Thursday, June 26, 2008

Pushing the years

In lecture this week we discussed taking care of the elderly. Seeing how our population base is getting older and older, and since my parents are in the beginning of pushing their years, I thought this topic pretty relevant.

The professor was talking about the issue of what to do when you believe your patient should not be driving anymore, ie) when you may have to take his or her license away. The ability to drive is very liberating; the idea of taking away that freedom is actually quite depressing. I remember a patient while I was on psych that was a 70 year old woman who we were consulted on to assess her capacity for decision making. She wanted to leave the hospital and go home---not to a living facility that her medicine team was trying to set up. She was able to answer our questions---although most of the them were wrong--she just made stuff up. Once we figured this out and found out that she still drove---but not much, only to the bar and back---we were a bit worried about her (and the rest of the drivers out there). It was difficult but we recommended that the medicine team consider to take her drivers license away (I dont really know why we didn't do it ourselves). And we also recommended some anti-alcohol therapy since her driving to the bar excursion happened daily and not weekly.

The professor brought up a patient of his----a father, son situation where the father had severe alzheimers--he wasn't able to remember day from day. The son and doc both believed it was time to prevent the father from ever getting behind the wheel, even though it was one of the father's favorite activities. So instead of making a big to do about it, before they went anywhere, the son would just say, "Dad, I really like to drive too, and since you got to drive yesterday, I think today I should get a turn." The father being a sharing loving man would always say alright.

The son said that to him everyday.

Sunday, June 22, 2008

Lost in Translation

A joke to lighten the mood, but also why some patients just don't seem to here what we say....

Fred a 92 year old man had just been to the doctor for a physical. A few days later the doc saw him on the street with a goregous young lady on his arm.

"Fred, what do you think you're doing??" his doctor admonished.

"Why just what you said, Doc!" Fred answered. "Get a hot momma and be cheerful!"

"No," the doctor replied, "I said you've got a heart murmur. Be careful."
A few things happened this week:

*I made the decision to do EM/Peds. I am tired of switching around and although I did think about OB again for about 10-20 minutes Friday afternoon, I am going to stick with it. I visited the residency director for the peds department and he promised me the world---"we'd love to have you here....i've heard such great things about you..."

*we had a class meeting where a favorite doc said "don't listen to residency directors. they tell everyone they want them. they don't usually mean it."

*I am newly single. I dont have much to say about this one. I dont really talk about my private life here. But there it is.

*I have one more week of 3rd year left. I cannot believe this year is almost over. It has been a whirlwind of a year. And although I am so excited for 4th year, I am also terrified.

Tuesday, June 17, 2008

On top of the world

As second year med students, we are paired up with a doctor who is supposed to teach us how to properly interview and do a physical exam on a real patient. In addition they should go over how to come up with a differential and start to think of what to do for the patient. My "preceptor", as they were called, was an ED doc. She did a great job of just throwing me into a patients room and letting me do my thing. She also did a great job of making the ED a classroom. We'd pass by a random x ray left up and she'd have me read it. A resident would present a case and before they could get to their assessment, she'd have me go through it. I learned a lot.

By the end of my second year I remember feeling on top of the world. I was almost done with a whole year of path---I was taught the most common diseases as well as some of the most random ones. I knew my shit.

I went down to the ED one day to work with my preceptor. There was an emergent case of giant man with kidney failure and leg weakness. She handed me the EKG and I had no idea what was going on with the squiggly lines but she was giving tons of orders, so I knew it wasn't good. He ended up having hyperkalemia and the EKG showed a prolonged PR and peaked T waves (the classic sign for hyperkalemia). She went over the treatment (C BIG K is the mnemonic) and what to do as I furiously scribbled it down in a little note book trying to hide my shock. I remember looking up from my notebook and asking "Dr. C--when am I supposed to be learning this stuff? I mean I am almost done with my second year and I've never heard any of this." She sorta chuckled and said, "You didn't know this already??! Hahaha, just kidding. No worries--you will."

Looking back on that instance and then where I am now is astounding. The amount we learned in this one year is incredible. But again, I feel on top of the world. But the main difference is, I am starting to worry---this time around, I know there is STILL so much to learn and I'm worried there may not be enough time before I'm given real responsibility.

Wednesday, June 11, 2008

don't give in

I am currently reading this amazing book called Complications: A Surgeon's Notes on an Imperfect Science by Atul Gawande. It is a fascinating book and all --science or non-science minds should give it a try. Below is an excerpt from one of my favorite paragraphs--he's attempting to diagnose a person with abdominal pain:

"I am sure I can figure out whats wrong with her, but, if you think about it, that's a curious faith. I have never seen this woman before in my life, and yet I presume that she is like the others I've examined. Is it true? None of my other patients, admittedly, were 49 year old women who had had hepatitis and a drug habit, had recently been to the zoo and eaten a Fenway frank, and had come in with two days of mild lower right quadrant pain. Yet I still believe."
I still believe.

Monday, June 9, 2008

what it made me think of.......

Today we had a lecture on STIs (the new acronym replaced the old STD; it stands for sexually transmitted infections)--which just so happens to be one of my favorite topics. This, I suppose, is an odd statement, and usually I keep it to myself, but in all honesty--I am FASCINATED with STIs. I like trying to figure out which one it is based on the history, and I also like treating them--most are very easily treated (minus HIV) and you get a chance to educate patients about them. So all in all, they are awesome cases for me.


We were discussing douching--and how some women can get a chemical irritation from basically washing away the normal bacteria from the vagina. But this is not how the doc put it. He described it as washing the normal "flora and fauna" away. This immediately made me think of a dense jungle, with lots of branches and gigantic leaves everywhere, maybe some tree snakes. What a disturbing image! Especially when you try to put that into a woman's unmentionables. And thats why, I've decided, men (and some women) have no idea what's going on down there.

Sunday, June 8, 2008

Giving Advice

Here is what I do well: I am a good listener. People feel reasonably comfortable sharing secrets. Most of my closest friends know that I will listen and be understanding to what is going on in their lives. I am comfortable asking lots of questions to get to the bottom of how a person is thinking or feeling. And usually it is done in a completely non-judgemental tone (I am usually without judgement-- although there was this one time where I was "practicing" interviewing a patient---he was a homeless man who smoked tons of crack cocaine. For some reason I was completely fine with that. It wasn't until he told me that he had 9 kids til I freaked with out with a high pitched "Nine kids?!?!" response. The med student I was working with completely lost it) I think I've been able to apply this to medicine---I can get a good story from the patient--the who, what , where and why and also how they were feeling, and what they think the reason this occurs.

Here's where I need help: So once I find out that my 15 year old patient has been having unprotected sex and drinking every weekend, I fail at telling them why it's a bad idea to be doing what they are doing. I am good at getting the info, I just stink at giving them the medical advice. (I think I may stink at giving friends advice as well). So then I go report to the attending that they are doing this risky behavior and they always ask "So what did you tell the patient?" Thats when I stutter and say something about how I wanted to see how the attending handles it because I've never crossed this bridge before. When in fact, I've had at least a dozen patients like this and I just stink at at it. I think I am worried about coming off as being judgemental. I can remember my dentist making me feel bad when I wouldn't floss---I never wanted to see him again!!! I am worried that I will lose the patient forever and then when they do get an STD, or start coughing up blood after 50 years of smoking---they won't come into the doctor and ask for help; instead they will pass the disease on or die of cancer.

On my current rotation---family medicine---I've started trying to speak up. This is part of a doc's job---recommend some actions (take this medicine) and to dissway patients from others (pretty much everything else) Here's to me finding a voice!!

Monday, June 2, 2008

Sometimes its painful being a med student

One of my favorite meals as a child was a rice cake with peanut butter and honey (I severely disliked jam or jelly). The other day I got a craving for my past time treat and went to the grocery store. Just as I was about to put the honey bear into my basket the word "Botulism!" started ringing in my ear. (botulism is a rare, but fatal, disease where muscles become paralyzed. It has been linked to eating honey) And even though I'm more likely to be held up at gun point after my visit to the grocery store, I couldn't bring myself to buy the honey. Curse medicine!!!