Friday, September 15, 2000:
Feeling:  Really tired.
Playing lately:  Soul Calibur.
Favorite Room In Our Future House:  The Library (my room). 
Sweet A.S.S. (Appreciated Scott Supporter) link:  Molly.

GARDEN

"So, this floor is pretty serious, isn't it?" Mr. Adam states from his ICU bed.

He lies in a virtual garden of plastic I.V. tubing, invading and multiplying like so many weeds.  Feeding and nurturing him with simple nutrients in this artificial garden of the sick.

My back faces him while I finish the consult note in his chart.  I just interrogated him five minutes earlier.  Most people forget the important questions until their doctor is already down the hall.  My delay gives him a chance to remember.  Plus I get to watch TV for a couple minutes.

"Yeah, things are pretty intense here. That's why it's called the Intensive Care Unit," I swivel around and answer simply.

"I almost died ...." Mr. Adam looks past the metal and glass walls of his terrarium.  He sees his naked mortality in the reflection of his own corneas for the first time.

At least he won't be one of those people who go home and brag that they actually DID die.  The lucky ones who were brought back with a shock or a shot of Epi or atropine.  People who still had enough of a gradient between depolarizing cellular membranes that allowed them to come back with a bio-electro-chemical jump start.  You're not truly dead until that balance between ions is irrevocably on the wrong side of the entropy curve.  We're a simple matter of tiny plus-minus charges and timing, really.  

"Yeah, I think you are over the worst part, but you've got to stop putting those drugs into your veins," I say well aware of the irony of all the intravenous bug juice and vasopressors we're pumping into him.

He lifts up his finger, there's a painful bump at the tip, "This? This is from the drugs too?"

It's funny, or not so funny, how patients and family often focus on the most miniscule details, while remaining in denial about their growing cancer, crippled lungs, or failing heart.  It gives people a sense of control that they can complain about something that they can actually see or feel, I guess.  Or maybe it serves as a distraction from the same.  Those little fig leafs of their imagination.

His fingertip hurts to touch.  "Ouch, for Osler's nodes," is the medical student’s mnemonic.

"Yep, your finger, the stroke you had, the vegetation growing on your heart valve, it's all from that I.V. drug abuse.  This is how most drug users die," it's a slight exaggeration but it's true enough.  Infection, stroke, seizures, inhaling one's own vomit ... the usual prophecies.  It makes getting whacked in an alley over a bad crack deal seem glamorous.  At least, that will get you on the news.  Sometimes.

Mr. Adam is rotten to the core, his heart that is. Bacteria ... bugs have rooted themselves on his heart valve, eating him from the inside out, like a worm in an apple.  He'll need weeks of antibiotics to purge him of this microbiological shame.  But eventually his days of being fed by angels in flowery jackets and watching Robin Givens on Forgive and Forget will be over.  He'll be given a new shiny clean apple to take care of once again.

Then he will be expelled from The Garden.

Whether to take root in a new life or to fertilize the tree roots at the Lynch & Lynch funeral home, will be up to him.

"There's no other floor more serious than this one, is there?" he continues.  It's his first time in The Garden.

"Right, the sickest of the sick come here.  People who almost died come here, like you.  There's no other floor after this one."

Unless you're a religious person, I think to myself.

HOLY SOCKS

It's funny how people react to you differently depending on your status. Today, I was talking to a patient with an infected eyeball (technically, it's "endophthalmitis" but I find "eyeball" to be much more fun to say) when my new intern hurriedly rushed in to do the same.  

I introduced myself as did she, since our team had not yet met each other.

"So, what time does the team want to round today?" I asked.

"Um, I haven't spoken to the attending yet," she answered mildly annoyed at the delay.

"I am the attending," I said as I watched her transform from a bedraggled tired intern into an enthusiastic wide-eyed trooper at attention.  I think I even heard her shoes click together.  She reintroduced herself then with a grand handshake and an even bigger smile and apology.

I see that transformation of respect a lot, since I hardly ever introduce myself as "The Attending."  That would be like having all my checks and bank cards printed with "M.D." after my name.  Or ordering at the McDonald's drive-thru like, 

"Hello, this is Dr. Scott, Imperial Faculty Attending, I'd like Meal Number Six.  STAT." 

At least to me, it's like that.  Maybe some people want that recognition, but, trite as it sounds, I'd rather be liked (or ignored) for me.  Of course, if I were single, things might be different.

I was in a coffeeshop with my brother earlier this year when he looked around, laughed and said to me,

"You are the last person I would think was a doctor in here."

Sure, I took that as a compliment.  In all fairness, I was wearing a ratty Dreamcast promo T-shirt advertising three games I would never buy and one I did (Mortal Kombat 4).  But in my defense, the shirt was free, and it smelled much better than the rest of the "recyclable" clothes pile that particular morning.

I see my colleagues who graduated from residency two years ago and even just months ago come back into the hospital with nicely tailored suits with slick angles that must have cost a fortune, and I wonder why.  So I consult my fashion expert.

ME:  "Why do some people spend so much on clothes when they finish residency?"

AMY:  "Because they're attendings now.  They want to look the part."

ME:  "Look the part?  But I AM the part, whether I look like it or not.  I don't have to look like anything."

AMY:  "They have to look confident, successful.  It's good for business."

ME:  "I know.  I'm glad I don't have to worry about all that outpatient business crap."

AMY:  "By the way, I'm throwing out all your old socks and underwear with holes in them."

ME:  "Why?  No one can actually see the holes.  I can go without any underwear at all for all anyone knows.  Going commando or free-balling!  You love it don't you?"

AMY:  "Do you go to church baby?  Then why do you need holey socks?  Haha, get it?"

ME:  "Yeah, that was a good one ... six years ago."

AMY:  "Bwahahahaha!!  Holey socks!!  Socks with holes in them!  Woohoohoo!!"

ME:  (sigh).

AMY:  "Plus, whenever we go to my parents' house, I have to hear it from everyone in Korean.  Your clothes are a reflection on me.  No more holey socks.  It's time for new shoes and shirts too."

ME: "Man, I hate clothes shopping.  Fine, just none of that pink shit."

MEDICAL CHART QUOTATION OF THE DAY

"Pt (patient) less confused than yesterday but still walking halls naked at night." -- written by myself.

 

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