Blood

The movies are right . The books are right . If you are a doctor sooner or later you will see blood and sometimes a lot of it.

From small injuries  to epistaxis to motor vehicle accidents and surgeries . Blood is everywhere . Ubiquitous is the word I think.

Believe  me I am as scared of blood as my five year old daughter ,maybe more. Still I do biopsies , lines , intubations if needed and all the usual stuff.  I pray I never have to see car wrecks or gunshots again and in my field I probably won’t but in my training I did, as all of us do.

So what to to if you are scared of blood but want to become a doctor . Well! fake it till you make it . (Courtesy Steven Tyler)

A jock friend of mine fainted the first time he saw a drop of blood . In our physiology lab we had to one out and each other’s finger for some lab work. Don’t remember what was the actual assignment . He literally fainted . Dropped flat on the floor with a bang. Now he is an anesthesiologist working in OR everyday.

Ii know girls who ran out of dissection hall and quit medical school  and I know the ones who ran out but did not quit medical school. Guess what ! The ones who did not quit did alright and the one who did quit did alright too.  But the one who did not quit got to be doctors , something they all wanted to do in the first place.

one word of advice for new residents and medical students . The blood you see is less then you think it is . A 100 ml bleed can look like a an entire pint of blood when it is spread flat on a surface . I m not telling you to be ruthless and careless. However if you placing a line or doing a biopsy don’t let a little bit of blood scare you into not doing it.  I would worry more about pain. Your procedures should be as painless as possible . Use that lidocaine.

One the other extreme is the daily labs . Almost no patient need daily labs but almost every one admitted in the hospital gets them.  If you have to get daily labs use pediatric tubes. Most of the blood that is collected is discarded. I know it’s only 5 ml in one tube but 5 of those tubes everyday for a week in an elderly severely ill person can take its toll. Because we as a doctor don’t actually see those tubes we don’t think about them. So next time you order daily labs if you absolutely have to , please order them to be collected in pediatric tubes.

I can go on and on on blood and may be I should. Some other day.

 

 

 

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7am

What’s the worst thing a nurse can say to a doctor when he or she calls to check on their patient .

“I don’t know . I just started my shift”

Believe me we don’t care about your schedule. We don’t care about your love life, your child’s drug problem or your father’s suicide . If you are in the hospital taking care of a patient you should know basic stuff about him. There is such a thing as ‘sign off’and in most cases vital signs are just a glance away.

If you really have issues please get help. Talk to me in your free time.

Let’s say you are a clueless nurse . How can you better serve the purpose of your existence?

Suggestions :”I just started my shift but if you hold on one minute I can get you the information ”

Or forget the shift” I can text / call you with the required information in one minute ” 

Maybe I m a narcissist and want the world to revolve around me but you have to understand that I ,like a moon revolve around the care of the patient atleast until my shift is over and nurses like gravity are the connection between me and the patients.

Lawyer

I was at the gym a few days ago. Somebody had pooped into the pool and we had to wait till the pool was cleaned. 

I started talking to the person sitting next to me. Found out he was a personal injury lawyer who had sued many doctors .

“So why does get the doctors sued”

“It’s mostly when they don’t follow up ”

That make sense

”  if surgeon does a surgery and something goes wrong, he usually is not in trouble if it’s a recognized complication but if he misses that on follow up then he is in trouble”

” I can see that ”

That does make sense, I thought

“Or if there differential diagnosis is not broad enough”

I pondered over this .

” the bottom line is, dont be afraid to order more tests, the more test you order the safer you are” the lawyer offered his sage advice.

Sex and  Doctor Sexy MD

Over the course of 15 years I have worked in small  50 beds rural hospitals to big  million bed city hospitals and everything in between but for some strange reason nobody in the hospital has ever wanted to have sex with me .
Nobody ! No nurse , no doctors , not even the cleaning ladies!. Not even the nymphomaniac on the psyche ward.

 I have decided that the problem is me . I definitely  need to work out more and get a stylist or something because I am sure , based on all the hospital tv shows that a good lay is just around one of the hospital corridor and almost inside every closet.

Even the Ph.D. Doctors on tv seems to be getting illicit sex everywhere .

In my case every closet I open turns out to be the  janitor closet with the big burly janitor inside and even he is not interested.

Maybe I need to develop a Ptsd or some complicated past love life or perhaps find the one Doctor in the entire universe who paid for medical school by working as a lingerie model.
Or is there a slight chance that the hospital tv shows are wrong. Nah that can’t be!

Paging

So I get a page . I am in a patients room . I get out and answer the page . A nurse from 12th floor is looking for me but she is with a patient so I am put on hold . After 5 minutes I break the connection and go up to the 12th floor . The nurse is still busy . Another nurse gives me a paper I need to sign . I sign it, ask if they need anything else and go back to my work.

Get a page again. The same nurse. I am put on hold . Five minutes later she come on the phone . She can’t find my orders . I explain to her where they are. Then I am back to work.

I started with 18 patients and have got 9 new ones. No lunch. I have planned my day down to each minute. Basically I am on roller skates.

Get a page again. Same nurse but of course she is with a patient so I have to hold . This time for close to 10 minutes.

I thought when somebody pages me they need me . Why would they page me if their issue can wait. If you want me , talk to me.

Is it too much to ask of a nurse to page a doctor only when you can talk to him. And God forbid if you get angry. Heavens will move if you ever express your unhappiness.

Kim Davis

So Kim Davis refuses to marry gays and she is a hero but Doctors have to treat rapists and pedophiles and even murderers in the best of their capabilities.

My residency program director said in one of his last lectures to us  ” you don’t have to like your patients, you don’t have to be their friends but you do have to take care of them as best as you can regardless of who or what they are ”

And that is fine .I can keep my personal feelings out of my work . When you are paid to do something you have to do it . That is a millennia old truth.

If a doctor refuses to see a patient because of patients immorality , it’s rare but it does happen , they Lose money too.  I have a friend  in private practice who refuse to take care of pedophiles unless it’s an emergency. The fact that he lives in a very Bible part of middle America means he has lost quiet a few patients. He loses money because of his convictions .

Also, if he was government employed he would not  have this choice .

If Kim Davis does  not like her job she could quit.