Wednesday, October 07, 2009

How Doctors Think? Oh, my...

Call me a nonconformist -- everybody else does. Yeah, I was the guy with long hair and a ZZ Top beard in college during the height of the "preppy" era. I even went so far as to sew an Izod alligator onto my flip flops just to be annoying. I suppose I haven't really changed. That's why I don't have a whole lotta use for books that paint physicians (or any group, for that matter) with a brush as wide as a '57 Caddy. How Doctors Think, for example, really is more a collection of one man's opinions (like this blog) than a complete investigation into what goes into everyday issues that make us doctors tick. Don't get me started on this guy, either, whose deeply flawed study on checklists in the OR has unfortunately been adopted as Gospel without being objectively repeated and verified.

So, how exactly do I think, you may ask. The stream of consciousness in my head that passes for rational thought is populated by all of those doctors that influenced me along the way --- their images and words just fly by so fast at times I have a hard time keeping up. Here's a little preview of a typical day for me.....

Me, pissed off that we are yet again not starting on time in the OR.

Ma'am, we are surgeons and we are here to operate. We're just waiting for a starting time. That's all.

Me, talking to an administrator.

You're hiding... hiding behind rules and regulations. ...Logic? My God, the man's talking about logic; we're talking about universal Armageddon! You green-blooded, inhuman...

Me, seeing someone who presents a difficult diagnostic dilemma.

I think we may go mad if we think about all that.

Me, irritated at one of my more senior partners showing up late.

Someone get that dirty old man out of this operating theater.

Me, when audible bleeding is found in a trauma patient.

Work faster, Doctor!

Me, irritated at the patient who assumes that I take every Wednesday afternoon off to golf.

Oooh, cutie pie, eh?

Me, at 2:12AM, explaining for the 4,693rd time to the same night shift RN that, yes, this truly is an emergency and I need to get this patient to the OR right now.

Look, mother, I want to go to work in one hour. We are the Pros from Dover and we figure to crack this kid's chest and get out to golf course before it gets dark. So you go find the gas-passer and you have him pre-medicate this patient. Then bring me the latest pictures on him. The ones we saw must be 48 hours old by now. Then call the kitchen and have them rustle us up some lunch.

Me, beating myself up while waiting on a CT to see if I may have missed a diagnosis, second guessing myself over a possible error in judgment, or while I'm just plain worried about a patient.

You bubble-headed booby! You realize what you've done?!

Me, finding an abdomen full of stool from perforated diverticulitis.

You put me right off my fresh fried lobster, do you realize that? I'm now going to go back to my bed, I'm going to put away the best part of a bottle of scotch...

Me, talking to myself when I'm getting ready to start a case.

With a knife in your hands?

Me, trying to be patient when I have a full day of complicated cases lined up and a new scrub tech student in the room.

And then give me at least ONE nurse who knows how
to work in close without getting her tits in my way.

Me, seeing a drunk and abusive idiot just brought to the ED after his third MVA in as many months.

Oh, a wise guy, eh, I gotta good mind to hand you a ticket. Where's your driver's license?

Me, cautiously entering a no mans land of inflammation and adhesions in a multiply operated upon belly.

Is it safe?... Is it safe?

Me, meeting with the hospital CFO.

Silence, you ninny.

Me, scalpel in hand, ready to get to work.

Nurse: Everything''s ready.
Moe: We''ll make an incision like this.
Curly: No, we''ll make an insertion like that.
Larry: No, we''ll make an excursion like this.
All Three: Tic-tac-toe!

Me, hoping for a break from taking trauma call.

There's a CATCH...Sure. Catch-22. Anyone who wants to get out of combat isn't really crazy, so I can't ground him.

Me, getting some insight on how best to proceed in a difficult case

Sir! I have a plan!

Me, exasperated with some supercilious JCAHO reviewer.

Laugh-a while you can, monkey-boy!

Me, to my partner, trying to break the tension in a difficult case.

If this guy knew the clowns who were operating on him, I think he'd faint.

Me, dragging my ass out of bed at 5AM to make rounds before the 7AM meeting that precedes the 8AM start of a full OR day.

Now come along with me, you ludicrous lump, there's much to be done!

Me, wondering yet again if I made the right career choice.

I been in the right place
But it must have been the wrong time
I'd of said the right thing
But I must have used the wrong line
I been in the right trip
But I must have used the wrong car
My head was in a bad place
And I'm wondering what it's good for

Me, with my end-of-the-day martini.

Wonderful stuff, that Romulan Ale...I only use it for medicinal purposes.

Me, when asked if I'd like a refill on said martini.


For those of you too young to know, these are direct quotes from (in order) Hawkeye Pierce in M*A*S*H, Dr. McCoy in Star Trek, Dr. Zhivago, Hawkeye Pierce, Dr. Phibes, the Three Stooges, Trapper John in M*A*S*H, Dr. Smith in Lost in Space, Hawkeye Pierce, Dr. Phibes, Trapper John, the Three Stooges, Dr. Szell in Marathon Man, Dr. Smith, the Three Stooges, Dr. Daneeka in Catch 22, Dr. Strangelove, Dr. Emilio Lizardo in Buckaroo Banzai, Trapper John, Dr. Smith, Dr. John, Dr. McCoy, and the Stooges.