Monday, December 20, 2004

Bangkok

Things are a little strange here in Bangkok. I got in late from a 24 journey from new york to an airport hotel in Bangkok for a night before heading off to cambodia to see Angkor Wat, the largest temple in the world. I was guided to my room by the bellboy who on the way up to the room told me that he liked california and "boy-on-boy" which I thought was a little strange. He then proceded to ask me if I liked "boy-on-boy" and offered a personal massage even after I told that I preffered women. I feel like in the US this would be lawsuit material, but this is thailand so I just shrugged it off and went to sleep feeling slightly violated.

Jet lag, damn, my mind is broken. Cambodia here we come.

Thursday, December 16, 2004

Goodbye Speculum. Hello the Rest of My Life.

There is an outside chance that I will never have to be personally involved with the operation of a speculum ever again in my career and I am embracing that chance with pleasure. Some things just aren't your thing. Dear GYN docs, thankyou for all that you do so we don't have to.

In three days I will be venturing to Cambodia/Thailand and lets put it this way: If you leave NYC on a sunday, you can expect to get to Cambodia on tuesday three flights later. That should be interesting.


Catholic Medical Centers

Catholic medical centers refuse to provide options such as tubal ligation to older women who do not wish to become pregnant in the future. Did god say that tube tying is not allowed? No. Is tube tying abortion? No. Is an unfertilized egg a person? No.

Catholic medical centers believe that all methods of birth control (even between monogamous married couples) are morally wrong. The only method of birth control condoned is the rhythm method, which has a failure rate of up to 40%, ie it doesn't work.

So the point being: This is a bunch of bullshit which is why residents prescribe birth control without documenting it in patient's chart or if it is documented medical reasons for the oral contraceptives are falsified.

This brings us to the question of the day:
Q: Does the bible mention the use of tubal ligation or oral contraceptives?
A: No.

And remember, we are not talking about abortion here (oral contraceptives inhibit ovulation altogether).

Wednesday, December 15, 2004

CD4: 8

CD4: 8. It is hard to diagnose patients who do not have an immune system. What might they have: anything and everything. You mean 80 right? No, CD4: 8. Good place to start: Diflucan.

Everyone, well not everyone, but a significant percentage of our patient population has HIV/AIDs. So many patients have HIV that every prenatal patient is screened for HIV and HepB and TB. This is not the national standard. This is the high-risk standard. This is the metro NYC standard of care.

If you are like me you did not have a good grasp on the "underground" in the 80's. Maybe this is due to the fact that I turned 10 in 1989. Therefore, I was decently versed in mainstream media and music but missed out on the "good" music. Thankfully a recent release has changed all of that: Left of the Dial - Dispatches From the 80s Underground (www.rhino.com). If you missed the 80s or want to relive them, I would start here.




Tuesday, December 14, 2004

Clinic Woman

Picture me, I'm forty years old and pregnant for the second time. Last year I got in a fight and and my spleen ruptured so I have this giant scar from my sternum down to my pelvis. I varicosities in my legs and venous stasis and my veins are fucked up from shooting drugs and I have scars on my face and my left ear had an earing ripped out of it so there is a big tear in my ear that was never sewn back together. I'm pregnant with my second child and I'm forty and I work all day lifting heavy boxes. I am missing half of my teeth and I don't have insurance. There isn't even enough time today for me to tell you about my problems and pain? you askin me about pain? My legs ache and my baby keeps kicking me all day and night won't leave me alone. Pain? Kid I've been through more that you can ever imagine, you with your white coat and your pressed shirt and parted hair and tie and shinny shoes. You will never be able to relate to what I could tell you about my life. You will never.

Monday, December 13, 2004

Cancer

This woman is crying and pleading with my attending physician to leave her ovaries intact if she is not going to live very long. She is sobbing. She doesn't want her insides removed if she is going to die anyway. She says it is her life, that it is the only thing she has and that this is her opinion. She has colon cancer and probably metastasies to her ovaries that need to be removed. She is begging us to understand and to listen. My attending physician says he will leave as much as possible while removing the cancerous sections. She is confused and thinks she only has a few weeks to live but she will probably at least live a few more years. She doesn't speak english very well and its hard to understand doctors because they only know how to speak in doctor dialect. They pay very close attention to the detail of each word used for legal reasons. All they can say is that they do not know how long she will live. Its impossible to say right now. We can't see into the future. All we can do is cut you open and take out as much cancer as possible then sew you up and give you chemo and radiation. She says that she is not scared of dying. She just wants her wishes fulfilled. She feels out of control. I guess its frightening to put your life into the hands of others.

I went to the MoMA (www.moma.org) this weekend and discovered vast collection of creative misery and mystery. Do you have to be miserable to create the art of museums? Its hard to name a great artist not a victim of self-torture or self-mutilation or self-destructive drug use. Is confusion the path to artistic genius? Does the struggle just burn stronger in some than others?

Path to enlightenment: www.thiswebsitewillchangeyourlife.com I'm serious. I swear I am.




Saturday, December 11, 2004

Burgandy

Luckily Obstetrics and Gynecology lasts only 6 weeks. This means that pap smears and pelvic examinations and impersonal, expressionless, disgruntled residents will no longer dominate the daylight hours. Are you having in vaginal discharge? How would you describe this discharge? Is it malodorous?

I need insight via burgandy. A bad habit started in college involving writing papers half drunk and recieving better grades on the drunk ones then the sober ones. I think the alcohol can allow you to take harder stances on the issue at hand. There is no sitting on the fence when you are drunk. Professors hate it when you sit on the hypothetical fence. The course was in Greek religion and the professor had a tatoo of a woman riding a dragon on his shoulder. He was brilliant and he one night a year ago he shot his girlfriend and then himself. They were both found in bed, naked and dead. In bed, naked and dead. That has a ring to it.


Dave Gorman is a Genius!

A good day means no pap smears. A good day means as little contact as possible with these residents and attendings for the next few days. Today a young couple comes into the clinic and she is five months pregnant with pain and a sore throat and she says she can't affort a small bottle of tylenol. I tell her I'm sorry and that we don't have any. She should go to Duane Reade. She's nineteen and her boyfriend says she can get the money from her mother. She denies the likelihood of these prospects. Its miserable and raining as it has been lately. I just saw googlewhack(www.davegorman.com) in the Village Theatre a few days ago and I'm feeling inspired to get the hell out of this place and leave it all behind in pursuit of ridiculous shit for no reason. All of these doctors with there expressionless faces and stress cases are getting into my head. Dave Gorman is a wise man. Googewhack=a web site that can be found with the google search using only two words in the search and google only finding one site. ie type in two words and you come up with one website out of billions. Its a little harder than it sounds at first.

Manhattan is a million times dirtier when it rains and the garbage mixes with the water and spreads out over the concrete collecting in puddles. Some people come to the ER just to get off the street. They leave when we start sticking them with needles and making their lives as miserable as possible. If you've been in a busy city ER then you know what misery is.

This week a young woman walks in with the complaint of vaginal bleeding for the past few days. She is 15 weeks pregnant but the ultrasound shows a fetal size of 8 weeks and there is no heartbeat. She is diagnosed with a missed spontaneous abortion at 8 weeks. The fetus has been dead for two month and it is still inside her. Unfortunately it is our job to remove the dead baby from her uterus. Luckily one of the operating room techs speaks mandarin so we can explain to her the procedure. She seems confused and says multiple times in English "Baby Ok, Baby Ok." I wanted to say no baby not Ok but instead I let the tech continue to speak loud mandarin in a manner which appeared very matter of fact. Everything is matter of fact in a hospital and not because the staff and doctors are incompassionate by nature but instead it is how we cope with what we do. Mam your baby is dead so we are going to take it out. The complications are bleeding and unlikely, death. These are always the complications of a procedure, bleeding and death. You might get one, two or both. I will spare you the details of the procedure performed but lets just say it involved accessing the uterus through the vagina with a high powered suction device to access and remove the "products of conception."

The crowded subway is wet from all the wet people. Put on headphones and ignore everything and everyone. Go home.


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