holidays

Wow! It has been awhile. Being the lucky student I am, we get 3 weeks off for the holidays. Oh how I will miss this once I become a resident.

Seeing as this is my only time to travel, I visited my college town for a few days. It was great to be back, walking down the hallway of the science buildings. When I got to the floor where I did research, I looked at the large posters of the project I was working on. I was working on the makings of a bio-sensor which could be used against the chemical warfare that had picked up when I was in college. Looking at all the organic chemistry and equations, I felt a rush of gratitude: I am out of that hell. Medicine may not be as hard core as biochemistry in terms of "science" but dealing with people instead of pipettes makes me really happy.

Of course having a break gives me time to reflect on the past year and think of where I am to go next. We're starting to plan our fourth year and although I am nervous about committing to one type of medicine, it is also really exciting. In terms of abroad programs I'm looking to go back to Ecuador and finally visit Ireland. Get the passport out!!!

I'm off to NYC for New Years. My favorite thing is watching that ball drop so where else could I get a better view??

Be safe and Happy New Year!!

my final day

For my final day on OB, I decided to visit my favorite patient. I met her my first week on OB--originally from Peru, she married a Boston man 5 years ago, decided it was time for kids, and signed up for in vitro fertilization (IVF) after she attempted to get pregnant. She is carrying triplets and because of her "incompetent cervix" she is stuck in the hospital until she delivers by c-section. The plan was to cut her at week 30, but now she's there and doing so well, the docs are pushing it back to week 35. She is excited that she is doing so well, but sad that she will remain in the hospital through the holidays and into next year. (understandably!)

Her story for this week, though, sounds like it came straight out of a movie. Apparently a 60-something year old woman walked up to the nurses station, stated they were there to speak with the pregnant lady with triplets and they pointed her directly to my patients room, no questions asked. This woman walked in and told my patient how she had triplets too, showed her pictures of five year old kids, which supposedly looked like they came right out of a catalog, and said she was there to offer my patient help once she had her kids. She gave my patient her contact info and said she must call her once she delivers. Luckily my patient started to catch on and began questioning her about who her doc was, who her in vitro doc was, etc. Somehow the lady could not remember the names of either one, but dodged the questions. Instead she tried to scare my patient into needing her help and then left when she wasn't getting anywhere. Subsequently, my patient's laptop was stolen the next day. (which is probably unrelated)

Now my patient is having nightmares of someone coming into her room, in the dark, cutting her open and stealing her babies. I thought I was stressed!

I gave her my contact info today. She said she would call me when she delivers. I hope she does. I would love to visit with her again. She's made quite an impression on me--OB moms are of a special breed of patients. Most of them like going to the doc and are happy while there. Even through all of this mess, my patient said to me "You just have to think positively. I still have the babies and thats what counts."

Christmas is early again

The other day we had a lesbian couple come into the hospital for pregnancy issues. The pregnant woman had a history of seizures which apparently get worse when she is pregnant. We admitted her for observation and to get on top of her anti-sz medications. We also did a fetal lung test to see how mature her baby's lungs are (she was at 36 weeks + 4 days). While talking to her and her wife, she confessed that she had absolutely no idea how she got pregnant. She is 100% faithful to her wife and hasn't slept with a man in years (incidentally she already had 5 previous children). She insisted that it was an immaculate conception. I informed the hospital priest, but apparently he was busy explaining to a patient on the ICU ward that they weren't jesus even though they had "come back from death" after being defibrillated.


PS the fetal lung studies came back immature, meaning if she delivered her baby, he would have died--not maybe, but definitely. The couple tried to convince an OB doc to deliver her anyway, saying her seizures would not get better until the baby is out. My resident explained that no doc in the nation would deliver this baby (very dramatic--it could have been in a telenovela), but they were still persistent. We later found out that her seizures were "pseudo-seizures" or psychological seizures, not resulting from abnormal firings in the brain. I am guessing god would not be happy about her killing Jesus #2....

comfortably confused

I know there has been a real lack in my blogging lately. What can I say? I am not sure if its been the change of weather, my current living situation, or just finally being exhausted, but things have been "down" for me.

When I start thinking deep about my life--or rather what I should do with my life---it can also be a real downer. A never-ending theme in my blogs is that I went into medicine knowing exactly what I was going to do---Emergency Pediatrics---and ever since starting 3rd year, my life or the idea of what my life will entail, has been thrown upside down.

So was no surprise to me that psych and neuro were not my favorite. I am good at talking and listening to people, but dealing with schizophrenics and bipolar people is not something I would sign up for on a daily basis.

I ended up really liking the OR. I was ok with waking up early and going to work. I didn't mind scrubbing in the last case added on the end of the day. Doing peds surgery was awesome--kids heal so quickly and feel so much better after their operation. Trauma was exciting---its a time in a person's life where they really need help and where you can actually make a difference. In general surgery, people had a problem and you fixed it. Done and done. But a part of me is terrified of surgery. It is something I am interested in, but scared shitless of that responsibility. And even though the residency is the same in years as Peds ER, it seems so much worse.

And now to add another. OB. I thoroughly enjoyed delivering babies. I started OB not excited, sorta disgusted, and not happy. Last night was my last night on call and I almost cried when I realized I may never deliver another kiddo (my exhaustion can play with my moods....). The residents I worked with really cared about their patients. They were excited about delivering babies, doing surgeries, etc. It was a great environment to be in. Can I cut out half the population by only working with women and stop dealing with kids? I dont know.

I dont know. I think I realized last night that it is possible I will be one of those people who loves everything they do, so maybe none of this will really matter. I am confused. And while some days I am comfortable with it, others I have a steady rise in panic where my stomach ends up in my chest. I feel this way until I remember to breathe and try to enjoy the fact that the world is still new and open to me and I can pick anywhere to go.

Get in my belly!!!

I know I've been in a posting slump recently so here's a mini story until I find the energy to write more......

While I was on L&D last week we had an overly obese pregnant woman who came in for a scheduled c-section. Her BMI was 39. (normal is 20-25, which may change soon b/c NIH is considering increasing the numbers since so many people are now obese by definition....) We had to tape her pannus (a hanging flap of tissue) back so we could expose her lower abdomen. After a difficult surgery (I held retraction the entire time), we got the quite large baby out (10 lbs!!)
The first thing mom said to her kid while we were sewing her back together--
"You look so cute, I could eat you right up!"

I did my best to hide my (small) giggle.

(today parentheses are my favorite)

The Multi Purpose Adhesive Tape

So today in lecture our doc showed us a bunch of pictures and asked us what we thought each one was, how to diagnose it, and how to treat it. It was a bunch of fun, mainly because some of them were tough and so we all looked like an idiot at one point.

For example, my picture looked like a huge tumor/mass in the vagina. I confidently described the mass and I opted for a biopsy it to diagnose what type of cancer it was. The doc asked how big of a biopsy I wanted. I choose a 1cm punch biopsy--standard for skin cancers. He informed me that my results were some epithelial tissue, a layer of periosteum, and then some neuronal tissue. By this point I turned bright red and replied "Sorry little baby!" It turns out that my "mass" was actually a baby being born. OOPS!

The best response came from a fellow classmate though. There was a picture of external genitalia with a large circular white lesion on it. My classmate believed it was a genital wart and so she wanted to biopsy it. Genital warts arise from a virus called HPV--the same virus that causes cervical cancer-- but there is a specific type that causes cancer and a specific type that just causes warts. Anyway, the typical treatment for genital warts is to laser or freeze them off. When my classmate was asked how she would treat this genital wart she replied with "put duct tape on it." The teacher sorta giggled, all classmates were stiffling a laugh, while I yelled out "and what? Say see me in a month?" (sometimes I loose all tact...) When the doc explained duct tape may work on feet, its not generally used on genital warts, her next treatment option was "How about Dr. Scholl's wart removal?" At this point, all of us, including the teacher, lost it.

allergies??

So recently I've noticed that patients have absolutely no clue what an allergy to a drug actually is. As med students/doctors we've had to add the follow-up question after asking what alleriges they have with: "What happens when you take that medicine?" so we can screen out the true allergies from the phony ones. Now a true allergy is when you get a rash, your tongue swells up, you have trouble breathing, or your throat closes. Here are the responses I've gotten lately:

"The morphine made me nauseous." (sometimes followed with "That drug that starts with a d is better for me....what is called? hmmm....oh yeah! dilaudid! That usually works!)
"I threw up six times."
"It gave me a tummy ache."
"What happens when I take it? I've never taken it...didn't you hear me? I'm allergic!"
"It made me dizzy."
"I gained weight."
"I vomitted like a hour after I took it."
and my personal favorite:
"Last time I took amoxicillin, my mom said I got real violent. And angry."

Labor & Delivery

It is about 2:30am on a very early Thursday morning. We've just admitted two patients---one who will deliver sometime during the day today and the other sometime before morning rounds (or so we hope). I've had 3 C-sections, and 3 normal vaginal deliveries today. I am on call for L&D.

Most people would take their "down time" and use it towards taking a short nap. I am not fortunate enough to have this work---I wake up groggier and more upset than I was before the 40 minutes or so I got to close my eyes. So instead I practice tying knots, I read my email, I write a blog. Sometimes I just walk up and down the halls to keep the blood moving. Don't get me wrong---L&D is exciting and I am really liking the deliveries.....but during the down time there really isn't much to do. Unlike trauma call, where someone always needed stitches or someone needed an official reading of a CT scan---on OB if they aren't pushing or they don't need a cervix check (they get checked every 2hrs!), then you've got nothing to do.

I mentioned my first delivery was last week---it was pretty amazing, gory, but amazing. I remember seeing the baby and thinking "OH MY GOD!! THIS ONE IS DEAD!!" and then wondering why no one else was freaking out. That's when it occurred to me that all babies look sorta white when first delivered. Now, I feel my heart rate go up after each delivery, but quickly assess to see if anyone else is worried before I react (say by calling a crash cart...). The mom who I delivered was 21, and this was her first child. Unfortunately she had something called a "4th degree" tare, meaning she tore quite a bit (I wont get into the specifics). Lets just say she'll have life long problems. It was upsetting to see but even more unfortunate--they are hard to avoid.

Will I become an OB doc? I don't have a clear answer to that---It is pretty cool to see happy moms and dads after a delivery (although to be honest, people aren't jumping up & down for joy like I expected them to....so instead, I sorta do that for them when they are lacking), but I am not so sure I want to limit myself to taking care of only women.....

and so the internal debate continues........

OB stand up

Today during rounds my attending was talking about the new filters at the hospital preventing people from sending emails and how tight security is these days (i think the conversation sparked from the discussion about AT&T handing in the towel to the gov't).

Apparently the OB department was affected with the hospital filtering system----they were planning a conference at Beaver Creek Colorado and needed to send an email to the residents and fellow attendings to give them the updated info. Every time they sent the email, it came back to the administrator. Finally the hospital informed him that the filter screens out emails that have the words OB/obstetrics and beaver in the same email.

hahaha...this is gonna stick with me for awhile....

Ps delievered my first baby last night!--more on that later....

first week on ob!

Seeing as I never want to have kiddos of my own, it is not surprising that every time I see a pregnant woman I think to myself "oh did the condom break?" I've learned to keep my mouth shut and this in my head after my patient today told me of the intricate details of her in vitro fertilization. Some people want spawn so bad they'll go to great length to have one----or in her case- 3, of their own. And when a woman is pregnant with triplets---she deserves royalty and respect---not only because she's been through so much, but because she's big enough to take you down.

done with psych, bitches!!!!

After a tough shelf test, I am officially done with psych! (well as long as I passed) It was a long 6 weeks and I do not plan to ever go back. Sure, the hours weren't bad, and hearing people's stories can be interesting--but when its not, its boring as hell and the hours drag on forever.

I did learn some important things. Like I have at least one personality trait in every personality disorder. (ahhh!) When my coat hung over my door looks like the boogey man, it's only an illusion and not a hallucination. That my favorite defense mechanism, displacement, (where you are upset with one person and turn it against someone else) is very immature, when the humor defense mechanism, which is usually really annoying to me, is actually mature.
Oh and everyone does drugs and everyone thinks of suicide.

the end!!

SPOOOOOOKKKKYYYY

My favorite holiday of the year!!!!


HAPPY HALLOWEEN!!!!

ransacked

Yesterday after studying for 4 hours I decided I needed to release some energy. I got ready and left to go to the gym when I noticed my driver side door was prompt open. I opened the door completely and saw my car was ransacked. The glove box was left open, the center console opened and contents were thrown about, old gym clothes that were on the ground were thrown everywhere. Luckily few items were stolen---my ipod, a few old already expired credit cards, a few bucks that were hidden in my ashtray and my insurance card. No damage was done, well, to the vehicle.

I, on the other hand, was pretty upset. I've never had anyone steal or break into anything of mine before. I felt violated. The car was parked right in front of my house, in my driveway, literally 20 feet from my bed. There was a huge knot in my stomach, pretty much all day. And I know that I was lucky and it could have been A LOT worse, but the upset feeling was still there. I wondered why this person or people needed to break into my car---did they need money for rent? for drugs? or did they do it just for fun??? A lot of the kids I work with now have stolen to keep their habits up. I wondered if this was a future child psych patient. And I wondered how many times they will commit these types of crimes before they actually get help.

ROOOOAARR!!

So tomorrow when I meet with my 15 year old female patient with suicide ideation I am supposed to be mean. My resident says that its time to push her buttons and get a response out of her, otherwise she'll stay in the facility forever. She really enjoys the psych ward and isn't interested in leaving (possibly a borderline personality disorder) so the resident told me we've got to make her slightly uncomfortable. I have a problem with this.

I suck at being mean. I may think of mean things to say after a fight or during a situation but they never actually come out of my mouth to the person. I can rant and rave about being pissed off at something, but thats as far as it will go. I even have a hard time writing mean things on here! So I've decided that this will probably be more therapeutic for me than for my patient. I've got to push her buttons while hiding my feelings of feeling bad for doing it.

this is not going to be easy........

OCD

OCD: Stands for Obsessive Compulsive Disorder
Obsessions are:
recurrent and persistent thoughts, impulses, or images that are intrusive and inappropriate and that cause marked anxiety or distress
Compulsions are:
repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly

The worst patient my doc has ever seen: the guy counted how many breaths he took each day. That is all that he could do--day in and day out. Breath (1), Breath (2) Breath (3)....Now that's commitment!

I gave it my best shot, counted one breath, got bored, and quit.

thinking thru the kid crisis.......

I love kids. Ask anyone. I was a nanny in Denver during undergrad. I spent a lot of my free time taking the kids to Chuck E Cheese or to the movies or taking them swimming or to the science museum. It was always a blast. They ask great questions, have great imaginations, and laugh at words like poop and fart (lol i said fart...). So although I whined like a little kid my last blog I was actually looking forward to hanging out with the 3'9 clientele. That was until I realized that these are sick kids.

Sick not as in physically ill (although a couple had the flu), I mean psychologically and socially. The cute 12 year old girl told me how much cocaine she snorted. The 15 year old girl old me about how her 23 year old boyfriend was going to be mad at her once she got out. The 9 year old girl told me how she attacked her stepmom in the car while she was driving...for no reason. And these are just the girls.

I know I'm not going to personally "save" anyone, but looking around the room and hearing these stories, I start to lose hope that anyone will. I would say that usually I'm a positive person. But these situations suck the positive thoughts right out of me. These are the kids that grow up and become the adults that I saw the past 4 weeks. These are the kids that my mom sees in juvenile court--time after time.

How do I go back every morning with such a grim outlook? Each day I go into work hoping that someone will be given a chance to make a good choice and actually choose it. Unfortunately the real test is not while these kids are in the safe inpatient facility---its when they are surrounded by temptation or pissed off at the world, but at least they get some practice in a safe environment.

resistance

i dont want to go. I don't WANT to go. I DONT WANT TO GO!!!!!!!!!!

ok now that I have whined like a little kid, I'll go start my child psych rotation.

ugh.

the hospital

Yesterday I completed my two weeks for psych consults and this next week I start outpatient child psych. Although I am ready for a change, I am sad about leaving the hospital.

The past few weeks I realized how much I love being there. I look forward to chatting with the caf workers---they have become my friends because I eat there so often. As I roam the hospital halls I run into people I know who stop to say hello---other medical students, surgeons that I worked with last rotation, and even a couple of patients. When I descend to the basement and I walk into the emergency department, I feel at ease. Not only do I know the docs there, but I get excited about what cases could be there---anyone need stitches? an ABG? any traumas come in today???

Psych has gotten better over the past two weeks, but its definitely not for me.....I think I would be too invested and unable to separate my life from theirs. Which is why I think surgery or Emergency might be better for me---there is a degree of separation already built in.

After my psych test, I am moving to a different city to do my OB rotation. I guess new scenery will be good for me, but I'm definitely going to miss the hospital.

you did what??

Last week when I was on call, we were consulted for a patient on the floor who had a small bowel obstruction leading to surgery. During surgery they found a condom full of water. We were consulted to assess his suicide thoughts and see if he needed some psychiatric help.

When I questioned him how a condom full of water ended up in his small bowel, he explained how it was a complete accident. Just when I was about to press the issue about how a condom filled with water was in his mouth, he states that he didn't mean to swallow it. Apparently he was having sex with his girlfriend, thought it would be hot to deep throat a condom, it got stuck, he choked and had to swallow it. He thought his stomach acids would digest it. He woke up at 3am with severe abdomen pain and vomiting that he couldn't explain so he came into the hospital.

I love these patients.

quote of the week

When asked if a kid was intentionally doing bad in school to passive-aggressively show up his parents he replied:

"No way! That's like shitting my pants just so someone else will have to smell it. I mean, come on, you still have to sit in your shit."

the child experience

Last week I spent a morning in child psych. The doc specialized in kiddos with substance abuse problems----all the kids live at a ranch in a near by town for a year and they take online high school classes, do gym, and then help out with chores on the ranch.

The first kiddo was really outgoing and friendly. I realized I could be totally manipulated by this kid if the had the brains. He then started telling me what he did before the ranch.

"My first choice was alcohol. I drank A LOT! Then we did cough syrup. Which was great because the only screening test for it costs about a thousand bucks"
-- how much cough syrup did you drink?
"At first it was just a bottle. I quickly developed a tolerance and had to drink almost a liter."
--a liter??(!) how did you purchase all that cough syrup??
"Well, I'm a good writer. I wrote to the nearest cough syrup production company and told them I worked in a lab and that I was doing research on the CNS effects of cough syrup by testing lab rats.....they sent me a shit load."
---oh my god.

(OK I didn't say that- but it was clearly what I was thinking. I am sure my face expressed it and the kid probably totally read me. I am so screwed with the wicked genius kids!)

what i think about

Going in everyday to the psych ward makes me feel like I'm part of the movie Girl, Interrupted.

It all started my first week--all the patients really got along well and they would talk about one another during our therapy sessions. It reminded me of the part when Susanna (Winona Ryder) and Lisa (Angelina Jolie) all got together in the basement and did their own "therapy" thing.

Everyday I wonder who will be the patient with the baked chickens rotting underneath their bed.....

Haven't left it yet!

Yesterday my mom and I hit up the mall in order to get some fun stuff for my upcoming trip to Seattle for the ACEP Conference. We were just leaving when I heard someone sort of yell and then heard a large Bang! I had a feeling that someone had fallen so I turned around and sure enough, a lady was out for the count.
When I got to her side, I began taking her pulse--about 66 beats per minute---completely normal. She was awake and she was holding the side of her head. I asked her what happened--she just bought 2 inch high heel shoes and was wearing them around the store when she tripped. She was completely coherent and could recall the entire experience. She moved her hand and that's when I noticed about a 2cm laceration on the left side of her head (temporal region). It was bleeding (all head lacs bleed more than the extend of the cut) and I wanted to warn her that there was some blood, but definitely not bad. She actually was pretty calm and said she understood how vascularized the head is (I was surprised by her answer). Meanwhile another person sees the blood and completely freaks out, starts shouting "She's bleeding! she's bleeding!" I look at the lady and say "Its not bad---she's going to be fine." I then turn to the lady and ask if she feels like she could sit up. That's when the department store lady pipes in "We need to wait for someone who is trained." I look at her and reply, "I am trained."

I miss trauma surgery.......

First day in lala land!

So today was my first day as "psychiatrist in training". For the most part it was awesome----I got there at 9 am and I left by 2:15pm. I only had to make one phone call. We saw 6 pts and I just sat and listened to the attending interview each patient. It was relaxing---I was in a nice big comfy chair and just listened to people's stories. They even gave me a lunch break. But sitting around all day would drive me crazy so I'm just going to enjoy it for the next 6 weeks.

Never having much experience interviewing and treating psych patients I was surprised the by the way the doc took a stance on some things. For example, there was a pt hearing voices (which told her to jump off a building and commit suicide) and going through dissociative periods. Today, she was really anxious about the idea her parents will die someday. She said that's all that she could think about. In response, the doc told her that "none of us are ever really separated by the ones we love. In heaven* we are all joined together so you can look forward to that." All I could think was you're giving a suicidal pt one more reason to take the plunge......

Overall, it was a good day! I'm on call tonight so we'll see how that goes.


*the doc later told me he usually never talks about religion but he knew that she was religious so he went that route.

Cutting is over....bring in the crazies!

So my surgery rotation has come to an end. Definitely mixed emotions about that one--I've spent 9 weeks getting up around 4:15am and getting home sometime after 6pm so its time to have my life back. But I really liked the OR and I already miss it.

On Monday I officially give up the scalpel and pick up the prescription pad---I start psychiatry. I am not going to lie---I am nervous. When I worked for ambulance crew I did a lot of psych transports and there was always a level of uncomfortableness.

We all have some craziness in us, we just don't talk about it all the time. I am usually ok with that. =) Get ready to go there......

test time

well this is it! whenever i wake up 3 hours before a test to continue studying, it reminds me of my first two years of med school. Once before my neuro final, i tried using reverse psychology on myself by attempting to convince myself it was 4 PM instead of 4am. I thought maybe I wouldn't be as tired if my mind thought it was 4pm. So I went to bed that night saying "I'll just take a nap til 4pm and then my test will be at 8pm. Its a night test this time."
um, yeah......it didn't work.

study study study!

So the hardest thing about still being a student (besides not knowing anything that is going on....ever) is that you have massive amounts to study once you get home after a 13 hour day running around the hospital. Most days I'm happy if I can get a hour in. But unfortunately this week is test week so that one hour a night just isn't gonna cut it.

So today my study partner and I hit up the library. There's a packet of vignettes that are super important and the word "escharotomy" came up. Neither one of us had any idea what it was so I looked it up:
Escharotomy is a procedure doctors perform on burn patients suffering from severe edema resulting from full-thickness, or third-degree burns. Doctors perform escharotomy when the severity of burns produces edema that limits circulation to the traumatized area. A physician uses a scalpel to make incisions along the skin that allows the tissue to expand and decreases pressure on the underlying structures. Due to the tension in the skin the swelling causes, the skin spreads far apart after the incision.

Whoa! thats intense!! Oh yeah and I forgot to mention:
Because sensory nerves are destroyed in a full thickness burn, no local anaesthetic is required.

Can you imagine? so basically, you come towards your patient waving a large scalpel saying "Trust me, this won't hurt. Trust me." And they're supposed to sit nice and still for you??
Picturing this kind of interaction makes studying fun =)

oh so thats what 120 hours feels like

i never knew i could work this much and still be somewhat functional!
haven't had a day off since labor day, and not getting one until Sunday.
2 calls within the week.
still trying to study.
BRING IT!

Big decisions

Lately, I've had several doctors and residents----surgeons i should say---tell me to go into surgery. They tell me that I have a "knack" for it, and I should continue to think about during this year. I have no idea how one has a knack for something they aren't even really doing---if you mean I have a knack for surgery because I can hold a retractor, or obey an order (mainly just cuz I'm trying to avoid getting yelled at---knackity knack, don't talk back) then I would think most people could have a "knack" for surgery.

I guess my fear is this "knack" they are speaking of is that I am sorta anal and like to see things done well. I can organize things--vacations, events, groups of people and I do try to get things to run smoothly. In those situations, sure, I may have a "surgeon's personality." But sometimes I don't like my type A side and I feel bad for having it. Plus I have also been called the mother of the group. I take care of others, and usually have a Mary Poppins bag with anything anyone could ever want or need. How and when does a surgeon = mother?

This whole deciding what I'm going to do with-the-rest-of-my-life -is quite stressful. Trying to figure out what you love doing in medicine, how you can pay off the med school debt, and what kind of life you want to lead (aka do you want to have a family) within the year can weigh a person down. People outside of the med school think---you, idiot, you're gonna be a doctor! you have it all figured out! Well let me tell you something---deciding to be a doctor is like deciding to get married and choosing what color flowers you want at your wedding. Once you decide that you still need to choose what kind, how many, and figure out how it is all going to be arranged within the bigger picture. I may have picked the color (although some times I question why I'm even going through with the marriage) but everything else is still unknown and the florist is demanding a check by the end of the week.

priceless

Today I got the pleasure of checking a 50 yr old man for a inguinal herina. He walked into the room, told resident and myself how he had squamous cell carcinoma removed from his penis several years ago and now he has a few enlarged lymph nodes in the groin area. He happily dropped trout to show us his inguinal herina ---which he excitedly showed us how he can make it go in and out---and the lymph nodes. My attending entered the room at this point and made some comment about how he was probably the life of the parties with this hernia. My resident taking his quirky attitude a bit far called it a "little party favor". Just when I wasn't sure if I should leave the room so they could all talk sizes, the patient exclaimed, "This is the only time I ever wear underwear! To come to the doctors office, I mean." My attending replied with "Thank god for that," and then walked out of the room.

We then scheduled the man for an inguinal herina repair and lymph node biopsy in October.

simple words carry much weight

There are several words that I'm learning in 3rd year med school that I use everyday now. Two of them particularly stick out in my head. These two words are probably the most important words used by the attendings, residents and medical students. Aparently they are crucial to saving lives. Here are some working definitions and how you can use them in a phrase.

1) PLAN -- This is a one word phrase to sum up what "we" are going to do for the patient. It can be anything from going to the OR, to starting them on a regular diet, to consulting another service. It's used in phrases from one speciality to another like-- "whats the Plan?" or from one chief resident to a med student "whats our plan for this patient" (and by our i mean how can the chief scut the med student around the hospital so they feel like they're participating in the plan) I've heard discussions about plans between nurses, med students, doctors. I've only actually heard it once directed towards a patient and it went something like this: " We're still trying to figure out what our Plan is with you" I'm still not sure if the pt understood that it was a formal type of thing and that we weren't really saying "we have absolutely no idea what we are going to do with you"......

2) The List ---Although two words, they are always used together with a capital T and L. The List is a crappy excel sheet with all the patients in the service, when they were admitted, when they went to the OR, why they are in the hospital, what meds they are on, and what do we need to for them (see plan). Phrases used: "Go update The List" "Why isn't The List updated?!!!" "Oh shit, I lost my (the) List!"
It seems simple, but The List is one of the most important tools if you want to be a doctor. I have yet to meet one without a (the) List. Plus, after 4 years of college and 2 years of med school, you can be granted permission to "update the list" which supposedly means the residents actually consider you a person on the team. But if you ef' it up, you are screwed and everyone will hate you so its best to update in little bits and double check everything prior to clicking save.

who else knows some good ones???

hard night

I am currently in week 8 of rotations. This means 2 months of walking, no-- make that frantically running ('cept when i was on neuro), the halls of a hospital, pretending I knew exactly what was going on, while having my third ulcer and shitting my pants ("that, my friend, is why I wear brown shoes" -Dr. Johnson). In truth, I think I've got the "I'm on top of everything look" while in front of the residents and attendings. By myself, when I'm running from floor to floor, the sheer terror takes over my face and people usually ask me whats wrong. =)

2 months of being in the hospital means that death has come across my path as well. And although I may joke about some things, this is not going to be a happy post for me.
Being on trauma surgery means you will be exposed to patients dying, which hit my med student partner and I hard on the first day, but nothing compared to what I experienced earlier this week.

Sunday night was my second day/night on call. Things were busy as usual (read "first call") and then we got a trauma red (1 * 1* 10* 20--meaning trauma red* 1 person* arriving in 10 minutes* trauma bay #). The normal trauma bay was packed so this trauma had to go to another room that usually isn't used for traumas. All we knew was it is a 19 yo who attempted hanging.

When the trauma arrived, it was the usual organized chaos. People were running around the small room, calling out for things they needed, yelling physical exam findings. Except I knew, with that dreaded-pit-in-my-stomach feeling, that this was going to be bad. She was cold to the touch. CPR had been going on for who knows how long. We, the med students, were actually told by the residents to go away, to do something else. My partner and I would visit and see them pushing more atropine, more epinephrine. They eventually got a pulse and a BP that was "acceptable" but she was on a ventilator and cerebral hypoxia was clear.

We found out that she was from Ohio, a freshman at the U here in town. That she didn't get into the sorority she wanted and felt suicidal. Her roommate found her.

I lost any sort of "composure" I could fake. I ran away, out of the ED, searching for a hiding spot so I could cry. Everyone keeps telling me that its OK to show how upset I was, how upset I am. That there is nothing wrong with it. But its impossible to think I could ever be of help while I break down like this. Its hard to remember what the hell I am doing here while faced with something like this. I am told that the sadness of these circumstances never goes away, you just learn how to deal with them differently or something.

That night she was transferred to the pediatric intensive care unit.

She coded several hours later.

First call

so its been a while since i've posted ( a whole week!) and a ton has happened--its crazy how one week feels like a month on this rotation--not necessarily a bad thing just bizarre.
I was on call last tuesday night and it was INTENSE.

I, of course, am a black cloud. A couple of residents told me (kiddingly i hope) that they do not want to do call with me. Ever. Again.

Our first trauma call was at 8pm and we were non stop except for a hour from 4:30 to 5:30....then we needed to preround. We had a pick ax to the head x4, a motor cycle vs tree, motor cycle vs car head on, person vs train (3 limb amputee in the field), gunshot wound to the chest, and i think one more...all on a tuesday night.....

I was handling myself pretty well until the person vs train. He was trying to commit suicide and so when he came in he was screaming and yelling all kinds of stuff---in part because of the severe pain he was probably experiencing and in part because he realized he was still alive and was really upset about it. They quickly intubated him and I stood with my mouth on the floor, in shock as well. He was bleeding from every missing limb profusely, people were rushing all around, getting as many lines as they could into his body, pumping him as fast as they could with blood and saline. I eventually woke up from my freaked out daze, grabbed a roll of gaze, and applied pressure to his right stump avoiding the sharp shards of his tibula and fibula poking out. They got him as stable as possible and wheeled him to the OR to complete the amputations. I had several nightmares about him the following night.

my next call is tomorrow (sunday!) which should be interesting. I wonder what the max number of traumas in a 24 hour period is.....

Slash

my 19 year old pt was walking his grandma to church last friday night when a couple of guys from out of no where jumped out of the bushes and stabbed him 5 or 6 times. He had never seen them before and has absolutely no idea what provoked them. Luckily his grandma was unscathed.

His stab wounds, however, were significant. One went thru his diaphragm, one into his heart, and several piercing his bowel. He has had multiple surgeries, including a bilateral skin graft from his upper thighs to his abdomen, and a tracheostomy. But the pain is not so bad---he is super tough---just wait til he gets out of the hospital, he'll find those guys, who ever they are.

I go to check in on my super strong, bad ass 19 yr old knife fight patient, and he is happily (although he is tearing up from the pain on his legs) lying in bed glued to the tv, premiering sponge bob square pants. The little yellow square is running around on the big screen, and that's when it hit me. My 19 yr old "slash" is a little kid trapped in a big scary adult world. He was somehow forced into this "bad ass" lifestyle, when all he would rather be doing is watching cartoons, selling lemmonade at the street corner, riding his bike through the community.

There is no doubt there will be some sort of "revenge" on his behalf. And his predator will be lying in the bed next to him watching barney or pokemon.

first day

40 pts on the floor in total, 13 hours at UMC, 5 traumas, 4 pts on the floor for the med stud., 3 ABG attempts, 2 cups of coffee, 1 trip to the bathroom, 1 paper to present, 0 obtained ABGs, 0 food.
It was a crazy first day on trauma. Besides being exhausted, I loved it.

gratitude

After the first time I scrubbed into a surgery, I noticed the residents made sure to say "Thank you!!" to the attending as they were scrubbing out, so I did the same. I was confused to why we were thanking the person who had just verbally attacked everyone in the room. And then I realized that we were saying thank you because they had left it at verbal attacks and had not actually thrown anything. . . .

Say what?!?!

For years my fam volunteered on Turkey day to feed the homeless at church on the south side of town. So last year, I used the fact that hundreds of underserved people would be at the same place and I organized a medical screening for them on Thanksgiving. About 8 other students and a doc volunteered about 4 hours in the morning to do HTN screening, listen to heart & lungs, diabetes screening and a few depression screenings. If something abnormal came up, we handed out a flyer to get people to go to one of the free clinics in town. Overall, it was a good success.

This year I was ready to pick it up----I wanted to offer the rapid HIV tests & TB tests, so a doctor in my college recommended the health dept. I called them today. And I am livid at how it all went down.....

"Hello! My name is Samantha and I am a 3rd year medical student at the U of A. Last year I started up a homeless screening clinic and I wanted to expand it to include the rapid oral HIV screening tests. It would be about 3 hours in the morning of Thanksgiving day. I was told you would be the person to call to help."

----Well, we couldn't do it on Thanksgiving day. Could you do it the day after?

"Unfortunately, no. Thats when the potential patients would be there, and not all med students get the Friday after Thanksgiving off. Is Thursday a bad day?"

----- No. Its just that we can't pay people time and half for a holiday since we're county.

"Well this would be more of a volunteer thing. Last year, the doctor and the medical students volunteered their time."

-----Thanksgiving is a family day. And we wouldn't get paid time & a half.

......
The conversation continued like that. I asked for another organization in town that may help, but I was to make sure to tell them that the health dept said they didn't have to work on Thanksgiving.

So basically, they are interested about getting paid and not about screening one of the highest populations of HIV. What the heck is that about?!?

PS little do they know that when i get fired up about this kind of thing, i get even more determined. There WILL be rapid HIV screening on thanksgiving day!

myths uncovered

I have completed my three weeks with the Pediatric Surgeons and I start Trauma Surgery on Thursday...after 3 days of orientation to surgery (yeah, that would have been good before I started pediatric surgery....). I am definitely excited to try out this trauma stuff---especially since i'm interested in emergency medicine.
Surgery is an interesting field. Besides shadowing a surgeon before I started med school, the only exposure i've had was Turk thru Scrubs and of course Greys Anatomy. Most people think that surgery is just like Grey's anatomy, or they think its so far off. I'm here to tell you thats a little bit of both.
Myth #1. Everyone sleeps with each other. Although there are some crazy sex scandalous stuff that goes on in the on-call rooms; no, the residents I worked with were definitely NOT sleeping with the attendings, nor were they sleeping with each other. The fact is, they were so excited to actually sleep, and they are all so wound up tight during the day, that i'm pretty sure no night-time activity goes on for any of them.
Myth #2. All that surgeons do is cut. Well that is close to true for the attendings, but not at all for the residents. The residents would finish up a surgery, run out of the room, go see a patient who was vomiting post-op day 2, give some meds, discharge another patient, stop by x ray to see an image on a different patient, and be back in time to start the next surgical case. I was amazed how efficient they were (btw nothing like my neuro rotation). The attendings would finish a case, see the parents of the kiddo and then read part of the paper, or polish their devlish trident.
Myth #3. Surgeons do not have good bedside manner. This is sad, but true. I saw docs make awful jokes---my skin would crawl, I'd feel so awkward. I saw them talk down to teenagers and the parents of the teenagers. Yes, they could preform amazing tasks with their knowledge of anatomy, and skill, but no, they are not like our favorite SBS teacher in any way, shape or form.
Myth #4. All doctors are good looking and have time to do their hair, makeup, and workout---just like the docs on Greys or Scrubs. Yeah right. My resident told me one day that it had been 3 days since she washed her hair. One person mentioned working out, once. The truth is---they all work really hard and they love it. They couldn't think of any other way to live their life.

thats all i have for now. i know it sounds like a lot of bashing, but as i said before i'm actually interested in surgery, so I'm just trying to really think this out before i sign myself up for this kind of lifestyle. =)

change of heart

Being on peds surg I've seen some amazing things. Inguinal herinas that were so small I could hardly believe that was the reason we were operating (it was on an infant), Mastectomies for teenage boys with gynecomastica, doing crazy operations on 34 week premies. But the surgery I saw the other day took the cake. These surgeons performed a nissen---its when the doc takes the fundus (top) part of the stomach and wraps it around the esophagus and sews it together. This is done for patients with GERD (gastro-esophageal reflux disease); when it is medically unmanagable. They did it on an 8 month old. And guess what...they did it laparoscopically. Five tiny incisions and that was all. It was amazing.
The anatomy was incredible. I could see the tiny heart beating against the diaphragm. All the vessels along the stomach were pulsating. I was so excited about this surgery it got me thinking. I may actually go into surgery some day. (say what??) Yeah, they kicked my ass. And I did hate my life at first. But who knows......

Breakfast with Mr. Webber

I am currently on my pediatric surgery rotation. To say it has been difficult is not doing it justice. But every evening I look forward to escaping the horrors of pediatric surgeons as I sleep, only to have dream after dream about scalpels, writing SOAP notes, and being yelled at as I push my patients out of their bed so I can sleep in my dream. Even dreaming is exhausting.

You can imagine my surprise when I wake up at O-dark-thirty every morning to have a collection of songs from musicals stuck in my head. In the first few days, I woke up singing different phrases from Phantom of the Opera. I was so out of it, I didn't even know I was singing the famous Andrew Lloyd Webber musical until I was on my way to the hospital. The next few days it was CATS. Followed by Les Miserables. And just when I thought I had a thing for Mr. Webber, this morning it was Rent.

What is the connection to pediatric surgery and musicals? Could it be my roommates are playing different muscials in my room as I sleep? Or have I crossed into the Twlight Zone? These are the important questions I have.

parents

you know things are bad with this generation when a surgeon is about to do a 4 hour open abdominal surgery on your premie 3 month kid and you think perfect! now i can finish all my errands.....

how old am i

This is my favorite quote from scrubs.....


"All right, calm down. Now listen - you've been to four years of college, and four years of medical school. So I can safely assume that you are at least eight..."- Dr kelso from Scrubs......and there is my life......

Christmas came early

my first real ER patient was Santa. I was there for a neuro consult but I had the feeling he just needed to know what to fill my stocking with. He had a full beard and a jolly laugh...he was early this year----i mean he should be up in the north pole planning my gifts..but i guess the cold weather does get old.....he had tattooes all over his body and was missing all teeth 'cept the two bottom ones---but what can you expect when you eat all the kids cookies?? His diabetes---insulin is hard to come by in the north pole---had given him a neuropathy---he had decreased sensation in his feet and a radial nerve palsy..... His famous trade mark: Occupation in AZ: apparently due to the lack of reindeer he worked on horses, which means several falls to the head---they are not used to pulling the sleigh....