Police Ride-Along

I went on a police ride-along the other night. It. Was. Awesome. !

I got assigned to a lady police officer (as most of you know, I am also a lady!), and she was Jewish (what are the odds! I am also a police officer! I mean, Jewish!), annnnd she was hilarious. We first responded to a supermarket shoplifting case which turned out to be a FELONY because the person had prescription pills they had bought off the street (obviously with no prescription). According to the supermarket security, a lot of drug users steal tin foil so they can use it to free base (if you don't know what this means, look it up on urban dictionary just like I had to). Oh alright, I'll help. Apparently certain pills, such as oxycontin, are abused by rolling them around on heated tin foil and inhaling the fumes.

Oh no- I just said how to use a drug illegally! Aren't I worried about the info reaching the kids? I would say no, because I'm sure you could get much better and more detailed instructions just from paying attention in D.A.R.E class. Do they even have those anymore?!?

Point being: drugs are bad. Especially prescription drugs that are bought off the street. Why? (A) Drug dealers DON'T CARE about their clients. How do you know this for sure? Because they are SELLING you things to HARM YOURSELF with. Okay. (B) You can't trust a drug dealer [please refer to (A)], so how do you know for sure they are selling you what you are paying for? There are tons of pills that look and taste about the same. I've actually seen a couple of times where people come to the ER after collapsing, and are found to have mysteriously low blood sugar even though they have no history of diabetes. When they are revived, the only recent ingestion they report is "street valium." WTF does that mean? There is a diabetes medication similar in size/color to valium. The HUGE DIFFERENCE is that if you abuse the diabetes medications, it will give you prolonged hypoglycemia (drop your blood sugar dangerously low), quite the opposite of a high (pun intended). Terrible joke. But seriously kids, don't do drugs.

Back to my story. So we arrest the shoplifter and take him to jail (and when I say "we" I mean the police officer did all of this and I was following her around silently thinking the whole time "No way! No waaaaay! I'm in a jail! A jail!!"). I felt bad for the shoplifter and for everyone else there. Jail is a scary place. The one we went to was like a big concrete cave full of all kinds of people you don't want to be locked in a concrete cave with.

Other adventures that night included trolling around midtown for a drug dealer's car, driving through a residential neighborhood searching for a "suspicious" looking man, helping relocate a mentally ill woman who was evicted and directing her to resources for housing and social services, and driving along the light rail tracks in pursuit of a suspect. Who was riding the light rail, while drinking stolen alcohol.

And he got away.

Anyways, I learned that police (1) have to be incredible multi-taskers, (2) are well versed in community resources, and (3) put up with a lot of crap.

(1) Can you carry on a text message conversation with two friends, look somebody up on facebook, google a number, and do your job on your touchscreen laptop, all simultaneously, while driving? This is essentially what the police on patrol do every day. They have computer screens and keyboards in the car, which they use to send messages to headquarters or other patrol cars, use a program for running license plates, a database for looking people up, and they are continually getting a stream of new "calls" in to respond to (such as burglaries, disturbance of the peace, collisions, etc). They also have radios they need to be paying attention to at all times, and staying mindful of where their colleagues are so that if one of them started yelling for help they know where to go immediately instead of wasting time trying to figure out where that person is. Did I mention that this is all done while driving?

(2) Patrol officers need to be able to know their neighborhoods well not just for navigation, but also for using community resources effectively. The officer that I rode along with had to help an evicted woman find a motel for the night, and because she also knew where the local shelters were, she was able to pick the least expensive motel that was also within walking distance of the nearest shelters. Being able to see how community assets interface (in this case, the police officer referring a mentally ill woman to proper housing, social and medical resources in the community) was really great.

(3) Police officers put up with a lot. In a space of maybe 3 hours, 3 or 4 cars honked loudly and noticeably at the officer I was riding along with. I get alarmed when someone honks their car horn anywhere near me when I'm on the road; can you imagine getting honked at like that on a regular basis? One of the times a person appeared to make a sharp turn JUST for the sake of pulling up behind us and laying on the horn- the officer was worried that the person behind us was trying to hail her, so we actually pulled over to the side (and she also pulled out her gun just in case), to see if the person was going to pull up beside us... and they drove away. WTF man, they just drove up behind us to honk!!! This happened a few other times as well. I asked why she didn't just pull the cars over for doing this, and I suggested that I would totally have pulled them over and then said, "You were honking at me. I thought you needed my help!!!" She said that people enjoy their civil liberties and don't like being pulled over for no reason, and that "besides, you'd be surprised how often people call in to complain." Complaints about an officer can prevent him or her from getting a promotion, etc.

Speaking of things that suck, the officer mentioned that whenever the police had to go into the ER to get a patient's statement (if they were involved in a car crash or some sort of crime), the ER nurses were pretty consistently rude and unhelpful. They thought they were treated this way because they are police officers. I assured her that most ER nurses are equal opportunity assholes in their approach most everybody else who attempts to interact with them while they are doing the most important work in the world. Many ER nurses are wonderful. But many of them are also turds who are unhelpful at best and often unpleasant to boot. Can you tell I'm excited about my upcoming (mandatory) ER weeks?

I have a new respect and appreciation for what police officers do on patrol. So, the next time you see one of our friends in blue... smile and give them a wave! (Honk if you love having your license plates run!)

Feel the Community

"Community Engagement" week continues. This, my program tells me, is a week where they are empowering me to become skilled in assessing and utilizing community resources. This in turn will make me a more effective physician in my community as I am able to refer patients to said resources. Under this guise, my program sent me to a women's shelter to serve breakfast and lunch for 3.5 hours. I'm all for volunteer work- but when it's actually VOLUNTEERED and not MANDATORY. Most of the time I stood behind a table doling out cereal, nachos (popular), fruit (not so popular- one obese woman asked me what was in the fruit bowl, I said, "Fruit," she said, "What?" and leaned in closer to look into the bowl. "Delicious fruit!" I elaborated, "There are apples, oranges, even some pears!" I smiled. She gave me a look that can best be described as "Eww. You're crazy," and with a disapproving look fixed at the fruit bowl, shook her head and walked on by to get some juice. A lot of obese women walked past the fruit bowel with a dismissive wave of their hands after picking up a donut or danish. That was real encouraging for the doctor working the fruit bowl.) Anyway. Highlights included cutting my hand working in the kitchen, and a squabble breaking out in the nacho line that was eventually broken up by a nun. I spent another 3.5 hours later that evening preparing bags of food for people at the county food bank, which was actually very interesting. I learned about all the other functions that the county food bank serves in my community (they offer adult education classes including parenting skills, English language, job skills, computer literacy, and more, all FREE with free childcare offered at the same time!).

I have to go now. Why? I have to get ready for a meeting with someone who is going to talk about community asset based something or other, and then I have a police ride-along. What does that mean? I don't know. So cheers to that, I'll update you later!

Starting my week of "community engagement". Activities for this week include volunteering to serve breakfast at a food pantry, going on a police ride-along, etc., to familiarize ourselves with community resources. One such resource: Harm Reduction Services (for ex: they run a needle exchange program). Directions for this activity: "corner of ____ and _____ streets. Look for a blue van and a woman named Michelle."

What's in YOUR pee?!?

You know how some fortune tellers are into reading tea leaves? The gross bit that's left at the bottom of a tea cup after you drink it? Well. Nephrologists (kidney doctors) are big-time believers in reading the pee leaves. What the hell does that mean? It means that they don't trust the lab's report from the urinalysis. They have to see it for themselves under the microscope.

Okay...

No! It's not okay!!! Because most of the patients we've been consulted on have been in rooms pretty far from the Nephrology lair. Which means that I have to steal some of their pee, then carry it with me back to our lab set-up, several floors away. That's a lot time spent walking around the hospital with a cup o' stranger pee.

"So hey. Did you just pee in that jug? Okay great...I'm going to take some of your pee now. Yes. This is me, stealing some of your pee, from your pee jug. Now I'm walking away with it. Because the pee analyzing room is 7 floors down, and two units over. So I'll be walking around the hospital with your pee in my hand for quite some time."

I don't know how to end this. This rotation, that is. I'm just kidding!!! It's great! I love it! If you see me in the hallway this week, though, I wouldn't shake my hand. Or investigate the yellow stains on my white coat too closely... (oh come ON man, it's tea!)

....colored urine?

NO, JUST TEA.

Peepee

I'm about to go pick up a urine sample so that I can spin down said sample and look at the urine sediment under a microscope. Ewww!! I have to handle a sick person's pee?!? Of COURSE I do- I'm a DOCTOR! I probably shouldn't have said "Eww!!!" to the Nephrology fellow. OH WELL.

Enchanted Kidneys

FIRST DAY OFF HEME/ONC SERVICE. AHHHhhhhh. RELIEF!!!

The pain of heme/onc was almost a distant memory... until I was paged. By medical records. Once again. To remind me that although I am off the service, although I had finished all my transfer summaries, I still had two DISCHARGE summaries left to go.
...from last week. I have never felt so happy about a d/c summary as I felt after finishing my last summaries for heme/onc. I formally wash my hands of this service!!!

Today I started Nephrology consults. So I am a nephrologist. For the next five days. Except for Friday afternoon, I'll be in my continuity clinic then. It's kind of like how the pumpkin in Cinderella magically turns into a carriage, but only until midnight, when it suddenly and rather alarmingly turns back into a pumpkin. So what I'm trying to say here is that if you have any nephrology questions, you should ask me, but only for the next 3.5 enchanted days!

"Man. I saw my reflection today and I thought, 'Oh my God, I look like shit!' And then I realized...I felt even worse than I looked!" - another anonymous medicine intern on heme/onc

"I am not okay with my patients calling me 'baby'!" - another intern on heme-onc

Use as Directed

One of my neutropenic leukemic patients had a cold sore; we gave him antiviral pills (since cold sores are caused by a herpes virus) as well as an antiviral ointment. When I placed the order in the electronic medical record, it prompted me for directions as to where the ointment should be applied, I typed "lesion on upper lip." Ok, makes sense.

When I went in to see the patient later, he said he had received the new ointment and that it was GREAT. While he was talking, I looked at the little tube, and thought it was strange that so much of the tube looked used up... he said it felt GREAT- on his lips, on his hands, all over his face- it was SO MOISTURIZING!

Apparently his nurse had told him to go ahead and use the new "lotion" all over his arms, his face, anywhere his skin felt dry. DUDE, it's TOPICAL ACYCLOVIR! And this was not a new nurse... anyway, she called me later, laughing about it, saying she didn't realize what it was or what it was for, and that she had encouraged him to apply it liberally all over the place, since "there wasn't any directions what to use it for, I just assumed it was another lotion." Uh- I couldn't place the order without specifying exactly where the topical ointment was supposed to be applied. If you don't read the directions, then yes, you won't know what the medication is used for. Plus- isn't it a red flag how tiny the tube of ointment was? Like maybe this has a specific purpose? Plus, she's been a cancer nurse for HOW long and the name "acyclovir" is still totally foreign?

Anyway, no harm no foul. He really liked the topical acyclovir, and since it's an ointment I'm sure it was indeed moisturizing.

3.5 months into intern yr. Today is the first day I officially regret this.

F Heme/Onc...FONC !!!

Ahhh.... I'm trying hard to find the humor in the AWFUL, AWFUL experience that is Heme/Onc. I'm violating the 10hr rule all the time (supposed to have a 10hr break between shifts at the hospital...allegedly). The nurses pager-bomb us about EVERYTHING ("Just wanted to let you know the patient's temperature is in the high 98 degree to low 99 degree range! It's not actually a fever yet, but it could BECOME one- I just wanted to make sure you were aware!"), so I can't get any of my notes done until late. And I know it's random because we alternate admissions between interns, but I keep getting all the most sick, least stable patients. In the last 2 weeks, I've had 3 transfers to the ICU, 2 near transfers, and 3 deaths on service. Came in today to hear that yet another one of my patients (aplastic anemia and hemorrhaging) got transferred to the MICU overnight. In retrospect, it probably was not an appropriate transfer for Outside Hospital to admit her directly to our Heme-Onc service from their ICU. Anyway.

I usually get to the hospital around 6:15am; I'm there until 8 or 9pm. 10pm sometimes. By the time I get home, eat dinner, bathe... it's 11pm or midnight. I go to sleep, and wake up at 5am to do it all over again. This in itself would be depressing enough; add to it that the entire day we're working nonstop, trying to juggle all our patients (the service has been at or near capped most of the past 2.5wks), who are all seriously ill cancer patients. Seriously ill = time intensive care. Cancer patients = every story is a sad story. There are no happy stories. The closest thing to a happy moment with a patient today: agreed with 27yr old new mother with leukemia that she looked "very punk rock" with her newly shaved head. She had given herself a buzz cut last night since her hair was falling out in disturbing chunks due to the chemo.

Or how about another of my patients, formerly healthy construction worker, now with acute leukemia, usually so cheerful and positive but today... just starting to feel the effect of his chemo. He asks daily about his prognosis (the heme/onc fellow's predictions aren't going to change, they're all based on genetics and his bone marrow biopsy...which we review every single day)- today after he asked his usual questions, he just stared off into space and looked so sad. He looked like he was facing his own mortality for the first time as a real and imminent possibility. Like he was watching his own soul wander away from his body and leave him there, helpless. Then his wife came over and caressed his forehead and told him not to worry, they were going to fight this one day at a time, and she smiled and winked at me, and then she thanked me for "everything" and gave her husband a prompting look, and he turned to smile weakly and thank me also, and wish me a good day. I felt so worthless as I walked away. Thank me for what? The PRN antacid I ordered? I'm not doing anything for you. The fellow wrote the orders for the chemo. I'm just watching your electrolytes and making sure your red blood cells and platelets don't get too low. And as shitty as you feel now, I know you're probably going to feel worse over the next week. And this couple is SO SO SWEET. It breaks my little intern heart.

So essentially this is an oppressive, depressing rotation that consumes all my time. This leaves no time left over for...DISCHARGE SUMMARIES. I got another deficiency notice (see prior post about S/C summaries) in my inbox informing me that I'm behind in my discharge summaries, as well as death summaries (a discharge summary for a patient who dies in hospital... a celestial discharge). I ignored the damn notice because I don't have time to do my laundry on a regular basis, let alone respond to stupid notices reminding me I have work to catch up on.

And then it happened.

CONTACT.

I got PAGED by someone from the medical records department. First thing she does is laugh and make fun of the message on my pager (where I say my name and identify what service I'm on); because I "sound sooo tired! Hahaha!" [strike ONE] She informs me that I am late on two particular discharge and death summaries. I say I know, I am very busy on the inpatient Heme-Onc service, but I will get to them. She tells me that I will do them, and do them TODAY. [strike TWO] I remind her again that I am very busy with sick cancer patients, but that I am aware and will write the summaries as soon as possible, I'll try to tonight after work. She tells me that not only will I write them both TODAY, she also tells me which one I should write FIRST. [strike THREE. Patience is out.] Pause. I ask WHY. She says because they are late. I KNOW. Why does she need them done today? She says.... because they are holding up billing. "Oh I SEE. Well I'll get to them eventually!" and hang up. I stayed (extra fucking) late and did one that night. The other, I still have to do tonight. Then I'll only be 5 or 6 behind.

I hate this service. Last week, after grabbing a hurried lunch in the hospital cafeteria, I told one of the other interns that I refused to go back to work. I curled up into a ball on the floor of the lobby just outside the cafeteria, held up a fist, and said the only way I was going back to work is if she dragged me. Annnd she did, all the way across the lobby over towards the elevators. Apparently the coefficient of friction for white coats is similar to steel bearings because the ride was actually quite fun and the highlight of my day. That's right, I said getting dragged across the floor of the lobby was the highlight of my day. Do you feel better about your life yet? You should!!!