new scutmonkey: the 6 stages of overnight call

This may be a slight retread if you follow me on Twitter, but one particularly bad night on call about a month ago, I posted a poll surveying the worst overnight call phenomena. After that...well, after that it was just a matter of drawing the thing.

Here, panel by panel:

For those who are curious, I've been meaning to get back into cartooning for a while now (despite the long hiatus I've actually drawn comics...well, basically my whole life, since I was a very small odd child with too few friends and a bit of a defensive sense of humor to match), but as I noted previously, making these comics does take some significant amount of time. I mean, at least the way I do it, which is extremely analog and old school, it involves many inefficient, labor-intensive steps.

Joe actually got me one of those Wacom tablets about a year ago because I've been yammering about drawing more since forever. He thought, quite logically, that a tablet might be a good tool that could input the my drawings directly into the editing software. It was such a thoughtful gift, but...I don't know. There's something about the tactile sense and resistive friction of drawing with specific tools, and I'm picky enough as it is about my writing implements.

I did try to do a sort of quick and dirty YEARS ago, with this "colonoscopy face" comic...

...which I deliberately did on a yellow notecard just to force me to treat the exercise it casually. I briefly considered doing more things like that--just casual, tossed off, straight ink to paper, no erasing, no post-processing cleanup, nothing. But the fact is that I don't like things that are careless and tossed off. I want to do things how I want to do them, and how I want to do them necessarily takes a certain amount of time. It just does.

Anyway, everyone has their weird outlets. Writing and drawing stupid comics are mine. I hope you liked this one.

shiny new scutmonkey: patient allergy stratification

I don't even remember when the last time it was that I made a new comic (I suspect it was right before I submitted the manuscript for my book to the publisher,* so that would put me in the last few weeks of residency, roughly a lifetime ago), and I don't want to make a big thing about this, because the comics...are really pretty stupid. But anyway, here's a new one.

The comics really do take a lot of work, which is probably why I haven't made a new one in just about a decade. There's the sketching and the penciling and the inking and the erasing and the scanning and the cleaning up and the titles and cropping. To think, I used to go through this entire process every single weekend for three years when I was in college and the cartoonist for the Wellesley News. This makes me realize that back then, when I thought I was busy, and had so little free time? I had nothing but time. Kids...don't know stuff.

Anyway, it's many years later now, and I am old, and semi-responsible, so I feel the need as an attending to say: Allergies are real, and can be serious. Listen to your patients. Use common sense, but respect the histories they are giving you.

However, sometimes funny things are funny. Maybe this comic is one of those things. And maybe now you understand why I was on that fine point mechanical pencil bender.

And here, so you don't hurt your eyes (we're all a decade older now, aren't we?), I have it panel by panel.

Happy trails.

* My editor ultimately decided not to include the comics with the book, which...look. At the time, I was a little disappointed, because I'd worked hard on them. But even at the time, I knew it was absolutely the right call. Strong work, Emily Griffin.

vintage scutmonkey: psych

OK, I think this is the last of this throwback series. It also happens to be the first "Scutmonkey" comic I wrote (even before "The Twelve Types of Med Students," even*), and I finished it about a month before I graduated from med school. It seems that the Wayback Machine doesn't archive every last image in a deep side branch of your main blog, which is why half the panels are kind of greyscale and janky (photos of a photocopy, you know). But hopefully it's all still legible.

Two small points. One is that I think it's not necessarily the kind of topic I'd write about so freely now, because, you know, mental health awareness is important and sensitive and all that. But for what it's worth, every single patient interaction or expressed delusion in this comic was absolutely true, almost to the word (if somewhat condensed in certain cases). Actually, all of it is true, right down to what people wore. (I was mesmerized by the chunky pendants and flowing tops my course director wore and therefore studied them in great depth before drawing them...badly.)

Second point. The building we used to refer to as the "old Psych Institute," shown in the first and last panel of the comic, is now the School of Public Health at Columbia. It's the exact same building--it even still reads "Psychiatric Institute" in the carved stone arch over the door--but, you know, they put up a new sign at eye level. So the one part of this comic that's not true is that I never went back. I am back, and the location seems like a tiny bit of poetic justice.

* Edited to add: I was wrong. I looked at the dates and I finished "The Twelve Types of Medical Students" 2 days before I finished this one. I had likely started this one first, though, because, you know, it took longer.

vintage scutmonkey: doctor id

This is a rare bird indeed, in that it is the one Scutmonkey comic that I never disseminated widely. I in fact never completed this strip. This string of panels originally ran with the tag line, "To Be Continued..." but I never followed it up, because...I don't know. I think it just never felt very funny to me. Don't get me wrong, for someone who has worked in the Peds ER, there is a decent dose of acerbic humor in there, but on the whole, when taken with the other comics I wrote, it felt...kind of darkly bitter. A little too much dark, and a little too much bitter.

In retrospect--and I don't think I needed that much distance from that time to realize this, I think I even realized it at the time--there was a point in my first year of Peds residency when I was likely borderline clinically depressed. It was circumstantial depression, certainly--I think many of us were at the time--but nonetheless it was a period of my life that both imprinted deeply and which I don't remember well. Day blended into night, one rotation blended into the next, there was very little time, very little spontaneity, very few genuine sparks of joy that I can recall. This had very little to do with my residency program per se (to this day I have nothing but good things to say about my Pediatrics residency, which turned out some of the finest doctors I know), but had everything to do with the nature of residency itself, which somehow, despite all best intentions, tends to bleed the humanity out of the young people training to take care of human beings at their most needy and vulnerable. It's quite a paradox, when you think about it.

So despite the fact that I cringe a bit reading this now, remember the place I was in when I wrote this, I'll republish this nubbin of a comic from the archives anyway. But I will also link these two things.

One is this older blog entry I wrote seven years ago, entitled, "It Gets Better."

The lowest point in my residency was in January of my intern year. I was a Pediatrics resident back then, doing a month-long rotation on "Team 2," which is what we called the general inpatient pediatric team, with a focus on the patients on our liver transplant service. 

It was a very long month.

I'd get to work at around 5:45 every morning to pre-round, and invariably leave after dark every night--not difficult, considering that, in January, it seemed like it started to get dark around 3:30pm every day. I was there much later than that, of course--most nights I'd leave around 7:00pm, unless I was on call, in which case I'd leave at around 10:00am the following morning. We'd have pre-rounds and then rounds, then attending rounds and work rounds, followed by teaching rounds and radiology rounds, with time at the end of the day for sign-out rounds. Twice a week we'd have Grand Rounds and Chief of Service Rounds. How we ever got anything done with all this rounding, I'll never know. How I ever got to spend time with any patients in between all these rounds is even more of a mystery. It just felt like a day of endless, endless scut. Losing the forest for the trees. It would be a day full of writing down numbers and pagers beeping and phone calls and faxes and entering computer orders, and not nearly enough time practicing medicine or spending time with patients. And then I'd go home and collapse and wake up at 4:15 the next morning to go in and do it all again... 

And let's get this straight. I liked residency. Really, I did. Yes, it was hard, and yes, I was tired basically all the time, but I expected that, and now that it's over, most of my memories are affectionate. Residency, like medical school, was full of stories, and many of them, in retrospect, are funny--not at the expense of patients, but at my own expense, because Lord, how serious and inexperienced and bumblingly well-intentioned I was! But that first January of my intern year, I was very close to being clinically depressed. It just all felt so grim and featureless and endless, and I felt more and more like I was just some kind of task-programmed automaton, not like the doctor that I thought I was supposed to be at this point.

I wanted to quit. Not just quit being a Pediatrics resident, but quit medicine altogether. I was unhappy. I didn't like my life. I wanted to be done. I know that this comic was intended to be a joke, but there were time, real times, when I passed by a Gap or a Starbucks or whatever, saw that they were hiring, and seriously considered stopping by to fill out an application. At least they don't make you take call at The Gap, folding chambray button-down shirts at 2:00am. 

Now I'm going to tell you a secret. Everyone who has been through a residency has felt this way at some point. Everyone. 

Maybe you're feeling this way right now. So here's another secret. There's more to life than this. Even though it feels like residency is your life, it's not. There's more to life. There's more to you. And it gets better.

It gets better.

The second thing I would like to say is this. I am not a great person, and I know this. The people who work in the Peds ER are...incredible. Phenomenal. Superhuman. It is one of the rotations during my residency--both residencies--where I learned the most, and one of the rotations from which I have retained the most indelible memories. There's a chapter from my book, and though this is one of the less sensational excerpts (you would have never centered an episode of ER around it, for example), it's still the one that sticks with me the most.

...[T]here are some subtle changes of the twenty-four hour cycle that, to the experienced eye, can give some clue as to what time of day it is, but otherwise, days and nights in the ER are all pretty much the same, a constant stream of low-grade urgencies punctuated by the occasional heart-stopping emergency. 

In fact, the only event that allows me to reliably tell time in the ER is the 3:00 a.m. sandwich drop, wherein a café across the street, just prior to receiving their bakery-fresh goods for the morning, drops off heaping mounds of day-olds for the patients and staff of the Peds ER to pick through. Walk through the Peds ER at three thirty in the morning and you will find leftover yogurt cups lined with soggy scrims of granola, see patient attacking chicken salad wraps, and watch ward clerks turn away from their work stations to deal with a mouthful of cheese danish. "Try the turkey sandwich," the attending urges a floridly tattooed teenager with the air of insider knowledge, "the bread is really good." 

At these times, the ER feels like it could be anyplace where unlikely company is trapped together for an interminable wait. The DMV, the passport office, an airport terminal after all outgoing flights have been canceled due to a storm.

Anyway. Dr. Id. We don't often immortalize the worst of ourselves in amber, but it's still important to remember that there was a time when that person was there. Is still there at times. And to remember the small moments of happiness and good humor, no matter how inconsequential. And to know that it gets better. To know that you get better too.

It gets better, and you get better too.