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!!