Hey good-lookin'

The characters:
A feisty 97 year old patient
My short and balding, but gracefully aging, neurology attending

ATTENDING
When was the last time you saw your doctor?

FEISTY PATIENT
Pshaw! I don't need a doctor. I've only seen a doctor TWICE in all these years. And I didn't even need the checkup!

ATTENDING
Well, I think you need an internist now for sure. I'll make sure we set you up with someone. Do you prefer a man or a woman?

FEISTY PATIENT
A man, of course! Can you make him young and good-looking??

ATTENDING
Hm. You want a young, good-looking internist. Well, I'm sorry ma'am - I'm a neurologist, so we'll have to find you someone else.

Say my name

NEURO ATTENDING
[droning on and on about something]
...blah blah blah, and so then we use clozapine frequently for that reason.

ME
But dude! Clozapine has so many terrible side effects...that agranulocytosis would not be worth it in my opinion.

NEURO ATTENDING
[staring at me]

ME
Um...or not?

NEURO ATTENDING
Did you just call me 'dude'??

ME
Of course not, my good kind sir.

In 1984 (who could ask for more)

Joshua Bell plays Bruch, Cafe des Architectes, triple chocolate mousse, raspberry cheesecake, green tea cream trifle, cupcake cakes shaped like fluffy puppies, really just way too much cake, sushi galore at Meiji, lots of birthday surprises and unsurprises, 8 lbs of crab legs (no joke!), neuro call, Cranium meets Taboo board game mash up, Godiva chocolates, the best friends in the world, and a really fantastic boyfriend.

Thanks much to everyone for helping me celebrate my quarter-century milestone.

Run this town

Google + Japanese animation = CUTENESS OVERLOAD!!!!

Looking up

Dear agony

I must have some mild form of Asperger's.

Seriously. There's no other way to explain how I can be so frightfully awkward sometimes.

So a couple of weeks ago, I met my friend Amy at a high-end grocery store. I had just gotten home from a long night on call, so my hair was a mess, my face was oily, and there was a peanut butter stain on my pants. She wanted to take advantage of a 15% off sale, and I just wanted to get some dinner. And since Amy is non-judgmental, I figured she wouldn't mind seeing me in all my dirty glory.

She didn't. But I really ought to know by now that when I look my absolute worst, I am bound to run into someone. (See here, here, and here.)

So as Amy and I were perusing the pastries and desserts, I saw someone familiar. Realizing who it was, I shrieked, grabbed Amy's hand and pulled her down to the ground with me to hide behind a large display of condiments. It was my first boyfriend. I haven't seen him in years and then on a day when I look terrible, I randomly run into him in a grocery store? What are the odds? Seriously, fate has a wicked sense of humor.

Amy yelped as I pulled her arm down. "Who are we hiding from?" she whispered. "An ex-boyfriend," I replied. She peered around the corner and upon seeing who it was, asked, "but wasn't that like five years ago??"

No, it's actually been seven years. One full dog year. What is wrong with me?

In the midst of our whispering, someone came up behind us.

"Michelle?"

It was him. He had heard someone cry out, and being a responsible doctor and all, had come over to investigate.

"Oh hi! We were just, uh, checking out these cool Frontera Grill salsas. Look at the crazy variety!"

Amy was cracking up, and after making up some obviously fake excuse about her cupcake being ready, she darted away.

We made small talk. Very awkward small talk.

"So, I hear you've moved into that new condo building along the river. It looks so nice!"

"Yeah, sadly, the monthly mortgage bill is not so nice."

"Haha. So how's your intern year going? Oh! My intern from last week is in your program!"

"Oh yeah? Who?"

My mind blanked. I had just spent a whole 80-hour work week with him, and I could not for the life of me come up with a name.

"Ummm, it starts with a J. Uhhh, oh JAMES! James! His name is James. Yes, James."

I said James four times. Count them. I don't know why, but I couldn't stop the word vomit.

"Oh, there are a few James. Does he have a last name?"

He was jokingly mocking me, but the thing is, again, my mind blanked. Seriously, I had worked closely with this guy. I had introduced him so many times to my patients. What was wrong with me?

"Oh last name! Yeah, he has one of those. [Nervous laughter.] Uh, it rhymes with moose. Tousse. James Tousse. That's my intern."

"Hm, I don't think I've met him yet."

"He's tall, incredibly smart, and All-American...he kinda looks like an Abercrombie guy."

He started saying something, but in the midst of my embarrassment over not knowing my own intern's name, I only heard the last bit: "....man, competition!"

It was my turn to say something, as he looked at me. So I blurted out, "oh he's not! He's married!"

There was an awkward pause. Did I really just say that? Holy cow, I did. WHY? Why did I just say that? I still have no idea what prompted my subconscious to associate competition with marriage. I floundered for words. "Oh you meant for chief resident! Dude, no, you're going to be great. Uh, I'm going to go find my friend and see how her cupcake came out...but good luck with everything and uh...I'll see you around!"

I high-tailed it out of there as soon as possible, my face as red as it would be after a couple of drinks.

What is wrong with me?! Seriously! It's been seven years!

Sigh. I must have Asperger's.

Digital monkey

After a week or so on the wards, my resident sat down and taught us how to get the Code Status from patients. It’s required that every patient be asked their code status, of course, and it was always a bit awkward that I would spend 40 minutes getting to know the patient, and then after I left, my intern or resident would see the patient for two minutes and quite informally ask them about DNR/DNI. Needless to say, the patients were always somewhat taken aback. “The medical student didn’t say anything! Am I going to die?! Are you expecting me to need to be intubated?” So my resident decided that it would be best if we learned how to get the code status, so that it could just be a part of our spiel. We practiced with each other and had a pretty standard speech set and ready to go when I would need it.

All I knew about my patient was that she was an 82 year old female who had an atrial fibrillation episode with a rapid ventricular rate. She was Russian, she told me in broken English after I walked in and introduced myself. No problem. I picked up the phone, dialed in the Russian language line, and we started having our conversation. The history went really well, even with the awkward pauses as we each waited for the interpreter to translate. In the middle of our conversation, I got a page from my resident - “Don’t forget to get the code status!!” After the initial butterflies and a couple of deep breaths, I reassured myself that I could do it. I'd practiced with my resident, with standardized patients - how hard could it be on a real live person?

So I pulled out the pre-written speech that my resident had given me, and I started my code status spiel. “Lastly, this is a question we ask all of our patients who are admitted into the hospital. Now, we think you’re going to be fine, but in case of an emergency – specifically, if your heart stopped or you had such difficulty breathing that you’d need a breathing tube or ventilator, what would you want us to do?”

She was smiling as the translator translated. And then as more of it got translated, confusion and shock took over. “You’re my physician! I came to the hospital to be taken care of by you!”

I reassured her that we would of course take care of her. I explained to her what we normally do during a code status, adding at the end, “so I’m just asking if you had wishes or beliefs contrary to this.”

She spoke rapidly in Russian with the translator.

The translator then broke from her translator role and told me that in Russian culture, it is taboo to talk about possible life-threatening situations, as my patient thought that it was essentially inviting in the devil. My patient didn’t want to make this decision, since she felt it was the doctors’ responsibility to determine whether to do everything or let her go.

I apologized, and ended the encounter as gracefully as I could.

When I went back to the team room and relayed the whole story to my resident. He nodded understandingly, told me to review her chart and said, “and if there’s nothing, just put her down as Full Code.”

She had never been to our hospital before, so there were no records for her. So, like a lemming, I did as I was told, and put her down as full code.

Two weeks later, I had a class on difficult discussions, and the issue of obtaining DNR/DNI status was brought up. We were told to never use specifics - don't ask about their heart stopping or breathing cessation, and NEVER ask if they want the care team to do everything. And of course, never assume anything. And NEVER go in alone.

I had done everything wrong.

Luckily for me, nothing happened. Her hospital stay was uneventful and she went home the next afternoon. But I can't help worrying about the Full Code status that is now in her chart. Because, chances are that she will return to the hospital with yet another heart issue, and another med student will interview her and she will again refuse to make a DNR/DNI decision, and some resident will tell that med student to review the charts. And there it will be - FULL CODE.