Things that are stressing to me

Picture from: http://1927cafe.wordpress.com/2007/09/26/stress-qoutes/

I usually don't go too negative on this blog, but today, I need to vent!
4th year med school is usually the best thing ever---but I've discovered that the party doesn't actually happen until March 20th, 2009. Until then these are things that stress me out:

1. I have no money: Money can be a stressor to everyone, but usually I'm stress-free about it. Today that is not true. The gov't has not distributed my loans to my lender for the year yet. This means I haven't paid tuition yet. This also means I do not have money to pay rent, buy ridiculously expensive gas, or go on that awesome trip I had planned for "party time fourth year". My stress relieving options? either take out short term loan or sign with a different lender.

2. I'm in the middle of moving: I am literally moving 4 blocks away, but having half my stuff in one house and half in the other is daunting. I've got to finish the move (but not for another 3 days which means I'll be anxious about it until its over), clean up the house, do the walk through and pray that I get a decent amount of my security deposit back (this would also be a stress reliving option for #1) but seeing as how my land lord is threatening a law suit, I doubt that will happen. Options: finish the move, do the walk through and pray

3. My landlord is threatening a law suit: enough said. Options? Hire a lawyer, but see stressor #1.

4. I have got to be dependent: 4th year means in the first few months you've got to be on top of your game so you can impress the attendings and hopefully hear the phrase that every med student hopes to hear, "Please let me know if there is anything I can do to help you." Once you hear that, its like a golden ticket for asking for a letter of rec, which is your entire point of impressing them in the first place. These letters of rec are on the minds of each 4th year--until about October when you won't be able to get it into the system for your ERAS application so we just give up. Options? Kissing butt, asking about 100 attendings in hopes of getting 3 good letters, changing your entire shift schedule so you can work with at least one attending twice, etc.

5. In sending my request for a letter of rec, it was sent twice: I hated the idea of asking attendings by email. I thought it should be professional and in person. But I was not going to work with this particular nationally known attending again, so I thought it was my chance. The day after my shift I decided to email him for a letter. Getting a letter from him would be like getting a letter of rec from Steven Spielberg if you were an actor. I drafted my email and attempted to send it. The Internet went out so I quickly closed the email and redrafted it. Feeling more confident with the second draft I restarted my email and attempt to send the second version. Several hours later I checked my sent messages to see the horror of my life: the first version did send. I had sent two emails, both with the same question but written completely differently. AGHH. I still can't get over this one. Options? I asked my roomie if I could send an "OOPS!" email, but he said I've sent enough emails for the night.

6. I'm 26, single and my moms asking for grandbabies. Oh wait that's more of a Sex and the City episode. No worries about that one!! :)

The eerieness of the ED

Prior to a trauma coming in, the patient is assigned a trauma name since usually they come in altered and cannot completely register. This expedites the process of getting labs, xrays, CT scans, etc. Usually they are just random nouns such as Wade, Ij or Taco, Iv, but lately it seems like the patient's findings are correlating nicely with their trauma name.

The first situation occurred last week: he was a 20 something year old male who was arrested that day due to reckless behavior---he was drugged out and drunk. He decided that instead of posting bail, he would run at full speed toward the nearest brick wall, head first. He had a positive loc (loss of consciousness) and was altered. He also had a very large goose-egg on his left frontal head. His trauma name? Unicorn, Ij.

Last night another 20 something year old male was getting out of his car at a friends house when a male jumped him and started hitting him repeatedly in the face. He came in complaining of jaw pain. When we looked into his mouth we noticed a positive step off in his teeth, suggestive of a mandible fracture. His trauma name? Enamel, Ij.

Coincidence? Or is someone playing a trick?? I will get to the bottom of it!!

This one is on me.....

So at precisely 12:32pm yesterday I had a series of unfortunate events while in the ED that, again, made me turn a nice shade of red as well as go numb in the face. Let me explain.....

I was setting up for my first lumbar puncture (LP). While having butterflies in my stomach, I was also really excited and had visions of getting spinal fluid on my first try and the resident congratulating me on a job well done. (who doesn't envision this?) Anyway, I as I pulled back for some lidocaine (the stuff that we inject to decrease sensation) I shot a bit too much (about 8 ccs too much) of air into the bottle. It exploded and the stuff went all over my face. This all occurred when a dear friend of mine, who is a surgical resident, just happened to be walking by to see how I was doing in the ED. My lips started to go numb, and of course I yell at the top of my lungs, "I've had an exposure!!" Now, I guess I could have called it an exposure, since I was technically exposed to some lidocaine, but this phrase is generally used for when we get exposed to a patients' bodily fluids, not sterile lidocaine. Luckily the ED is a loud place, and only 3 patients, my friend, and 2 RNs heard me.

I only drooled once and the sensation came back to my face/lips by the time I had a chance to eat some lunch---around 2pm. =)

Not the brightest color in the crayon box!

A 23 year old male comes to the ED after a motor vehicle accident. He was a driver and rear-ended the car in front of him when he didn't see the car slow down to make a right hand turn. He wasn't wearing his seat belt, no air bag deployment, and no loss of consciousness. He was a trauma green, meaning he was pretty stable. In a sense he was fine.

To practice, we did a Focused Assessment with Sonography in Trauma, or a FAST exam, which finds free fluid (usually blood) in the belly. To be humorous we added, "Sir, we are going to use this machine to make sure you are not pregnant." The patient got an upset look on his face and replied, "There is no way I'm pregnant---I'm not a bisexual!"

Maybe he did have a head trauma afterall.....

First shift in the ED

I experienced my first shift in the ED on Thursday. At first I was just so anxious that I stood around trying to act calm and collected. This means I tried to hide in a corner and not be in the way, but really I bumped into about 2 physicians, 3 nurses and knocked over an entire large diet coke. It spilled every where. My face has not turned this shade of red in a long time.

My first patient was a lady with a headache. At first I thought she was a drug seeker, but after doing an MRA of her brain we found an aneurysm! I felt like I saved a life, but truthfully, we didn't do anything except admit her for pain control.

It was my second patient that made my pulses rise and really got me excited for Emergency Medicine. It was a 25 year old man who works as a carpenter. He had shot a nail gun in which the nail ricocheted off a knot in the wood and went through-and-through his ring finger on his left hand. He and I were both lucky that it did not go through the bone---he was lucky because it meant no surgery,while I was lucky because it meant I got to pull it out. I did a digital nerve block on his ring finger, held down the finger while the attending held the wrist and I did a 1,2,3 PULL!! I gave it tiny tug at first to see how hard it was going to be, realized it was really stuck and pulled with all my might! It came out with a gush of blood and I couldn't hide the smile off my face. What a rush.

4th year

So this week I started my first week as a fourth year medical student and my first week in Emergency Medicine!!! Have I saved lots of lives? Done tons of procedures?? No and no. We've been in lectures all week--but they think they have learned us enough to set us free!! Thats right folks---I set out for my first shift tomorrow night! Watch out!

And for all the non medical people out there---stay out of the hospital (and clearly the ED) this month! This is everyones first month--- meaning everyone is being trained---from the medical student to the resident to the attending---NO ONE IS SAFE! :)