Saturday, June 9, 2001.

Hatless Baldman Index: 38 (+3 since last entry)
Inevitability Index: 37 (no change).
I liked this description of my site: "Practicing sexpot medicine." HAha!!
Quote o' the day:
"Some people think it's cool to own a Lexus even though
you can't afford it. I, on the other hand, think it's cool to drive a Civic even
though you can afford a Lexus". -- Paul K.

Larger version of her in the gallery.

FULL METAL ROUNDS

I once said I would try to explain what "rounds" were in the medical profession.

When I was a medstudent, I approached a friendly intern who hadn't judged me as a complete waste of neuron tissue and asked that burning question, "What exactly are rounds?"

The intern pondered a moment and said,

"It's like when we see patients. But it's also like that conference. Or when we don't see patients and talk about them. Or when the team eats together. Or when we go out to the bar, haha! I can't explain it but you'll know it when you're rounding. Are you going out to the bar with us tonight?"

"Um, no thanks. This won't affect my evaluation, will it?"

So rounds are like pornography. Only without the fun part, it seemed.

I think the best way to describe it is whenever a bunch of doctors (or just one) get together for the purpose of patient care, almost always in a hospital setting.

Like Patient Rounds … actually going "around" to see the patients in their rooms either by yourself or with your team. This is also called "work rounds" because you finalize the day's plans while seeing each patient.

Teaching Rounds … getting together with your team and discussing / teaching.

Chief Rounds … Formally presenting a selected "interesting patient case" with your team to one of the big bosses of The Empire. The presentation has to be memorized and "polished," and you should expect follow-up questions to make sure you read about all the disease processes involved. In our institution, it can be a learning / teaching experience.

In others it has been often been a way of establishing pecking order, or breaking in the new recruits / interns, like at boot camp. As in,

*wavy transition to flashback in early 90s*

MEAN ATTENDING : "You pathetic excuses for doctors will never know even a hundredth of what I the God of Doctors knows. I'd be amazed you didn't kill all of your patients yet if not for the fact that you are completely ineffectual in every way. Have I proven how superior I am and worthy of your fear and respect yet? I thought so. Ahh… I feel better now. Let's move onto the next patient, shall we?"

INTERN or STUDENT : "Sir yes sir!! I already saw Full Metal Jacket sir!!"

(And the intern grows into a bitter resident or attending who has to belittle interns to make himself fell worthy as well ... sometimes. This is more common in surgery programs, as even surgeons will admit.)

Sidetracked there, sorry. The scars heal, but never really go away.

Grand Rounds … This is when there's a big lecture / conference on supposedly patient care. Although it is sometimes a 60-minute waste of time justifying the presenter's years of research on mouse genetics and Power Point skills, or something equally irrelevant. This is why I always sit in the back row during Grand Rounds. So I can pretend my pager vibrated and I am being paged to more important matters, and I leave.

Most times I don't even bother to pretend though.

G.I. Rounds … A euphemism, G.I. being short for "gastrointestinal." This is when the team decides to eat together in the hospital. Sometimes active (or crazy) patient issues are brought up. Other times, we try to guess what part of yesterday's food has been recycled into today's.

Liver Rounds … Another joke. This is when there's a "bar night" and any one is invited. Called "liver" rounds because of the damage alcohol does to your liver, in excess. Even doctors still drink to unwind. Some smoke too. Not everyone drinks at liver rounds though.

My antisocial self prefers to spend liver rounds at home pounding on a computer opponent's liver in a video game. No alcohol, of course. Diminishes reaction time.

There are probably more rounds, but that's it for now.

Seven years of medical training and over $100,000 in student loans to figure that one out. You people owe me.

BUG MAN

When I was a kid, one of my greatest disappointments was learning that a genetic mutation didn't result in an X-Man, or a six-armed giant, or bestow immortality. Instead, human mutations often result in death or a birth defect. The human body is already as nearly perfect as imaginable. There's not much room for obvious improvement without major sacrifice. (Example: Having two penises would make it even harder to run in boxers.) It's all about equilibrium. Yin and yang.

In bacteria, a mutation can result in resistance to being killed by a particular antibiotic.

During patient rounds …

ME : "What's keeping her in the hospital at this point?"

INTERN : "Just nursing home placement. Continuing care is working on it. It's going to be difficult to find a nursing home that can accept her with all the resistant organisms she's colonized with … and with her insurance."

ME : "Of course."

I grab the mentally vacant elderly woman's hand to see if she makes an effort to grasp it.

INTERN : "Do you want gloves? She's colonized with multi-drug resistant organisms."

ME : "I'M colonized with multi-drug resistant organisms. We just have to wash our hands before and after touching other patients. You know a third of medical personnel have MRSA (Methicillin Resistant Staph. Aureus, a common resistant bacteria) in their noses. I'm sure I've got more than that by now."

INTERN (smiling) : "You'd be a very difficult nursing home placement, Dr. Scott."

The misconception about resistant organisms is that "normal healthy" people are in danger from them. These bugs don't attack like killer tomatoes or multi-penis - er, tentacled manga monsters. For the most part, it only becomes a problem with frequently sick, institutionalized, or immunosuppressed people (the elderly fall in this category). The antibiotic choices become limited. So there's a constant race to keep up with resistance by making newer antibiotics.

Most bacteria are resistant to something, but we don't want to encourage multiple resistance. This is why good doctors are hesitant to give someone antibiotics for their cold or any viral illness. Antibiotics don't work against viruses, but sloppy use of them will foster newer and more resistant bacteria. So new drugs have to be made faster. Prices go up even more. Etc.

The drug pharms win. Grandma loses.

Many times it's easier to just give the antibiotic to a demanding patient in the office who has no concept of how or when antibiotics really work or the long-term consequences above. That's a shame. Another reason I'm glad I don't see office patients.

I sometimes wonder when I'm elderly and sick, how many resistant strains I'll have, after working with hospital patients for so long. Maybe by then they'll gain a collective resistance, and take over my body and become invulnerable to every thing known to man. I'll be the invincible Bug-Man!

Or maybe I'll be a 70-year old petri dish without a place that will accept him.

Of course, they'll have newer and better antibiotics by then.

Right?

(Oh, and don't worry. You can't get really get what I got by talking or touching me, or grandma even. It's more related to where you spend much of your time, like a nursing home or a hospital.)

(I also wouldn't want two penises either. The one I have barely gets enough action as it is.)

THE FRONT YARD OF A DOCTOR

That's our driveway on the left (the watery mud pit). And our front lawn on the right (less watery mud pit). When it stops raining, they'll put real grass and pavement there.

Getting to the car every morning is an adventure, as you can see.

The good thing is : I don't have to mow the lawn yet!!

 

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