Hurricane Jill

Weapons of mass destruction

Every neurosurgery service needs at least one blue-eyed, blond-haired female among its residents and attendings.  I am probably going to be tarred and feathered by my female colleagues for making this point, and yet I doubt anyone could truly deny it with a straight face: most males 15-50 who are in any way conscious and processing visual information are going to have a better neuro exam for someone they find attractive.  Which by conventional standards in our society is the blue-eyed blond girl.  If they’re capable of regarding and tracking, they’ll do so.  If they can follow commands and talk, they will.

The same can be said of female patients and male doctors.  But the fact is that most trauma patients are males 18-35.

I’d always considered looks more of a liability than an asset for women in this field.  You know, the whole, “why do you feel it necessary to do this kind of grueling, depressing work when you could easily have married well, and be off having smart, good-looking children while your husband earns a living instead?”  Nobody really gets it, and frankly I ask myself that question as well.  There’s no rational answer.  Other than that I like to work, and no guy has yet convinced me it’s a good idea to have kids with him.

I’m not against the idea of kids in principle, but I’m not having any unless I also have the resources to raise them well.   End of subject.

Anyway, I’ve noticed that with certain patients, the nurses and I routinely get better exams than the male residents do.  And not just that, I’ve noticed that I get better exams when I wear my hair down than when I wear it in a ponytail or up in a bun or twist.  It’s actually kind of funny, and on a couple of occasions recently I’ve been sent in to see patients in that demographic who won’t respond to any of the residents.  But I can get an exam.  I don’t fool myself that I’m any better at examining patients than they are–it has absolutely nothing to do with skills or knowledge.  But at least I’ve finally found an acceptable use for the blond hair and blue eyes.

The REAL reason there’s a helipad on the roof

My last call was… how shall I say it?… interesting.  We very nearly won the game, at least with respect to the floor patients.  And the ICU portion of the service was relatively small and stable. But contrary to what you might think, it is actually not at all desirable to be going into a call night with a small service.  You see, the limiting factor on the size of our service is not the supply of patients who need a neurosurgeon, but rather the availability of ORs and nursing staff for the ICU.  So all that a small service means is that the on-call resident can get that many more hits before the on-call attending has to stop accepting transfers from the remote corners of our catchment area.

And then, of course, there are always the patients who come in through our own ER and need to be evaluated.  The yield is somewhat lower for these, with respect to problems that might actually be operative and interesting.  But they still have to be seen and recommendations made for treatment or follow up, or potentially admitted for observation.

And for whatever reason, that night we also had several old-school pre-op admissions, where they come in the night before surgery without any labs, studies or even the H&P, and all those things need to be done and reviewed by morning.  These days all of that is usually done at a clinic visit beforehand.  The patient shows up the morning of their surgery, and comes to the floor or ICU postoperatively.  It involves a great deal more cat-herding, in terms of handoffs, coordination of care and paperwork to do it the way we do now, but it minimizes hospital room charges, which by the usual accounting practices is more cost-effective.  If we could somehow quantify those intangibles, as well as resident learning and an overall less frantic pace and fragmentation of planning and preparation for surgery, I think that might not be the case.  But the last 20-30 years’ focus on cost-effectiveness and patient safety in hospitals has come at the expense of medical education and training. Residents are cheap labor, and one role of a good residency program is to keep the service component of residency subservient to the learning and teaching components.   An unintended consequence of all this concern over money has been a significant decrease in resident autonomy. You can’t bill for services if the attending wasn’t directly supervising.  Not to mention the public outcry over the idea that a resident may actually be directing Grandma’s care over at the county hospital, without significant attending supervision. This kind of fearful overprotection has paralleled the trend in parenting over the same period: how can kids learn to make good decisions when their parents are constantly hovering, ready to rescue them and fix all their mistakes?  Helicopter attendings are the new reality in medical training, and current rules encourage them to be that way.  They literally can’t let the residents make their own decisions, even if they want to.

Frankly, I like the old-school system better, as painful as it makes a modern-day call night.  I felt like I knew those patients better in the morning, because all their clinical information was coming at me when it was immediately relevant, and I could link all the parts together into a coherent whole of what we were doing and why, rather than getting the information weeks ahead of time when I’m just checking off boxes to be diligent, and may or may not be the one who actually needs it.  The way we do it now is not conducive to adult learning.  And no matter how young some of us are when we start medical school, by the time we graduate we are all adult learners.

Anyway, we have a few attendings who seem quite good at letting us drive the bus overnight and then pointing out the cliff we were dangerously close to (or on occasion drove over) the following morning, all without compromising patient care in any significant or permanent way.  It’s amazing how much more you learn when all you have is a cushion to prevent serious injury, rather than a net to keep you from hitting the ground at all.

Don’t tell me this thought hasn’t crossed your mind at least once

Today’s fortune: Often, the definition of success is just hanging on after all others have let go.

I’ve found this to be very true, and why success is often not as satisfying as we expect it to be.  It makes you wonder whether you’re just the idiot who was too stupid or stubborn to reconsider, and is now left holding the bag.

First post from the new computer.  It went fairly smoothly, with the exception of transferring my iTunes files.   I still can’t figure out how to do that, and I think the main problem is that my old computer was just too old to run the latest few versions of iTunes well.  And you have to be able to set up the transfer correctly on the old computer in order to move all your files to the new one.

The only annoying thing is that all my old photos are now distorted in that particular way that HD displays distort regular definition TV.  I wonder how to fix that?

Ditching it for a newer, flashier model

This computer is over 10 years old now.  Although I replaced the hard drive about 6 years ago, so maybe it’s officially only 6. Who knows?  I bought the exact same hard drive configuration, so I say 10.

Either way, it’s served me remarkably well, and for far longer than I expected.  I did a lot of research into the various kinds of hardware components available at the time, and bought it from one of those places that will let you select each component separately, and totally customize your computer.  So I was able to get something that would stay current–at least for my anticipated uses–a bit longer than the average 3 year lifespan.  After that, it was just a matter of not minding too much if it ran a little slow, and could only run two or three applications at a time without freezing up.

But when I can’t run Firefox and iTunes at the same time, that’s where I draw the line.  And it’s been like that for about 6 months or so now.  At first I was waiting for Windows 7 to come out.  I’ve been running XP for a decade now and would like to continue the pretense that there’s no such thing as Vista.  Then I couldn’t find a computer I liked.

It’s pure commitment-phobia.  I would go to Costco, and see a whole host of affordable, up-to-date, perfectly good computers.  And I’d stand there dithering around, comparing them all, liking one thing about one of them, and something else about another, but not finding any with everything I want except ones that are overpriced and cluttered with all sorts of other gadgets and gizmos and programs I don’t want.

It’s quite the metaphor, now that I think about it.

I hadn’t even been able to decide between a desktop and a laptop.  My laptop is totally dead, but I really want to replace it with a netbook instead of another laptop.  And I can’t justify buying a netbook when what I really need is MORE power and functionality, not less.  So, I finally decided, desktop first.  Then when Google comes out with their OS next fall, if it’s any good, I’ll buy a netbook at that time.

So having made that decision, I was surfing around yesterday looking at what’s out there.  Still not entirely liking anything I saw.  You know, lots of memory but a low-end processor, or good memory and processing speed but still running Vista, or a crappy graphics card, or a high-end graphics card but a stingy hard drive.  Yes, I’m picky.  When I buy something, I want to be happy with it, and not wonder if maybe that other one would have been a better choice.

Fortunately there are several companies that will still let you customize your computer, so I ended up going to one of them and just building what I wanted from scratch.  It was much cheaper this time around, thankfully.  And I got everything I wanted–or at least, as much of what I wanted as I was willing to pay for–and just as importantly, nothing that I didn’t want.

Sadly, this only works with computers.  But at least my computer and I will live happily ever after.

Meh, happy new year everyone.

For once, I’m neither happy nor sad to see the year end.   2009 was kind of blah.  Which I guess is not so bad in a life like mine, where the boring and conventional are in short supply.

It really hasn’t been a good year, although there have been far worse.  It was much closer to the middle of the scale than to either end, really.  I’ve learned a lot of new things, and met a lot of new people.  I even managed to meet a few who didn’t remind me of someone else I’d met before.  But it hasn’t gotten me closer to any of my major goals in life.  I feel like I’m just treading water, waiting for the arrival of that epiphany I can sense just over the horizon.

I don’t have any new year’s resolutions.  The things I need to do require substantially more dedication than the average new year’s resolution, so the whole idea that changing one particular detail of my life will make all the difference is kind of a joke.  Plus, new year’s resolutions imply that there’s something you dislike about yourself and want to change.  And I don’t actually want to change myself, I just want to be the best version of myself that’s humanly possible. Which involves a multitude of small choices, every day, rather than any single big poor decision.

Yeah, I try to set the bar low like that.