tag:blogger.com,1999:blog-20550099982823092292024-02-07T02:11:44.038-08:00I Tell Stories, And Try Not To Kill PeopleDr. Ahttp://www.blogger.com/profile/15241658350065546680noreply@blogger.comBlogger40125tag:blogger.com,1999:blog-2055009998282309229.post-53900959510340669832014-01-18T05:44:00.000-08:002014-01-18T05:44:25.643-08:00Just When I Think I've Seen The Saddest Shit Ever, Life Proves Me Wrong.<div dir="ltr" style="text-align: left;" trbidi="on">
Alright, I think it's safe to say that this blog, over the years has officially transformed into a venting space for me. Gone are the days in which I try to find humor in a hopeless environment.<br />
I hate that.<br />
More than any of you will ever know.<br />
<br />
Bear in mind this is probably one of the saddest stories I've had the liberty to witness. I tell it not because I want to, but because I feel it'll convey how truly hard life can hit some of us. So the next time you're sad about something, try to remember this story. I promise its resonance will haunt you for a while.<br />
<br />
Deep breath. Here we go.<br />
<br />
Like you all know, I work in a privately owned post operative ICU. That means we receive patients that undergo surgery and try our best to steer their fates into an absolute recovery rather than an absolute mortality.<br />
<br />
A few months ago, a 9 year old boy had undergone a cardiac surgery. Due to circumstances 'beyond the hospital's control', he got an infection. Now, post operative infections are tricky things. Obviously due to the body's state, the immunity isn't quite up to par so we have to assault the infection with powerful antibiotics and hope for the best.<br />
<br />
The kid wasn't responding. His prognosis was poor and after a month in the ICU, there was this silent understanding that he was going to die. We talked to the parents about it and they were very understanding about it. No arguments, no guns pulled out, no anger. There was acceptance and the subtle hope that maybe, just maybe, God would provide a miracle.<br />
<br />
He stayed in the ICU for a good two months and a half. It happens. We call them 'fighters'. I'd bore you with all the horrific details (like the fact that the infection spread to the sternum and he had to undergo a surgery known as 'rewiring' 3 times because the sternum, when infected becomes brittle and needs sutures to fixate) but that's not the point. A week ago, when I was on call, it was clear that today was going to be the day. His systems were failing. I talked to the father, and told him, that today was probably going to be the day. Once again, I was met with understanding, acceptance and more importantly relief. Relief that today was going to be the last day in his daily struggle with dealing with the fact that his son was dying.<br />
<br />
A few hours later, the father came to me and wanted to talk to my boss. Something about finances. When I asked for specifics he had said that he was worried that he still owed the hospital money and he was terrified that when his son would die, he wouldn't be able to take him and bury him. I counselled him and got my boss to tell him not to worry.<br />
"Don't worry, that's not going to happen. You've already paid a large sum of money and we're sure we can somehow work out the details later." Those were the words my boss told him.<br />
<br />
The father calmed down, and sure enough within a few hours, we called it.<br />
<br />
The 'fighter' in him just stopped fighting and he died.<br />
<br />
We broke the news to the father. He cried, and it was over and done with. We told him to go downstairs and finish up the paperwork and we'd prepare the corpse (he had an open wound). Another hour goes by, and the father comes upstairs again, distraught and unable to compose himself.<br />
<br />
"They're not going to let me take my son until I pay them the remaining 6,000 LE. I have no money. I already sold some of my land and there is no way I can provide that sort of money right now. I don't understand. I've already paid 36,000 LE for my dead son. I know I owe the hospital money, but I just can't provide that money now."<br />
<br />
.............................<br />
<br />
I ran to my boss, told him that the father was waiting for him outside and informed him of the situation.<br />
<br />
"Wait, so he knows I'm still here?"<br />
"Yes."<br />
"God damnit, fine, let me call the hospital owner."<br />
<br />
The owner didn't pick up.<br />
<br />
"Oh, so where is he exactly. Do you think I can manage to leave the hospital without him seeing me?"<br />
"..............No. He's right outside."<br />
"Fine, come with me."<br />
<br />
His cynicism seared my brain.<br />
His lack of empathy disgusted me.<br />
Never before, did I truly harbor such anger towards a human being.<br />
<br />
Anyways, he went outside and told the father that he'd go downstairs with him. This was around 1:30 am. The security guard accompanied the both of them downstairs and we all hoped that the situation would be dealt with.<br />
<br />
At 4:30 am, the security guard came upstairs and told us that the father had just left with his son. The situation, although dealt with, took longer than expected because they couldn't find a mode of transportation to take the father and the body all the way to Aswan. They finally found a cab willing to go, for 1,800 LE.<br />
<br />
<br />
There is no moral to this story. There is nothing I can write in bold or italics that sums up this situation in a few words.<br />
<br />
His words still haunt me. He basically paid a huge sum of money for a body. Not just any body, but his 9 year old son's.<br />
<br />
The reason this story bothers me so much isn't because the father went through Hell and back. It's not even the fact that maybe, just maybe, his son could have made it had circumstances been different.<br />
<br />
It's the lack of empathy. The lack of respect. More importantly, the lack of humanity that is encouraged in the medical industry.<br />
<br />
I understand that medicine, like any other profession, is a business and people have to make money but the line is blurry. It has to be.<br />
<br />
I once said the health care system in Egypt is doomed, due to a variety of reasons.<br />
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<b><span style="font-size: large;">I think that if I had to pick one though, it'd be our diminishing humanity. After all, how can you call yourself a healer of the sick, if you don't care about the sickly. </span></b><br />
<b><span style="font-size: large;"><br /></span></b>
What do you know. I was able to provide a statement.<br />
<br />
God bless.<br />
<br /></div>
Dr. Ahttp://www.blogger.com/profile/15241658350065546680noreply@blogger.com0tag:blogger.com,1999:blog-2055009998282309229.post-65582875921641786922013-11-30T05:24:00.000-08:002013-11-30T05:24:54.875-08:00Why I Can't Seem To Leave Egypt's Health Industry<div dir="ltr" style="text-align: left;" trbidi="on">
<br />
<i>This is a reply to what was possibly the most depressing post I'd ever written here. To the friends and family that called me right after I had written that post and were possibly worried about my mental state, thank you. It was unnecessary but thank you. I'm going to try and write about the good things. The happy things. After all, the purpose of this blog was humor and not wanton depression. Anyways here goes.</i><br />
<i><br /></i>
I love the atmosphere at the hospital. I love that there's a united sentiment amidst all the doctors, workers, nurses and security staff. It's a sentiment of "We're all in this together. So let's try to do and make the best of it." I love the fact that if I have a problem with a patient, all I need to do is go and ask a fellow colleague on the same floor for his advice and we'll both work really hard to find a solution. Camraderie during wartimes.<br />
<br />
I love meeting new people and their families. I love how for a while, I'm part of their life. I love how vastly different their life is to mine. I love that sometimes, when it's a good day, we share stories on the difficulties and glorious moments life seems to always throw our way. I love that for a moment, we're family.<br />
<br />
I love it when it's late at night and one of the older patients can't sleep and so we sit up late at night just talking. I love asking them what their favourite subject is. I love when they say their favourite subject is English and so for the rest of their stay in the ward, I talk to them in English. I love the look their mother gives me when this happens.<br />
<br />
I love when everything sometimes magically goes right for a critical patient and they come out of it 100 percent. I love that when they came in, they were distraught and torn with all these horrible emotions and when they left, all you can see on the patient and the patient's family is joy.<br />
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I love the chronic well managed patients. I love it everytime they're admitted again for a course of therapy and whatever underlying disease they have is managed well. I love catching up with them and their parents. I love how close our relationship has become.<br />
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I love that phone call I sometimes get from a parent months after a patient is discharged. I love hearing the boy or girl on the other line quarrel with her mother and say "Mom, give me the phone, I want to talk to the doctor now."<br />
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I love that sometimes in the ward, parents get to know other parents and offer support to one another. I love that when a patient is critical or not doing too well, all the other mothers pray for her and her child. I love how tearfelt this can actually be and how humbling it can be for me.<br />
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I love the silly romantic love affairs the younger patients sometimes have for each other. I love that I once had a male and female patient, both aged 10-11 and how they'd hold hands when they'd take their medication through the cannula because according to them, holding hands meant they'd have super powers and so they wouldn't feel the pain. <br />
<br />
I love it when a parent asks me when their kid is discharged if they can have the follow ups at my clinic. I love the look on their faces when I tell them I'm far too young yet to have a clinic. I love how they tell me I'm going to be alright and how I'm going to be a great doctor when I get older. I love how red my face gets and how humbled I feel when I hear that.<br />
<br />
I love it when a surgery goes by smoothly and the first time the parents meet their child after an operation, all I have to say are good things, happy things.<br />
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I love the mothers and fathers that take an active interest in their child's disease. I love having to explain, in broken Arabic what's going on. I love the laughs they sometimes get out of hearing my broken Arabic.<br />
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Most of all though, I love the stories. I believe in the power of stories, and I hope I continue to feel that way about them.<br />
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<b>Good or bad, a story is a story, and sometimes that's enough. :)</b><br />
<br />
<br />
<br /></div>
Dr. Ahttp://www.blogger.com/profile/15241658350065546680noreply@blogger.com3tag:blogger.com,1999:blog-2055009998282309229.post-56559569713284385682013-11-28T06:31:00.001-08:002013-11-28T06:31:39.875-08:00Death<div dir="ltr" style="text-align: left;" trbidi="on">
I know I've brought up death countless times, over the previous posts. I also know that I've talked about it at length with friends who wonder how, as doctors, we're able to deal with death so casually. I guess this is a post that'll help maybe clear up the misconceptions or at least give people an idea of how we deal or rather, process death in the health industry.<br />
<br />
Bear in mind this is all going to be coming from an unclear mindset. No drafts and second drafts will be made, so there is a possibility I might veer off topic, and if I do that, then I apologize.<br />
<br />
The first time we're exposed to death is in the morgue during our anatomy lessons. This happens in the first year, within the first week of education. I remember that clearly but not vividly. The class is usually divided up to 20 people to one corpse (specimen is always the preferred word) and we're shown muscles, nerves, arteries and veins. That first class is always interesting. You're always able to differentiate the students into two, those that will stay the course and those that finally realize they have no business being a doctor. You're able to differentiate through attitude. There are those that are unfazed, those that are interested, and those that just freak the fuck out. The professors explaining on the specimens are usually relentless in the fact that they will try to gross you out as much as possible. I've seen girls faint. I've seen boys puke. I remember thinking how cruel those professors were sometimes with the more queasy students. I probably didn't realize how necessary this 'reality slap' was until much later when I became an intern. I realized that they do it because they know for a fact, that if you can't stomach a preserved corpse, drained of all its blood, then there can possibly be no way for you to handle what will come later.<br />
<br />
The specimens were drained of humanity. They were more like the preserved mummies you see at the museum than they were actually human beings. Still, that was probably my first time seeing a dead person in front of me.<br />
<br />
Much later when you become an intern. That's when you truly witness death. There is a difference between seeing a dead body and seeing a person die before your eyes. I actually don't remember the first time I saw a person die. I do remember the first person I performed CPR on though. I don't particularly remember which round it was in, but I remember being ridiculously anxious over the arrest. The nurses had shouted out that there was an arrest and I ran to start performing CPR. I remember being very anxious and nervous. This was it. There was a chance that, through some maneuevers and medication, this patient might very well survive. It was ----exciting. I also remember the nonchalant behavior of the residents. It was more a chore to them. They had this air of "Oh, here we go again." rather than "I hope this patient survives." I was very upset by the demeanor. After all, why become a doctor at all, if that's the attitude that'll prevail.<br />
<br />
In retrospect, I realized my naivete.<br />
<br />
I remember asking my senior resident about it. All he told me was<br />
<br />
<b>"You'll understand later."</b><br />
<br />
He was right. I did understand later.<br />
<br />
Arrests aren't portrayed very well on television. On TV shows, when someone arrests, there's a chance they come back at 100 percent ; that all that's necessary is bringing back that base line to a normal heart rhythm and suddenly everything will be okay again. That's a very rare thing. It might be true in trauma cases and sudden arrests but usually when a patient arrests in the hospital, it's because his or her body is giving out. Sure, you can do CPR and give them some adrenaline and they'll come back, but that only means that most likely, they're going to arrest again within a few hours. We call these patients Post Arrest patients. When you're looking for an ICU spot for these patients because obviously when they come back they need to be ventilated mechanically (something you don't see in the TV shows either) the resident in charge of the ICU will very rarely ever admit them. That's because they're hopeless. It's a harsh reality, but it's also the truth. When you're in charge of an ICU, selecting a hopeful patient over a hopeless patient is always the priority. The question usually asked is "Will his stay in the ICU actually improve his condition or just be a place for him to die in?" <br />
<br />
It's a difficult question. It's also totally lost on patients' families.After all, they'd just been told that his heart stopped and now it's back. As far as they're concerned, there's still hope.<br />
<br />
I hate false hope. I understand the need for it. Doesn't mean I still can't hate it.<br />
<br />
I remember the first death that mattered though. That didn't happen until I became a resident. It was during my second or third month and I was on call in the ward. There was a kid, who had something called Fallot's Tetralogy (which was a congenital heart disease). It's not the worst cardiac disease a kid can have here, and there's a surgery that can correct it completely (given that they fulfill the criteria for it). This kid however, did not fulfill the criteria for the surgery (her brain was damaged, which was a complication for neglected Fallot patients and so her brain was basically mush which meant that even doing the surgery wouldn't bring her back to 100 percent). I remember always sitting down with the mother trying to explain to her, in the nicest way possible, that there was no hope.<br />
<br />
That sucked.<br />
<br />
Anyways, the kid had arrested during a shift and so, I nonchalantly started doing all the necessary things we do when a patient arrests. It didn't work. She didn't come back. The mother was out buying diapers so she came a few minutes right after we called the time of death. I remember telling her. She wore the niqab, so all I could see were her sad watery eyes. She was angry. She was angry that she wasn't around. She was angry with me. She was angry with the surgeons. She was angry at God. She kept shouting that she should have been there. I told her there was nothing she could do. She told me it wasn't about that. She said,<br />
<br />
"I just wish I could have spent those final minutes with her."<br />
<br />
Yeah.<br />
<br />
I say this story because during the CPR and during the arrest, I felt nothing. There was no empathy. If anything, I was glad. This was by all means a hopeless patient and it was time for her to no longer be in pain.<br />
<br />
That all changes when you see the reactions of the parents.<br />
<br />
I'd mentioned in a previous post that that's why I hated the good parents. That is why I hate them. That empathy you feel, it doesn't help in making you a better doctor. It's just a burden that comes with the job.<br />
<br />
<br />
I think the issue is how routine it gets to be, and that's exactly the thing. Death, to alot of people, is something that's witnessed in the most trying of times. It's an event. But for us, it's no longer this catastrophic event. It's just something that happens that we deal with.<br />
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I think I hate that it's no longer this event though. I remember once I was sitting with friends (not doctors) and I had a shift the next day. I remember calling up the doctor who was on call that day and asking him how the ICU was.<br />
<br />
"So how's the ICU?"<br />"It's alright, Patient A is dying though so good luck delivering the news to the parents tomorrow."<br />"Oh man, is there no way she's going to die with you tonight?"<br />"Doubt it. But tomorrow definitely."<br />
"God damnit. Fine, but I hope she dies with you."<br />
<br />
My friends were flabbergasted. All they could think about was how harsh and cruel I seemed to be. It didn't help that we were both laughing about it as we were talking about it. Keep in mind, I'm censoring how cruel these conversations can be. Jokes are usually made about how the on call doctor should just kill the patient now and things like that.<br />
<br />
It is cruel.<br />
<br />
But only if you're not a doctor, and it's not because we have the notion of being superior to non doctors.<br />
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It's because we have to cope.<br />
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Otherwise, we'd all just kill ourselves.<br />
<br />
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<br /></div>
Dr. Ahttp://www.blogger.com/profile/15241658350065546680noreply@blogger.com1tag:blogger.com,1999:blog-2055009998282309229.post-2275659978655146292013-11-18T04:15:00.000-08:002013-11-18T04:15:06.304-08:00Why I Can No Longer Stand Egypt's Health Industry.<div dir="ltr" style="text-align: left;" trbidi="on">
I hate that a lot of the patients I see are dying or on the verge of death. I hate that parents aren't educated or well informed enough to notice catastrophic symptoms and signs in their kids. I hate that usually, it's too late by the time they come to the hospital.<div>
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I hate that sometimes, a patient will come in, and there won't be place to admit them. I hate the way I feel every single time I tell the parents of a sick kid to go on a wild goose chase looking for an incubator or an ICU bed. I hate how hopeless I feel, and how hopeful they feel when I tell them.<br /><br />I hate it when a kid dies, and I know something could have been done to prevent his or her death. I hate having to tell the parents, "It's all part of God's plan."</div>
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I hate seeing fathers treat their wives and kids like shit when it's visiting hours. I hate having to hear fathers go on about how it's time for the mother to come back home because he can't handle the house. I especially hate hearing the phrase "You said he was going to die anyways right? Well, we might as well go back home and care for our other children." I hate it because sometimes, it's a true and real thing.</div>
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I hate that sometimes surgeries are rushed or delayed not depending on the patient's health but more so on the whims of the surgeon. I hate that the bureaucracy can sometimes be so maddening, that all that's left for a distressed parent, is to cry in a corridor making sure his wife doesn't see him.</div>
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I hate the good parents. The parents that are supportive, understanding and completely and genuinely polite. I hate giving them bad news. I hate them for letting me sympathize with them so badly.</div>
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I hate having to see parents lie to the older kids. Telling them they're going to be okay when it's clear they're not going to be. I hate the false hope instilled sometimes, in the child's bright and fleeting eyes.</div>
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I hate seeing a mother give birth to her 8th baby. I hate having been part of her bringing this baby to the world, who will most likely grow up impoverished and resentful.</div>
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I hate the way the system works. I hate how it jades you and hardens your heart. I hate that I no longer treat death with the same respect it eternally deserves.</div>
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I hate the older professors, most of them having abandoned the public teaching hospital that taught them so much, all in search of greener pastures. I hate that the system forced them to resort to thinking like that.</div>
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I hate walking down the street adjacent to my hospital. I hate having to accidentally bump into a parent I haven't seen in ages and having them tell me how their son or daughter died a month or two after they left the ward due to some chronic illness they were having. I hate the looks they sometimes give me, with good reason.</div>
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<b>I guess what I hate the most is how helpless I sometimes feel when I go back home, lie down in bed and close my eyes.</b></div>
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Dr. Ahttp://www.blogger.com/profile/15241658350065546680noreply@blogger.com3tag:blogger.com,1999:blog-2055009998282309229.post-74000841962581369002013-10-27T07:26:00.002-07:002013-10-27T07:26:58.720-07:00The Public Sector vs The Private Sector (Or How I Grew Up To Be a Dickhead Doctor)<div dir="ltr" style="text-align: left;" trbidi="on">
Okay, I'm about to go on a rant and ignore the fact that I haven't posted here for over a year so bear with me here.<br />
<br />
Now you all know how much I bitch about the public health system here in Egypt. It's a mess. Facilities are minimal and the load is heavy, but despite that I like to think that sometimes we do good work. It's not the BEST work, but at least I can go home and sleep at night without having any ghosts of dead children wallowing and wailing over my sleepy carcass.<br />
<br />
I've recently started to work in the private sector, specifically a post operative ICU. That means I work in an ICU that receives kids that just had major surgeries and it's my job to manage their recovery and make sure they, you know, don't die.<br />
<br />
I had all these thoughts about how much better the private sector was going to be. After all, why wouldn't it? Better equipment, better facilities and better yet, there should be a lesser load (as in number of patients)<br />
<br />
I was wrong. I was horribly wrong.<br />
<br />
I mentioned previously how being a doctor, you sort of have to kill off the part of you that really sympathizes with patients, not all of it mind you, but just a little bit so you're able to function without any preconceived emotions clouding your judgement. Working in the private sector, I've realized that you have to kill off ALL of it.<br /><br />Let me explain why using my favorite method of analysis: bullet points!<br />
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<ul style="text-align: left;">
<li>In the public sector, the problem is always that there's no money and too many patients. So what happens in post operative ICUs is that there is a limit to two things, the number of patients you can have in the ICU, and the number of surgeries you can have in one day. The first one is self explanatory. If there are 20 beds with 20 ventilators, you can't have 21 patients. The second point means that there's only a finite number of surgeries a day because the surgeon working in the public sector isn't getting paid shit. That means that after he's done with his surgery he'll have to go work in the private sector to make his money. It has its cons for sure, for example there's a never ending list of patients, but that can also be a good thing. <br /><br />For example, say a child has chest infection or a fever and he was scheduled for surgery today. In the public sector, that child's surgery gets rescheduled and another patient ends up getting the surgery. When the sick child eventually gets better, he'll have the operation. It doesn't matter for the surgeon because he knows he's going to work 2 cases a day. It doesn't matter which cases he works so long as he works them. <br /><br />Now let's imagine this scenario in the private sector. Let's say a child has a surgery scheduled for today but he's got a chest infection. FUCK THAT SHIT, let's cut him open anyways. Why? Because there's a finite number of patients and the surgeon gets paid handsomely for each surgery. He has incentive to perform the surgery, fuck all consequences because at the end of the day, he's going back home with a big fat stinking check devoid of humanity. Now let's say we have 4 beds left but there are 6 operations scheduled for today. In the public sector, the ICU is closed until the beds get empty again, whether through death or recovery. Not true in the private sector. Something called 'overbedding' happens where there are more patients than there are beds. I do not need to explain what this means because obviously, you can understand how horrible a situation like this is. Why doesn't one of the surgeons cancel his surgery you might ask? Well, why would Surgeon A cancel his surgery when Surgeon B is working his and gets paid? Fuck that shit, I'm going to do the operation myself and we'll see what happens. After all, I get paid for the surgery, not for the welfare of the child afterwards.<br /><br />This game I call "Penis Envy Surgery Chicken" needs to stop. It doesn't though. Because like I said, money.</li>
</ul>
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<ul style="text-align: left;">
<li>This one is going to suck ass at explaining but here we go. Okay, so let's say the kid had his surgery and complications happened, whether in the ICU or during the operation itself. In the public sector, we cut no corners in explaining how bad the prognosis of the kid is. Sometimes, doctors are extra harsh in dealing out this information. If the parents dare complain or put the blame on someone, they are constantly reminded that the operation was a costly endeavor and that they should thank God that their kid was at least given the chance of a life free of any problems, even if it didn't pan out so well. <br /><br />The way doctors look at their work in the public sector, it's sort of like a 'charity'. I'm not getting paid for shit and you already signed away any legal rights you might have had with our iron clad 'pre-surgery' contract. Sorry your kid's going to die madame, but those are the ropes, EVEN if the surgeon or the ICU doctor (intensivist) made a huge mistake. You aren't worried about consequences because as far as you're concerned, no legal action will ever be taken so there's no need to pad out the horrible news.<br /><br />Now the private sector, that's different. The patient is 'entitled'. He's paid money to have the surgery. He gets his say in what's happening. So what do the doctors do? We pad the truth so much it becomes a downright lie. Things like "Oh he's got some secretions in his lung but he'll respond to the antibiotics we hope" are said instead of "Well, he's got pneumonia and we're not sure the antibiotics are working." Why do we lie? Because the truth means more questions. "Why did he get pneumonia?" "Why is hygiene piss poor?" "What do you mean the operation didn't work out as planned?" The more questions asked, the more likely it'll be evident that somewhere down the line, something could have happened to prevent the child from deteriorating. <br /><br />So we lie, and my God does it takes its toll on the soul. </li>
</ul>
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<ul style="text-align: left;">
<li>But at least we've got the facilities in the private sector right? Right? Also not true. In the public sector, we are funded through two mechanisms: Government money and donations by people. Most of the money goes directly into providing whatever facilities because money is scarce and because no one, thankfully from what I've seen so far, is going to steal from donations (which is where most of the supplies and medication comes from) Now who funds in the private sector? Hospital managers and owners. People. Not institutions. And they're trying to make as much buck as they can. So corners are once again cut. Why buy new ventilators when we've got perfectly ancient but functioning ventilators. Monitors aren't working? Come on, do you REALLY need to monitor a patient's fucking vitals? I'm exaggerating a little bit but that's the truth. All the hospital managers care about is getting by with the least amount of money invested into the hospital so that they can make a fatter profit. Paychecks are sometimes delayed or handed out in increments. Nurses are especially fucked in this scenario (at least in the hospital I work in). </li>
</ul>
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</div>
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Okay, so 3 massive bullet points, but you get my point. All this, gives the doctors a sense of superiority and grandiosity that feeds their ego and turns them into dickheads. In summary:<br /><br /><b><i>You are getting paid handsomely, for half-assing medical care, with no worry whatsoever of any legal or ethical (because that dies out early on) consequences.</i></b></div>
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<b><i><br /></i></b></div>
<div>
Fuck.<br /><br /><br />PS: Obviously, I'm focusing on the horrible here. At the end of the day, the private sector does ensure a better survival rate but there are different reasons for that which I'll one day explain in a different post that'll have a somewhat brighter view. </div>
</div>
Dr. Ahttp://www.blogger.com/profile/15241658350065546680noreply@blogger.com2tag:blogger.com,1999:blog-2055009998282309229.post-20471827039638659062012-09-22T11:41:00.001-07:002012-09-22T11:41:59.946-07:00A Matter of perspectiveOkay so I stumbled upon a few notes I had written back in 2009 that have absolutely nothing to do with medicine but I decided to share anyways. <br />
<br />
This first one is called "A Matter of Perspective" <br />
<br />
Enjoy.<br />
<br />
"Hey, sorry I'm late. The traffic was just ridiculous today? Did you see the car accident on the bridge?" <br />
"Hey, no, no I didn't. Listen we need to talk."<br />
"I know, you scared me on the phone. Is everything alright?"<br />
"Before we talk, promise me you won't get angry. Promise you'll keep your composure."<br />
"I don't understand. What's the problem?"<br />
"Just promise."<br />
"No, you're obviously going to say something that's going to aggravate me. I'm not going to promise you anything. Now spill it. What's wrong?"<br />
"I don't know how to say this… You've obviously noticed there's been distance between us lately."<br />
"I have, I remember clearly you excusing yourself on account of stress at work. I obviously knew you were lying and would tell me eventually what's wrong when you were ready. Guess that time is now then."<br />
"Why do you always have to assume I was lying?"<br />
"Well, clearly, it wasn't an assumption. You're just about to prove my point right now aren't you?"<br />
"I hate when you do that. I hate your "holier than thou" attitude and your assumptions. Work has been really stressful. It's the end of the fiscal year and we've got so much paperwork. Obviously, you wouldn't understand seeing as how you're always on top of everything."<br />
"You're diverging again. Just tell me what's wrong already."<br />
"This is exactly what I want to talk about."<br />
"What are you talking about?"<br />
"This, this little argument right now. I love you. You know I love you, but I can't just keep taking this abuse from you."<br />
"Abuse?"<br />
"Mental abuse yes. You're always thinking you're one step ahead of the rest of us. Always trying to prove your point and win your little debates just to satisfy that ego of yours."<br />
"So you're saying it's my fault that everyone we meet is an idiot and I shouldn't even bother to speak my mind just so the idiots can feel at ease? What the hell is this really about?"<br />
"See, there you go again. I'm presenting you with a fact. But you're not even willing to listen to me, because in your mind you've already made the decision that I'm trying to hide the real problem from you. You think everyone has a personal vendetta and everyone thinks in layers. Sometimes what you see is what you get."<br />
"Are you serious?"<br />
"I'm dead serious. This isn't a joke. Please wipe that smirk off your face."<br />
"Wait, wait, wait. Let me just get this straight. You're breaking up with me because I think for myself and speak my mind? You're breaking up with me because I don’t go with the flow?"<br />
"I never said I was breaking up with you. Why are you even suggesting that?"<br />
"Obviously, you're hinting at it."<br />
"Stop claiming you know me inside out! No. There's no hidden implication here. I'm telling you how I feel. I'm being honest here."<br />
<br />
"No you're not. You're trying to break up with me, but you don't want to say it. You want to piss me off and get me riled up and angry at you. You want me to see that there's no other solution. Clearly, you knew how I'd react to this and clearly you realized that I'd see no other solution. I mean after all, I do think 5 steps ahead, don't I?<br />
"No, that's not it all. Why is it always extremes with you? I'm telling you because I'm hoping you might find a solution to this mess."<br />
"You're lying. And I can't tolerate this any longer. Here's the money for the coffee. Goodbye and have a nice life."<br />
"So that's it. It's as simple as that? You're breaking up with me?."<br />
"Spare me your drama. It's what you wanted. Just once, just once, be honest about yourself. Take care of yourself and know that I still loved you even with all your flaws. Never once did I want to change you."<br />
<br />
And he left.<br />
And she cried and talked to her friends about it. They called him an asshole.<br />
And he was angry and talked to his friends about it. They called her a slut.<br />
And that was the end of that. <br />
It's all a matter of perspective in the end . Was she the paragon of virtue and him the renegade?<br />
Or was it the other way around?Dr. Ahttp://www.blogger.com/profile/15241658350065546680noreply@blogger.com0tag:blogger.com,1999:blog-2055009998282309229.post-29646376382498529832012-07-25T13:18:00.000-07:002012-07-25T13:18:33.903-07:00Why the Health Care System in Cairo is Doomed.<div dir="ltr" style="text-align: left;" trbidi="on">
Well it's not exactly one reason. There are a number of reasons the public health sector in Egypt is entirely flawed and not up to par with any golden set of standards imposed on it by even the saddest of developing countries.<br /><br />Lack of finance, lack of resources, lack of decentralization. These are all very valid points.<br />
<br />
But let's focus on one that can be changed but won't ever change due to how the health care system works.<br />
I'll call it the Circle of Residency.<br />
<br />
Now bear with me because I'm about to compress a lifetime of a medical student in a few measly sentences.<br />
<br />
First off, let's consider the student that just got accepted into medical school. Let's even assume he actually wanted to go to med school and wasn't forced to fulfill his parents' failed dreams of success. He's ecstatic, he's hopeful but most importantly he knows he wants to be a doctor to benefit society. He makes an oath to himself, swearing to study hard and become a success despite the poor teaching conditions in most of the public universities here.<br />
<br />
He finally finishes those 6 years, still wide eyed and full of hope. He guarantees a good enough grade to work in the hospital with a guaranteed teaching position.<br />
<br />
Then he starts his internship, and that's when things start to turn sour. He witnesses the corruption, the poor ethical standards, the abysmal working conditions of the resident. He starts to realize that maybe, just maybe, life isn't going to be that easy. He's still set on making a change though. He brushes off all the horrible attitudes the residents take and tells himself he will not be THAT resident. He finds a field he's comfortable with and decides to spend all his free time there, soaking up and absorbing all sorts of information to prepare him for when he becomes a resident.<br />
<br />
The year ends and he finds out he was 2 marks away from getting that field he wanted.<br />
So he settles.<br />
For a field that that he wasn't so in love with in the first place.<br />
<br />
No matter though, his heart will not be broken, his spirits uncrushed, he moves on! He goes into the field wholeheartedly, anticipating all the excitement. After all, he's a resident now. Now is when actual professors will give him advice on management and treatment and he'll finally notice how much of a difference he makes.<br />
<br />
Until the professors never really show up. And he's forced to make decisions based on his minimal experience and then he unintentionally harms a patient because he was forced to make a gut decision due to the fact that there was no one there to guide him.<br />
<br />
His mind begins to jade.<br />
<br />
And when the professors actually show up, they don't offer guidance or help. They ostracize and demean the poor resident. They put him in harsher conditions not offering him even the tiniest bit of solace or gratitude.<br />
<br />
He soldiers on.<br />
He tells himself, "It's alright. I'm going to be an Assistant Lecturer in 4 years. Then I won't be the one getting shit from the professors. Not only that, but I'll show them. I'll show them how it's supposed to be done. I'll teach the new residents. I'll be there all the time and guide them and make my hospital a better place."<br />
<br />
The man falls in love with a girl. They get engaged and soon to be married. Just as soon as he finishes his residency.<br />
<br />
He succeeds and gets his Master degree thus ensuring his position as assistant lecturer.<br />
It can only go uphill from now, he thinks to himself.<br />
He gets married, his wife gets pregnant and he's there teaching the new residents and enjoying his life.<br />
Then he realizes the money isn't enough. That he needs to work in the private sector.<br />
<br />
"It's only a few days a week. I can manage. I can do both."<br />
But then those days become weeks.<br />
The new residents call him on the phone, asking for the guidance but he's too busy. A month passes and he finally shows up and sees the department in a mess.<br />
He shouts at the residents for their poor management skills. He tells them how he barely made these mistakes when he was a resident.<br />
<br />
<b><span style="font-size: large;">He forgets how hard it was.</span></b><br />
<b><span style="font-size: large;"><br /></span></b><br />
Eventually as time goes by, he becomes exactly what he hated, and the cycle repeats itself.<br />
Believe me when I say, that I haven't even begun to shed light on what happens to residents in public hospitals. Believe me when I say, I totally understand why we become jaded, cynical and just not the greatest of human beings.<br />
<br />
<span style="font-size: large;"><b>It still doesn't make it right though. </b></span></div>Dr. Ahttp://www.blogger.com/profile/15241658350065546680noreply@blogger.com1tag:blogger.com,1999:blog-2055009998282309229.post-63768314949367417582012-07-15T16:03:00.000-07:002012-07-15T16:03:22.724-07:00Copts<div dir="ltr" style="text-align: left;" trbidi="on">
So we were sitting the Emergency ward me and a few other residents (one of whom is a Muslim non veiled girl because yes, they've become a ridiculously rare breed in the public sector) and we had two patients that needed an incubator. One let's call Mohammed, the other let's call Peter.<br />
<br />
They both needed to get operations done and they were both in pretty bad shape.<br />
<br />
Now, amazingly enough, we actually had an empty incubator available. Fucking fantastic, only until you realize I used the singular version of the word. Thankfully, it wasn't our choice; the ICU surgical resident (who gets to decide) decided to choose Peter (for actual medical reasons, he had a somewhat better prognosis), and we had to somehow explain to Mohammed's parents that Peter was going in and Mohammed wasn't.<br />
<br />
They didn't take it too nicely.<br />
<br />
Here's what they said and forgive me if it's not word for word:<br />
<br />
"Well OF COURSE you're going to pick the Christian kid. This is what happens all the time everywhere. We get treaded on while the Copts get all the special treatment. It's not fair."<br />
<br />
This was of course directed to my non-veiled colleague.<br />
<br />
My Muslim non-veiled colleague.<br />
<br />
Let's break this down and go over that sentence again.<br />
<br />
Mohammed's mother,<br />
<br />
1- Assumed the doctor was a Christian and so gave preferential treatment. This is fine. I'll forgive her for that. I've seen it happen before and I don't really mind it. I've never seen it during a critical call though. Just silly shit like donations and stuff.<br />
<br />
2- ACTUALLY fucking said, "This is what happens all the time". Here. In Egypt.<br />
<br />
In a Muslim Brotherhood run Egypt.....<br />
......During the aftermath of what was possibly the worst year Copts have had to endure when it comes to death.<br />
<br />
3- Further reassured her point by saying "It's not fair"<br />
<br />
Fucking Copts. Seriously you guys, aren't you all going to die already? Your 10% is totally putting a damper on the 90%.<br />
<br />
Rest assured, I explained the situation to her, not calmly of course.<br />
I told her why Peter was chosen. I had a beard. She had to listen to me.<br />
And all was well (until he arrested and died but that's not the point).<br />
<br />
You might be wondering, "Well, doc, it DOES happen! I've seen Christians give other Christians preferential treatment or whatever"<br />
<br />
You probably have, and that's your fault. Majorities have to to tend the minorities and let's face it, we haven't been a pleasant majority now have we.<br />
<br />
Everytime you wonder why some Christians give other Christians preferential treatment, remember the last time you said something along the lines of<br />
"Oh man, it's a shame he's a Copt."<br />
<br />
It's our fault for putting them in that particular situation, and if anyone needs to start a peaceful (and non hateful) coexistence, it should be the majority.<br />
<br />
Funny end to this story: The resident (non veiled) came up to me and said, "How do I prove to them I'm a Muslim?"<br />
<br />
I told her to tell them the Shahada (There is no God but Allah) so that they'd think they converted her out of shame.<br />
<br />
She didn't.<br />
<br />
Some people can be such spoilsports sometimes.<br />
<br />
<br />
<br />
<br /></div>Dr. Ahttp://www.blogger.com/profile/15241658350065546680noreply@blogger.com3tag:blogger.com,1999:blog-2055009998282309229.post-14776469614894087762012-07-13T18:05:00.001-07:002012-07-13T18:05:24.312-07:00I'm Sorry.<div dir="ltr" style="text-align: left;" trbidi="on">
After almost 6 months of being a resident, this is the one thing that's still pretty difficult to deal with: Telling the father or mother of a child that their kid is either terminal, hopeless, or just not going to be their same old son or daughter anymore.<br />
<br />
It's an emotional rollercoaster that's always different with each family. There's no routine to how it works or what you're supposed to do. I'm sure abroad there's a whole system or class teaching you how to deal this particular piece of information out but here, it's just an afterthought.<br />
<br />
Which sort of sucks.<br />
<br />
It's gotten to a point where I jump at the possibility of delivering bad news to families because I feel I'm the only one equipped with the ability to emotionally convey bad news and at the same time, share the emotional fuckage the family experiences. I don't think I'm better than my colleagues at it. I just think that they've been at this longer than I have, and that they've reached a certain jaded level of consciousness I'm not sure I'm ever going to get to... or want to at least.<br />
<br />
It's also a whole lot harder to do than say, telling the family their kid died. There's a finality to death. But with terminal illness or affection, I always feel like I'm damning them to both feel the loss of their child profoundly but also hope that maybe, through some sort of God given miracle, their kid will be the 0.0005 percent that miraculously becomes okay.<br />
<br />
And man, do they stick to that hope. Because after all, "God is almighty and works in mysterious ways."<br />
I sometimes thank God that I don't have to deal with atheists and agnostics. It becomes a whole lot easier to accept when the doctor says something like "Well, God is here and this is what He wanted to happen so who are we to judge."<br />
<br />
And I feel like a prick every single time I say that because it works every.single.time.<br />
<br />
So yay for Egypt not having any atheists.<br />
<br />
Another one that's always harsh is "Was there anything that could have been done to prevent this? Was it my fault doctor? Was I too late? Did I do something wrong?"<br />
<br />
I pride myself in honesty, but goddamnit does that become a whole lot harder when I say, a single shot of Vitamin K could have saved their newborn from having intracranial hemorrhage and subsequent brain atrophy for the rest of their life.<br />
<br />
And I tell them that. But I also tell them it's never their fault (unless it's aspiration pneumonia, ESPECIALLY after I've told them not to fucking breastfeed their kid but that's a whole other story entirely).<br />
<br />
After all, ignorance is rather rampant here as you might have sussed out from my previous blogposts.<br />
<br />
I have a few stories about a few of these moments and I might or might not share all of them here but here's one that really did a number on me.<br />
<br />
We had a 10 year old girl who got admitted into the hospital for having pancytopenia (all blood cells, including Red , white and platelets are decreased) Now, there are alot of causes for pancytopenia but we usually screen out leukemia first by doing a bone marrow aspirate and sometimes biopsy. So we managed to book her aspirate a few days later and I remember going upstairs to the labs to pick up her report.<br />
<br />
She had leukemia.<br />
<br />
I'm not going to lie. I felt nothing reading the paper at first. To me, this was just another girl who had cancer and we were going to tell her parents that and then she was going to go on to the Cancer Hospital and get her treatment and then maybe get better, or maybe not.<br />
<br />
Pretty standard stuff.<br />
<br />
But then I bumped into her father, who had been waiting for hours outside the lab for the test results.<br />
<br />
"Did the results come out Doc?"<br />
<br />
His eyes were wide open, full of worry and anxiety.<br />
<br />
"Yes, let's sit down first."<br />
<br />
So we sat on the bench in the hallway.<br />
<br />
"Well, your daughter, she has leukemia."<br />
<br />
"You mean cancer?"<br />
<br />
"Yes."<br />
<br />
Then and there he just broke down in tears, as if crushed by this immense weight. Not as if. He was, and there I was, sitting next to a crying middle aged man who just found out his 10 year old girl had cancer.<br />
<br />
I felt like shit.<br />
<br />
I felt like shit because I felt nothing a few seconds prior to seeing him, and now here I was, just emotionally syncing with him and feeling every ounce of sadness seep out of him.<br />
<br />
That's a lie, because obviously I couldn't even experience a fraction of what he was feeling, and even that small fraction was already too much for me.<br />
<br />
"It's not the end of the world. It's tough. It's going to be very tough, but I've seen kids with leukemia go into remission and get better and move on with their lives and become healthy individuals."<br />
<br />
"So you're saying she's going to be alright?"<br />
<br />
I fucking hate that question.<br />
<br />
".......... Listen. We're all going to do our best here. You're going to do what you can and the doctors are going to do what they can, and well, the rest we can leave to God. Okay?"<br />
<br />
He was still crying.<br />
<br />
So I hugged him.<br />
<br />
Might have not been the by the book thing to do. Might have not even been the right thing to do.<br />
<br />
But there we were; two sad men sitting on a bench trying to get through life's hurdles.<br />
<br />
<div style="text-align: left;">
<span style="font-size: large;"><b>And boy are those hurdles high for some people.</b></span></div>
<br /></div>Dr. Ahttp://www.blogger.com/profile/15241658350065546680noreply@blogger.com2tag:blogger.com,1999:blog-2055009998282309229.post-77130895896294690072012-03-10T13:58:00.000-08:002012-03-10T13:58:44.504-08:00Saving Lives and Trying Not To Get Shot<div dir="ltr" style="text-align: left;" trbidi="on">It's been a really long time since I posted anything here. I'd like to attribute it to ungodly hours at the hospital but most of the time I'm just really tired and couldn't be bothered. Gotta say though I did not expect to ever reach 12,000 visits , although to be fair 8,000 of those were people looking for pictures of Yousra naked and/or Demon picture searching. Read my post on my Psych ward days. It's somewhere in the archives and I'm too lazy to actually get a link.<br />
<br />
So I'm finally a resident in our local Pediatric government hospital. It's been a month now and the things I have witnessed, ranging from bitchy nurses to crazed parents, I suspect, have taken their toll on my psyche. But not to worry folks, that just means more stories for you, ESPECIALLY if I know you in person. Now a lot of things have happened in the one month so it's tough to choose a particular story, but seeing as how I haven't updated in a while, let me tell you about the time I almost got shot.<br />
<br />
It was like any other day in the emergency department. The flow of patients was unbelievably horrible and we were trying everything we could to stay on top of things. Among those patients, were 2 neonates (less than 28 days old) who were ridiculously sick. They both needed to be admitted into incubators (of which we had none available) and so we told them to go out and call as many hospitals as they could in hopes that one hospital would have an incubator available to move them into. Before you start wondering why we leave the patients' families to call hospitals and label us assholes, it's simply due to the fact that staying on the phone takes a long time and when you have a dozen patients at any given moment, you tend to use every given moment to good use on the patients you can actually help. <br />
<br />
Anyways it was all well and good, until suddenly one of the mothers lost her shit. She started shouting at us and called us 'fucking corrupt assholes'. Apparently, what had happened was that there was another patient that needed an incubator too but because those people had 'connections' with the hospital staff they were able to free up an incubator for them. When mother of sick baby number 1 asked mother of baby going to incubator what was happening, she literally told her, "It's because we know a certain doctor here"<br />
<br />
<br />
Ouch.<br />
<br />
<br />
Needless to say, it didn't take too long for both families to descend on our asses with full force. Not only were we outnumbered but there were other patients that needed management and they were just getting in the way of that. So I decided to go outside and talk to about 10 maniacally angry family members, who saw me as the devil's bastard son that never lived up to the devil's expectations. Like Peter The Pied Piper, I lured them all outside with my white coat, that they thought needed a little bloodying.<br />
<br />
Keep in mind I did not see this 'fabled doctor' that brought a patient upstairs. So I operated on the basis that this did not happen, and that the mother was full of shit.<br />
<br />
I went outside, and decided to talk to the two fathers; one very calm and one very VERY angry. Very angry dad shouted obscenities at me and kept threatening to destroy the hospital and everyone in it (normal fluffy stuff for doctors who have been to the Emergency department) and I tried to summon every ounce of my being to appear sympathetic. Its not that I wasn't. It's just that it's very hard to be sympathetic to a man who's constantly slurring at you with violent obscenities and things he'd like to do with your anus. After successfully calming him down (by promising to show him that we really don't have any incubators available) calm father decided to interject.<br />
<br />
"Doc, listen. I work as hospital security for another hospital, and I know and you know, that if I want to secure a place for my son, I'm going to go ahead and do so."<br />
<br />
Very normal, albeit a little bit irrational, statement from calm father. Now the thing is, he was saying this to me as he was pulling a gun out of his jacket.<br />
<br />
Puts a whole new spin on that last sentence now doesn't it?<br />
<br />
So there I was, not quite at gun point because he never pulled it out entirely, but still very much stressed out by a man with a gun who just threatened to kill me.<br />
<br />
I did what anyone would do at said moment.<br />
<br />
I smiled and laughed.<br />
<br />
Okay maybe not anyone.<br />
<br />
I asked him "Are you threatening me?"<br />
"Not at all, I'm just showing you what I'm capable of."<br />
"So you are threatening me then. Well let me ease this for you. If you kill me right now, that still won't free up an incubator for your son. The only way you can free an incubator is for me to direct you upstairs and have you kill one of the babies inside one."<br />
<br />
That totally caught him off guard thank God.<br />
<br />
"What the fuck are you saying? Of course I'm not going to kill a baby."<br />
"So you're going to kill me? A man trying to stay awake for 24 hours and at the same time trying to help as many sick kids as physically possible."<br />
<br />
That shut him up.<br />
<br />
He put the gun back in his pocket and started crying.<br />
<br />
I took everyone outside and gave every cigarette I had to everyone and we all shared a smoke and calmed our nerves down. That was it. Just as easily as the situation escalated, it was easily defused again.<br />
<br />
There is a happy ending and there is a sad ending to this story. Angry father's baby managed to stay stable enough for them to find an incubator the next morning. Calm father's baby didn't.<br />
<br />
There is no point to this story. I am not angry at the man who pulled the gun out on me. He was a father and didn't know what to do. I'm not sad at the kid that died. He was young yes, but there was alot wrong with him so he's definitely in a more comfortable place right now. I'm also not angry at the hospital due to their surprising lack of incubators (one might argue they have the money and they're not spending it correctly or one might argue that we don't get enough funds but that is neither here or there)<br />
<br />
<b><span style="font-size: large;">I guess I'm angry at the fact that it's never enough maybe</span></b>. I don't know. This story was supposed to be surreal and funny, and to my friends that I've told this story to in person, they can vouch that it was. I think it's because writing it down makes it seem a whole lot more real that it actually felt. A man resorted to something he probably thought he'd never do in his life to save his son.<br />
<br />
<i><b>It's so sad, stupid and brave all at the same time. </b></i><br />
<br />
<br />
<br />
</div>Dr. Ahttp://www.blogger.com/profile/15241658350065546680noreply@blogger.com2tag:blogger.com,1999:blog-2055009998282309229.post-16394302845610606602011-12-04T16:17:00.000-08:002011-12-04T16:17:55.104-08:00What Nobody Tells You About the Free Services We Provide<div dir="ltr" style="text-align: left;" trbidi="on">For all sakes and purposes, the hospital I work in, is truly a free hospital. That means that, technically speaking, the patient doesn't have to pay for anything at all ranging from investigations, medication or necessary surgeries to actually staying in an ICU ward. There is, however, a catch to all of this. Several catches, actually. Let me shed some light on them, and go into detail on one of them that particularly bothers me.<br />
<br />
<br />
<ul style="text-align: left;"><li>First of all, we will run all the necessary investigations to help reach a diagnosis, so long as our shit works. If you frequent this blog, you'll know we have an especially troublesome CT machine that tends to 'stop working' quite often. That's not all. Certain blood tests too, aren't readily available either. By readily available, I mean immediate. Let me give an example. In the Emergency ward in Pediatrics, it's a 24 hour shift. Now in the morning the main labs are open and stay open until about 2 pm. Now, if the main lab is open and you submit a sample at 8 am in the morning, they will not hand you the results until 2 pm in the afternoon. Protocol and beauracracy at its best. That means if a patient comes in at 8 am with severe anemia and you want to find the hemoglobin level not just to confirm the anemia, but to order a blood bag, they're going to have to wait until 2 pm. It's unfair too because if a patient comes in after 2 pm, then the emergency labs are open, and that only takes an hour for the results to yield. <b><u>So if you ever need to go to the emergency department in a free hospital, fucking come late because coming early isn't worth the effort</u></b>.<span class="Apple-style-span" style="font-size: large;"> Keep in mind that this isn't what bothers me</span>.</li>
</ul><div><br />
</div><div><ul style="text-align: left;"><li>We will give the medication for free, only if we have it. Some medication is simply not available in our hospital or requires a special order (that must be filled in only in the morning). Either way, if we don't got it, your best bet is to go buy the stuff outside. This is normally okay because even in the worst case scenario, most medication isn't that expensive. However, sometimes it can truly be heartbreaking. We had a patient that needed cyclosporine (a drug we did not have) and it cost them 1,200 Egyptian pounds to go buy. That's alot of money for the type of people we get in our hospital. It also becomes even more annoying when they end up spending money for investigations outside(to speed things up) and find themselves spending more money for medication. Alot of departments thankfully do get around the money issue by giving out donations courtesy of the older professors in each department. Sadly, not all departments have a heart. <span class="Apple-style-span" style="font-size: large;">As sad as this is, it's also not what gets to me.</span></li>
</ul><div><br />
</div><div><ul style="text-align: left;"><li>ICUs are readily available too, but only if they're empty obviously, and the problem with ICUs is well, patients tend to stay there for a while. So having to tell parents that they need to bust their asses looking for an ICU for their very sick child can suck at times but again, this is one of those things that is out of our hands. <span class="Apple-style-span" style="font-size: large;">Again, as much as this sucks, this is not what gets to me.</span></li>
</ul><div><br />
</div></div><div><ul style="text-align: left;"><li>Above all else, our hospital, is a teaching hospital. We have students readily coming in and patients regularly get examined by these students. Exams and classes with patients are prepared by the residents when the need arises and so on and so forth. It can genuinely be a bitch to find certain patients too. For example, neurology week would need different neurological cases. Cases we might not have, so we go around bargaining with other departments to give us their patients just for a while until the class ends. By bargaining, I literally mean bargaining. Usually, other departments also want other patients so we switch for a few hours until the classes are over. Just a few days ago, I had to go to the other Pediatric hospital across the street (we have two) and bring a patient for a class. It was especially difficult, because the mother was being difficult. Her kid had just had 7 samples taken out of her; she was tired and she wasn't ready for a class full of students palpating/groping her child. The mother had a point obviously, but she didn't have the right however. All patients admitted to our hospital sign an admissions form explicitly stating that we can do whatever we want and we have the right to use them for tests, classes etc. Now, I felt for this mother. Her kid was especially in high demand because the manifestations of her disease were easily shown to students. So this was her 5th day in a row. I managed to coax and convince her and she tagged along. Now this may not sound so bad, but it gets much much worse when it comes to exams, especially Masters or PhD level exams. Higher level exams require complicated patients that fulfill very specific criteria according to the examiner (our professors) and they can be ridiculously anal on what they want. Our professors also will not take no for an answer. Again, let me clarify with a better example. We had a kid (who I'm going to call Adam) with Rheumatic Fever in our department. He was a really nice 7 year old with a great and understanding mother. He got on the medication, got better and we told his mother that come Saturday they'd be going home and continuing their evaluation at a clinic. They were ecstatic because let's face it, a hospital is not a cheery place. The Friday before, a few professors came in and asked us what our cases were and we told them. They looked at Adam and heard his heart (he had Mitral Regurge, a complication of the disease that reveals a certain sound on the stethescope known as a murmur). They came back to us and told us, "Keep Adam for a week. He's going to be in one of the exams." We argued back and told them that we told the mother he was leaving. Their response was simply, "Doesn't matter. Make something up and keep them for a week."<br />
<br />
Let me clarify what "Make something up" means. Make something up means going to the mother and telling her that we just need to make SUPER sure Adam's okay so we'll run a few more tests on him, JUST to be on the safe side. It's all bullshit of course just to keep him there. <span class="Apple-style-span" style="font-size: large;">THIS IS WHAT I HAVE A PROBLEM WITH</span>. Thankfully, the specific scenario of Adam ended on a happy note with one of the more senior professors deciding he wasn't fit for an exam (not because of his health, but because his case was too easy for Masters students)<br />
<br />
This sort of shit is what ticks me off. It gets much worse as well. A few professors had entrusted me to find cases for a PhD exam in a few hospitals, one of them being our own version of a Cancer Hospital. Their criteria was simply, "Try to find a super difficult case so that more people fail than pass." So not only did I have to go about finding patients with rare fucking findings, I had to do it so that other fellow doctors would fail their PhD. This story got much worse because when I got to the Cancer Hospital and spoke to my contact there (Yes, a fucking contact established through the professors) she showed me an especially hard case (that had cancer and rare findings) and then she told me to let her know if they'd want her because if they did, she wouldn't have to start the next dose of chemotherapy on time and delay it for a few days until after the exam (because the findings would subside after a dose of chemo)<br />
<br />
Not only was I dealing in patients but I was sometimes prolonging treatment. Now, to be fair, we're not monsters either. I mean, the 'delay' isn't going to harm the patient and everything is looked after so as not to deteriorate the patient's health.<br />
<br />
<span class="Apple-style-span" style="font-size: large;"><b>But goddamnit if it doesn't make you feel like an asshole.</b></span></li>
</ul><div><br />
</div></div><div><br />
So the next time people talk about how free hospitals really are free, always realize that <span class="Apple-style-span" style="font-size: x-large;"><b>nothing in this world is for free. There are consequences and repercussions to everything no matter how great it sounds on the outside.</b></span></div><div><br />
</div></div><div><br />
</div><br />
<br />
<br />
</div>Dr. Ahttp://www.blogger.com/profile/15241658350065546680noreply@blogger.com0tag:blogger.com,1999:blog-2055009998282309229.post-20107813159185511422011-11-25T23:49:00.000-08:002011-11-26T00:23:07.405-08:00G6PD aka Favism aka What do you mean he can't eat Ful (mashed beans)<div dir="ltr" style="text-align: left;" trbidi="on"><br />
<div>I'm about to get scientific on all your asses right now so please bear with me.</div><div><br />
</div><div>There's a disorder out there called G6PD deficiency. Now G6PD is an enzyme called Glucose 6 Phosphate Dehydrogenase. It's an enzyme that protects the Red Blood Cells against oxidative damage. Now you might not know what oxidative damage means but all you need to know is that there are certain food items and medications that have molecules within them that can essentially destroy a red blood cell. G6PD is an enzyme that protects the red blood cell from this destruction.</div><div><br />
</div><div>The deficiency is pretty common especially here in Egypt, and it can be quite disastrous for the parents. Why is that you might ask? </div><div><br />
</div><div>Well, remember when I said certain food items. By certain food items I mean Ful (<a href="http://en.wikipedia.org/wiki/Ful_medames">http://en.wikipedia.org/wiki/Ful_medames</a>).<br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://upload.wikimedia.org/wikipedia/commons/thumb/e/e5/Ful_medames.jpg/800px-Ful_medames.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="http://upload.wikimedia.org/wikipedia/commons/thumb/e/e5/Ful_medames.jpg/800px-Ful_medames.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Looks appetizing no?</td></tr>
</tbody></table><br />
</div><div><br />
</div><div>Ful is the commonest and cheapest dish prepared here in Egypt. It's basically mashed beans along with some olive oil and garnish. Suffice to say, many people of a lower socioeconomic class have designated Ful to be their prime nourishment throughout their life. It's cheap and it's satisfies the hunger more so than any other meal I've heard of. </div><div><br />
</div><div>Having a deficiency in G6PD means you cannot eat Ful, forever.</div><div><br />
</div><div>If a person with a deficiency eats the beans, his or her red blood cells start getting destroyed (hemolysis) and the person presents with a case of acute severe anemia that cannot be corrected except with a blood transfusion. The destruction can be so severe that it can cause death in some cases. </div><div><br />
</div><div>There is no cure or anything like that. The only cure is to stay the fuck away from all food items, including Ful, that may induce hemolysis.</div><div><br />
</div><div>Now as far as enzyme deficiencies go, this one is awesome. Most enzyme deficiencies are fatal and severely affect a person's lifespan because they're involved in vital functions of the human body. G6PD is just a 'protective' enzyme and so all it does is protect the cells. So, whenever a kid comes with this condition I usually tell the parents that it could've been alot worse.</div><div><br />
</div><div>Problem is, parents don't quite see how it could be alot worse. </div><div><br />
</div><div>As I said, people of a lower socioeconomic level depend on Ful for sustenance. They can have it for breakfast, lunch and/or dinner. And in a country where more than 50% of Egyptians are on the poverty line, they try to be as economically wary as possible. </div><div><br />
</div><div>To them, it's a death sentence. Reactions I've had from parents who were told their kids had the deficiency have ranged from sheer disbelief to just mental breakdowns and tears. I remember laughing a little on the inside when a certain family just broke down into tears about the subject. I thought they were being dramatic. After all, they came to us in the ER and there were kids dying everywhere, so just needing a blood transfusion and staying away from the stuff, to me, was a win. After going back home and talking to my friends about it, we realised they were crying because they literally had no idea where or how they were going to get enough money to feed their kid something that doesn't contain beans. </div><div><br />
</div><div>We've had parents come in over and over again, because their answer was "We have to feed him something! He's going to die anyways if he doesn't eat, so we get him to eat the Ful then take him to the hospital for a blood transfusion." </div><div><br />
</div><div><span class="Apple-style-span" style="font-size: large;"><b>These are parents who are willing to take the risk of their child dying because they can't substitute Ful with anything else. </b></span></div><div><br />
</div><div>Fucking crazy.</div><div><br />
</div><div>All in all, it's a sad disorder to have if you're living here in Egypt. Ful has seeped its way into culture even and many (myself included) are not considered full blown Egyptian if they don't eat Ful at least daily. </div><div><br />
</div><div>I'll end this post on the funniest line I've heard from a patient's dad when I told him his son couldn't eat Ful forever, if only to document the mindset and to alleviate the sad tone of the post.</div><div><br />
</div><div>"Is this some sort of conspiracy? Is there going to be a Ful shortage so you're being forced to tell me that my son can't eat it? No, its impossible! God would not do this to the Egyptians. He can't! He knows how much we need Ful!"</div><div><br />
</div><div>It's funny, <u><i><b><span class="Apple-style-span" style="font-size: large;">but also sort of sad.</span></b></i></u></div><div><br />
</div><div><br />
</div><div><br />
</div><div><br />
</div></div>Dr. Ahttp://www.blogger.com/profile/15241658350065546680noreply@blogger.com2tag:blogger.com,1999:blog-2055009998282309229.post-41788274086047980032011-11-17T00:17:00.000-08:002011-11-17T00:17:59.947-08:00Stupid Things I've Heard Mothers and Fathers Say (Part 1)<div dir="ltr" style="text-align: left;" trbidi="on">Here's a list:<br />
<br />
<br />
<ul style="text-align: left;"><li>"NO! You will not take another sample from my son's precious blood! You're draining him away!" -Scared woman who was pissed off at us for taking a few samples for reports. I think she also said something about selling her baby's blood in the black market. </li>
</ul><div><br />
</div><div style="text-align: left;"><ul style="text-align: left;"><li>"I don't know why I didn't bring him sooner Doc. I just thought that his head growing faster than his body and that's where the brain is right? So he'd be getting smarter too!" - Mother who brought in her hydrocephalic child after months of leaving his head to grow in size. (Google hydrocephalus if you want, but I must warn you, it's pretty disturbing.)</li>
</ul><div><br />
</div><div><ul style="text-align: left;"><li>"Listen Doc, I know he had a seizure and he needs to be under observation for a few hours, but I have work in the morning and his mother's tired. Can't we just leave him here and come back to pick him up in the morning?" -Father after realizing he was going to have stay 5 extra hours with his child that had a convulsion.</li>
</ul><div><br />
</div></div><div><ul style="text-align: left;"><li>"Can't I just give him my blood Doc? Yeah I understand it has to be a match but I'm his daddy and I know MY blood will specifically save him." - Father upon hearing it's not like the movies and that it actually takes an hour for a kid to receive blood from the hospital.</li>
</ul><div><br />
</div></div><div><ul style="text-align: left;"><li>"I'm worried about his poop Doc! It's brown and it smells nastier than usual. What do you think it could be?" - Mother discovering that poop is actually brown and smells pretty bad.</li>
</ul><div><br />
</div></div><div><ul style="text-align: left;"><li>"So.... You're saying we SHOULDN'T feed him to the point of vomiting? But that's what my mom did and look at me! I'm fine!" -Mother reveals her wonderful technique for feeding her baby that is also, a family trade secret</li>
</ul></div></div></div>Dr. Ahttp://www.blogger.com/profile/15241658350065546680noreply@blogger.com1tag:blogger.com,1999:blog-2055009998282309229.post-14553558022616584512011-11-16T18:36:00.000-08:002011-11-16T18:36:59.756-08:00A New Start.<div dir="ltr" style="text-align: left;" trbidi="on">So it's been a long time since I've posted (4 months and then some) so I figure I should update you on what's been going on.<br />
<br />
Country's in shambles. Islamophilia and Islamophobia are on the rise all at once, and it's not looking good for anyone who's living here. However something monumentally life altering has happened:<br />
<br />
I've finished my internship.<br />
<br />
Now this might mean that the blog is done and dead. No more wacky stories from the intern who gave you a peek at an Egyptian Government hospital. Don't fret! For I have bigger news:<br />
<br />
I start my Residency in a month (hopefully less), and it's going to be in Pediatrics, but for now I'm volunteering every now and then at the hospital so that I'll know my way around when it all becomes official.<br />
<br />
Now, I know what I said before about me not being able to post that many stories when I was interning at the Pediatrics hospital, but, after much thought and exposure to both stupidity and mind altering moments of clarity, I've decided to keep posting about the stuff I'll be seeing. Keep in mind it might not be funny all the time, and sometimes, it's going to get a little dark and depressing. Anyways, let's get started.<br />
<br />
A few days ago, in the Pediatric ER department we had a patient that went into shock.We stabilized her but she needed to get into the ICU. Luckily, the resident at the ICU department said there was a free space available (a rarity in its own self) but we'd have to wait a while until the patient using the bed previously actually got discharged i.e: her parents would come and pick her up. So we comforted the mother and told her, and needless to say, she was ecstatic (she knew about the difficulty in actually finding a free bed available) After a few hours and dozens of patients we'd realized that the resident in the ICU hadn't called us back to tell us to bring her in. So I went to go talk to him about it.<div><br />
</div><div>"What happened? I thought you said it was a done deal and your patient would get discharged."<br />
"Yeah, about that, the patient's parents aren't picking up their phone."</div><div>"What do you mean they're not picking up their phone?"</div><div>"I mean they're not here in the hospital and I can't just kick her out into the street now can I?"</div><div>(Keep in mind the soon to be discharged patient was 4 months old)</div><div>"Well, keep calling them. They'll have to pick up eventually right?"</div><div><br />
</div><div><br />
</div><div>4 hours later.....<br />
</div><div>"What the fuck man? It's been 4 hours. Did they not pick up?"</div><div>"They did but we have a bigger problem.<span class="Apple-style-span" style="font-size: large;"><i><u>They don't want her</u></i></span>."</div><div><br />
</div><div><br />
</div><div>"What?"</div><div><br />
</div><div>"Like I said, they don't want her. It turns out they weren't the ones that brought her to the hospital. That was her uncle. Her parents don't want to have anything to do with her."</div><div>"I don't understand. What do you mean they don't want her?"</div><div>" I mean they don't want her. They said something about worrying she was going to die if she left the ICU but from what I gathered, they just don't seem to want her back."<br />
"Did you tell them we're not a fucking orphanage and that bed's needed."<br />
"Yeah yeah, all that, they still don't seem to give a shit though."<br />
"What am I going to tell the girl's mother upstairs? We practically promised her the bed."</div><div>"Well, she's going to have to leave eventually. When she eventually leaves the bed's still guaranteed to your patient upstairs."<br />
</div><div><br />
</div><div><br />
</div><div>So yeah.. </div><div><br />
</div><div>Now, it's not relatively uncommon for parents to not give a shit about their kids. If I keep posting, you'll soon realize how frustratingly apparent and common it's become. What ticked me off, was that there was a bed that was available that could have really helped another patient, and it was being wasted on someone who didn't need critical care. </div><div><br />
</div><div>And that. Fucking. Sucked.</div><div><br />
</div><div>I went upstairs and told the mother. She was amazingly decent about it. She kept asking me one thing though:</div><div><br />
</div><div><b><span class="Apple-style-span" style="font-size: large;">"What sort of mother would do that to her own child?"</span></b></div><div><b><span class="Apple-style-span" style="font-size: large;"><br />
</span></b></div><div><b><span class="Apple-style-span" style="font-size: large;"><br />
</span></b></div><div><span class="Apple-style-span" style="font-size: large;"><b><br />
</b></span></div></div>Dr. Ahttp://www.blogger.com/profile/15241658350065546680noreply@blogger.com0tag:blogger.com,1999:blog-2055009998282309229.post-44829953400338532362011-07-09T09:17:00.000-07:002011-07-09T09:17:22.113-07:00My first OB/GYN shift, in which, surprisingly, I don't see any lady parts.Okay so maybe I hyped up OB/GYN a bit more than I'd hoped for. <div>It's actually not as hilariously insane as I might have expected it to be. </div><div><br />
</div><div>I mean, sure I had to carry a bunch of samples, which included urine and tissue from an ectopic pregnancy (or a wannabe fetus as I like to call them) in a carton that was once a carton used to store a crap ton of eggs (there was no other medium of transportation).</div><div><br />
</div><div>Sure the sample with the fetal tissue was exposed and there was a big gaping hole in the bottle, which was ultimately worrying because I kept envisioning myself being drenched in, ummm, 'embryonic tissue'. </div><div><br />
</div><div>Which , BY THE WAY, totally DIDN'T happen thank God, much as it would have been entertaining I'm sure.</div><div><br />
</div><div>Yes, my first day was disappointing. </div><div><br />
</div><div>But then something awesome happened near the end of the shift. The resident, who I'd known from my previous stint in the resuscitation room (he was serving time there as well) came up to me and asked me who was covering the mid shift (I was in the morning shift).</div><div>"A reliable guy, don't sweat it."</div><div>"You don't understand, I need a man's man to get something done for me. Do you mind doing it and staying a bit later?"</div><div>"Sure, no problem."</div><div><br />
</div><div>Little did I know, that he wanted me to do something totally and utterly illegal..............</div><div><br />
</div><div>There was a patient that was due for a C-section the week after and she had mentioned a heart problem that she had when she was 6 years old. She didn't know the specifics but she remembered having had an operation. Now, the resident, ordered an echocardiography but it came up inconclusive. The problem was that no cardiologist would see her unless she had a chest X-ray. </div><div><br />
</div><div>So the resident wanted me to get a Chest X-Ray done, on a very pregnant lady, in a hospital that has a protocol of not doing X-Rays on pregnant women. Not only that, but he wanted me to do it in the ER (because any other way would take forever)</div><div><br />
</div><div>Now a few notes I have to mention here, just in case people reading this think I'm some sort of reckless doctor with absolutely no ethical background whatsoever. </div><div><ul><li>It's alright for a woman to get an X-ray during her pregnancy. It's not routine, but if it's necessary then it needs to be done.The few rads of radiation won't hurt anyone. The problem lies in multiple x-rays and so, just as a precaution the hospital banned all sorts of x-rays on pregnant women.</li>
</ul><div><br />
</div></div><div><ul><li>Now, there is a way to get around this, ahem, legally. You get a radiologist to sign in on the request, and he sets up an appointment for her to have her x-ray. That's a totally doable situation but there's a problem with this scenario. It takes fucking ages. As I mentioned in a previous post, the bureaucracy in our hospital is maddening, and shit tends to take a while. Time was not something we had.</li>
</ul><div><br />
</div></div><div><ul><li>She really did need an X-ray. A C-section is , for all means and purposes, an operation, and having an operation with undetected heart problems could lead to disaster for both her, and her unborn child.</li>
</ul><div><br />
</div></div><div>I was up for the task and told him I'd do it. So I went to her and explained the situation clearly to her. After she agreed, I told her to get dressed in her normal clothes and we were on our way to the ER. Now the only way we'd get the technician to do said X-ray was if we lied our asses off. So for 20 minutes, I had a brand new cousin who needed a Chest X-Ray. I told her that if anyone asks about her ridiculously swollen belly, she'd tell them she had ascites ( fluid in the peritoneal cavity). After getting our stories straight we arrived at the X-ray room. </div><div><br />
</div><div>I'd love to say that I had to convince the guy to do this one favor for me. I'd love to say that it took me ages to persuade the technician to perform the X-ray. </div><div><br />
</div><div>In reality, it took me all of 5 seconds. It went a little something like this:</div><div>"Hi, I'm an intern here and my cousin wants to get this chest X-ray done because the doctor at the clinic said she needed it done."</div><div>"So she's a relative, sure man no problem. Consider it your machine!"</div><div><br />
</div><div>God bless favoritism. </div><div><span class="Apple-style-span" style="font-size: large;">God bless corruption.</span></div><div><span class="Apple-style-span" style="font-size: x-large;"><b>God bless Egypt.</b></span></div><div><br />
</div><div><br />
</div><div>PS: In case you were wondering, the X-ray revealed ridiculous cardiomegaly, which did in fact mean that there was something wrong with her. She's now being treated by the cardiologists and she's on the proper medication and hopefully, everything will work out fine.</div><div><br />
</div><div><br />
</div>Dr. Ahttp://www.blogger.com/profile/15241658350065546680noreply@blogger.com1tag:blogger.com,1999:blog-2055009998282309229.post-2909909398175486762011-07-02T09:52:00.000-07:002011-07-02T09:52:59.165-07:00Obstetrics and Gynecology. Fuck Yeah!<div dir="ltr" style="text-align: left;" trbidi="on">That's right folks.<br />
<br />
For the next 2 months, I'm going to be talking about pregnant ladies and vaginas.<br />
<br />
Now before you perverts start thinking,<br />
"You lucky sonofabitch, women will strip down and show you their lady parts for free for 61 days"<br />
let me just illuminate your perspective.<br />
<br />
You're absolutely right. Women will strip down and show me their lady parts for free...<br />
<br />
Let me just add a few more words to that last sentence to show you why you're wrong.<br />
<br />
EMOTIONAL, HORMONE PACKED Women....OF ALL AGES.....will strip down to show me their SICK lady parts for free.<br />
Here's a list of bullet points ( because you all know how much I love bullet points ) to illustrate my dismay:<br />
<br />
<br />
<ul style="text-align: left;"><li>OLD WOMEN.......(In case you haven't been following my blog or you have no idea what I'm alluding to I urge you to read this post <a href="http://hospitaldelerium.blogspot.com/2011/05/my-first-clinical-exam-or-day-i-became.html">http://hospitaldelerium.blogspot.com/2011/05/my-first-clinical-exam-or-day-i-became.html</a> so you can clearly understand how ridiculously disgusting this can be)</li>
</ul><div><br />
</div><div><br />
</div><div style="text-align: left;"><ul style="text-align: left;"><li>SICK lady parts: Women, don't get me wrong. You're beautiful in every way. All of you. And I'm sure that your lady parts are perfect just the way you are. But like all other organs and body parts, when you get sick, they start looking less, how you say, perfect. I won't get into specifics, but fucking trust me on this one perverts, <span class="Apple-style-span" style="font-size: large;"><i><u>no vag is better than sick vag</u></i></span></li>
</ul><div><span class="Apple-style-span" style="font-size: large;"><br />
</span></div></div><br />
<br />
<ul style="text-align: left;"><li>EMOTIONAL HORMONAL women: Now hormones are a double edged sword. With them come all the wonderful things that make women women. Compassion, understanding, affection, love and all that. But when the hormones start working in overdrive you get all those other traits: Bugfuck Insanity, Absurdity, Illogicality ( I know its not a word but stay with me here) This becomes especially evident when a woman is pregnant, because according to her, EVERYTHING THE DOCTOR DOES is harmful to her baby, like say, take her god damn history and do an ultrasound.</li>
</ul><div><br />
</div><div><br />
</div><div>Now the non-perverts (or perverts in hiding) are probably thinking , </div><div>"But Dr. A, you're going to see the wondrous miracle that is child birth. It'll change your life every single time you witness it."</div><div><br />
</div><div>....................WRONG AGAIN!</div><div><br />
</div><div>Now don't get me wrong. I'm sure child birth is a beautiful process that brings a brand new human being into this wonderful happy planet (I hope to God you're realising the subtle undertones of sarcasm here) but let me explain why it's not as 'life changing' as one would hope.</div><div><br />
</div><div>I once saw a doctor go in....with BOTH HIS ARMS.....to properly position a baby. </div><div><br />
</div><div><br />
</div><div>That image is seared onto my brain, and is just a precursor to what sometimes happens in the 'Birth Kiosk' . Yes that's right, it's officially called a Birth Kiosk.</div><div><br />
</div><div>Now I'm sure its a beautiful process and all but witnessing this:</div><div><br />
</div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjCBFwWmHfYirDsNz2VMU1pUy8tBx5HEbPf0OtGTS6KBHYGYaEJWvEUZP0zByPHloLgmld5XCuCcaxH8uhZ6d8haT-leDgj5IMsx_K2o3hUvxTOYAC2gbUavJw8AznMxLl-lqs66aBklRU/s1600/newborn.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjCBFwWmHfYirDsNz2VMU1pUy8tBx5HEbPf0OtGTS6KBHYGYaEJWvEUZP0zByPHloLgmld5XCuCcaxH8uhZ6d8haT-leDgj5IMsx_K2o3hUvxTOYAC2gbUavJw8AznMxLl-lqs66aBklRU/s1600/newborn.jpg" /></a></div><div><br />
</div><div>coming out of a uterus that was once the size of your goddamn FIST</div><div><br />
</div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh14DiXA-MplHf-YWNVWr1HLIPVFIVMAwGXSe8dehOW4SP_tQX3tn84D5D0PtGx7gGwFxp0AV4ytRyjAW0HLKj7qhREQQwmtBcloioqw2nrA_B7nJK2LEcWCAuEl8jTb96RVdQEE2Zk49Y/s1600/fist.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh14DiXA-MplHf-YWNVWr1HLIPVFIVMAwGXSe8dehOW4SP_tQX3tn84D5D0PtGx7gGwFxp0AV4ytRyjAW0HLKj7qhREQQwmtBcloioqw2nrA_B7nJK2LEcWCAuEl8jTb96RVdQEE2Zk49Y/s1600/fist.jpg" /></a></div><div><br />
</div><br />
can be quite disconcerting for many. (The pictures aren't to scale I realize, but I'm too lazy to look for more appropriate pictures)<br />
<br />
All in all, I'm sure they're going to be an entertaining 2 months, more for you than for me. So sit back, relax and enjoy the endless, and hopefully hilarious torment, that I'm going to have to endure.<br />
<br />
<br />
<br />
</div>Dr. Ahttp://www.blogger.com/profile/15241658350065546680noreply@blogger.com1tag:blogger.com,1999:blog-2055009998282309229.post-23730283225335936452011-07-02T09:04:00.000-07:002011-07-02T09:04:52.900-07:00Let Me Explain My Absence (Or At Least Make Something Up So You Can All Love Me Again)<div dir="ltr" style="text-align: left;" trbidi="on">Alright, so I guess I have some explaining to do. It's been a whole month and a half since I've updated this blog but there's a reason for that. Here it comes. Are you ready for it?<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
I was in Pediatrics.<br />
<br />
<br />
<br />
<br />
<br />
Yup.<br />
<br />
That's my excuse. Now let me explain why it's a valid excuse because I know what you're thinking. You're probably thinking,<br />
<br />
"But Dr. A, Pediatrics must have been hilarious. Crying kids, crazy mothers; a shit ton of hilarious stuff MUST have happened to you!"<br />
<br />
The real answer is no, not really. I mean sure you've got the crazy mother who's worried about her crying child, but that's because most of the kids had serious afflictions, and try as I might to spin dead babies into something funny, I just couldn't. It was harsh, it was brutal and I had the world's stupidest resident for a superior (which meant more kids weren't getting the attention or treatment they properly needed). I have however, come to an epiphany of some sort.<br />
<br />
I want to be a pediatrician.<br />
<br />
<br />
Specifically, a pediatric oncologist.<br />
<br />
<br />
Yes, ladies and gentlemen, I've decided to pick the world's most depressing field when it comes to medicine. Do not ask me why ( I don't know myself ) . All I know is that it's something I want to do for the rest of my life, for now. But again, I doubt any of you really care about what my goals and achievements are. This was just merely an explanation for my absence.<br />
<br />
Does this mean I'm ending my blog?<br />
<br />
<br />
<b><u>Fuck no.</u></b><br />
<b><u><br />
</u></b><br />
Why?<br />
<br />
Because I've still got one more field left, and judging from how things are going from day 1, it's hopefully going to be the funniest field yet.<br />
<br />
To quote one of the great philosophers of anyone's time:<br />
<b><u><br />
</u></b><br />
<b><u>I'm back bitches.</u></b></div>Dr. Ahttp://www.blogger.com/profile/15241658350065546680noreply@blogger.com0tag:blogger.com,1999:blog-2055009998282309229.post-59350216744196302882011-05-13T16:04:00.000-07:002011-05-13T16:04:52.748-07:00I'm So Sorry You're Dying, But I'm Going To Need The Pink Form First.<div dir="ltr" style="text-align: left;" trbidi="on"><span class="Apple-style-span" style="font-size: x-large;"><i>Bureaucracy</i></span>.<br />
<br />
Just the word alone makes me cringe.<br />
<br />
I think, that one day, way back when man created government and government procedure, some smart ass said .<br />
"Well if the process for applying for any documentation is easy, we'll be working every [insert deity being worshipped at the time]damn minute , every day. Here's an idea. Let's make it complicated, perplexing, and best of all, soul numbingly time consuming."<br />
<br />
The hospital is government run , which means bureaucracy is effervescent within our halls. You're probably thinking, hey wait a minute! What if the patient's dying? Are they really cruel enough to let the family go through the unbearable torture of paperwork as he's slowly drifting off of this world into the next.<br />
<br />
Yes. Yes we absolutely are.<br />
<br />
Here's what happens so that a patient , let's say he's been in a car accident, can get admitted into a ward. This is assuming his only problem is , a broken hip for instance.<br />
<br />
(Get ready to be BORED OUT OF YOUR MIND)<br />
<br />
<br />
<ol style="text-align: left;"><li>The family goes to the window and gets a pink slip and records his name.</li>
<li>The pink slip is given to a doctor in the triage who then gives them a white slip to go to the Orthopedic ER.</li>
<li>The doctors there send the patient back to the ER because he needs to go to Resuscitation first (to make sure nothing else is wrong with him).</li>
<li>The doctor in the Triage gives them another white slip to go to Resuscitation.</li>
<li>The doctors in Resuscitation need a CT of the brain to make sure there's no injury as well. </li>
<li>A CT request is obtained.</li>
<li>The CT request is stamped.</li>
<li>The patient goes and gets the CT done (and if you've read any of my posts, you know this can go on for fucking hours) then goes back to Resuscitation.</li>
<li>The doctors declare he's alright and he needs to go back to Orthopedic ER.</li>
<li>The doctors in Orthopedic ER order an X-Ray.</li>
<li>The X-ray is done and the doctors decide he's worthy enough of an admission and consequently, surgery.</li>
<li>The doctors need the white slip to be signed by a Neurosurgeon AND a Surgeon so they can declare he's alright.</li>
<li>The family goes to look for said Neurosurgeon AND said Surgeron.</li>
<li>They wait a few hours until they find the doctors and they get the papers signed..<b>Possible ending to this step: The family lose their shit over waiting for the doctors and decide to threaten and hit doctors, OR they just leave with the patient. After Step 14, life is relatively easy. It can seriously take 4-5 hours until they find a Neurosurgeon AND a Surgeon free enough to sign a piece of goddamn paper.</b></li>
<li>They go back to Orthopedics, where the doctor tells them they need to go back to the window so they can sign and get an admissions form.</li>
<li>The window tells them to go back to Orthopedics and have the doctor sign on the white slip saying it's okay for him to be admitted.</li>
<li>They go back to the doctor. Just before he signs it, he asks the family whether or not he's gotten the blood samples and test results.</li>
<li>They shake their heads and say no.</li>
<li>The doctor doesn't sign and tells them they need to get a nurse to get the blood samples and send them to the lab for any diseases.</li>
<li>They go back into the ER and wait for said nurse or intern to take the samples.</li>
<li>The samples are taken and sent to the lab.</li>
<li>They wait another hour.</li>
<li>They get the results, show it to the doctor who decides to sign off on it.</li>
<li>They go back to the window, exchange the white slip for an admissions form.</li>
<li>They congratulate themselves and pat themselves on the back for a job well done.</li>
</ol><br />
<br />
25 FUCKING steps! I want to tell you I'm exaggerating. I want to tell you I'm embellishing, but I'm not. It's fucking ridiculous. Bear in mind this is all necessary paperwork, and if any of them is stopped, FOR ANY REASON, odds are the patient will have to wait until it's all done. Now we're not monsters. No, we don't let the patient do any of this. If the patient is in a critical condition, we'll treat him right away but someone's going to HAVE to do the paperwork in order for things to go smoothly. I've been with families throughout this procedure. It's relentlessly exhausting, and this is from someone who knows where to go and how to contact the doctors. Most of the times, they're just left there to do this ALL on their own (with the exception of the few obvious steps).<br />
<br />
<b><span class="Apple-style-span" style="font-size: large;">It's enough to drive any sane man crazy. </span></b><br />
<br />
I'll end this with a video of a cartoon I once loved as a kid: Asterix and the 12 Tasks. One of the tasks was for them to get a specific permit from a building, without going crazy.<br />
I urge anyone who's ever had to go through government bullshit to watch this. You'll get a kick out of it, I promise :<br />
<div class="separator" style="clear: both; text-align: center;"><iframe allowfullscreen='allowfullscreen' webkitallowfullscreen='webkitallowfullscreen' mozallowfullscreen='mozallowfullscreen' width='320' height='266' src='https://www.youtube.com/embed/JtEkUmYecnk?feature=player_embedded' frameborder='0'></iframe></div><br />
<br />
<span class="Apple-style-span" style="font-size: large;"><b><i>I hope to God that smart ass is stuck in Hell for eternity, doomed to look for a permit (that doesn't exist) in a building of gargantuan size and unbearable heat.</i></b></span></div>Dr. Ahttp://www.blogger.com/profile/15241658350065546680noreply@blogger.com1tag:blogger.com,1999:blog-2055009998282309229.post-10463999394525904542011-05-11T14:54:00.000-07:002011-05-13T13:36:38.540-07:00My First Clinical Exam or The Day I Became a Man.<div dir="ltr" style="text-align: left;" trbidi="on">Let's go back. Back to a time when I was just a young naive student, eager to learn, hopeful about my future and just ecstatic about choosing medicine as a viable career option.<br />
<br />
It was the day of my first clinical exam. Now let me just offer a quick explanation on what a clinical exam entails. It's a test (that you're graded on) that includes you, the patient and the doctor grading your performance with the patient. Bear in mind that the doctor doesn't care about how difficult the patient is, or how nice you might be. All the doctor wants is proper examination skills and a diagnosis plus or minus a management plan.<br />
<br />
Oh, and you have to wear a suit. With a tie. Not a white lab coat. A suit. In the summer. With a tie. While examining a patient. Something about respecting the fact that the senior professor actually had to get off his or her ass and grace you with his/her presence (I was never too sure about the details).<br />
<br />
Anyways back to the exam. There I was, nervous, anxious and ready to go. The patient was an elderly woman who looked like my grandmother (sweet and adorable old, not gray and senile old). I took it as a sign and went straight to work.<br />
<br />
"Hello, my name is Dr. A. What's your name?"<br />
"Zaynab, but you can call me Sayyeda Zaynab." (<i>Sayyeda Zaynab is a district here in Cairo hence the humor)</i><br />
"Ah. Ha-Ha. Okay well what brought you to the hospital Mrs. Zaynab."<br />
"SAYYEDA"<br />
................<br />
"Right, sorry. Sayyeda Zaynab."<br />
"Well, I've had this cough for a while and I decided to finally go and have it checked."<br />
<br />
After I took the history it was time for the ............................examination... (You'll understand my hesitation to continue with this story in a bit, I promise)<br />
<br />
I got the stethescope out and decided to auscultate her chest. Now she was wearing a gown so I tried to get the stethescope through but I failed. So I asked her .....nicely......... to unbutton her gown a bit. (We're almost there. God no. Please don't let me relive this again.)<br />
<br />
"Why should I unbutton? Here, let make this much easier for you Doc."<br />
<br />
<br />
She...<br />
She........<br />
She.<br />
<br />
<br />
Took off her clothes.<br />
She was 73.<br />
She wasn't wearing a bra.<br />
She was 73.<br />
You know what happens when you're a woman and you're 73.<br />
You..<br />
You..<br />
<br />
<br />
You Sag.<br />
Alot.<br />
Like touch the floor sag.<br />
<br />
<i>(Excuse me while I go puke again)</i><br />
<br />
<br />
I was 20 years old! My eyes lost their virginity. I was like a deer, caught in the headlights of a speeding car. I wanted to look away. I swear! But I couldn't. Apparently I stared for a while in silence because the doctor decided to interject.<br />
<br />
"Well, aren't you going to palpate?"<br />
"Excuse me? Palpate?"<br />
"Yes! Palpate the chest!"<br />
"Um. With my bare hands?"<br />
"Yes! You've got to palpate supra mammary, infra mammary AND mammary!"<br />
"............................"<br />
<br />
To this day I do not remember what happened. I get visions sometimes, late at night when i'm asleep. They wake me up. I'm getting better though so help me God. I remember how it ended though. Sadly my brain decided to leave me that memory.<br />
<br />
I remember her wearing the gown again. I remember the doctor telling me to leave. But right before I left, Sayyeda Zaynab grabbed me by the arm, winked at me and said<br />
<br />
<br />
<br />
<br />
<br />
<span class="Apple-style-span" style="font-size: x-large;"><i>"You've got great hands Doc."</i></span><br />
<br />
<br />
<br />
<br />
<br />
<b><span class="Apple-style-span" style="font-size: large;">I'm not a dirty whore. I'm not a dirty whore. I'm not a dirty whore. I'm not a dirty whore.I'm not a dirty whore. I'm not a dirty whore.</span></b><br />
<div><br />
</div><br />
That was and is my mantra every single time I shower.<br />
<br />
</div>Dr. Ahttp://www.blogger.com/profile/15241658350065546680noreply@blogger.com0tag:blogger.com,1999:blog-2055009998282309229.post-68125535663440984622011-05-10T10:31:00.000-07:002011-05-10T10:32:50.494-07:00Doctors Striking: Outrageous, Yet Very Necessary.<div dir="ltr" style="text-align: left;" trbidi="on">Today there was a nation wide strike calling all Egyptian Doctors working in any public hospital to simply stop working.<br />
<br />
I know what you're thinking:<br />
<br />
That's insane! So they're just going to let the patients die simply in a bid to garner media attention for themselves and ride off the coat tails of the revolution to spark some interest just so they could increase their salary?<br />
<br />
No. That's not it.<br />
<br />
As far as I can tell, the main reason behind the strike (read here if you're Arabic inclined <a href="http://www.edraab.com/?page_id=2">http://www.edraab.com/?page_id=2</a>) was simply a response to the incredible amount of corruption all public hospitals have to endure. Let me explain a few things in order to illuminate your perspective.<br />
<br />
First things first, it's not a complete strike. The Emergency Wards, Intensive Care Units, Neonatology units and Renal Failure units are still fully operational. That means any case that's at an immediate risk of dying will be looked after and resuscitated. This is a pretty big fucking deal. Almost all the wards in the hospital are full of stable patients, that, for lack of a better term, can afford a day of not receiving constant attention. Also, understand that not 100 percent of the doctors are participating in this strike. Most residents I know can't afford to not go to work because they're going to get in trouble with their superiors. So, although there might be a 'strike' to not work, it's not really all that effective because let's face it, doctors can't really stop practising even if for a day. I am 100% sure that if I were to talk to every single patient staying at the hospital and ask whether or not they'd support the doctors' strike in a bid for increased government spending, they'd agree and tell me that they'd join the protest if they could.<br />
<br />
Now there's a whole lot of fuss about how ethical it is to simply stop working in an attempt to prove a point. Surely there must be another way? Let me tell you a little story that happened in my days in the ER ward. The ER ward has its own CT machine. Now for those that don't know what a CT machine is, it's a souped X-Ray Machine. It can diagnose things better and sometimes even differentiate between different afflictions. It's a basic, fundamental and ESSENTIAL part of the process of reaching a proper management plan for patients.<br />
<br />
The CT machine has been offline for more than 6 months now. That means for example, that whenever a patient undergoes a head trauma and needs a CT asap, they have to go up to the 2nd floor use the ONE CT machine for the entire hospital. And you better hope to God that that machine is working because otherwise, the patient would have to get into an ambulance (that takes about 20 minutes to show up) and go the Internal Medicine Hospital (that's about 20 minutes away in rush hour) and wait for the elevator so that they can do it on the 2nd floor there. This is of course, assuming that the elevators are always working (...they're not.)<br />
<br />
This is one example. Others include, lack of proper intubators (for introducing a tube into an arresting patient's trachea) , lack of AMBU bags (which said tube then connects to for a proper supply of oxygen). Syringes, gloves, medication, even fucking saline are always deficient all the time.<br />
<br />
Now I know what you're thinking:<br />
<br />
But Dr.A, doctor shit is expensive yo!<br />
<br />
True. However that's not your problem. That's the government's problem. Fact: Back in the 60s and 70s Kasr Al Aini was an incredible and prestigious hospital. People flocked from all over the world to see this magnificent hospital at work.<br />
<br />
But we had more money back then!<br />
<br />
No, we didn't. It's just that corruption wasn't as fucking rampant as it is now.<br />
<br />
The worst part of all of it is that it reflects poorly on the interns and rising doctors as well. Imagine always being told there's nothing you can do because you lack even the most basic of facilities. That can jade anyone and turn them into a cynical asshole. I for one haven't escaped that mentality. Watching a mother's newborn die, just because there aren't enough incubators can darken even the brightest of souls. ( Here's another fun fact about that. The mother and father actually have to sign a paper that says the hospital isn't responsible for the inevitable death of their unborn baby due to there being no incubators. This is done before she gives birth. Imagine, signing a death warrant for your unborn child.)<br />
<br />
But surely the strike is a drastic measure? Why not goad the deans? Talk to people? Let the media in on the travesties that occur. Been there done that. Not much happens because the public hospitals are always taken for granted. And the important people don't ever get to go to public hospitals because why go to a public hospital when you can go to a much better private one. My friend personally tried to get them to repair the CT machine for months and gathered petitions and went the decent and righteous way, only to no avail.<br />
<br />
So yes, this is a drastic measure. However, I'm hoping it garners enough publicity so that the appropriate pressure can be put on the appropriate people.<br />
<br />
I'll end this with a joke. I'm a foreigner, which means I needed to pay for the entirety of my education in Kasr Al Aini. Now there's about 200-300 foreigners maybe in each year. So that's about 1,200 foreign students EVERY year. Each one has to pay 15,000 Egyptian pounds every year for 7 years (it's 6 but the first year they have to pay double so let's just say 7 for ease) . That's 18 million Egyptian Pounds a year.<br />
<br />
<b><span class="Apple-style-span" style="font-size: large;">Fucking Hilarious.</span></b></div>Dr. Ahttp://www.blogger.com/profile/15241658350065546680noreply@blogger.com4tag:blogger.com,1999:blog-2055009998282309229.post-82473609404606313952011-05-09T14:39:00.000-07:002011-05-09T14:39:47.765-07:00Niqabi Doctors: Oxymoron<div dir="ltr" style="text-align: left;" trbidi="on">Now this is just a disclaimer to remind everyone reading that this blog obviously reflects my own opinions. I'm not an expert. I don't claim to have a degree in studying human relations or human psychology. I do however, have something I like to call , "common sense" and it with that sense that we come to this blog post.<div><br />
</div><div>Let's just get it out of the way then.</div><div><br />
</div><div>Niqabi women cannot and should not be doctors.</div><div><br />
</div><div>I don't need to be saying this for fuck's sake!</div><div><br />
</div><div>Let's break it down into bullet points because I seem to love making them:</div><div><br />
</div><div><ul style="text-align: left;"><li>Doctors don't just cure people. They need to offer ease to the patient. They need to relate, understand and emote themselves to the patient. Notice how I put the word emote there? How in God's name is one supposed to emote with a fucking black curtain covering their face. It's impossible. I've worked with Niqabi interns and I can't even tell them apart. I can't even begin to imagine how a patient would feel talking to a Niqabi doctor. It just makes no sense. There's no trust because the patient can't see the doctor's face and therefore, expression. Suppose a doctor's giving a terminal diagnosis to a patient. I'd at least want to see the sorrow in their face. Not just because we are, whether we like it or not, governed by human empathy, but also because she could be smiling under the niqab. I know it's not plausible but hey, I don't fucking know that for a fact now do I.</li>
</ul><div><br />
</div><ul style="text-align: left;"><li>They're not 'big' on touching the patient. Now I might not be the smartest person in the world but last I recalled, being a doctor requires a 'hands on' approach. You must not be afraid to touch the patient and palpate for any abnormalities. You have to be comfortable feeling up a person from head to toe. I say feeling up because sometimes it does feel just like that. Now Niqabis are usually a conservative bunch, which means that they're not quite so adamant with touching and palpating a patient. They'll do it don't get me wrong. But they're going to do it quickly and inefficiently. They'll want to be done as soon as they can so they can atone for their sins of touching another man's body ( this is a joke. At least I certainly hope it is) This can lead to missed diagnoses especially in Internal medicine, where physical examination, is pretty goddamn essential to making a proper diagnosis. I really don't think God's going to be chastising you for touching a grown man's swollen scrotum. No matter which way you look at it, it cannot be misconstrued as sexual, even from the man's point of view. Unless of course he got the hernia on purpose because that's how he gets off: By having Niqabis feel his herniated groin. But that's like 0.03% of the world's population, TOPS!</li>
</ul><div><br />
</div></div><div style="text-align: left;"><ul style="text-align: left;"><li>The Niqab will get everywhere. Imagine if you were a Niqabi surgeon. Your Niqab will always be touching the patient infecting him with your holiness, and thousands of thousands of germs. He'll die virtuous.........and of sepsis.</li>
</ul><div><br />
</div><div><ul style="text-align: left;"><li>They're fucking creepy alright? As a patient, I'd like to not be surrounded by a shroud of dark blackness everytime I visit my doctor.</li>
</ul><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhIqWjqFUnIYCLcgZlUF-mxbNS6AfbSSfL5S_gAzg7IsDf031ZRATF8EImxrRkip1N_xNM2M4AOJ2kguhr3q9XIJ9jeORosO6GB3s2NZELyDU6oeDPrGBmW-Z1z_A4meumBDjw051JVWxU/s1600/niqab-women.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="209" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhIqWjqFUnIYCLcgZlUF-mxbNS6AfbSSfL5S_gAzg7IsDf031ZRATF8EImxrRkip1N_xNM2M4AOJ2kguhr3q9XIJ9jeORosO6GB3s2NZELyDU6oeDPrGBmW-Z1z_A4meumBDjw051JVWxU/s320/niqab-women.jpg" width="320" /></a></div><div><br />
</div></div><div>Seeing this is a sure fire way of raising up my blood pressure. Just look at the eyes. You're going to keep looking at them and end up overanalyzing the smallest gesture. Look at the woman on the left. She's clearly fucking pissed off. Or is she?</div><div><br />
</div><div> I DON'T FUCKING KNOW! AND NEITHER WILL THE PATIENT!</div><div><br />
</div><div><br />
</div><div>Point is, being a doctor and a Niqabi woman, in my opinion is almost an impossibility. The only area I can see them excelling at would be in the Obstetrics and Gynecology Dept. Even so, if you're going to want to specialize in OB/GYN you're going to have to go through all the rounds as an intern and as a resident as well. And even if you get to the residency, you're still going to have wear the Niqab because other men will most definitely be around you. And mothers, do you really want the first thing your baby sees be a Niqabi woman? </div><div><br />
</div><div>Then why do they do it? The reason, I've surmised, is painfully simple. To get goddamn married. You would be amazed at the number of girls, Niqabi or otherwise, that go into Med school simply to find a nice young doctor to marry and bear nice doctor fruit with. It's a sad reality, especially when you realize that medicine here, is ridiculously competitive, and that she's probably taking the spot of someone who actually WANTS to be in medicine for reasons , like, I don't know, say, healing goddamn people?</div><div><br />
</div><div>All in all, this is just a personal stance I have. It's not against the Niqab completely. It's just against the Niqabi Doctors. So if you happen to be a Niqabi and a doctor, please , I urge of you, tell me how you do it, because I sure as hell cannot see how.</div></div></div>Dr. Ahttp://www.blogger.com/profile/15241658350065546680noreply@blogger.com5tag:blogger.com,1999:blog-2055009998282309229.post-60695677544615321642011-05-06T14:45:00.000-07:002011-05-06T14:45:18.779-07:00Demons and Drugs.<div dir="ltr" style="text-align: left;" trbidi="on">This'll be the last story I tell about my days in the Psych ward.<br />
<br />
After a week in the ward, I decided to sit in during one of the psychotherapy sessions between a doctor and a patient.. I asked both the patient and doctor for permission to sit and they both agreed. Little did I know, I was about to witness some 'crazy ass shit'.<br />
<br />
<i>During the entire session I didn't speak or make a single expression. I remained silent and kept my cool. You'll understand how hard this was in a minute.</i><br />
<i><br />
</i><br />
The psychiatrist started:<br />
"So how are you feeling today?"<br />
<br />
"You know how I feel. I feel like shit."<br />
"What's going on? Why do you feel like shit?"<br />
"It's because I can't sleep. Every time I close my eyes, I think he's going to come and kill me."<br />
"Who's going to come and kill you?"<br />
"You know god damn well who's going to kill me!"<br />
"No. I don't. Who's going to kill you?"<br />
<br />
<i>Are you ready for this? </i><br />
<i><br />
</i><br />
<i><br />
</i><br />
<i><br />
</i><br />
<i><br />
</i><br />
<i><br />
</i><br />
<i><br />
</i><br />
<i><br />
</i><br />
<b>"Amr Diab."</b><br />
"The singer?"<br />
"Yes the goddamn singer. He wants to kill me. He knows I'm onto him and now he wants to eliminate my existence."<br />
"What's the big secret about him?"<br />
"If I tell you you're going to laugh. You won't believe me. But one day, I swear, ONE DAY, you'll read the newspapers and find out I was right."<br />
"I'm not going to laugh. I promise. Just tell me what the big secret is."<br />
<br />
".................He's a demon."<br />
"Excuse me, a what?"<br />
"A demon. He's not human. I know this because every time I see his face on the television, I see the real him. He's a devil. He wants everyone to listen to him and that's how he possesses people! He's done it to my brother, god rest his soul."<br />
"What happened to your brother?"<br />
<br />
<b><u>"He was killed by Amr Diab."</u></b><br />
<br />
<i>I need to mention that she actually laughed. I was pretty horrified. It was hilarious but still fucking horrifying to think that this man genuinely thought Amr Diab was a demon trying to kill him.</i><br />
<i><br />
</i><br />
"Why would Amr Diab kill your brother?"<br />
"Because my brother was a better singer than he was. Amr Diab couldn't handle street performances. That's where my brother shone, and that's when Amr Diab came and ran him down in a car. They could never prove it was him driving the car. But it had to be him."<br />
<br />
"If he killed your brother, don't you think he's had enough? Why would he come chasing after you now?"<br />
"Because I know who's even higher in the hierarchy, but you won't believe me.."<br />
<br />
"Tell me already. Who's controlling Amr Diab?"<br />
<br />
"Shhhh... It's Hosni Mubarak. He's a demon too. He's not human."<br />
<br />
We eventually wrapped up the session and he left. I couldn't help but feel sorry for the guy. I know it's hilarious to think that Amr Diab is a serpent demon that can possess people through the television, but this man genuinely believed that to be true.<br />
<br />
I was curious about the patient so I talked to the doctor.<br />
I asked her what she thought the diagnosis was.<br />
So she told me this:<br />
"Delusions of Persecution, Psychosis and Hysteria brought upon by Drug Abuse."<br />
My next question was almost immediate:<br />
"What kind of fucking drugs was he on? Acid? LSD? "<br />
"No, he tested negative for hallucinogens. <b><i><span class="Apple-style-span" style="font-size: large;">But he smokes a ton of hash</span></i></b>."<br />
<br />
I didn't question her. I should've. The stoner within me wanted to scream out<br />
<br />
"WHAT THE FUCK IS WRONG WITH YOU? NO WAY HASH CAN MAKE A MAN GO CRAZY LIKE THAT"<br />
<br />
But I didn't. Because then I'd have to explain why I was defending this 'horrible' drug.<br />
<br />
<i>I put 'horrible' in quotation marks because horrible here is a synonym for fantastical and magical.</i><br />
<i><br />
</i><br />
It's sad that hash is getting such a bad rap too. It's such a half assed diagnosis, especially in Psychiatry. I mean what sounds more plausible here:<br />
<br />
<br />
<ul style="text-align: left;"><li>He loved his brother alot. He was walking down the street and a car came in and smashed into his brother and ran off. As the car sped off, all he could hear was the new Amr Diab song in the car.</li>
</ul><div>OR</div><div><br />
</div><div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEja7Emhj3JT9ZmSIcbhpcRHet0YvNEa69nJD7OB9Br-sKS2b7zBtFBh0BKo_RrpL6r-AljoiO7M_TWnciNC285N0O89u586cmCBUzHsIP-4mfVrie9L3s3cKGXQXqz70WkbkEPeyhhD9dU/s1600/hash.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="261" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEja7Emhj3JT9ZmSIcbhpcRHet0YvNEa69nJD7OB9Br-sKS2b7zBtFBh0BKo_RrpL6r-AljoiO7M_TWnciNC285N0O89u586cmCBUzHsIP-4mfVrie9L3s3cKGXQXqz70WkbkEPeyhhD9dU/s320/hash.png" width="320" /></a></div> <br />
<span class="Apple-style-span" style="font-size: x-large;"> <b> +</b></span><br />
<br />
<br />
<br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhbOtPP7MfRzVnIbo-XbnvYJM3yLpU2iMpmx95kC3ltPZSuLOuUKKzNlnYEjLVsW1gG65GnplWWCG_31UbopjxqKlzUQwfuxrBb04bJ7O3a3lFwgQbrCT5-8Xb_iOeYxjPmTkPGTQcb2eo/s1600/amr-diab-20-699-7435309.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhbOtPP7MfRzVnIbo-XbnvYJM3yLpU2iMpmx95kC3ltPZSuLOuUKKzNlnYEjLVsW1gG65GnplWWCG_31UbopjxqKlzUQwfuxrBb04bJ7O3a3lFwgQbrCT5-8Xb_iOeYxjPmTkPGTQcb2eo/s320/amr-diab-20-699-7435309.jpg" width="277" /></a></div><br />
<br />
<span class="Apple-style-span" style="font-size: x-large;"><b>=</b></span><br />
<span class="Apple-style-span" style="font-size: x-large;"><b><br />
</b></span><br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj9vuHM0HJn8EH0aT1G9nBH7oPs03AUGQ2KW9Ha7uy_DJZ1Nxjez4hhl6km-AWT7Mj3B73mHysVvu2NF7W0AztlxtjtLOk_X7q97ABP_Affb7iNWqhyphenhyphenzkDgvkK8sN13MuzQ7_i2hIjoZK8/s1600/Mike_Demon_375x400.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj9vuHM0HJn8EH0aT1G9nBH7oPs03AUGQ2KW9Ha7uy_DJZ1Nxjez4hhl6km-AWT7Mj3B73mHysVvu2NF7W0AztlxtjtLOk_X7q97ABP_Affb7iNWqhyphenhyphenzkDgvkK8sN13MuzQ7_i2hIjoZK8/s320/Mike_Demon_375x400.jpg" width="300" /></a></div></div><br />
<br />
<br />
<i><span class="Apple-style-span" style="font-size: large;"><br />
</span></i><br />
<i><span class="Apple-style-span" style="font-size: large;"><br />
</span></i><br />
<i><span class="Apple-style-span" style="font-size: large;"><b>Yeah, I didn't fucking think so.</b></span></i></div>Dr. Ahttp://www.blogger.com/profile/15241658350065546680noreply@blogger.com4tag:blogger.com,1999:blog-2055009998282309229.post-5013762561257446352011-05-05T06:29:00.000-07:002011-05-05T06:29:48.386-07:00I Want Virgins....And Bad Actresses to Fuck! (Day 2 in Psychiatry)<div dir="ltr" style="text-align: left;" trbidi="on">I'm hoping you all read my first post on my first day in the Psych ward. I like to think it'll offer you true juxtaposition and insight to how wacky things are(It doesn't, but this story will)<br />
<br />
Second day at the ward, I was much more relaxed. The guy that pranked me was around and he decided to introduce me, properly and correctly, to the patients. Now there were a lot of patients, but one struck out as very curious.<br />
<br />
He had a Palestinian scarf wrapped around his neck and held a paper sword and was just walking around, reciting Quran and other religious prayers. I asked the guy that pranked me what his story was. He told me to go talk to him. He promised I'd be very intrigued. I manned up and decided to go initiate a conversation with the man.<br />
<br />
"Assalamu Alaikum." I said in the most non threatening, non intimidating way possible.<br />
"Wa alaikum assalaam. Now there's a proper greeting. You'd have made a great recruit!"<br />
"Uh Thanks. Recruit? Recruit for what?"<br />
"For the war of course! God's war! Against the non believers! And here I am stuck in this silly building, when I can be outside, slaying non believers with this sword of mine."<br />
"................That's....ummm...interesting."<br />
"Yeah well, it really sucks we're not living during the time of the Prophet anymore. God, what I would have done had I been there. It would've been amazing!"<br />
"Absolutely, I mean talking to the Prophet enough would have been really cool."<br />
"Forget that! The wars man! There were so many! So many non believers back in that day to kill. You'd walk down the street and find a non believer."<br />
<br />
<b><u><span class="Apple-style-span" style="font-size: large;">He sighed, "Boy, those were some good times. You just know they're having all tons of awesome freaky sex with the virgins now."</span></u></b><br />
<br />
<span class="Apple-style-span" style="font-size: large;"><i>Wait... It gets better.</i></span><br />
<br />
We walked back to the common room where patients were playing backgammon, dominoes and watching TV on their super big flat screen (The Psych ward is pretty god damn awesome, if you're not crazy).<br />
<br />
He plopped himself on the chair and started chastising everyone for watching the 'filth and sex depraved garbage' . Then Yousra came on the TV and that's when everything changed.<br />
<br />
<i>Yousra's a female actress here in Egypt. She's pretty famous and she's been acting for a very long time. She's old and plastic. Here's a link <a href="http://www.zawya.com/pr/images/EgyptianActressYousra_2007_11_04.jpg">http://www.zawya.com/pr/images/EgyptianActressYousra_2007_11_04.jpg</a>.</i><br />
<i><br />
</i><br />
<b>I was expecting him to lose his shit and start a religious tirade against her. The blonde hair, the fact that she plays empowered females, you know, the stuff that drives insane religious people more insane.</b><br />
<br />
He looked at me and said,<br />
<br />
"Maaan, what I'd do to fuck her. You just know she's got a great pussy. Wouldn't you fuck her Doc?"<br />
<br />
What..the...fuck?<br />
<br />
"But what about religion man? What about your relentless war and journey to be a martyr for God? What about the Virgins!?"<br />
<br />
<span class="Apple-style-span" style="font-size: large;"><b>"Oh that's all well and good.. But I'd GLADLY sacrifice all those virgins for sex with Yousra."</b></span><br />
<br />
So here's my idea to get rid of every single suicide bomber, and we have to act now, especially that Osama's dead and Qaeda's weak.<br />
<br />
Americans, instead of dropping bullets and fucking firebombs, print flyers of this woman and drop them right now in every country with crazed Islamic terrorists:<br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgbuLPZ1VpRTAM3_yAOuGKLRVwOFY7L5cAI1t9UUXD3m22w43Ho0FCW7Rw9grDf_wLwOKK05ui3EyKB9Msv1LQ3Its9r00_XYONL7OhEe4T7Nurf3lomTg6SpbFYAL13gPNrMYWmdo0QSI/s1600/normal_yousra.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgbuLPZ1VpRTAM3_yAOuGKLRVwOFY7L5cAI1t9UUXD3m22w43Ho0FCW7Rw9grDf_wLwOKK05ui3EyKB9Msv1LQ3Its9r00_XYONL7OhEe4T7Nurf3lomTg6SpbFYAL13gPNrMYWmdo0QSI/s320/normal_yousra.jpg" width="260" /></a></div><br />
<b><span class="Apple-style-span" style="font-size: large;"><br />
</span></b><br />
<b><span class="Apple-style-span" style="font-size: large;"><br />
</span></b><br />
<b><span class="Apple-style-span" style="font-size: large;">Guaranteed. To Fucking. Work.</span></b><br />
<br />
<br />
<br />
<i>Note: Now I don't know how many foreigners read my blog, but I figured I'd include this little addendum to inform people. This man was clearly not well in the head. He's by no means, an example of Islam ruining someone's brain. Islam doesn't ruin people. Religion does (especially if practised wrong). I also want to note that the person never killed anyone and he was just delusional.. He was by no means a danger to anyone at all. He just talked shit. </i><br />
<i>Thank you for taking the time to tilt your head and read my Italic note .</i></div>Dr. Ahttp://www.blogger.com/profile/15241658350065546680noreply@blogger.com1tag:blogger.com,1999:blog-2055009998282309229.post-85516524518625070732011-04-25T05:26:00.000-07:002011-04-25T05:26:52.791-07:00Psychiatry is Awesome. But Only If You Have A Sense Of Humor.<div dir="ltr" style="text-align: left;" trbidi="on"><b>I love psychiatry.</b><br />
<br />
I do. I'm not talking about psychology. Psychology and psychotherapy is important too, but eventually with some patients, you're going to hit a brick wall, and that's where the wondrous drugs psychiatrists prescribe comes in.<br />
<br />
Anti-depressants, Anti-psychotics, Sedatives are the legal equivalent of mushrooms, ecstasy and heroin. That alone makes the field of psychiatry a world rife with rainbows and unicorns.<br />
<br />
Now, I need to mention that Kasr Al Aini does in fact have a Psych Ward, and a good one at that. But you have to understand something:<br />
<br />
<span class="Apple-style-span" style="font-size: large;">The mentality of the normal Egyptian does not allow for psychiatry and the study of the mind. Ergo, you need to be really really fucked up in the head for your family to commit to you a government hospital's psych ward.</span><br />
<br />
Needless to say, my month spent in the Psych Ward was fucking awesome.<br />
<br />
I remember the first day I went. I was looking for the resident so that she'd be able to give me tips and pointers on how to deal with the patients. What to say, what to do, etc.<br />
<br />
I met the nurses and security guards and asked about the resident's whereabouts. They told me she was out and due back at any moment. So I decided to wait.<br />
<br />
A man came up to me. Big and burly. He looked at me straight in the eyes and just groaned a big UGGGHHHH. I figured he was one of the patients so I asked the nurse what I should do. She looked and told me not to freak out.<br />
<br />
<b>So I freaked the fuck out.</b><br />
<br />
He kept touching my pockets till he got to my cigarettes. Then he made an ever bigger groan GAUHHHH.<br />
<br />
The zombie was communicating with me, and I think he wanted cigarettes.<br />
<br />
"Do you want a cigarette? Is that what you want?" I felt like I was talking to Lassie. <br />
He nodded his head like Mary's retarded brother in 'There's Something About Mary"<br />
I took one out and gave it to him. He started smoking and he seemed calm.<br />
<br />
I decided to wait in one of the empty rooms till the resident showed up.<br />
<br />
Motherfucker followed me and closed the door right behind me.<br />
<br />
So let's paint a picture of the situation right now. I'm locked in an empty room with a zombie. Rape was inevitable.<br />
<br />
He walked to me and his face was RIGHT in front of my face with only a few centimeters of space in between.<br />
<br />
"GRAAAAAAAH!!"<br />
<br />
I prayed to God and hoped the zombie would have mercy on my anus.<br />
<br />
Just as I was about to scream, he started laughing.<br />
<br />
<b><span class="Apple-style-span" style="font-size: x-large;">I got Punk'd in the Psych Ward.</span></b><br />
<br />
Wait. It gets better.<br />
<br />
We started talking and I figured he was the security guard (they don't usually wear uniforms). He asked about what I wanted to specialize in and whether or not I was interested in Psychiatry as a field or not.<br />
<br />
"Of course I am. I love psychiatry. I think it's interesting."<br />
"That's great. Well you'll have a great time here. Most of the patients are harmless so you've got nothing to worry about. So are you more in interested in the Drug Rehabilitation side or the Psychiatric Illness side?"<br />
"No, I'd definitely have to say the Psychiatric Illness side. The problem with Drug Rehabilitation is that the patients are usually assholes. You help them. They swear they won't do drugs again, and within a week they've relapsed and they're back here again. It's just a waste of time."<br />
"Umm.. I'm a druggie."<br />
".................You're not a security guard?"<br />
".......No. I've been here for 2 weeks now and I think I'm ready for the outside world."<br />
"Oh... I'm sorry for what I said then. So what drugs were you addicted to?"<br />
"Hash and Tramadol. I really am worried I'm going to relapse Doc."<br />
"Well listen, I understand they're both drugs and everything and you'd be much better off without any of them, but if you HAD to relapse, then go back to Hash. You need to stop taking the Tramadol. Hash is totally fine so long as you do it in moderation."<br />
"Wait, so you're saying I should smoke Hash?"<br />
"No, No, No. That's not what I'm saying at all. I'm saying that IF you were to relapse, then relapse on the Hash because it's much easier to quit too."<br />
<br />
My first day of Psychiatry and I might have accidentally convinced a recovering addict to smoke Hash again.<br />
<br />
<br />
<br />
<span class="Apple-style-span" style="font-size: large;"><b>I'd say that was a good day.</b></span><br />
<span class="Apple-style-span" style="font-size: large;"><b><br />
</b></span><br />
<span class="Apple-style-span" style="font-size: large;"><b><br />
</b></span><br />
PS: I had taken his number and I'm happy to say that he's clean and gotten his life back together again. He still smokes hash, but MUCH less than he used to. Which is fine,<i><u> <span class="Apple-style-span" style="font-size: large;">I think?</span></u></i><br />
<br />
<br />
</div>Dr. Ahttp://www.blogger.com/profile/15241658350065546680noreply@blogger.com1tag:blogger.com,1999:blog-2055009998282309229.post-70299125093141763922011-04-24T06:04:00.000-07:002011-04-24T06:04:12.785-07:00Count From 10 To 1 Slowly Pleas....Oh Shit Cockroach! *SQUISH*<div dir="ltr" style="text-align: left;" trbidi="on">Yeah okay so we're not too hygienic in Kasr Al Ainy.<br />
<br />
But can you blame us?<br />
<br />
<b>Yes.. Yes you can.</b><br />
<br />
It's not just the lack of hygiene we've got in the hospital that's the problem. It's the absolute neglect of even attempting to stick to even our own sub-standard hygiene code. It becomes especially hilarious when it becomes contradictory. Here's an example:<br />
<br />
I was prepping up to attend my first surgery. There's a whole system to how you have to wash your hands. It's very thorough and specific and once you've got the garb and gloves on you absolutely cannot touch anyone or anything except for the equipment and/or the patient's body. So I washed up, had someone help me wear the garb (he was washed up too) and wham bam I'm in the Operating Room. Now, I'm an intern, so most of the time I usually just watch and pretend I understand what it is the surgeons are doing. So I kept my distance and watched . I folded my arms and observed without making much noise. Suddenly, my resident looked at me and told me,<br />
<br />
"Go wash up again now. You broke the rules."<br />
"What? What the fuck? I didn't touch anything?"<br />
"You folded your hands."<br />
"But I washed them! I did. You saw me wash them!"<br />
"Your hands touched the garb when you folded them. Go wash up."<br />
<br />
So I did as I was told and I went back inside, and I was extra careful to not touch anybody. Then the fucking nurse bumped into me.<br />
<br />
"What the hell Dr. A? Go wash up again."<br />
"Are you serious? She grazed my ass. That's it. Nothing else. I'm pretty certain my ass isn't going to come in contact with the patient."<br />
"It's protocol. "<br />
<br />
So I went again.<br />
<br />
<br />
<span class="Apple-style-span" style="font-size: large;"><u>This happened 3 more times. </u></span><br />
<br />
<br />
My hands resembled the face of an 87 year old woman. Finally, the operation was over and we got out of our suits but still wore our scrubs (that were also sterile and kept in the ward). My resident told me not to worry and that, during his first surgery, he had to scrub up 5 times as well. He just told me that the more surgeries I get to attend, the more cat-like my reflexes become in avoiding contact with anything. So I asked how many surgeries were left and he said a couple. So we went outside and smoked a cigarette and walked back in. He told me he'd meet me in the OR and I said alright. I went back and got another set of scrubs because I compromised my old ones by stepping outside in the filth infested hallways of our hospital. After getting dressed and scrubbing up, I noticed they started the operation already so I went in quickly.<br />
<br />
<i>Here's an important note: The hospital itself has scrubs that it gives to people who don't own their own. The hospital sterilizes its shit. So, though the scrubs may look worn out by dozens of sweaty surgeons, they're clean. You can own your own scrubs but they should also be left in the lockers so they get sterilized with the rest.</i><br />
<i><br />
</i><br />
That's when I saw it.<br />
<br />
The fucking resident was wearing the <span class="Apple-style-span" style="font-size: large;"><b>same </b></span>goddamn scrubs he wore outside. This is the same resident that told me to fuck off when my ass grazed a nurse wearing sterile scrubs.<br />
<br />
After the operation was over, I talked to him about it. I asked him why he didn't change into the scrubs that were sterilized in the OR.<br />
<br />
"Oh no, these are my own scrubs. I don't have to borrow them from the OR. I'm sure they're clean."<br />
<br />
<span class="Apple-style-span" style="font-size: large;"><b>He was sure they were clean. We smoked a cigarette, squashed a cockroach outside, and met friends and did the customary hug and this mother fucker is SURE his scrubs are clean.</b></span><br />
<span class="Apple-style-span" style="font-size: large;"><b><br />
</b></span><br />
<span class="Apple-style-span" style="font-size: large;"><b><br />
</b></span><br />
<span class="Apple-style-span" style="font-size: large;"><b><br />
</b></span><br />
<span class="Apple-style-span" style="font-size: large;"><b><br />
</b></span><br />
<span class="Apple-style-span" style="font-size: large;"><b><br />
</b></span><br />
<span class="Apple-style-span" style="font-size: x-large;">I can't wait to be a resident.</span><br />
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, </div>Dr. Ahttp://www.blogger.com/profile/15241658350065546680noreply@blogger.com0