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.