There'll be no shelter here ...

"They who have put out the people's eyes, reproach them of their blindness."
~ John Milton

...
I need to watch things die
From a good safe distance
Vicariously, I
Live while the whole world dies
You all feel the same so
Why can't we just admit it?
...

Vicarious
TOOL

I remember when it began. At the time, it was a novel thought. I don't know if MTV knew it at the time, but The Real World was ground breaking. It opened a whole new genre, entertaining through others' fortunes or misfortunes. For Generation Y, this has always been a part of their lives. Caricatured lives placed in the open for all to see. Computers and the Internet have perpetuated our desire to create worlds for make believe lives. Avatars are created; caricatures of our inner selves. Social networking sites explode. We don't call any more, just text. In this make believe world, we can live our fantasy lives and project our opinions in a forum with little anxiety, fear, or regulation. For those who felt they had something worth being heard, they took to blogging.

When I began blogging, I wasn't sure what to expect. What I found was that it was a wonderful community of people with different opinions on any number of topics. For many of the anonymous posters, it is a world where their voices could be heard. Like the wild west, it is an unstructured platform where opinions can be made, discussed, and debated without fear of repercussion. This community has its own set of rules. For many of the medical students and residents, it is their venue. They grew up here. From Myspace to Facebook to Twitter, their lives and ideas have been free form on the Internet. In this brave new world, I am a learner.

...
Hospitals not profit full
The market bull's got pockets full
To advertise some hip disguise
View the world from American eyes
Tha poor adore keep feeding for more
Tha thin line between entertainment and war
fix the need, develop the taste
Buy their products or get laid to waste
Coca-Cola was back in our veins in Saigon
And Rambo too, we got a dope pair of Nikes on
Godzilla pure m@#*&fu%@n' filler
Get your eyes off the real killer

Cinema, simulated life, ill drama
Fourth reich culture, Americana
Chained to the dream they got you searchin for
Tha thin line between entertainment and war
...

There'll Be No Shelter Here
~Rage Against The Machine

In terms of technology and popular information, the medical community is generally behind the times. Caught up in our world of IV's and Ambu bags, we lose perspective on the real world. We teach the youth of America, yet we have no perspective on what is important in their world. Our eyes open only when topics are discussed in the media or cause a direct effect on us (the medical community). We are naive on many issues and undereducated outside of our world.

Change and the unknown create fear. Blogging and social networking is an uncontrolled medium. A venue where opinions can be voiced anonymously open forum. The paranoid mind says this medium will be used to slander the institution or organization and must be regulated. Although universities claim to welcome differences, there are policies that prevent true open discussion of all opposing views. In the Ivory Towers of academic medicine, popular ideas flourish. We feign tolerance. Unpopular thoughts are discounted and discarded. Hierarchy and politics rule. In this atmosphere, subordinates believe they lack the power to question. In an open forum, would I voice my opinions to a superior? As a subordinate, where is my platform?

Born with insight and a raised fist
A witness to the slit wrist, thats with
As we move into 92
Still in a room without a view
Ya got to know
Ya got to know
That when I say go, go, go
Amp up and amplify
Defy
I'm a brother with a furious mind
Action must be taken
We don't need the key
Well break in

Something must be done
About vengeance, a badge and a gun
cause I'll rip the mike, rip the stage, rip the system
I was born to rage against 'em

Fist in ya face, in the place
And I'll drop the style clearly
Know your enemy...know your enemy!

Yeah!

Hey yo, and d!$k with this...uggh!
Word is born
Fight the war, f@!k the norm
Now I got no patience
So sick of complacence
With the d the e the f the I the a the n the c the e
Mind of a revolutionary
So clear the lane
The finger to the land of the chains
What? the land of the free?
Whoever told you that is your enemy?
...

Know You Enemy
~Rage Against The Machine

Why does radiology have to be difficult?

“When angry, count to four. When very angry, swear.”
~Mark Twain

With orthopaedics being a high volume user of radiology, you would think that they wouldn't give you such a hard time when ordering studies. I understand that I am in an academic center and other services have residents calling for studies without an attending even seeing the patient. But, that is not how I roll. So, today I had to lay the smack down on a attending radiologist. When another service disrespects my residents, it makes me go volcano. So, here's the brief story.

I was minding my own business when 2 dudes ... oh sorry, that's a trauma story. Let me start again.

I am in clinic seeing my usual Monday morning 35 patients. I have a patient come in with a complaint of one foot problem (foot turning in) and we find another problem (probable PFFD). The mom is a poor historian and we have no charts from the outside hospital. On clinical exam, the patient just doesn't look right. He had dysmorphic facies and lower extremity anomalies. Something just wasn't right with this kid. We obtain the x-rays and realize that the other leg, which mom is not complaining about, has no hip. I further questioned the mother about his past medical history without any more information gathered. I thought about it and thought well how do I further evaluate this hip. I could do and MRI, Arthrogram, or an Ultrasound. Probably the least expensive and risky procedure would be an ultrasound. I ordered it and asked my nurse to see if it could be done today. I didn't think it would be such a big deal. Do the ultrasound and send the patient home with follow-up. Yeah, but no such luck.

As I go in and out of rooms, I hear my nurse trying to get things set up. There is some kind of back and forth. Then I hear they want to talk to the doctor. I said, OK; but my resident said he was all over is. I went into the next room. I come out again and my resident and nurse are saying how they don't want to do it because the kid is to old and they won't be able to see anything and yada yada yada. He gave one excuse after another. My resident said well Dr. P would like this done because it would be the most helpful and repeated what I had told him (this was confirmed by 2 others in the room at the time of the conversation). The radiologist said well I don't care what he wants, so forth and so on. (pause) "Oh no he didn't."

So, I walk over to radiology clinic. I walk into the reading area where 2 radiologists are reading films. I can't say everything I said. But, let's say if it was on TV it would have been bleeped out. I chewed him out for being rude to both my nurse and resident and for being a general @ss&*!#. The other radiologist got scatter from the fray as he tried to chime in on the case. I asked the just to do their f#%k!ng job and stop trying to act as if they are actually providing useful patient care. They should do the procedures they are asked to do like good technicians. In the end, I got my point across and the proper test was done.

Radiologists are like shadow merchants offering one expensive procedure after another and waffling on every diagnosis. They are like pathologists who need just one more stain or immunofluorescence to make the waffle diagnosis. Have some balls, make the call, and stop giving those who actually are taking care of the patients such a hard time.

"Anger is never without a reason, but seldom with a good one”
~Benjamin Franklin

PS. I actually have a lot of love for my radiology and pathology colleagues.