This made my day

A couple weeks ago I snapped this picture with my cell-phone camera--hence the poor image quality. I saw this truck parked outside our hospital's building which houses the inpatient psychiatric unit. It advertises a carton of ice cream that is half vanilla and half chocolate.



In case the text isn't clear, the words on the red banner state, "Satisfy your split personality..."

Athena would be pleased...

My favorite room

"I like how clean this plate-cover keeps the microwave," I remarked to my roommate David recently as I gingerly removed my steaming left-overs from the microwave.

"Yeah, that's pretty much my favorite thing about it," he replied.

Along those lines, I thought I would feature my bedroom in tonight's post. It was designed as the study, but my two roommates and I use it as the third bedroom. At 10x12 feet, I try to arrange the furniture to maximize space. I'll comment on guiding space-saving principles, as well as my general philosophy of feng shui with each picture

In this first shot, we have the bed. A copy of my grandmother's art is hung over the bed. I use a twin-size bed for a couple reasons which I will now ennumerate: it's a big space saver over anything larger, and it's what I had anyway. I bought the curtains on clearance, and the dark fabric does a great job at blocking out light from the courtyard at night, as well as obscuring the afternoon sun on post-call days. And I know it's bad sleep hygiene, but I love reading in bed with only lamp-light, and when the time comes, turning off the lamp and drifting into peaceful slumber.

At the food of the bed, I've placed my green armchair, which has appeared in a couple earlier posts. It's coziness quotient is increased by the crocheted afghan my mom made. Behind the armchair is a compact bookcase which houses a goodly selection of reading material.

And lastly, we have the other longer wall. I bought the desk for $35 from a friend moving last spring. It's a ful five and a half feet long, but at only 20 inches deep, it saves space. The dresser is angled so that I can store my suitcases behind it since there's not enough room in my 8 square foot closet.

The best thing about the room has been its teaching me to live simply and throw out things I no longer need or have room for. And I like the simple bold colors: navy curtains, red desk chair, green armchair. And lamps.

Texas wildfires

Just wanted to share this striking picture. It was on the front page of the Dallas Morning News on March 14, 2006, and the photo was taken by Daron Dean. Grass fires are so foreign to my world that it's hard to imagine here in the 21st Century the lack of control we see with something so primitive and elemental as fire.

Jonathan follows the rules

I had just visited with a patient in contact isolation for clostridium difficile diarrhea. This is a bug that is spread easily between hospitalized patients, so I appropriately put on a plastic gown and rubber gloves before examining the patient. I was supposed to have washed my hands before exiting the room, but I think I forgot this time.

I opened the door of the patient's room to exit, then closed it behind me. Right then a nurse standing nearby, in a more than subtly condescending tone, said, "Doctor, would you like to clean your hands?" as she motioned toward the sanitizer mounted on the wall nearby.

Appropriately chastened, yet still a little irritated at her tone, I replied rather deceptively, "Hmmm, are we supposed to use the sanitizer even if we wash our hands in the room?" (I knew full well that this would be redundant, but the phrasing of my question implied I'd already washed.)

"Yes. This patient is in contact isolation."

Now, there are plenty of rules and protocols at the hospital, perhaps even too many. It seems that nurses often excel at following the rules down to the smallest jot and tiddle. But in this case, her newly-imposed rule of double hand sanitization seemed excessive. And right then, I remembered a sign on the door. Turning toward it and pointing, I said, "I guess I'm confused by this sign."

On this makeshift printed sign were the instructions, "Do not use sanitizer. Hand washing only." Of course, the intent of the sign is that sanitizer is not sufficient; one should wash with soap and water after seeing these patients. But I felt that it was more important at this instant to teach this nurse a small lesson about following the existing rules without adding her own, and so I relished the act of pointing out the literal and explicit instructions of the sign! Do not use sanitizer!

As she stood there slightly baffled, I smiled and reached for the hand sanitizer as I said, "But I use this stuff all the time! It's great!"

Male activists want say in unplanned pregnancy

This article was posted today on CNN.com. In no way do I mean this posting to be a political commentary; rather, it's intended to highlight a certain line of thought which is now receiving the attention it seeks. I must say that when one considers the ideals of chivalrous knights of yore--bravery, honesty, valor, sacrifice--this article is reminiscent of none. A few of the "nobler" quotations are in italics, and my comments follow each one:

"If a pregnant woman can choose among abortion, adoption or raising a child, a man involved in an unintended pregnancy should have the choice of declining the financial responsibilities of fatherhood." In other words, the degree of responsibility I accept is limited by how accountable another person is for her actions.

"I'm trying to find a way for a man also to have some say over decisions that affect his life profoundly." That's right, because right now men really have no options.

"Roe says a woman can choose to have intimacy and still have control over subsequent consequences," he said. "No one has ever asked a federal court if that means men should have some similar say." What we're striving for is a dissociation between actions and consequences. We must be free to do what we please without dealing with the results.

"The public is still dealing with the pre-Roe ethic when it comes to men, that if a man fathers a child, he should accept responsibility." Precisely.

Everyone's tucked in

This call night hasn't been so bad, except for the 10 pages I received in the span of 3 hours, most of which demanded I either see the patient or at least drop a quick note. A sampling of a few of them:

• The cross-cover patient with a hemoglobin of 4 who got a transfusion reaction when we tried to transfuse her. (I made a call to the attending hematologist on that one!)
• Irate family
• A demented patient who wanted a sip of water, wanted to hold my hand, didn't want me to leave!
• The cross-cover patient who should have been discharged since his stress test was negative, but fell through the cracks for several hours!

But lastly, there was the cross cover patient with a short run of a nonsustained ventricular tachycardia. We usually see this rhythm in patients with sick hearts (notably after a heart attack or with severe congestive heart failure), or with electrolyte abnormalities. I ordered a chemistry panel on this elderly gentleman who, though clear and lucid, was quite content to lie on his bed totally naked from the waist down. I think it weirded out the nurses.

Anyway, I wanted to make sure that he was asymptomatic during his arrhythmia. He was, but he was concerned about the Congestive Heart Failure Information Packet left at his bedside. "Do I really have CHF?" he asked. "Why didn't someone tell me, instead of just leaving this packet?"

I went out to the hall and checked his chart. An echocardiogram had been done that afternoon which showed he had severe congestive heart failure. I went back in, and apologized, telling him usually a doctor would have sat down with him to discuss the diagnosis. I didn't know why the primary team hadn't better communicated with him.

Later, as I was talking to the nurse, I found out that everyone on that telemetry floor receives a CHF Info Packet, whether or not they have CHF! This patient was handed one indiscriminately, but it was reading material he needed in the end!

I think all loose ends are tied up for the night, all the cross cover patients are taken care of, and it's time for me to get a little sleep before the next admit or code!

n.b.: The picture above is a representative patient who is surprised to hear that she too has CHF.

Back on line!

After reviewing the multiple--and at times belligerent--comments in regard to my absence from blogging, I must say that it's nice to be missed!

In the interim, I've filled my time with numerous and varied activities:

• My first experience with Q2 (every other night) call. This was an interesting experience as I worked admitting patients February 28th, and then at 0700 March 1 I picked up seven new patients after handing off my old ones. And then after sleeping that afternoon, I was on call again March 2nd. This delightful scheduling mishap was the result of someone, somewhere, inadvertently having me switch teams although I was on wards back-to-back. All in all, it wasn't too bad, but now I know what some of my surgeon friends experience on a much more regular basis.
• Grading write-ups. My medical students had a big deadline last week, so I spent hours looking over their write-ups and making recommendations for improvements. I even helped a couple of them find a pertinent article to include!
• A grade-school production of the musical Secret Garden at my brother's school. It was a cute little story, made even cuter by the kids' little mistakes!
• A community symphony orchestra performance of Mozart's 25th Symphony and a Wieniawki violin concerto performed by a somewhat lackadaisical Juilliard grad student. Pizza and beer afterward.
• Running.
• Family time with my niece, nephew, brother, brother-in-law, and sisters over the weekend.
• Dessert and entertainment with friends (Brad, Crystal, Bonnie; rum cake and the Academy Awards)