There's an old joke among doctors: A patient comes into his doctor's office and screams, "Doctor, doctor, it hurts when I do this to my arm! What should I do?" The doctor calmly responds, "It's simple...stop doing that to your arm!" I was reminded of this joke as I saw a new patient at my weekly resident's clinic in the hospital.

"So what can I do for you today?" I asked my patient as he stepped into my "office." He was a young guy, younger than me even, and yet he had somehow managed to compile a medical file that was thicker than a Bible. In the vast complicated world of medicine, this either means one of two things: he was a very, very sick patient with some horrible terminal illness (unlikely given his young age) OR (more likely) he was someone with long-standing chronic pain issues.

"My wrist hurts. And my shoulder hurts. And both my knees hurt. Can I get some Percocet? Or Tylenol #4 (Tylenol with codeine)?" he responded to my question. Ah, he was one of those patients. I had taken a look at his chart before he came into the clinic, and he recently had a bunch of X-rays and MRIs showing that his wrist, shoulder, and knee joints were all essentially normal. No signs of early arthritis or any other sort of joint disease that should be causing his pain. 

"Well, we'll see what we can do," I said to him, trying to tactfully work my way around his request for pain meds right off the bat, "But first, can you tell me what causes the pain?"

"When I lift weights at the gym," he replied matter-of-factly.

"Ah...and how much do you lift at the gym?" I asked, probing further.

"200...250? I can max out at around 300 pounds," he answered.

I raised my eyebrows upon hearing this. "I see...and you say your joints hurt only when you're lifting weights?"

"Pretty much," he nodded.

I looked on incredulously. My patient was basically asking me for narcotics because he was having joint pain due to overexerting himself with his weightlifting. "Hrmmm...ever think about cutting down on how much you lift at the gym?" I suggested.

His response was priceless: "Well...I'd just rather keep on lifting and take a Percocet or Tylenol #4 if I feel any pain."

Welcome to the resident's clinic. Where half the patients are looking to score some painkillers and the other half don't speak English. Outstanding.

Attending a friend's wedding. Catching up on old times with friends coming in from out-of-town. Going to Six Flags New England for the first time ever (Superman...is...AWESOME!). Finally finding the time to watch The Dark Knight. Staying up late every night to watch the Olympics. Getting a chance to take care of the bajillion errands I needed to run but never had the time to do until now. Yeah, I'd say it's been a pretty good week off.

Back to the rat race tomorrow!

J: So you're a resident? What's the craziest thing you've seen in the hospital so far?

Me: Well...there was this one patient who came in with a facial droop and weakness in her left hand. At first, we were concerned that she had suffered a stroke, but then the CAT scan revealed all these ring-enhancing lesions all over her brain. Seems she had recently been diagnosed with HIV, and when we checked her CD4+ count, it was ridiculously low - she had full-blown AIDS. Turns out all those lesions were from toxoplasmosis, which is a disease caused by a parasite that hangs out in the brains of anyone who has ever been around cats, though most people have immune systems strong enough to keep the disease in check. But in patients who are immunocompromised, such as patients with HIV/AIDS, well...it's a different story...

J: Oh. Wow. Okay, I was totally not expecting that. I was asking more along the lines of if you've seen anything crazy - like seeing light bulbs stuck up people's butts or anything like that.

Oh sigh.

Finally got my car back from the repair shop this morning. It looks okay now; my wallet, on the other hand, is a different story. I'm still shaking my head in disbelief that the smashed rear window cost over $300 just for labor (in comparison, the window part itself cost about $70). And don't even get me started on how much the new ignition system cost me. It's like, even though the woud-be car thieves failed miserably in their attempt to rob me, the dealership just went ahead and finished off the job. Factor in the money that I spent to get my car towed (twice!), and this little fiasco pretty much cost me an entire hard-earned paycheck. Oh sigh.

And to think: all this happened because I needed to make a quick run to the grocery store to pick up a loaf of bread, a pack of chicken breasts, and a bunch of bananas. I know the news has been reporting about how inflation has caused food prices to skyrocket, but who knew that this is what they meant?

This past Sunday marked the last day of our first official month on the wards. To celebrate this mini-accomplishment, a group of us interns from the hospital went out to dinner that night. We spent the entire meal trading humorous anecdotes about our crazy patients and commiserating over the utter misery we each had felt at various points throughout the past month. And as we did so, I couldn't help but feel an overwhelming sense of relief upon realizing that there actually exists a group of people who could relate to my experiences on the wards.

I think that one of the hardest aspects of my job is the fact that I often feel like there's no one out there who truly "gets" what I'm going through. 99% of my friends & family are completely out-of-touch with how this internship/residency process works. And it's damn near impossible to have a conversation describing my life as an intern when that happens to be the case. Let's face it, if you don't even know what the difference is between an intern vs. a resident or what it actually means to be "on-call," there's no way you'd understand how emotionally devastated I am when I have to initiate a family discussion about changing a patient's code status to CMO. You'll never identify with the exasperation I feel towards the HIV-positive patient who shows absolutely no regard for her own well-being when she insists upon signing out AMA even though she might have a pneumonia that could kill her. And you sure as hell won't ever be able to even begin to comprehend the hopelessness I feel when my patient simultaneously has both CHF and ARF, and knowing that treating one disease process will likely worsen the other disease process, I'm essentially forced to watch helplessly on the sidelines as he slowly circles the drain. (And if none of the scenarios I just outlined makes any sense to you, I rest my case.)

These are just but a small sample of the wide multitude of gut-wrenching emotions that I'm subjected to on a daily basis. And though I desperately long for a cathartic release of all the pent-up thoughts & feelings that I experience, I'm just not sure that any of my close friends would get it. Unless you're getting your hands dirty down in the trenches with me, you'll never quite understand the sobering reality of my job.

I guess that's why I just blog about it instead.

J.D.: I just don't think you deal with your problems the way emotionally healthy people do.

Dr. Cox: Well, hold on a second there, rainbow! This just off the newswire: you're not licensed to comment on how people deal with their emotions!

J.D.: I beg to differ.

Dr. Cox: Well, at least I let mine go. You, if you ever were able to actually release all the tensions that are bottled up inside you, what would that look like? How would that go?

J.D.: Maybe I just don't have anything bottled up.

Dr. Cox: Uh-huh. And what happened to that schoolteacher you were prattling on about?

J.D.: Passed away.

Dr. Cox: Croaksville. That's what I thought. And what was the first thing you did when you found out that he'd died?

J.D.: [pause] I made a joke.

Dr. Cox: And jeepers, I sure hope it was a good one; I do. Because here's the inside scoop: life's hard enough. And there's no way in hell you can survive in a dump like this unless you find a way to get your emotions out. Fact.
~Scrubs, Episode 1.16 ("My Heavy Meddle")