CME Credit

It was a warm weekend evening, and the new interns were completing some of their first shifts in the ED. We were drained, but exhilarated, and a little punchy. One of the senior residents was sitting in the corner of the lounge, by himself. He was reading our textbook -- Tintinalli -- and by the looks of it, he'd made it to page 1675 or so.

One of the interns approached him. "Hey, buddy, we're got the rest of the weekend off. We're thinking about going out for some drinks tonight -- you want to come?"

The senior waved him off, "No, I've got a lot of reading."

Undeterred, my fellow intern pushed, "Come on, what for? You have boards coming up or something?"

The senior looked up from the book, and said something I'll never forget: "I'm reading to become a better doctor."

I don't remember what we ended up doing that night, but whatever it was, the senior's comment had lowered our enthusiasm for it by more than a few notches. In those heady days after graduation last year, nothing else would make the point so succinctly to this newly-minted intern: We were done with medical school, but we weren't done being students.

"I'm not the man they think I am at home"

So, I went out this morning at the crack of dawn for my brioche and coffee, and I saw a rocket ship on the curb, by the trash.

The model looked like it was out of 1950's sci-fi features: a silver metal cylinder with riveted wings, and a thick antenna nose. It was about a foot and a half long, angled upward on a metal pedestal with a thick base. There was a loose electric cord dangling from the base; it was not immediately apparent what electricity would do for the model.

I stood for a moment on the sidewalk, flummoxed over the model (remember, I still hadn't had my coffee). The rocket, almost certainly, would not fit in with my apartment decor. But dammit, it was practically on my doorstep, and I was curious about the plug.

I resolved to get my breakfast, then pick up the rocket on the way back. Just to try it out, of course -- and if it didn't work, or didn't fit, it'd go back to the sidewalk.

When I returned, ten minutes later, the rocket was gone.

It was not yet 5 AM. Once again, I have underestimated the depth and breadth of geekdom in this town.


Speaking of which, I shouldn't have made that mistake, so soon after the Fifth Avenue Apple Store opening. I went, mostly because there was a rumor on teh internet about a big-name concert outside the cube. That, and I thought I might finagle a free T-shirt during the opening and giveaway, Friday at 6 PM.

After all, it had been raining that afternoon, and who really goes to these things, anyway?

It turns out, a lot of people go to these things. This, for instance, is the blog of a guy who travels the world, going to Apple stores. The line wrapped around the GM building, from Fifth to Madison and back. There was no concert, no Steve Jobs speech, but a mob scene nonetheless.

I quickly gave up on the free-T-shirt idea, or even getting into the store. Instead, I wandered around the cube. I found a nice roped-off spot near the northern fountain, where spectators were speculating on the identities of the honchos moving in and out of the store's entrance.

After a few minutes, one of the young, all-black clad Apple employees walked over to our area. He asked, politely, "Are you ready to come in?"

It turns out he wasn't talking to me, but rather to Elizabeth Berkley, who had appeared right behind me. Maybe she was in town for this. Or maybe everyone's a geek, now.

My patient, the car

I misinterpreted the title of a Polite Dissent post -- Doctor or Auto Mechanic? -- which immediately conjured a version of this classic game in my mind.

And since, well, some doctors are called "auto mechanics of the body," I started making a list of tools and terms that sound like they could go in either profession -- medicine or car repair.

So far my list includes the peak flow meter, front fascia, nebulizer, curing lamp, 4x4, clean-catch, head gasket, pacer leads, valve grinder, hepatic duct, surgi-lube, colposcope, universal joint, and of course, a Hemi.

I'm sure there are many more such terms, especially within the realms of orthopedics and ... emissions.

Familiar Quotations

Here's something I realized recently: a good fraction of the books I've read over the past year -- maybe half -- have been with written by people I know. Or at least, in some cases, by authors with whom I've corresponded.

Yes, it's partly because of the rise of independent publishing, and partly because I've been hanging around academics for more than a decade. And certainly, this wouldn't be the case if I read more of the classics, or bestsellers. But knowing these authors is a nice trend, seems likely to continue, and lends itself well to sparkling dinner conversation.

I must keep in mind Uglow's assertion -- that a group with the right mix of insularity and homogeneity can produce great things. Alas, Uglow (and Gladwell) are two authors I haven't met.

Cause for Alarm

For as long as I can remember, I've been reading reports in the lay press (and, in recent years, medical journals) about the growing problem of antibiotic resistance. I recall the faint, faraway dread these articles inspired, about a future when even community-acquired staph infections will be methicillin-resistant, when mighty vancomycin and linezolid will be rendered useless.

I get the same feeling, now, with my wakeup alarms. Long ago, I gave up on my weak bedside clock radio. But twice this past month, I slept through the moderately-loud cell phone alarm, and even the powerful digital egg-timer. Double coverage, failed!

The egg-timer's use was once restricted to critical situations -- like interviews and presentations -- but gradually became overused during intern year. Now, resistance has developed.

Fortunately, in both cases of alarm resistance, lateness was avoided -- through frantic, accelerated morning routines and a bit of freak subway luck. Next time I may not fare so well. New, out-of-the-box approaches may be required to confront this problem.

I could also try sleeping regular hours... but that's too unsettling to contemplate, for now.

Post-Call Stress Syndrome

My medical school prepared me very well for my floor medicine months, in terms of how to function as an intern, what to know as a physician, and even how to relate to patients and families.

What I haven't been taught, nor have I seen mentioned anywhere, is how to manage the curious camraderie-withdrawal that occurs among colleagues, after a call month ends. The scenario, spelled out:

You've just spent pretty much every day of the month with a resident, maybe a co-intern and student as well -- and every third or fourth night you'd serve together in an exhilarating, giddy, sleepless haze of admissions and cross-coverage. You share a lot of laughs, maybe shed some tears, learn a lot, and certainly freak out about the workload on a frequent basis. Then, the month ends and you may never see your teammates again -- certainly, never in the same context.

So, what to do? Get together for drinks, a few weeks later? That doesn't seem right -- you spent all your time together wishing you were with family and friends, and even if your new schedule permits it, revisiting your old medicine colleague seems like a step in the wrong direction.

Instead, there's the occasional email, and a wave and a smile across a crowded amphitheater. If you pass each other in the hall, you reminisce briefly about that nurse who waited until 5 AM to page you about a diet order, or the frequent-flier DKA patient who said, "Doc, I think I've got The Diabetus again."

And you move on to the next month, the next team, the next set of memories.