Inner Ramblings

It seems that I always blog in a halt. That is H.A.L.T. = Hungry, Angry, Lonely or Tired. Right now, I’m just in a H.I.T. mood, which is I’m Hungry, Irritated and Tired. I really am tired of the NICU. I find it absolutely ridiculous that I’m so hit or miss on shoving a needle into a tiny newborn artery and that my emotions seem to soar and crash on this one seemingly insignificant feat. I can’t stand that every time I work with a new nurse, their instinct is to try and ride roughshod over me and render me obsolete unless I (to quote a good friend of mine) slap them down. There has got to be a good reason why I’m subjected to the unit that appears to be the antithesis of myself as a person and my thought process, the ICU, but I’m having trouble figuring it out. Actually, that’s a lie. I know that I’m supposed to learn how to care for the sickest patients, rapidly triaging them and stabilizing their complex medical problems in order to bring them back from the brink of death but let’s face it…I’m not good at reactionary thinking. I HATE being placed in situations that force me to think fast and act faster because I’m afraid that if I don’t have all of the information, I’ll make the wrong choice! I keep hearing a nagging little voice of my quantitative methods professor in business school, telling my class over and over again that we will often be called upon to make decisions with imperfect data and unforeseen variables because “that’s life.” Forget the fact that I’m not completely confident in my medical knowledge when it comes to the pathophysiology of these patients; throw in a bitchy nurse or a whole unit of them and I’m screwed. I did get some great advice from an attending recently. She told me to “arm [my]self” when it comes to those areas that I don’t feel confident. She advised me to dust off my old study skills and read about the top 10 diagnoses that I’ll likely run into in the ICU and re-familiarize myself with them so that I can walk into it feeling comfortable. What a fantastic idea! I’m sure you’re thinking, “duh!”, right? But you have to realize that the whole first year I was in residency was concerned with surviving. I learned what I needed to learn to get through each rotation alive; there was very little time for outside reading - I just had to absorb what was coming at me on a day to day basis. Now, I have more time to read and reflect as a second year resident but I feel like I need to review a lot of topics and I’m not sure if I’m going to be able to re-learn it all. This is compounded by the fact that I’m Med-Peds and I’m now feeling the pressure of trying to learn it all and wondering if I wouldn’t have been just as happy/happier as a family medicine resident….Hmmm…I should probably get back to reading and save the musings for another day.

Reading is fundamental…

catalogliving:

Just in case anyone doubted that Gary and Elaine valued books over television, Gary brought in the secondary book stool to drive the point home.

Check this story out (courtesy of cnn.com): http://www.cnn.com/2010/WORLD/africa/06/29/nigeria.oil/index.html

Apparently, oil companies have been harvesting and spilling oil in the Niger Delta for 50 years. Yea, you heard that right: 50. The Nigerians are understandably upset and they are even more hot under the collar over the attention that the U.S. Oil spill has been given. Nigeria provides roughly 8% of US oil. It is on the basis of their contribution to the US that some Nigerians are clamoring for the United States to “play its part.”

But I’m confused. Exactly what part are they asking the United States to play?

Potential roles in the theater of an oil spill:

1) Concerned global citizen: Their role is to shake their finger at the evil oil company(ies) and rail on behalf of said country in hopes that the oil company will feel abashed enough by being “called out” on the national stage to clean up the spill in an efficient and timely manner

2) Friendly good samaritan: This role is to offer aid, in the form of money, manpower or other resources, to help said country get the spil cleaned up without intervening in the dealings between the country and the oil company

3) Rubber-necker: Slow-down to gawk and point at said spill, sharing news of what’s been seen with other passers-by through media outlets, social networking and the like. Do not actually get involved in relief efforts or public outcry

4) Human ostrich: Stick nose back into own business and pretend that said spill did not even happen

5) Big Daddy Warbucks: Popularized by the little orphan Annie movies, this role capitalizes on the role that America has chosen to play on the world theater during the past 60-70 years - namely, let’s step in to every major conflict/world disaster/crime against humanity and try to right wrongs using our money, our time, our young American lives and our God as our shield.

Don’t get me wrong. I take pride in the fact that Americans feel the tug of human rights atrocities, war and the general miserable-ness of those not fortunate enough to enjoy the freedoms that we often take for granted. But where is it written that we shoudl continue to be the ones that clean up other folk’s messes? In the case of the Nigerian Delta becoming a glorified oil slick, does the responsibility not rest upon the companies that propagated these spills? Yes, shame on us for turning a blind eye to what was going on while we continued to import oil from Nigeria but come on! Are we not also dealing with an oil spill catastrophe of our own? Did we not hold BP accountable by putting the burden of cleanup and economic subsidy for the Gulf workers upon the company itself? In times of crisis, people look to their national government to right ginormous wrongs. It is the responsibility of the Nigerian government to hold these oil companies accountable for what they’ve done. Unfortunately, it is well known that Nigeria continually ranks in the the top 20% of countries perceived as being corrupt by Transparency International’s annual global corruption perception index. The CNN article even states that the oil companies give the government money to hire cleanup crews that are dirt cheap and often ineffectual.

My heart goes out to you Nigeria but you have to realize that when you start with the finger pointing (America needs to “play it’s part”), there are always three other fingers pointing back at you.

Preface: I’m in a foul mood.

I cannot stand administrators. I don’t mean the people who are in actual administrative positions at companies across the globe, well, some of them are included in this diatribe too. I mean that I hate people who have an administrative mind set. The i-dotters. The t-crossers. The box-checkers. The bean-counters. The quality control folk on the widget assembly line.

Picture the following in an annoyingly nasal yet condescendingly gleeful tone:

“Ah, ah, ah! You can’t (insert ridiculously achievable goal here)_ until you’ve filled out the forms in triplicate, signed and dated here, here and here and cut off your ear to spite your face.”

These are the people who get off on sticking it to those of us who are big-picture, go-getters. I just want to accomplish the task. I’ll worry about the details later. In other words, get your clipboard-toting, finger-waving, expense-report tapping, “it-has-to-be-done-precisely-THIS-way” nagging self out of my way so I can do what needs to be done.

You administrate. I’ll manage.

I know what I’m supposed to do as a doctor. Provide treatment schemes. Sift through mountains of data and apply to it a clinical lens so that I can make the best decision in the moment for a patient that I most likely have never met before in life and will likely never see again. We treat strangers, day in and day out. We have to make life and death decisions on or about people whom we have no real emotional ties to. Is this the best way? Would I make a better decision about someone whom I care about or would my emotions get in the way?

I have a friend who is very sick. I’m scared.

I don’t know if she is going to live or die.

I don’t know what to do.

Every day, I talk with the family members or my critically ill patient and have learned to become so detached from their suffering that I present their options in a logical, rational fashion. They often cry and talk about how this decision is “so hard” and that they want to “carry out their [the patient’s] wishes but struggle with trying to fulfill their [the patient’s advocates’] wishes at the same time. I help them sift through the medical data and explore what their loved one would have really chosen, had they been lucent enough to make their wishes known. And yet, I find that I can’t do that for myself when a dear friend of mine is ill.

i’m mad.

I’m Mad at the world.

She didn’t deserve this.

Why can’t I make her better? How do I comfort her husband? What the hell am I supposed to say?

Here I am, at a retreat - drinking and bonding with my colleagues when I want to be with her, telling her that she HAS to get better; that it’s not her choice to give up. That so many people need her.

Really, to cuss her out.

“How the **ck could you give everyone such a scare?! Don’t you know that your husband is woried sick?!”

Really.

Like, it’s her fault.

It’s not her fault.

It’s no one’s fault.

But I need someone to be mad at - damn shame I’m taking it out on her.

Get better my friend, for God’s sake.

I used to keep a diary. Didn’t write in it every day, only when really big stuff happened. I keep all of my old diaries and notes and scraps of stuff that were important at one point locked up in a box. By the way, my explicit instructions are to burn that box, without opening it, upon my death. I read through some of the books a few years ago and noticed a theme; I only wrote when I was angry, hurt, sad or otherwise emotionally frayed. I used to play this game in my head when good things happened to me; I’d pretend that I was reading a speech at a banquet held 50 years in the future, honoring me for my life’s achievements and I’d be detailing all the good things that happened and at what ages so I could weave them all into little turning points. “And it was at the tender age of 13 that I was inducted into the Order of the Falcon Society which forged within me a responsibility to…
blah, blah, blah. Why is it that i write down the hurtful things that I probably don’t want to remember and only make a mental note of the good things that happen to me? Probably think that the good things get stored away much more quickly and efficiently and it’s easier to recall good things because of how they made me feel. But searching for that emotional high is like crack, you keep searching for more and bigger good things to happen to you because that sweet feeling is too fleeting and impossible to recreate from your memory alone. Now bad feelings, they’re easy to relive. Maybe I keep those journal entries to remind me that I don’t want to endure those situations or those feelings ever again. But aren’t those very same situations the ones that make up the fiber of who I am today? Okay, enough. How about I just jot stuff down in whatever format I choose, regardless of what mood I’m in and never read it again?

Vanishing hindsight. Sounds good to me.