Wednesday, February 20, 2008

Me and My Big Head

Being a physician is for the most part a humbling experience. You think you’ve figured out the key to helping a patient control her hypertension, and the next week she gets admitted to the hospital with a pressure of 230/110. You don’t even think of asking the sweet grandmother about substance use, and she has a stroke from smoking crack. You reassure a chronically complaining patient that her shortness of breath is nothing to worry about, then find out that her oxygen level is low enough to qualify her for home oxygen. I shouldn’t be using the second person; I did all of these things.

But every now and then, you—I—hit one out of the park and feel like a freakin’ genius.

The other day, another attending was supervising the medical residents in the outpatient office when she pulled me away from my own charts.

“You like Derm stuff,” she said. “Maybe you can figure this out.” It was a very young woman who had what the attending and the residents thought looked like bad psoriasis—but it had happened very quickly and in some unusual areas, including in the places where she’d irritated her legs by shaving them dry.

I swept into the room, which was now filled with several residents, a student, and the poor girl, who was sitting on the table clad only in a gown. A red, angry-looking, scaly rash was spread over her elbows, her wrists, her abdomen, her knees, and down her shins. In many places, the rash was in the form of small round patches.

“Mm-hmm.” I said. “Tell me: did you recently have strep throat?”

“Last month!” she said, her eyes widening. The residents literally gasped. “It was culture-proven,” one of the residents said.

“Yep, that’s it,” I said.

What?” they all asked.

Guttate psoriasis,” I tossed off casually. “Happens after a strep infection. What’s on the legs is the Koebner phenomenon.”

Now they think I’m The One.

I won’t tell them just yet about the guy I said could go home who went to the ER instead and ended up in the ICU, intubated, in a hypothyroid coma.

Thursday, February 14, 2008

You Are [INSERT WORD HERE]

Your words are way more interesting than mine. To amuse myself while propping up a febrile three-year-old (who, having finally exhausted the orifices from which noxious liquids can be discharged, is all better), I categorized your words into several groups (and arranged them in alphabetical order – no, my word isn’t “compulsive,” why do you ask?):

Tough Stuff
I was interested to see that this is the largest group. If you find your word in the list below, you don’t break under pressure. What doesn’t kill you makes you stronger, etc., etc. I aspire to be here myself, but I’m really not:
Alive
Assertive
Bitch
Brave
Driven
Feral
Fierce
Impossible
Incorrigible
Independent
Intense
Persistent
Relentless
Resilient
Happy
If you find your word in this category, your theme song is “What a Wonderful World,” especially as sung by Israel Kamakawiwo’ole. We need more of the likes of you:
Content
Fortunate
Happy-go-lucky
Hopeful
Joyful
Loved
Optimist
Positive
Satisfied
Sad
Is your word here? You’re not in a good place. No silver linings for you; life is one big ugly cloud. Your glass is half-empty – or maybe even bone-dry:
Barren
Broken
Disgusted
Hopeless
Jaded
Overwhelmed
Pessimist
Worried
Noncommittal
If your word is here, you have trouble deciding, though you may be charming while you ponder:
Conflicted
Curious
Distracted
Eclectic
Neurotic
Shy
Trying
Undecided
Work-in-progress
Wise-ass
This is the category for those who don’t want to follow stupid rules. You make your own rules, and if you want to have three words instead of one, you damn well will:
Bad Attitude
DILLIGAF (“Does it look like I give a fuck?”)
Friendly Cranky-Pants
Nagging
Shoot here
Smart-Aleck
Smartypants
Whatever
Witchy
Yeah, yeah, whatever
Generous
Not too many people fall into this category, more’s the pity for the rest of us:
Compassionate
Listener
Mommy
Artless
No pretentions here; you are what you are:
Fresh
Genuine
Jennifer
Kosher
Loquacious
Pragmatic
The realists:
Curious
Inquisitive
Realistic
Thoughtful
Sharp-Eyed
It is the last group into which I fall, because my word is:

PRACTICAL

Boring, right? But accurate. This essential aspect of my nature explains many of my choices and actions in life. It’s why I was much better suited to being a doctor than a writer. It’s why I can’t stand spending money on fancy cars or cosmetics or wedding dresses. It’s the backbone of most of my advice to others (“What is it you hope to achieve in this conversation with your ex?” “In deciding what you want to do with the rest of your life, think about what will make you happy to be doing every day”). It allows me to remain Zen-like in the face of “difficult” patients (getting upset will only hurt me, after all).

Being incorrigibly practical has its downside. For instance, it makes it hard to dream big. I hate the interview question “Where do you see yourself in ten years?” because I have a hard time imagining my perfect future. This seems sad. I do save like crazy for retirement, but only because I am following the rules, not because I have any specific plan for what I’ll be doing with the money. Being practical made infertility treatment uniquely awful, because I had a very hard time wrapping my mind around doing it when each procedure was more likely to fail than not. And occasionally my aesthetic sensibilities are pitted against my pragmatism. I learned the hard way that I can’t live in an ugly place no matter how much money I’m saving, but I am feeling very conflicted over our current plans to replace our hideous but relatively new kitchen cabinets with ones that yes, will function better, but mainly will look nicer.

Have I miscategorized? Anyone want to change their word?