Sunday, June 22, 2008

Reasons I'm Leaving Emergency Medicine (number 10)

As I approach my exit from the circus of the Emergency Department I thought I would do a 'top ten' list of reasons I am leaving.

Number 10:

Dr. "Spanz" was an attending at my residency program. He was widely feared by all in the hospital for his temper and his commanding presence.

Prior to residency I had been a Medical Officer in the service. There I worked for and took care of warriors. Leaders. They treated me well... probably better than I deserved, but I was their 'doc', and they at least acted like they were happy to have me.

There I learned that a General worth his salt treats his 18 year old enlisted folks like they are adults and then punishes them when they aren't. Dr. Spanz treated us like children and punished us when we acted like adults. Of course, across the spectrum of medical training this is the sad norm.

When I started my residency other residents said of "Dr. Spanz", "You will hate him while you are here but when you leave you will remember him fondly as his lessons will not fade and his teaching will save your ass."

The first part of this bit of wisdom proved true, but the latter... not so much. This guy was very fond of reaming you a new one at every opportunity, and was a staunch defender of all manner of dirtbag patients who frequented our club. Kick, spit, cuss, and hit, as a patient you could get away with it when Dr. Spanz was on. He would go up to the most abusive patients and smile and pat their hands and talk to them like they were the Queen of England.

We, as residents, were, for some reason, deserving of his wrath, but patients were always right and wonderful and fluffy. I have never in my life met as self-important an asshole as Dr. Spanz- a big fish in a smallish pond. He WAS the smart kid who was always picked last for kickball. He's still taking it out on his indentured servants, and he still has a hole in his heart that he can't fill.

Fifteen years out and I still can't let it go. Do I have issues? Yes, but Dr. Spanz, you suck. It was hard enough as it was. Your pomposity and barely concealed neuroses would have not been tolerated in any other setting than academic medicine. And by the way, you are ugly too.


  1. You need some primal scream therapy 911. Or maybe a drum circle, two rounds of aromatherapy and a side of reflexology.

  2. Gee 9-11 are you the twin brother my parents didn't tell me about? I had the same kind of relationship with the Assistant Dean at my Medical School. He had the same attitude as your boss except he had never legally seen a patient since he was a Ph.D. I've held off pissing on his grave, but only cause its 800 miles away.

  3. I am truly sorry Dr Spanz was such an A$$hole. That behavior is truly unnecessary. What with, the new SSRI's and counseling, I cannnot see any reason for his behavior.

    I myself am anitomically incorrect since I have had a second ass chewed out so many times by a certain OB. So I do sympathise.

  4. 911, I'm sending some Reiki your way...feel the burn, baby.

  5. Dear Nurse K (capitals for you baby!),
    Spot on. In fact, the push down the stairs in a strait-jacket is a perfect video metaphor for the golden-handcuff world of ER, and, more and more, medicine in general.

  6. (capitals for you baby!)


    Dr. Spanz' only school chum was the lunch lady.

    He runs like a girl and he sits down to pee.

    And he's ugly too.

  7. There, there... feel better now?

  8. Weirdness.
    My sister has stage 4 breast cancer. Tests are still going on.

    Obviously, if my sister's partner of 10+ years could be here -- she would.

    They do not want "marriage" in the routine sense. Certainly, not outside of the liberal churches that are willing to do it.

    Stupid thing being that it's pretty easy to find that liberal church who'll marry them under god, Jesus, whathaveyou. But they don't have the same rights as heterosexuals under the gubberment.

  9. "Stupid thing being that it's pretty easy to find that liberal church who'll marry them under god, Jesus, whathaveyou. But they don't have the same rights as heterosexuals under the gubberment."

    please take this discussion elsewhere. the government of our republic is supposed to represent and enact the desires of the people within the constitution and its ammendments. right now, and with california under rule by the judiciary, there is a huge majority of the populace that DOES NOT WANT homosexual marriage. therefore, outside of california, the 'gummnent' is actually doing what it's supposed to do.

  10. I believe they said the same thing about mixed-racial marriages, fifty years ago. :) But whatever.

  11. When I feel like there's a hole in my heart I can't fill, I look at internet porn.

  12. Broken record lesbian cancer woman,

    Get over it. This isn't even related to the post, and nobody comes to this site to see the internet equivalent of a panhandler pitching some probably false sob story about her lesbian sister who can't find love.

    I've seen plenty of lesbians on the internet. In various movies. They seem quite happy with each other. Very very happy. I don't think any of them are married. It hasn't hurt their film careers, albeit in a very limited genre, and it hasn't turned me off, so to speak, to them either.

    At least make it convincing. Tie it into the post some way. Sneak attack. This was too obvious this time.

  13. Your sister can appoint anyone she wants to be her HC proxy etc, and I've never seen a hospital say "no lesbians allowed on visiting hours".

    That's one of those myths.

    911 is completely changing careers---let the man explain to us why.

  14. Just Curious 9-11, did any residents ever mess with Dr. Spanz? You know, putting Rainbow Bumperstickers on his car, signing him up for 30 Gay Porno Mags, threatening letters to the President, Flyers left in the bad parts of town advertising Free Beer/Rap Concert at his house?

  15. Thanks for the ideas Frank!!!! My nurse manager would love gay porn

  16. frank,
    alas, no. we were too scared to make a peep or to fight the power in any way shape or form.

  17. I had attendings just like your doctor Spanz. However, how does this make you want to leave medicine or at least the ER?

  18. fair question,

    i'm really just listing the ten things that stick in my brain... the bad things, about my career. dr spanz clocked in at number ten. even though he is ages in the past he set the tone and the tone remains constant.


  20. You know, my mentor in residency was awesome and is the reason I cam back to academics.

    He worked his ass off, treated everyone fairly, and inspired us to become well-read, evidence-based physicians.

    Too bad some docs have to play the God-wannabe asshole arogant narcisitic fucks. There are those around here, too. They give the rest of us a bad name.

  21. I got called for a "short of breath" at some outpatient clinic. Blocking the fire lane, in true douchebag fashion, was some BMW Roadster, a Lexus, and Range Rover. Personalized plates reading "BIG TEN MD" and "MD VIP".

    It's labelled "ambulance and fire only" on the sign, so I find my target, the BMW, ooops, fucking door just smashed that fucking car. Red paint all over the motherfucker. Damn wind.

    Anyway, we get inside and there's this harem of doctor types. There's about $5000 in silly stethoscopes dangling around their necks, lots of white coats with embroidered with alphabet soup titles, "Rod Throbber, MD, FACEP MEA DSSDF MPH FAG" etc...

    But it's hard to tell who the patient is. There's a guy sitting in a wheel chair who kind of looks off, but these doctors aren't looking too good either. Jowly, chubby, profusely wet from sweat, pit stain city, flushed, can't speak in full sentences etc...

    What do we have? 4 patients? What the hell?

    And this momentary pause gives a slight purchase for the fucking attitude. The aforementioned "God-wannabe-asshole complex."

    Out comes this snooty stream of lab results, tests, exam findings, etc...

    I'm thinking well, short of air, how about some ooos? Little canula action, simple shit. Bread and butter. Oxygen, exam, HPI, do a monitor, 12 lead, IV, etc...same shit different day.

    Fuck no. Apparently this patient's doctor is going to make an example out of me and my partner. He is going to show, in front of the patient, family, and his associates, that he is Mr Fucking Horse Cock, MD. I'm talking the Ron John Jeremy Holmes of medicine. Such a good physician, he delivered himself from the womb.

    We have a form for these situations. Rather innocently entitled, "On Scene Physican Intervention Form". It's a rather verbose legal document, quite dense and intimidating, that says in so many words, "If you're a fucking idiot, and it's obvious to even your own mother you are a fucking idiot, it's our patient now, bitch."

    I am a fairly customer service oriented guy. And I ask nicely if Mr Horse Cock, MD would be so kind as to sign this form that he will accompany patient to the hospital, assume all treatment decisions, deliver report to the ED physician, and take responsibility for patient care.

    But he won't. He is an arrogant shit. And some paramedic, me, is challenging him. How dare I!? In front of company?! The horror!

    My theory is "you call, we haul." Don't give a fuck how, don't give a fuck why. What's wrong? How long has it been happening? What hospital? That's all I care about when it comes down to it.

    So unfortunately, I have to tell Horse Cock, MD, that if he won't my form, but he continues to harass me, that I'm going to remove him from my ambulance. He's interfering with my work. This gets things going. The police come. His nurse called them.

    So cops are a little upset. They don't like this shit either. They ask me what the deal is, ask the physician. The sergeant arrives. The cops talk to the sergenant. Sergeant talks to me.

    Sergeant says to the doctor, "You either sign their form or get out of the ambulance. If you don't, I'm going to have these guys drag you out, handcuff you, and you'll be charged with interference of a public safety official."

    So that's the matter was decided. Patient had pneumonia. Got admitted, was there for a few days, and went home.

  22. There should be a $50 bounty for the scalps of drivers who block Firelanes. I'm generally opposed to serial killers, but why can't the next Zodiac/Green River/ whatever target those assholes?