Paging Dr. McDreamy ... to the supply room

One day, I was flipping channels and Grey's anatomy was on the TV. I saw two very attractive people who were disrobing in a supply closet. My eyes narrowed to focus better. Are those two supposed to be doctors? And in a supply closet?? In a hospital? No, thanks. Most doctors who are wearing scrubs are ... not cute, and smell like BO because they have either been in a hot operating room all day or have been sleeping in the hospital.

So, recently, I was asked about whether or not it was true that a lot of sex took place in the hospital. My immediate reaction was, "Are you kidding?" But, let me not impress my own experience entirely. I had to remember - most doctors are somewhat repressed geeks, who never got any in high school, and not much more in college. NOT QUITE Katherine Heigel or Patrick Dempsey. When new doctors leave medical school and are working in the hospital, they go from untouchable to ... well, considerably more desirable. When you are a resident, you spend much of your awake time in the hospital. So, while I was never personally involved in it, sex does happen ... but not often.

Why not? Well, MRSA for one example. I mean, while most people think of hospitals as very sterile places, they are actually kind of filthy. In a place where I would not even consider a three second rule for food, it is hard to imagine taking your clothes off and engaging in an intimate act. But, apparently parking lots are NOT off limits, since I have it on good authority that several intimate acts between a doctor and hospital staff in the parking lot... regularly ... in plain sight of the cafeteria.

Also, the serious nature of life and death in a hospital usually is kind of turn-off. Well, apparently not a for one doctor, who was called to a cardiac arrest in the company of a woman with whom he was having an affair, in this case, a nurse. After they decided the patient was dead, and everyone had left the room, a friend of mine realized she left her pen in the room. She found her pen in the room with the deceased, as well as those two people having sex on the other bed in the room.

I think because there are beds in the hospital where doctors sleep that some folks assume they have sex with people there. In my experience, though, most doctors treat these areas with the reverence. These beds are for the most treasured and valued act - sleep. In residency, our call rooms had bunks beds. YES, BUNK BEDS. We are highly trained, intelligent people in our late 20's ... sleeping in bunks beds. As residents, though we learned so much about each other through these encounters ... who snores ... who talks in their sleep ... who farts in their sleep, etc. It was so asexual, that we felt more like brothers and sisters than a prospective hook-up, like a slumber party for the socially crippled. I never gave it a second thought until one night, I emerged from my call room bleary-eyed, and found the guy who I was supposed to be in the call room with me with passed out in a chair. "What are you doing out here?" I asked.

"I didn't ask you if I could sleep in the same room as you, and I didn't want to seem inappropriate," he mumbled. I thanked him, and shooed him into the call room. He snored like a freight train. Not sexy.

Can you call Dr. House?

House, MD. How I hate you.

I have never watched your show, but I hate you nonetheless. You are the hero of my patients. Many of them believe you are a real doctor, and not Hugh Laurie, an actor. I bet most of them don't even know that you have an English accent. They wouldn't care if they could have you as their doctor instead of me. They believe you are out there, somewhere ... yet they are stuck with me.

Am I not charming? I am. House is not, but that does not seem to matter to patients. Am I not well-studied? I am (good enough, smart enough, and Gosh-darn it, people like me). What does House have that I don't? Hollywood. And what has Hollywood created that I am unable to? An answer. Every patient, the complicated/bizarre ones and the more straightforward ones - all of them get ANSWERS. What do my patients get? "Here is what probably happened ..." or "Here is what you don't have ..." This drives them CRAZY.

"Well, doctor, when WILL we know what happened to me when I passed out?" I take a deep breath.

"We may never know. I can take the aspects of what you have told me, put together an idea of what happened, and then assess you for some life threatening problems and try to make sure it was not one of those problems." I explain what those are. I explain that this will take 1-2 days, and then I can likely send them home if the testing checks out, and they are feeling well. I pause. This usually goes over like a lead balloon, and about the time some ask request a House, MD consult. Or, my personal favorite - a CSI consult.

"You need those CSI people. They use all sorts of crazy science, and they always figure out what happened." I usually nod to this, not mentioning that a murder had taken place when CSI is called, and they would have to die in a violent way for me to call them.

I understand where these feelings come from. We think of doctors like mechanics. Hook it up to the diagnostic machine when the check engine light comes on, and then fix the problem. We certainly order a lot of tests in medicine, probably too many, but often they are just suggestive, and not diagnostic. My great Aunt Celia told me once that you can never be sure of ANYTHING except death and having to pay taxes. When someone is sick and scared, though, no one wants to hear about uncertainty. OFTEN there is no definite answer. I can't reconstruct your crime scene. I can't say it is for sure your brake pads need replacing and you will never pass out again. I can tell you you didn't have a heart attack, and I can tell you it is unlikely you had a stroke, and I can tell you the most common causes of passing out, and which one likely happened to you. Common things are common, and what happened to you is probably not a bizarre presentation of Ebola. I will listen to your fears, and do my best to try to calm them, but we can only be sure of death and taxes. If anyone tells you they know what happened to you with certainty, they probably also carry a SAG card.

In the future, please ask me for a Car Talk brothers consult - they are more into the art of medicine that I feel comfortable with.

There is no crying in medicine!

While there have been many changes in the training of doctors in the last 30 years, there are a few things that never will. No matter how you slice it, becoming a doctor means sacrificing a lot of free time in your twenties. So, our capacity to whine about this is pretty much intact from the 1970's. In fact, doctors carry this as a badge of courage. We wallow in our work ethic. We love to rub EVERYONE'S face in how tough we are; repeated nights on call harden us to suffering, clearing our thoughts and separate us from the trials of our patients. We can remain cool, calm, collected ... and distant. More recently, though, this is changing. We are supposed engage more deeply with our patients and their families. Okay. For those who want the distant doctor, we must be ready to be that doctor, too. This hard for many of my kind. This episode has to do with this issue.

As as resident physician, I dealt a lot with the"old-school" doctors, but the medical students who I was assigned to look after and teach were "new-school" - touchy, sensitive, and soft. One day, one of my medical students whom I will call "Flower" was assigned to take care of a lovely elderly woman (lets call her "Granny" because I have no imagination) with a urinary tract infection who had a sweet personality and lovely family. Anyone who knows anything about medicine knows it never ends well for people like this. Well, Granny's kidneys begin to fail unexpectedly, and over the course of about 2 days, to everyone's surprise, Granny goes from knitting blankets to, well, you get the rest. Anyway, Flower spends those last 2 hours of Granny's life with her family, praying with them, crying with them, etc. Afterward, she is a runny nose, sniffling, hot mess. She used most of the tissues paper on the floor. She tried, but just couldn't pull it together. So, I suggest that she just collect her stuff and take the rest of the day off, not to worry - the rest of us will be here tomorrow. She hugged me, and then carried her puffy-eyed self home. This scene is observed by one of the older "attending" physicians who looks like a Jeremy Piven's much older, much geekier, and MUCH more nearsighted brother. Anyway, he is looking at me with disgust, muttering under his breath.

"What?" I ask him.

"What was with her?" I explain about our tender Flower.

"She shouldn't be crying. That person wasn't in her family. It scares the patients." I have no response to this, so he continues, "There is no crying in the hospital." I am still silent, as this is starting to remind of Tom Hanks' rant in A League of Their Own. "No CRYING!" he exclaims.

"Um, okay." I say. I realize I should be vehemently defending Flower, but I kind of agree with Bizarro-Piven. Families look to us for strength, and while we can share in their sadness, I suspect that when we grieve with them, we are really taking the opportunity to relive our own losses.

Really not the venue.

But, the downside of this is we are often walled in. I never get choked up in the hospital, yet weep when I see commercials for the ASPCA. Should we be like Flower? Should we be more like Bizarro-Piven? The middle ground is the achievement of a truly grounded, even person. How many doctors do you know who meet that description? Me, neither.

Welcome to the House of Dog

Let me first say this blog has nothing to do with dogs. I am not selling, buying, or processing anything for canines. There is no symbolism here; I am not that smart, and anyway, everything I write about really happened, or is happening. You can't make this shit up.

The name of this blog is merely a reference to the infamous book penned by "Samuel Shem" (aka Samuel Bergman, The House of God. I read this book as I prepared to apply to medical school - actually, I was commanded to read it by my peers. "If you want to apply to medical school, you HAVE to read it!" Reading it reminded me of reading Jane Austen. I thought it was amusing, but it felt so tethered in the 1970's, that I considered it a period piece. Nearly 15 years later, I am a practicing physician. I did an internal medicine residency, heard the terms "turfing," "wall," and "sieve." In learning to speak "medical," I learned not just the real names for muscles and how to improve someone's potassium, but the slang terms listed in Shem's book. So that part of Shem's novel checks out. What I found so dated in his book was the silly personal lives of the characters. Who has sex in a supply closet or a call room? Nasty.

Flash forward to the late 1990's-current. ER, which began as a respectable show, suddenly had helicopters landing on people. Grey's Anatomy had more sex in the hospital than gall bladders removed. House? People began to request "Dr. House" to see them when I can't explain EXACTLY why they passed out. We are not Hollywood. We are limited people, working for you, at some of the worst moments of your life. We can be uneven, some days when we have the Midas touch, other days when we have shit finger. But, most of use have no idea what else we would possibly do it we weren't your doctors.

All of these are real stories. Welcome to our world.