medstudent101

MOMMMMMYY!

2010-02-09T17:53:00.000-08:00

So just when you think you're getting a month off of hospital call, the residency surprises you with something called "Mommy Call." It sounds innocent enough. Not only in the name of the call, but its home call---how bad can that be?

bad.

First let me say that when you're on Mommy Call you are also the resident for jeopardy call (see previous post). Secondly, parents will call about anything and everything. At all hours of the night. Demanding things.

My first (really second, cuz the first one I was Jeopardized. again see previous post) Mommy Call consisted of Moms calling about a child jumping on a couch and fell on her face and wondered when she should check to see if her face is "mushy." Another call was from a mom about her child having a rash and wondering what it was. Over the phone.

But my last call of the night (at 5am) was a mom who wanted to discuss illnesses in her 5 children. 5 CHILDREN! So I said start with the oldest and go from there. All in all, the whole call took about 40 minutes to get through it. Just enough time for me to get ready for work. Because even though we take Mommy Call overnight we still gotta work a whole day the next day.

Oh the joys of residency. Even with all this craziness, I love my job and would not change it for anything.

JEOPARDY!

2010-01-18T18:24:00.000-08:00

Not the fun American Game TV show that we all have come to love. No, this is an intern nightmare. Its the phone call you wish would never come. Its the request to come in and work someone's call. When you had made dinner plans. Or in my case, a Saturday in which I was to go hiking, then to a movie, and then out for drinks. All down the drain with a simple phone call.
The first idea is the intern you are covering for is really sick. Or has had a disastrous emergency. The second idea is you will be "paid back" by the person who jeopardizes you for one of your calls. So you can schedule a time when you should be on call, in my case a Saturday call, and poof! It goes away without any guilty thoughts. I dreamt about this payback all 30 hours of jeopardy call.

First illness

2009-12-02T10:07:00.000-08:00

Ugh. I am home sick today. One of the little tykes decided I needed the viral gastroenteritis. Well I didn't. I haven't called in yet and I am upset that today was the day. I was hoping to make it at least a year. But the idea of puking on a little kid was disturbing, so I am home today. Dang it.

Ahhhhhhhhhh

2009-11-22T19:41:00.000-08:00

My new recent pet peeve in the hospital is examining a patients throat. Especially adults. I have my little light turned on. I ask the patient to open their mouth. Then I ask them to stick out their tongue. And then usually their big fat tongue is blocking their pharynx so I have to ask them to say "ahhhhh", which will raise their uvula and pushes down their tongue bringing their pharynx (back of the throat) into clear view. Do you know how many times I have to ask before the patient actually does it? It usually takes three.

This sort of perplexes me because they followed all the other directions prior to that on the first command. They will even roll onto their side with ease for the rectal exam without a hesitation. But there is something about saying "ahhh" that people just do not want to do. So I ask them to say it multiple times. I'm even doing it when I ask it. And generally without a response. Until I explain why I am asking them to say it. Then I finally get an "ah" but not an "ahhhhhh."

With kids they don't understand the "say ahhhh" command. Which is why I have to gag them with the tongue blade. And then they cough onto my open mouth and I get mycoplasma pneumonia. But they are kids, and are cute, so I quickly forgive them.

But I am fed up with resistant adults. So adults beware. I know we all have flashbacks to our pediatricians using a device to see our throat. I'm pulling out the tongue blade. Thats right. Without me asking you to say "ahhhhh" first.

Reassurance

2009-11-14T16:04:00.000-08:00

Today marks my final day of OB---a two week stint of up at 415 in the morning, pounding on women's bellies that had just delivered a baby and asking if it still hurt, about 200 pelvic exams, 15 babies delivered by yours truly and three sad cases of babies that did not make it.

It was a whirl wind.

I remember my third year rotation where I heavily considered the field of OB/GYN. Delivering babies was fun and those residents work their tail off. But after these two weeks I realize that I am in the right field, which is one of the most reassuring things I have felt since I started residency.

I may still have the opportunity deliver more babies in the Emergency Department. Which to me is the most exciting idea---you just never know what will walk through those sliding glass doors on the first floor of the hospital. And thanks to the amazing ladies of the OB program I feel more prepared.

going to hell

2009-10-13T09:53:00.000-07:00

My last call was particularly difficult. I know I've semi discussed ethics in previous posts but I honestly didn't think it would be such a huge part of my life as a resident. I am quickly learning that this isn't the case.

Around 130am I got a page about a pt on the floor who was not doing well. He was a 90 year old man who has recently been in and out of the hospital for pneumonia. He was actually getting better when that evening he aspirated an entire bottle of ensure. He then started breathing really fast (tachypnea) and required more and more oxygen (hypoxic)and started running a fever. So we transferred him up to the ICU and started to get ready to intubate.

But then we all paused.

He was a full code. He wanted CPR, intubation, cardiac life saving drugs.

And yet we paused. He was 90 years old. The likelihood he will be able to come of the ventilator is small. We tried to explain that to him and he responded with "I dont want to talk about that right now. I dont know what to do." Thats when everything changed.

To go up the chain of command in terms of power of attorney (POA) it usually starts with the patients spouse (but only if they are straight---dont even get me started with that), then their kids, then their parents/family, and then maybe friends? It all gets muddled.

So we called his son because that was the only number we had in the books. He comes into the hospital and we have a 2 hour conversation about to intubate or not to intubate. Meanwhile Mr. H's respiratory rate is slowly declining. After this discussion we realize its his wife who has the medical POA. So then we call her, who says to do everything.

So we set up the intubation again. And I start tearing up. If this man was 20 years or even 50 years old I wouldn't think twice. But with all his other diseases there is a very high chance he will not survive this. I am about to intubate someone who probably will never come of the vent. I am supposed to be doing this to save people. I am exhausted because it is now 4 am. So I start tearing up but try to hide it by pretending I am excited to "do a procedure".

When my pulmonary fellow comes in that morning I start with "I may be going to hell because of this one....."

this is what i've come to....

2009-10-05T20:24:00.000-07:00

This when I feel like the singleness is just pouring out of me.....

I recently got a message from one of my pediatric attendings--one who I am fairly close with socially--asking me if I was interested in going on a blind date with a friend of a friend.

That was all it said. So of course my next question is "who is this guy? any more details??"

The response made it all a bit more embarrassing. Apparently another peds attending that I worked with last month "loved" me and wants to set me up with his nephew so he asked around the attendings to find out if I was single.

My attendings are working harder on my social life than I am.

ouch.

The thin line

2009-09-24T19:11:00.000-07:00

I am currently on my first medicine ICU or MICU month of residency. And not only that, but it is at the VA where all the patients are already knocking on deaths door, and just waiting for the final say so to move on. Yeah, its pretty intense.

We had our first almost code situation today. And I say almost not because it was a close call---he did pass away---but it was almost called a "code."

He was a 60 something year old man who had perfed his bowel and required extensive surgery to remove the damaged small intestine and then got an infection in his blood which then gave him a really bad infection in his lungs and he started to down spiral around 3pm today. He was actually on the surgery team, we were just the medical help out. His blood pressure dropped and then his oxygen saturation dropped to the 60s (we want most patients above 90) and the highest we ever got it back was the mid 70s even after turning up his ventilator all the way. When his pressures dropped again, we were about to flip on the code button--which announces to all the pagers that someone is in a "code blue" situation and everyone comes running. Thats when someone decided to call his wife and verify his "code status."

We were told we were not to do chest compressions. So we turned off the code blue announcements and continued with increasing his pressures and such. Then there was a discussion what exactly his status was: increase pressures? start drips? chest compressions? withdraw all care? withdraw only some care? give shocks? only do CPR? It has gotten so specific of all the different choices a person has that it got me thinking about the thin line of what each person wants and how it can make such a difference---I needed to know how this whole DNR stuff actually started.

In a basic search on the internet it appears that the history of a person being able to decide what forms of resus they wanted started in 1976 with the case of Karen Ann Quinlan v New Jersey in which a 21 year old woman was found comatose after taking tranquilizers and ETOH. Her family wanted to withdraw life support but the medical team just flat out refused and the case was brought to supreme court where they ruled in favor of the family ruling "Karen's "right of privacy" included a right to refuse medical treatment and that her father, under the circumstances, could assume this right in her stead."

It wasn't until 1991 when the Patient-self Determination Act that mandated hospitals honor a patients desire in their healthcare. And now today's occurrence is so common place across the US.

In the middle of us giving a stronger pressure medication we were told to stop doing what we were doing. What does that mean? Stop the medication? Turn off the vent? The surgeon was running back and forth from where the family remained asking each specific question. Finally an understandable conclusion was given: Stop the pressure medication all together. Then 5 minutes later: turn of the ventilator.

He passed within minutes, hopefully at peace with the decision his wife made for him.

being a (good) teenager....

2009-09-21T19:05:00.000-07:00

I recently saw a 16 year old boy who was super awesome. He was a talker. I mean I asked him how school was going, and I think I got a 10 minute response. Straight. Without pauses. Loved it! It sorta reminded me of myself when I realized someone was listening. Now I dont even need people to listen...

Anyway, after kicking mom out to do the genital exam and HEADDSSS exam (Home--are they safe?, ETOH use, Activities besides watching the tube, Drugs,Depression, Suicide, Sex, Smoking) he said, "yeah they asked me if I wanted a female or a male doctor. And I was like, come on! I am 16 year old boy. My hormones are screaming 'Female! Female! Female!' But I'm more mature than that, so I told them either one is fine. Because it is."

Then he immediately followed it with "are we gonna talk about sex now??" I said, "Well that is one of the topics I'd like to cover." When asked if he was having sex his response was "I dont really think of it as having sex. Its called making love for a reason. And I am not in love. So not really making it either."

CLASSIC.

Hmpf

2009-08-25T21:07:00.000-07:00

I was extremely excited to be on vacation. And then it suddenly hit me that no one else was going to be on vacation at the same time as me. The amazingness of medical school was we could all go on a trip together. All these new interns I have desperately tried to connect to are still slaving away in the hospital, while I get to roam free. But who wants to roam all by their lonesome? I have recruited my hound on a trip, which he'll have a blast, but he's not much of a conversationalist. But the truth of the matter is my next vacation is in 8 months so I best enjoy this one!!

Listening skills

2009-08-02T16:20:00.000-07:00

A conversation between a nurse and a patient in the Emergency Department....

Patient: "Excuse me nurse? Are my testicles black?"

Nurse lifts up the patient's gown and takes a peek, "No they look normal."

Patient: "What are you doing? I asked if my test results were back!"

Gotta love the communication that goes on in the ED....

LOST

2009-07-28T20:00:00.000-07:00

This is one of my favorite televisions shows. This is also my constant emotion these days. I haven't felt so, well, LOST since the beginning of medical school where I was convinced that everyone was constantly studying and I was incisively behind. I eventually just did stuff on my own pace and my own way and things went fine.

But doing things my own didn't really affect anyone else. My actions did not influence patient care. Now I can't really hold off on reading that chapter on hyperbilirubinemia because that kiddo is in the ED NOW.

I know I don't need to and can't possibly know all the answers now (why would I be doing residency if i did??), but I feel like I've got nothing in terms of knowledge. I am just roaming the island trying to figure out how to get back to what I know.

Did you goose it???*

2009-07-17T09:04:00.001-07:00

The first trauma red came in around 1030 am yesterday. Being an intern and not having done trauma or ATLS (adv. trauma life support) it means I cannot sign up for the trauma patient. But it being 1030 in the morning, and nothing else to do, I asked my third year resident if I could tag along.

The pt was running from the police, up a hill, and fell, severely dislocating his right knee. After a few xrays and a quick physical exam, the residents and attendings quickly realized that the leg was pulseless below the knee and that compartment syndrome was setting in...and fast.

It felt almost like a Greys Anatomy episode (except no one was sleeping together)-- the decision was made to intubate in the ED and I quickly jumped in and asked my third year if I could do it. He paused for about fifteen seconds. When he finally said yes, I did a double take--wait did I really want to try this?

I got my stuff all set up. And we discussed which drugs we were gonna use. My attending pushed the drugs and said, "Ok, you ready?" I had a quick "OH MY GOD YOU ARE NOT READY!!" But I picked up the laryngoscope and started opening the mouth. The patient was in C-spine so I couldn't open the mouth too widely for fear of hurting his possibly fractured neck. I used a CMAC (we have an awesome airway man attending who tries out all the new airway stuff before it even goes to other hospitals)--it is a video laryngoscope but allows the intubator to also use it as direct, meaning you look into the patients mouth while intubating, and not at the video screen. Which is what I did---I didn't even realize it was video until my attending said "Go in a bit deeper."

I wasn't used to seeing the mouth with saliva. I was used to the plastic dummys so when I saw all the bubbles, I quickly yelled "I need suction!" but then I got a glimpse of the vocal cords (hahahaha! see previous blog) I yelled "Need the tube!" and I quickly jammed that thing down there. Then I reminded myself DO NOT LET GO OF THE TUBE. We use a color indicator to help us make sure we are in the correct spot (if the color looks like urine, then "ur in!") The stress and excitement quickly came rushing at me and I had some uncontrollable shaking. I left the trauma bay to try and pick up where I left off with my other 3 patients.

I was on a high the entire shift.

*Apparently this means did you stick the tube down the esophagus into the stomach. I of course screamed a yes! when asked this the first time. I quickly realized this is not a good thing. and luckily I did not do this.

watching it convert

2009-06-30T22:09:00.000-07:00

I know I have said this before, but I loved my trip to Nepal. It was absolutely amazing and I would never say it wasn't worth it.

It may have not been worth it.

Today I spent several hours at my hospital being reminded of washing my hands after every patient (even after just entering the room), who the lawyers are to call when I get in a bind, and the number for the pharmacists for when I have no idea what the dosage is.

Then we got our ppd skin test. I had an inclining (ok I thought it was definitely going to happen) that I might sero-convert. This occurs when you are in contact with a patient of TB. You can either sero-convert and not get the disease, or you get the disease and sero-convert. It depends on the length of contact with the patient, the health status of the person who is exposed, the type of TB the patient had.

I had contact in Nepal almost everyday.

So this evening, while I baked cup cakes for my birthday tomorrow, I watched as the ppd test slowly enlarged over time. (dang it!!)

The next steps entail: a chest xray to prove I do not actually have active TB currently and then 9months of Isoniazid (INH) therapy. This drug does not come without heavy side effects. It can cause serious liver damage; especially if you drink while taking it.

What does that mean for me? I will be sober for a solid 9 months and I wont even get a baby out of it.

Thank you Nepal.
(I'd go back in a heartbeat!!!!!!!!!!!!!)

birthday

2009-06-28T09:33:00.001-07:00

A year ago I spent my birthday in one of my favorite vacation spots in the US: Lake Tahoe. I was surrounded by a group of fabulous ladies and it was possibly the best birthday of my life. I ran an amazing 10 mile trail race (although I got lost and added an extra mile to it) two days before my birthday. I went kayaking. We laid out on the lake shore. AMAZING is all I can really say.

This year, I turn 27 and I have to say the birthday will be completely opposite of last. My birthday marks the first day of residency (well, for most programs) and thus I will spend 12 hours of it in the hospital (doing more orientation) and I will attempt to round up ANYONE who would be willing to grab a beer. And although it won't be a bad night--I love birthdays and I dont believe they could ever truly be "bad"--it will be different. Instead of being surrounded by people I know, for the majority I will be surrounded by people I am desperately trying to get to know.

I am to have a birthday party filled with those I met about a week ago.

So I guess this goes back to a previous post---I LOVE YOU AND MISS YOU GUYS!!!!!!!!

Pop Up Thoughts

2009-06-24T20:00:00.000-07:00

Over the past two weeks and for the next couple of weeks, I have been and will be certified in several life saving courses. They include Basic Life Support (BLS) twice, Advanced Cardiac Life Support (ACLS), Pediatric Advanced Life Support (PALS), Neonatal Resuscitation Program (NRP), Advanced Pediatric Life Support (APLS--this is basically the same as PALS), and Advanced Trauma Life Support (ATLS).

By the second course it all starts to sound very similar. ABC--Airway, breathing and circulation, then do other stuff. That other stuff varies based on age and what the monitor says.

One of the "exciting" things in all of these courses is the idea of getting to do some procedures that I've wanted to get my hands on for awhile now. Putting in advanced lines, and intubating a patient. I know this will sound a bit off color, but I've decided that the human vocal chords really look like a very small vagina. I know I know, its bizarre. But here's a picture

And once this idea got into my mind I couldn't stop thinking about it each time I intubated. And now I think this might just be what I think of each time I intubate in the future. And maybe its not a bad thing because codes are a bit hectic, so to have a moment of lightness could be actually helpful.....

So if you see a flash of a grin while I intubate it may because this pop up thought has appeared. Or it may be because I still cannot believe I am intubating someone; that I have actually graduated from medical school and in residency.

cambio

2009-06-03T22:13:00.001-07:00

As things change rapidly around me, and we are warped closer to the start of residency, there is a large melancholy feeling about everyone "moving on."

Most of my closest friends have left the state to pursue amazing residencies elsewhere. And while I am so excited and proud of them, I am also sad when I realize many of them I may not see again. When will I have time to travel in residency? When will they? And of course I will make new friends, as will they. But I started this medical journey with them, and it would be nice to continue it and complete it together.

So while my own excitedness for my residency start date grows, so does emptiness of missing my friends, my classmates, my colleagues. I love you guys!!

MD!

2009-05-17T20:46:00.000-07:00

Well it is official---I am now an MD!! Patients beware--especially starting July 1st--I would suggest you visit a non-teaching hospital, at least for the month of July. But then please come all you want, I gotta learn somehow! :)

Graduation weekend was a lot of fun, but it seemed a bit anti-climatic at the same time. I've been trying to remind myself that I am actually done with medical school. Although I believe we learn throughout life, I am no longer an actual "student" anymore. I have spent 20 years of my life as a student. Weird.

The house drama continues---I think we might actually close next week!---but I am (trying to be) kinda glad---being an MD and house owner all in the same week is a bit overwhelming!

So do I change the name of the blog and just keep on telling my tale? Or do I just put this to rest (already!)?? hmmmm....

Sadness

2009-05-09T19:30:00.001-07:00

Its been a pretty awful week. I am sure some will be upset with this blog, but I have to write it. I guess this makes me selfish in some way, but that is how it goes at times.

We, as a class, were informed that one of our classmates a week from graduation committed suicide. Although we hadn't spoken in a little over 2 years, I knew her well.

Our first year of medical school we became study partners. Unlike me, she was a true genius. Her photographic memory helped with her with graduating high school and college in 6 years total. It made studying really difficult since I was super slow compared to her. But we still made it as fun as possible.

As I got to know her, she began to tell me how hard life really was for her. She was extremely depressed---everyday. She once described it as being unable to hear the birds sing, or kids laugh. She was amazing and could hide it with her wonderful smile when she needed to. But I was deeply worried. Eventually I went to our school counselors about my fears, and was reassured that she was receiving treatment--both therapy and medications. Unfortunately it was these medications she used for her first attempt.

It was the day after spring break. I was pretty sick and took some NyQuil to go to sleep. She called me around 945 pm. NyQuil had done its job--I didn't even hear the phone ring. She didnt come to school the next day. I called her about three times in between classes throughout the day. I got a phone call from the police department at 5pm that evening. She was picked up for a DUI and needed a ride home. I was shocked--she didn't even drink. I went down there and she was a mess--I was told she took her prescription meds and she should not be operating a vehicle. I got her in the car and she confessed she took all the meds at once. I immediately took her to the ED, called her psychiatrist at home, and our closest friends. They met me at the hospital. While she was evaluated, we lied to her and got her parents phone number to tell them what had happened. I am pretty sure that she figured that one out, but she never let on if she was upset. She was admitted to the psych ward for a few days. During that time she blamed me for not answering the phone that night. She wouldn't have taken the pills, if I had just answered. The blame even came from her parents. It was so difficult to have a friend try to end her life, but to get the blame for it was unbearable. I started seeing a psychiatrist at that time.

She called me again at night after she was released. I freaked out. She called just to say hello. No big deal. But I stopped sleeping. I found myself checking my phone throughout the night. I would wander my apartment late at night. I was in a constant worry about how to keep her alive. I was not doing well.

At the time I did what I needed to. I was trying to save myself. I eventually had to sit her down and tell her that if she ever called me late at night again, I would just send a police officer to her apartment because I was so worried she would hurt herself. She laughed at me. But I was very serious. When the blame continued after that conversation, I left the friendship.

Over the next couple of years I worried about how she was doing. But the space between us was too great---I had created a canyon to protect myself and left her (with psychiatry help) alone.

Now that she is dead the guilt has hit again. I know that this is not in any way my fault. But what I feel is completely different--I feel that blaming me makes perfect sense. My feelings and my knowledge are in disagreement. I am devastated by the circumstances. It is entirely possible that if we had remained friends she still would have died--that is not what I feel guilty about. I feel guilty about leaving a friend when I knew that she was not okay. That she was not, by any means, stable. And when I left I was/felt relieved. How sick am I? Would I do it this way again? How angry did I make her then? Before she died?

How do I say I am sorry?

Considerations

2009-05-07T15:50:00.000-07:00

I like to travel. Roadtrip, long flight, bus--no problem. I like getting all my things situated into the car, plane, bus and then listening to music, reading, sleeping. Just enjoying the ride.

I do not like airports. Its a holding situation for me. I can't really get situated yet because I'm not going anywhere, and as soon as I try to get comfortable, they're gonna call my seat number to board and I'll have to gather everything up. So I sit in this semi-anxious situation, just waiting for them to call me so I can really get comfortable and get a move on to where ever I am going.

I have the same feelings towards buying a house. The inspection process is just like me sitting in the airport. I am so ready to get moved in, get situated, put my towels in the linen closet. But that readiness/anxious feeling may mean that I am over looking serious issues that are going on with the road ahead.

I found out today that the house may need a new roof. The pipes are pretty old as well. The two things I really didn't want to deal with when buying a house. We're talking a huge cost at some point. Or maybe not.

So do I just jump in with the first classers even though I know I will be pushed into economy and possibly out of the plane just because I wanna get on the road so badly? Or should I really stand by, and see if another house will come my way.....

Growing Up

2009-05-02T08:58:00.000-07:00

When you're ready to purchase your first house people have a lot of advice on how to go about it. Truthfully, I've appreciated all of it, because I honestly have no idea what I'm doing. I have a fabulous realtor and, still, no clue on what I'm doing.

The first offer I made on a house was an embarrassing outcome. The way it works is you make up some price you are willing to pay for the property. This is generally less than the asking price. Then they can accept, reject or counter. So I got countered, but it was no where near what I had hoped to pay. So I increased my offer and re-countered. And then it was the big fat REJECTION!

Within 1 day of being rejected, I put another offer on a different house.

Its hard getting rejected when you're used to doing pretty well. I dont want to sound arrogant, but I've worked hard and you begin to feel a bit invincible (until residency starts) once you are matched. This has definitely brought me down.

One part of advice that has been absolutely impossible for me to follow is "do not get attached to the house." The only reason I can come up with is its not really yours til about a month into the process and therefore it can be taken away at ANY moment. I am about to spend a LOT of money (at least in my book) on something---I better well like it, be excited about it, and want it----how the hell do I stay aloof about it?? (maybe some males can respond to this.. ok ok...that was just mean)

So today I await for the counter on the second offer. I have been waiting for 4 days. Literally sitting on my couch. Waiting.

This has been one of the hardest weeks of my life.

More Nepal

2009-04-28T19:43:00.000-07:00

My last week of living in Nepal, I sort of had a freak out that I would forget what it was like there, what I felt, what I saw, so I wrote several Nepali things down, of which I will share!

*It is always tea time. And it is the best tea in my life---especially when its super cold and there isn't any power to turn on a heater. Oh wait! There aren't heaters either.

* Lunch is served at 10:30 am, but that is because all Nepali's wake up at 5am. (gotta milk the goat, go to the temple and pray, sweep the floors) Dinner is not until 8 or 9---but there usually is a supper or snack in between there somewhere.

*Rice is eaten at EVERY meal

*If a car honks at you it either means "I'm coming!!!" or "Move over--I'm coming!!!" so its best just to move over.

*Nepali men tell the doctor when its their wife who has the complaint---even if it is vaginal discharge. If the husband does not know a particular answer to a question, he'll just make it up. Its very difficult to kick him out, but it is a must.

*All Nepali music sounds the same---the exact same---I absolutely LOVE it. My mom, on the other hand, hates it.

*The large trucks that transport garbage are decorated nicely. They have green or gold tassel, xmas lights on at night, crazy horns that are probably some sort of Nepali theme song. At least it has become that way to me. Move over--I'm coming!!

* When the power comes on at night--and a light turns on---all people touch their head and then their chest and repeat---its a thank you to god for the power. If you are in a bar when this occurs it is a UNIFYING to see---I have been known to participate as well---it has become a reflex. Because the days are hard, and the evenings are long without power---everyone must be grateful at some point for something.

*I LOVE IT HERE. I told Harka that I would love to be an elephant trainer. Because, lets me honest, I was born to ride. Harka said he would teach me Nepali. I'd just have to pick up elephant poop (no problem) and climb trees to get the food (problem). If I ever come back--and I hope I do---I will definitely visit that man.

(this written earlier): In 5 days I find out where my life will be for either 5 years or 3 years and for the first I am not consumed with what that will be or where else people might go or about feeling alone/single/unwanted---I feel free.
After being asked a million times if I was married, and/or how long it will be before that occurs---I am happy to announce I am single! I made my rank list based on what I wanted! And I can go to Nepal for 7 weeks and I don't worry about some silly boy ruining my time!

What a trip

hello again

2009-04-25T21:12:00.000-07:00

Its been several months since my last entry. My final time spent in Nepal was amazing--I have grown to completely love the insanity of that country. And I cannot wait to go back.

I came back to US craziness--the Match day. Lets just say I am very happy (exstatic!) where I matched and I, still to this day, cannot believe it.

I then did a quick turn around and headed to Honduras where I was in a friends wedding---it was an amazing trip and wedding.

Now I am in limbo land---I have not yet graduated, but I am not on any rotations. I guess this is where 4th year is supposed to be amazing, but I have to say its not my favorite time this year. Firstly, I dont like to be bored, and when deadlines are like 3 weeks away, its hard to motivate to get things done. So I am in this sorta bored but have lots to do situation. Secondly, I am attempting to purchase my first home. This is harder than it sounds. And I think it sounds awful. It has been a super hectic week in this department. And still the search continues. The good news is the banks are crazy enough to think I am a good lender with student loans up to my neck already----suckers!!! I fooled them! :)

I wrote down several Nepal stories/ways of life while I was gone, ready to share with who ever happens to read this. Those are to come this week while I continue to wrap up my med school career.

Greetings from Nepal!!

2009-02-27T22:22:00.000-08:00

I know it has been awhile (ok so only two weeks--but time feels differently here) but I hope you have not forgotten me and my Nepal stories--because here come more to jostle your mind! (read: its a long one---again grab a beer, panni (water), coffee, chiya (tea) and be prepared!) I was in a little town called Ghorahi in the county of Dang which is western Nepal. :)

I am back in Kathmandu--after a crazy 19 hour trip yesterday...it was only supposed to take 12 hours--but there was a road strike (of course--just my luck) so we had to go the extra 6 hours around to get to Kathmandu. I got in around midnight---slightly freaked out if I was going to be able to grab a taxi and get me to the hotel. Plus i had no idea if the hotel was expecting me. So I befriended the only slightly english speaking Nepali and won him over---he lent me his cell phone to call the hotel---they were lights on and waiting for me once I got home! (wow i just called it home here in kathmandu---pretty crazy)

My experience in Dang was absolutely crazy. I lived in the hospital which added to the craziness---the Dog gang outside of the hotel was worse than in Kathmandu--one night I finally got a peak and saw the dogs running happily down the street while happily barking away --free from passing tractors, cars, motorbikes, bikes, cows, goats, etc etc etc. It is definitely their turf at night. :)

I ate dhal bhat and sag every day, two times a day. It is rice, and lentil curry and bitter BITTER boiled cabbage. It got old. REAL fast. But what was I to do? It was free and all Nepalis would be grateful to get that much food everyday---so with a happy smile I scarfed it down like it was the best food I'd ever tasted. Every day. Twice a day. for two weeks. you get my drift. BUT the morning coffee was still the best I've ever had---starbucks has something to learn! I have also eaten cooked fish---the whole fish with the eye staring at me---they are lightly fried....its pretty awful actually. the bones are nasty and I spend the rest of the evening worrying I am going to perforate my intestines (yes i am paranoid at times). Sadly my peanut butter jar is finally finished---it has lasted me a month (I"VE BEEN HERE A MONTH!?!?) so it did its part. So that is the update on the food....My mom is getting in this evening (WHOHOO!!!) so I am ready to eat some good stuff with her---some of the curries are amazing so I am hoping to stick to that for a few nights....

The cases. Not much OB. Mainly gyn stuff so that was good. But I also worked a ton in the general clinic and emergency. I saw two cases of Miliary TB----the chest xray was text book---it was so sad though---the prognosis can be bad. Luckily for that DOTS program I was telling you all about (gov't requires ppl to come in daily for the meds) people actually live good lives through TB. I saw many cases of typhoid---high fevers, headaches, and usually constipation although diarrhea can be there....it can be quite serious because they can perforate as well. I saw a lot of PID---pelvic inflammatory disease---but surprisingly it is not usually from sexually transmitted diseases---hygiene is just so poor that B. Facillis is usually the case (although it was never cultured so who knows...)

I debrided a burn wound that took up half a 72 year olds man's thigh---it happened 15 days before he came to the hospital and was VERY infected. He smelled awful---I am pretty sure it was pseudomonas. The burn was from a candle---since he lived in a village and had no power. I had a 7 year old with a type three supracondylar fracture (its basically an elbow fracture for the non medical readers) with vascular compromise---her hand was cold, without a pulse and decreased sensation to her hand. She needed surgery. I tried to reduce it....it was actually a really good reduction but still no pulse---so we sent her to nearest surgical hospital. It was a three hour drive.

I helped with a bad case of COPD and cor pulmonale (right heart failure) of an amazing 60 year old lady---she had pitting edema (swelling) up to her sacrum. All the woman get COPD here---not because of smoking, but because they cook with a wood fire. She was the hospital first charity case. She didn't have money for even food. (the hospital does not provide to the inpatients!) I bought her a pair of shoes---she couldn't afford any and wouldn't walk because her feet were so swollen. I loved her and was sad to see her leave---no money left and was O2 dependent. So she went to her village and will probably die in a couple of weeks.

And I had two TERRIBLE awful sad hearbreaking deaths. They were one day after another of less than one year old baby boys. It was awful. The situation in both cases was just so sad--i dont think i can comment any further right now.

Every day we rounded twice in our 10 bed inpatient hospital-once in the morning, once at night. The labs we were able to do: HIV, malaria, TB, urea, creatine, CBC, ESR, and urine. THAT WAS IT. So for the severely dehydrated patients we had no idea what their electrolytes were. We just just look for renal failure. We had no culture capabilities. So we treated empirically for everything. Luckily resistance for like pneumonia isn't bad, so we could use basic antibiotics--which is good since we didn't have anything else anyway. The only IV pain killer we had was something like pethidine ? I have no idea what it was truthfully, but I dont think it worked so well. Dr. Sanjeev was the only doctor (does it sound familiar Pancho??) so he worked 24 hours 7 days a week. Overnight the paramedics (think of an 8month training after tenth grade---they really knew nothing) would see the patients and then call him if anything happened so he could come in. But there was a brittish doc there as well---Dr. Jessica (no one goes by their last name) and she was just great!! We immediately became great friends and she taught me a lot. She would work with Kumar--one of the paramedics--at night because he had the best english, so that gave Sanjeev a break.

I had to get used to people staring at me. I guess seeing a white girl is pretty rare---I am thinking most people out there have never seen one in person. I had people (random people) ask me if they could take my picture with them. It was so bizarre. I would be just walking to buy some bananas or something, and someone would walk up to me holding a mobile phone and ask to take a picture (in broken English). Better watch out---I am famous now! Hahahaha

I ran a few times in Dang---it was goregous scenery with rolling hills and a river. It was amazing. This really surprised the people---to see a white girl running by. It even surprised them more when I would pant “Namaste!” to each of them or “Good morning” their eyes would jump out of their sockets and then they would smile and yell “Hello!” or “Namaste” back---it was awesome. The security guard was named Shreedhar (Shre-dar) but I called him Shredder--like the Rat from the Ninja Turtles—because I felt like he was my personal protector and I am pretty sure he could do some Ninja moves if necessary (I might have just imagined him doing these…). I loved him--he didn't speak any english so we spoke with my 30 word nepali vocab and lots of hand motions...he was an ex police man so was into running and exercising with me--it was just great.

My main contribution to the hospital was putting together the emergency bag. After their first code (i missed that one--it was a week before I got there) Jessica said it went so poorly that something was to be done. So we bought a computer case type bag and I put it together. It consisted of two ambu bags---one pediatric and one adult (we only had two fask masks---so we cleaned them with spirit which is ethanol drenched cotton---definitely not US standards) and two laryngoscopes--one peds one adult, but we didn't have batteries for the adult and we didn't have pediatric ET tubes (the tube that goes down the trachea to help people breath when we intubate) so we really couldn't intubate anyone....I also put IV cannulas, NG tubes, fluids, and then made a drug box of adrenaline, atropine, dextrose, diazepam, etc (all meds necessary for a code arrest or seizure). I also made saline flushes since those don't exist here. Hopefully it will be a big help the next time a true emergency comes in. Because the way it worked before---we would need to put an IV in a patient, but first the family would need to buy one, so they would go to the pharmacy (which is attached to the hospital) and buy an IV cannula and then come back with it---this could take up to 5 minutes and really delayed the treatment of the emergency. This also goes for medications, fluids, oxygen, etc etc etc. At least some of the real saving stuff is ready available and then the family can just pay to replace it in the bag. Does that make sense???

well that is the best update i can give right now--more after my travels!!

Subha prabhat!

2009-02-14T07:37:00.000-08:00

Oh my dear friends!

There is a gang that takes over at night. At first I was sleeping through the night (mostly) without a problem, but around 2 or 3 in the morning I can hear them strutting their stuff on the streets, letting their presence be known!!! Yes, I am talking about the stray dogs. Howling in the night. at first I loved the stray dogs---I even saved some breakfast to feed one (french toast)...he turned his nose up and walked away from it! That was the last attempt, trust me....Anyway, so I have started using my ear plugs at night to sleep, which means I sleep through the watch alarm...but you all know its no big deal since it is absolutely impossible for me to sleep in. :)

update: i leave for Dang tomorrow! WHOHOO!!!

So back at the hospital I must explain the confusion I've had recently. Apparently to the Hindus the year is 2065. The date today is 28-10-2065! Whatever that means. SO the ladies NEVER know when their last menstural period was...and when they do know, I have no idea what that means since I go by the the 12 month calendar that we all depend on (MATCH DAY IS TOO SOON!!). And I found out that next year they will be deleting their last month because the stars and their calendar are just not matching up...... Imagine that.... Then imagine if you were told that we're just gonna delete December this year.......

Now imagine you are a woman patient to see me and the lovely doctor (I LOVE HER!)...you enter a small door into a small room that has one white desk and three chairs---the doctor sits in one, I sit in the other, and the patient sits in the third. Then there are about 10 nursing trainees who loom a half circle behind you, listening to any menstraution problems or discharge, while your husband tries to listen outside, or sometimes comes IN and chimes IN! Then three white sheets are strung up behind you were you are told to lay down on a sheeted half bed and put your feet up (no stirrups). Then via flashlight (more on power outtages below) you are examined with the 10 trainee nurses all tryingto get a peak (the sanitary issues for the speculum and such will not be described---they do their best here, but it is NOT up to standard by any means). Then during one of the breaks--we see from 4 patients to 24 patients in a 2 hour span---so some times there are breaks---one of the trainees plops herself down and tells the doc about her anal puritis. I am shocked---there are not many people I would share this little issue with! But she is not embarrassed (my guess was pinworms) and gets the treatment without a blush.

Oh and on the outpatient side---we check anemia by looking under the eyes of the people. If they are pale, we assume anemia and we immediately treat for hookworm since that is the most common cause of anemia here. No tests necessary.

In my attempts to recreate some sort of normal lifestyle, I have found an amazing coffee shop! It is very clean and they have free wifi and american music playing. So I go there when I am absolutely freezing in my room to warm up and studyNepali. I have to say---its coming along alright. I learn a phrase or two a day. But it is very difficult and I finally realized why. When I first got here I was so upset because it seemed like the doctors would talk to the patient for like 5 minutes and then would turn to me and just say "he has fever for 5 days." I would always be like...yes? and what else did you discuss?? but it is possible that was it! For exampl;e to say "you're right" you say "ta-pai Le thik bhah-nu bho-yo." damn. i guess if you're gonna tell someone that they're right---you will better mean it!! Anyway, after they played the Aikon song "I'm so lonely" TWICE---I had to leave....it was hitting a bit close to the heart, ya know?

Oh! and don't think America is the only one with Pharm reps! I've had two sightings on my short stay here! They come VERY nicely dressed---you can definitely pick them out---and have little signs on each of the drugs, giving a sales pitch---when you think calcium think pearl-one!

Today I did Tot Shots Nepali!! Tuesday is shot day and we give polio---two drops of a liquid into the kiddos mouth and then one shot of HepB, DTap, and something else. I did well until--like my lidocaine accident when I was numb for a hour when it exploded in my face---I exploded the polio bottle in some unexpecting 2 month kiddo's mouth. He is well protected. :) Also they put eyeliner on these 2 month kiddo's eyes! Its supposed to be ramro--or beautiful. So its so interesting to watch the very nicely eyeliner eyes go from happy staring at me, to sobbing as I inject health into their little plump leg.

I cannot seem to get the power situation correct here. Just when I think I've got it--its all been changed. Right now we get power from noon to four pm. Then power comes back on at midnight to 7am. The gov't realized that giving power during the day is absurd because we use it! So instead they do it at night when we are supposed to all be inside and sleeping anyway. I am not too sure how long they will last. But the good news is---they may or may not be increasing the
power times! we find out next week--all very exciting.

Nepal

2009-02-12T03:42:00.000-08:00

Hello folks! Well I have officially been out of the country for 2 weeks now! Its pretty crazy....I dont have much time to write a full post, so I will instead put an email down that I sent out from my first week....its been INTENSE, but good....missing everyone!!

Namaste! and subha sandhya! (good evening!)

this is to be the longest email ever! so please...grab a cup of coffee, beer, a glass of panni (water), and then come back to read this!!

Firstly I would like to thank everyone who has written me an email---you know you who you are. They mean a lot---I feel like I am actually having a conversation sometimes. :) and it has been great talking to some of you over phone! So I start this email there---I may sound sad and upset and possibly cry over phone. but please know---i am doing good....really good. I just get a bit sad over the phone because I dont have "normal" conversations here and so it comes out over phone. SO know that I am good--unless i say so, of course---and that I can't wait to hear about you! even if i make the phone call all about me, because to be honest, i dont speak that much around here. :) (EXCEPT FOR MY JOURNAL---court---i write in that at least twice a day!!)

ok about nepal. I am living in Kathmandu---in the Thamel area---a very touristy area very busy, someone is always trying to sell me tiger balm, or a shirt orm out from 8am til about 9pm (tonight is the exception but you will see why below) because there is little power (sometimes none) and so that is that. Today marks my one week experience here and I have to say at the end of th week--i am so glad i have come.

My first 24 hours i desparately missed my cellphone---i longed to make a quick phone call to say hello, chat about whatever, etc etc. I also realized how dependent on my ipod i was---when i didn't have power to charge it and it was completely dead. Luckily i am able to charge it from 6pm -8pm so i can listen to my music before bed (you know how i am). it took a good 48 hours for me to let go of these, now seemingly silly, necessities. i have gotten over that, although finding a place that only charges 5 cents per minute to call, means i can call more frequently (although this has come to an end---keep reading) and proabably have this week. (Thanks to those who have answered!!!)

I'll start with my daily life this week (And please know this comes mostly from my journal): I wake up around 645 or 7am...i wake up to crows or dogs barking usually. or the luggeee (sp?) man who lives somewhere near by---it wasn't long before I became the luggee woman---the dust and pollution help create some good ones!!! SO i get out of bed and begin doing my "workout" this consists of wall sits, push ups, situps, pike ups, etc etc etc. i cannot run here due to smoke, dust, pollution so my work out is inside...without a gym. I then sometimes take a shower (nicola and court--you should be proud---its been 3 days!!!) but the hot water is solar power so really it would be better for me to do it in the afternoon but i just dont. then i will write, read, or pack up my stuff, etc. I head to breakfast usually around 845 even though they ask me to come later everday. I drink milk coffee which costs about 70 cents for a small point--and this is possibly the best coffee i've had in my entire life. in addition i have french toast, or toast (depending on the belly). Ratna, the man who drives me to work everyday, is always punctuional (i am constantly suprised when he is there) and takes me the scariest 25 minute drive to Chabahill---the name of the area of where the helpnig hands hospital is. I have gotten used to the roads, although the first few days were awful. The pot holes are as big as I am, there are people walking every where, motorbikes, other cars, somehow we have not hit anything (knock on wood). I honestly don't know how he does it, but I love him for it.
I arrive usually around 10am but the doc arrives around 1030 or so. I work in the outpatient clinic in the mornings---I have seen typhoid, hepatitis (type unknown--they dont bother figuring it out unless it lasts for a long time), many many many pnas and chronic coughs. Which brings me to the TB situation. The people here pretty much have TB. Young, old, etc it doesn't matter. And the people refused to take the medication---even when it was basically given to them. SO the gov't (more on that below) has instituted DOTS---a system that requires people to come to the hospital everyday---they sit, take their medications under a person's supervision and then they can leave. in return they get something reduced (rent or something). its crazy to see the line of people everyday. to see the outpatient doc--it costs 60 ruppees or about 85 cents. to see the OB/GYn--its a bit more expenisive---150 rupeees or about $1.75. crazy eh? to get a CBC its about a dollar. it is costly to the people, but not just low enough that they will pay. they come from all over teh country---one family took 10 hours trip to get there. the clinic has been open 4 months and they ahve seen already 20thousand patients. pretty good i think.
there is no ICU, but they have an inpatient of about 12 beds. there is one OR and one post op room that holds about 8 beds. I have lunch in a office---i eat dumplings basically everyday. i now HATE dumplings. :) In the afternoon I finally get to do OB/GYN.
I love the OB docs. I also love the OB nurses...well one is a sorta nurse, and the rest are just training. but they are super friendly and have taught me most of the nepali I know (I can now ask if the pt has a fever, a cough, pain anywhere, and for how long...the ob stuff is much more complicated to learn, but i'll get it!). The OB stuff is great---they definitely estimate fetal age based on physical exam---how big the uterus is, etc etc. We listen to the fetal heart tones by stethoscope!! I have never seen this in the US, but it works well. I have also seen so many prolapsed bladders, and many many many cystoceles, rectoceles, etc etc. Menopause is late here---woman start around age 54 or so. So it is common to see a woman on her 7th pregnancy at age 45 and still baring a child. abortion is completely legal here, and surprisingly it has become more of a birth control method than anything else---i bet the prolifers would love to hear that. Woman refuse to use OCPs so they get pregnant, and the docs take care of it. pretty crazy. They dont run many tests here----so if they see discharge---they decide what kind it is (yeast, bacterial, etc) based on appearance and then they treat for it. No wet prep test, etc. today my last patient---had suspected choriocarcinoma. I actually felt her uterus enlarged and another mass. They'll take it out next week.

So after work, i get home and read. I read by head lamp when the power is out. The power goes out random hours. I never know when it will be there or not. But it sucks when it is out and i'm in the middle of something---the joke is my room probably looks like watergate from my head lamp. I fall asleep around 9pm and then I get up and repeat. I have finished two books so far---first one was a bunch of short stories about nepal called royal ghosts (about when the royal prince killed his entire family and then himself---pretty intersting) and a jodi piccoult book. I tried reading about the history of tibet, but the book was SO dry that I sold it. I am now on book two of the twilight series.

so my big news. last night i met with the founder of the helping hands organiztion. i went to a dinner at his friends house. it was a very nice house---even by US standards--of course I couldn't see much of it because the power was out when we first got there, and i felt ridiculous getting my head lamp out, so we pretty much sat in the dark for the first 30 min. then the lights came on at 8pm and I saw we were sitting in a large living room that had four couches. I was on one of them and then there were about 8 nepali men on the rest, and the woman sat on the floor. i almost jumped up then to sit with them. I was given a homemade alcoholic drink--to which i took one or two sips of---(i was so worried about offending people) and then a large bowl of hot water with a lemon in it was brought to me and the founder. i was told to wash my hands. I copied the founder. Then a large plate was brought to me---one side had hard seeds, sausage on another and fried meat on the other. I first tried the seeds but they were so HARD that I couldn't even chew. I left those alone. So I tried the sausage, but it had the weirdest spice that I gave up on that. I was about to try the fried meat when the founder told me it was goat intestine. My stomach flipped. So I said I would try it. Lets just say I did and there was no second bite. then other things were brought---a doughy type thing, a couple of chips sorta things, carrots ( I ate all of those) cold vggies in a strange sauce. and then another fried meat. I was ready to eat it although my stomach WAS NOT HAPPY at this point. they told me it was fried goat lung. a fine nepali delicatesee. SICK. I took one bite and knew I was done for. I tried to figure out where the bathroom was , just in case. This whole process was but 1.5 hours. During this time I was told my trip out east was canceled, and instead I was leaving in 3 or 4 days (no one knew) for the west where I will remain until my mom comes. I was shocked and a bit pissed no one told me before hand. So I started saying that I was Full---no more fried meats for me. And this entire time the people kept speaking Nepali to each other--so to busy myself I acted like JD from scrubs (something I now do regularly) and drift into my own head...this time i pretended they were plotting ways to kill me---i envisioned how i would escape everytime---from posioning to beating me up===I would dodge it all with my trusty 25 spray pepper spray that is always in my pocket. I was finally brought fried potatoes and asked repeatively if iw as on a diet. I was then told this was just the start---the real dinner was to come. My stomach flipped. again. So I ate the potatoes and hope I misunderstood.
I didn't.
the real dinner was bout 30 minutes later---in the dining room---rice, goat meat, curry, lentilss and truthfully it wasn't bad. but my stomach not being happy already could only eat a bit---more jokes about dieting ensued.

SO I leave monday or tuesday for the west. i am promised to have internet and phone booths but i am guessing they are mucn more expensive so I will not be writing or calling as much. I am told I will be the only OB doc...for which I replied that I was not qualified for that. and I am told I may be living in teh hospital...for which I hope is a joke, but guess it is probably not. I am told the Maoists are at peace here (although a year ago it was not the case) I go there with the founder and so if any problems arise, I come back with the founder. I am excited to leave kathmandu---this is a busy polluted city...i would love fresh air!! But I feel very safe here--probably because I go to bed early and dont go looking for trouble, but also---the people here are SO friendly. The nurses==who live on less than a dollar a day---bought me tea today to say goodbye. I was so moved I almost cried.

And if you felt the earth move this morning---i had my first dance party in my room tonight. picture this: me listening to Counting Crows hanging around here and dancing like no-one-could-see-me in my room. I am happy here. BUT I MISS ALL OF YOU!!!

Recapping

2009-01-23T14:15:00.000-08:00

I know, I know....its been forever. I have tried to sit down and write--several times---but I had so many different things to say and they would have been so many different blog entries. So instead I'm compiling everything into one huge cluster. Its not so different as my life! :)

Interviews: I am done with interviewing! I actually finished a few weeks ago. It was exhausting, but pieces of it was really fun. Here are some memories from that experience:
*I flew 5 different airlines, set foot in 12 different cities in a period of 2 months--all while doing an anatomy and an ED rotation (ok the schedule was flexible---but it still was a rotation!)
* Interviewing with up to 6 different people for fifteen to twenty minutes at a time---which felt more like speed dating than anything.
* Meeting the biggest gunner of each interview, and just hoping their number one didn't match mine.
* Having a residency director respond to my comment that I like classical music (I listen to it when I study) that he doesn't because it makes him feel depressed. And then he mentioned that he is probably just someone who is more apt to feel depressed anyway.
* Being asked where I am going next year aka what is my number one pick---ILLEGAL QUESTION---at several of my interviews and me just smiling away with a big "I dunno response."
* Being asked about 150 times if I had any other questions about the program.

Working in the Peds Ed for the past month has been interesting as well:
* A father knew the first day of his 16yr old daughters last menstrual period.
* The same 16 yr old girl replied to my question about being sexually active (I kicked the dad out by this point) as "Oh, Its been ages since I did that." When? I asked. 3 weeks prior to her dysuria. I didn't realize teenagers had such awful dry spells.
* I walked into the room of a 20something mom bringing her 2 year old son in because of an abscess. He was sucking on a starburst. Only she hadn't unwrapped it for him so he was also chewing on the paper.
*After waiting for 45 minutes to be seen, taking the history and doing the physical of a kiddo with asthma, the mom tells me she really doesn't want to be in the ED anymore. She'd rather just take her kiddo home.
* I have seen more "viral syndrome" URIs (aka colds) than I thought possible while working in the ED.

I've also been working on the yearbook for my medical school class. Its been sorta tiring, but fun to revisit everything we've been through and all the fun times we had. Motivating medical students to do something, though, its a challenge that I didn't appreciate until this task....

I am heading international next week. I will be gone for 6 weeks! I am doing an OB rotation in Nepal---its going to be amazing but I would be lying if I said that I wasn't a bit nervous as well. I hope to write at least one entry while I'm there, but we will see what sort of access to Internet I will have!!

Which means I have to make my rank list. It is due Feb25th. AGHH!

4th year = decision time

2008-12-23T09:05:00.000-08:00

We were told that 4th year was the best year of medical school. We were lied to.

Don't get me wrong---I've had a lot of fun this year, and definitely enjoyed not having exams after the end of every rotation. But undoubtedly there is this HUGE pressure to make big decisions---something I've never been fond of.

Flashback to senior year high school----I could not decide where to go to undergrad. So much so, that I almost took a year off in order to prolong the decision making process. What ended up happening? I signed up for the Unv. of Denver on the last day acceptances were due---and secretly hoped my letter got lost in the mail so I'd have to take the year off. Good choice? It took a year before I fell in love with Denver, but once I did, I was so happy I ended up there.

Now to present time. I actually joked a couple days ago how I will be in Nepal (whohoo!) when our ranking list is due. And how Internet may not be so great out there, so maybe I wont get my rank list in and then I'll have to take a year off.

For some reason I'm seeing a pattern.

you know it

2008-12-07T20:51:00.000-08:00

You know you're an emergency resident wanna-be when after you run a half marathon and then jump on a plane to get to an interview, your main worry in life is getting a DVT.

thought for the day

2008-12-02T08:50:00.000-08:00

A medical students LEAST favorite question in the whole wide world:

"Do you have any questions for me?"

I wonder if I could throw that question back to the director as my question........

My right hook

2008-11-19T16:58:00.000-08:00

One would think after my interviews I would have quickly written a response to my last posting, but to be completely honest, my final interview sorta hit me hard and I wasn't quite sure what to think.

My standard question to the directors is "How are the residents evaluated?" Its a an easy way to get the program director to chat away and I can think of a follow up question, or we can move on.

Well at my final interview, I think this program director took this question the wrong way. He gave me the quick run down, told me that I will do just fine in residency, and then quickly shot me a question that to this day I'm still thinking about. He asked me if I beat myself up.

The question seems innocent enough. Just say no and move on. But I paused. Because the truth is---to a point, I do beat myself up. I don't want to say my family was particularly hard on me, but when you grow up with work-alcoholic parents, your options are to rebel and be a slacker or follow in their footsteps. I clearly chose the later.

So after the pause, I attempted to explain this. I fumbled. I came across sounding like I'm super competitive which, I guess I am, but truthfully, I'm only competing against myself. The program director finally saved me and said, "Listen, we all appreciate excellence."

And that's when I shut up.

Interview season!

2008-11-09T13:52:00.000-08:00

www.glasbergen.com

This week I start my first rounds of interviews. I had hoped that I could have started the interview process with a program that I wasn't hanging my life on getting into, but that is just how things go.

So in order to put my best foot forward (is it my left or right?) I've been practicing. A LOT.
I've been caught talking about myself while running along the canal. But thinking back to the really weird faces that I passed--- it is possible that I was yelling since I always listen to Boston's "More than a Feeling!" full blast while practicing (and running). It has been my theme song for fourth year---I wrote my entire personal statement while listening to this song over, and over, and over, and over (angela--you know what I'm talking about!).

I found an excellent website with practice questions. So today, on my final day off, I found an awesome coffee shop and tackled them. I was quite surprised to find the potential questions I might get asked:

* Tell me a joke.
* Teach me something non-medical in five minutes.*
* Besides medicine, how else are you intellectual?
* Present to me a patient you seen in the past, as if we were in the clinic.
* Ask yourself a question, and then answer it.

And of course the infamous: do you have any questions for me?

Now maybe these don't seem so bad just reading them over, but imagine if you just introduced yourself and the program director asks (or demands) a joke! I know that my head will go completely blank under the pressure. My plan? I'll just giggle a lot.

*I'm gonna teach that program director how to swim---that'll get him/her out of her comfort zone! I'll just have to bring a small kiddie pool....

Politics

2008-11-04T14:05:00.000-08:00

It is election day!! Go vote!

But I have to say neither candidate has a really good handle on the health care issue. And just cuz health care is sorta my life I wanted to bring up some facts that we went over yesterday in class...

Why people go to the ED:
- they have a true emergency
- they are traveling to that city and get sick
- lack of alternative access: uninsured, no PCP appointment available, PCP closed
- societal outcasts: homeless, illegal immigrants,etc
- drug seekers

Average cost of an EM visit: $383
Average cost of a PCP visit: $60
(although this is not comparing apples to apples---most people who visit the ED are generally sicker, although 55% of the 90 million ED visits were deemed unnecessary in 1996)

Number uninsured:
- 47 million uninsured

Who pays for the uninsured?
- The insured. Premiums and such don't just cover the individual needs. We're all paying for everyone to get medical help. The money has to come from some where

Why is this important?
--if the insured are paying for everyone else---wouldn't we all want everyone to be insured and then no one would be paying extra??

Just some food for thought!

My Favorite Day!

2008-10-31T11:33:00.001-07:00

It's the most wonderful time of the year!!!

Happy Halloween!

If you're looking for a spoooookkkkyy flick---try The Strangers! Its the scariest thing I've seen in a long while.

Med student informs attendings and isn't beaten down!

2008-10-23T10:35:00.000-07:00

Being back in the ED again, and being sincerely happy about it, definitely makes me a bit more confident about the whole EM/Peds thing again--cuz I have to say---there are days that I very much miss the OR. And being on the Peds side for the past few months got me thinking that maybe Peds was more my thing, but after one shift downstairs, I realized my heart is totally into the ED thing too.

I am currently doing my first, and only, away rotation. It is pretty interesting to see how the ED works here compared to back home. Firstly, for all lacerations: the nurses numb up and scrub them out for you. This lets me get other work done like calling surgery or pediatrics, or discharging someone. Secondly, I never have to look up a single number to page someone---I just tell one of the three secretaries that I need to talk to Dr. C and they take care of it---within ten minutes I'm getting paged overhead that he is on the line waiting. Lastly, people here are ridiculously friendly.

Last night I had a sick kiddo. In the ED the main purpose is to decide who is "sick" and who is "not sick." I have to say as a second year I thought everyone was considered "sick"---I mean why else would they have gone to the ED?? Now I think I finally have it down. So this kidddo had a fever of 104, hadn't eaten/drank anything all day, was tachycardic and tachypnic and just looked out of it. I was worried. So we started an IV, got cultures from her urine and blood and gave her Tylenol and Motrin. She perked up after the second bolus and I felt much better. Her urine came back with a UTI and we decided we were gonna send her home, but my attending really wanted me to talk to her pediatrician prior to sending her home. Of course the parents had no idea which Dr. F it was in town (there were 3 by the same last name) so I had to do some serious searching.

Around 10:30pm I was pretty sure that I narrowed it down to the correct doc. I was nervous to page this doc late at night just to do a "let you know" conversation, but it was important. So I dialed away. She responded about 10 minutes later and was amazing. She was completely appreciative that I informed her. I couldn't believe it. I hung up the phone with a smile on my face. And that's when I started thinking---I hadn't called a single consult so far that resulted in someone getting nasty or being rude---people here were happy to help out! What an amazing concept---we were all on the same side --trying to do best by the patient. And that's when I started thinking, maybe I could live here.

tying up the PICU

2008-10-19T17:56:00.000-07:00

I finished my rotation and at PICU--- I know I didn't report much on it, ok like nothing really on it, so I am gonna sum it up here!

It was intense. And as a close peds mentor told me---you have to be deranged to like it.
Call me deranged!

Because I liked it enough that I actually applied to a pediatric program. Who woulda thought?!?! I was able to cardiovert a stable arrhythmia twice, I did my first LP on a kid, and I saw more central lines placed that I believe I could now do one on my own. I took care of a ventilated congenital cardiac kiddo---balancing lasix and fluids carefully. I took care of a very sad head bleed teenager---she was in the bed of the truck when it rolled over. I managed a very dehydrated kiddo (sodium=170!) and normalized her sodium carefully. All in all--I learned a ton but I also experienced awful things.

My second to last day we had 3 children die. It was probably one of the worst days of my medical school career. (I had a hanging death of a college student while on trauma which now is in second place) The first death occurred around 9am: it was a previously healthy 6 year old who had a T&A (tonsil and adenoid removal) the previous day. At 4am, mom gave him hydrocodone and by 8am he was blue and not breathing. We coded him for 90 minutes. And just before we were about to call it, someone found a pulse. So we put him on a epinephrine drip to allow mom & dad to say goodbye. It was so sad. By the time it was all settled it was around noon. I grabbed a quick lunch and then was told there was a 2 month old boy coming in coding. He was sleeping on the couch with dad and dad woke up and he wasn't breathing. We coded him for 60 minutes, but he did not make it. The final death was a cardiac kid who went to surgery. I came up from the ED after the 2 month old didn't make it to find out that the cardiac kid died while in surgery.

I pretty much cried all day. But it got me thinking which is "better"---having a sudden situation, where your child passed away suddenly and out of the blue, or having a chronically sick child and them passing away in a high risk situation---aka surgery---but a situation that you believe will save their life. I am not sure which one "wins."

Things I learned way before med school....

2008-10-02T19:40:00.001-07:00

So I recently (aka Monday) started my rotation in the PICU -Pediatric Intensive Care Unit- and let me tell you---its intense! More on that later....

We had about a 10 minute break the other day and started looking up kids on the floor that might come up to to the unit. At one point the peds resident recognized a kiddo there and started telling me their story:
Its a 10 month old kiddo who has had chronic diarrhea since birth. They've done all kinds of tests to figure out the cause. They found out the kid is unable to digest both proteins AND sugars. This is actually quite rare. Apparently kiddos usually just have one problem or the other, but not both at the same time---this is a good thing because if you cannot digest proteins, then we give the kid sugars to eat, and if you cannot digest sugars, we give them proteins. For this kid they are playing a fine line in feeding him.

The lesson with this kid??

Don't marry your cousin.

Boo-ya!

2008-09-18T07:44:00.000-07:00

Jokes made by Dr. S:

How do you hide medical information from an orthopod?
----publish it!

How do you hide patient information from an orthopod?
----put it in the chart!

Booya!

Bonding

2008-09-16T19:46:00.000-07:00

This morning was clinic day with Dr. S. I was pretty excited about it because Dr. S told me that we would have at least one HIV positive kid, and not to sound morbid, but I was looking forward to it, because I find HIV fascinating and I've not met a known HIV kiddo before and I wanted to learn about how they were diagnosed and what their prognosis was like, etc.

18 year old R was our first patient. I walked into the room and there sat a healthy appearing cute kid. Cute enough that I would let my daughter date him. He was polite, and answered all my questions. He was diagnosed with HIV as a small child---it was passed on perinatally meaning while his mom was pregnant. He is currently on four medications to suppress his virus*---some of which he has to take twice or three times per day adding up to at least 9 pills per day. His viral load has been undetectable for several years. Meaning he is doing great. So great that Dr. S has wanted to change his meds so that he only needs to take 2 pills per day. But R has been reluctant to do so because he is doing so well and he is worried about going downhill once he changes his meds. Pretty amazing for an 18 year old. Most 18 year olds can't even remember to brush their teeth or put on deodorant.

When Dr. S walked into the room R jumped off the table and gave him the biggest hug. I didn't start crying (that would have been my usual reaction) but I felt this over whelming joy --- like Dr. S and R had this amazing bond and all I could do was to hope that some day I would have the same bond with my patients. After their inital hellos, R opened up and told Dr. S that he was smoking 6 cigarettes per day and pot about 2 times per week. I was impressed with his honesty but sad he was headed down that road. So Dr. S and I gave him a talking to, where I suggested running instead of getting high because it is a "natural high."

And alcohol and rock n' roll will send you to hell!! Sigh..... kids probably think I live in the 1950s.

* in talking with the mom and the kiddo---I realized they knew more about antivirals and HIV therapy than I probably ever will.

Data Collector

2008-09-09T20:40:00.000-07:00

I've been working my butt off in Peds Infectious Disease. We cover two hospitals, plus there is clinic so basically we're constantly picking up new cases and finishing up others. We've got some sick kiddos recently: a Rocky Mountain Spotted Fever, lots of osteomyelitis, Leptospirosis, bacteremia sepsis, and today I diagnosed malaria!

But part of the hardest part of this rotation is getting my thoughts together in order to get the assessment and plan ready to present. I am good at getting the information--I can ask the important questions, and I can pick up abnormal findings on the physical exam. I can also get the vital signs and the lab values off the computer. After that I am supposed wrap it up with a simple one line sentence and explain my thought process for what I think it is. This is where I falter. While I was on ED I could get it together, but on Peds ID, I am usually so confused and have a billion things running in my mind that it sounds like blllllaaahhh.

Lucky, my attending sort of expects this. He believes our teaching was geared at making us great Data Collectors and looking back over 3rd year I actually completely agree. For example, on surgery I would wake up early to "round" which really just means I would make sure to find out if anything bad happened to my patient while I slept. If that was a no---did they eat? did they have a temperature? did they get out of bed? how was the pain? after I collected that info and their vitals and labs (which we rarely ordered anyway) I would just recommend that they eat, get out of bed and make sure their pain was controlled. Done and done. On OB it very similar only I'd mention something if they wanted any form of birth control. On psych I never rounded. On medicine we were told by the ED what they had, and we just consulted various services so I'd make recommendations on that and I'd look up journal articles to learn.

So it seems like I really didn't have any creative thought of my own when it came to summing up the patients---I was medical student, the Data Collector.

off it went

2008-09-04T16:46:00.000-07:00

www.cartoonstock.com/lowres/jkn0020l.jpg

I submitted my application for residency last night (AGHHH!!) and I am freaking out (AGHHH!!). I tried drinking a beer after submitting, but in all honesty---it didn't help. So I might go towards heavy drugs---like chocolate.....

I wasn't going to submit until next week (I'm still waiting for a couple of letters of rec) but after talking to the Peds Residency Director---it changed my whole outlook. It was a simple run in---we both happened to grab our lunch at the same time. He is super friendly so he asked me how I was doing and what rotation I'm on, etc etc. Just plesant chat until we hit the elevator. Thats when he asked if I submitted yet. I said, I was working up the courage. Thats when he mentioned that he already had 250 applicants. 250!!! The option to apply was only open for 30 hours at that point and he already had 250?!!?! So I went home and stared at my computer until I finally hit enter. And off it went.

So I've checked my email about 30 times today in hopes to have an interview request. But no such luck. The worst part is you can look up who has downloaded your application. Several have downloaded it. Still no interview requests. AGHHHHH

Having a kid is just like owning a pet.....

2008-09-02T19:48:00.001-07:00

http://www.cartoonstock.com/lowres/amc0336l.jpg

My first patient on Peds Infectious Disease (Peds ID) was supposed to be a kiddo who lives in the near-by bigger city. I find it absolutely amazing that the neighboring city which has about 4 million more people does not have a single Peds ID doc. Instead they have to come here or the docs from my city, go up there. Well aparently this kid doesn't even have a doc to begin with---he's been seeing a veterinarian.

He got diagnosed with MRSA---the strongest bug there is out there! Its a resistant strain of staphylococcus (a bacteria) which will definitely need some big gun antibiotics. But instead of going to a doc for this diagnosis, his family took him to a vet. Aparently, it only costs $17 per day for the kid to stay at the barn shelter. Which I guess compaired to hospital bills ---this is a fabulous deal. Why did he go to a vet in the first place? no idea. What kind of MRSA does he have? no idea. Why do I not have the vital information on this kid? Because he was a no show in clinic today.

Meeting with the Big Guy

2008-08-28T16:07:00.000-07:00

Yesterday I had one of the most important, and yet terrifying, meetings of my life (ok I am known to exaggerate). I met with the Residency Director for the Emergency Department at my Medical School. He is known to be a bit blunt and tell you exactly how he sees things, so I was ready to be tackled down and told that I was never ever going to become an Emergency Pediatric Doc.

He surprised me.

I first sat down wishing I had not worn a white top because I knew that sweat marks were already shining through, when he barked "So why did you want to talk to me?" I took a deep breath and opened my mouth and replied "I came here for 2 main reasons. First I want to know about what you think about letters of rec...." and I really didn't close it much after that. For some reason he responded well. He went over each and every one of the residencies on my list and graded them for me based on what I said I was looking for. He then did a mock interview and told me how to revise what I said. Which is when I decided it was time to know, to really know, how I stood up against other applicants. Because I'm gonna be honest---sometimes I'm like an ostrich--I just like to keep my head in the sand and push on through without realizing everyone is running away from the lion.

So I told him my Step 1 board score---its pretty much the mean of what his department takes--which I expected. We discussed Step 1 for a bit. And then I mentioned that I honored everything except for medicine. Now, here comes the hard part. I am pretty sure I prefaced that with "In third year I honored everything but medicine," but looking back, I am not so sure. He was impressed. He asked if I was AOA (they are the ones to be impressed by!). I said "No--I have a very competitive class." And thats when he said, "Well if you rocked Step 2 then I think this whole Em/Peds Residency is a reality for you." My head swelled up 2 sizes and I floated away from that conversation elated. ELATED.

It wasn't until 7 hours later when I realized he might have thought I meant I honored EVERYTHING except for medicine---meaning everything first year, everything second year, everything third year----except for medicine. My elated feeling fizzed and now I'm back in the sand again with the lion circling. I mean what was I thinking?? I knew that conversation went too well. My luck isn't that amazing. So I wasn't sure what to do with this new thought. Some of my closest friends (I love you guys) told me thats definitely not what he thought, it was clear that we had moved on to 3rd year when I mentioned that. And hopefully they are all correct. I am just having a hard time shaking this one off.

Tuesday I start Peds Infectious Disease---you all know how I love the little buggars!!!

Selling my soul part 2

2008-08-25T19:01:00.000-07:00

I've said it once, I've said it a million times, but I have FINALLY made a choice about what kind of doc I'm set out to be. (have I already posted this?) Anyway, just so the record is straight--I am applying for the combined Emergency Pediatric Residency programs (there is only 3) and then Emergency on top of that. It all sounds so simple, but after a year of liking almost everything, and then changing my mind every 3 days or so, you would think I could catch a break once I made a decision, but this application business is anything but.

ERAS, or Electronic Residency Application Service, is where the thousands of medical students send in their first 3.5 years in hopes to land their dream residency. Whats interesting to me, we go through these ass kicking years, thinking we're working so hard, signing up for extra projects, etc etc, when in reality we're just like every other medical student out there. Signing up for the extra stuff, studying your butt off to honor every rotation except one (TRUE STORY!), turning down social events, saying no to your family---is no big deal when you are compared to everyone who is just like yourself. The residency has already heard of it before. About 500 times before.

So how do you stand out? What will make me special? I actually know of a medical student who started hiking (she went 2 times) in order to have something to say at the interview when they asked about hobbies. (saying it now makes me want to puke) As I fill out my personal statement and my resume I think about the random things that I wish I could add: making good luck cards for every class member for a year, organizing several trips to mexico, camping, lake tahoe, planning dog park days, surprise parties (x2), etc etc etc. I wonder if the 60-somethings attendings on the admission committees will appreciate that stuff. Somehow I doubt it.

And so it continues.....

2008-08-07T19:08:00.001-07:00

So I know I haven't posted in a while, but the stress level really hasn't died down and haven't had anything non-stressful to post.

I am currently studying for Step 2 of the Boards. I've decided this is the worst name for this test. I am a 4th year. I think the Boards by now should be Step 186 or maybe Step 309. I mean Step 2??! It seems like I haven't made it that far with just the second step. I am going to propose this to the headquarters. After I take the test, of course.

On a happier note---after the boards I'm heading to the wild territory of Las Vegas! Any suggestions of what to do while I'm there?? We'll see if that helps with the stress. :)

Things that are stressing to me

2008-07-23T21:58:00.000-07:00

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

2008-07-22T19:31:00.000-07:00

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.....

2008-07-18T08:02:00.000-07:00

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!

2008-07-15T13:52:00.000-07:00

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

2008-07-12T20:57:00.000-07:00

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

2008-07-09T16:47:00.000-07:00

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! :)

Pushing the years

2008-06-26T18:15:00.000-07:00

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.

Lost in Translation

2008-06-22T21:50:00.000-07:00

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."

2008-06-22T09:41:00.000-07:00

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.

On top of the world

2008-06-17T22:04:00.000-07:00

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.

don't give in

2008-06-11T21:33:00.001-07:00

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.

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

2008-06-09T11:52:00.000-07:00

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.

Anyway!

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.

Giving Advice

2008-06-08T16:02:00.001-07:00

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!!

Sometimes its painful being a med student

2008-06-02T13:17:00.000-07:00

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!!!

selling my soul....

2008-05-22T22:18:00.001-07:00

So in continuing themes of hot debate, I decided to discuss the whole pharm rep thing this week.

I started my family rotation---I'm at a clinic on the south side of town which means I see a lot of patients who do not have much money, especially for medications, and most of them are on 4 or 5 chronic meds. This gets pretty pricey. In starting this year, I signed a pharma free pledge, meaning I wouldn't except anything from pharm reps except for information. I lasted 3 weeks before I accidentally ate a breakfast that was hosted by some pharm company ( I had no idea at the time). Since then, I've had a couple of lunches here and there. As much as I hate it, I am broke, and its nice not to have to buy my lunch everyday. But at the same time I know it increases prices of the meds to my patients.

Apparently, at the clinic I'm working at they have pharm lunches everyday. The entire staff partakes. Today was a half day for me, but the person I was working with really wanted to "support" the pharm rep because "it must be really difficult to be a pharm rep." So I stayed. I wanted to see this person eating up everything they had to say as well as their free lunch. We got our food, sat down and started munching away while the pharm reps asked the doc how she was doing, what her plans were for the summer, how her kids were, etc. I finally piped up and asked how their bisphosphate drug compared to calcium and vitamin D supplements. They quoted a couple of studies and then discussed how pharm reps weren't allowed in several clinics around town, and how this was the detriment to medicine. I didn't really listen then---It was the first time I've ever questioned a pharm rep---I usually run for the hills, worried I will be consumed by the ads and free pens, but I have to say, it felt good to ask questions---kind of like it does while I'm in class.

I hope to never sell my soul, but to continue to question. I hope to not rely on drug supported lunches someday. But for now, while I'm broke, I'm going to eat and question.

To be remembered by our patients

2008-05-13T17:53:00.000-07:00

Yesterday we started the conversation of to circumcise or to not circumcise. It can be a pretty serious debate between physicians as well as families. (has anyone seen the scrubs episode??) But there are some real medical advantages such as decreased incidence of childhood phimosis---a condition where the male foreskin cannot be retracted from the head of the penis. (phimosis is normal in infants, but pathologic in children or adults) The real problem is when phimosis gets infected or if paraphimosis occurs. And its the treatment of paraphimosis thats the kicker.

This brings me to the title of this blog. Its wonderful when patients remember you and have nice things to say about their doctor. Every doc wants to be remembered for something. The treatment for paraphimosis can be circumsion or it can be done the hard way. This entails 4 people to hold the kiddo down. Then one person grabs the foreskin and forcefully pulls it down. This results in mild to moderately bleeding, and a severely traumatized kid. A doc described the aftermath of this treatment: He was walking down the frozen food isle in the local grocery store about 6 months after treating paraphimosis on a 4 year old uncircumcised kiddo. The kiddo took one look at the doc, grabbed his penis, and ran screaming toward his mother. The family actually had to change doctors because the child was so traumatized.

And we say we all want to leave an impression on our patients.

Looking back

2008-05-03T11:11:00.000-07:00

I remember back to my first few months of medical school when I was studying neurology. It happened to be one of my toughest classes in medical school, but at the same time I remember thinking the brain is amazing. This was also the time that I thought medicine was amazing and that we could heal all.

I attended a wedding that fall and met a friend of the family who had a 12 month baby. He was adorable. His mom told me he was recently diagnosed with cerebral palsy (CP). I quickly searched my my mind for that disease, but my mind was blank. I hadn't learned about it yet. His mom found out I was in med school, and typically started asking me tons of medical questions about CP, to which I knew none of the answers, but feeling reassured that medicine could save all, I told her that neurologists were doing amazing things these days and I was sure there would be an answer for her. I went back to school and looked up CP in our huge neurology book, and found that it didn't exist in there. I let it go and completely forgot about the whole thing.

Until now.

I've seen several CP kiddos in clinic and in the hospital. Although the severity of the disease is different for each kid, the prognosis is not good. I feel horrible for dropping the ball on that cute kid I saw 2 years ago. I had no idea what his mom was experiencing and I just played the "everything will be alright" card without really thinking and then moved on. I am sorry.

Billy Rubin

2008-05-01T21:35:00.000-07:00

Today we had a 2 day old kiddo come into the hospital because of increased bilirubin levels or a fancy medical term that I've been known to use---hyperbilirubinemia. The treatment for increased bili is to expose the kiddo to UV lights. It binds up the free bilirubin and takes care of the job.

The two other med students and I, plus a resident, and a nurse went in to meet the happy couple and the brand new baked-duck-to-be. One of the main reasons why this disease occurs is because of dehydration. Mom and dad were pretty freaked out, but were eager to learn how to breast feed their kiddo better. The resident had mom de-gown and show her what she's been doing during feeds. The resident was explaining how to engage the entire breast to help the kiddo out, while we stood behind her trying to get a peek of what was going on. Dad just kept shouting "Stick the whole thing in her mouth!" "Stick it in her mouth!" "Just stick it in!" I would have loved to be a patient on the other side of the curtain.

Bacteria infested humans

2008-04-21T06:10:00.000-07:00

After 2 weeks I am still loving peds (whohoo!!). But there is something to be said about the bacteria infested little buggers they are (booo). It is quite known to the med school population that the pre-adults are notorious for getting the med students sick. Some how the residents and attendings have built their immune system up so well, that they are resistant to every bug there is out there (somehow I must market residents and attendings as antibiotics....). As students we are sent in to look at the throats, check the ears, and sometimes, see what color phlegm it really is. And just as your telling your three year old tike to stick out her tongue and say "agghhhhh" she decides its the perfect time to sneeze or cough.....right into your open mouth, because lets be honest, you're saying "aggghh" with her.

Yes, after only 2 weeks, I've come down with a sinus infection.

But I am still really excited for work. :)

rash

2008-04-14T17:07:00.000-07:00

Last week I treated a 2 year old girl with a diaper rash. The kiddo had a rough social life---she was living with her parents when they got charged with drug trafficking. CPS got involved and she was put into a foster home. She is now currently living with grandma & grandpa (they just got custody). The attending and I took a look at the rash, and although it was difficult to get a good look (grandma had coated it with Desitin) we thought it was infected with staph/strep and wrote her a prescription for some meds and told the family to bring her back if the rash got worse or didn't go away.

The rash didn't go away. Today we were able to get a good look because grandma purposefully did not cover it with any meds. Today it did not look bacterial. Today it looked viral. This means one thing---genital herpes. Which means, most likely, this kiddo was sexually abused.

Today I hated adults.

Kiddos

2008-04-12T09:05:00.000-07:00

This week I started my peds rotation. After the last month of Eternal medicine, I thought I could no longer enjoy being a medical student and going into the hospital. I was wrong.

Pediatrics has lifted my soul. Every day this week I was excited to go into clinic and do anything from well child check ups on 4 day old kiddos to 16 year olds with pink eyes (oh and a burning pain while urinating). I haven't felt this good to be doing something since being in an OR, and I am not getting yelled at by anyone!

Oh and I call kids, kiddos. A fourth year once told me that if you have a "positive kiddo sign" (meaning you use the word kiddos instead of kid or child) then you're most likely going into peds.
Well, I hate to continue to contradict myself, but I am back to thinking emergency peds might be my route of choice.

Wear and tear.....

2008-04-02T23:26:00.000-07:00

In medical school we are taught how the body works, how the body can break down after diseases, and how we can treat the body. In a completely different class and mind frame, we are also (supposedly) taught how to deal with the patients soul-- asking open ended questions, bringing up end of life issues, and offer anything that will make them more comfortable while at the hospital (within reason, of course).

Meanwhile we, as physicians, as medical students, are to check our own lives at the door. Any situations that may be going on at home---emotional, financial, even our own sickness---is just not acceptable. In any other job, this would be irrational, but for some reason, in ours, its not even thought over twice. So I guess that it's not surprising that at this point in our short career---as third year medical students---we are all feeling the wear and tear of this process. The process being, weighing the importance of taking care of ourselves vs taking care of our patients.

I think we all started this year eager to learn, ready to go the extra mile. Now we're exhausted and are finally hitting the repercussions of letting everything else besides the hospital go--we're paying bills late, forgetting relatives birthdays, and letting the stress build. Conversations now start with "back before med school" or "a couple of years ago, you know, when I had a life". I look at some doctors now and think it might just get worse. I am not sure what the answer is to fixing this situation.

bad jokes

2008-03-24T23:00:00.000-07:00

"A Pharmacist handing a prescription to a customer: 'Take one of these every four hours, or as often as you can get the cap off.' "

telling it like it is

2008-03-21T16:43:00.000-07:00

So this week was my first week of letting myself say, "I'm going into surgery."(yes I have issues) And I am not going to lie---there was actually a wave of relief when I said it out loud. I was always an indecisive child, but when I would finally make a decision, I'd get a sudden rush of just feeling right in the world. And I would know that I made a good choice. Saying it out loud, well, was kind of like that.

Over the next couple of days I let the surgery idea sit. I wanted to get to the bottom of why I can't commit to it. And I now know why I hide from surgery. Here's the brutal truth.

1. I am scared of the hours. I'll be honest, I am a morning person. Most of my friends find it very annoying how much of a morning person I am. But I also like my wind down time at home, maybe with friends, maybe alone. So I while I'm not scared of the mornings, I wont make it without my personal time. Plus I dont want to be alone for the rest of my life. What kind of husband and/or kids could put up those hours?

2. The idea of associating with surgeons with the rest of my life is unsettling. Surgeons don't always treat other people nicely (understatement of the year) and I dont want feel like I need to defend them because I am one. I know there's an awful story for every type of doctor out there, but surgeons seem to have a lot of them.

3. I am afraid surgery life will make me become angry and mean. This is a continuation from #2. But its true. I worry about getting hard. I am usually a pretty bubbly person. I dont want to lose that.

4. My dog will hate me. (as will my parents, sister and brothers) Being on call every 4, 5 or 6 nights means my dog will have to chill at home alone a lot. I would definitely feel guilty about that one.

I know I am supposed to make this decision for myself. Its supposed to be what I like to do. But all these other things start messing with my head and then I sorta loose sight of what I want. My good friend, C, reminded me of the first C-section that I scrubbed into. I had completed surgery 6 weeks prior. As soon as I scrubbed in and stepped up to that table, I got a rush of excitement and then a sudden peace like I was supposed to be there. I felt amazing. Lately, going through medicine, I had forgotten all that. Thank goodness C reminded me.

"Because the underwear is pulled up from the back until ... it wedges in."

2008-03-15T23:36:00.000-07:00

Being in outpatient medicine means you get to experience a day-in-the-life-of each specialty. Last week I was at rheumatology clinic which usually means a lot of arthritis and back pain. I got to see this interesting case of ankylosing spondylitis--which is basically an arthritis of the spine which will lead to fusion of the joints. Its pretty painful and debilitating.

I went into the patient's room with my attending, who is this bubbly middle age woman who is so awesome that by the end of the day you actually consider rheumatology as a field to go into. After introducing the patient to the doc, the doc wanted to show me some key features of AS. She had the patient stand with his back facing her while she attempted to untuck his dress shirt, which was tucked into his pants a top a white undershirt. She freed the dress shirt, but the white undershirt was really stuck in there and she just kept pulling and pulling and had it almost to his arm pits when we both suddenly realized that she had grabbed his tightie whiteys, and instead was giving him the largest wedgie ever. Meanwhile the patient did not utter a single word, as if this was a standard of care and it occurred at every doctors appointment. Both the doc and I turned bright red, apologized and gave it our best shot at keeping the laughter to a minimum.

For future clinics, I apparently need to work on keeping the laughter to a minimum.

the answer is in the urine

2008-03-11T22:23:00.000-07:00

On a recent camping trip my friends and were discussing a book that I had meant to bring with me called "Why do mean have nipples?" Its a fascinating book, about all the crazy things patients want to ask their docs, but are too afraid to bring up until their third martini. And before you ask, no, I'm still not sure why men have nipples.

The discussion lead to why asparagus makes your pee smell awful. Well low-and-behold, the second question is aimed at answering that!

"Asparagus contains a sulfur compound called mercaptan. This is also found in
garlic, onions and in the secretions of skunks. The signature smell occurs when
this substance is broken down in your digestive system. Not all people have the
gene for the enzyme that breaks it down, so some people can eat all the
asparagus they want and never stink the place up. One study in Britain found
that 46 % of British people produced the odor, while 100% of French people
tested did. Insert your favorite French joke here__________________-."

we need a doctor joke

2008-03-09T20:54:00.000-07:00

A patient complained to his doctor, "I've been to three other doctors and none of them agreed with your diagnosis."

The doctor calmly replied, "Just wait until the autopsy. Then they'll see that I was right."

Time after time

2008-03-07T07:39:00.001-08:00

When I envisioned being a doctor, I dont think I really realized how time consuming it would be--in almost every field. I pictured going into work, doing some things for a little while (aka helping people) and then leaving it all behind and going home. But until last year, I also thought doctors made about $50,000.

When you talk to the last generation of docs, they are shocked we new docs want a life outside of the hospital. They were bred to live and die by that hospital. While somehow, someone, told us or showed us a life separate of the hospital, and all of a sudden we wanted it. Who wouldn't? This also means, we new docs will always be the less dedicated, less interested, and less helpful if we actually slept 6 hours and maybe went out to dinner. Which is always interesting when the old docs start bitching about how many times they've been divorced.....

But I have to say that even though we've been told or shown this outside life, the old docs and the hospital do a pretty good job of sucking us in anyway. I just finished two months of inpatient medicine. Two months of being on call every 5 days, working 6 days a week, spending ridiculous time at the hospital. As much as I fought it, I got into a pattern and it was just a way of life. This week I switched to outpatient aka the sweet life. I told a non-medical friend how happy I was to get 2 days off each week when they replied, "You mean like the rest of us? You're excited to be normal?" Yeah, I'm excited to be normal.

Becoming a patient

2008-03-03T18:37:00.001-08:00

I recently had the opportunity to experience our health care system from the eyes of a patient. Lets just say, it wasn't pretty.

The other morning I was finishing a shower, when I started feeling really hot and lightheaded. Worrying about passing out, I got out of the shower, and called to a friend who happened to be over. I walked back into my bedroom, sat on my desk chair (my dog happened to be sleeping on my bed) and tried to take some slow deep breaths. Whatever was happening, was progressing, and I remember saying "Please don't be scared." I then slumped back into my desk chair, went unconscious and had about a 15 second seizure like activity. All of which, I have no memory of. I woke up and, although scared and very embarrassed, was doing alright. But to be on the safe side, I went into the emergency department to make sure.

They were able to get me back really quickly (one of the perks of being in the medical field!), but they set me up in a hallway bed which was a bit annoying since I know a lot of people who work in the hospital---Emergency docs, surgical residents, med students, medicine residents, psych residents, etc. All were stopping to ask how I was doing, very nice, but embarrassing. Luckily I was put next to a very entertaining psych patient who kept me and the family all entertained while I waited 5 hours for blood work, urine tests, EKG, Chest Xray, Head CT and a neuro consult. After all that I was diagnosed with a syncopal episode which lead to a seizure---a very lucky diagnosis because it means I can still drive. (if it was a seizure event I wouldn't be allowed behind the wheel for 6 months!) The bill?? Still undetermined until I hear from my insurance company--but I'm interested to see what that'll cost me.

All in all, not a fun experience. But those folks in the hospital took good care of me. I know its not that way for every patient, but I hope it is for most.

Surgexperiences

2008-03-03T07:35:00.000-08:00

Hey everyone---

Check out Surgeperiences 116 @ other things amanzi! My blog about Slash was added to the list---thanks for including me!

ding!

2008-02-18T08:19:00.001-08:00

I think my attending said it best to me at the hospital yesterday.

"We're not actually treating any of these patients. We're just trying to keep them from coming here."

And it hit me like a ton of bricks---there is so much in this life that I cannot "fix". It is something that I struggle with quite often. Therefore professionally, I want to fix.

Here I come--surgery, emergency or OB!!!

can you grab the knife in my back?

2008-02-14T18:13:00.000-08:00

So I started this post back when I was on surgery and didn't want to finish it because I was worried about offending someone, or calling someone out, but after the last few weeks I've decided its important to say.

Med students do not always have the best intentions for other med students.

Take my dear friend, Joe, who was brutally f-ed over by a fellow med student, Kristi. She told him all he needed to do in the morning prior to rounding was to get vitals on every patient. So thats exactly what he did. Imagine his surprise when the attending lashed out on him when he didn't do a physical exam or find out why the patients needed surgery.

Or how about when my friend Alexis was working with John on medicine. They were on call together, and their team told them to go home for the night. John acted like he was going home in front of Alexis, but turned around (after she had left) and stayed the night, bonding with the residents to screw her over.

The worst is the med student who talks to residents about a fellow med student--in a not-so-positive-way.

And heres the other thing. As third years we are graded both subjectively and objectively--its to the benefit for some and to the detriment for others. As for my personal opinion---it can stink. You work your butt off to get a mediocre eval? Thats not good. But truthfully, I sometimes have a hard time with standardized tests, so to be praised for my hard work and have descent test scores is rewarding.

Plus! When did we stop being happy for one another? When did we stop saying "Congrats!" to a fellow med student when they found out they rocked a test? Or when did we stop saying good luck to other students prior to tests? My first year of med school I made over 400 good luck notes to each classmate---and I sincerely meant it. We're all a team here---we can do this by ourselves and be miserable, or we can work as one and succeed together ---even if it's just one of us succeeding at the moment. I miss that in my fellow students. Lets see more of that.

yeah, he's gonna die

2008-02-09T18:52:00.000-08:00

So maybe I'm just a bit too sensitive lately. Or maybe I'm just too much of a novice, but lately the phrase "he's going to die" is really starting to tick me off. My next thought is "do something about it!!" Which is weird because when we're in the patient's room and they're on death's door, all I can think is man, I wish someone would help put them out of their misery.

So I guess I'm really conflicted with the whole death thing. On one hand I think we should do something when the patient is headed in that direction (that is definitely the surgeon mind in me). And on the other, if they are elderly and can't do anything for themselves, I think why is physician assisted death so bad?

I think the other thing my attendings have failed in mentioning, or perhaps even doing, is when a patient is on death's door and it seems like we're not doing anything to prevent it, its a really good time to talk to the family, make sure the patient is comfortable, if there is anything the patient would have wanted in those final days, and work on those kinds of things. Otherwise it seems like getting that final CT of their abdomen really isn't that important anymore.

frusteration builds.....

2008-02-01T15:32:00.001-08:00

Recently we got a patient who is well known for leaving AMA (against medical advice). She continues to pop her hip out of place, get surgery, and then just when we're about to send her to an inpatient rehab, she leaves AMA. This has happened 4 times. None of the nurses like her; the case manager is ready to pull her hair out when we ask her to find placement; and now the surgeon refuses to fix her hip again.

Now I can understand the frusteration. I can't imagine doing this over and over and over and over. But guess what? Thats what we do anyway---its just on different patients. So part of me thinks, just suck it up and do your job. We're here to help people. That's what we signed up for. Residents, nurses, case managers get paid the same amount every year and it doesn't matter who we help, how many we help, etc. So you can understand why I got tiffed when the case manager said, "And just think-- Hillary Clinton is going to tell us we have to do this for everyone!!! Like hell I am! I am retiring if that happens."

I guess I just don't understand why it matters. People could care less if a medical student delivers their baby, and yet, the idea of everyone having an oppertunity to get well again by having health care available to all, absolutely freaks people out.

A person is a person is a person. Now make the f-ing phone call and get Ms AMA inpatient rehab.

why health care cost so much....

2008-01-25T16:31:00.000-08:00

In continuing a story about Larry (see previous post) I thought I'd give a little more information about his 4 night stay with us in the hospital. He is a 40 something year old obese male with congestive heart failure (CHF), acute renal failure, and a possible GI bleed. Our work up for the GI bleed on day 1 was to do a fecal occult (checking to see if his stool had blood). On day two we got the results---it was positive. So we scheduled a barium enema for the next day. That night Larry needed to drink about 4 liters of "go lytely" which washes your whole system out. I spoke to the RN to see when he should start, they suggested 5pm. So I wrote the order to start at 5pm and then for him to be NPO (ie nothing in the mouth) after midnight---standard orders before this procedure. Well on day 3, I went to visit my friend Larry to discover he had only finished half of his go lytely. Why ? you might ask. Apparently he was sleeping at 5pm and the RN didn't want to wake him. He started the 4 L at 8pm and wasn't able to finish it before midnight---at which point the RN made him NPO. This means no barium enema for Larry. Frustrated, we kept him NPO that day and had him finish the go lytely and rescheduled for day 4. On day 4 he he was ready to go, but we get a call from radiology saying he is too big to even fit in the CT machine. No barium enema for Larry ever. What do we do? We discharge him and tell him to follow up with his outpatient physician.

Gotta love our health system.

taboo

2008-01-24T14:50:00.000-08:00

The Health Insurance Portability & Accountability Act or HIPAA was established in order regulate group health plans so they do not accept or deny patients based on their genetics, medical history, etc. It does allow group health plans to refuse pre-existing conditions under certain measures. This stinks for the patient. But the main way it affects doctors, nurses, medical students is the privacy act--which basically means: do not discuss patient information in the elevator, the cafeteria or the hallways. SHHH!!! So how do we get around it, you ask??? By practicing our Taboo skills!

Taboo--one of my favorite board games--helps us master our talking about the patient without actually saying the patients name. For example if we need to "run the list"* in the cafeteria, we just start with the first patient as "the guy who suctions all his breakfast out of his mouth." We immediately know its Bill** on the 4th floor. Or if we need to jump ahead to "the guy who can't fit into the CT machine" we all know we're discussing Larry**, and we can proceed in a timely matter, while filling our guts with awful cafeteria food.

I am so glad I've had younger siblings who were into board games, otherwise I may not be good at avoiding HIPAA violations as I am today.

* running the list is probably one of the most important things you do in a day. and trust me, we do it probably 2 or 3 times per day. its when you discuss patient by patient what else you need to do before you can escape from the hospital.
** you thought you caught me! But I'm too clever---this name is made up to protect the real suctioner and large man.

Deflated

2008-01-19T16:34:00.000-08:00

I am deflated. I dont even know if thats a word, but I'm using it. My 31 year old female pt, the one who had nausea and vomiting for 2 months along with a growing liver and jaundice, has sadden me. She came in to the ED (emergency department) last week complaining of seeing yellow. With no past medical history, she denied any blood in her vomit, denied taking any vitamins, denied IV drug use, and said she rarely drank alcohol. She denied this everyday for a week. (I like to triple check) So we started working her up for hepatitis and cholecystitis.

Everything came back negative. I mean everything. She had a CT, MRI, HIDA scan, MRCP which just showed a fatty liver. We ran almost every autoimmune liver disease possible. Finally we had no choice but to take a liver biopsy (which was pretty cool---it was a transjugular IR bioposy). What were the results you ask? Alcoholic hepatitis.

At first I thought they mixed up the patient's results. But my resident said it was definite. I couldn't believe it. I had forgotten the first House, MD rule: "Everybody lies." or "I dont ask why patients lie, I just assume they do." When confronted, she said "Oh I am just so glad it was something as simple as that." She must have known the whole time. Or she is in incredible denial. Either way I was deflated. If I can't trust my patient then what is our purpose?

The beginings of medicine

2008-01-14T22:10:00.000-08:00

So I'm currently in week 2 of a 12 week process, or what we call medicine rotation. I am following 3 patients, we're currently on call Q 5, meaning every 5 nights we're on overnight call, and my residents are fantastic--they teach, they're friendly, and I wouldn't mind hanging out with them outside of the hospital. But when people ask me "how was your day?" a response hasn't really jumped out at me. I guess I'm just sort of blah. I feel like I am going through the motions. I'm not bored at work. I am tired. My patients are interesting. I enjoy figuring out what is wrong with them. But then...well...I am kind of over it. So living every day is just a way to get to the next. It sounds terrible. Like I'm having a horrible time, which is definitely not the case--I have been laughing all the time at work, but I think I need something else to spark the situation. It hasn't happened yet.

paging the resident

2008-01-12T20:37:00.000-08:00

its a ritual that occurs with each new rotation. we get a packet of information. we're told what is expected of us. and how often we will be spending the night at the hospital each week. they explain what is mandatory and what we can skip. and then we get a pager number and we're instructed to page our resident to meet up with our teams. We walk in a herd to the nearest phone and line up, single file. Each one of us takes a turn, dialing the 4 digit number and the rush of anxiety builds as we await for the return call. Will we look like a fool and be asked a thousand pimp questions today? Will we be scutted around the hospital? Or get lucky and leave early? What will really be asked of us? Will we get along with our team? Will lunch be involved at any point? Where is the nearest bathroom? Its these questions that plague our minds during the paging of the resident. Luckily the anxiety only builds for a few minutes, until they call back, we introduce ourselves over the phone (they either sound happy, indifferent, or bothered) and they tell us where they are and we leave the line of med students to join our teams.

holidays

2007-12-30T15:00:00.000-08:00

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

2007-12-13T09:06:00.000-08:00

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

2007-12-08T10:09:00.000-08:00

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

2007-12-07T16:45:00.001-08:00

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!!!

2007-11-28T18:31:00.000-08:00

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

2007-11-20T16:51:00.000-08:00

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??

2007-11-16T15:31:00.000-08:00

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

2007-11-15T01:06:00.000-08:00

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

2007-11-08T17:06:00.000-08:00

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!

2007-11-06T19:56:00.000-08:00

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!!!!

2007-11-02T15:59:00.001-07:00

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

2007-10-31T08:42:00.001-07:00

My favorite holiday of the year!!!!

HAPPY HALLOWEEN!!!!

ransacked

2007-10-29T11:50:00.000-07:00

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!!

2007-10-28T12:42:00.001-07:00

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

2007-10-25T20:10:00.000-07:00

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.......

2007-10-23T11:27:00.000-07:00

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.