HIV and ID Observations

I have a friend who is a thoracic surgeon.

Imagine his daily agenda:

5:00 AM:  Oops, slept late.
5:30 AM:  Drive to hospital; not much traffic.
6:00 AM:  Round on inpatients. They’re all doing great! Wonder why they’re not more talkative.
6:15 AM:  Coffee, gossip with other surgeons.
7:00 AM:  Get in scrubs, prepare for first case.
7:15 AM:  First case. Remove this person’s esophageal tumor.
11:00 AM:  That was fun! Another person saved.
11:15 AM:  Next case — bronchoscopy/mediastinoscopy; darn, non-small-cell lung cancer. Cigarettes are bad.
1:00 PM:  Time to get lunch.
1:10 PM:  Finish grant proposal. Give feedback to army of office staff, nurses, and PAs, who work for us.
2:00 PM:  Next case. Remove this person’s lung nodule.
4:00 PM:  Granulomas on frozen section? Great, it’s not cancer! Call ID consult.
5:30 PM:  Start new grant proposal
7:00 PM:  Time to head home. I wonder what part of the chest I get to remove tomorrow?

Now I don’t really know what his day is like. He might as well be piloting a hovercraft in the Everglades, periodically pausing to shoot crocodiles — that’s about how close the ID doctors’ daily life is to this imagined Thoracic Surgery life.

But I was thinking about this the other day when I was talking to him during a neighborhood party, because he implied mystification about what we do. In fact, he quickly acknowledged he couldn’t do what we do in a million years. “You guys know everything,” he said.

(Thank you. I didn’t disabuse him of this view.)

And while we might not — okay, don’t — know everything, it’s true we get to see absolutely everything that’s going on in the hospital. It really is quite extraordinary how diverse the cases we ID doctors see. On rounds or during clinic recently, I saw or heard about individual patients with the following medical/surgical/social/miscellaneous histories:

1. Shot a raccoon.
2. Weight > 700 pounds. [Unable to verify exactly.]
3. Weight = 83 pounds.
4. Adult with complex congenital heart disease.
5. Six total joint replacements — of the same joint.
6. Just arrived here from Mali.
7. Has a cat, two dogs, two birds, a guinea pig, and a rabbit. [All completely unrelated to his ID problem, but interesting nonetheless.]
8. Retired New Orleans chef, now sells pickles from his van.
9. CD4 = 6.
10. CD4 = 660.
11. Reported vodka consumption: 1-2 liters/day. [They say always double what people report.]
12. Fever > 107 Fahrenheit.
13. Tattoos on her ears — just her ears.
14. Started smoking at age 11 in Venezuela.
15. 80% surface area burn.
16. Speaks only Hmong.
17. Sells real estate on the Baja Peninsula, lives in Boston.
18. Regular Tough Mudder participant.

Note I deliberately left out specifically why they needed ID consults, but you can probably imagine in most of the cases. (Maybe not the pickle guy.)

But ID issues aside, isn’t it incredible what we learn about medicine — and people — just from doing our job? What a privilege.

Almost makes me regret whining about what we get paid.