Day 298 The last Song

Well today was clearly not the ideal day. Where sometimes it feels good to come to the hospital to try to make a difference and help some people, occasional you have a day like I just had. The day started and ended on the same note. At 745am I received sign out and my first beeper page was the medical floor where I was called to pronounce someone's passing. I jotted down the room number and proceed towards the floor.
Its not the ideal way to start the day but it is expected. When I arrived at the room I was shocked to learn that it was one of my patients that I had on the previous day. He had throat cancer that was non operable and had a trach that was constantly bleeding. The family was consulted through the years to provide hospice for the patient, but the wife refused. She insisted that everything be done. It really was a shock to me. I didn't take it well. He was alert yesterday when I rounded on him. I'm only talking about it because I just can't forget it. I can't forget how his wife fought for him. She just didn't want to let him go. She was constantly at his side. She use to sleep in the bed next too him. The nurses hated that, but they had no choice. He seemed to be out of control with the nurses and was more calm when his wife was in the room. I still remember a few days ago when a particular smell was coming from the room- It was coming from the trach site that was infested with the metastatic cancer. The room smelled awful. The nurses had changed the sheets but the smell was tough. The only person in the room with him was his wife. I remember finding her sleeping with the bed covers over her face.

When I talked to her, I honestly felt she was neurotic and kind of pushy. But then I took a step back and tried to place myself in her shoes. I realized that its difficult to let go of people we love in this life. And it should be. It should not be something easy. We should all fight long and hard for the people we love, because we love them and cant live without them. Sometimes your judgment can get clouded and you might need time letting go, but for some its difficult and
it should be understood.

At the end of my life . I only hope and pray that someone is by my side praying and fighting for me and she was for him.

The entire situation wiped a part of me that day.

And the day ended with me pronouncing another person at night. I was called to the room for a gentleman that was recently admitted about 2 hours ago! When the nurse paged me she told me
to come pronounce, but that there were family members their. I kind of hesitated a little bit. (Its always difficult to pronounce a patient in front of their family especially when you don't know the history much.) I went to the chart immediately and read a bit of the story. He has severe heart failure. When I walked into the room I was surprised to only see 1 person standing in the room below the bedside. Her eyes were all red and full of tears. She had her hands clench together with a napkin. When I saw the patient he seemed extremely pale. I know from history that he had bleeding but family refused transfusion. I pronounced him dead at 945pm. I walked over and hugged the person in the room and told her how sorry I was for her lost. I stood their to talk to her wondering who she was. In our conversation I realized that she was his wife. She said something like "well after 45 years of marriage.." Wow that seemed like a long time i thought. She also said "and he just sang happy birthday to my son downstairs 2 hours ago." I said my good byes again and talked to her about funeral arrangements and she thanked me. I walked away and left the room. As I was leaving the room I could hear her walk to the bedside and start to moan & cry. I really didn't know what to think. I was just in shock again. Wasn't he just singing happy birthday to his son? and now he is dead? It really took a tole on me. I was pretty much drained and the night is not even over.

The more I spend around people that lose their lives to disease and sickness. The more I see the frailty of life, the more I realize how special each waking moment is. Elisabeth Kubler-Ross
(Swiss-born psychiatrist and the author of the groundbreaking book On Death and Dying where she first discussed what is now known as the Kübler-Ross model.) once said that the more you study death, the more you realize how precious life truly is. You learn that you have to live life to its fullest. You have to value as much of the time you have here on this earth. You have to appreciate the time you spent with your family and friends. And the more time I spend in the hospital and experiencing moments like today, the more I realize all of what I just said.

My wife send me a text a few days ago. "is it ok if I spend the weekend with my parents.?" I text her back and said "enjoy your family. This is what life is all about."

God Bless

Dr.Mike

Day 334 Cops, Xanax, and Helicopters

9:46 pm Man I'm tired. I'm on call the second Saturday in a row. I wanted to write about what has been going on in the hospital but I can't right now. I feel a bit drained. There is this resident that has been asking me for help to do his power point, and I guess he has never used it before, and I have been helping him even with the little time I have free this week. I hope I get some time of next week when I go to ACP in Philadelphia. (which the program is paying for !!! weee!!!) But anyways. Man I'm tired. By the way my friend called me from the parking lot before he left. He is a second year resident. He wanted me to come out and watch the helicopter on the roof. I was like "huh? helicopter?" He said "yeah you can see it hanging from the roof come and take a pic!!" I was like "this is not a joke right?" he said " no, no man... its for real. If you are coming I'm turning around." So I took my camera and I went outside the hospital lobby. And sure enough there was a helicopter on the roof. Boy my friend was excited. Not sure if he had ever seen anything like that. But he was a "kid in a candy store" happy. It got really cool when the helicopter starting moving the tail and started to speed up. And as it was taking off my friend said "you know what this means right?" I was like "what?" He said "that's means someones got a unit admission!! " He started laughing. It was a cool site to see.

Other than that the floor has been ok. I saw a patient of mines that has been pretty "un-popular" here with the staff. I remember seeing her about 2-3 weeks ago in the general medical floor. She had come in for sinusitis/ recurrent and was staying in the GMF floor, and she was giving the nurses a really hard time. I wasn't sure what they met till I went to talk to her. I think she spoke to me almost an hour. I was trying to "escape" but I tried to be understand and listen to her as long as I could. She seemed very anxious, and I have learned that sometimes anxious people just need to be heard. She when on to tell me how she thinks there is a conspiracy against her. The last 2-3 hospitals she has been to have been really bad. I think she said she was going to call her congressman. She said that she was also kicked out of R__ W___ hospital too, but that the fault was mostly the nurses. But when I saw her she was upset because they were being "racist" towards her. The African American nurses were treating her bad she said. And also her neighbor in the bed next to her had her family over last night which was about 20 of them (according to her) and she really felt a bit uncomfortable, even though she has no problem with black people. She has a lot of black friends. She says that while she was lying in her bed, there was a little girl just staring at her, and it made her really uncomfortable. She said it got so bad she even called the cops!! I was like "what, you called the cops?" She said "yup, I sure did. You can't treat people like this. What kind of country do we live in? These people are just racist." That has to be one of the first I have heard of patients calling cops from the hospital at the bed side. It didn't take too long talking to her to make me realize that she has some anxiety issues. I tried to listen as much as I can. I told her I would get the patient advocate to come and see her. The following day I saw the attending who she was under. He told me "Hey, Dr. Mike did you make MS.___ non teaching?" I smiled and laughed and told him "her? no....lol. I wouldn't do that to you. By the way, you know she called the cops yesterday right?" His eyes widened and he seemed shocked, he said "what ? are you serious?" I said "no..I just wanted to tell you. She called the cops and they came here, so if I were you I would be careful." I left the room, but I got the sense he was a bit worried. He is one for the attendings that try to avoid any legal issues or situations like this. Who can blame him? The next morning on sunday, I actually saw him come in to personally discharge her. I think thats the first sunday I've ever seen him in the hospital. I laughed when I saw him. I think he looked at me and smiled back.

Well fast forward to today , and here she was again. Guess what ? she was a patient of Dr. DEvil !!! (dr.DEvil http://thankyougodforresidency.blogspot.com/2008/08/across-your-time-in-wards-and-floors.html) out of all people!!! I saw her this morning and she was in a state of mild panic. She seemed very upset and was angry.I said "what happen?" She said "last night was horrible. I had the doctor come in and he basically screamed at me and told me that my asthma is triggered by my anxiety, and I told him that was not possible." She then asked me to give her a second because she was upset now, and she was having a hard time breathing. I tried to "explain" to her that maybe the stress of the situation might be causing your body to react differently and it might cause you to breath differently. She said she doubts that it was from the anxiety, but that while she spoke to me she felt a little better. I told her I would give her some more respiratory treatment, incentive spirometry and mucomyst. She said ok and she agreed to try to relax. I told her if she had any problems that she could call me. Surprisingly she hasn't called the entire day.

10:12 gonna try to get some rest. Have to wake up at 4am to do some notes. and tomorrow that resident is coming to my house to finish up the power point at 7pm!!! amazing huh...... geesh must be nice to sleep and have a day off........

God BLess
Dr.MIke

Day 295 Resident with Usmle Scores 98 & 99 Gets kicked out !!

I suspect that the situation I'm gonna talk about is one that doesn't happen often. You might here about someone with 99's on their boards not getting residency (which is most of the time due to visa issues) but you never heard of one of them get kicked out of a residency program. Well lets talk about one of that is no longer part of my program. I will give him a false name to preserve anonymity. We'll call him Dr.Jack. So it so happens that jack was a replacement second year for a spot in the second year that was open due to the fact that one of the 2nd years got sick. He had been a recent first year from a program in Manhattan. (It was one of the mount Sinai hospitals) I spent a great deal with him, so I knew him well compared to the other residents, but as it turns out, not too well. It must have been 3-4 weeks of him starting the program that trouble started to arise. I still remember clearly the day all "Hell" broke lose. It must have been around 6 pm at night and I was taking a break in the resident lounge when we heard in the over head microphone of the hospital: "Paging Dr. Jack. Dr. Jack Please pick up line 8765". Being the intern and newbie, I didn't think anything of it, but in the next 30 minutes there was about to be an explosion. I was sitting at the computer and writing some orders when the door of the lounge opened and it was jack. Jack seem to be his cheerful self. I got along with him well. I said "hi "and kept doing my work. 5 minutes passed and I heard screaming from another second year resident. She was pretty upset. I didn't understand everything she was saying because she was speaking arabic to him. But she was really upset! They were in a room and there was one more 3rd year resident in the room with them. When the door opened all three of them were in the middle of the lounge and they were going at it!

"I told you ... why didn't you pick up? why didn't you go to the unit when they were calling u?" she said to him. He responded "I told you I was in the E.R. I didn't hear the page and I was taking care of someone that was having an MI. How can I be blamed for this?" . She responded back "You are not suppose to do this! If the unit is calling you , then you must go. You cannot behave like this!" I learned later on that their was a critical patient in the unit that needed a resident to evaluate (knowing the unit, it must have been someone desaturating or someone in an acute rhythm that needed help.) In other words, a pretty critical situation. I also learned that you shouldn't have your name called out loud in the speaker. It basically means that you are not being reached by your pager, or that you are not returning calls to you. So most of the residents cringe if they hear their name pronounced over head. And it seems that our friend jack never heard the page. It also turns out that the admission he was doing was of a patient who had been having chest pain, but was stable. Troponin might have been mildly elevated, but a person who was not in any critical state. (We have tons a patients each day that come in for chest pain. They are closely monitored for 24-48hrs and most get stress testing and cardiac cath.) Anyways, that was what they were talking about, but they were really screaming and arguing. He didn't feel like he did anything wrong. I still remember raising her hand and pointing to his face and screaming in arabic something pretty bad. I remember him just looking at her and kind of surprised. She left the lounge and he stayed their kind of perplexed. He stayed talking with the other senior. Wow, was she pissed! I've never seen her so upset. I remember him speaking to me after this had happened. He had told me that he wasn't going to leave the patient.

The next few days it seemed like most of the second years really didn't like working with him and were complaining to the program director all the time. And it only got worse. It turns out that nurses were complaining about him -that he didn't call back and that he didn't handle their problems, and didn't order the medications they asked him to. An attending also complained that he had been a bit flirtatious and un-profesional. Looking back I still remember the moment. It was in the E.r and we were doing an admission, and he was discussing the case with the attending. At the start of the conversation it went something like this "HI how r u?.... You remember me? Its Dr.Jack. We had good time last time Remember? (he's talking about the last time he had discussed a case with her)" It sounded a bit strange when he said it, but I didn't think anything of it. But turns out that attending had complained to the medical office about that conversation. Depending how you look at it, it can be seen as some type of harassment? I had also heard that he had given his phone number to one of the nurses. (I was their when he gave it to her. I found it awkward, but then again he was a very friendly guy, Always laughing and telling jokes.)

Over all, I think the seniors expected him to get use to how the hospital runs in a short period of time. This is a small community hospital, but the patient load is heavy and their is a lot of work to do. I don' think he ever adjusted to it. And it kind of hurt him. People had to pick up the pace for him, and were having to work extra and were not happy with it. SO even if he might have made small mistakes, they were exaggerated a bit. I still remember being in the E.r and hearing on of the cardiologist on the phone complaining about him to the administration because he was to slow. They were doing cardiology rounds, and he had spent about 2 hour on one patient! And these cardiologist had 30 patients to see!! I also remember him talking a lot about religion and arguing about it with the residents. He was deeply religious. He spoke very softly to me. I considered him a good friend. I still remember doing a 3-hour cellulitis admission with him one time, and him talking the attending to sleep over the phone while he gave a 30 minute admission call over the phone at 3 am in the morning. I can still remember him speaking into the phone "Hello?...Hello?.... are you there?...hello?" But perhaps the most amazing story I heard about him was when he fought with the program director. He was in her office, and she had been trying to work with him and explain the situation, when he grabbed her by the side of her arm and said "don't worry about me, my god will provide for me."
It turns out that Dr. Jack was a very spiritual person. I had endless private conversations with him about religion. He use to walk to attendings and start kind of preaching to them. I thought it was a bit strange, but then again he was a strange guy. I heard he also had problems with the chief resident who was trying to help him with the situation he was in. They had paged him for an admission and never went to the admission and blamed the chief for never getting paged for the admission.

I'll never forget the last time I saw him. It was 730am in the morning and their was sign out. And like usual, whoever was overnight, signs out to the morning team and we distributed the work. I sat down and started handing out patients and then I cam to a name on the bottom of my sheet. It said DR. Jack Pgy-1. They had demoted him to first year again as a trial basis to catch up with the system. I still remember the look on his face when I called his name out loud in front of the group. I said "Dr. Jack? Ok these are your patients for today." He seemed embarrassed and upset. That was the last time I saw him. Later that day around 6pm I heard that he had been escorted out of the hospital with security . I felt bad when I heard that it had occurred. I was told later on that he had been arguing with a nurse in the telemetry and he had grabbed her the wrong way, and their was a complaint of harassment placed on him. After he had left the program I spoke to one of the first years who told me that he had seen that he had scored a 98 and 99 on his boards and 97 step 3. I was kind of shocked. He said that he had been working with him on applying to other programs and had seen his cv. To this day we were all in shock when we had heard that he had scored so high. Some believe that he probably stole someones grade, but I believe that he just wasn't use to the system we had here. It was a change for him and the work that he had been doing in his previous hospital was not as intense as it was here. I later found out that he had gone to a VA Program his first year, where there were a lot of patients, and where you don't do a lot of admissions the first year. (We have been doing admissions from day 1 here.) Over all, it was a very sad situation. He was a warm fellow that was poorly understood. I wish him the best. I have tried to call him a few times, but he never picked up his phone. I hope he was able to find another program. IT might be difficult if the previous program calls here for references.

I believe that it is important to have good grades. Knowledge comes by reading, but it also comes by doing. Most of the residents here have learned there medicine at the bed side. Next to a patient. This is how you perfect your medicine. I will try to call him today . I'll let you guys know what happens.

God bless

DR. Mike

"I hear and I forget. I see and I remember. I do and I understand." - Confucius

Day 286 Trouble in Paradise

I have thought about writing this for a long time. The reason I haven't is because I wanted to be positive as much as I can, but I realized that this experience would be incomplete, and I would be living a lie if everything I wrote always seemed positive. Although I talk about my program with a lot of positivity and joy. There are also un-pleasant moments and situations that arise occasionally, and I believe its just part of life and residency, and its something I'm having a hard time adjusting to. I recently had a meeting with the program director and one of her assistants to go over the yearbook which we were planning. (I had already made a video and placed it on youtube, but it was taking down because of the soundtrack.) As I sat their collecting my thoughts, one of the administrative directors sat down next to me and said "you know what has happened this year, has never happened before. This year all of you guys seem to really get a long. We have never had such a tight group here. It's really amazing" By this time the director was sitting next to me and was hearing the conversation. I turned to her and said "I know what you mean, we were even discussing this a few weeks ago, and we were saying that people should pay to be in our residency." They both laughed.

My friends -there's trouble in paradise. I guess it was naive of me to believe that this place is perfect, but then that would not be reality. People are people. They have emotions and they can be quite mean. They have their bad days and their good days. No one is morally perfect. For instance, I was kind of shocked when I first found out that one of the first years in the program tried to kick out one of my best friends whose a first year. She was covering for my friend one Sunday, and he had not given her a proper sign out (it might have been in-complete) and because of it she had a bad day and had to do a lot of "extra" work. Well, instead of talking it over amongst us, she went to the chief resident and had a 1 hour meeting about him and wanting to get him in trouble with the program director and hospital. The meeting was an hour because the chief was trying to convince her not to complain about my friend and not get him fired! Whats shocking about all this is that we are all first years and in the same group. We have all been through a lot. We should be working with each other instead of going up against each other. To top it all off, she even complained about me. She was complaining to the other residents that I'm late a lot of times. I couldn't believe she did not discuss this with me, but instead went to the other residents and was talking about it. I still talk to her, and I still get along with her. Many of the interns and seniors are careful when they spent time with her because they know that she is capable to complain to the highest office if something goes wrong. There are probably many small examples of situations that has developed in the past this year, but I don't think its relevant to describe them all. (I have written about a few of them and will post them.) Even today, I asked one of the seniors to help one of the interns on Sunday (because I 'm leaving for a wedding of one of my best friends in the program). The covering intern is pretty much covering all the floors 2 hours, and I spoke to the senior and asked them if it was ok to help him out so he will not get over whelmed 2 hours. I didn't think it was anything. And I have gotten along with her pretty good the entire year. But when I asked her, she put this face like "This damn interns. We are seniors and shouldn't be doing this." It really took me back. I felt very awkward. Its like if you have every felt like you are in the wrong place- like walking in to the ladies room by accident- you just put you head down try to apologize and walk away. Her entire demeanor changed. She seemed very upset. And if she tried to cover it up she really didn't do a good job. There are 2 seniors on this Sunday, and I got the same reaction from the other senior when I asked her too. She has this face like "these damn interns." But in all fairness, I can almost understand them. I'm not going to go into details, but the seniors before us were living a nightmare based on all the stories I heard. I heard people were very abrasive to one another. There was a lot of infighting. People wanted to leave the program. Senior residents were not helpful for the most part. It was a very cold place. (I'll post about it in the future) SO the seniors that we have now look at the environment and are in shocked of how much has changed. People are working better with each other. Helping each other out more. It feels like we are all a family. But like any family, none is perfect. We all have faults. There is trouble in paradise after all. On the other hand, a small part of me kind of hurts a bit. Hurts because of the realization that even in this place we cannot have complete happiness and harmony. We are all after all part of this world. We are in a hospital where people are sick and dying day in and day out. There are human beings in pain. There are people that suffer and are angry. We laugh but we also cry. We love but we also fight. We bless and we also hurt. Just a small part of me wanting to be part of something that was bigger than anything. Bigger than me and any place. I wanted to be part of a place untainted by the evilness of this world. I wanted to belong to a group of like minded individuals that are solly concerned about others and not themselves.

I was in a bus one day. And there was an individual that was handing out this small little papers that read "How to have eternal Life" She must have been a missionary and she was handing it out to everyone. As she went towards the back, she handed it to one guy who gave her back the paper and said "Eternal Life? No thanxs! I have enough problems as it is. I don't want to live with my problems for ever. I don't want to have bills the rest of my life. Theirs just to many problems in life to live with them for ever." The missionary looked at him and was confused. She told him "this is not to live on this earth for ever. This is to live in heaven for ever." The man smiled and said "ok." and took the paper. I Still love and care about the residents that I work with. We are like a big family with occasional problems. We have faults and we have to accept them. I pray to God that I can accept mines and other peoples.
GOd BLess

Dr.Mike

Day 280 Best Day in Residency !!!!!!

Today was perhaps one of the best days in my residency. After almost a year I finally saw the attending that gave me my first interview here!! The attending that helped me to get one of the spots in the program. It happened while we were in noon conference at 12 pm. I didn't even recognize her. I helped her set up the slide show presentation. Then she turned on the slide show, and her name was on the slide show presentation. I was in a state of quiet shock. I can feel my heart racing fast. I was so elated, (nice word huh? elated? ..lol) I was really happy inside. lol. I thought to myself "I have been looking to thank her an entire year. I turned to one of the 1st years sitting next to me "Thats the attending that gave me the interview." I can almost remember what the interview was like. I remember being in the waiting room. When it was my turn to interview I left the waiting office and saw the Male attending; who seem very cheerful and easy going, I almost regretted not having him for one second, but that all changed when I first saw her. She seem very soft spoken and nice. I remember walking into her office and saying "so how is everything going? Busy day?" She was surprised I think when I asked her this, shesmiled and said "Yeah its pretty busy. Its a lot of work." And we sat down and we started the interview. Needless to say it was one of the best interviews I had ever had. I had about 10-12 offers when I applied that year (2008) This was my second interview. MY first had been at Jamaica hospitla in queens (another memorable interview. I even cried in that interview. They also send me letter stating they would rank me high, but no pre-match). This was my second interview. I never forgot how calm she was and well spoken. She had a nice soft demeanor to her and was very educated, spoke in soft sentences. I really tried to control my emotions and tried to rise to her level. I read a lot of interview books that said you should adapt to the person that interviews you. Try to relate to them on a common level. We really had a good talk. When I left the room and went down stairs, my wife was waiting for me. I told her "wow, that was a good interview" She was like "it was?" I said "that was probably best interview I ever had." ( I had gone to 16 interviews the last 2 years.) Even if I didn't get the spot I would still say it was the best interview I have had. Everything just seem to "click". She asked me during the interview if I had plans to stay in the area. It was a strange question. No one had ever asked me that befor. I told her I would definitely like to stay in the are. I never thought anything of it. But 2 days later I received a pre-match offer in the mail. I went the next day to sign and cancelled my other 9 interviwews. TO this day I framed that letter of the offer -it sits in the office in my apartment. I later came back to the office and wrote her a thank you email. I wanted to buy her a Tiffany gift pen (silver) but the quality was bad(I still plan on buying her something.). I was expecting to see her when I started residency. But that was her last few days their at the program. GO figure. lol. Fate ? Maybe.

Any ways, I was really excited to see her!!! I waited till the lecture finished and till everyone left the room. I think she was kind of surprised to see me. She had a plate of food in her hand. I went up to her and told her "I'm not sure if you remember me. I interviewed here with you last year?" she said "Yeah I remember you. How is it going?" I smiled and said "its been going really good. I just wanted to tell you that I have been looking to talk to you for the last year. They told me you are no longer here, but at the sleep center. " she said "yeah I work at H___ sleep center." I then said "I just wanted to tell you that I wish you all the goodness of Life. From the bottom of my heart. I wish you all the happiness that is possible on earth. You are a very great and special person. I never forgot our conversation. And I wanted to thank you once again from the bottom of my heart. (I think I had few tears in my eyes.)" She was a bit surprised when I said this. She smiled and said "Your welcome." I told her "you really are a special person. Thank you very much. Thank you for giving me this opportunity." I tried not to say too much. I didn't want to scare her. lol. That's what my wife says of me sometimes when I'm grateful to some people. I shook her hand and put my hand on her arm and looked at her and said "thank you." I turned around and as I was walking out she added "Do you like it here?" I turned around and with a smile on my face, and watery eyes "I love it here." I left the room and didn't look back. I wanted her to eat her food. (She still had the plate of food on her hands.) I didn't want to say anything else. It was the end of another great, but short interview. I wanted to remember it like that. overall one of the best days I've ever had here.

God Bless

Dr. Mike

Day 272 He Died

It must have been around 2pm and their I was crying in front of the program director. It was hard to control my emotions. I didn't know who to talk to once I had found out the news. One of the most well known teaching patients that I had taken care off had past away. He was well known to the teaching staff and residents. I was in shock to find out about him today from one of the residents. It was very painful and heart breaking news. I felt as though a friend had passed away. (I also wrote about him in for my blog a few weeks ago.)

Ironically the attending and I were the last doctors he saw in our hospital. When I found out about it I was in the middle of doing an admission. I tried to hold back my emotion. I wanted to go up stairs and talk to the attending that I had seen with him the last day he was here. It was strange, but I felt that I had to apologize to the attending. I had to say I was sorry. Sorry that I had not done enough. Sorry That I let him down. Sorry that this had to happen. It was strange but I had seen him at noon conference and he had seemed a bit down. I didn't think anything about it, but looking back I think he had found out the news about what had happen, and he might have taken it a bit hard. Or at least he was saddened by what had happen. When I went down the hallway and approached his office- which is right across the program directors office- I had a change of mind and decided to visit the program director. I think I needed someone who was a bit more emotional, not saying that he was not, but I figured that the program director might be more inclined to listen and I decided to first go to see her.

I went to the program director office door and waited for someone who was in her office to leave and she saw me and said "hi mike, anything I can do for you? " I kind of put my head down and told her "I'm not sure if you heard, but N___ L___ died today at R__ W___ hospital. I just found out about it now.....and...... I just wanted to say..... ( started having a bit of tears) We tried everything we can to help him. Me and doctor G___ tried everything, and he just didn't let us help him. We tried...(crying)" She stood up from her chair and closed the door behind us. She said "Mike, don't cry.... you did everything you could. Here have a seat." I sat down at a small round table she has in her office. I sat their and told her "we tried...we tried.." She stared at me a little and with a smile said "you know its OK to have a connection with your patient, we try to do the best we can, and that's all you can do. Its good that you care. Its good that you want to help." My nose started running a bit. She stood up and went to get some tissue paper for me. When she came back we spoke only a few seconds more. I said "thank you for the talk and sorry for interrupting you." She said "no, any time, any time you can come by, don't worry." I stood up and thanked her and left the office. When I stepped out, I went to visit the other attending across her office, but he wasn't in the office. I only saw the secretary and I said hi to her. I figured today when I get home that I would email the attending the brief blog I did about the patient and the situation. I think he would appreciate what I wrote about him and the situation. I'm going to email him now.

God Bless

Dr.Mike

why does God allows evil?
http://www.discoveries08.org/episode-4-high-quality

Day 261 Caught in the Act

Well It was a pretty surprising day today. It was around 2 pm in the afternoon and a patient
had to be discharged and I needed a prescription signed by an attending. The chief resident was
not around, so I went up to the program directors office. I walked into her office and asked her for the paper signed. There was another staff member in the office. She had a strange look in her face, and she was about to say something. But the secretary told her bye and she didn't say what she wanted to. I asked her for the script and right before I was about to leave the room she said "I wanted to thank you for what you wrote." I was like "huh?" she said "I got a letter from the President of the hospital, and I wanted to thank you for what you wrote." I was trying to play it off, and I said "what ?" with a smile. She said "It really meant a lot to me and I wanted to thank you from the bottom of my heart." It seem like she was about to cry. I kind of had the same feeling. It was just real appreciation for the chance she gave me and how good she has been with us. I said something like "I think you deserve it and you are special......etc" It was probably a lame response. But I was speechless I didn't know what to do. I just put my head down. About two weeks ago I decided to write the president and vice president of the hospital (which she probably doesn't know yet.) telling them about her. Telling them that we as residents really apprecited all she has done for us. I will post the letter at the end of this. I'm not sure where I got the idea from, but I figured it would be a nice thing to do. I figured she would really like it.

I have been writing to some of the residents private letters thanking them for all their help that
they have giving me. I have been very surprised by their response. Some of them said they even cried when they read my letters. Since it got such a good response I figured I would keep on writing them. Its amazing the response people get when you tell them how special you think they are.

I guess its a nice feeling to know that someone cares about you, and looks up to you. All in all, a good day. I was a bit embarrassed after she told me that she knew it was me. I had signed the letter pgy1 Internal Medicine. I figured she might not figure it was me, but I guess I got caught. I wanted to keep it anonymous. After I left her office. I had to return in 5 minutes again to ask her for something. I felt a bit wierd. lol. I had to walk down with her so she could sign some papers. As I walked down the hallway with her I turned to her and asked "so how is work going?" She smile and said "work is pretty good, especially with residents like you." I smiled and turned my head and Laughing I told her "I still don't know what your talking about."

God Bless you

Dr.Mike


Below is the letter I sent:

Dr. ________
Vice President, Medical Affairs

I’m writing this personal letter to you because I’m aware that you like to be informed about important patient issues and Health Care practices at ______. I’m a first year Internal Medicine resident that was hired in 2008. And I’m writing this letter on behalf of Dr. ________ (IM program Director) because I feel that you should be aware of the great job she is doing as program director.

I just wanted to say how grateful me and the other residents are with all the hard work that she has done in the program. There have been a lot of positive changes ever since she became program director and we as residents have felt it. For many of us, ______ is our second home, and we feel very honored to be part of your system and Hospital. Dr. _____ as been a huge blessing to this program and hospital. Not only does her leadership inspire us all but she she has a great deal of patience and human qualities that make her stand out from anyone I’ve ever met. Her demeanor and approach with us is a welcomed change.

She has put together a great team of residents. Her hard work and positive reinforcement makes motivates us daily to be better physicians and persons.

We have all been giving a special privilege in out lives. We have been placed in this planet to make a difference in the lives of those that surround us. Our meaning and existence in life is found in trying to relieves the human suffering that surrounds us. Our meaning It is found in providing quality health care to everyone we can. We all have a purpose. And we could not achieve our life goals without individuals like Dr. _____.

She is like a bright ray of sun on a cloudy day. She is a star amongst the sky. She is part of our lives and our mission on this earth.

I write this letter just so that you would be made aware of the impact she is having at _____. She is to be highly commending for building such a strong health team who sole purpose is to provide the uttomost medical health care at ____.

We also wanted to also say thank you to you. Thank you for Dr. _____ and her Staff. Thank you for giving us the chance to be part of ____. If we have changed lives, if we have help even one person to live life a bit better, if we have helped one person to be able to spent a few more hours of his life we the people he/she loves the most in this world, then all the struggle and difficulties we have faced in life was worth it.

Thank you in advance for your time

PGY 1

Internal Medicine

p.s. (feel free to share this letter)

Another email sent to a resident:

Hi _____

I was really Glad to hear that you won the award no one deserves it better than you. It was really good news to my heart. I can't think of anyone that deserves it more than you. I know that you went through a lot of difficult time last year, amd I think this is God's way of him showing you his goodness. A lof times we ask for strength, and God allows us to be stronger with the trials we face in life. The difficult situations you had last year only helped to make you stronger and to show you God's grace.

Always remember that happiness not only comes from receiving what you want, but also comes from making a positive difference in someones life. And you have and will continue to make a positive difference in all of our lives.

Your passion and goodness inspires us all the time. Very rare in life do people have the opportunity to do what they like and love. I feel that you have been blessed with the desire to better yourself, and others. In all the dark moments of your life God was always with you and did not abandon you. I think now maybe you see that even more.

I wish you the best. Your happiness is my happiness. Your joy my joy. It's good to see people overcome and better themselves. Its good to see the happy moments in the life of someone you care about.

Good luck.
I look forward to working with you the rest of the year.

God Bless

Dr. Mike

Day 253 Almost Died Today !!!

I almost DIED today. It happen in the e.r when I was called to do an admission. I was in the small resident room writing the orders when I heard the voice of what seemed to come from a young person who screamed "Stop!..... everyone stop!......put everything down now. I'm not playing!" It seemed like he was right outside the door, and he was! He kept on screaming. It sounded like he had a gun or a bomb. I wasnt sure what to do. I figured maybe when he passed by the room that I could just ignore him. For ONCE in my life I wasn't nosy and didn't want to know what was happening. Their were 2 attendings in the room and boy they were scared!! One of them was a female and other was a male attending. I'm sure one of them peed in their pants, but I couldn't smell it. The female attending went to immediately close the door, but she kind of hesitated- not wanting to stick out her head.

I remember thinking "that's it I'm dead..." I really didn't have anytime to think. I stood there frozen (there were no exits in the room. Its like a little closet with 2 computers where we do the admissions.) I was just in a slight state of shock. The scream got close and closer and sure enough there passed a young man being carried by 8 cops and security gaurds and he was screaming like he was on fire "do you see what their doing to me? Let me go? Somebody
HELP!!!"

Boy I was happy to see him! Well you know what I mean. Wow! I was happy to be alive! I laughed. I told the attending' s "I thought he had a bomb and that we were dead." They didn't smile much at that. And for the SECOND time in my life I didn't even bother finding out why he was their. I didn't think it would make much of a story. The fact that I was alive was enough of a story!!

The Er shows on television sometimes shows the crazy stuff I've seen HERE!!! I still remember one of my earlier admissions. I was walking into the e.r with one of the senior residents, and as I walked out of the nurses station. There was a naked woman lying in front of us face down on the floor. And it seemed like nobody noticed or even cared. The senior resident looked at me and she kind of was like "whats going on here? who is this?" While she said this, a few people walked by as if not noticing anything. As we walked closer we could hear one of the nurses walk up to her and say "come one get up. We already told you , that you can't go home." There was a male nurse that tried to cover her up. She smelled like alcohol. And we just kept walking. It was surreal.

I still remember my conversation with an E.R nurse. We were discussing the crisis room- its a place that these types of patients go to when they are hysterical. Its a special room with a camera thats monitored by 2 people. As I walked by the room, he smiled at me and said "Don't walk into that room" I looked at the room and it was empty.

I asked him "why?" He said smiling "trust me, you don't want to go in their."

I think I understand him now.

God bless
DR.Mike