emergency medicine: kinda like an un-funny version of "Scrubs"

Warning: the following is a complete waste of time!

I've always been interested in the social construction of health and disease, the supplanting of religion by science, the perception of healthcare and medicine by society. So it's interesting to see what people assume about you-- good or bad-- when it is revealed that you are a doctor. Also, some of it stems from the fact that so much of your time/development/personality goes into medicine that you can't help but view even your own life through a medical lens. As when JD in Scrubs looks at all of his friends in terms of what's likely to kill them. So, it's fair to say that at times my life does feel like an un-funny version of "Scrubs." (probably something from season 4-- was that the low point or what?). Anyway, interestingly, a survey of the ACP (Internists' professional association) a few years back asked what the most realistic medicine show on TV was. "ER" won at the time, I think primarily because it was the one most watched and most familiar to people. But "Scrubs," a comedy focusing on the absurdity of medicine and the hospital as work-place, came in a close third-- and this was after only one or two seasons...

Maybe because it's so related w/ questions of our own mortality and what it means about how or when we die, everyone has an opinion about everything medical or health related. Especially as we ?finish/enter a acrimonious "discussion" about how we'll be paying for it all-- or not.

http://www.theamericanscholar.org/to-die-of-having-lived/

To quote Sir Ken Robinson, "It is one of those things that go deep with people, you know, like money and religion, and other things."

http://www.ted.com/talks/ken_robinson_says_schools_kill_creativity.html


It is a universal preoccupation.

And so it deserves to be mocked.

I think ER in particular lends itself to a certain kind of gallows humor. And also a certain amount of frustration (there are facebook groups "911 is for emergencies" and "being drunk is not an emergency" started by fed-up providers) that is sublimated in this same sense of humor.

So, here are a few of my favorite medically-related comic moments from various internet sources. I'm sure you can think of a few others.


Man Stroke Woman -- hysterical British series starring among others Nick Frost from Shaun of the Dead and Hot Fuzz fame:

ER Gyn exam- http://www.youtube.com/watch?v=1wAYCgqc2uk

"May I be blunt with you?"- http://www.youtube.com/watch?v=_Eng-pRT9uA

Breaking bad news - http://www.youtube.com/watch?v=ka0_wc4n8oc

Intimate role-playing, nurse - http://www.youtube.com/watch?v=rZIb1VPEpEk


This is a good website where apparently you put in a script and they create a cartoon based on it. This ER patient is a composite (probably) but it's not far off! (thanks Dr. Boddie) - http://www.youtube.com/watch?v=_m64cy1MMPg

At big centers, we often refer to patients sent in from outlying (and often smaller and less-resourced) health institutions as being sent from an "outside hospital." As in, "this is a 45 yo M referred from OSH on 11/3/10 for cough w/ a presumptive dx of..." This is a vid from med students out at University of Pennsylvania detailing a few issues w/ some referrals - http://www.youtube.com/watch?v=xskFo75Wdhs

n.b. - "cathing" someone is a procedure that interventional cardiologists get paid a bit for in private practice. The other jokes are quasi inside jokes at the expense of the care providers being commented on. A favorite pass-time in medicine...

The outstanding movie Spies Like Us has hundreds of great moments. One great one is the "doctor" bit in which Chevy Chase and Dan Akroyd play spies pretending to be doctors - http://www.youtube.com/watch?v=AqBPOWpOg0o

Another great moment is when they do a surgery w/o knowing what they're doing, but I couldn't find it apart from in Czech!

The comedian Brian Reagan has a great take on his Emergency Room visit - http://www.youtube.com/watch?v=b-JRQXYy9wk

You can always count on Monty Python for good stuff. This Hospital Sketch from "The Meaning of Life" hits the heroism of the hospital administrator on the head - http://www.youtube.com/watch?v=lxOu1DyVQV8&feature=related

The Onion is fantastic for some of my favorite bits:

Preparing for a hospital stay - http://www.theonion.com/content/node/38410

kidney donation video - http://www.theonion.com/content/video/anonymous_philanthropist_donates

an excellent example of the need for "further research" in academic medicine in which studies of the overtly obvious or esoterically irrelevant can be the basis of an entire career -
http://www.theonion.com/content/video/study_multiple_stab_wounds_may_be

Organ and tissue donation, anyone? -
http://www.theonion.com/content/video/medical_miracle_man_lives_thanks to stolen heart

"You are only as old as you feel" -
http://www.theonion.com/content/video/worlds_oldest_neurosurgeon_turns

And finally, a few bits from Scrubs, which thru Season 3 was some of the best stuff on TV (I hear Season 5 picked up a bit) - http://www.youtube.com/watch?v=wLGT24NYguM&feature=related

Dr. Cox, my personal hero - http://www.youtube.com/watch?v=rRBq-6lVxzU&NR=1

Good luck!

--andrew s.

224 South Exeter is not that into you... and other stories

unfortunate hair --> responsible man

It has been some time since I've been able to update the doctoroffortune blog, so I'd be surprised if it's still being checked. But, that's primarily because I've been having some fun and doing a few thins (hopefully) worth blogging about. Interestingly, I've also been pressured by friends to get my photos up on Facebook where they're more easily accessible, so it's kind of interesting to think of how the medium changes the message. Blogspot is a little slower in uploading photos, but obviously there's a larger space for narrative. How would this change how you tell a story, or which story you would choose to tell? Looking at what I've chosen to write about, and what pictures I've chosen to upload on Facebook, I think that the blog is more about my experience of the situations, or at least my observations of them, than the situations themselves, which make for better snapshots.

Ants at "Jonestown" They of course have developed some kind of immunity and are now again overrunning my apartment....

In any event, time has flown here. It's hard to believe that I'm having to start thinking about cancelling my salary packaging and so on-- I've not even gotten all the Christmas gifts out! But it has been fun. Below are a few pictures from the Launceston City Park event "Carols by Candlelight." Given the late sunset, it was still pretty sunny out for most of it. Also below are the lyrics of "Six White Boomers," which is about Santa using kangaroos to pull his sleigh. Yeah, no one here knew the words either...

www.tasgreetings.com/boomers.html

There've been a few concerts and so on in Central Park, including Symphony under the Stars, when the Tasmanian Symphony Orchestra would play. There was also the Festivale, which was a food/wine tasting shin-dig, at which I saw "Mariachi Australia." Kind of awesome & hysterical. I have Snr. & Snra Marlow to thank that I knew the words to "cellito lindo" and sang along in Tasmania. Life takes you weird places, anyway.

Of course, there are still the things that make me giggle inside. Like, for example, this ad for "homely" accomodation...

As far as the title goes, I'm not a huge fan of romantic comedies in general, but my old roommate Brian let me know about this scene in "He's Just Not That Into You" a few months before it came out. That's right, _before_ it came out. I'd moved up to the Bronx from 224 S. Exeter (or "sex-eter," as I pronounced it) and got the call from him that they were filming a movie and using our house as a location. So I finally got around to checking it out:

It's in this scene, and Jennifer Connelly pulls up outside her (our!) unit in a Baltimore townhouse block, walks up to the door, and -cut!- That's about it. The rest of the interior shots were done elsewhere. But first, a shout out to Little Italy and Vaccaro's cannoli and the bocce courts around the corner. So, apparently what happened was an Assistant Director got Brian's permission to film the facade. Then they came and replaced our rusty mailbox, improved the shaky fence, and put in a new screen door. They filmed the 3 seconds or so of screen time-- then took everything down and put back what was there before. I later learned that the place was supposed to be undergoing renovations in the movie. Ok-- three things. One, if you have to do that much work, why not just pick a door you liked better to begin with. Two, thanks for the comment on my place-- that you had to spruce it up to make it look like it was in need of renovation. And three, can we have some of that stuff back?

More soon....

--andrew s.

Shorn Sheep Look Ridiculous

It's true-- but I wonder if they're ok with it because they're not as hot as their un-sheared flockmates? I didn't get pictures, unfortunately. The sheep which inspired the above observation were seen from the car, driving on a trip post-hike, so we were in a hurry and didn't want to stop for pictures.






The sheep field was also located next to a poppy field, which are pretty common here (I'm told Tasmania produces about 90% of the medical use opium/morphine for the Eastern Hemisphere). So not too excited to stop the care and approach the fences (the pictures give an inkling as to why...).




Besides, it'd be a little dicey to go out of your way to spend extra time w/ sheep out in the field anyway. As I said to my friend Dale, “Cloning? I don't know-- I'm kind of leary of any scientific advancement that results from the Scotts doing strange things to sheep.”

Can you imagine if the fences broke down? A bunch of naked sheep, wandering around the countryside, high? Wobbly, naked sheep. We refer to the ability of high-addicts back home to just sort of stand there, swaying slowly side to side, eyes closed but never falling down as the “Heroin Tai-Chi." This could be a potentially difficult to deal with but at the same time hysterical agricultural disaster if these particular fences failed..

A few posts back, I mentioned the group Tripod and a performance of theirs on the TV program “The Sideshow.” Well, I didn't get my shift switched to see them in Lonnie, but I was able to find the song I was talking about online. Sorry for the earlier mis-quotes-- these guys are great. All scrawny, pale technophiles take note! It reminds me of the Onion online video commentary “Are video games doing enough to prepare our children for the coming apocalypse?” Also, watch for the appropriate use of the term “rooted.” “Bush-tucker” is a term for wild game. Sorry for the video/audio dysynchrony.

http://www.youtube.com/watch?v=xetsxpKjmQo&feature=PlayList&p=7F014126BB46D8FA&playnext=1&playnext_from=PL&index=14
For those interested, here is there homage to adult-aged males who still play Dungeons and Dragons on the weekends...

http://www.youtube.com/watch?v=0IgVPnhmVNE&feature=related

Similarly, Tim Minchin is another Aussie musical act that I've enjoyed since being down here...


http://www.youtube.com/watch?v=78XrI_2bPVA&feature=PlayList&p=E2C04E96920A17A5&index=3&playnext=3&playnext_from=PL



And I thought I'd add the following text from an email I received from a patient down here. It contrasts sharply w/ the experience a friend of mine (an OB) related of a patient opening up the initial conversation with the threat of a lawsuit. Yup, it's a different world...

"Dear [AWS], This is just the briefest note to express our appreciation of your advice and help when [E] presented at your emergency department with a Lt. basal pneumonia on 26-12 09. I am pleased to say she is responding well and almost apyrexial now. I hope to meet you sometime while you are here and will be in touch again. Yours sincerely, many thanks and best wishes, [...]"



Anyway, about to head in for another weekend of "babysit the drunk head traumas and hope no one herniates until the morning." Not to stereotype, but people love beating the hell out of each other out here. I mean, for a relatively moderately sized town, there are quite a few "bashings" a night (I heard "bashing" referred to as the cause of death of an off-duty cop on the news the other night. I guess in the States we'd say "beating death"?). So no guns, one stabbing, but plenty of blunt trauma on the weekends, which is a little unsettling. Makes me wonder if I've got post-traummatic stress disorder from my mugging... :)

A good friend of mine said, you know you're getting into a little bit of a self-pity mode about your relationships when pop songs start speaking directly to you (you know what? He was just pushing my love over the borderline..."). I think this relates to High Fidelity's point of "Did I listen to pop music because I was miserable? Or was I miserable because I listened to pop music?"

While not miserable or self-pitying, I thought I'd throw out these lyrics to a few of my favorite songs I was listening to again (gotta love the "shuffle") for good measure. 10-points for identifying the first, 20 for the second. Cheers, --aws

"Some say life / will beat you down / break your heart / steal your crown /
So I started out / for God knows where /
I guess I'll know / when I get there..."

we break and train our children just like animals
we fill 'em up with parasites of poison dreams and fear
We hand 'em false gods on a golden platter
then we remind them to wash behind their ears

We gave up our own dreams so the kid could go to college
then they grow up and resent us; accuse us of impossible psychological crimes
the normal relationship in Hell is about getting even
but you won't find that in your Sunday New York Times

Anger Sadness Hatred Envy--
these are just Fear wearing the same old cheap masks
You're doomed if you don't learn forgiveness, Sister
we're all driving around lost, we don't know who to ask

We're all stopping at abandoned gas stations to ask directions
there's no more road maps to tell us who the hell we are
raised on TV commercials, organized religion
following corrupt wisemen who've been navigating by
the wrong star...

We've reached the end of the road and find out no one else can make us happy
we've waged all the wars of drama and control
we've sacrificed it all for wives husbands money children false religion-- that old line about gaining the world but losing your soul.

Hiking: Western Tiers Region- Quamby Bluff and Meander Falls to Split Rock Trails

So, was able to get out and around the island some these past weeks. It is actually very nice country, with an interesting range. Getting transportation arranged has been a bit, but now at the point of getting to see some of the island, which is great. My friend Young has been up for coming out to some of these spots, which has been good. Of course, the whole “hiking” (here, “bushwalking”) concept has taken some getting used to for her (“Yes, there will be insects and worms. Yes, we have to carry our food and filter our water. Yes, there will be mud” [ala Daniel Day Lewis...]).

Anyway, we first tried out Quamby Bluff, which was just a bit of a day hike a few minutes south of... the hamlet?... of Deloraine. Quamby was fun, but certainly after years of New York living my wood-walking legs needed to get used to things again. And yes, I really am that pale..

Later on, headed out to Meander Falls. The first bit was fun, and though the falls themselves weren't the most impressive things in the world, the terrain felt a bit more varied than that of Quamby. Because of a late start, once at the falls we had the option of returning via the same route or taking the Split Rock trail back to Meander Road. It was reported to be a tougher track, but faster. Yeah, not so much w/ the faster part. I think the only time I was ever really worried that I would die out in the woods was during a trip to Puerto Rico w/ my girlfriend at the time when we went off-trail for a bit, got lost, and a few hours day hike ended up as an almost overnight. Luckily captain Boy Scout had brought along some food and flashlights. Oh, and another important safety tip: if you're going to rural Puerto Rico, it's important to tell your travel companion that you have an anaphylactic allergy to banana before you go. Also, it might not be a bad idea to bring along an epinephrine injector. Just a thought.

Anyway, the least amusing part of the Split Rock trail was when there was an impromptu conference on the dolerite boulder scramble (marked by questionably maintained carins only for its length) that began with “This is terrifying. I don't want to do this anymore,” was punctuated with glucose repletion, and ended with “I know this is tough going, and I'm sorry and would like to let you rest more, but we really need to get off these rocks before the sun goes down.”

The most amusing part was how many times after that I said “Not far now..” (about 15 min intervals). I felt a bit like Papa Smurf ... http://www.youtube.com/watch?v=Vi0tje6xfWs

Still, some good pictures :)

And, 35 points if you get the reference made in this video (I couldn't even find a link to the scene in You Tube!). Yes, I recognize I said "underwater" river as opposed to "underground" river.

Cheers,

Uncle Traveling aws

“I cannot be held responsible for what my giggling little hind-brain may kick up”

I found myself in a large performance space, with tiered risers and chairs and music stands arranged for the orchestra that was present. The amphitheater was filled with teen and pre-teen wunderkinds all playing violin. Along with myself, also holding a violin and bow, but not able to keep up with what was most likely Mozart's Eine Kleine Nachtmusik, K525, Allegro. So I just sat there looking at them. This is likely related to my college-age attempt to learn to fiddle, my current attempts to teach myself guitar, and the 15 year-old guitar playing psychiatric patient I'd seen the day before. After the session, I left the building and found myself walking up the slope from the Hill Theater at Kenyon College, still toying with the violin that I was carrying. I was asked if I played often by one of the early Harry Potter-esque younglings that was leaving with me. Nope, just learning.

I walked up spiral stairs that I recognized from the old Philip Mather Hall, entering a room reminiscent of one of the small-group seminar rooms of Kenyon College, perhaps Ascension?, complete with wood panels, large tables with high-backed chairs, and narrow neo-collegiate-Gothic-architecture leaded windows. You know, the kind that grace the pages of the Kenyon brochures (“Our student to teacher to cow to corn ratio is 3 to 1 to 2 to 17,000!”).

Myself, Junior Year, with Tim Shutt as Santa (Kenyon, 1997)

As I circled the table (“rectangled” the table?) to grab my seat, Mr. Campbell, my 9th grade Drama and English teacher at Jackson Junior High, looked up quizzically and asked, “Hunter transfer?” This was interesting because my only associations with Hunter College are a reference f om Terry Gilliam's “The Fisher King,” as a subway stop on the Upper East Side 6 train, and where my girlfriend completed a masters of Social Work-- the latter two being several years after Kenyon and at least a decade after junior high.
No, I was just attending as a “conditional” student-- meaning I signed up but could not be assured of a place in the class. I knew it would be good to take this apparently philosophy course for my personal education even though it wasn't my field and would be new for me. I might have to end up auditing, or taking it for no credit. Especially, Mr. Campbell pointed out to me, as I hadn't taken the required seminar the semester prior. He slid over to me a brochure of the same, which had former Kenyon President Rob Oden's picture on the cover.

The class continued with the student to my left, who turned out to be Wes Overby, a kid I knew from elementary school, but who looked like he did in high school (long hair, earring, I think a Metallica t-shirt) reading from a small booklet of what sounded like Austrian German philosophy. In Austrian German. All I know is that he seemed to be reading from the middle of the page up, to “heighten the emotional impact” of the text, he said, when Mr. Campbell pointed this out to him. And that at one point he said the word “auerwuff,” which I don't think is a real word, but which I transcribed in my book as “Airwolf?!?”

It was then my turn to read. I struggled over a few of the words, affecting a thick movie accent (half of speaking a foreign language is a fake accent anyway), before Wes and Mr. Campbell started helping me by pronouncing the words along with me. I eventually asked if the required seminar was one in which you were taught Austrio-German. Across the table, a stern looking blond body-builder type who had no business being a college student-- in fact I'm pretty sure he was the Austrian hit-man from “Tomorrow Never Dies,” the Pierce Brosnan James Bond movie-- sneered and took over reading.

So, interpretations? I'm open to them-- fear of trying new things? Too many movies seen? Too many shifts in a row? Let me know what you think. Today, I have to do some left over dishes, go grocery shopping, practice some guitar, do some of the CORD tests online for Board Prep, and head to the hospital to do some left over charts. Then hopefully head to the West Coast for some beach time. Obedient to some strange spell,

--aws

Merry Christmas!!

Just remember, I get to open my presents about 16 hours earlier than my brothers...

:)

Merry Christmas!

Apologies for the blog delay-- been trying to work a few things out here in prep for heading back home. Apparently, I'm in need of a "career." Who knew?

In any event, the days have brightened up and here the solstice in December is the longest day of the year. Back home, my brother is dealing w/ mountains of snow in DC. In HI, my other brother is I'm sure doing just fine (sigh!).

The TED website really is fantastic and I wanted to share the following link:

http://www.ted.com/talks/ryan_lobo_through_the_lens_of_compassion.html

We'd heard all about General Buck-Naked while in Liberia, though I never met him (obviously).

These are a few pictures from around the 'Merican Thanksgiving table:

And here are a few of the DEM Christmas Party:

Time has gotten away from me and I need to head in for another shift. Things are a little tough @ the hospital now w/ staffing issues, so that's an excitement. I'll likely be off camping for the actual Holidays (nothing says "Christmas" like scraping a leech off your skin w/ the back of your knife...), but hope everyone enjoys them at home. There's a postal strike on in Aussie now, so I'll pretend that's why I haven't gotten your presents in the mail!!! :(

cheers, --aws