Life is getting complicated. Yesterday I had my first serious run-in with a drug-seeker who did.not.want. to leave the hospital, especially not on the level of narcotics I was prepared to prescribe for him. The fact that one of my colleagues had – let’s say, taken a strategy I would not have chosen, to get the patient off their back a couple nights ago only complicated matters. . . I was very frustrated. The patient would probably be diagnosed with borderline/histrionic personality disorder if seen by a psychiatrist, and although I knew objectively that there was nothing much wrong with him, he sure took me for a guilt trip. . .

Next week one of the attendings is doing a transgender surgery, which the chief proposes to send me to. I was too shocked to see the case on the schedule to make any objections when it was first discussed. Also, to be honest, the thrill of being first assistant on such a big case is seductive. But I don’t see any way to excuse the matter – either the patient for asking for it, the attending for agreeing, or myself for assisting, if I were to do so. Breast augmentation (the most major cosmetic surgery I can think permissible) is bad, but it’s not downright evil. This would be mutilation, in open rebellion against all God’s laws. I don’t think I can or should do it. Not looking forward to explaining to the attending that I disagree with his ethics, or to the chief that I’m going to back out of the biggest case I’ve been offered in my career to date (1 week and x days) . . .

One reason I steered away from OB was to avoid ethical issues. Ha.