A few recent surprising self-realizations, Part Deux.

A few recent surprising self-realizations, Part Deux. Plus just some general clarifications about life the way I see it currently.

continuation from 8/09....

1. When a dying man who is NPO in the ICU begs you for water, you should give it to him. Regardless of whether he may aspirate or may go to surgery. It's bad enough that he is tied to a bed with tubes coming out of his neck, groin, wrist, and penis, tele leads all over his chest, and BP cuff and SCDs firing every few minutes... Give the old dying man water. Period.

2. I like some people a whole lot. But I don't like most people much at all. This sentiment is exacerbated by sitting across from 25 of them complaining in my face all day in a rapid-fire clinic session that has to be similar to speed dating in Manhattan.

3. The only thing worse than sitting in clinic all day is sitting down to chart afterwards.. For 5-8 hours. Recapping every painful conversation, discussing all the possible things their problems could be due to, but admitting in legal jargon that you don't know what the hell the real problem is. Then making a plan that you don't really believe in to cover your ass legally. Knowing full well that >90% of the time, things will run their course and get better on their own no matter what you do.

(Sorry, it's true... )

4. Well, that's probably not true. I'm sure there are worse things than clinic and charting, but it is pretty painful.

5. I truly believe people would be much better off going on a hike like I did today for their mental health than sit in my office, fuming with anger because I'm running so late in order to get their serotonin enhancers refilled. Other things that boost seratonin: exercise, rest, music, good food, falling in love. I recommend doing those other things first, then sit in the office fuming if still needed.

6. Politics is dumb. Administration is crap. U.S. Medicine has been taken over by Lawyers and Politicians. The specifics of Medicare coding are the most ridiculous things I have ever seen in my life.

7. Despite the accusation, I do not believe that I have some sort of internal or innate discontent seeded within me that is traveling with me, haunting me. Sometimes, I feel so happy in my life. Like on a really beautiful hike, a day filled with skiing, a good book in a comfy coffee shop, delivering a healthy, happy baby, hanging out with my family, meeting someone new and exciting. It's just that this job sucks. And I'm really lonely here.

8. I love to hike alone. I prefer to hike alone. Like running. These are times for me to think and process. Like on an airplane. Please don't talk to someone who is obviously and intentionally ignoring you on an airplane, we need a people break. Leave us alone.

9. I can't imagine how I can survive this job for the next +/- 30 years required to pay off my massive debt. I have to find some way out.

10. Ironically, despite my discontent with primary care, I have become very passionate about caring for people and healing. I have discovered a great divide between "making people feel better while they are living" and "making people live as long as possible, indefinitely, miserable, and demented." Some people want to live as long as possible, but most don't. Most people just want to feel better while they are around.

11. It is my worst fear in the world to end up intubated and sedated in the ICU. Please extubate me if this happens. I don't care what the reason is.

12. The most hurtful thing possible in the love realm is dishonesty. Everything else is OK.

13. Even though I love it, I don't think I'm ready to move back home. I'm not sure why.

14. People who are allergic to every pain medication except Dilaudid are full of crap. And physicians, including myself, are enabling and propagating opioid and benzo addiction in this country. We all know it. And almost all of us do it anyway. I do it because I'm already too burnt out to argue any more.

15. Primary Care Physicians have become drug dealers catering to opioid and benzo addicts. Until we make psychotropic prescription drugs illegal, primary care will be an intolerable profession. Why can't we make these things street drugs? I don't have time to sit around prescribing whiskey to alcoholics who are stinking of booze. Nor reason with a Meth addict picking their skin off. Nor do I have time to sit around trying to communicate with a narc'd out opioid addict. What's the difference?

16. Suburbs are like Dementors that suck out my soul. I like culture.

17. There are some people in this world in their 30s who don't know what hummus is. Not like the specifics about what makes it, like "I've never heard if it, what is it?" I cannot understand how this is possible.

18. There are 2 things I've learned for sure in residency:

#1 - sleep is overrated

#2 - if you don't do what makes you happy when you have the opportunity to do so, you will waste away in misery and self-pity. If you identify things that make you happy and do them, you will feel a lot better.

19. I don't know why I feel the need to chronicle my life online.

20. I'm single, alone, and lost. Don't own a car or house, and won't claim a job title. I have no idea where I will end up.

------------------------------------------------

"It's funny how fallin' feels like flyin'...for a little while..."

-Crazy Heart