Pontificum Scriblerus

Not exactly, but I wanted the gist of the great Lennon song... Where exactly has this year gone? What have we done during this time? Sigh. At least we still have the Muppets.

During residency these days, the only true overnight call is in the ICU. But it's serious: every third night in the hospital, working 20 hrs, maybe an hour or two of sleep, and then almost always a full 8 hours the next day. You gotta stay for rounds, and then finish your work: pre round from 6-8, 8-12 rounds, 12-2 finish up stuff. Anyway, the post call feeling is so awful, it's like an illness. So, we came up with a pathognomonic constellation of symptoms. Behold, the Post call triad: 1) Somnolence 2) Flatulence 3) Inability to handle secretions After a while, it developed into a pentad: 1) Somnolence 2) Flatulence 3) Inability to handle secretions 4) Slurred speech 5) Priapism (where appropriate) I'm almost glad to discover the consistency of the syndrome, seeing as it occurs during at home pager call as well. Almost glad. Almost.

You know that feeling when you realized you fucked up? The one where your heart drops to the floor, you feel faint, and get blurry vision? Immediately followed by a surge of incredible anxiety? And also, you know how when a really nice person is upset with you, it's 10 times worse than a mean person? And how no one really gives a shit about excuses or reasons for why you fucked up? On the other hand. Whose fault is it that I'm so exhausted that I pass out, and cannot wake up to the sound of the pager?? FOUR times?? ME!! The one who wakes up when the wind blows! Now working on getting the groveling, apologetic, guilty look off my face. Shape up, doctor!!

If you think about it, the tree is an amazing creature. As a tree grows and ages, it becomes more and more difficult to deliver water to the top from the roots, thereby setting an upper limit to its height. Eventually, distal limbs become too "expensive" to support, and stop developing; this is why the topmost branches are the smallest. Despite the deficit, the tree is still able to put a new ring around its trunk every year. The paradox is in that the taller the tree gets, the more difficult it is to support itself, the less new branches it grows, and therefore, the less new leaves to carry on respiration that it needs to conduct photosynthesis to produce said support. The trunk rings do get thinner and thinner with each passing year, but eventually, they cannot get any thinner - and distal branches sacrifice themselves and die off. To stay alive, a tree has to be small, and grow slowly. It's either an ecological system of checks and balances, or a perpetual limbo create...

One day, my dad, who was a teacher in a school, took me to work with him. I was very little, significantly younger than a first grader, which would make me 3 or 4? He had a few classes to teach, and in the meantime, he took me down to first grade to be watched. He handed me over to a girl, whose name I don't remember, and said, "Please play with Sasha for a little while." The girl looked dubious but she took me by the hand and started taking me around her classmates. To each one she'd say: "Would you like to play with Sasha?" I got eyed up and down, and most people declined. I wasn't paying attention, just looking around: I had never been to a school. Finally, I tuned in to what she was actually saying: "Would you like to play with this nice little boy Sasha?" The customer she was trying to pawn me off on said, "I don't play with boys." "Wait, wait!" I said, "I'm a girl!" She took a second look, also lookin...

August, 1989, Avtovo

I don't generally like to bitch about irksome things at the hospital in this forum because I think if laypeople were exposed to the inner workings of the system, they'd be horrified. However, given the fact that I just survived my first full weekend of being on call, I am too full of righteous indignance and the spirit of complaining not to write this down. A patient arrives to the hospital with a suspected intestinal bleed. The backdrop is that he was recently in the hospital for unrelated reasons, and needed a feeding tube placed; GI refused to do it because of extensive ulcer disease in his stomach, but surgery placed one anyway, despite the contraindication. So, now this guy is sitting pale and dizzy in the surgery outpatient clinic. They call me, the GI fellow, to evaluate. I come - I say, check all labs, transfuse the patient, get his numbers to look better, and we will take a look in endoscopy tomorrow. Tomorrow comes, and the gentleman comes down to endoscopy. I'm ...