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???