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.

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