Thursday, June 12, 2014

8 years later.

Tomorrow is the last in a long line of graduations. After 8 years at UT Southwestern and later Parkland, here are some things I've learned:

- Some parts of medical school are absolutely terrible. If I had known what I was facing when I went in, I may not have gone through with it. But at the end I was glad that I did.
- It is normal to think about quitting during the process, then realizing you can’t because if you quit you’ll never pay off all the loans.
- don't drink coffee and take ephedrine to stay awake to study or your chest may feel like it is beating out of your chest.
- I was never smarter about the basic science of medicine than the day I took my step 1 board exam. So much general science knowledge has been lost since then, pushed out by things that I actually use.
- class rank in medical school has limited correlation to how good of a doctor a person turns out to be. There is only so much that you can teach people skills.
- Every medical specialty is smug in their own knowledge and amazed at what physicians of other specialties don’t know.
- Some doctors are assholes. You have to work with them anyways.
- Some patients are assholes. You have to treat them anyways.
- Be wary of anyone from the 903 area code (East Texas)
- be nice to nurses because they are the constant hands, eyes, and ears on the patients. Their jobs are hard and they have to deal with a constant stream of gradually less idiotic residents that changes every July 1.
- Also, nurses have your pager number and if you try and pull shit on them they can call you about non-urgent labs or medication changes every 15 minutes if they so choose.
- patients and their families are often scared and stressed out. They may need someone to yell at, and that someone may be you.
- physicians make horrible patients. I once had a doctor pulling up his own CT scan on his laptop before I could get there to tell him a diagnosis, and he then dictated to me what I should be prescribing him to treat it.
- do not cook meth in a moving car
- brain injured patients are sad, but they can also sometimes be hilarious (as an example, a wealthy Dallas businessman and major university donor once asked me in front of his wife if he could see my boobs. She was mortified.)
- A good poker face is an important life skill.
- a lot of people will show sympathy by starting prayer chains or bringing cookies or flowers after an accident, when really what the patient needs is someone who will come and help them get on and off the toilet. Flowers are pretty, but they don't help that much when a patient can't wipe his own butt.
- patients will trust you more if you explain what is going on and what they need to do to change their situation. Patient education produces results.
- For all of the sins that Wal-Mart has committed, their $4 prescription drug list is a Godsend for indigent patients.
- do not throw gas or lighter fluid on a fire. If you must add fuel, add diesel. The fumes are not inflammable.
- laying hands on a patient , touching them where they hurt, can by itself help them to feel cared for and therefore make them feel a little better.
- Just because someone is poor, does not mean that they are lazy. A lot of my patients work their asses off and remain poor.
- the worst illnesses always happen to the nicest people. If you’re a church deacon who helped thousands of children through the foster care system, and are loved by all, you are probably going to get brain cancer. Assholes almost never get brain cancer.
- Some people talk a lot more than they work. AND I HATE THEM.
- The most common thing to be cut with at a shady club is a box cutter.
- unless you’re in Puerto Rico, then it’s a Machete.
- a person will always be better at a job that he truly enjoys. Looking back, I was a pretty shitty surgical intern, although I tried not to be. I am much better as a rehab resident.
- The biggest guys are the biggest wimps when it comes to needles.
- The VA truly is a fucked up place where bad employees are impossible to fire, but if you focus on the patients, it makes working there seem a little better.
- every time someone writes PM&R as PMNR or PMR, a fairy dies.
- Most other doctors don’t actually have any idea what PM&R physicians actually do. We’re like the secret society of the medical world.
- I don't care, because I love what I'm doing. And I like to be surrounded by a cloud of mystery.

Peace out, Parkland. It's never been boring.

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