education. Excellent physicians and surgeons keep true to both, i.e. humility and education. They go hand-in-hand. Medicine is a field of humility encompassed by in depth, continued education: those who can do for those who cannot with selfless actions built on years and years of training.
I was pimped twice this last week: once during lab and once during lecture. Pimping is an unwritten passage that ALL student physicians must come to terms with early on in their careers. Call it an initiation. But, also, understand, pimping makes physicians better physicians. Pimping is sort of a one-sided dialogue, a barrage of questions directed from the senior to the newbie or rookie or underclassman all the while putting the student on the spot under a floodlight in the stark of night. These questions are designed to find the edge of student's knowledge and then push the envelope a few notches. The effects are two-fold: 1) reminder of humility and 2) reinforcing continued education. Excellent physicians and surgeons keep true to both, i.e. humility and education. They go hand-in-hand. Medicine is a field of humility encompassed by in depth, continued education: those who can do for those who cannot with selfless actions built on years and years of training.
Sunday, September 3, 2006
Like Ducks...
Tuesday of this last week, I was told that Labor Day weekend was this coming weekend. To be honest, I was completely clueless of such a three-day weekend. Yesterday, the remnants of a hurricane / tropical storm paid us a visit...again, clueless of such a storm brewing off the eastern seaboard. Since starting, school has become my universe, and for the most part, I'm ok with that. I enjoy what I am learning. I pray that the information sticks in my head so that I can remain in this privileged profession. I'm so focused that when I learned it was a three-day weekend the first thought in my head was (as with most of the class): awesome another day to catch up. For most students, there are those freakish exceptions without any such gauntlet, the gauntlet of medical school does not reside in scientific theory. If one has a sound foundation in the basic sciences (biology, physics, and chemistry), then the theory, found throughout medicine, digests without much difficulty. The gauntlet pretty much comes down to the volume, the amount of information. I have tried to use the fire hose analogy a few times, but then I realized accuracy wasnt up to par. Better to compare medicine like this: take two or three fire hoses of information, turn them full throttle, and stick your mouth on the outlets. Comfort comes when one realizes that others past and present will or have walked the same bumpy road. Last week a fellow classmate and friend told me a good analogy she had once heard:
Liz: Med students are like ducks.
Me: Like ducks, Liz?
Liz: Yeah like ducks. We look completely calm and put together on the surface, but when you look below the water, we are frantically kicking and moving around just trying to stay afloat.
You work very hard. You play hard, and if there is still time left, then you sleep, or, in my case, you write.
In some ways I have already changed greatly. In others, I'm the same. As a student doctor, I met my first living patient this last week on Tuesday. Sounds early, doesnt it? But, this was exactly what I wanted from a medical school. Although Irma (my groups cadaver, we assigned the body a name as a sign of respect) will teach my fellow lab partners and me very much, she cannot communicate back to us. Medicine is as much about science as it is about human relationships, a balance of science and art. This first living patient really left an impression on me. I will not speak of our communications, just of big picture stuff. His condition was congenital, meaning from birth, and very debilitating in the eyes of the healthy, non-deformed population. He however looked at life very differently, in the most pleasant and refreshing of ways. To him, life embraced a blessing. He does not see debilitation; he sees a challenge. During the visit, he smiled the entire time; his undertone spoke of running downhill on a nice fall day in lieu of running uphill and against the wind in the snow. His love of life, his outlook just completely amazed me. I hope when I am infirmed and/or injured, as I will be...we all will be, that I can take life by the balls and hang tight like this patient, this fellow human being.
Liz: Med students are like ducks.
Me: Like ducks, Liz?
Liz: Yeah like ducks. We look completely calm and put together on the surface, but when you look below the water, we are frantically kicking and moving around just trying to stay afloat.
You work very hard. You play hard, and if there is still time left, then you sleep, or, in my case, you write.
In some ways I have already changed greatly. In others, I'm the same. As a student doctor, I met my first living patient this last week on Tuesday. Sounds early, doesnt it? But, this was exactly what I wanted from a medical school. Although Irma (my groups cadaver, we assigned the body a name as a sign of respect) will teach my fellow lab partners and me very much, she cannot communicate back to us. Medicine is as much about science as it is about human relationships, a balance of science and art. This first living patient really left an impression on me. I will not speak of our communications, just of big picture stuff. His condition was congenital, meaning from birth, and very debilitating in the eyes of the healthy, non-deformed population. He however looked at life very differently, in the most pleasant and refreshing of ways. To him, life embraced a blessing. He does not see debilitation; he sees a challenge. During the visit, he smiled the entire time; his undertone spoke of running downhill on a nice fall day in lieu of running uphill and against the wind in the snow. His love of life, his outlook just completely amazed me. I hope when I am infirmed and/or injured, as I will be...we all will be, that I can take life by the balls and hang tight like this patient, this fellow human being.
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