Third year medical student

I'm in my third year of medical school now. 

 I'm working in the trauma ER and learning quite a lot. 

 We had a guy in the other night who spoke in a strange language that seems to be used a lot in the ER.

 "Sir, do you have any medical problems?" 

 "Al vish rrrr amov." 

 "Sir, are you allergic to any medications?" 

 "Errmig abo immerr Hahaha Haaa!" 

 The police found him passed out in the street. No other information. Not even a name. He was drunk, he was filthy, he stunk. 

 His dental work was quite interesting. He had the right half of his upper teeth and he had the left half of his lower teeth. Everything else was gum.

His smile was contagious.

Of concern was the fact that he kept coughing up bloody sputum. After a while I noticed that all the staff were wearing masks. I did likewise. 

Then I heard the chief resident say, 

"Sir, we need a urine sample. If you don't urinate, we'll have to put a catheter in you." 

 Loose translation: "Sir, if you don't urinate the medical student (me) will have to put a catheter in your smelly penis."  

I went to the rack and grabbed a bed bottle and brought it over to the guy. I got down in his face and said, 

"Dude, take a pee.. please." 

 "orrr voo em Hahahaha." He replied but he started to do it. Thank you, Jesus.

Drunk as he was he held the bottle all by himself and calmly urinated, looking down at the drama.

This business of the police just finding people passed out in public is pretty common. A week before we admitted a different guy who had had a little bit to much to drink. His blood alcohol was 5.9 (five point nine) and he spoke that same language. 

The police found him in a ditch. At 2am. 

 This is February in Chicago. 

 The man was cold. Like FREEZING COLD! 

The cops brought him in and dumped him on us. They were busy. Bye Bye. 

He was just disgustingly drunk. And funny. He kept growling at everyone. And the nurses were cracking the funniest jokes. You should have heard him when I did the rectal exam. "ARRRGGGG!!!!"  He yelled and all the nurses laughed and mimicked him. They were merciless. 

He was fat too. 

His family told us he had a drinking problem. Doh... 

No one knew how he wound up in the ditch. Shit happens. 

Anyway, let me give you the whole picture. I'm not just the medical student. No no no. I'm the THIRD year medical student. Basically my main job is to assess core body temperature, heme positivity, and rectal tone. 

Loose translation: Everyone who comes to trauma gets my finger up their butt. Call that insult to injury. 

The other night we got in a 20 year old Hispanic guy who had rolled his car. The paramedics on the scene reported that he had had a loss of consciousness so that bought him a ticket to trauma service.

Actually he was just fine but he was in trauma now.. 

Trauma is a zoo. When a patient shows up a team of about six doctors and nurses start working on the them. Each member of the team has a different job. I focus on the bottom. 

"Excuse me," I said to him, "I'm going to put my finger in your anus." 

I guess that kind of came out of the blue because he looked at me with bug eyes and said, "Why the hell you gonna do that!?" 

People were swarming all over us and in the confusion I replied. "Dude look ... I have to..." 

The gloves were on and the lube was ready. I looked at him and he looked at me and said, "Buddy, you do that and you're gonna die..." 

We had a bit of a stare down and I must admit I lost. 

I glanced at the chief resident, and he shrugged his shoulders. "Forget it". He said. 

We took an oral temperature and just assumed his rectal tone was OK.  Anyway, we had more important things to worry about. 

On the stretcher next to him was my other patient, his girlfriend. She was more serious. 

Chicago 2003

Spanish Onions

 

Spanish Onions

 

 

 

I was in the check out line at the grocery store today. I had my groceries all placed on the conveyor belt when the cashier picked up one of my items and held it up to me.

 

"What's this?" he asked.

 

I looked at it and said,

 

"It's an onion."

 

Can't fool me.

 

"Oh." he said and looked back at the cash register. He was poking buttons and looking concerned.

 

"Is it a Sweet Onion?" he asked.

 

"I don't know," I said, "I didn't taste it."

 

I got the feeling that he was building up to something.

 

"OK." he looked back at the cash register.

 

That last question had me a little concerned. If I remembered right Sweet Onions were expensive.

 

"Is it a Spanish Onion?" he asked.

 

Spanish Onion sounded cheaper so I said,

 

"Yah."

 

I tried to act like I knew that all along.

 

"OK." he said and went back to poking buttons.

 

"What the heck," I tried to laugh, "Everything else in Miami is Spanish. I guess the onions can be Spanish too huh?"

 

"Yah," he said. But he was all cash register now. I was a distant memory.

 

I watched him fiddling with the buttons for a moment or two. Then, I don't know why but I guess I just felt like talking.

 

"Have you ever eaten an onion like an apple?" I asked him.

 

He didn't look up but he did make a little sound with his throat. I took that as somewhat of an answer.

 

"You have to get them nice and cold first." I explained. "In the refrigerator."

 

He continued to poke buttons and furled his eye brows.

 

"It has to be a juicy onion though."

 

I guess he didn't feel like talking.

 

"The purple onions are my favorite." I added.

 

After a while he finished swiping my items and then he looked up at me and smiled.

 

That put me on guard.

 

"Would you like an 'Easter Dollar', Sir?" he asked me. I guess we were friends now.

 

"Er.. What is an 'Easter Dollar'?" I asked.

 

"OK," he got down to business, "You give me two fifty." he explained gesturing with his hands, "and then a dollar fifty goes to the Cancer Research fund," he paused for a second so I could keep up, "and then.. you get back an ‘Easter Dollar’."

 

He looked straight at me and smiled like presto!

 

I still didn't know what an "Easter Dollar" was but somehow it seemed to me that a Real Dollar got lost somewhere in that transaction.

 

And something told me that was what he was smiling about.

 

"Gee," I said, formulating my words with care. "Maybe I'll do that tomorrow."

 

His smile melted.

 

"Let me think about it overnight." I added.

 

"OK," he said and got back to the cash register.

 

I guess our friendship was over.

 

He rang up the total and I slid my debit card. Cash back? It asked.  Nah, it just goes for soft serve ice cream cones and I can live without that.  I pressed "enter".

 

We both stood there ignoring each other for a few moments waiting for the grocery store's computer to talk to the bank's computer.  Then I heard the cash register begin to print out and I breathed a sigh of relief.

 

The bagger put all my items in plastic bags and handed them to me. He looked sullen.

 

I took the bags.

 

I stepped out into the little village of Surfside, Florida.

 

I walked down the sidewalk with my two bags of groceries hanging down at my sides. There was a steak in one of those bags that I had plans for.  Nice.

 

The anticipation of dinner warmed me and I smiled at strangers just to surprise them.

 

I managed to pass by the pastry shop and continue walking.

 

The ice cream parlor exerted its magnetic effect on me but hey,

 

I didn't have any cash.

 

 

Miami 2009

 

 

Earwax like this

“How long have you been getting cold sores on your lips?” I ask.

“Ohhhh… I’ve been getting them my whole life” She replies.

“I see.” I’m taking notes.

“And I gave them to both of my sons,” she adds.

I put that thought away for later pondering.

“My sons keep licking their lips.” she goes on.

She’s licking her lips now to show me.

I look down at my notes. “I see,” I say.

“That’s how you get them you know.”

I look up again. She’s stopped licking her lips. She’s just looking at me now.

I hold another thought and ask, “What do you use to treat the sores?”

“I put peroxide on them and then I put on alcohol.”

Ouch, I think.

“I see.” I say.

I keep writing.

“Have you ever used any antiviral creams?” I ask.

“Sometimes I use ear wax.”

I look up and look at her like, did I hear what I think I heard…

“Earwax,” she repeats looking at me. “I get a piece of ear wax like this.”

She’s putting her little finger in her ear digging.

I’m watching her now.

She’s digging.

“I get a little piece on my pinky like this..”

She’s showing me her little finger.

I look at her pinky.

“Then I rub it in.”

She’s rubbing her little finger on her lip.

“Like this.” She says.

Then she smiles.

“Why are you laughing?”

Then we’re both laughing.

Los Angeles 2017

Life is ubiquitous

 

 

LIFE is ubiquitous.  Entropic eddies swirled by stars. 

Life can best be seen as a river flowing through time.  The river takes a branch at chaos.  Not so much a branch as a focusing.

Johnnie, my nurse, is gay.  "I just had my pap smear" he informed me. 

I looked up from my desk.  He thinks he has surprised me.

"People like us get those, you know."  He said.  My drama alert radar was beeping.

"The doctor went down there and scrapped."  Johnnie decided to go into detail.  "It hurted me,” he said, “But it also felt good." He giggled and laughed at me.  I get no respect.

I was finishing a note in a chart.  I can write and think at the same time, but I can never talk and think at the same time.  Sometimes that's a problem.

"Mrs. Hernandez is here," Johnnie said handing me a chart.  "She's saying something about how she fell and a dog was running, I don't know, you have to talk to her." He passed me the chart with a shooing away jester.  "She's in room five."  He said.  And he was gone.

A new patient can best be seen as a gift from a stranger.

When I entered room five Mrs. Henandez was standing, leaning up against the examination table, holding her rib cage like this is the big one.

Mrs. Hernandez was an short, overweight, middle aged Hispanic woman with a full head of wavy grey hair and yesterday’s makeup.  I knew her very well.  We went back.

"Oh doctor Clark!" she started out then suddenly cried, "OH! OH! OH! OH!" she clutched her ribs with both hands, "OH! OH!" she exclaimed.”

"Hi Mrs. Hernandez." I said, "What’s goin’ on?"

"He ran out the door!" she blurted out between heavy breaths.  "It was Sparkey my dog.” She took several deep gasps.  “Not Trixy.”  Gasp,  “It was Sparkey."

"OK," I said, gently patting the air in front of me, "it was Sparkey, I got that, but what happened."

"Out the car door!” She cried.  “I opened the door and… OH! OH! OH!"  She was wincing in pain holding her ribs and I was starting to get an image.

"OK," I said, stepping to the side. "You were standing next to the car like this."  I indicated where a car would be with my hands.  She was watching me now.  "And you opened the door like this."  I motioned like I was opening a door.

“Sparkey shot out!” She gave a shooting motion with her hand and then,” OH! OH!" She was holding her ribs again.

"Hmmm, I think I get it." I said, "The dog jumped out.  You ran after it.  And you fell on your face."

"Yes."  She said with finality.

"Gee." I said, looking down at the chart.  Mrs. Hernandez had a body like a potato walking on toothpicks.  I pictured her chasing after a little dog and falling headlong.  I winced.

"OK Mrs. Hernandez let's get you up on the table so I can check you out." 

I put both my hands under her arm pits and gave her a little.  After some effort she and I negotiated her mass up onto the examination table.

I put my stethoscope in my ears and listened to her lungs.   There were clear breath sounds all over which was good.  Her heart was working overtime but regular.  I helped her lay back.  "Ohhhh Ohhhh." She said quietly while we laid her back. 

She had an abrasion on her right knee. 

"And my hand." she said.

I look at the palm of her hand.  She had taken quite a tumble.

I raised her blouse and checked out her rib cage.  I didn’t see any bruises but when I felt her ribs she winced.  

“You might have cracked a rib.”  I said to her.  “You should probably go to the ER to get an x-ray.”

“I can’t afford that doc.”  She said, and gave me a look.

I surveyed the situation.  She was breathing fine.  Vitals OK.  A few scrapes but otherwise nothing major.  Even if she had a cracked rib, they probably wouldn’t do anything.

"What would you like for pain?" I asked.

"What you got?" She answered. 

Now I had her interest.

"Well," I looked at her and said, "I could write you for some vicodin. which is exactly what I would be asking for if I was in your shoes.

"Yah," she said brightening up.  "Give me thirty vicodins"

Which started me laughing. 

I know I shouldn’t, but I laugh at my patients all the time.  I'm sorry.

"Hold on now Mrs. Hernandez.” I said,  “I’ll write you for some vicodin but I don't think you need thirty."

"Just so I can sleep."  She said in a little voice.

I got out my drug reference manual and thumbed through the pages looking for vicodin.  I always use a book.  I’ve never had a patient express surprise that I’d be using a book, which has always surprised me, however, if I’m ever in court that’s the book that I’ll throw at them. 

I ran my finger down a page and got to vicodin.

“Make it the 10 miligram.” Mrs. Hernandez said.

“Geesh,” I said and then.  “OK, I’ll give you ten of those.”

 

Life is ubiquitous.  Everywhere from the deepest hot vents at the bottom of the ocean to the highest levels of the stratosphere.  And so beautiful.

Life can best be seen as a river flowing through time.  Birth, life, death.  Birth, life, Death.

If we could look back each one of us would see three billion years of uninterrupted generations.

Everyone.

 

A few minutes later, Mrs. Hernandez was leaving the office and I heard her say to Johnny, “Doctor Clark is my favorite doctor.”

I looked up from my chart and called out,

“If you love me, give me one of those vicodin.”

“No way!” she laughed.

Laughter is a good indication.

 

Los Angeles 2017

 

 

Go lightly my dreams

 

The past and the future don't exist. They literally don't exist. I tell myself.

All that exist is this thin sliver of a moment that we call, now, wedged in between a past and a future that aren't even real. Go figure, I know, but..

 

But tell me, why is the past so real in my dreams?

 

I woke up. Outside in the distance I heard roosters crowing.  Slowly, I remembered where I was and I felt my dream vanish into nowhere. Kind mercy.

 

Dim morning light gently poured in through the curtains casting gray shadows across our bed. I straightened my legs and gave my entire body a deep stretch, squeezing out the last of the demons. I looked up at the clock. 5 am.

 

We sleep together on a huge bed. My wife and myself with our two young kids nestled in between us. Piled together. Filipino style.

 

I quietly made my way over to my wife's side of the bed and climbed in with her.

 

Early morning is our time.

 

Time is real. I know it is. But it plays with me.

 

Time is something that happens on the outside but not on the inside. Inside there is no time. There is only now.  The same now I’ve always known.

 

Now, is eternity.

 

Wedged in between a past and a future that aren't even real.

Calbayog City 2025

We’re in the Philippines now

"Frogs can jump higher than the Eiffel Tower," Sean, my eight-year-old son, told me mater-of-factly,

"No they can't." I said.

"But Dad," he said, starting to laugh, "the Eiffel Tower can't jump.

I sat back.  He did it again.

After a few moments he controlled his laughter and asked me,

"Dad, do you know why dinosaurs don't eat fish?"

I thought for a moment and gave up.

"No" I said " why don't dinosaurs eat fish..."

"Cuz they're dead!"

He's holding his sides laughing.

We were in my office. I was working on a drawing. He sat down on the floor and began playing with his Legos.

Presently he looked up at me and asked, "Daddy, are the suction cups on octopus tentacles like plungers?"

I paused for a moment to take in that image.

"Yah," I said, "pretty much so."

"They don't let in the air." he said knowingly like he'd already figured this one out. Then he stopped and thought for a moment like wait a second…

"Daddy," he said, "is there air in water?"

"Well, yah," I said, "There is air dissolved in the water."

"Then why can't we breathe under water?" He asked.

Hmmm.. That's actually a good question. How can I explain..

My mind raced for a moment considering semi-permeable membranes, concentration gradients, oxygen partial pressure, selective transport systems, hemoglobin binding capacity.. and..

I breathed a sigh of relief and relaxed.

That shit's over.

"Little dude, we're in the Philippines now." I laughed. "Go ask an octopus."

"Hey dad." He said after a moment. "Do you know why the skeleton didn't climb the mountain?"

I braced myself.

"Cuz he didn't have the guts." He said running away laughing.

Calbayog 2024