No pressure.

This week in clinic:

Me:  "Okay, so our plan today is going to involve adding a medication to get your blood pressure down."

Her:  "I'll pass on that. I have some natural remedies I'm gon' try instead."

Me:  "I think natural things are very helpful. My concern is that we've agreed to do that on the last two visits. I think we're at the point where we need to go ahead and do something a bit more aggressive."

Her:  "Mustard and vinegar bring blood pressure down. I bet you ain't never knew that, did you?"

Me:  "I actually have heard that."

Her:  "Well, I'm going to do that and also some other things."

Me:  "How 'bout if we start the medicine and you do those things? Then if it comes down low, we can take the medication away."

Her:  "What you think I look like? Boo-boo the fool?"

Me:  "Pardon?"

Her:  "You know damn well y'all don't take away no blood pressure pills!"

Me:  "Yuh huh. I mean, yes. Sometimes. Yeah, we do sometimes."

Her:  "Mmmm hmmm. Yeah, right."

Me:  "Mustard? And vinegar?  Aaaah. You're killing me."

Her:  "Naw. That's you that's trying to kill somebody."

Me:  0_0

Her:  "I'm gon' meditate."

Me:  "What's that?"

Her:  "I'm said I'm gon' meditate. That helps your pressure, you know."

Me:  "How about meditate right after you take this low dose water pill?"

Her:  "Nope. Then I'd have to pee."

Me:  *sigh*

Her:  "It's true!"

Me:  "Okay. My recommendation is that we start something this time. It doesn't have to even be a water pill."

Her:  "I hear you. But still, no."

Me:  "Did you get the colonoscopy appointment?"

Her:  "Naw. I don't want that neither. They put a camera in your rectum to do that."

Me:  *Sigh*

Her:  "Why y'all steady trying to do something to somebody? Push pills and probe thangs up in folk?"

Me:  *Sigh*

Her:  "I don't want all that. None of it. I'll go buy me something herbal to cleanse my bowels."

Me:  "That's not the same. This tells us if you have a polyp or something like an early cancer."

Her:  "Cancer? Naw. Y'all ain't searching around in me and bringing something in there. I'm fine."

Me:  "Okay. Then tell me--what do you want?"

Her:  "To be healthy!"

Me:  "That's what I want. But you keep trying to stop me."

Her:  "Just 'cause I like natural stuff? Chile please."

Me:  "Okay. So you don't want the blood pressure medicine, the cholesterol medicine, or a colonoscopy, correct?"

Her:  "Correct."

Me:  "So that's it?"

Her:  "I reckon so."

Me:  "So I'm confused. What did we even do today?"

Her:  "We stopped somebody from getting poisoned and getting a camera stuck in her behind that's what."

Me:  "Can I at least give you the prescription so that you can meditate on it?"

Her:  "That sound okay."

Me:  "Great."

Her:  "But that colonoscopy? Tell 'em they can stick it in the same place they trying to stick it in me."

Me:  "Gotcha."


This is Grady. And I love this place.

***
Happy Monday.

Manscaping and highbrowisms.

*Warning:  100% non-medical post ahead. Proceed with caution.

The last few weeks have been pretty crazy. Crazy, do you hear me?  Craziness at home, craziness at work, craziness all over the place. Whenever my life gets crazy, some of those quasi-important-to-me-but-not-really-important-in-the-grand-scheme-of-things items get placed squarely on the back burner. They bubble and overflow and sometimes even scorch on the bottom. But when life gets too crazy, that's just the way it has to be.

What things qualify? Oh lots of things.  But one in particular that I have really let get out of hand during these past few weeks was eyebrow grooming. Yeah, I said it. Eyebrow grooming.

So. In the craziness of all this craziness,  my brows started looking a little something like this:

What you know about Andy Rooney and 60 minutes?

Okay, okay.  Maybe not quite as bad as ol' Andy Rooney's are, but you get the idea. Anyways.  As some of you may remember, thanks to one of my greatest Grady adventures of all time, I have this amazing place I go to here in Atlanta for eyebrow grooming. It's this place that uses thread to neatly shape your brows to natural-but-not-Curious-George-looking perfection.  And if you don't know the story behind me and the eyebrow threaders at Hair Images, if you have absolutely nothing important to do with your time, read this.

Now. I know somebody somewhere is reading this thinking--really? Eyebrow grooming? What could be more unimportant? Oh, and someone else who is new to this blog is like, "Wait--I thought when so-and-so told me to check out this blog she said it was about medicine and other medical coolness?"

First, I'll say that--yes, eyebrows are not exactly life-or-death. But for whatever reason, up until I met the Karate Kid, I had been in hot pursuit of the perfect eyebrow groomers. And the key to the perfect eyebrow groomer is one that makes you look neat and natural but not surprised.

Hello?  You still with me?  Good.

Okay. As for the new person reading this blog, sigh. . . .okay.  I may as well come clean and let you know that while a good deal of the material found on this blog is medical-adventure related, a fair amount isn't at all. But in my defense. . . .I think life and all of the observations we make in it go together like a big tossed salad. Like, noticing something in the grocery store or the hair salon isn't that different from doing a double take in the hospital during a physical exam.  

Uhhhh, okay. Where was I?  Oh! Eyebrows.  Okay, so finally on Friday, I get some free time to tend to eyebrow grooming. I grab my Nook e-reader and head over to Hair Images for a walk-in appointment.

Now let me tell you--this place stays packed.  It used to be the well-kept secret of all of the gorgeous Indian and Pakistani girls in Atlanta, but eventually everyone else caught on. (All of my Indian and Pakistani sisters are nodding right now going, Mmmmm hmmm!)  Even if you have an appointment, the wait is bananas, so you have to come ready to be patient.

What's made it even worse, though, is that NOW it isn't just the dreadlocked sistas and the blonde sorority girls getting in on the act. Now there's DUDES up in the spot, too. Yes. Dudes.  And not just the androgynous types or the Ru Paul types, either. I've seen the most regular-looking joe hunched over with elbows resting on wide open knees and thumbing through magazines. Periodically looking up and wanting to yell out, "Hey! I got next!"

Confused, are you?  Let me let you in on a little secret.   . . . .shhhhh. . . . they call it. . .wait for it. . . .ah hem. . . .

Manscaping.  (Sorry. Just threw up in my mouth a little bit.)

Yeah. Manscaping.  Shaping up those renegade eyebrows and sometimes even waxing ears. No. I ain't kidding.

Now before you even ask--the answer is NO. The B.H.E.  is not a manscaper, but I can honestly say that if Harry did have a monobrow, I doubt that he wouldn't at least consider it.

Okay, so I'm telling you ALL OF THAT to tell you about what happened when I was getting my brows done Friday.  I walk in and the lady I usually see isn't there. I've been coming long enough to know who is the next best thing, and who to avoid. So I survey the situation. There's the new lady who seems hit or miss, the lady who used to do my brows but who I really think needs reading glasses because she kept leaving big holes in my brows and then there's the lady that has the station next to my lady who does a really decent job. I sign up for the lady-next-to-my-lady and took my seat to wait.

But wait--there's more!

Right beside HER is this other woman who I did try once when my lady (and the backup lady) were gone. She left my eyebrows so thin that I looked ten years older (and like a black version of Pamela Anderson's scary brows.)

Anyways. I call her the butcher-brow lady and have waited a full extra 45 minutes to avoid her. And everyone she does gets the thin treatment. Lucky for her, some folks seem to like that Pamela Anderson-just-got-electrocuted-Curious George look so she gets her share of clientele. Good for her.

Anyways.

So check it. I'm reading my Nook e-reader and minding my business when this hyper-masculine yet hyper-hairy dude comes in and sits beside me in the waiting area. I glance over and notice that he definitely has the unibrow thing going on so he's in the right place. He was good looking, too. I know I'm married and all, but I can still say that this guy was pretty easy on the ol' eyeballs--unibrow and all. I couldn't place his ethnicity. . . .Persian or Armenian or Sicilian? I wasn't sure.  He was wearing some kind of keg party frat shirt and looked a little uncomfortable with all of the estrogen in the room.  But, baby?  That unibrow needed attention--he wasn't going anywhere.

Okay, so y'all! You know what happened next. Of course you do!

Like this, but less shmancy

Now, the way this spot is set up is basically with five chairs on the right and five on the left. Everyone waiting can see everything that's going on (with the exception of these private rooms where allegedly the waxing goes on.) Anyways. . .So lady-next-to-my-lady calls me and I go to her chair. I'm laying in my seat with my chin tilted up ready to get my eyebrow groom on.

That's when it happened. Yes, it did. The butcher-brow lady calls Frat dude!  It was like she called his name in slow motion. . . . .

"F---r---aaaaaa-----ttt D--oooooooo-d!" (insert vacuous echo here)

Gasp! I almost sat up in my seat when I heard her call him; I felt like it was my civic duty to warn him that this woman does not believe in "cleaning up the strays" and "shaping things up."  Lady-next-to-my-lady freezes and gives me the hairy eyeball (no pun intended.)  I settle back down and (literally) start praying for Frat boy's siamese brows after deciding that jumping in front of butcher-brow lady's chair would be inappropriate.

Lord, please don't let her over thread him. Please don't let her overpluck him.

I strain and hear him mutter a few lines about "just make them look neater" and "you know, the middle part."  She cheerily obliges.  I narrow my eyes and curl my lips because that's exactly what she said to me before she had me looking like a seventy year old woman. Poor Frat boy. I continued my prayer.

Lord, for real. Don't let her butcher his brows, okay? I mean, if that's Your will and all.

So, I lay there until my eyebrows are done. I sit up and look in the mirror. Not as good as my-lady but it's the next best thing and waaaay better than when I got there.  As she hands me my ticket, from the corner of my eye I see butcher-brow lady handing Frat dude the hand mirror. What happened next scratched the needle all the way across the record. I heard him growl under his breath--but not so low that nosy me couldn't hear him:

"What the f%#@!?!?"

I swung my head in his direction and saw what the expletive was about. And boy was it warranted.

OM-expletive-G. This was a disaster. His brows were--as my friend David calls it-- "all the way snatched!" 

Okay, so obviously God had bigger things to deal with because that prayer didn't EVEN get answered in my favor. Well. . . on second thought. . . maybe I should have been more specific. Frat dude's eyebrows weren't nearly as bad my Pam Anderson-scary-Curious-George disaster of 2009. . . in fact they were lovely. . . .had he been a woman.  Perfectly arched and perfectly groomed. But too perfect for a dude's dude. Overly intentional in their appearance, in their exquisite precision, and the absolute antithesis of what a dude wants in his manscape.  

"I can fix it," she said to him.  And I was thinking exactly what he said next.

"Fix it?!?"  

Awww hells nawww! 

Dang. Frat boy looked like he was going to cry up in there. And you know? He had good reason to. Those brows were a hot mess. For real. I mean the dude looked. . . .well. . .the dude looked like a lady.  Poor Frat dude. Poor, poor Frat dude. I felt so bad. Like I should have stopped him, but I was trying (for once) to watch my own lane.

To make matters worse, his girlfriend or whatever she was walks in as he is paying at the counter. She stands there studying his face as his face grows redder and redder.  Finally, she can't take it.

"Dude.  Your eyebrows look. . . .oh my gosh, dude."

She snickered a bit and covered her mouth realizing when she saw him looking tearful that this was not a good thing to say.  And out they walked. Her staring at him with her hands over her mouth and him sulking out like he'd just been branded on the cheek with the scarlet letters PTDQ (for part-time drag queen.)

Wow.

I still feel kind of bad, y'all. Should I have stopped him or was it none of my business? And is it awful that I wish I'd gotten a picture of his brows and that I couldn't wait to blog about it? Awful, I know.

See? These are the important things I have to think of when I get some time off from Grady.

***
Happy Sunday, y'all. 

P.S.  Harry insists that I did not do my civic duty and that I should have intervened. But I'm saying--what was I supposed to do? Say it right in front of butcher-brow lady?  He laughed so hard that I thought he would be sick and kept saying, "Babe, you're dead wrong! You're supposed to help people--you're a doctor!"  (And then he laughs louder and harder.)

Hmm. I guess.

***

Reflection on a Wednesday: To the Generation Y Learners with Love

*Disclaimer: This is a slight rant. If you are easily offended, please skip this post as I have much touchier, feelier offerings for your reading pleasure. . .

You DO realize that we can hear you, right?
_____________________________________________

"To all the learners that we've taught before

Who traveled in and out our doors

We're glad they came along

We dedicate this song

To all the learners that we've taught before. . ."


(Remix on Julio Iglesias and Willie Rogers' "All the Girls I've Loved Before")
_____________________________________________________

I started medical school in July of 1992. Back then, we called every doctor "Dr." and were so formal and deferential that you'd think it was a military academy instead of medical school. Although the internship I started in 1996 was slightly more relaxed, we regarded every faculty member highly, and never dreamed of anything that might come across as overly familiar or presumptive--especially when it came to our attendings and their time. Now, I'm not saying that there aren't students and residents who hold their attendings in the same esteem now. . .but sometimes. . . .just sometimes, it seems like the culture today in medical education is different than it was back then. The Generation Y learners seem to have a certain chutzpah that took us some time to grow into. . . . (I'm just saying.)

Case in point:

Just about every week, I find myself in a water cooler chat with a colleague about something an intern, student or resident said that was so . . . .uhhh. . ."no-he-or-she-di'in't!". . . that it leads to more discussion. All from off day "requests" to emails about being excused early for flights to texts about getting out of teaching sessions to you name it . . .all approached with such nonchalant audacity that it, literally, blows the minds of faculty. Our water cooler conversations are almost always punctuated by an emphatic,

"I wish I WOULD have even THOUGHT to say something like that to my chief/attending/program director/senior resident! No way, no how!! I would have been torn a new you-know-what!"

::five way faculty fist bump::

The verdict: Times have changed. Learners are much more comfortable making suggestions to us that never occur to them as outlandish. I can honestly say, I have heard them all. I have been a senior resident, a chief resident, an attending, and now a residency program director--and with every year, the ante gets upped with boldness that makes me (and my colleagues all over the country) say, "Awwww, hell naww!"

Now don't get it twisted--everyone knows how much I love me some interns, residents and especially medical students. . . .so for this reason, out of sho' nuff love and nothing else, I cannot allow this to go on any further. So. . . just for all of you-- my beloved learners, here is a guide to what NOT to say to your attending, program director, chief resident or adviser, no matter how extraordinarily cool and approachable they seem.

Yes, it is 2010, but no, assuming that we do not have a life (or feelings for that matter) is NOT cool. So this is an intervention of sorts. And lucky you, I'll be as concrete as possible by providing a few examples . . . . . balancing it all with some viable alternatives. Yeah. . . . this is a love-filled intervention indeed.

Let's jump right in, shall we?

***

Examples of "No-he-di'in't/No-she-di'in't" Correspondence:

What you said over an email (three days before the start of the rotation):


Dear Attending,

Hope you are well! I am looking forward to working with you next month on the wards. I am emailing you because I made a schedule request with the chief residents to be on this schedule so I wouldn't be on call over the three day Weekend. I have plans to go to Vegas for my best friend's bachelorette party, and was hoping to fly out early (around 4pm) and get that Saturday and Sunday off. I already spoke to the senior resident who said she's fine if you are. Touching base with you to make sure it's okay.

Thanks in advance!

Dr. Pria Sumptive

Let's try a better approach, shall we. . . . .(One month or more before the rotation starts)

Dear Attending,

My name is Ina Turner, and I will be rotating with you on Team X in September. I am contacting you to discuss a scheduling issue that I have considered for next month. My best friend and roommate from college and medical school is getting married this year. I have been fortunate enough to be asked to be her honor attendant, and already scheduled vacation to be able to attend her New England nuptials. She is also an intern, and she, as well as several of our mutual friends, have coordinated their schedules to meet out of town for a bachelorette celebration in her honor over the Labor Day weekend. I recognize that so early in the month and in my internship that this could be a hardship. I am respectfully asking for the consideration of being afforded two consecutive off days for my best friend's celebratory weekend. While our team is not admitting, I realize that this could potentially inconvenience others on our team, especially you. I have not yet purchased a flight, and would absolutely understand if this were not possible. The specific days are Saturday, the 4th and Sunday, the 5th. I will be post overnight call on Friday the 3rd. Thank you for your consideration and I am very much looking forward to working with you next month.

Very best,

Intern

That's what I'm talking about! Okay, maybe it was a bit longwinded, but it was definitely unassuming and respectful. (You would SO get that weekend off if I received this correspondence! Again, I'm just sayin'.)

***

What you said. . . .

Text message:

Hope u don't mind but gonna pass on our special session this afternoon. Long day for me in the hosp and feel a migraine comin on. BTW feel pretty up to snuff on stuff ur covering. Hit me back if an issue --thnx. Holla--

Noah Di-int, Medical Student

What about this approach instead. . . . . .

Good afternoon, Dr. Attending. I am concerned that I am feeling a migraine coming on. Do you have a moment to call me to discuss our session this afternoon? Thank you, Noah D. Medical Student

Isn't that better? Was that so hard? (Even if I say no and make you come anyway, at least you won't get the hairy eyeball when you arrive.) By the way, note that not everyone is cool with the text message. If you do get the green light to text, I might suggest avoiding "text speak:" e.g.

"OMG Dr. M! LOL ur blog is awsme! TTYL!"

***

What you emailed the Chief Residents or Program Directors. . . .

Dear Program Director/Chief Resident,

I was counting my shifts on the ER schedule and noticed that I have one more shift than everyone else. John got ten shifts and Jasmine got ten shifts, too. I have 11 which is not fair. I also noticed that I did not get a full weekend off, which doesn't allow me to make any kind of plans such as travel, etc. While I do not celebrate Christmas, I am kind of annoyed that I got picked as the one to work during that time. I just don't think this is fair and hoped you could step in. Also, is it normal to have two calls that fall one on a Friday and another on a Saturday? Jasmine did get one Sunday, but she didn't get a Friday which does not seem fair. You can tell me if I'm being irrational.

Wine E. Resident

Try this approach. . . .an invitation to talk--not an email about this (which almost always sounds whiny.)

Dear Chief/Program Director,

Would you be available to meet with me soon? I wanted to discuss a couple of concerns about my schedule with you and hoped I could get on your schedule. I am at Grady all this month, and am available whenever you are open. Thank you for your consideration.

Resident, Pager 12345

So simple, yet so effective. Ya dig?

****

See? It isn't really that hard.

Here are the take home points:

• Assume nothing.
• Our time away from work is just as valuable to us as yours is to you.
• If you just started your residency or medical school, factor that into your requests.
  
• Sometimes you just can't go.
  
• Do NOT buy plane tickets before speaking with the attending. Don't do it.
  
• When you have a request, make it formally and make it EARLY.
• You are NOT entitled to your request unless there are special circumstances.
• Why? Because this is what you signed up for.
  
• THINK about what you are sending and to WHOM you are sending it.
• We work harder than you realize on teaching students and residents. It is hurtful when that is not considered.
  
• Just because our response doesn't sound like we want to go off on you, doesn't mean that we aren't going off about what you said/did/assumed/requested in our heads/to our spouses/at the water cooler.
• Formality gets you further than overly familiar assumptions.
• You signed up for this.
• To quote my friend and fellow Grady doctor, Ira Schwartz, M.D.--"This ain't college."
• 
  

On a serious note, medicine involves sacrifice. Be smart before you speak and ask yourself if what you want is actually realistic and appropriate for the timing, rotation, and even your profession. If the answer is no, let it go. Know that we work hard to strictly adhere to duty hours rules, off day regulations and all measures designed to protect you from burn-out, stress, and not having a life during training like we experienced. Despite those measures, medical school and residency involve work. They also involve missing out on a couple of things sometimes. It is our job to help you achieve work/life balance through it all--but you must know that the word "work" is a part of the equation, too.

Capisce?

***

For the record, I am 100% serious, and hope that the medical students and residents out there who run across this take it as such. Feel free to save a med student and forward this to a friend. . . .

~ With nothing but love and hopes for your very best future, Dr. M ***

**Students, Interns and Residents that I saved today:

You can thank me with Target giftcards, red wine, or key lime pie. :)

***