Wednesday, July 26, 2006

This just in, ya'll: Lance Bass, formerly of N Sync, is gay. Hooray for coming out! And his boyfriend is hot, which I am very pro in regards to.

In other news, the ER exam is this Friday. Some tell me it's ridiculously easy and some tell me it's ridiculously hard. In short, I have changed absolutely nothing in my approach to this exam. I do plan to start studying today though!

And, finally, on shift last night I saw paronychia.

Treatment for this is lancing to let the pus drain out of there. However, my attending decided the nail was on its way out the door anyway so he did a digital block (numb up the finger with injected lidocaine) and then removed the entire finger nail with a scalpel and a pair of scissors.

I have never passed out in the hospital before but I came pretty close last night. I got really lightheaded watching it and felt my skin get really warm and sweaty. I started to see pulsating lights. I totally knew that I was vasovagalling but I didn't want to look like a wuss so I just stood there and watched. When we came outside I started fanning myself; the attending took one look and was all, "Maybe you just go sit down for a minute."

Fingernails, ya'll. Fingernails and eyeballs. Everyone has their thing(s) that grosses them out and I encountered my kryptonite last night. The ER resident said he can't handle nail-ectomies either, which is why he just walked out when the attending started ripping it out.

Friday, July 21, 2006

Today I got to leave work a few hours early to go to a patient simulator with the other students on my rotation. The simulator is actually pretty cool: it's a mannequin in whom pulses are palpable in the extremities, heart/breath sounds are audible when you press your stethoscope up against the chest, he can be intubated and the internal anatomy is very accurate to real life: you can end up intubating the esophagus down to the stomach instead of the lungs, or have the tube go down the right bronchus and only oxygenate the right lung.

It's also totally fun: they basically split us up into a couple of groups and then each group in turn takes care of the simulator, who is inevitably critically ill and ends up crashing. The simulator is controlled by someone operating a computer in another room, and this person is also hooked up to a microphone, and they respond to your questions as though they were the patient. A nurse stands in the room with you, and she administers "drugs", EKGs, etc. A few minutes after you a request something you are handed a sheet with the lab results, or imaging, or whatever, on it. You can place verbal orders with the nurse, which is tough because none of us know the dosages for sedatives and paralytics (which must be administered before intubating), or pain meds, etc, and we always end up wasting time flipping through our little medicine books.

The hilarious part is that while you're in there sweating and freaking out [they do a pretty good job of making it a pretty high pressure scenario], the whole thing is live fed to another room where the other med students sit and watch you, and laugh at the incredibly dumb things you say and do.

And I must say -- it's very easy to sit in the room and laugh when someone can't remember the difference between dopamine and dobutamine, but when you're in there with the mannequin trying to read the EKG with all the machines in there beeping and the nurse asking you what dose of epinephrine and whether you want it subcutaneously or IV and the fake patient demanding to know what the hell's going on, it's a little stressful. Like, I realize exactly how ignorant and ill-equipped I still am.

I am happy to say that my partner and I were correctly able to diagnose and treat our patient without sending him into cardiac arrest. Hooray for saving the mannequin! I actually had a really tough time keeping a straight face, because the doctor who was running the simulator was a total joker who kept saying things like "I think I just wet myself," and giving hints to the other groups like, "Doctor, do you think that maybe I need to be defibrillated?" Which reminds me of a nightmare I had a few nights ago where a patient crashed and for some horrible reason I (the least qualified person in the hospital) was running the code. [EVEN MY DREAMS ARE SQUARE.]

And also...I LOVE NURSES. They have so much practical experience and knowledge, and they're the ones that administer direct care to patients. Hospitals would be nothing without their nursing staff. They are also very friendly and will teach you medical-type things without making you feel like an idiot or pimping the hell out of you.

Today's Procedure of the Day: Somebody came today with a chief complaint of "wax in my ears." Dude, it takes ALOT of wax in one's ears to bring them to the ER. Her hearing was impaired, and when I looked in her ears her ear canals were totally occluded by wax. So I got to attach a catheter to a 30cc syringe and flush her ears out with saline! It was a little gross yet oddly very satisfying to see all the big chunks of wax come flooding out. (But then, I'm the sort of person who likes to look at the hairy wax strips after I get my eyebrows done.)

O. M. G. YA'LL.

Hey, remember how a couple of months ago I swore to never binge drink on a date again? I need to stick a post-it on my hand or something everytime I go out, am in the vicinity of a bar, or am otherwise in public, because I'll be damned if I didn't up and binge drink on a date again last night. [But with decidedly less morbid results this time!]

I got out of my MPH class at 9, and caught up with one of my former classmates (just graduated and now an intern!--this is off topic, but I see many of my former classmates in the ED, mostly the surgery and medicine interns who are called down for consults/admissions and it's SO WEIRD to see them in their long white coats. Like...I remember seeing you turn green in anatomy lab first year and have a panic attack in the library about Boards second year....you can't be a real doctor!) at Matisse in Lakeview. Turns out neither of us can resist a good deal on a drink (dude...I'm desi. It can't be helped. He's clearly just an alcoholic.). I was ok with this though, as I didn't have to go to work until 1 PM today. He, on the other hand, had to go in at 6 AM.

"Enabler of vice" is not the ideal image of myself I wish to present on a date, but we did end up splitting a pack of cigarettes and drinking til 1 AM, at which point I insisted that we part ways before I ended up being responsible for him vomiting on rounds or something.

Anyway, I just got off shift and listened to my messages, and there was a hilarious one from him this afternoon:

"So, I had the most ridiculous day...

Here I was expecting some outrageous story about starting an IV on himself instead of eating lunch to rapidly hydrate or something...PEOPLE, IT HAS BEEN DONE BEFORE.

...
this morning was a little painful, especially when it started hailing as soon as I left for work.

Evidently I slept right through this hailstorm.

I decided to just take a cab to work, but unfortunately the rest of Chicago had the same idea, so I was waiting in the hail for over 20 minutes and no cabs came by. I called in to let my resident know I was running late. My resident was pretty surprised to hear from me, because apparently, today's my day off. So I pulled out my schedule, and what do you know! Chuckles heartily. Then I went back in and slept all day. Isn't that hilarious?"

People, does that not sound EXACTLY like something I would do? I am the MASTER of confusing my schedule up. Hee! I don't know if this bodes well or deadly, but it certainly cracks me up.

Tuesday, July 18, 2006

Hey ya'll! You know what I love? MANUAL DISIMPACTIONS. (Is that pretty much the most disgusting picture ever? I wish it were as easy as pulling out the poop.)

"What's a manual disimpaction?" you ask. "Is this something I might like to have done electively?" NO. Basically, a manual disimpaction is when hard fecal matter is palpated in the rectal vault and digitally removed. And by "digitally", I mean with a finger. The MED STUDENT's finger, to be precise.

Now, I actually do love poop. I love all GI-related things and think we'd be closer to world peace if we could just get more people to have regular colonics. I'm not a fan of pooper scooping though, but my attending showed me a trick to ease the pain: swipe some benzoyl peroxide on the inside of your mask, and all you smell is the intoxicating aroma of sterilization. Instead of poo. Now that I know that trick, I can manually disimpact for HOURS.

Monday, July 17, 2006

Embarassing Moment of the Day: As I was standing back up again after leaning over a patient to listen to her heart, I totally banged my head on the stupid IV hanger thing that dangles from the ceiling in the ER rooms. I was hoping I could play it off cool like, y'know, my hand just whacked into it, but my patient (also a head trauma) looked right at me very sympathetically, "Did you just hit your head on that? I've got ice right here."

Sunday, July 16, 2006

On Friday night around 2 AM Gaya and I found ourselves at that little park near Rush and Division where the Gloria Jeans coffee stand is with 2 of our recently graduated classmates who are doing transitional internal medicine years here in Chicago.

MK: That guy over there totally looks like he has Treacher Collins.

G: Definitely some kind of chromosomal abnormality.

MK: I really want to karyotype him.

R: Is that the one with cherry red spots in the eyes?

KI: No, that's Tay Sachs.

G: It's not Lesch Nyhan?

MK: That's the one with some kind of amino acid deficiency...

KI: Purine! It's a purine deficiency!

MK and KI high five excitedly.

G and R: Silence.

MK: And that's why we're not getting laid.

Thursday, July 13, 2006

Have you ever met someone of the opposite sex who's so attractive you sort of lose all mental functioning when they're around? Like, your IQ suddenly drops about 60 points. I just had that experience yesterday, for the first time in my life. (Fun!) Unfortunately, it happened in the ER, in the context of massive trauma. (No Time for Mack.)

I came on shift at 6 am Wednesday morning after a train on the Blue Line derailed Tuesday night. It happened in the Loop about a mile away from where our hospital is so 99 of the train patients came through our ER that night. Most people were just screened for carbon monoxide levels, given oxygen and discharged, but several ended up getting admitted. As a result, every inpatient and intensive care unit bed was filled that night, and the hospital was on bypass, meaning ambulances weren't supposed to bring patients to our ER, because we couldn't admit them as inpatients if we had to.

So -- CHAOS. The ER was FULL of patients. All of the rooms and trauma bays were full, and patients were in the hallways. It also just felt like the people who came in yesterday morning were just SICK. Everyone was just really, really sick, needed a lot of close monitoring, were constantly looking like they were about to crash etc.

In the midst of this I had a patient with acute cholecystitis (infected gallbladder, which likely needs to be surgically managed) and I had to call a surgery consult. No big deal -- a good many of ER patients need to be surgically evaluated, and many end up going up to the OR.

Unfortch, it just so happened that the surgery resident who came down to the OR for the consult was HOT. RIDICULOUSLY HOT. And no, not just med student hot, but real, honest to god, MOVIE STAR hot. It's a little high pressure as a med student to present a patient to a senior resident or attending, because they'll probably ask you a lot of questions you can't answer and make you feel like a doofus, but this guy had me forgetting things I already knew.

Witness:

Ridiculously Hot Resident: Hi, what's your name?

R: Trauma Bay 1.*

*I honestly thought he was about to ask me where my resident was.

Ridiculously Hot Resident: Regards R carefully. Looks tired, like he's been up all night saving lives. Tired but gorgeous. Like, if I had been up all night repairing someone's spleen, I'd be looking ROUGH at 7 am. This guy looked like he'd just stepped out of an Axe commercial. And then put on scrubs and a white coat. HOT. Are you taking care of the patient in 21?*

R: No. Oh wait...yes I am! I mean, um...I don't think so. Who are you talking about again?

*In all fairness, the confusion was warranted. This patient had been in Room 21 but was then moved out to the hallway so a neutropenic fever (who I was not taking care of) could have the room.

RHR: (Hotly) Exasperated. The acute choly.

R: Oh yes! Yes I am. Proud of herself that she was successfully able to answer the question.

RHR: What's her white count?

R: Um...it's...elevated? Uh...I can't remember exactly what it is ... voice trails off as she scrounges through all of her pockets, shuffles crumpled up sheets of paper. Two minutes later triumphantly produces a torn up piece of paper. Sixteen! Her white count is sixteen.

RHR: We're admitting this patient to our service. Translation: You are the least competent medical student I've ever met and I'm fearful to leave this patient in your care. Have your resident page me whenever she's free, okay? Translation: In fact, you're such a doofus that I can't even trust you to fill the paperwork out correctly so I won't even ask you to do it. What year are you anyway?

R: I'm a third ye--no! No, I'm a fourth year!

RHR: Shakes head and walks away. Hotly.

***

And to break the monotony, here are pictures! I have been missing Iowa lately, so I thought I'd post some Iowa pics here:

Yes. That is a stripper pole. At someone's house. I think it'll help the resale value.


Do you see the poster in the window? That is Baby Stewie telling us we suck. Liz's neighbors put this up in the window directly facing Liz's house after she called the po-pos on their loud obnoxious rottweilers. Liz contemplated putting up a similar poster in return, or maybe a peace sign in the spirit of nonviolence, and in the end decided to respond all Zen-like with nothing at all. Though I would have loved to help construct something with which to flip the old el birdo to the neighbors, I was proud of Liz. And I think an important lesson was learned that day. DO NOT COME BETWEEN THE LESBIANS AND THEIR DOGS. The lesbians RUN that dog park. Don't even go there.And finally...my sweet little Reflux! I'm happy to report he's doing well in his new home. He is well loved and is now surrounded by people 24/7, something I couldn't provide for him. I found his octopus toy in one of my boxes of books and I almost decided to drive to Centralia this weekend just to see him but unfortch ... I have to study. (MY GOD. It has been so long since I've said that. That felt really unnatural.)

Monday, July 10, 2006

Now that my ER night shifts are out of the way (I know -- from the way I endlessly bitched about it one of my friends actually thought I was on nights all month...it was actually just 3 nights) I miss it! I really love ER! As much as I thought I would be the doofus med student because I'd been away for a year, it wasn't that bad. (And, uh...for ER you don't need to know too much detail about anything) This morning the attending actually told me that it was a shame I was going into ob/gyn because I'd be great at ER! My head got really big after that, until 5 minutes later when I realized he probably had me confused with the other med student on shift, another Indian woman who's pretty hard core about going into ER. (It's tough when there's more than one of us in the same room.)

Unfortch now I'm having another identity crisis where I don't know if I really want to do ob/gyn. I don't think I could say goodbye to the OR for good but being in the ER and seeing patients again made me realize how much I do love medicine. I love the excitement of a good case where you don't know what your patient has and you just want to try your hardest to figure it out so you can make them feel better again.

The only bad part about medicine is all the sort of terminal, hopeless stuff. There's a lot of that. When I was on medicine we had a patient who was admitted for rule out MI, turned out not to have an MI, fell on the way back from the bathroom one night and broke her hip, then caught pneumonia and C. Dif. [v. unpleasant hospital acquired infection involving explosive diarrhea] while she was here. Our team was happy to discharge her no sicker than she was when she came in. I'm a novice but there are some truths I'm learning. People that come to the hospital are really, really sick; usually too sick for us to do anything about it. But when someone comes in for something that we actually CAN help them with, it's the best feeling in the world. And I'm too immature to be happy without instant gratification, which is why I think I need a surgical subspecialty (with healthy young patients!). We'll see I guess. I'm doing my internal medicine sub-I soon so that'll be my chance to figure out whether I hate it or love it.

[And I'm sorry! This is all boring med crap. I knew I would get this way once I started M4 year again! Lo siento!!]

Saturday, July 08, 2006

I survived my first ER shift ya'll! Can I tell you something? NOTHING sucks ass worse than having to walk to the hospital at effin' TEN PM decked out in your scrub finery and short white coat flapping all over the place. Especially when you live in downtown Chicago and you pass all the girls hooched out in their going out clothes, and all the outdoor cafes with people drinking wine and having fun, and you're about to enter the bowels of the hospital and not be allowed to leave until morning. It just sucks, is all. I used to BE one of those girls!! Take me back!! TAKE ME BACK!

Anyway, I have mentioned many a time my total lack of medicine skillz, and EKGs in particular are especially weak. I have managed to deal with this problem by avoiding chest pain patients like the plague, but last night in the ER it was ALL chest pain. [By the end of the night even my intern was like...GOD I just wish we could have a car crash or stab wound or something.]

Behold the skillz [and please keep in mind I took the last year off to do GYNECOLOGY research and in so doing completely forgot everything I learned in the past 3 years]:

R: ...oh, and you can hear a pretty pronounced S2 split on this patient.

R's resident: And what EKG finding would we expect with a PARADOXICAL S2 SPLIT? I'm thinking about a BUNDLE BRANCH BLOCK.

R: Huh?

R's resident: Do you know the bundle branch blocks?

R: Um...I know of them......?

And that was pretty embarassing. Now that I'm back on the wards this is but one of many embarassing stories to come.

Friday, July 07, 2006

In preparation for my first night shift in the ER tomorrow, I'm attempting to keep myself up all night tonight. I anticipate failing miserably and probably passing out sometimes in the next 45 minutes. The only things I have to distract myself with are a) assembling my bookcase and shelving my books b) writing my personal statement for residency application c) teaching self how to read EKGs again, because have completely forgotten every last nugget of information learned in the first 3 years of med school. Unfortunately those don't have a chance when pitted against d) lying in bed reading trashy novel while eating Nutella out of the jar.

Thursday, July 06, 2006

Reflux Update

As long as I'm on the hold with the STUPID, STUPID, MOTHERFUCKING DUMB ASS WANKER AT&T BASTARDS (Seriously: AT&T? What do you assholes actually DO over there?)who do not understand the concept of "appointment" beyond taking multiple appointments but not comprehending what it actually means to KEEP the appointment, I thought I would write a Reflux update. They gave me a time range of MOTHERFUCKING EIGHT AM TO FIVE PM. Like...I understand the world of repairing high speed Internet is akin to the OR but a MOTHERFUCKING NINE HOUR time range is complete bullshit. BITCHES.

Many people (well, 2) have been wondering how Reflux is faring in his new highrise home in donwtown Chicago. Well, to be honest -- he hated it. He was completely miserable here. That coupled with the fact that my building doesn' t even allow pets and I had to sneak him in and out in a big duffel bag really didn't make a happy camper out of him. I knew I couldn't keep him here and I wasn't sure what to do with him so I called some puppy adoption services in Chicago but no one could guarantee that they could find him a home or even keep him from being euthanized, and I was very reluctant to hand him off to a shelter. So I would cry, and Reflux would pee, and then I'd have to put him in the bag to take him down for a walk, and then he would try to bite me and maybe walk into a few walls.

Then, like magic, my parents found a family in Centralia who would take him (YAY!). So this past Sunday I packed up his food and water dish, and his blanket and towel, and his toy, and his fence, and all of his little possessions, and loaded him up in my parents car to drive down to Centralia. I was very weepy, sad etc. Reflux had no idea what was going on.

Yesterday I heard from his new family, who have 2 very small kids, which I was a little worried about, but they said the kids love him and that they're shy to hug him because he's so skinny and fragile. It's for the best, though, because Reflux doesn't like being hugged and he also pees when he's scared, so unless you want a urine bath, let's just give Reflux his distance. And that's the story of my baby! When I go to Centralia to see my parents I will go spend time with him and let you all know how he's doing.

Wednesday, July 05, 2006

My ER rotation started today, ya’ll! There were several notable events of the day, the first being that no matter how hard I try, or how early I wake up, or whatever steps I take at night to get my things organized to make my mornings easier, I will always be 5 minutes late to wherever I’m going. Always. (What crunches do you do to make yourself be on time more?) The irony is I walked in just as the clerkship director was emphasizing how important punctuality is to this rotation. Oops.

Next momentous event: free lunch! (Potbelly’s!)

And thirdly, I realized how much I bloody effin’ hate (HATE) my white coat. It’s so heavy, all loaded down with stethoscope, tuning fork (ok, for a second this morning I was like why the hell do I even carry this around? I can’t even remember the last time I used it.), various little pocket books, half eaten NutriGrain bars (dating back to June of ’05…gross), chapstick, hotel lotion, little notebook, vials for collecting blood in (??), butterfly needles, reflex hammer, Palm pilot, and most importantly, specimen bag of change for peanut M&Ms from the vending machine.

And now, don’t judge me on this, but my white coat is DIRTY. It hasn’t been washed since April of 2005. I will preface my next few comments by stating that I do shower and stay clean, and while I can be kind of a slob around my apartment and whatnot, I AM NOT UNHYGIENIC. Despite my good hygiene, I always have ring around the collar on my white coat. I KNOW. It’s pretty effin’ gross. I think it has something to do with how heavily the pockets are weighed down and how that rubs along your neck all day as you run around getting soda from the vending machines for your patients and being yelled at by the ortho residents for consulting them. [And for the record, my patient didn’t break her hip to piss you off, so dial your shit down a little.]

So as we speak my white coat is festering in a bucket of OxiClean. It’s supposed to soak for 6 hours but I plan to let it stew for at least 48 hours. And I can do that, because I’m scheduled to work in the ER from 10 pm – 6 am every night this weekend. [BITCHES] I was actually planning to just get a whole new white coat, because in addition to a thick layer of dead epidermis on the collar, there’s also a blood stain around the right cuff, a big pool of where I must have spilled coffee down the left side, and a suspicious brown stain on the back where it looks like I sat down in some black bean soup. Or poo.

GROSS. Can you believe I used to wear this thing every day? I dug it out of the drawer it sat in for a year while I did research (O research! Sweet flower.) and almost vomited putting it on today.

We also had 2 hands on sessions today, one where we intubated a plastic head with an attached thorax, and the other where we practiced suturing on pigs feet. I accidentally poked a hole in the dummy trachea with the …uh, metal foldy thingy we use to …um, shove their tongue down with, and I was a little grossed out because my pig’s foot was kind of hairy and bleedy. (Medicine!)

In other news, AT&T promises that they will send their incompetent asses over here to fix my DSL line, so until then I’m pirating off my neighbors very, very slow wireless connection, but after I get my very own legal connection, I promise I will update more regularly!

AND… in other, slightly more irritating news, I have a friend from Iowa I will refer to as the K-Hole. I thought using his initials might be boring, but calling him Special K was too flattering, and then in ER today I learned that a particularly bad bender on Special K (street for ketamine) is known as going down the K-Hole. Folks, I am on a bad bender. Thus he will be known as the K-Hole.

Alright ya’ll, let me vent for a second. What does it mean to be passive-aggressive? I’m not exactly sure, and I sort of it use it anytime anyone pisses me off in a nonconfrontational way, which is exactly what the K-Hole was driving me nuts with over the weekend. I was a little sad but mostly thrilled to see him go back to Iowa yesterday. Why? Why do guys suck ass like that sometimes? How am I supposed to know what they're thinking if the K-Hole doesn't tell me? Ok, I’m moving on now. I need to take a wooden spoon and go poke my white coat around in its bucket for a little while.