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A Doctors Footlocker - Dr. Vasliev ( IC BOOK )

Ash

Lancer
Dr. Vasliev. A Doctors Footlocker
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Introduction:
Comedy as a doctor.







Having been born in Russia until I was the age of sixteen, having been placed into a lifestyle and educational background of medical science with helicopter parenting from both sides of the fence, and obtaining multiple doctorates and PhD’s as I remained within the United States, I was placed into clinical based operations for a majority of my employment at various hospitals; spending over thirty years in what people would call the ‘front-lines’ of medical care.
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These details that I am going to describe in this book are from numerous memories that I hold from hospitals I’ve been pleasured with working with, although names and details will be substituted to protect identities as the goal of this book is to bring light and humour to the less favourable place of a hospital, including that of my world, a surgeons office. Additionally, there will be short stories that took place after the introduction of our benefactors as well as during my conscription as a Field surgeon.; the same process applies where details will be omitted.

Glory to the Universal Union.

To help me start this short book, I was going through my briefcase while enjoying some homemade soup one of the interns at Clinic 24 brought in when I came across my portfolio; it’s suggested that all doctors keep a detailed log of their clinical experiences, a type of ‘reflective practice’. Looking through my portfolio, I could look back on everything that I would consider remotely interesting, skipping over the brutal hours I worked as a doctor. I was able to relive some of these incidents. Yes, I am reaching an older age now, albeit it is still within working age, but some of these entries into my portfolio are experiences I will never forget.
The decision for me to get into the medical field was predetermined before I even had the ability to have that choice. At sixteen, the typical reasons for someone to pursue a career in medicine are generally like, ‘My father or mother is a doctor, which is perfectly fine. Still, in my case, where that was not the fact, and I lived up to the line of ‘I am your father, you will become a doctor’ was something I had just accepted. I faintly remember painting a race-car driver at age five or six, but I don’t think it could be seen as a legally binding document for me to become a race-car driver. Poor boy Vasliev was put in schools designed to spew lawyers, doctors, nurses and politicians. Thirty years later, I don’t think that was the wrong choice.

My first day working as an intern at Los Angeles County General Hospital was similar to watching the movie Titanic, a true horror but with a story that moves people's hearts. In this case, minds wonder why anyone in hospital care needed a medical degree.
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As an intern, I was shadowed by a doctor who watched my every move, questioned my processes and quizzed me on things that, at the time, I had no idea about. It was early morning in the clinic, and my very first patient walked into the consultation room and started to list off his various symptoms in a robotic-like fashion.

“ My arm hurts a lot during the day, especially in the morning. It’s never hurt like this before, and I’ve never had any history with it. I looked at some books, and I think it may be arthritis. It only hurts when I sleep on it, though.”

Having listened to what the patient had said, it should be noted that he was only nineteen at the time, and I had to take him seriously due to the lurking shadows over me.

“It only hurts when you sleep on it, you say?” - I asked inquisitively.

“Yes, I sleep on my side, laying on my arm during the night”.

“Have you tried not doing that?”

“No. “

The laughter coming from the shadowing doctor was deafening. My first patient and I solved an entire case within a matter of consolation.

“You should try not doing that.”

“Can’t you give me some pain-medicalation?”

“No.”

The patient did not return to the clinic.







My internship was short-lived at the Los Angeles hospital before the Queen's hospital in Hawaii picked me up; people consider this a massive jump that someone with only a year and a half of experience should not take, but I ignored it. I’m glad I did, in some respects. This was the path to becoming a doctor.
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One of the days that has stuck with me was the most uneventful day in the hospital. Having been transferred, I was considered a doctor, but not … officially. I was on paper, but in the social circle of the hospital, I was just another intern.

It was a day in December, close to Christmas, when I was called to pronounce death on an elderly patient. He had been sick since I first got to the hospital, with no attempt at resuscitation and in all brutal honesty, we were expecting it, and so was the family. I arrive at the cubicle, point out the former patient, and speak to the then-wife, who … is technically not a window yet but soon to be as I was yet to sign the forum. I expressed my condolences and suggested that they were to wait outside, but they insisted on staying. I didn’t fight against their wishes, but perhaps they wanted to be together, front-row seat and centre. I should have laid out refreshments for such a procedure. It was odd having an audience.

After confirming who the patient was, I began checking their respiratory functions and any responses to physical stimuli. I checked for a pulse before listening to their lung function with a stethoscope for two minutes. Two minutes is a very long time to stand beside someone dead … checking that they are dead, while there are on-lookers watching everything you’re doing. The audience kept asking me if I was ok; I hadn’t moved because the check had to be concluded; it was agonizing two minutes before, and eventually, death was declared.
Finishing my duties, I handed the rest of the responsibility over to the on-duty nurses when I returned to my so-called office, only to find that a once precise, immaculate and lack-their-of paperwork desk was piled high with paperwork consisting of a small post-it-note saying ‘To be done by the end of the day, followed by a smile and the lovely name of the Senior Doctor in the ward.’ - I was gone for two minutes, looking back on this, I think I was baited out of the office. What fun.
 
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Ash

Lancer
As a doctor, people trust you with quite personal information, so much so that they are willing to overload you with it as soon as you walk in through the door into the clean white rooms. It’s one of those things you get used to quite quickly, learning people's entire life stories in the matter of a five-minute consultation.

One such day occurred at the same hospital where I first became a Doctor in Hawaii. It was a couple who had arrived there for their honeymoon and were having a wonderful time before the Husband, who shall remain nameless, was unable to move his jaw, his mouth gaped open and as pale as a ghost. His interpreter, his wife and the obvious sensible one within the relationship explained to me what had happened.

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“ He put his foot in his mouth. “ - She said, in one of the most pedantic tones of voice. “ I told him not to, but he insisted he was able to do it. “

“How long ago did he do this?”

“ A week ago. “

“He hasn’t been able to speak for a week?”

“I thought it would go, but the fact he couldn’t speak has made my honeymoon a million times better”.

The temptation to respond with, ‘Would you like me to fix it?’ was astronomical. Still, having taken an oath, I forwarded him to a maxillofacial surgeon who would be able to fix his jaw and return his ability to mouth words.


I never got to see the aftermath of this patient; however, considering what I was told during the consultation, it would be safe to assume their marriage was already a foot in the grave’.









Fast forward numerous years until we’re blessed with the introduction of our benefactors, where I am still practising medicine in a new, more generous system,
CITY 24 is the second city I have ever bestowed the pleasure of being a part of, following a transfer from District 47, Russia. Of course, having a strong medical background, I was reinstated into their clinic before the administration placed me into my civic duty as a conscript. As a well-experienced surgeon and practitioner, I was placed immediately into the 186th Medical core of the CITY-24 conscript forces; as a Sergeant with the goal of teaching others the basics of trauma surgery and advanced life support. I was honoured to be selected for this position, and the rush I had from getting on that train to a place unknown.
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I arrived at what I will refer to as CAMP WILBUR on the outskirts of Russia, Sasyr, into a mess of unkempt snow, disorganisation and pure chaos, following a lack of administration within the area. It was only then I was informed that it became my job to sort out the mobile clinic; well, why not?
Organising my colleagues together, it was established that morale was low, with numerous people entering the clinic with falsified injuries with some clinic officers approving said papers, so serving conscription people were sent back home. Being a conscript is a privilege and a proud honour to have within the confines of our benefactors. I immediately put a halt on all discharges for secondary review by myself in regard to discouragement. A majority of patients did not return to the clinic for a secondary checkup. Those who did were checked, and to preserve some kind of humility, were provided with a stash of lollipops as if they were a child.

Of course, I would never put someone who is genuinely stuck into the line of conscription, or those who feign injury due to laziness or ‘they are not getting along with other conscripts’ (Yes, that was a genuine reason given to me.) wish to sacrifice a lifetime opportunity.
I am proud to have served the union as a conscript and encouraged more and more people to do so if they’re fit or wish to be fit.
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In the conscription service, you have the ability to defend the union, learn discipline, grow both yourself physically, and mentally and boost your confidence within yourself. You learn vital skills, such as what I was teaching during my stay within Sasyr, that apply to trade work when you return home. These skills remain with you for life, and you may even find yourself wishing to remain within the conscription service.
One of my dearest possessions is a medal I received from the service I wear with pride on all formal occasions. I suggest that if the opportunity arises, don’t take the lollipop option, obtain your medical check and sign up for your civic duty within your local conscription.

You won’t forget the magnificent sights and the people you’ll meet. (Pictured - Staff Sergeant, Dr Vasliev - Taken 28/09/2014 )



 
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Ash

Lancer
Dr. Vasliev. A doctor's footlocker.

It’s early 1980, myself a young aspiring man with a wealth of knowledge buckled under my belt. I’m only twenty-five years young and on trauma duty. A male who can’t of been no older than sixteen rolled in, having been shot in between his calf and lower abdomen, you can assume where. A nurse attending removed his clothes with shears, and I conducted the examination to be both practical and quick when I found a nice little half-inch read hole in the area, you can safely assume. No other injuries were apparent.
He was awake and scared; he kept shouting at me that there wasn’t anything wrong, insisting that he just cut himself, but on the rectal examination, my then blue gloved finger came back a dark red coated in blood. I threaded a urinary catheter and observed the results; a bright red flow directly from his bladder.
The review was prominent; blood in the bladder meant that the bullet had torn straight through him, both his rectum and into his bladder; I tried to console him in regards to what else may have been hit, blood vessels, his kidney, sections of the bowel may have been hit as well. I wanted him to go to surgery. I said before glaring at him, and I believe the look I gave him and the fact that the surrounding nurses had already begun prepping for it made him decide it was the best course of action.

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The gurney with eight people surrounding it ran down the hall, with everyone watching every part of this man, ensuring he safely got to the operating room, holding the doors open, and providing him with morphine before eventually putting him under anaesthetic. We arrived at the surgeon's theatre; I asked my then-college, Dianna (whose mother named her after Princess Diana), to go speak with the parents who arrived in the main lobby.
I made a notable cut down the middle of the man's abdomen, around his pubis, holding it open with clamps, and after five minutes of searching … I found nothing. There wasn’t any blood, there wasn’t a hole in the bladder, no hole in the rectum and most importantly, no bullet.
Myself and the attending were stumped, I performed another urine test via a catheter, and it was now normal a clear yellow. No sign of any blood whatsoever.

What else could I do? — I brought x-rays across his entire pelvis, abdomen and chest in the works. No sign of a bullet anywhere. All of this was odd; after an hour of endless searching, there was nothing else I could have done. I sew him back up.
Only then, after another checkup within a couple of days, it displayed something abdominal, showing a bullet lodged inside the upper right quadrant of his abdomen. There was no real explanation for this. How did the piece of lead get from his buttock to his upper belly without causing any injury? Why did it not appear on any X-rays or where the blood had come from? I ended up doing more harm than if I had done nothing, leaving him with a horrible scar he’d have to live with for the rest of his life; he turned out fine.

Being a medical professional, in my eyes, is a dangerous and disturbing business. The risks are so high, and the responsibilities you hold are quite literally life and limb. We can kill people, drug people, stick things into people, and manipulate their chemistry, biology, and physics. Put them into a state of unconsciousness and open up their bodies for everyone to see why we do this.
Because of our profession of being a Doctor, the self-doubts and mistakes you can make as a doctor outweigh what you see in terms of success. People in their world don’t see how fundamentally shocking practising medicine is. Usually, when people think about practising medicine, people think about the pitch-perfect doctors that know everything about science and what to do to make people better, to fight sickness and misery, the tests, the machines, the drugs, the procedures and without question. This is what medicine achieves, but rarely is it explained to people how it works.

Does your throat hurt?


Call a Doctor; they can sort you out; they know everything! — When we are just reading books on other people's mistakes, we don’t repeat them or at least, we hope not to.

Footnote, if your throat hurts for longer than two weeks, please seek attention from your doctor.
 
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Ash

Lancer
Cutting the line.






Your patient has died, and their only friend is dawning over them; for the sake of anonymity, I’m going to be referring to this person as Luke,, the patient had been declared dead twenty minutes before their arrival. I knew what I had to do and what I had to ask the family, and there was no clear-cut way to do it; the autopsy.
How should you go about it? - You could go abruptly and with energy, “Shall we do the autopsy, then?” or you should be like a Civil Protection Officer and instruct them to leave to permit us to do the said autopsy. The need for that consent is no longer present within the age of our benefactors and in the eyes of advancing medical science. — Take this as a positive.
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I remember Lukes's face when the Civil Protection officer instructed him. “An autopsy?” - He cried as he waited outside. “Hasn’t he been through enough”? - I value life, but once it has expired, people should focus their attention on the future, to benefit mankind and the union. The view is that once you are deceased, there is no violation; in aid of scientific advancement. But I do understand the emotional attachments and how these can be inescapable even in these present times.
There have been numerous medical breakthroughs once these restrictions were unbound and the social construct was adapted by our benefactors, similar to back when the Catholic church was the most predominant. Being able to order an autopsy against the will of the people on Pope Alexander V; simply to determine if his successor had poisoned him. We have come a long way and owe it to our benefactors.
Depression checkup.







Throughout my years as a doctor specializing in mental health sciences, I was able to experience people from all ends of the world and attempt to understand what their concept of thinking is; I’d like to talk about a patient I had, for the sake of this book I’m going to call him James; James had a fantastic life, and perhaps career living in the central part of Tokyo; a Union manager earning a healthy living. But he regularly visited me in the clinic, stating that absolutely nothing was going for him and that he hated where he was and the people he had impacted.

He was sure he ended up checking himself into a set program I had provided externally to private patients. He paid for it in full; it was difficult, at times confrontational, one every four days. He wasn’t ready to admit all he had done or accept all the responsibility he owed for other people's safety. The primary diagnosis I gave him was long-standing depression; their conclusion was blunt, and I provided him with a note stating that.
“Is unable to practice safely and effectively within the workplace, and is required an indefinite period in self-isolation” - with adequate and prolonged treatment.
“He will have the potential for a full return to work”. The diagnostic labels they gave him are probably less important than the intervention itself: the act of telling him, with institutional authority, that something was wrong with him, that he must not work.
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He was put on Prozac and then Effexor. He stuck with the program. “The first three months, I didn’t care if I lived or died,” he told me. “The second three months, I wanted to live, but I didn’t want to go to work. The third three months, I wanted to go back to work.”

Overall it was good progress, and after that long period of months, I was happy for him to return to the workplace in such a demanding position with a lot of institutional authority. The administration permitted him to return to his workers' practice with restrictions. First, he wouldn’t be able to work more than forty hours a week and, even then, only under strict supervision. He had to continue to see me in my clinic as well as have a physical once a month with regular testing of alcohol levels and drug intake. But the results of his absence? - No one remembered who he was, and his return had such little impact that his former and new colleagues wouldn’t take him.
I was required to visit James at his home; it was a set of loyalist apartments, and lucky for him, he lived at the very top; although unlucky for me because of the stairs. His apartment was bland; he was half dressed in his worker's attire; immediately, it was apparent to me that he had very little to occupy himself with at home. Considering his hour restriction, the place became his overly regular four walls. His life could not have been further than what we expect from someone so senior within the union, but he felt the fire for the work coming back for him. I tried to picture James in a suit that Union Officials wear that is designed to be impressive. I found it difficult; who could say how he would turn out?
No matter what we do, we are all in the hands of flawed humans. James was in charge of copious amounts of necessary machinery that could easily lead people back to my clinic, yet he could barely function. It’s a fact that's hard to stare in the face but is inescapable.

I ended up going out with James for a meal, at a local union bar, before returning to his workplace so that I could look around. I didn’t have to go, but I had never been inside such a building without there being some kind of severe medical emergency. Both of us walked through various doors down a nicely kept hallway before coming to a stop at a reception desk.

“Why, James! - I haven’t seen you in months!”

Said a dark-haired woman behind the desk; James stopped in his tracks, saying;

“I retired”

The woman appeared confused, considering the fact that she appeared to be near twice his age, James. James spoke to her as a phased out, something about all the fishing he did during his retirement. He finishes the conversation with;

“I’ll be back. “
 
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Ash

Lancer
Doctor mess-ups.







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Mr’s X, a thirty-eight-year-old woman, arrived at my clinic within City 24 while I was away for a week on a scheduled holiday, prebooked by the Union. (It was amazing) Mr’s X was a hard labourer, a middle-class loyalist with a heart of gold. She had come into the clinic stating that her knee, although painless, was frequently swelling with fluid. My then colleague at the time, Dr Muhammad, examined the knee stating it was hot, painful and tender; having put a needle into the knee, foul-smelling pus came out. What should he do?

It was clear from the description I was provided when I returned home, was that the woman's knee was infected and that her knee should have been opened, drained, and cleaned to prevent any further damage; however, Dr Muhammad was busy and with me being on holiday, there wasn’t anyone else suitable within the clinic. Dr Muhammad didn’t consider any action; he didn’t admit her into the hospital, did not see her, did not even send a colleague to check on her, did not prescribe any kind of oral antibiotics and said to an intern who brought this to their attention.

“Ah, she’s just complaining, don’t worry about it”.

Two weeks later, the patient came back while I was present; the knee had gotten more swollen and infected as I began to drain it. But at that point, it was too late. The infection had consumed her cartilage; the entire knee joint was destroyed. I spoke to her and questioned the lack of response our clinic provided, but throughout the ordeal, Mr X didn’t seem fussed.

“I’ve adapted”, she told me, with a lack of a functional knee. She can’t run, she can’t bend down, she can’t work with her entire lifestyle being drastically over something that the proper medical care could have easily prevented. Anyone who practices medicine can make dumb, awful decisions, like Muhammads, but in the last few years of my being within the City 24 Clinic, he made them over and over again.

In another case, Dr Muhammad placed the wrong-size screw into a patient's shoulder plate. It went in far too deep and caused the patient unbelievable torture, yet; the Doctor refused to admit that anything had to be done.
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He could have easily replaced the screw, or even when conducting surgery on a member of the workers union; the initial idea was to assist the patient after suffering a broken hip by use of pins to repair an isolated fracture; however, upon performing a keyhole surgery leading into the primary pin surgery, Dr Muahmmad told me that he could have done a total hip replacement rather than just the pins.

It wasn’t a surprise that the patient's hip fell apart within a year, becoming infected and eventually leading to their death. This ended up being the downfall for Dr Muhammad as a full investigation into his medical misdiagnosis and overall laziness when it comes to the people he was treating; it came to light that these incidences were not, in themselves, unique. Mr Muhammad had developed a reputation for ignoring pleas for help from patients believing that his word was indeed in-fact gospel; a majority of his patients went for second opinions at a clinic outside of the central city; the feedback I had from their respective doctors stemmed from the lines of

“He didn’t do anything, although there were obvious signs that even an intern couldn’t ignore.”
“A basic x-ray would have shown that this was an issue.”
“How is that man practising medicine?”

Dr Muhammad was fired with short notice, following the investigation with one of the administrators where I had to testify against him. His laziness, incompetence and overall lack-their-off will to practice medicine in such a benefactor world were his own doing. I believe he was stripped of all titles and positions and was transferred to another city.

Corrupt doctors are ones that intentionally cause people misery, bad doctors are idiots with a lab coat.
 
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Ash

Lancer
An unlikely Soldier with a positive attitude.





In CITY-24, I was informed by a protection unit that I was required for my conscription service, although I cannot recall where I was or what I was doing at the time. Despite initial doubts, I knew I wanted to become a conscript, as military service was in my blood. My father served in the Russian Army, and my elder brother, Aleksandr, followed in his footsteps by joining as soon as he turned 18. I was named after my father's brother, who was killed during World War II. During my youth and early adulthood, my family frequently moved between places as my father rose through the ranks.

However, I chose a different path in medicine after strict instruction from my father and joined the 186th Medical Core, which became my home and family. My daily routine consisted of physical training, a shower, a change of uniform, and conducting the "sick parade," where any acutely unwell or injured conscripts in the unit were pushed forward for medical appointments. My weekly schedule was varied and exciting, a mixture of medical practice and weapons training that fought off the mundane. I loved every moment of it, although I still had a lot to learn from a practical skill perspective, such as applying hospital trauma care to a live combat zone. Nonetheless, plenty of selfless colleagues were always willing to help.

In late April of that year, I had been brought aside by the Unit commander into his 'office', although, at the time, it was merely his tent; he had been slumped in a chair behind a so-called desk, which was just a foldout table. He didn't rise from his chair to greet me, as I had braced myself for the worst; his expression was hardly encouraging. The Commander had asked me about my intentions within the conscription service and if I wanted to remain or return home. I stated,

"I had applied to return home and continue. Practising medicine in a city setting."

His reaction was delayed as he sucked air through a laugh with enough condescension that it felt like a ton of bricks had stuck in my chest. In the process, he managed to inhale a small remnant of food, which caused him to spark into a violent coughing fit; his face reddened and transitioned to purple, veins in his neck bulging. I couldn't look away.

I don't think he approved of my wishes.
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The following day, I had a training exercise: a ruck march with the unit, going as best as possible, gracelessly clambering over rocks, often on my hands and knees. I had hauled myself up onto such rock and went to stand up when my face struck a tree branch in front of me. I hadn't seen this owing to the limited light my head torch had given me; while I was dazed, I had stagged backwards. I recall flailing my arms as a last-ditch attempt to counter the weight of my ruck pack before I fell off the rock and was knocked unconscious.

I don't remember how long I lay there, out cold. But when I did come around, it took me some time to work out where I was. My head torch was gone, and I couldn't see it. I was wedged between two rocks. As I surveyed myself, I felt a warm stickiness of blood coming from my nose and the back of my head; this wasn't good.

I was in the middle of nowhere, injured and disorientated, and had lost my only critical vice, which was my torch for the early morning; it was pitch black.

I played there for ten minutes, thinking about what had happened, focusing on the positive that I had regained consciousness. My colleagues would have taken days to find my body, which is the danger of solo-based training exercises. I had covered around 5 Kilometers back from camp. I remember that I had a stash of chemical light sticks in my back at the time as I slowly struggled my way out of my position between the rocks.

I looked at my map and decided the road was my best route after being injured.

I gave myself a bare-bones set of medical attention as my head throbbed from the hit I had taken. It had taken me three hours to get back to camp; luckily, by then, dawn had just broken, and I was greeted by one of my unit officers; he had woken up early and had been on the verge of hitting the panic button to send out a search party for me. Thankfully, he hadn't done that to save my embarrassment; I had a shower before collapsing into my bed.

This whole experience was a debacle, no question, but rather than discouraging me from taking similar risks, I viewed the experience positively. I had set a goal, met adversity, and managed to pivot my plan and devise a solution. It had been a tough night, but I had been equal to it.
 
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