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The Good, the Bad and the Ugly


The New Physician March 2001
Their legends are heard in whispers in medical school halls. When they ride into town, patient charts close, computer screens get tilted away from view, halls become silent, and greetings are short and curt. When gunners come to the wards, everything changes. The following is a legend about my encounter with a gunner—well, not quite a legend since it happened recently.

It was a typical morning at the hospital—or so I thought—and I was about to round on my patients. When I arrived at the nurses’ station, I saw that my medical student partner, Sam, or as others liked to call him, “Yosemite Sam,” came in early again and was already finishing notes on his patients. Sam was a bit of a gunner. The term “gunner” can describe a variety of medical students. It might be used as a compliment to a friend who has done well on an exam, or it could be one of the worst insults connoting a malicious, ultracompetitive student, like Sam, who’s willing to use the slimiest tactics to get good grades.

For example, despite being a third-year medical student, Sam was still informing people of his Medical College Admission Test scores. “Just so you know where I’m coming from,” he usually said. “So you won’t wonder why I got a perfect score on my boards.” And then there was the rumor that he slipped extra-strength laxatives into the coffee he offered fellow medical students. Of course, there was also a rumor that he was in league with Satan.

“Hi, Sam. Early morning?” I asked.
Keeping his eyes on his notes, Sam yawned and said, “Yep. Want some coffee?”
“Uh, no thanks. I can’t handle the caffeine,” I muttered as I tried to hide a 24-ounce bottle of Mountain Dew inside my coat pocket. Then I made a quick escape to see my patients.

The first was Joe, a 49-year-old diabetic who was in for a rule-out myocardial infarction. Seeing me approach, he rolled his eyes and said, “Again?”

“We need to see each patient every day,” I said.

“But the other doctor already saw me,” he said. Believing he meant my resident, I continued the exam. Then I rounded on other patients. Afterward, I went to get the patient charts from the unit clerk, Blanche, and was surprised when she reacted to my routine request with more anger than was usual.

“Someone already took them this morning!” she said. “How many times do you people need to see the charts?”

“Hmm….” I began to wonder who else took the charts and again assumed my resident got in and rounded insanely early.

During the team meeting, we reviewed patients on our service. When we came to Joe’s room, Sam suddenly got a look on his face similar to that of a 10-year-old child making obscene phone calls—devious. Shrugging my shoulders, I started my update. My attending asked me for Joe’s potassium level from three days ago. I flipped my note cards over in search of the information. Out of the corner of my eye, I saw Sam’s hands move in a blur of motion. He whipped out a card and shouted, “4.3! 4.3!”

My attending turned to me and asked, “What was his 7 p.m. glucose?”

I said, “163,” but my response was drowned out by Sam as he jumped up and down, exclaiming:
“163, 163! I said it first!”

Sam was nearly wetting his pants in anticipation of the next question. Tension filled the room. Finally, as if he were Regis Philbin asking the million-dollar question, my attending said, “If Joe goes to the orthodontist, does he need to receive antibiotic prophylaxis?”

I paused and reviewed Joe’s medical history. Sweat trickled down my forehead. My lifelines were spent, and I had no friend to call. Then the answer came to me. I remembered Joe’s history of endocarditis.

But before I could even inhale, Sam leapt in front of me and said, “Yes! He has a history of bacterial endocarditis!”

Looking at me, my attending asked why Sam was answering all the questions. Sam spoke up again and said, “Oh, I’m really sorry if I overstepped my bounds, but I was finished with my patients this morning and saw that it was getting late and Simon wasn’t in yet. I couldn’t bear the thought of a patient not being seen before rounds.”

Before I could defend myself, the team moved on. Sam stood still for a moment, gloating. It was as if he expected a hospital administrator to leap out of a supply closet and erect a plaque in his honor.

I was dumbfounded. What just happened? Suddenly the world blurred and colors began to fade. The disappointed expression on my attending’s face made it clear: I had failed. I had been gunned down. The world continued to go dark, until there was a sudden flash of light accompanied by music.

Shot down in a blaze of glory….

Jon Bon Jovi’s voice filled the air. My vision had returned, and I discovered I was lying in the hall of a different hospital. Red dirt blanketed the floor, and a tumbleweed rolled across it. A young man wearing cowboy boots with spurs and a hat large enough to conceal a small high-rise building stood over me, poking me with a reflex hammer. Several heavy instruments bulged out from under his white coat. “Hello? You OK?” he asked.

I turned my head to get a better look at him. “Who are you?”

“Bonney. Dr. Bill Bonney. Shoot, you probably didn’t even realize that I’m an attending. Folks always think I’m a medical student ’cause I look so young. Everyone calls me ‘Billy the Pediatrician.’”

“Oh, so you’re a pediatrician?”

Billy laughed and said, “Nah, a neurosurgeon.”

“I’m confused.”

“Nice to make your acquaintance, Confused. Har, har!” Laughter erupted across the wards.

I winced at the bad humor and asked, “You don’t get out much, do you?”

A man wearing a bolo tie glanced up from his note and said, “Of course not. We’re gunners.”

Sitting up and feeling a little lightheaded, I saw that the wards were filled with physicians wearing white coats and a variety of accessories strapped to their belts. “Who are all these people?”

Billy the Pediatrician introduced me to the other members of the service. “That there’s Wild Bill Hematologist. Watch out for him. He’s always looking for a good stick, and those veins of yours are looking pretty accessible.” I rolled my sleeves down.

“The man with the bolo tie is Doc Scurlock, and over to his right is Doc Holliday. The young lady writing orders is Dr. Clonidine Jane…. She gets special favors from the Clonidine rep.”

Doc Scurlock walked up to me and said, “Son, looks like you got outgunned. You need to win back what’s yours. Now, let’s go over different patient-card strategies.”

At the mention of this, I zoned out and thought back to when I was shot down. Bon Jovi’s voice rung in my ears.

I’m going out in a blaze of glory….
Wait a minute—there was no glory. I shook my head, and the song stopped. I had to find a solution that would make rounds more bearable. Billy woke me from my daze. “Are you listening to us?”

“Something about patient-card strategies, right?” I said.

Scurlock threw his hands up in frustration and grumbled, “I talked about that half an hour ago!”

The gunners huddled around to prepare me for my impending wards showdown. Clonidine Jane suggested slipping highly potent laxatives into Sam’s coffee. Wild Bill Hematologist urged me to stick Sam with a 14-gauge needle. “I call them straws,” he said, laughing.

Scurlock handed a small package to me. “I reckon you’ll be needing this.”

Opening it up, I discovered a handheld device preloaded with all the latest medical software. I released the safety by snapping the cover off. Admiring the neon blue steel construction, I drew my stylus from its holster and fired off a few runs of Winter’s formula.

“Careful where you point that thing. You want to poke an eye out?” Scurlock said. “Feels good, don’t it?”

I nodded. Then, just as suddenly as I arrived here, the world faded, and I found myself slumped against a wall and back with my original team. “Was it only a dream?” I asked.

My attending looked at me, annoyed. “Are you nodding off again?”

I mumbled an incomprehensible apology and tried to reorient myself. My hand brushed against something strapped to my belt. My handheld—it wasn’t a dream after all. I quietly whispered, “Thanks, Scurlock.”

We were on a new patient—one of Sam’s. I drew the handheld and snapped back the cover, sending a resounding “click, click” through the wards.

“So, Sam, what’s the predominant age for Osgood-Schlatter’s disease?”

Quietly, I tapped the stylus against the screen and then shouted, “Ten to 16 in females, 11 to 18 in males!”

My attending nodded approvingly. “What about Ewing’s sarcoma?”

A few more taps of my stylus revealed the answer. “Teens to 20s!”

Sam’s face turned red. He reached into his backpack and retrieved the heaviest, largest, most colorful handheld I had ever seen. “Two can play at that,” he said with an evil cackle. “By the way, our elevation is 450 meters above sea level!”

“Expansion modules!” I shouted in horror and dove behind the nurses’ station for cover.

Blanche glared at me. “You better not try and sit in my seat,” she said.

Questions and answers ricocheted off the walls as Sam and I engaged in battle. Egos getting bruised, hate and resentment building, we focused only on each other.

Growing exhausted, I got up from behind the nurses’ station and shouted, “Stop!”

Sam paused for a moment, hand on stylus, watching my every move.

“Morning rounds are a time to learn, not a time to try and make ourselves look good at the expense of our fellow medical students,” I said. “Handhelds should be used for wholesome purposes—to supplement our education with useful medical software and, of course, to play Dope Wars.”

Sam slowly loosened his grip on his handheld, and a small parachute deployed (yes, the antigravity expansion module). The handheld fell gently to the ground. Sam nodded his head. “I agree,” he said. “Let’s work to build a medical student community based on cooperation and mutual aid. Let’s create a nurturing atmosphere that will foster the selfless compassionate ideals that all physicians should embody.”

I smiled, and we shook hands, saying, “To the future then—a future of gunner control, where we respect each other’s education during rounds, where we put an end to all the childish games.

“So, Sam,” I said, “how will we spread the word and enact meaningful gunner control reform?” But my words fell on deaf ears. Sam was busy trying to get a cap off a small, orange, pill bottle.

“Huh? Oh, yeah, sure. What you said. So, you want a cup of coffee?”
Simon Ahtaridis is a fourth-year medical student at Temple University School of Medicine.