Wednesday, December 30, 2009

the boredom finally hits me...

so i'm still in sick recovery...i've nearly cleaned up my room. i've explored all of facebook and read SDN way too many times. (i know, i'm a super nerd for enjoying the SDN forums. hee hee...) i've made bread pudding, loaves of bread, shrimp bisque, mushroom linguine, and fantasized about other items i want to cook. i've replenished my liquor and wine supply and watched enough food network to drive anyone crazy. i've caught up on all the "teen mom" episodes on mtv...don't judge me, i love that series! but now i think i'm bored. i want to go back to school, but not really. still haven't really cemented new year's plans, but that's ok.

i did some shopping yesterday and got some on sale sweaters. that makes me happy. i did get a wallet and BOOTS. everything else can wait...can't do too much at once. i could do laundry. oh yeah, and the ironing...blugh.

alright, fixing up lunch and then will deliver it to H. fun stuff!

Monday, December 28, 2009

happy holidays and oh yeah i'm sick

this happens to me every time we have an "extended break"...i get a cold. alas! for the past few days i've been runny nosing, sneezing, coughing (productive), blah feeling...alas. i thought i shouldn't get RSV again after having it with the children, so maybe an adenovirus? blah!

holidays were nice...got to see all my friends and H's friends and respective families. i am the proud owner of black pumps and whatnot...my mom went a bit overboard in getting me professional shoes but methinks it's ok in the long run. i'm waiting on K to be done with her morning stuff so we can spend the day shopping and possibly lunching. (i need to return one of the black pairs of shoes for brown...i always forget about BROWN!) i'm keeping my eyes open for cardigans (i'm old), tights (i'm regressing), sweater(s) for H, and whatever else catches my fancy. oh, a wallet. a part of me would love a charcoal gray nice winter coat that i could wear to interviews and nice events...so maybe i'll look out for that too. but mostly it will be nice to travel about town with friends and window shop.

this week i'm hoping to get back to school and volunteer some hours on L&D. i liked it, but am i liking surgery more? i also need to do a thorough cleaning/organizing of my apartment. it's my goal before the new year begins to have a clean apartment! ha, wonder if it will really happen...

sorry posts have been sparse, but i'm on vacation. ha!

Monday, December 21, 2009

on vacation!

two weeks of doing NOTHING unless i want to do something. christmas shopping is done and wrapping almost complete.

i really enjoyed plastics...i think i would love being a plastic surgeon for reals!

now i am going to lay on couch and watch tv, or nap, or whatever. i don't have to do anything! well, except get my tire patched. it's currently got a nail in it, alas...

Sunday, December 13, 2009

gangrene is the worst smelling shit ever

yesterday i was on call again...7 am to 7 am sat-sun. no prob. it was pretty slow, actually. first page was an alpha (which means get your butt down here NOW)...unfortunately the patient had already expired en route but the ER went through the ACLS code algorithm anyway. it was surreal...strange to watch, but at the same time i needed to watch it. first code i've witnessed as an med student. then we had some really long stretches of nothing. i knitted a lot, and i think i'm nearly done with my scarf. (i've been knitting this thing for about 3 years now i think.)

i went to bed around 10:00 pm or so, and wasn't paged until 4:30 am! i can't believe it! i actually woke up every few hours out of instinct i guess to check my trauma pager to make sure i hadn't slept through anything, but i'm really good at waking up to outrageously loud annoying beeps. i keep the pager right next to my head while i'm sleeping so i wake up pretty quickly. evidently there were 2 surgeries that were about to go: an open appendectomy and debridement of fournier's gangrene.

the open appy was already rolled back, so my call partner scrubbed in that one since i had already scrubbed in a case. so i waited for the fournier's. basically that's when a dude's scrotum and associated area becomes infected with GANGRENE and turns black...it's a total emergency and the only solution is to cut all the nasty out. omg, when the patient was finally rolled back, the stench was AWFUL. i can't even describe it...the worst smell ever, like poop and sewage sludge and rot and dead stuff all rolled into one. one of the residents told me to remember that smell because "that is the smell of death" because, well, the tissue is literally dead and rotting away. it was blackish brown and dripped juices. i even put cinnamon oil on my mask to help deaden the smell and it DID NOT work! everytime we had to move the patient, a waft of horrible stench would come out on top of the base layer of stench. the fifth year resident who went to task debriding the wound, well, he has a nose of steel. i couldn't have done that. i had to step back and just hold my gag reflex in check. (one of the ER nurses earlier told me "now you get to decide whether you want to dry heave or blow chunks!" in response to my musing of whether or not i should grab some food before the case.) the sight of it was gross, definitely, but the smell. omg the smell. ugh. the trauma attending goes MED STUDENT GO IN THERE AND HELP OUT! then he laughed. so i did just that, took some scissors and cut out a chunk of foul, dropped it in the bucket, and then said "ok, i'm a pansy, i can't handle it. look, i got juice on my hands (gloved, of course), so that means i experienced it, right?" the attending laughed some more and was like "ok you're good, but the smell, it's nothing!" then he took his mask off and sucked in a HUGE BREATH...everyone in the room just groaned. he must have a defective nose or something. so after that, i just stood by the scrub tech's table and watched from afar. after about an hour of torture, a different resident asked me to scrub out and print out some admission orders, which i gladly did, and then it was time for me to leave (thank goodness).

the worst part about it all? the smell seeped through my gloves and got on my HANDS. no juice on my hands, but the SMELL. omg. i had to wash my hands so many times to just get rid of the smell, and i'm still having horrible thoughts about the stench. i hope the patient is ok, but in reality, he's not going to be ok. he was really sick going into the surgery, and from what i could tell, he'll end up with a colostomy (where he poops in a bag outside his abdomen) and some sort of stent or tube or something in his bladder area because even though i couldn't see the penis (due to the ginormous scrotum that was all swollen with infection), i can assume they probably had to cut it off or do some serious damage to it.

so note to self: keep all your parts clean! stay as healthy as possible!

after i got home i had some breakfast with H, read some magazines for free, visited with K, napped, gymmed, and ate lunch/dinner. i suppose i should read some now. one more week of plastics then 2 blessed weeks of winter break! yay!

Thursday, December 10, 2009

plastics

just a quick check in to say that I LOVE PLASTICS! it is SOOOOO COOL! tomorrow i get to see a tummy tuck and breast reduction surgeries, but this whole week has been pretty much non-cosmetic stuff. reconstructive. hand surgeries. SO NEAT! and wound care...skin grafts! this week i got to use the bovie to cauterize blood vessels and use a scalpel to take off granulation tissue and use a dermatome to make skin grafts! how much fun!

so yeah, just wanted to let y'all know...also on trauma call again on saturday...wonder what else i'll see...!

Sunday, December 06, 2009

first trauma call

trauma call was interesting, fun. the weather was appropriately icy so we basically just had car crash victims. scrubbed in an abdominal aortic aneurysm repair! super long, blood squirting everywhere...even got yelled at by the attending but who cares. didn't really bother me because he was screaming like a toddler for a piece of equipment that wasn't going to be life or death at that moment. but now i know what it looks like, ha. won't dilly-dally for 10 extra seconds next time. not my fault the scrub tech couldn't get to it...don't put the retractors next to med student! got to do a lot of peds surgery consults too. dare i say it...i really enjoyed peds surgery! i don't want to move on. if you told me that i had to be a pediatric surgeon, i think i could do it. it just takes so long to get to that point, and it's so competitive...and i'm so NOT competitive at this point...oh well. next up is plastics. (this is the kind of stuff that gets me down sometimes...i know my path through med school happened for a reason, and i feel like i'm a better person now for it, but i feel like it's going to really limit me when the time crunch for residency selection begins. who knows. blah!)

so i spent the majority of today sleeping after i got home. now i'm craving a pb and j sammich. i think i'll make myself one and then lay on the couch some more. i've been so lazy, which is nice for once. i can't wait for christmas break...i want to get back to the L&D suite for a few hours, but really i'm just getting more and more confused. i feel like my personality fits in more with the surgery females moreso than the ob/gyn females, but blah. it's still too early in the game.

enough of this! eating time...

Thursday, December 03, 2009

woo!

today was super cool! surgeries were long, BUT, wait for it...

I HELD A KIDNEY IN MY HANDS! AND IT HAD A WILM'S TUMOR IN IT! OMG OMG OMG!

we had a radical nephrectomy case for a kid with a humongous wilm's tumor (that had been shrunk significantly by radiation and chemo). i got to see this kid a few weeks ago when i was on peds hem/onc. the tumor then was so huge you could plainly see it sticking out of the abdomen. in general, wilm's tumor is very curable, and the type this kid has is a "better" subtype, if that makes any sense.

tomorrow is a CHOLEDOCHAL CYST REMOVAL! even more rare than wilm's! omg omg omg! i am super stoked! evidently that was in clinic...alas!

am i weird in that i'm actually excited to be on call (not really excited, but more looking forward to being able to suture, or hopefully suture). haven't done much on peds surgery because they don't like us students to "practice" on babies where everything is so precise. i don't blame them. i wouldn't want an M3 practicing/learning technique on my baby...but i'm still learning so much by watching. but on call, maybe there's some lac or something that will need to be sewn up that an M3 can do...i've been practicing my knots and suturing this week...i've sewed on a lemon and a magazine (it was just laying there).

ok, bedtime. i should have gone to bed at 8:30, alas. didn't see the sun at all today. 13 hour days are grueling...

Tuesday, December 01, 2009

what i did today

today i got to school at 5 am. i left at nearly 6 pm. fought traffic all the way home. my feet hurt. but today was AWESOME! i was the only med student there, so that meant i got to scrub into everything. still haven't been able to do anything past retracting or cutting sutures, but it's super cool to finally see stuff i've only read about in notes, etc.

surgeries i scrubbed in today:
  • chemoport placement
  • another chemoport placement
  • laparoscopic liver biopsy and g-tube placement
  • anal polyp removal
  • omphalocele removal and belly button creation
  • umbilical hernia repair
  • exploratory laparotomy (and i got to feel intestines for the first time)
super cool. i'm really enjoying myself...i can't wait for when i finally get a chance to do something more, but for now it's really fun to watch. i like scrubbing in...i know, i'm weird. haven't been asked too many questions, and my team is super cool. they've been so nice to me so far...just don't want to disappoint, ha.

Sunday, November 29, 2009

thanksgiving was awesome

four days in a row of not having to be at the hospital. wonderful. however, that bubble will be busted tomorrow at 4:30 am when my alarm goes off. pediatric surgery has been going well so far, all 2 days of it. i'm bringing my leftover carrot cake tomorrow for the surgery residents, and if i can get my butt off the couch i will be making some bread today as well. i should also gym since i ate an obscene amount of food the last few days. i just want to nap.

tomorrow is the last day that i will have M4s on my service. starting tuesday (december 1), i will be the only med student. aak. that means i scrub in on everything, or close to everything, and have more work to do. but that's ok. i think i can survive? only 3 weeks until christmas break! woo!

i suppose i should resist the nap urge and get up and do stuff. ugh. i want a couple more days off!

Saturday, November 21, 2009

golden weekend

just chilling. it's kind of nice. reading for fun. sleeping in. tomorrow me and H are going to a food festival a few hours away. i plan on plumping up as much as i can. woo!

some of my friends have given me excellent advice for surgery. another friend gave me some sutures and needle drivers so i can practice. i got some books too. just overall kind of nervous.

it's weird, i'm not really missing peds. maybe i will once i get into surgery more, ha, but i don't feel like i'm missing out on the fun stuff like i did once ob/gyn was over. we toured the NICU on thursday, and that is a very sad and strange place. it's weird, when i was in high school i thought i would like to be a neonatologist, but after seeing all those tiny babies and hearing that "necrotizing enterocolitis is par the course", i'm like, PASS. is it really worth it? i know i'm not a mom, and maybe that will all change if i ever have kids, but i just don't know. alas...

i saw some ob/gyn residents the other day and they remembered me and asked when i was coming back. that made me really happy. i don't think the peds residents would have been the same way with me. it just seemed like on peds the students were more of a nuisance or something. at least to me. i dunno. blah!

i'm reading "delivering doctor amelia". so far, it's interesting.

OH, the "spirit catches you and you fall down" book club meeting was really cool. the attending who is our "leader" or sponsor or whatever, she went to medical school with some of the residents depicted in the novel. she was able to give us some excellent insight. that book really just stirred a bunch of emotions in me. i found myself at various times so upset and angry, and especially angry at the two pediatric attendings at the hospital that this took place. turns out they are "awesome" people, but i dunno. it made me really angry at the medical people, and especially doctors. i guess it just made me realize that i personally need to watch myself and my thoughts because i do not want to end up being a doctor that patronizes my patients and whatnot. and i can already tell that i have to catch myself from having really jaded thoughts towards certain types of people. alas. it just all makes me confused sometimes. people in the world say that being a doctor is like being on top of the world because doctors are "rich" and "powerful" and whatever, well, there's so much pressure because you can get sued at any moment or what if you make the wrong decision or what if the patient just hates you and sabotages themselves...what then. alas. too much thinking.

i'm excited about thanksgiving. it's my favoritest holiday of the year. i'm making pumpkin pie and carrot cake for my family's house. and some cranberry shortbread cookie bars if they turn out better. prototype 1.0 turned out ok, but not to my liking. too tart, needs to be more sweet. then it will be time for mucho gymming afterwards. hope my stomach doesn't pop.

Wednesday, November 18, 2009

nursery week

this week i get to stare at babies who lay in cribs. some of them are cute. some have weirdo freakazoid parents. alas. such is life.

i saw a boy get circumcised this week. OUCH! but i will say that they did a nerve block and everything, but it did look brutal. i'm still going to circumcise all my future sons if i have any! better to do it younger rather than older, and it really does have good health benefits. but still, ouch!

today i sat through a nearly 3 hour lecture on breast feeding. it was quite informative, but maybe a bit too informative? and long? ha. i will say breast is best. the vacuum pumps though, i pumped my arm to just feel how it feels and it is WEIRD. kudos to all those breast pumping moms because to have things sucking on your boobs has got to feel very odd. but i fully recommend breast feeding over bottle, or at least trying. no bad feelings for those that breast feed and supplement with formula, because i can imagine that it is hard to keep up. if i ever have kids, i'll certainly try my darndest to breast feed for the first 6 months (what is recommended, ideally up to 1 year).

only 2 more days of peds then surgery! aah! and i have a test on friday! aaaak!

Sunday, November 15, 2009

the best book ever, or at least a very good one

the spirit catches you and you fall down. by anne fadiman.

seriously, read this book. it's about a hmong family in merced, ca, and how they interact with the local doctors, community, and also about all the warfare they've had to endure. a cultural book, very striking. the author does a terrific job conveying everything.

i just finished reading it, and wow.

just had to post this so i would remember to talk more about it later. the ethics book club meets tomorrow to talk about it, so hopefully i'll make some more comments.

now i think i'll make an apple cranberry pie.

Friday, November 13, 2009

week recap

wow, have i not really blogged in over a week?

my bad.

i've really enjoyed this week...i've been on hem/onc clinic in the mornings and in continuity clinic in the afternoons. continuity basically means well baby checks and whatnot. hem/onc is great...say what you will about it being "so sad" and whatever, but the patients are so interesting. i've seen a kid with TAR syndrome (thrombocytopenia and bilateral absent radii...basically low platelets and missing arm bones), neurofibromatosis type 1, various sickle cells, and the best yet...one of my patients that i followed post-operatively on gyn! she had a tumor removed, i followed her for a few days after her surgery, and now's she's getting chemo at the hem/onc clinic. it was so nice to be able to see how she's been doing, and she looked so good. not that she ever looked bad, but being all bundled up in a hospital bed to dressed all trendy and whatnot, it was nice. and she remembered me. that really made my day.

also, i've gotten to do 2 LUMBAR PUNCTURES this week! and they were both clear champagne taps! woo! they were on kids getting chemo in their csf due to cns relapses, sadness. but i guess for the positive spin, i LOVED doing the procedures. yesterday i did my first one, and today the second. one of the nurses in the OR commented that yesterday she couldn't believe it was my first LP since i was able to do it so quickly and smoothly. well, today i got the needle in the right spot almost immediately, the attending was surprised and was like "i gotta hurry up and draw up my meds!" and the nurse had a look of shock on her face. a "good shock" look, but it made me have the biggest shit-eating grin ever. ha. not to brag on myself, but i was so very happy that everything went so well (times two!). i may not say the right things, but i guess i make up for it with my skillzzzz...ha! but i must say, it helps when the patient is sedated and of normal weight. so i had some advantages. i can't wait to do another one! who knows when that will be, alas. you just find your bony landmarks, angle your needle correctly, and go on in...if you hit bone, pull back and just angle your needle a bit more, take out the stylet and see if you have csf flowing out, if not, push a little deeper, and BAM! there you go. simple as pie.

so yeah, this week was really good. and i got to do some procedures and look in microscopes. maybe peds hem/onc is the way to go...ha! (but i wouldn't want to steal tiny letter's specialty!) regardless, i just find myself really enjoying the hands on stuff...surgery starts in a week so who knows, maybe i'll love it.

now it's time to go get some awesome frozen yogurt! woo!

Monday, November 02, 2009

evals and f$&@ RSV!!!

so i believe i have caught a delightful case of RSV...it is the season, after all. first it started off as the "feeling of impending doom", and then a slight sore throat, then after all sorts of halloween party exposures over the weekend, the doo-doo hit the fan and BAM i was sick. i was on call sunday and you know you're sick when every time you sit down you fall asleep if not otherwise occupied with important M3-like duties. today is better...i have more energy, but the sickness has evolved into the more classic upper respiratory gunky sinus one nostril is plugged at any given time phase. i am also sneezing. and coughing. i live for those brief moments where BOTH nares are PATENT! yes. also, it sucks to have to climb up and down stairs...the children's hospital elevators are the major suck so it's quicker to just climb 4-5 flights of stairs than wait. so i've been getting my gym on at school. this is also my last week of wards, and i'm kind of excited. because that means moving on to clinic. which means no more wards. which means no CALL. which means i am happy.

peds so far has been a double edged sword in a way...i enjoy being with the kids, i really do. i like the babies, even if they make me sick. however, it really saddens me to see the abused kids, and the ex-preemies who are now trach'ed and feeding tubed and whatnot living out some sort of strange existence. i know, these kids are someone's child and they are loved and have their purpose in this world, but at the same time, on some level it just seems almost wrong. i don't want to start an ideological/philosophical war, because i have never had children or suffered through horrible chronic diseases, etc, but it just seems wrong to try and "beat nature" or surpass "God's will" and prolong life when it seems that the most humane thing would just be to let nature take its course. i have had a couple of ex-preemie kids (like extreme preemie...like 23 weekers) who have such severe neurological devastation (so they are functional vegetables), they have a tracheostomy (so they breathe through a tube, most of the time there is oxygen being pumped into the tube as well), they have feeding tubes (so they are fed through a tube that goes into their stomach or intestines)...it just really makes me sad. these folks are in and out of hospitals for seizures, pneumonias, you name it. i have no idea what that family has gone through, or the decisions they have had to make, but i can't help and think that for me and my future family, i don't know if i'd want to "do everything possible to make life happen" if i happened to deliver a child at extreme prematurity. call me selfish, but i just don't see how that is humane to that child to keep them living when there is really nothing to live for. maybe they do have hopes and dreams, but it's hard to imagine that they do when they can't even interact with the world around them.

just some thoughts i've been having on that topic.

it's kind of hard to not wrestle with those tough topics when you see the patients every day. are we really doing good? for example...kid has some crazy something going on. they can't feed by mouth for whatever reason. ok, well, they need to eat. how will they eat? let's stick in a feeding tube. that tube goes in through the abdominal wall into the stomach. uh oh...now the hole in which the tube is inserted is leaking. oh, it's leaking stomach acid. now there's a ginormous hole in the abdominal wall and all the skin around it is disintegrating because of the acid. how do we fix it? also, how does the kid get nutrition? we got to stick more holes in the body to get to a vein to give some IV fluid nutrition, but that doesn't help out too much in the long run. then all those veins get clogged, and now you have clots that are threatening to go into the heart and lungs and cause some major damage. and you still have the ginormous acid hole in the abdomen...

another example...a kid who is deaf and blind and has a whole host of other neurological problems. why is the kid that way? mom had some sort of infection while she was pregnant, and the infection crossed over the placenta into the baby and now the kid is just a living vegetable. i guess the kid only knows if people are there because of touch. what kind of existence is that? no speaking capacity, can't even move, or see or hear...it's just tough to wrestle in my mind sometimes...

ok, let's move on to something else.

i just checked out my last set of evals from ob/gyn, and i got the nicest, most uplifting evaluations from that rotation. things that said "would make a great house officer" (a.k.a. kickass resident). "above average student". "worked well with others". "hard worker". i guess it's just wonderful and incredibly validating to do your best and for your work to be acknowledged by others in a positive way. when i read some of those comments, it really gave me a good self-esteem boost, because i sure feel like i'm dragging now, and surgery is yet to be done! and i know i'm not the smartest person...i certainly get a lot of questions wrong, which sucks, and i don't know what's supposed to happen next 99% of the time, but at least i'm learning from my mistakes and people recognize that i'm a good worker. that makes me feel good about myself, and sometimes that is hard to come by when everyday in medical school is just another reminder of what you're doing wrong and of how much you just don't know and need to learn. i know, what a fatalistic way to approach life, but that's kind of how it is nowadays.

ok, i think having RSV is making me a bit too philosophical. and it's time to make dinner, which will be pancakes, eggs, and sausage because dammit, breakfast for dinner is awesome!

Thursday, October 29, 2009

h1n1!!!

i got my h1n1 vaccine today, and my arm isn't hurting at all! when i got my seasonal flu shot earlier this year, my arm hurt like hell. this time, no pain. though i do feel tired, but that could also be due to lack of sleep and 2 glasses of wine...

go get your H1N1 vaccine if you can!

tonight was the ob/gyn interest group "mixer"...it was really nice to see all the residents again! it just made me feel all excited again about ob...hopefully this christmas break i'll get a chance to go and play on L&D some.

today was a bit hectic as far as patients were concerned...had to pick up 3 without even having seen them while they were being admitted, and then told i had to pick up another. that's ok, more work is alright by me, but it was just a tiny bit hectic. i was glad to go home for sure. tomorrow should be better since we won't be post call, and i get to wear my cat ears for halloween fun! woo!

ok, early bedtime for me tonight. bye!

Tuesday, October 27, 2009

a milestone

i can now say without a doubt that i have finally watched FOREST GUMP the movie!

and it was a darn good one too! why did i wait all these years? haha...

i am now in my 3rd week of wards...it's going alright. i'll be glad when wards is over...i'm on call tomorrow. i plan on waking up a bit early to make some banana muffins for the team. or moreso for me, ha.

there's an ob/gyn party on thursday that i'm going to. i'm going to do my best to not force myself down one specialty path, but to compare and contrast several. when i applied to college i only applied to one place, and sometimes i wonder what life would have been like if i had applied to several places. so for my future career, i'm thinking of different things. i may end up with peds anyway...the kids are fun! i just kind of am just "blah" about wards. maybe it will be better next year when i do it as a sub-intern...that way i have more duties and more work which makes time pass by so much faster than just sitting on your butt for hours...alas. another story for another day.

i gots to sleep. chao!

Monday, October 19, 2009

update needed, i suppose

so i've been on peds for a week. i've had some good moments and some blah moments. is it everything i've hoped for and then some? eh. i've still got 5 weeks left to go. i do enjoy being with the kids, but it seems like all my patients have been BABIES, like 2 wk old babies. while i do enjoy a good baby, well, they aren't too exciting. i've certainly had some interesting diagnosis, like pyloric stenosis, labial abscess, suspected child abuse resulting in significant brain damage, rsv (like a really bad flu), and UTI in tiny babies. i haven't gotten sick yet, but i'm pretty sure that this week i might get a virus because one of my patients wasn't on contact isolation, but then all of a sudden was (the rsv baby), and of course i was all up in his business and so it's just a matter of time. as far as hours, it's not so bad.

it's just hard to think about IS THIS GOING TO BE THE THING I DO FOREVER AND EVER? i just get anxious i guess. i really liked ob/gyn, but all i can think about now is the female domination (leads to cattiness, i guess, and i'm not so much of a girly girl), the really long hours, the high insurance, etc, etc. and now i'm like, peds? it's only been a week, and it's alright, but i can't judge the entirety of peds just on one week of being on the wards. i still have my clinic week to do. and i like the kids, i really do. i guess i just hate wards? or rounding? blah! haha...i'm just so anxious about it all. just don't want to make a mistake or something. WITH MY LIFE. aak. the pressure, alas.

yesterday H and i had a really nice bike ride at a local park. my butt is still sore, but it was super fun to ride through the mud and the trees and whatnot. i really need to invest in a helmet...almost had a few close calls with some puddles. tonight i'm going to make a curried pumpkin soup. i'm super excited. i've really been into winter squashes lately for some reason...i guess it's because roasting is fun and especially ROASTED PUMPKIN SEEDS! those are the bomb.com. for serious.

i guess it's time to go to the store to get ingredients for dinner, and then i needs to study. got a small group tomorrow i gotta prepare for, and to write my H&P. boo that. and then i think i have a test on friday? better check up on that!

Monday, October 12, 2009

taste test

so today during our peds orientation we got to taste some of the medicines that are prescribed to the kiddos while they are sick with various diseases. some of the medicines were tasty enough, evoking banana, bubble gum, and cherry. however, some of them i wanted to just hurl afterwards...ferrous sulfate anyone? or clinda? prednisolone? YUCK. disgusting, but very important exercise to understand how hard it is to get kids to take their medicines.

today was light...just got oriented and assigned a patient to see in the morning, so the real stuff starts tomorrow. and i'm on call tomorrow. fun times!

now i need to get ready to go to an alumni event at a local swanky restaurant. don't tell anyone, but i'm just going for the free food, but i guess it would be nice to mingle with fellow engineers, even though i'm not an engineer anymore. who cares. free food is always good enough to get me somewhere.

Sunday, October 11, 2009

golden weekend

this weekend is the glorious weekend-in-between-rotations...that means no responsibilities, no studying, no NOTHING! oh how it makes me happy. friday i went out for sushi with some friends, yesterday i slept in till like 10:00 am, laid around and watched tv, ate some dinner and gymmed, played in target, and today i slept in AGAIN till 10...so far i've just straightened up my apartment a bit, washed dishes. and now i'm just laying around. ha. i've also been brainstorming a halloween costume idea...my school puts on a huge party and i really want to "go all out" as they say.

the last week on gyn onc wasn't so bad. i had the privilege of taking care of a 14 year old girl for a few days post-op from an ovarian mass removal. unfortunately she is going to have to have some chemo, but her prognosis is actually very good. i just really enjoy working for the teens, i really do. it's kind of fun to be like, ok, have you tooted today? pooped? THESE ARE IMPORTANT QUESTIONS!!! THE ONLY TIME IN YOUR LIFE THAT EVERYONE WANTS TO KNOW ABOUT YOUR POOP! and i say it dramatically, ha, and everyone laughs. and when she finally pooped i did a mini-happy dance and all was well. i found out later that the family told the resident that they really liked me, and that made my day. i wonder if i'll see her in the cancer clinic in the peds hospital...

the last surgery was so crazy. a lady came in looking like she was full term pregnant, but turns out she was only 14 weeks or so. she shouldn't have really been showing anything at that point. took her back for surgery assuming we would take out her ovarian mass that the radiologist said was on the ct scan. turns out, ovaries were fine. she just really had a liver mass! liver what? check the scan, and then, plain as day, a huge liver mass was very apparent. lesson learned? check the scan YOURSELF before doing the surgery! don't just rely on the report! so we had to get the transplant folks in to remove the liver mass which turned out to be benign. us M3s got to run up and down the various ORs in the different hospitals transporting the various equipment...we got a lot of interested looks and i was like YES WE ARE IMPORTANT AND OUT OF THE WAY. hopefully the lady will be just fine and the baby too.

so with this, i'm going to try and not opine too much on how i loved the ob/gyns. i will say that i've gotten some great feedback so far on my evaluations and that is very encouraging to me. i'll definitely have to make some time to come back and hang out on the L&D suite. but now i got to look forward to peds! woo! i already got some stickers so can bribe the little ones...monster stickers. i mean, how cool is that! i just hope i don't get chronically sick. i got enough health issues going on, i don't need anymore.

so the rest of today, i plan on going grocery shopping. i was thinking about making some bread, but also thinking of baking a veggie torte or something with some puff pastry if i can find it at the store. and i'll probably watch a lot of tv, just because i can. i already did laundry, and finally hung all my skirts that i haven't had hangers for. i could try and mend the sole of one of my shoes. i should also try and sort through my clothes, but eh, i'm too lazy. i'll save that for later.

Saturday, October 03, 2009

interesting week

last week i was on benign gynecology. spent a few days in clinic, few days in surgery. got to assist in 2 abdominal hysterectomies. also, my car wouldn't start one morning...turns out a cell in my battery had died. luckily a classmate on his way in to the hospital just happened to be driving by my street when i called, so no harm there. got that fixed easily. H went off to boston for a week and some change, so i'm taking the opportunity to just clean up my apartment (kitchen specifically) and STUDY for my ob/gyn board on friday. then i'll start peds...and my mind is just so conflicted. i know that i'm going to miss all the surgery...there's nothing like seeing inside the human body. it's such a privilege and a crazy thing and such responsibility all at the same time. there's all kinds of crazy sounds...the bovie as it burns and cauterizes blood vessels and cuts through tissue, the suction of the vacuum sucker, snips of the scissors, the music (sometimes) in the background. i really enjoy the process of it all...the scrubbing, the gowning, the way everyone interacts in the OR to take care of the patient. all defined roles. i just think it's pretty cool.

you know what's crazy? there was a PIG meeting last week and *gasp* i didn't go to it! i forgot all about it, and was stuck in surgery anyway, and the kicker? i didn't care that i missed it. i wonder what that is saying about my love for peds...is it dwindling? is the ob/gyn love greater? i also happened to look up pediatric/adolescent fellowships for ob/gyn...they're not completely "official", but some programs offer 2-3 years of extra training in various areas. maybe i can pair my 2 interests together after all...but we'll see. i'm so glad peds is next in my rotation schedule. i'll really be able to compare/contrast the 2, because i really feel that's what it's going to come down to in the end.

this morning i finally got a haircut. i sheepishly told my hair stylist that when i was bored at school i would play with my split ends, so it's been time for a long time to get a cut. he just gave me one of those "alas" looks, and laughed. i love my hair guy...i don't know what i'm going to do once it's time to move on to a new locale. bring him with me? so now my hair is just a touch shorter, but still long and luscious...ha! i also went down to the ann taylor loft and they were having a sale...i got a gray skirt and a khaki skirt (and i've been needing a good khaki skirt to round out my colors of skirts!) and some brown capri pants. i probably shouldn't have spent money, but everything was on super sale, so i didn't spend too much. plus i got basics that i've been wanting, and the only thing left on my list of "i want" are some black pumps that are FUN but also comfy, but i'm not too much in a hurry about that. one thing i want to get into this fall/winter is wearing tights under skirts...i hate wearing pants, but it's a necessary evil. i want to be stylish like my friend Seriously Silly...she always wears fun tights with skirts and dresses in a way that i want to.

for this afternoon, i figure i'll go to the mega-beauty store and look at the hairbrushes...i've been wanting a new one for a while. maybe i'll pop into the shoe store next door, but i'll end up at the bookstore so i can get a fancy coffee drink, read some magazines, and study my blueprints questions. the weather is just so nice, i love fall! then i'll go grocery shopping for just a few things and come on home. it's a "me day" today, and i'm thankful for it. next week i start gyn oncology, which i hear is a toughie, so taking some time off for myself before a hard week + hard exam is always welcome.

Thursday, September 24, 2009

la la la

sorry folks, i've been a bit lazy. that's what REI does to a student...not so many patients, not so many surgeries...more time to just catch the ol' breath.

so far so good, we had adolescent gyn clinic on tuesday. that was really cool to get to see some of the kids and teens. what was sad was seeing little girls with genital warts. "her cousin got the same warts from taking a bath and sharing the wash towel with her daddy!" newsflash: you do not get warts from sharing baths. you do not get warts from using the same wash towel. shady. this patient though probably got it from her mom via the birth canal during her vaginal delivery. sadness.

today we saw a lady in clinic and her BP just happened to be over 200 systolic. yeah. that's bad. hypertensive urgency. no symptoms, thankfully. so we told her to go to the ER immediately after her appointment was over. she appropriately started to freak out a little, but we assured her that this was just urgent, she's not having symptoms, but she needs to get it fixed. i spent some extra time with her just telling her that she is allowed to have a visitor and that it would be fun to talk about the strange folks bumming around the ER, which made her laugh a little. and then i told her that she had a great personality and attitude and that she was going to be able to conquer her high blood pressure and control her weight. she was already aware of her problems, which is the first step. i really do hope she does well, and i actually feel like she is going to do well.

so yeah, at this point, i really feel like i may end up doing ob/gyn as a career. i know, completely different than peds, but i have REALLY enjoyed myself. i really like hearing about all the different women issues, and i like the idea of being able to be there for fellow women and help them out through their hard times. also, i can still see the peds patients because they got their own issues going on, and you don't have to do a fellowship to be a pediatric gynecologist. it's just a niche field. well, peds is the next rotation, so i feel like by christmas i may have my career choice already settled. i don't see myself doing surgery, family med, or psych. and none of the other fancy specialties (rads, derm, etc) appeal to me. so now it's between peds and ob/gyn. how about that.

it's funny how people change. i may even change my mind again. HA.

Friday, September 18, 2009

end of shift

no more night shift for me...finished with a nice shift. last night i assisted in a c-section, watched an epidural, put in a foley cath, and checked a cervix. plus the writing of a ton of notes. and then rounded on patients in the morning. i got the lovely task of taking of bandages...ripping tape off of people's skin at 5 am is probably not the best idea of the day. i definitely had some angry people at me, and i tried my best to just be gentle and to take breaks and let the patient tell me when they're ready to keep going. alas. i was going to take some staples out of a lady but she was wigging out on me so bad that i didn't even want to go there. the resident said i did the right thing, evidently that person had some documented "issues" so i'm glad i didn't go ahead and attempt the staples.

the saddest part about L&D is seeing the very young girls having babies. well, not all the young girls make me sad. just one in particular...this girl was 14, got pregnant at 13, and had suffered all kinds of abuses which are currently manifesting as a bazillion different psych disorders. (and if i had to go through what she did, i would have some major issues too. all of us.) the worst part about her situation was that her home life was just atrocious. the mom of the girl was all kinds of weird and an enabler of some of the abuse, and it just made me so sad to think that this girl and now this girl's baby probably will have zero chance in the world. ok, maybe not zero, but definitely a very slim chance of getting out of all the craziness and getting a decent shot. just sad. when i checked up on her this morning i made sure to tell her that she did a wonderful job during her delivery and that she should be proud of her beautiful baby, because who knows if the mom said anything. i instructed her to make sure that if she was ever hurting, to ask for pain medicine because the nurses don't just automatically give you some, you have to ask. when she said that she was going to try and breastfeed and use bottles for backup, i said that was a terrific plan and that i was glad that she was going to try breastfeeding, since it is best for baby. and then i left the room and she actually waved goodbye to me (she hadn't been doing that at all before). such a sad situation...wish i could have done more, but i did what i could.

so now i am regulating my body back to normal sleeping...today when i got home i slept until 2 or so and then woke up. hopefully i will go to sleep at a normal time tonight and be adjusted back without any problems.

next 3 weeks are going to be just gyn. i start off on REI, which is reproductive endocrinology and infertility. i think that is just going to be super fun. i know i'll miss the babies, but it's good to learn about everything, and since they force us to i don't really have a choice...ha. i hope i enjoy gyn though overall...i hear a lot of people love the ob part and then hate the gyn. i'm going to have to really jump in and try to experience all i can because if ob/gyn is what i want to do as a career, i got 3 more weeks to really "see it all" in a way. but then again, if i really hate it, well, alas. then peds is the next rotation. it's going to be so hard to decide, or maybe it will be super easy. i really do feel that if i did go into ob/gyn, then i would probably focus my practice on the adolescents. for some reason most of the patients i followed on L&D were the 14-20 range, and i really liked interacting with them. and i have thought about going into adolescent medicine before, so maybe that would be a possibility for me.

ha, and watch in 6 months or so that everything that i've ever thought about "what am i going to do with my life" just go out the window. i can always go to culinary school, right?

Wednesday, September 16, 2009

night shift

is not so bad. i feel like i've adjusted pretty well without too much trouble. the only problem is night shift is WHERE ARE ALL THE PREGNANT LADIES!? ha, for the last 2 nights there just have been not many pregnant womens! where they at? hopefully tonight will be bumping...i haven't had any opportunities to scrub in on a c-section or really assist with a delivery...and i'm getting antsy!

also, last night i was following a spanish speaking patient, her english was so limited that i had to break out my broken spanish to talk with her. i kept screwing up of course, and didn't know all the words, but managed to get through what needed to be asked. her family was really appreciative i think because i tried. and the husband knew more english and helped to translate once he got the gist of what i was asking. and we can get into all the arguments of "the foreigners in the US should learn english"...i 100% agree with that assessment. if you are here, learn some english! at least try! my family moved over here from korea and learned some english real fast...i go to visit foreign countries and i practice my phrases because i don't expect them to cater to me. but alas...it is the here and now, no use making people feel bad when they need help, and i'm so glad that i was able to build rapport with that patient. it just strengthened my desire to become working-fluent in spanish anyways. and she had a super cute baby! ha, and during the delivery she kept yelling DIOS MIO!!! love it! no translation needed there...

last night i got to check a cervix and i finally could appreciate the dilation and effacement...and i was accurate with my check! 6 centimeters! and felt baby head! very cool indeed. and i took out some staples from a c-section wound. taking out staples is fun!

so now i'm eating some granola and about to start reviewing a case to go over tonight. hopefully the ladies be all trying to deliver or something...i'm going to be really sad when L&D is over!

Sunday, September 13, 2009

baby!

i delivered a baby yesterday! on my own! the resident was RIGHT THERE to help, and at the end, he goes, "you can call that your first ever delivery". so exciting...baby was 4 pounds 11 ounces, not heavy at all...no fear of dropping, ha! and IMMEDIATELY started wailing as soon as she was out in the real world. good stuff. it's really fun to know that you're the one who the baby (theoretically) sees first outside the womb...and also to be able to tell the new mom congrats and good job!

and now i can get up in c-sections without the faintest feeling of wooziness. the other day i got to suture some of the fascia! that was fun, really was.

and also yesterday i saw a urethral prolapse in a little girl. craziness. it was the "biggest one" the attending had ever seen. so i wonder if that will ever happen again, seeing one that big.

so now my count is 5 c-sections and assisting on 4 deliveries, 1 being solo! woo!

i love the rush of someone saying ROOM ___ IS DELIVERING! you run down the hall, get geared up, and BAM, here's the show! and it's definitely not as nasty as i'd thought it be...i mean, it is pretty gross if you think about it, but not so bad. but i love the excitement and the action and all that fun stuff. plus during c-sections when the baby's out everyone gets excited and starts squealing in high-pitched voices, the mom gets all happy and all that. then while we're closing up, you just hear snores from mom. ha. why you so sleepy when you didn't do any work to get the baby out? it's just funny to me. the moms who vaginally deliver don't zonk out post-delivery, not until everything is said and done and whatnot.

so yeah, i'm REALLY loving this rotation so far, if you dear reader can't tell. bump medicine, i could never do that now after having experienced something else.

today i get to study for my test tomorrow and then somehow ready my body for night shiftage starting tomorrow evening. so yeah, test at 8 am, and then go home, sleep (?) and be ready for action at 7 pm. supposedly, all the craziness happens at night, so i'm super stoked! so i think i'll just try to stay up as late as i can tonight, sleep a little, and test, and then sleep more. hope it works.

Thursday, September 10, 2009

staples!

today i scrubbed into a c-section, made it all the way through, STAPLED AT THE END, and then was on a surgery high for the next hour or so.

i think i'm going to make it through surgery, perhaps.

also, more babies. we had a trisomy 18 today. unfortunately, the baby did not make it, but the nurses dressed the baby up and did the footprints and took photos for the family. and i think in the end the family spent some time with the baby. always good for closure. i thought the whole situation was so sweet, and the work the nurses did for the family was excellent.

and with that, i'm off to bed. 12 hour shifts are hard on the body. switching to nights next week is going to be tough as well. at least i'm enjoying myself and learning a lot. i'm really liking ob!

Tuesday, September 08, 2009

babies!

scrubbed in on a c-section today for TWINS! lots of blood and gore. and i almost made it to the end! i'm so proud of myself. only got queazy once the uterus was nearly done sewed up. a heckuva lot longer than i thought i'd last. and amniotic fluid smells bad. and literally the uterus is flipped OUT of the body for the sew up at the end. then they stuff it back in.

frylime does not want a c-section!

but the c-section was totally cool to watch. TWINS! and i got to retract! haha...and wipe away blood!

then later on i got to witness a delivery up close and personal...i think the next one i go into i'll get to do myself! super exciting!

bedtime now...just have to say that ob so far is great and giving peds a run for its money...we'll just have to wait on the gyn part...alas. that's where i hear a lot of people are turned off. we'll see.

Wednesday, September 02, 2009

it's getting better

ok, so i haven't had to see more bloody mess, but today i did my first ever cervical check! and i felt a whole lotta baby HEAD. how nice. at least i wasn't like my friend (hee hee) and totally miss the vagina and head towards the anus...she redeemed herself on her second try, no worries! i really never had a clue in how deep your hand goes up in there to check for dilation and effacement...and it's definitely not as scary as i thought it would be. had no hesitations when my intern was like "gloves on, here's the jelly, and check that cervix for me". nothing like the "gotta check your bottom for blood in your stool"...maybe because things are meant to go in vaginas and not anuses?

so as of today, i'm still undecided as ob/gyn as a career...i really like the IDEA of being an ob/gyn doc...but i don't know if i'm cut out to do it as a career. the residency, from what i've seen so far, is pretty intense. the interns are basically pooped on constantly, and everyone who is above you seems to be a little too eager to point out your flaws. i know everyone will get critiques, but today i witnessed an incident that if it were happening to ME, i would have been like GET OUT OF MY FACE. or something like that. or i would have probably taken it, like i saw the residents do (while being admonished by the attending for not a big reason), and grumbled and giggled to the med student (like the upper level did, ha!) and went and fixed the problem. it makes me wonder if all ob/gyn residencies are that intense, or if it's just my program in particular. at the very least, ob/gyns are VERY different than internal medicine folks. alas.

a look on the bright side, i really enjoy reading ob/gyn things...it's just really interesting. so with that, i'm going to start reading up on maternal/fetal physiology...joy!

Monday, August 31, 2009

ob receiving

just wanted to throw out there the fact i started my 3 weeks of ob today. then 3 weeks of gyn.

a woman came in because her c-section wound was infected. i felt nauseous and whoozy when the resident was digging around in the wound and all this nastiness was spilling out. there were some foul odors. i had to leave the room.

this is going to be a tough 3 weeks. alas.

also, what the hell am i going to do on surgery? or delivering babies? or the rest of the week! aak! hopefully it will get better...

Tuesday, August 25, 2009

last week of medicine! and other thoughts...

i'm done on friday, and i'm quite excited to move on to ob/gyn. not that i hate medicine, i actually like it a lot, but i'm ready to try something new.

for the book club we are going to read "the last goodnights" by john west this month. it's about a guy who assisted his parents with their suicides. i'm really excited about reading this book because i feel very strongly about end of life issues...namely that we don't really talk about them that much in our society. and it's interesting to see how various doctors handle asking patients their code status. so far the way i've asked patients is "if your heart should stop beating, do you want us to do chest compressions and deliver shocks to try to restart it", and "if you should stop breathing on your own, do you want us to put you on a breathing machine to breathe for you". i feel that way is truthful and explanatory. and if they don't understand, i can explain further, but at least i've been honest. i've heard people ask "when the angels are coming to take you away, do you want us to stop them", or even "in the event that you 'go', do you want us to save you". wtf?! like, what does "go" mean! go outside? go smoke? go take a crap? alas.

one frustrating patient we have is a person who is my age and basically has end-stage AIDS and every infection that goes along with having AIDS. the last CD4 count was like 5 or something like that. that is very bad. (basically, these days, if you are HIV positive, the medicine we have is so great that you will die of SOMETHING ELSE, not from HIV if you take your medicines. HIV is not the death sentence it used to be, and that is a wonderful thing, really.) the patient repeatedly comes to the hospital for various complaints, but yet, refuses to take medicines that will drastically improve the quality of life and prolong it to that of a normal healthy person. and when you're in the hospital with a nurse handing you the pills, where you don't have to count them out yourself, dose them, and remember the correct times, you have no excuse! then they'll say "i want everything done". this person will surely die soon if they don't take personal responsibility for their disease, but yet, wants to be "full code". full code for what? so you don't take your medicines and live? it's very frustrating, especially since it's someone who is YOUNG. i'm 24, and if i had an HIV infection, you better believe that yes, i would have my phases of denial, grief, and acceptance, but ultimately i would take my medicine. HIV is not a death sentence anymore unless you make it become one by not being responsible. i completely understand if this patient just wants to let the HIV take its course and succumb to it, but you can't have "everything done" if you can't do your part as well.

i could go on and on about other frustrating patients, but i guess the theme of this post was end of life issues. i try my very hardest to not become jaded or to judge people, but i can't help being frustrated at times. but then again, i can't fault people for being scared of talking about death. it's just not in our society to really talk about dying and the various stages and feelings and whatnot. and the whole "death panel" thing just didn't help that out either. i've been very fortunate to have great attendings that address death and dying head on with the patients seen by our team. i just hope that when i'm ultimately the one in charge that i won't be afraid to really talk about those things with my patients. i'm trying to set a good precedent now of being honest and up front with all the facts and impressions so i don't bumble and make vague statements in the future. i know that if i were a patient needing to hear about end of life issues, i would be super pissed if my doctor was vague, not confident, and nonsensical with me.

with that, it's time for dinner. i made kimchi chigae the other day. it's a korean soup/stew made with kimchi, pork, and tofu. you eat it with rice. it's super delicious.

Wednesday, August 19, 2009

tired

i'm at the less than 2 weeks left for medicine mark. and i'm tired. i accidentally took a 3 hour nap today, i guess that could be a good thing because i've felt so sleep deprived. i was wanting to go to the gym today, but i guess that might not happen. or maybe it will. i got to bake today for the PIG meeting tomorrow...i'm making some peanut butter brownie/cupcakes. they're a hybrid dessert, can't figure out which category i want to put them in. i did drop my coat off at the cleaners today. it was filthy, so filthy.

today at school i just felt kind of down in the morning. it makes me really sad when i see doctors talking a particular way to patients. i think it's perfectly fine to "not" know what's going on, but at least convey that to the patient. and say it in a way that is empathetic. not "duh you have ___", but more like "you had ___ and it's gotten worse." or something. and it grates me to see certain specialties "waffle" on doing a certain procedure on a patient that has clearly stated that they want that procedure done. i really hope my attending can get to the bottom of it...he mentioned that he might call an "outside the hospital" group. i just want what's best for the patient. i guess this is all part of the learning process.

i guess i should go gym. i dunno. i'm feeling a bit out of whack at the moment.

oh, and i pulled out my first line yesterday. a patient had a femoral line put in and needed it out. it wasn't hard, just peel off the tape, clean the skin, cut the sutures, hold some pressure over the site of insertion and pull! after it's pulled out you cut the tip of it off to culture it just to make sure there's no infection. the whole time the patient was on the phone with who knows and she said "some girl doctor is pulling out my line and she did a good job". i said thank you. ha. i don't think the patient was expecting that i was listening to her conversation, but she then was quite nice to me while i was holding pressure on her wound for several minutes. hope she doesn't come back to the ER soon. (she has a history of hanging out with us for prolonged periods of time.) an amusing thing was while i was holding pressure in her groin area, the psych team decides to come in and talk to her. one of my classmates was there, and the look on his face was priceless. here 3 men walk in the room to talk to the patient, and i'm there with my hand under the covers holding pressure in the patient's groin area. just kind of funny.

Monday, August 10, 2009

a lot has happened...

since the last time i posted. i went to a conference, had some fun in the smoky mountains, did my FIRST SOLO PROCEDURE ALL BY MYSELF, and had a patient say inappropriate things to me. and now it's raining, i'm lying on my comfy couch, and contemplating a nap and researching things to bake for tomorrow's call. (my team this month are all FOODIES! so tomorrow we're going to have a smorgasbord of goodies.)

so conference. my talk went really well. but then during the question session, some jackass PhD said "and not to throw cold water at you, but blah!". alas. i figured i would get some negativity. oh well. the best part was after i sat down after my talk, the moderator stood up and had to remind everyone that we were all STUDENT PRESENTERS, so PLAY NICE. i mean, alas. the worst part was after everything was over and we were leaving the room for the first break, the guy came BACK over to me, cornered me, and basically mocked my whole project to my face. "i hope you're not trying to get this published, it's LAUGHABLE." can you say that i was shocked that someone would say that to me? it was all i could do to either not cry on the spot or not cuss the guy out. and then to rub salt into the wound, another guy came up and they started mocking me together. finally my adviser saw what was going on and came up to talk, and the two men were all smiles after that. what terds. at least i got a $500 travel stipend so i got some money out of the deal. i'll put up with being disrespected once by a terd, but not next time. (and once i get my paper published, i'll be mailing a copy to the evil man and handwriting a note thanking him for all his "concern" about my project. jackass.)

other than that moment, i had a really good time. me and H did a lot of good eating and hiking and bike riding and just general good times. the weather was perfect! and we visited a lot of breweries and drank a lot of good beers. can't complain!

and then today at the hospital i did my first SOLO PARACENTESIS! i was so excited! HOWEVER, after i took off my white coat to hang, the patient goes "you look sexy". OMG. seriously? i was wearing a brown wrap dress, nothing remarkable. and he was talking to me in that way, and kept saying "you dressed up for this didn't you" and UGH. i was shocked, and instead of immediately going all angry asian on him and cussing and/or severely reprimanding him, i just said "okaaaay" very slow-like and with a lot of attitude. then he proceeded to say "oh you're all embarrassed now HAHAHAHA". what a jerk. i wasn't embarrassed, i was trying not to rip you a new asshole with my verbage. you shouldn't piss off the person who is about to stick a long ass needle into your side. and then to make matters worse, he farted throughout the procedure. FARTED. with reverberations. alas. then he said that i did a terrific job, and he should know, he's had like 20 paracentesi along the years. but you better know that next time a patient does that to me, i will be calling him out because that is very inappropriate and very disrespectful. ugh. and people complain that doctors have the glamorous lives...we have to deal with rude patients who harass you and poop and nasty smells. alas alas.

my friend who was with me at the time said it was divine intervention that the patient pissed me off before i did the procedure because then i wasn't fixated on my fear of needles. and she was probably a bit right about that...i wasn't scared at all doing the procedure, had no problems with the sterile technique, but you best believe if he does it again he's getting an earful. i don't care if he reports me to the admin, i'll report him right back for sexual harassment. touche!

so i think i need a nap, then dinner, and then some baking for tomorrow. snacks while on call equals happy call. ha!

Wednesday, August 05, 2009

ascites and such...

today i assisted on my first procedure ever! paracentesis! ok, so the intern did all the fancy work, i just sucked fluid out of the abdomen. but STILL! i had to wear the sterile gloves!

basically, one of my patients has some crazy huge ascites. ascites is basically fluid that builds up around your liver due to a multitude of things, usually cirrhosis of the liver. he looked like he was bigger than 9 months pregnant. imagine this on a skinny dude. his belly was so taut...i had images of it just exploding if i poked it too hard. so for a paracentesis you stick a needle on the side. around the needle is a catheter (hollow tube). after you get the needle/catheter in far enough, you can pull the needle out. the catheter stays in, and is connected to a bunch of tubing. the fluid comes out through the catheter, through the tubing, and into whatever vessel you want. we had these vacuum sealed glass jars that were 1 liter each. we were only allowed to take out 5 liters of fluid. by the time we were done, his belly had NOT changed at all, just that it didn't look like it was about to explode. why couldn't we have drained his whole belly? well, that would have just caused the rest of his bodily fluids to shift around, and that would have been VERY problematic, and probably could send him into renal failure and then some. so you could say we just "relieved" a bit of the pressure that was pushing up on his lungs.

so yeah, this week has been a whole different hospital with a whole different system. a lot of stuff is on the computer, but notes and orders are hand written. and i totally believe the doctor stereotype of bad handwriting now. some of it is just horrible. alas. i think i've finally gotten the hang of it now. the new team is great, definitely a different vibe than last month, but still good. the attending is definitely a fun guy and likes to play around, but is also a great teacher and makes me feel comfortable with learning. if i make a mistake, he allows me time to correct myself and explains everything without making me feel totally stupid. (it's ok to feel stupid, we're not supposed to know everything now anyways.)

i was a bit sad today to not be able to go the book club talk on "mom's marijuana" (by dan shapiro), alas. i had other stuff going on, like the paracentesis and i had to meet with my research advisor about my talk. hopefully some of my friends went and i can get a good synopsis of what happened. i'll try to remember and do a post about my thoughts on the book. just in case if i don't, i HIGHLY recommend this book to everyone. it's a quick read, and highlights some terrific points for healthcare workers, and is quite entertaining. just do it.

tonight i will be packing and going over my talk some more before me and H leave tomorrow for the conference. he's coming with me because i have to get my own hotel room anyway, so why not make it a fun trip! my talk is friday morning, and the "trainee awards" are that evening. so i hope to do really well...maybe i could win a prize! and i was able to get time off to go from my rotation without any problems, so that makes it just that much better.

the new M1s and M2s have started schooling...it's kind of fun to see them and think back about what it was like when i first started med school. i think terrified is a good word...ha. but i'm also glad i stuck with it, because i'm really enjoying myself now. so advice to the newbies: IT GETS BETTER. seriously. if medicine is truly for you, just know that in 2 years you'll finally get to be with patients. 2 years is hella long to have to wait, but you have the rest of your life to be doctoring, so it's worth it in the long run.

Thursday, July 30, 2009

almost done at the VA

tomorrow is the last day we'll be with our current residents. i'm kind of sad. my team this month was GREAT. we have to stay sat/sun with the new team for some so-called "continuity of care", and then we go to the university hospital for another month of general house medicine. the big difference is that the VA's health records are all computerized...you type up your daily notes and all the labs, images, etc, are on the computer. at U, you have to hand write your notes, but all the labs and imaging are online. you dictate your final notes.

i just took out some vegan peanut butter cupcakes (more like pb brownies, honestly). they are smelling heavenly. they're for my team...i just hope next month is as good as this month was!

so after a month of medicine, i can say that i know a bit more info than when i first started. my brain has started thinking more "like a doctor", and i'm definitely understanding better how to construct the impression/plan list. basically you break down everything that is going on with the patient and then talk about how you're going to fix or treat those problems. easier said than done, but i'm getting better. today i worked on a "final progress note" on a patient that i've been following since he came to the ER a week and a half ago. the hard part of the FPN is the "hospital course". you have to succinctly describe what happened while the patient was in the hospital so that the next person can look at it and know exactly the gist of it all. i had a hard time trying to put it all together...i sat with the resident as she went over my note and turns out i had all the important information, she just switched the order of some of my statements. but i had all the correct info! that made me feel really happy, like at least i didn't screw up on something, and i know better how to do them in the future.

yesterday we had a PIG photo shoot with a giganto check. it's all good and cute, the peds doctors were really impressed. job well done. i'm proud of my fellow officers. we worked really hard and it certainly paid off. i'm just waiting on getting the damn photos though...they are being slow on that end and it's starting to irk me just a bit! and i delivered the "real check" today...i hope the money goes toward something useful...i'm sure it will. all for the children!

my conference is next week and i still haven't finalized my slides. i need to practice. i'm kind of getting nervous. i've been so busy with hospital work that when i come home, i just sleep. this weekend, i'll be practicing for sure. the conference will be a nice respite from being here. i just hope i don't screw my talk up. 15 minutes in front of PROFESSIONALS. and i'm just a med student. it's kind of daunting...

rounds tomorrow are at 7:15. which means we get there at 6:00. which makes me very happy. normally we get there at 5, wednesday i got there at 4. so yeah, when i'm told "6:00", i am very very happy.

hopefully tonight i can do some weights. i've been meaning to exercise more, but when you're on call every fourth night it's kind of hard. luckily at U we'll be on call every fifth night (q5), so i'll get a little bit more "me time".

alright, time to work on slides, do some weights, and then bed. fun times.

Sunday, July 26, 2009

i have tomorrow off!

life is good...i stepped out of the VA yesterday at noon and i won't have to go back until TUESDAY! how exciting!

today i got a new book called "how to cook everything vegetarian" by mark bittman. i'm really excited about the prospects. the only reason i got it was because H got me a gift card to a local bookstore and today i actually went in to use it...fun times. not that i want to become a vegetarian, but i'm always looking for ways to expand my vegetable repertoire...

i'm currently debating ordering a bunch of various kaplan flashcards for step 2 studies. yes, step 2. not that i'm wanting to really study hardcore NOW, but i do need help shoring up my diagnostic skills, and i think these cards would help me out.

i went to the gym today...powerwalked for 30 minutes on an incline. it's amazing how fast your body gets out of shape when you don't have the time to properly work out. once medicine is over, maybe i'll have more time.

the green beans i have planted in my fake garden are starting to flower...i hope this means i'll have real beans in the next few weeks! the dill has died, but my parsley is growing baby parsley leaves. the mint is trying to take over my porch...maybe i'll try to trick one of the runners into growing in a different pot.

tomorrow i'm making this fruit "tatin" that i saw the barefoot contessa make on the tv. she used plums, and i'm going to use plums, blueberries, and strawberries. it's like a caramelly cake pie sort of thing, and i'm kind of excited to make it. also, i'll be making some banana muffins for my team. we're on call tuesday, and it's nice to have good snacks laying around.

i learned last week what melena smells like. just imagine the nastiest poo smell ever. we opened the door to one of my patients' rooms and the smell just hit us like a freight train. just awful.

also, i don't understand the logic behind a patient's family deciding that the patient should now be full code (previously DNR/hospice) because the "patient would want to be full code now". well, currently, the patient has severe dementia, is nonverbal, been coded several times, has a trach and requires ventilation, severe upper extremity contractures, and just lays in bed all day drifting in and out of consciousness. this poor person's eyes are just sunk into their head, no teeth whatsoever. when i went to see this patient before pre-rounds, i knew he was nonverbal, but i still make it a point to talk to the patient and explain what i'm doing. it's just good practice, and maybe he can hear me. i could hardly hear his heart over the loudness of his lungs. and then he scared me, because he coughed, i wasn't expecting him to make any noise towards me. and i let out a yelp, and then started laughing, and explained to the patient that he startled me and how silly i was. i tried to listen to his abdomen, but couldn't really get very far due to his contracted arms. quick check of his legs for swelling and then i told him goodbye. it was a little bit creepy, that whole encounter, not because the patient was scary or anything like that (ok, maybe just a tiny bit because of eeriness of it all), just the situation he was in. i don't know what the family is thinking, or their reasons for doing anything, and i shouldn't judge...everyone has their reasons. but i can't help but make a mental note that if were in that patient's position, i would want my family to just let me rest.

on another note, i've realized that whenever i talk to a patient, my redneck accent comes out in full force. maybe it's because i talk a little bit louder than normal to the older people so i can make sure they hear me. i thought it had gotten cleaned up, but for some reason, it's coming back with a vengeance. not that i care...it's amusing to see the look on people's faces when they see an asian girl talking all southern at them.

Wednesday, July 22, 2009

wtf?!

allow me to vent a tiny bit about something...people giving me an evaluation WITHOUT EVER SEEING ME DO THE THING THEY ARE EVALUATING! i got my half-way eval from my VA medicine attending...he said wonderful things. no complaints there. he just said i need to continue to read and learn and build my "knowledge base", but that is to be expected since it's my first rotation. plus one of my partners is a freaking genius who make a 260 on his step and knows everything about anything and isn't afraid to tell everyone about everything he knows. so of course next to him i don't know as much. alas...but the attending told me to keep up the good work and keep learning. how much more could i ask for?

but then i finally got my eval and grade from the ID attending. according to him, i'm just on the high end of "meeting expectations". ok. i can deal with that. but then i started to read what all the various categories were, and half of them HE NEVER SAW ME DO. why would that be? because on ID, we never got the opportunity to interview a patient by ourselves. we just shadowed. i'm not going to complain too much about the grade (because we were never really given opportunities for us to be graded upon), but it does irritate me that i just "met expectations" on patient interviewing when 1) i never interviewed a patient, and 2) if he DID let me interview and he watch, he would have seen that i am good at being very thorough! aaak!

alas.

//end rant//

in the end, can't complain too much...it could have been a lot worse, and my grade for ID is decent. but it is also irritating. grrr. at least he didn't write any comments down. who knows what he would have said. i'm sure he didn't really care in the end. everyone on ID kept wondering why they had med students PERIOD...i guess they don't really get students, so having 2 at the same time freaked them out.

i still haven't gotten my final neuro grade, and that is a bit bothersome. maybe i'll send them an email about that soon.

tonight i have to work on my presentation for the conference. they want my slides by next friday. ha. that kind of sucks, but at least i'll have it done early.

Thursday, July 16, 2009

follow up to a comment...and i think i like medicine?

on my last post, someone wrote:

how did u do in terms of your score? Will it still let u do whatever field you want?

i'm happy to answer, i'll just have to overlook the "u" replacing the proper "you"...i'm sort of a spelling freak! (i circle misspelled words in my textbooks all the time. PEOPLE, can you edit?!)

moving on...

i believe that with my score and some hard work put into step 2 and good strategic networking and applications, i should have no problem finding a residency i desire in peds (which i am most likely to do). who knows, maybe i'll change my mind about what i want to do, but i think i'll be ok. looking at just my numbers, i'm not the most competitive person, but i think as a package deal, i'm pretty darn awesome! i have no intention of doing surgery, maybe i'll look into neuro or even ob/gyn (the intern on medicine right now is ob/gyn and she is really trying hard to sell it to me, and she's all about me doing genetics after an ob/gyn residency to counsel the pregnant ladies) but nothing i desire to do is something that is considered super competitive. so i think i'll be fine. it will be hard work, but i believe i will be somewhere i am happy for residency. i doubt i'll be at CHOP, ha, but it will be all good in the end.

now on to medicine...it's kind of weird...i kind of like it! i don't know if it's something i will end up doing for reals, but i really enjoy the thinking and the thought processes and the NUMBERS! so who knows. the crotchedy old men are growing on me, but i am still holding out for other specialties...of course. who knows. and the ID subspecialty rotation has proven itself to be quite helpful...i recommend it for anyone thinking about doing it!

and funny, evidently i ask a lot of questions, so many questions that a schizophrenic patient told me he was tired of answering all of them. my residents thought it was funny...2 of them LOVED how thorough i am, and the 3rd year resident just thought i was weird because i ask a lot of questions. (but i think in a good way, obviously.) ha, well, better to know too much than not know enough!

oh, and i joined a book club at school. basically we'll read books about doctoring and medicine and ethics and whatnot. this month we're going to read "mom's marijuana" by dan shapiro. i'm excited! evidently he's going to come to my campus and do a talk, so i'll get to meet him. book isn't too long at all. i'm just excited to have an excuse to read stuff NOT too terribly technical.

alright, bedtime soon.

Wednesday, July 15, 2009

I PASSED STEP 1!!!

i am SO happy! that chapter of my life is closed. the first 2 years of med school are done. it feels so good to finally just be over and be into something new. i can finally officially call myself an M3.

i took the step on may 27. i had studied hardcore for a month beforehand. and then waited 6 agonizing weeks to finally view my score. i am just so glad that i don't have to repeat all of that.

here's to the second half of med school...i'm so glad that it's finally here.

Monday, July 13, 2009

it's been a while...

i think i might be almost adjusted to waking up at 4 to get to the hospital at 5 to be ready for pre-rounds at 6 and then class at 8 and then big rounds at 9. almost. i come home and then take a long nap. i haven't gymmed in over a week, probably almost 2, sleep is more important. my eating habits are all whacked out, but i'm doing good on not overdosing on caffeine. i've managed to stick to my one cup a day habit...

medicine is going well...my team is great. the residents are amazing. the cases are interesting, i enjoy looking at all the lab numbers and thinking and whatnot, but i have to say that sometimes, i find certain patients' conditions to be disgusting. case in point...i can now confidently say i do NOT like anything to do with COPD. the coughing noises and the spitting up gross stuff and the heaving...GROSS. other than that, medicine isn't so bad. i don't know why the lung stuff just freaks me out. i certainly haven't had that "oooh i want to do this" sort of emotion, but it is interesting and it's growing on me. who knows.

i've seen a lot of sad stuff too...most of the people in the hospital are there because they smoked their whole lives. people, JUST DON'T SMOKE. you do not want COPD and to hack up a lung everyday and not be able to breathe. you don't want esophageal cancer so you can't eat. there's a patient on the service right now with this huge tumor on the side of his head that is ulcerated and infected. he has brain mets. he has at least a dozen lung mets. it's so sad. then there's another guy with a decubitus ulcer. i saw his FEMUR through the open wound. no pain. i'm sure the ulcer hurt like hell when he first got it, but as it got worse and worse the nerves are killed off and then it doesn't hurt anymore. but i saw his bone. *shudder*

when we present our patients we have to follow a certain format. "mr. so-and-so is a ___ year old ___ male with ___ who was admitted on ___ for ___." well, it's sad when their problems list is a bazillion things. i had a patient who's medical history list was at least 10 items long. it amazes me how people don't take care of themselves. granted, sometimes, it just can't be helped that you get ill. but a lot of these chronic diseases occur because the patients just didn't eat well enough, or exercise enough, or smoked for too long, or just didn't pay attention to their bodies. if you think something is wrong, get it checked out. don't sit around and just let it fester. then you end up with brain and lung mets, when if you had just noticed that maybe you had a funky looking mole on the side of your head, you could have gone in, gotten it removed, and call it a day.

other than the sad cases, we do have some good ones. i like it when the patients come in sick, and we make them better. i know, it's basic, but i like it. i especially like it when a really ill person comes in with no hope of survival, and their families have decided to put them on comfort measures only. i think that's the most humane thing anyone could do for a loved one.

ha, so not to end on a depressing note, we had a 94 year old patient who was SO CUTE. omg, so cute. (also, he was my first patient to do a FOBT on...ha! and i still have my finger! it didn't get sucked in or anything...) he talked so much about how he worked on building the panama canal and various bridges and how he loved fishing in montana and whatnot. yes, he was super old, but his brain was very sharp. too bad his talking couldn't keep up with his thinking...

so on my list of things to do is take a nap, do some reading on FeNa and the various classifications of kidney failure. oh, and finish up some H and Ps. busy busy.

Thursday, July 09, 2009

drrr...

it is way too early this morning. been awake since 3:30 am. contemplated a shower, but have decided to just ponytail the hair and throw on my yesterday scrubs and get moving. blah!

Friday, July 03, 2009

ID is over! look out VA medicine...

with ID being officially over now, i think i can say that while i enjoyed being on the service, i don't think i will go into ID. all the women doctors were all hippy dippy and fun and i enjoyed their personalities, the men doctors were a nice array and everyone seems laid back and enjoys their lives. it's just, i just don't want to have to deal with the same types of patients over and over and over...not necessarily boring but i guess you could say that? HIV, hepatitis, osteomyelitis, cellulitis, etc etc...interesting things, the doctors all seem very happy to do ID, but i don't think i would be after a while. it gets kind of "cookbook-ish"...once you help someone with HIV get on a good medication regimen, they soar back into great health.

monday i am to be at the VA at 6:30 am to round. that means after i get my patients, i show up EARLIER. my colleagues on surgery have already had to experience this early morning nonsense, but this will be my first time. granted, on neuro i had to leave my place at 6:15 to get to where i needed to on time, but now i'll have to leave to get to school probably at about 5:30 to properly round on my patients and whatnot.

i'm kind of dreading starting VA medicine...well, the patients will be daunting enough, but moreso because i've witnessed some discussion about my third partner for the month that is less than ideal. it's already been made out in the open that this particular person "steals" patients from other students and shows no remorse for doing so. hopefully it was a one time fluke and the person doesn't do it anymore, but i am fully prepared to do some talking when i need to. finally now my team player skills and team management skills are going to come out...things i learned in engineering school. i think i have had every type of undesirable partner and effectively dealt with it all to come up with a good group dynamic in the end, so i hope that i can make this coming up month a good experience for all. the most memorable one was the guy who had a crush on every girl he worked with, but not in a good way...eek!

this weekend i need to sleep a lot to ready myself for VA medicine action and READ!!! i have a test next week and i want to make sure i do well.

OH, and i submitted my abstract and got a platform presentation AND a travel grant to go to a conference in august! i'm super excited. though i just made my hotel reservation and that pretty much wipes out the travel grant...haha. but H is going to go with me so the money will be well spent. i'm excited about the location, i've never been and looking forward to it!

ok, breakfast time, chao.

Saturday, June 27, 2009

ok, ID is getting better...

so ix-nay on the STD clinic, but i've still managed to enjoy ID a bit more than earlier this week. i think that mostly had to do with not being around a certain fellow, but then i saw how crappy he got treated by his attending...i felt sorry for him. no wonder he's a grumpy guy...he was getting bossed around by a woman younger than him (i assume). and i also believe that where he's from, men don't get told what to do by women, so i can just imagine...

one thing i have noticed...out of all the doctors that i've been around, the ID ones are the folks who don't wash their hands as much as they should. not ALL the ID folks, but just 2 of them off the top of my head, i have witnessed bad behavior! (trust me, i am ALWAYS washing hands and using the foams and gels and whatnot...i keep a bottle in my pocket.) for example, one of them was examining a patient's diabetic foot ulceration, poked his finger all up in it, and then GRABBED MY STETHOSCOPE TO USE. he didn't even ask. he just took it out of my pocket with his nasty gloved hand, used it, and gave it back to me. i was wearing gloves, but now omg my stethoscope was contaminated with freaking MRSA. i used copious amounts of antibacterial gel on it, let it dry, and then alcohol rubbed the hell out of it. ugh. so i suppose it's clean now, but i'm still pissed. and yes, the doc took off his gloves and didn't antibac-gel his hands. i guess it doesn't really matter, but i'm grossed out.

and now my friend K has convinced me that i need to go volunteer at the free clinic today. so i should get ready. egads!

Tuesday, June 23, 2009

infectious diseases, or maybe not so infectious?

so now i've been on ID for 2 days...and let me say...i wish i were still on neurology!

don't get me wrong, it's been interesting seeing patients in the various clinics. i've seen patients with HIV, osteomyelitis, and hepatitis C. pretty cookie-cutter stuff. it seems like most of the treatment plans follow standard algorithms. i signed up for this rotation because i thought it would be good to get to see patients that i really haven't been able to see yet, plus i would learn some useful things. but honestly, i'd rather be doing something else.

it's all part of the process. i enjoy clinic, but i also enjoy consults. i like to get in on the action, but then i like to just step back as well. alas...this blog is here to help me sort all my thoughts. i would be very surprised to see myself as an ID doctor...it's just not going to happen! but i am learning very useful things that i can apply to my future patients...

ok, going to do some reading and then repot my plants...they are growing so well!

Sunday, June 21, 2009

the end of neurology...

today i was on call for neurology, and let me tell you, sitting on my ass for 5 hours in the hospital is NO FUN. ok, i take that back...me and A went to the VA for an hour or so to visit our patients and read some updates. why did we do that? i dunno...nobody would have known if we hadn't. we have nobody to report to about it. but it was the RIGHT thing to do. i wanted to tell my patient goodbye and check on his progress. (it's amazing at how much recovery can happen in a stroke patient in just a few days.) what really gets to me is how much my "patient" looked to me for answers...some of the stuff was common sense, etc, but really it was just the fact that he looked towards me for answers to his questions. i guess i look like i know what i'm doing sometimes, or that i sound competent...ha. when i first walked in the room he goes "i thought i was never going to see you again!" i just laughed and said that there were a few more things i wanted to check out. and then i told him that after today i hoped i never had to see him again, because that would mean that he was getting better. he agreed. he sure does like to talk though, and was a great patient to learn from. i told him to keep exercising like the physical therapist said to and NO CHEATING. i wish him as full a recovery as he can get. he's got a lot of people depending on him back at home.

well, in the end the resident we were on call with was like "the weekends are boring and nothing happens". well, it might be boring to you mr doctor man, but to us students, we think ANYTHING is something exciting. oooh, our resident is calling another doctor up to do a phone consult! ooooh! another patient in the ER with a mysterious drug-seeking headache! fun! ooh, he's filling out paperwork! let me look so i can learn! so yeah, he was trying to spare us the "boredom", so we just sat on our butts and twiddled our thumbs. i wonder how much money i spent on tuition to do that. probably at least a $100 or so...ugh. that really pisses me off. i see where he was coming from, but i'm still at that "excited to do anything" stage. blah.

yesterday me and H went kayaking on a 7 mile trip. it was a ton of fun. mini-vacations are always great and i was really thankful that he planned that trip for us. it was wonderful to get out of town and do something in the outdoors.

also, the school is pissing me off because i have yet to receive my loan moneys. nobody else has gotten their loans either. we are all without money. ugh. i'm going to be so pissed if july 1 comes around and i still haven't gotten my loan money...this is something that should have already been worked out. i just hate inefficiency. blah!

and tomorrow i start my 2 weeks of infectious disease. STD clinic, here i come! woo!

Wednesday, June 17, 2009

what a day

neuro so far is going really well. i'm really enjoying myself. things that have surprised me:
  • i say answers to questions that are CORRECT. wow, i know stuff!
  • i'm not as afraid of old people as i thought i was.
last night was my first night on call. resident let me and A leave at about 7 pm, so we retired to the neuro library and in some sort of divine inspiration, finished all of our required neuro "modules" by 9:00 pm. H was incredible and had made coconut chicken curry for a late night dinner. i'm sure i talked his ear off because yesterday was just so jammed packed. here's a recap:
  • went to sign-ins. listened to residents and attendings "academically debate" about when to treat stroke in various situations. actually followed along.
  • went to nephrology class. wish i hadn't been talking so loudly on the way there in front of the chief medicine resident, who definitely called me out during class...but in a good way.
  • went to the VA and sat around for a while. and sat and sat.
  • finally rounded on our *2* patients. one was asleep. the other was not. i got to witness my attending with her patient in a very poignant moment...patient was having some talk of depression and the doctor just tackled it head on in the best way imaginable. it was so sad though...when i'm at the VA i just feel so SAD for all those little old men. (to sum the patients up, just imagine "old man who used to be totally independent and taking care of their families until they have a stroke. then they can't do anything and they're stuck at the awful VA where time stands still." it's just heartbreaking.) the whole time i'm thinking "wow, i want to be like HER if i ever am in this situation."
  • went to try and get free lunch. vendor cancelled last minute. aaah!
  • went to afternoon stroke clinic. really cool stuff there. saw some nice patients who wanted to get back to work and lead full lives. saw a hypochondriac/overreacting patient. saw one who was milking her pathology for all it was worth. (complained of "neck pain" and whatnot, but as soon as she got comfortable and distracted around you, she seemed to have no problems moving her neck around.) and then i saw another physician "tough talk". this time the patient was basically dicking his life away with beer and cigars. umm, can't really do that when you are in heart failure and expect to live 10-15 years more. the doc did a great job of "this is your problem, this is how we can fix it, however we CAN'T because you are doing x, y, and z. so you have to stop." it was said firmly but respectfully. another great teaching moment.
  • then call. we just saw one ER patient. migraines!
ok, and with that, i think i'm going to eat some breakfast and head on to the hospital. i think i'm going to be taking a long nap when i got home today because i woke up and do NOT feel refreshed. ugh!

Friday, June 12, 2009

yay for neurology!

today was great! it started off kinda hairy...i realized now that instead of leaving my apartment at 6:30 to be in morning sign-ins by 7:00, i need to leave no later than 6:15. yes. 6:15. such is the life of a med student. class at 8:00 was weird...switching from neurology to delve into a boring ass lecture of nephrology? ugh. spare me. i hate kidneys.

after class A and i hopped on over to the VA to do our neurology fun times. lucky for me, the attending i am with is a personal acquaintance and is SUPER nice and and awesome teacher! it was great to be with someone that i know outside of all things medical, and we were able to catch up on a few things. during rounds we saw 4 patients. one was sort of a "charity case" (nowhere to go), another one was doing some sort of PT, and 2 were in the MICU in comas. one of the guys was so bad off when the resident went to test for a babinski (this is done by forceful scraping of the bottom of the foot...it's supposed to be painful), he was scraping skin off of the foot. he wasn't doing it on purpose...the patient's skin was just that thin. sad sad sad. the other guy in the coma was in the coma due to a medication given to him by his primary care doc. the dude just wanted to get his health in order, finally goes to see a doctor, gets a medication, and bam, he's in the MICU with a trach and in a coma with literally no hope of ever getting out. very scary and very sad. highlights the importance of the front line doctors needing to really know their stuff.

after seeing the patients dr R goes through the neuro exam with A and i. i never realized how hard you have to hit to get reflexes, but now i know because a real live neurologist tested mine. (fwiw, she graded my biceps reflex as a 1+, but my patellar reflex was 2+.) i also need to get myself a tuning fork. 128 Hz. this weekend i will be doing a lot of practicing.

this afternoon dr R showed us a "mystery patient" and wanted us to guess the diagnosis...parkinsons! we got it right. i got to feel firsthand what muscle rigidity is. unfortunately i couldn't really detect the cogwheel rigidity, but evidently it wasn't very prominent in this patient at that time.

i have this weekend off. i'll be doing tons of reading up on how to do good neuro exams, reviewing CT scans, and practicing using the ophthalmoscope. and doing yoga. and cooking!

Wednesday, June 10, 2009

acls

today was acls. it was long. i did chest compressions. i practiced my intubating with the mac and the miller. i participated in mega code simulations.

all in a day.

and we got done 45 minutes after we were supposed to. alas.

then H and i went and split a hamburger. deliciousness.

i believe i will be going to bed early tonight and practicing waking up early tomorrow morning. if i gotta be up and running by 7:00 am, might as well begin waking up earlier than 6:45. so tomorrow, i'm shooting for 6:00 (i have to be at acls part 2 by 8:00).

now i understand why the M3s always look so tired...

Tuesday, June 09, 2009

all orientated and then some...

i figure i'm sitting around till 6:00 so i can go gym, so why not blog?

yesterday's orientation was a full day of boring. alas. it made my butt hurt from sitting in that stupid chair for that long. the white coat ceremony was nice, but not necessarily needed...i didn't feel all "shiny and new" so to speak, but my name looks spiffy on my coat. (and i need to get a second one so i can put my middle initial in it and possibly get my sleeves hemmed.)

today was a big day of wtf is going on. i had medicine orientation this morning. then it was VA orientation. omg. sitting in a room just to learn how to use a computer. i'm sorry, but i know that a lot of people probably don't know how to use computers, but WE ARE ALL OF THE MODERN AGE. i could have done everything that we did in 2.5 hours on my own in less than 10 minutes.

furthermore, we hadn't heard anything from neurology yet. finally in the afternoon we meet up with neuro people, and I AM SO EXCITED ABOUT NEUROLOGY. they have changed up the course somewhat from last year, and the new course director is really fired up about everything. my group is kind of getting the shaft on the timing, since we won't really start neuro until friday and the block is only 2 weeks long! but it works out in the end...we get a few perks as being the first guinea pig group.

so tonight i will be studying for ACLS...i renewed my BLS skills today and the instructor said that i did an EXCELLENT JOB. that's right kids, EXCELLENT. that made me super happy. not that BLS is hard or anything, but still...that's POSITIVE REINFORCEMENT.

ok, so i'm off to gym and to grocery shop. chao.