Wednesday, June 30, 2010


Today was my last day of fellowship. I'm pagerless for the first time in 8 years.

This has been a long, long journey. I'm not sure I've ever told the "how I knew I wanted to be a doctor" story. Unlike some of my friends, it wasn't something I ever thought about doing. I didn't know any doctors. No one's dad or mom was in medicine. It wasn't something people did where I grew up. I'll save that story for another day.

Today wasn't a bad day. Busy, but not terrible. I turned in trusty pager 3446, thankful to never hear the screech of that thing again. I updated my sign-out, the list of patients we are actively following, for the next fellow coming on. I took a few last phone calls, talked to some residents about the plans for their patients.

Soon it was 5p. I unceremoniously got up, put my white coat on, grabbed my purse, and left. I saw another of the fellows, and said I'd see her tomorrow for the "We're Unemployed!" Party I'm hosting.

I walked out of the VA. It won't be the last time. I have a few more days of liver biopsies to do. But, it was my last day leaving as a fellow. I felt like there should've been music, fireworks, something. Instead, I just felt a great sense of accomplishment and freedom. True, those feelings were mixed with the nausea of wondering how I'm going to fool people into believing I know what I'm talking about.

Every one's journey to being a doctor is different. Mine was pretty straight forward. College for 4 years, then med school for 4 years. Residency was 3 years, plus an extra year for the Chief Resident year. Now, 2 years of fellowship have ended. That's 10 solid years of medical training. Ten freaking years. On the one hand it's a ton of time. On the other hand, there are a whole host of diseases I've never seen. Heck, there are a ton that I've barely read about, let alone seen with my own eyes. So, although I'm as prepared as I'll ever be, there's always that feeling of wanting to train just a little bit longer.

Eventually, we need to step out of the nest and see if we can fly. Let's hope the next years are as great an experience as the last 14.

Monday, June 21, 2010


The past few weeks, I've had a difficult patient. His personality isn't difficult; he's a complete sweetheart. His case is difficult. He has lung cancer that is nonoperable. So, he's dying, but not any time soon. About a month ago, he came down with a case of Clostridium difficile diarrhea. It's a terrible infectious diarrhea that is most often caused by giving someone antibiotics.

(Allow me to step on my soapbox...)
Do. Not. Ask. Your. Doctor. For. Antibiotics. Ever. There, I've said it. We can't cure everything that ails you with amoxicillin. Not every sniffle needs Augmentin. Not every time your kid pulls at his ear is it infected. Your body's natural immunity does a darn good job most of the time. If you doctor says it's a virus, go home, drink your 7-Up, take a hot bath, and go to bed. Atibiotics always carry a risk with them, and people forget that. They aren't Tic-Tacs. They are drugs with side effects, some of them dangerous.
(Stepping off my soapbox...)

So, Mr. W got a bad case of C.diff. He got treated for 2-3 weeks, which is standard. His diarrhea slowed down, so they stopped it. However, a week later, the diarrhea returned with a vengeance. We started him on our most potent antibiotic for C.diff. Three days later, no improvement. His tests for the bacteria were negative, but no one believed them. His case was classic for relapsing C.diff.

I doubled his antibiotic dosage. No improvement.

His white blood cell count climbed every day. 16,000. 25,000. 33,000. 45,000. [normal is 6,000-10,000). He was getting weaker and weaker. He lost his appetite. I kept assuring him that it would work. That we would figure it out. That before long he'd be back in the nursing home where he could talk to his friends and watch movies.

The team called me on Saturday morning and said his chest X-ray looked like it had a small pneumonia. I wasn't too impressed by it, and I asked them not to treat it. He had no fever, no respiratory symptoms. More antibiotics would make the C.diff worse. They agreed. Twelve hours later, he had some shortness of breath, so they started some antibiotics. It was a reasonable thing to do.

Sunday, his chest X-ray LLS. That's my shorthand for "looked like sh^t." I think I learned it from my surgical chief resident. More important, Mr. W himself LLS. He was on a face mask delivering high flow oxygen, and he was breathing fast. But, he said he was comfortable. He told me how he was doing. I told him, as I had every day for the past 13 days, "Don't worry, we'll figure this out."

Today, I walked into his room, and he looked like death. He was always cachectic - so skinny you could see his ribs, and his temples were sucken in. But, there's a look that death has. Once you see it, you know it. Mr. W was there.

My eyes welled up. The respiratory therapist (RT) was in the room, giving him a breathing treatment that was clearly futile. I asked how Mr. W was doing, and he told me the obvious. I leaned over Mr. W, and listened to his chest, even though I knew there was nothing I could do. A few tears fell on Mr. W's sheet. The RT said, "Did you know him?" I told him I had taken care of him for the past 2 weeks. He asked me if I was ok. I thanked him for his concern, and I told him I'd be fine.

I just felt like I didn't do a darn thing for Mr. W. I told him it was going to be ok. I told him we'd figure it out. I told him he'd be better soon. None of those things happened. I don't know what killed him. I don't know if he had relapsed C.diff. I don't know why he got septic.

I just know I felt robbed.

I felt like Mr. W was pulled out from under my grasp. I thought I had a hold on him, and I didn't. I thought I could pull him out, but I couldn't. I was robbed. What hurts more is that I feel that Mr. W was robbed, too. Of a few more months. A few more movies. A few more laughs with his old buddies. Yeah. He was robbed.

Saturday, June 19, 2010

I'm Crazy??

I was doing a liver biopsy on a patient yesterday. He's about 58 or so, very nice guy. His arms were covered in tattoos, from shoulder to wrist. His abdomen and chest were also covered. I told him I was going to be getting my first tattoo, and I asked him what he thought. He said, "I think you're crazy!"

I laughed and said, "I'm crazy? After you've got all these??..." He countered with the most logical answer: "Well, I got mine in prison."

And....End scene.

I did not see how that answered my question at all. Regardless, I pushed him on it, and he said he spent about 10 years in jail in Indiana. I told him I went to college near his jail. I figured this made us something akin to blood brothers. He didn't seem so moved.

He said that in jail, they would sharpen down the E string on a guitar to a sharp point. Then they'd rig that up to a tape cassette player and turn it on. The mechanism that would spin the heads somehow fashioned an amateur tattoo gun. I said, "Wait, you got most of these in jail - even the colored ones?" He said yep. He said, "I don't know how they do it now a-days, I haven't been in for awhile, but that's how we did it."

I guess if you've got 10 years to kill, painfully marking your body is one way to pass the time. I was mostly impressed at the resourcefulness of these convicts. I was also mostly convinced that was how he got Hep C. Regardless, he has some beautiful pictures that I'm sure represent the many people and many situations he's lived through.

Monday, June 14, 2010

Proud Asian Mom

This past weekend was the West Hollywood Gay Pride Parade. It was fantastic. There were lots of fancy costumes, lots of floats about safe sex and HIV awareness, and a lot of half-naked men. Not bad for a Sunday afternoon if you ask me.

It was the 40th anniversary of the gay pride parade. There's a great history of the parade at this link if you go the side link that says "history." Quite amazing.

There was one parade participant who nearly brought me to tears. The elderly lady above was walking with 2 young men. Her sign says, "Proud Asian Mom of a Gay Kid." This woman registered as a parade participant. She may have had to pay an entrance fee. She had to make her sign. She went through all that trouble to show support for her son.

How amazing. My mom doesn't have to march in a parade to show her support for me. I'd like to think she would if it came down to that. As it stands, my vote for Mother of the Year goes to this proud Asian mom. And I'm sure there's a proud Asian kid out there who thinks the same thing.