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Shirlywhirl, M.D.
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2020-08-22

Since I’ve been a resident, insurance has denied: 1- an MRI for a developmentally disabled patient who was gradually + dramatically losing motor function / developing contractures 2- fidaxomicin for our patient w/ recurrent severe c diff who didn’t show improvement with PO vanc for several days 3- a biopsy for a patient with a suspicious neck mass 4- an absurd number of medications that have strong evidence behind them 5- rehab for elderly patients bc they didn’t meet inpatient criteria for two months. 6- DOACs for eligible patients (in favor of warfarin, which is a huge hassle) After a while, one gets used to Coverage Cobra dictating care plans. I work for an underserved population, and am routinely struck by the barriers that Coverage Cobra puts in place explicitly to prevent people from accessing care. For example, physical paperwork that requires a doctor’s signature to verify orders that were placed via the EHR seem to have no purpose but to overwhelm doctors and prevent patients from accessing care (while shifting blame onto PCPs.) as they say- the cruelty seems to be the point.

#healthcare #insurance #comic #resident #intern #inpatient #doctor #womeninmedicine #blackdoctors #graphicmedicine #premed #premedmotivation #residency #internalmedicine #medschool #medicine #medicalschool #medlife #md #medstudent #nurse #physician #singlepayer #medicare4all

Aug 22, 2020 2020-08-22T00:00:00-05:00

2020-08-15

About a year ago, I was on my cardiology rotation. One of my mentors, who I had worked with clinically and in research multiple times, was attending. We were discussing my interest in Cards, and encouraged me to consider EP. I offhandedly said, “I don’t think I’m smart enough for EP.” My mentor did not let me off the hook for that. He assured me that I was plenty smart enough, and told me, quite firmly, that I should not sell myself short.

I didn’t realize how bad of a case of imposter syndrome I had until that moment. In medical school, I was a “middle of the road” student- not stellar but not struggling either. But I didn’t do well on Step exams, or NBMEs. It didn’t matter that my clinical evals, and later, my evals as a resident, have generally been stellar- I still had a perception of myself as the one who “slipped through the cracks.” Every now and then, an article like the JAHA one pops up, or I overhear attendings discussing who they consider “good” candidates, and that feeling just gets confirmed.

So I’ve since made an effort to change both my inner and outer self-talk. I gas myself up a lot. It’s usually in a jovial tone, but I figure if I say “I’m a great doctor” enough times out loud I will believe it in my heart. I try to squash the self deprecating talk. And I use my natural tendency to doubt myself for good — I’m more thorough, I listen to and seek out outside opinions, and I look up articles to support evidence based practice, all things that I think are positives!

(Also shoutout to my patron and insta-buddy, @realworldnp!)

#impostersyndrome #comic #blackinivory #resident #intern #inpatient #doctor #relatable #womeninmedicine #blackdoctors #graphicmedicine #premed #premedmotivation #residency #internalmedicine #medschool #medicine #medicalschool #medlife #md #medstudent #nurse #physician

Aug 15, 2020 2020-08-15T00:00:00-05:00

2020-08-08

A couple weeks ago, my fiancé pointed out to me that I had spent an hour on the phone every single day that week mentoring a different black female premed/ medical student on their career trajectory. That didn’t include emails I’ve sent back and forth trying to connect them, or the times I’ve spent creating lesson plans (literally) to educate my classmates on institutionalized racism because our schools considered such knowledge “controversial.”

Some of this is me doing work that I think is necessary. But this invisible, unpaid labor is done by most black students I know, starting from undergrad, and continuing as we get further into academia. It doesn’t get us AOA. It isn’t looked upon especially favorably in admissions, despite the fact that the institutions that accept us expect us to continue this labor for them once we get there. It- and the constant micro + macroaggressions we face - distract us from other elements of our education. Imagine taking Step 1 without just the pressure of your own dreams on your back, but also the knowledge that if you don’t do well, you will jeopardize the fates of the students who are coming after you, who will be painted with the brush of the “undeserving?”

#comic #blackinivory #resident #intern #inpatient #doctor #relatable #womeninmedicine #blackdoctors #graphicmedicine #premed #premedmotivation #residency #internalmedicine #medschool #medicine #medicalschool #medlife #md #medstudent #nurse #physician #medkini

Aug 8, 2020 2020-08-08T00:00:00-05:00

2020-08-01

A little positivity for the feed! I complain a lot on Shirlywhirl because it doubles as an outlet for me, but I don’t think I could do anything other than this. For one, I’m motivated by being needed, and I likely wouldn’t feel needed without the high stakes in medicine. For another, even though I complain about actually talking to patients, my relationships with them / duty to their care is what makes me feel fulfilled. I try to remind myself of this after tough 28 hour calls.

#comic #webcomic #coronavirus #resident #intern #inpatient #doctor #relatable #womeninmedicine #blackdoctors #graphicmedicine #premed #premedmotivation #residency #internalmedicine #medschool #medicine #medicalschool #medlife #md #medstudent #nurse #physician

Aug 1, 2020 2020-08-01T00:00:00-05:00

2020-07-28

I’m glad a conversation about professionalism is starting. The idea of what constitutes “professionalism” has long been one of the most insidious aspects of the profession to me.

When I was in medical school, a few of my classmates sent out a petition to the faculty denouncing the AMA’s endorsement of Tom Price as Secretary of HHS (if you recall, he turned out to be a crook.) The response of this small act of advocacy was fascinating… and disturbing. Many faculty agreed with the denouncement, but emailed her privately to state that they couldn’t sign the petition publicly out of concern that it would reflect poorly on them. Even worse, an ‘important’ member of faculty sent this student a long missive, lambasting her for her lack of professionalism, her lack of insight, and… wait for it… reported her to the dean of our medical school demanding that she be disciplined for “unprofessionalism.” Luckily, my admin was largely tolerant of advocacy work, and so my friend didn’t get in trouble, but the experience was eye-opening. As a student new to the field, the language that attending felt comfortable using, as well as the eagerness with which he used his position of power to damage a young woman’s budding career because she had a different political opinion was terrifying.

As physicians, we talk a lot about our powerlessness. But this powerlessness is perceived. The system doesn’t run without us. First, we need to redefine professionalism to include advocating for patients, and also to accommodate being whole people who aren’t defined solely by medicine and can chill by the pool or even take #thirsttrap photos in our free time!

Jul 28, 2020 2020-07-28T00:00:00-05:00

2020-07-18

My hospital is based in the southside of Chicago and has a predominantly black population. It follows, then, that we have a large number of Sickle Cell Patients. We do not, however, have a Sickle Cell Clinic, or an inpatient program. We don’t really learn about how to manage sickle cell patients– for the most part we slap them on a PCA, make sure they don’t get Acute Chest, and whine about how long it’s taking them to wean onto orals.

Here are my thoughts about it: SCD is a debilitating disease. They are at risk of horrendous complications; even the most notorious patients we see at our institution have had strokes, episodes of acute chest, seizures, MIs, you name it. Why do we put so much energy into declaring them drug seeking? Why are we not vehemently looking for a cure? Why is every academic center not rushing to be the one that fixes sickle cell anemia? Why aren’t we enrolling every SCD patient possible into bone marrow transplant programs? Why don’t we hire more SCD specialists in hospitals where we see SCD patients?

I am not trying to diminish the difficulty of living with Cystic Fibrosis in this comic. But there’s a reason the two diseases get compared: one predominantly affects white people, the other black, their prevalence is about the same (about 70-80k cases in the United States), and they both have a life expectancy that’s in the early 40s. Let’s just say the energy for CF patients is just different. To put it in perspective– NIH funding per person for CF between 2008-2017 was $2807 vs $812 for SCD. Philanthropic expenditures? $7690 vs $102. Annual CF publications? 1594 vs 926. You catch my drift.

We need to do better by our SCD patients. I want to be a Cardiologist, not a Hematologist, but for the next year I’m still going to be seeing these patients. I want to treat them with the dignity they deserve, and now that I am giving them their best shot.

1- Elander, et. al., Understanding the Causes of Problematic Pain Management in Sickle Cell

#scd #sicklecelldisease #healthequity #comic #webcomic #residency #intern #inpatient #doctor #relatable #womeninmedicine #blackdoctors #medschool

Jul 18, 2020 2020-07-18T00:00:00-05:00

2020-07-12

We’re starting to see more COVID cases again. A lot of them are linked to travel to states that refuse to mask up, like Texas and Florida. I always feel like healthcare workers are under appreciated by the general public, but I’m feeling that especially now.

#comic #webcomic #coronavirus #resident #intern #inpatient #doctor #relatable #womeninmedicine #blackdoctors #graphicmedicine #premed #premedmotivation #residency #internalmedicine #medschool #medicine #medicalschool #medlife #md #medstudent #nurse #physician

Jul 12, 2020 2020-07-12T00:00:00-05:00

2020-07-04

I complain a lot at work. It’s usually good-natured, and happens because I’m talkative at baseline. But as much as possible, I try to avoid bringing my complaints about the hospital home or to my non-medical friends. Only recently have I been sharing some of my more traumatic experiences with my fiancé. I think I do this in an effort to protect them, because non-medical folks don’t interface with trauma with nearly the same frequency that we do. I’m lucky enough to have great friends in the program who I can rely on for emotional support. As far as outside help goes, I’ve been to therapy for residency-related ‘processing’ before but felt like I was just traumatizing my therapist lmao.

Sometimes, I feel guilty for being a “feeler.” The medical field normalizes messed up ish because a lot of times, we’re too busy to process or properly sit with our experiences. I’m the kind of person who needs a little extra time to reflect. That’s a huge part of why I draw these comics. So if you’re a healthcare worker who is a “feeler” like me - it’s okay to go have that bathroom cry. It’s normal to go home and feel awful after a bad shift. We’re human, and our ability to still feel for our patients and ourselves is what will help us maintain our empathy. In the meantime, find those people outside of medicine who can help you keep things in perspective and remind you that, no, what you’re seeing every day isn’t normal.

(Shoutout to @edna.md, a fave coresident who was brought into my life by fate and is an absolute queen.) #comic #webcomic #coronavirus #resident #intern #inpatient #doctor #relatable #womeninmedicine #blackdoctors #graphicmedicine #premed #premedmotivation #residency #internalmedicine #medschool #medicine #medicalschool #medlife #md #medstudent #nurse #physician

Jul 4, 2020 2020-07-04T00:00:00-05:00

2020-06-28

Hi guys I had a really busy last four days that were kind of harrowing. Was thinking of drawing about the traumatic ish we see in residency- but I’ve decided to save that until I’m out of the MIcu and focus on people I’m thankful for. This time, I want to thank our clinical pharmacists! I am a lot less effectual without you all by my side! Thanks for catching my mistakes, looking out for medication interactions, and generally making sure this hospital runs. You’re invaluable, and I appreciate you

Shoutout to my two “Fabulous Physicians,” Kelly and Ryne! Justin and I definitely had a debate about what your eye color was.

#comic #webcomic #pharmacists #clinicalpharmacists #pharmd #resident #intern #inpatient #doctor #relatable #womeninmedicine #blackdoctors #graphicmedicine #premed #premedmotivation #residency #internalmedicine #medschool #medicine #medicalschool #medlife #md #medstudent #nurse #physician

Jun 28, 2020 2020-06-28T00:00:00-05:00

2020-06-20

It’s almost July, and I cannot believe that there are new interns starting. I also can’t believe I’m a third year resident already! People really weren’t kidding when they said that “the days are long but the years are short.” Our PGY-3s are leaving, and now WE are the PGY-3s. Interns are becoming leaders of their teams, medical students are becoming interns. This is both an exciting and incredible time for everyone in residency- but also a hectic one. And no one will have any idea what they’re doing except for seniors. But then something magical happens around September - everyone settles into their roles, and the hospital begins to operate like a well-oiled machine again. And especially for interns/ PGY2s, that change will be transformative! Shoutout to my first “Fabulous Physician,” @paging_empress_snark Also shoutout to y’all, bc i must love you to still be posting after this night shift from hell lmao.

#comic #webcomic #coronavirus #resident #intern #inpatient #doctor #relatable #womeninmedicine #blackdoctors #graphicmedicine #premed #premedmotivation #residency #internalmedicine #medschool #medicine #medicalschool #medlife #md #medstudent #nurse #physician

Jun 20, 2020 2020-06-20T00:00:00-05:00