You guys know I work in Urgent Care, right? So my day is full of the bread-and-butter complaints: sore throat, cough, ear ache, rash, it burns when I pee — and when the day is full of “the usual suspects,” it can be tempting to downplay (or outright IGNORE) any symptoms which don’t fit with the Top 5 diagnoses.
I’ve seen Urgent Care colleagues and staff completely ignore Really Important Symptoms because it would mean that Something Really Important (i.e. “a diagnosis that will require more than a physical exam to establish”) might be going on, and ain’t nobody got time for Something Really Important in the Urgent Care — we’ve got viruses to treat here, for pete’s sake!
But I strive to keep my brain turned on with every case — due to a combination of good training + a mild-moderate case of OCD — and about 2 months ago, that habit really paid off.
Hello Dr.! As Christmas season is coming up, what sort of gifts would you recommend to help improve the well-being and life-enjoyment of a pediatric resident? She loves to read and enjoys beauty products, so I’ve considered a few books (I wouldn’t mind some more recommendations) and hand creams (to soothe that constantly sanitized skin), but I was wondering what other ways I could help make her life a little less stressful? Thanks so much!
What a terrific question! I’m gonna ask my medical Cranquistadors to please add their own suggestions to this post (since I usually just buy whatever was rated the highest on the other person’s Amazon wish list, BOOM finished, moving on).
But for what it’s worth, Dr. Cranquis would consider these Potential Holiday Gifts for Residents (and Med Students too!):
- Books: healthcare-related books (memoirs, fictionalized, history, political, etc.) are an obvious choice, and you’ll find quite a few recommendations from me (and from Cranquistadors!) in my #books tag. As for non-healthcare-books, that depends on your knowledge of your friend’s tastes — and whether you think that receiving a “just for fun” book will just rub salt in their wounds as they reminisce about the days when they actually had time to read something that didn’t have Latin anatomic terms in it. :)
- Media (movies, music, Netflix subscriptions, etc.): Sometimes all your numbed post-call brain can handle is a few hours of Battlestar Galactica or Monty Python. (Or maybe they can watch ‘em while they’re ON call, if their call-karma is way better than mine ever was.)
- Gift Cards/Cash: Most med students and residents live on a combo of loan money/paltry stipends + gifts from friends and family. Gift cards to coffee shops, bookstores, shoe stores, big-box stores, and good old Amazon are fantastic! Even a roll of small bills for vending machines will make a resident smile. Don’t worry about the “But giving money is so impersonal” argument — they will appreciate it and USE it.
- On-Call Hygiene Products: Travel-size personal grooming-kit items (or an entire kit, if you want to go all out) are so handy when you’re doing all your grooming in the hospital! Sometimes, the only thing that keeps you going at 4 in the morning (the Dead Zone between admitting the last patient and starting pre-rounds on all the other patients) is two minutes in the bathroom to brush your teeth and apply another layer of deodorant.
- Drugs: (No, not THAT kind of drugs). Despite working in a hospital, residents who need pain relievers/anti-histamines/gas-reducers/antacids for personal use are usually out of luck! Toss a few handy OTC meds into that grooming kit.
- Mugs: You can never have enough (spill-proof, easy-to-carry/clean) containers for hot stimulating beverages.
- Pens: Yeah, yeah, we’re all “paperless” and “electronic” in healthcare now. Whatever — our clinic printer goes through more paper now than it ever used to before EMR. So pens are ALWAYS needed by/being stolen away from students and residents. Find out if they prefer the “click” (YES!) or “uncap/twist” (BOOO!) style. Only buy black pens (medical records have to be in dark color ink, and some facilities don’t allow even blue). No felt-tips (can’t write through carbon-copy forms). No fancy/engraved/expensive/meaningful pens (didn’t I mention these things get stolen all the time?). But not super-cheap-crappy ones (it’s considered bad luck to have your pen die in the middle of a call-night) (not really) (well maybe NOW it is).
- Phone plug-ins (micro USB or Apple whatevers) or emergency quick-chargers: Having your smart-phone die while on call is like getting a surprise lobotomy. Anything which can prevent/remedy that situation is priceless!
- Subscriptions to medical reference websites/apps (maybe): Some residency/med-school programs provide these for free, so check with your recipient before dropping $100+ on a subscription to Epocrates, Up to Date, etc.
- Diploma Frames: Help them look ahead to the glorious day when all that they’ll have to show for these years of toil and tears is a really nice piece of paper and a sizable financial debt (well, and a lot of knowledge/skills, of course.)
- Plane Tickets: Just in case your gift-giving budget is REALLY loaded. But be sure to either discuss the travel dates WAY ahead of time, or buy tickets with simple no-fees exchange/refund policies.
Hope that helps. Oh, and just for kicks, a few things which the average resident/student (probably) does NOT need/want for Christmas:
- Scrubs: Either they already own enough, the hospital provides them, or they won’t dare to wear that uber-nice set you gave them around actual patients.
- Medical Equipment: Exceptions exist, but for the most part, they already have a couple of functional stetho/oto/ophtho-scopes, and more tuning forks than the New York Philarmonic. However, if they plan to work in mission fields/under-served areas, extra equipment is ALWAYS needed.
- Textbooks/Reference Books: They need to pick what works for them, without feeling guilted into carrying around that deluxe copy of Gray’s Anatomy (the book) you gave ‘em. If you really want to contribute to their medical reference library, talk it over with them first (or go with a gift certificate to a bookstore).
- Phone card with a passive-aggressive “Try calling me more often next year” note: Med school is hard. Residency is hard. Right now, they need your support and your permission to focus on surviving, not your demands.
Any other to-give (or to-avoid) ideas, Medblr folks?
Depression and burnout may play varying roles in how physicians treat patients and themselves.
— Nelson Mandela
Victorian medical students learning anatomy in the cadaver lab
A taste of what’s coming up in the next issue of The Medical Chronicles. Reminder, you now have about a week until the deadline - December 11 (it can be extended a bit to Dec. 15, but that’s the latest, please).
Clumsy Medic submitted:
In his blog piece “Remember Why We Came,” Rick Pescatore, a medical student at Philadelphia College of Osteopathic Medicine, writes:
To some degree, depression and exhaustion are an almost expected result of the medical school journey. With constant pressure to pass exams, excel amongst the most talented of peers, and develop oneself as a competent future clinician, medical students often report alarming rates of dysthymia and depression. Anxiety during The Match, worry over board exams, and apprehension about one’s place in the crush of clinical academia become the constant progression, and students’ angst and unhappiness come to define their days.
When I am supposed to be cramming for all the exams that are drawing awefully close, I am reading this piece instead because I too am spending most of my free time worrying about where I will be in a year and a half. Will I even be able to make it, will I make a good doctor, do I even have what it takes?
All these worries haunt me. Sometimes I wake up in the middle of the night with a feeling of hopelessness that’s impossible to push away. Other times, I tell myself that I am going to do whatever it takes, even if it kills me. And that does almost literally, kill me until I go into a low where I don’t do anything for days and just worry.
There’s another way, though. Hidden beneath the stacks of library books, nestled between the rooms of patients tucked away and stable for the night, we find the reasons we came to medical school: The older gentleman who shares amazing stories with you in the dead of your third call night in a row. The sick kid we’re able to make a difference for. The ailing individual who, returning from their darkest moments, brings you the brightest of yours.
I could have written the same thing but in different words:
And yes, I woke up at 3 in the morning trying to get some studying done and yes, when I enter the clinic at 8 AM it’s already been 5 hours since I woke up and I would love to just get to bed and never get out. But then I sit in my chair and this kid walks in holding his mother’s hand and smiles at me shyly. We chat about his school and his friends. When I take him in for a physical, he gets all quiet and scared. But then I tickle his tummy and start talking to him again and he starts giggling and telling me all about his day like we are long lost friends. And I forget that I am so exhausted or that I would kill for a cup of coffee, but can’t get one because of all the panic attacks, or that I am going to have to kill myself again when I get home, trying to study. At that moment, all I can feel is happiness.
The thing is, no matter what words we use to say it, at the end of the day, we all say it. We complain about the insane amount of work. Hell, there have been moments when I have (almost) seriously considered quitting. But most of us usually turn back. And we do that because deep inside, somewhere, we all know that we wouldn’t be able to live without the joy that fills us when we have been able to do something for a patient.
I think that’s what’s so incredible about being a medic—the community. No matter where we are and no matter how we are doing it, when you tell another medic that you go to med school too, they will smile that half-sympathrtic-half-understanding smile. We don’t need to explain to each other what we are going through. And I think the community acts as a support system like no other; when I am going insane, I come across a blog post of a fellow medic complaining about my problems and the feeling of hopelessness and it makes me feel less hopeless because I know that I’m not alone. Or I read a piece like this one which reminds me why I started this journey in the first place.
That’s why I think it’s so important to write, because what may seem like thoughtless rambling to you may help someone else in your place to make it through the day. Because no matter how bad a place one is in, one is never there on their own. There is always someone who has been there and made it through. And that knowledge somehow makes it easier.
I want to thank every medblr/blogger out there, anon or otherwise for writing, sharing their experiences, their miseries,and motivating those in need. I honestly don’t know how they did it in the pre-Tumblr/Blogspot/internet era.
"Two men, both seriously ill, occupied the same hospital room. One man was allowed to sit up in his bed for an hour each afternoon to help drain the fluid from his lungs. His bed was next to the room’s only window. The other man had to spend all his time flat on his back.
The men talked for hours on end. They spoke of their wives and families, their homes, their jobs, their involvement in the military service, where they had been on vacation.. Hospital window.
Every afternoon, when the man in the bed by the window could sit up, he would pass the time by describing to his roommate all the things he could see outside the window. The man in the other bed began to live for those one hour periods where his world would be broadened and enlivened by all the activity and colour of the world outside.
The window overlooked a park with a lovely lake. Ducks and swans played on the water while children sailed their model boats. Young lovers walked arm in arm amidst flowers of every colour and a fine view of the city skyline could be seen in the distance.
As the man by the window described all this in exquisite details, the man on the other side of the room would close his eyes and imagine this picturesque scene. One warm afternoon, the man by the window described a parade passing by.
Although the other man could not hear the band – he could see it in his mind’s eye as the gentleman by the window portrayed it with descriptive words. Days, weeks and months passed. One morning, the day nurse arrived to bring water for their baths only to find the lifeless body of the man by the window, who had died peacefully in his sleep. She was saddened and called the hospital attendants to take the body away.
As soon as it seemed appropriate, the other man asked if he could be moved next to the window. The nurse was happy to make the switch, and after making sure he was comfortable, she left him alone. Slowly, painfully, he propped himself up on one elbow to take his first look at the real world outside. He strained to slowly turn to look out the window besides the bed.
It faced a blank wall.
The man asked the nurse what could have compelled his deceased roommate who had described such wonderful things outside this window.
The nurse responded that the man was blind and could not even see the wall.
She said, ‘Perhaps he just wanted to encourage you.’
There is tremendous happiness in making others happy, despite our own situations. Shared grief is half the sorrow, but happiness when shared, is doubled. If you want to feel rich, just count all the things you have that money can’t buy.
‘Today is a gift, that is why it is called The Present.’
The origin of this letter is unknown.”
To generations of medical students, from mine to the present, the name Frank Netter has a magical connotation. He was the doctor who drew the remarkably lifelike images that we all used to learn anatomy. They were so lifelike, we joked, that we trusted them more than what we actually saw in our cadavers or on CAT scans.
Who was Frank Netter and how did he come to be the world’s most famous medical illustrator? Fortunately, his daughter Francine has written a forthcoming biography of her father, entitled Medicine’s Michaelangelo.
As we learn, if Netter’s mother had had her way, Netter would have retired his paintbrush in favor of a stethoscope. It is because he did not, though, that we have timeless illustrations like this.Copyright Elsevier Inc. All rights reserved.
Netter was born in Manhattan in 1906 and showed aptitude for art at an early age. During high school, he studied at the prestigious National Academy of Design, where he drew nude figures. At New York’s City College, Netter drew portraits and cartoons for the school’s yearbook and spent the summers as an artist and set designer at a hotel in the Catskills.
But despite his remarkable talent, he had promised his mother he would go to medical school and, in 1927, he enrolled at New York University Medical College. While his fellow classmates spent their spare time studying for examinations, Netter drew haunting images of Bellevue Hospital, where he would eventually complete his internship and, in a harbinger of things to come, a picture entitled “Healing Hands,” in which a doctor applied a bandage to a patient’s fingers.“I do not know of anybody in the past several hundred years who has done anything like this.”
Netter did practice medicine briefly but, as Francine writes, “the demand for Frank’s sable brush grew faster than the demand for his scalpel.” His portraits, drawings of body parts and, at the behest of pharmaceutical companies, images of new drugs and how they worked were simply too vivid and unique to ignore. In 1934, Netter saw his last patient.
It would be Netter’s relationship with drug manufacturers that propelled forth his career as a medical artist. In 1937, the Ciba Company asked him to prepare an illustrated flyer for its version of digitalis, a heart drug. A remarkably long marriage was born. Over the next five decades, Netter worked with the company, later known as Ciba-Geigy, to produce the Ciba Collection of Medical Illustrations and the Clinical Symposia, beautifully illustrated books that depicted both normal anatomy as well as the pathology associated with specific diseases. The over 4,000 illustrations made by Netter during his career also depicted patients (drawn from models) suffering from conditions like bronchial asthma, angina and major depression. One picture showed a patient with end-stage liver disease on water restriction desperately drinking from a toilet. When Netter required surgery for an aortic aneurysm near the end of his life, he used the occasion to make diagrams of the operation he needed. Netter’s work was voluminous, covering a vast array of topics and diseases. Ciba distributed his illustrations far and wide to medical students and physicians—usually for free—as a marketing tool.
Words do not really do justice to the exquisite nature of Netter’s diagrams. The Saturday Evening Post termed him the “Michelangelo of Medicine” and featured his work alongside that of Norman Rockwell. A reviewer of Netter’s Atlas of Human Anatomy, which compiled hundreds of Netter’s best images, equated Netter’s influence on anatomy to that of Leonardo Da Vinci.Copyright Elsevier Inc. All rights reserved.
Medicine’s Michelangelo is less of a page turner than a labor of love. If many famous artists are temperamental, Netter was not. Indeed, he seems to have been humble to a fault. In addition, the book contains lots of names of Netter’s various coworkers that will not be of interest to the average reader.
Nor did Francine Netter situate her father’s career within other relevant developments in the history of medicine. For example, it would have been interesting to explore Ciba’s decision to distribute Netter’s work for free to physicians in light of all of the negative commentary about the marketing techniques of modern pharmaceutical companies. And I would have loved to have heard what Frank Netter thought about the revelations that the famous German atlas of human anatomy by Eduard Pernkopf contained images of Jews killed during the Nazi regime.
But Francine Netter has done an admirable job of documenting her father’s remarkable career. As one of Netter’s many awestruck colleagues wrote, “I do not know of anybody in the past several hundred years who has done anything like this.”
Love it when posts hit things right on the head.
No matter how much education you might get in the future…never ever let your brain get bigger than your heart. You have to feed your heart just as much as you feed your brain. :-)
One of my patients had recently got a keyboard brought in to them from the music therapist. After an extremely hectic shift I sat down on this particular patient’s bed and sang ‘lean on me’ with him as he played the keyboard with his good hand ( he was a stroke patient ) It was amazing to sit down for five minutes and just sing. We both did so with smiles on our faces. It’s the little things that count in nursing, you don’t have to be a hero you just have to be they are most vulnerable, when they need you most.
I interrupt your daily posts with another semi-nonsense one. As always, I was thinking and daydreaming, and thought, how awesome would it be if somehow Tom Hiddleston submitted a piece of work to The Medical Chronicles? I mean he’s into charity, and he can sing, dance, act, quote poetry/literature, so perhaps he does some writing himself! Or even draws.
While organizing our Fundraiser Talent Show, a group member once joked that I need celebrity endorsement in order to get a large attendance - but jeez imagine if he did submit, sales on the print copy for that issue of The Medical Chronicles would go off the charts! And I could donate all that money to Doctors Without Borders!
…yeah ok. Anyway, all of you are always welcome to submit (and then you can direct your friends and family to buying the magazine for a good cause), and remember that the deadline for the next issue is December 11.
Reminder: you now have one month until the submission deadline! The Medical Chronicles Volume 3 Issue 1 is coming out near the end of December. Send your work via the submit page or via email to firstname.lastname@example.org. Make sure to include whether you’d like to stay anonymous and use your Tumblr name, or would like to use your real name (and I of course do not bite nor give away identities).
The magazine is open to all works - writing, illustrations, etc that you feel falls at the intersection of medicine and the humanities.
Happy Thanksgiving everyone! And Happy Hanukkah!
0725 finishing report so I can go home when the tele tech looks over at me. “Was 412 brady all night?” The number is slowly creeping down...
- Generation Y.Receptionist:Don't you feel like your generation is just lazy?Me:Lazy? I'd say apathetic.Receptionist:Isn't it the same?Me:No. My generation is criticized and toiled with, and I don't see why not - just turn on the TV and watch what they're feeding us. But my generation is not lazy. My generation fought in Iraq and Afghanistan. My generation fought for womens rights in a fury that hadn't been seen since the 19th Amendment. My generation got our first black President elected. My generation fought for Gay rights for the first time in American history. And with all that, we are apathetic, and that's because things aren't going to be better for us down the road. We are the first generation expected to make less than our parents. We are the first generation to see America lose its status as a super power. We've lived through the worst economic times since the Great Depression, and are forced to take out thousands of dollars in student loans at the same time, all while our college degrees slowly turn into a highschool diploma. We've done plenty, and expect nothing. So no, I wouldn't say we're lazy, just apathetic.
- “Baby. Caught.”— Yeeesssssssssss