another code blue to start out the day. it seems like they usually occur in the morning between 6 and 8. kinda like earthquakes how they usually happen at night. pt survived.

1 down, 1 to go

i went in to the hospital at 6am yesterday. i left the hospital today at noon. that, just in case you cant count [or are just in disbelief] is a 30 hour shift. i got to sleep for about 4 hours. how did i end the shift? the best possible way...had to do a rectal exam right before i got to go home. like i always say, theres no better way to end a 30hour shift that to stick your finger in someones...

Code green

i heard "code green" over the PA system and asked the nurse next to me what that is...she laughed and said it means a patient went AWOL. apparently its the code you call if your patient is missing.

an hour later in the residents lounge we were sitting with our interns and one of them got a phone call. after he hung up he said: "that code green was for our patient Mr. X. hes gone, i guess they found him running towards firestone blvd."

Fungi

was sitting in the resident's lounge when two interns walked in.
 one said to the other, "wow, that presentation was pretty good." [this was referring to Tan's presentation he had just given them on an assigned topic.]
when i heard this i said, "thats nice, im gonna tell him you said that" [thinking i was being nice, i know how hard Tan works on his research presentations.]
next thing i know the intern is looking at me laughing saying, "you know what, just for that im going to assign you a presentation. is that ok with you? [turns to my intern who says yeah sure why not because she thought he was joking--he wasnt.]"

know i have to do research on different systemic fungal infections just for opening up my big mouth.

i need to stop talking.

another one of my patient's died today. i swear its not me, they are just really sick!

one that isnt really sick is my 60yo pt who checked himself into the hospital for alcohol withdrawal symptoms. this can get pretty serious if your body is used to alcohol at all time, you can have a seizure and thats not good. Originally, i thought 'wow, good for this guy. he wants to clean up his act.' FALSE. after talking with him, i found out the guy had a stomach flu and was vomiting for 3 days and he couldn't drink because of it. so he started having tremors and felt like crap so he checked himself into the hospital to get IV fluids. we call it a banana bag because it really does look yellow. its normal saline with supplements that most alcoholics dont have beacuse of their poor nutrition. rumor has it that they cost around $1,000 because of all the calculations to mix one up [complete bullshit i think to cost that much...]. so we were forced to check him into the hospital because of his withdrawal symptoms. your tax money hard at work [medicare patient].

"Is it just me or is it unnatural to have to be asleep by 8pm?" -Tan

Thursday at 11am:

While eating lunch Nicole looks at her watch then looks up at me:

" I know, don't say it. It's still the AM" -me

"yeah. so wait, that means I'll be able to go home in about...24 hours" -Nicole
[ps lunch at 11am is the norm when you wake up at 4:30]


"why do you like to torture yourself? -nurse
"[long pause]what do you mean?" -me
"why did you go to med school?" -nurse
"i ask myself that everyday..."-me

"its like the show ER without all the dialogue" -one of the 10 people crowded outside the patient's room who was coding

First code blue

before i could even set my coffee down this AM we heard a code blue announced over the speaker system in the hospital and a couple of us went to check it out. it was an old man who's BP dropped. after giving him some bicarb he came back, he didnt need any CPR or epinephrine. a couple hours later while i was seeing my patient another code blue was announced. after finishing up with a quick physical, i went down to the 2nd floor to check out the code. it was an old man with no previous history of cardiac problems. they gave him a couple rounds of epi and were doing CPR. this is the first time id seen CPR and man is it rough. this mans body was going through hell. the daughter was called and asked to continue until she got there. a couple of the interns asked us if we wanted to do CPR and i shyed away and let victoria and darron do it. i figured its my first time seeing it, ill take in the experience and then jump in on the next one. unfortunately, with all the geriatric patients we have in the hospital, im sure there will be more in my next 3 weeks there. when the daughter eventually got to the hospital she didnt go into the room, she just asked that we stop and let her father die in peace. im sure that was best because if she saw how rough the code really is, she would have been much more upset than she already was.


the interns let us go at noon today, saying it was our christmas present. i went home and slept for a good part of the afternoon. this week was exhausting. i hope i get used to these work hours soon.

Found out this morning that Dorothy died last night before we could even send her home to be with her family. sad and very scary how quickly she went from stable to dead...

Went in at 6am and found out Dorothy, my 86yo patient, went downhill fast overnight. When i saw her yesterdy, she had dementia like she has had for many years but she was still able to respond to my questions. the only problem with her was her morning lab values showed a decline in her kidney function. we got a renal consult yesterday and they decided to leave her in the hospital for one more day. so instead of sending her home we kept her for another night expecting to discharge her today. well, when we came in at 6am this morning to get our patient assignments, our intern told us she was transfered to the ICU. they did stat CT abdominal scans on her because she was complaining of stomach pain. after doing the scan we found out she had cancer all over her liver. it must have been there for a year or so and she hadnt shown any symptoms until now. She was transfered from the medicine ward to the ICU and her family decided to make her DNR.   When we rounded [the first time we did so on the wards] my attending spoke with her son and daughter and they decided to bring her home and give her hospice care.  it was such a quick decline and it left us all wondering how the hell she had been asymptomatic up until now.

After eating lunch, nicole and i went with one of our interns to a skilled nursing/rehab facility a couple blocks from the hospital. our attending helps run it and takes care of lots of patients there. Twice a week he sends his interns [and us] to write progress notes of some of the patients. i did a note on a lady with dementia, arthritis, bipolar disorder, etc etc. She was sweet but had a lot going on. anywho, went spent a couple hours there and left around 3:30. it was the shortest work day i had yet [9.5 work day is short these days].

IM Day 2

the day started at 6am at the hospital [actually at 4:30 when i woke up and commuted to work]. myself, nicole and one other student met with the 2 interns on our service and we divided up patient progress notes. we have all morning to write their notes except we have to come back to the conference room for a case presentation lecture at 7:30. the case is presented by the student that did overnight call and he talks about the patient he admitted. today it was a 49yo M with abdominal pain for 3 weeks. there was obviously a lot more to the case but once we got to building a differential list, we went around the table each saying a disease. as we were finishing up the case and getting ready to work on our notes again, an intern stopped us and said, "for the rest of your career you are going to be asked for differentials. if you ever get stuck, say cancer or thyroid disease. they always work." good to know...

couple thoughts:
-one of my patient's today was named Dorothy. she was 86, confirming the fact that i am the only person under 80yo that has the name.
- the hospital i am in has a pretty big residency program and there are 12 interns in each year. i am still trying to figure out which of the interns are hooking up and which hate each other.
- a bunch of the interns today were talking about the christmas party they are having tonight, its gonna be fun to see them all hungover at 6am tomorrow
-i just got really excited when i found out i can download an iPhone app that is the same program that i use on my computer to study for boards. this made me really excited then made me confirm to myself that i am a huge nerd

Being the chick's again

Monday 2:00pm
We got to the hospital for orientation at 8am. there was around 20 of us medical students starting either internal med, family med or surgery. we listened to more lectures about professionalism and proper handwashing, then took a tour of the hospital. while looking at the ORs and surgery lounge, a surgeon that has obviously been a surgeon for a very long time [imagine grey hair and long white coat] needed to walk through the group and he just laughed and said to the tour guide, "are these all the new chicks? hello chickens," and walked right through the sea of short white coats with 'deer in headlights' faces. it was very appropriate for, lets be honest, we were all starting new rotations in a new hospital and were all pretty nervous. he just chuckled along, obviously having cracked himself up.

after that we got split into 2 groups and we met our attending around 11. Nicole is in the same team as me and word on the street is that we got the cool laid back attending. When he came in for rounds I found out why people say so. He was wearing jeans and our rounds took place in the resident lounge while we occasionally chatted with people that would stop by (compare this to the other group that does rounds starting at 9am on the wards and has to be on their feet walking around until 1ish). I was concerned at first that I wouldnt learn a lot from him since it's so casual but i think the decreased anxiety in the situation will really help us stop worrying about looking bad and just focus on learning medicine. It's always nice to have an attending who's goal is to make you feel smarter not dumber. Though, I'm sure making us feel stupid makes us study harder...

I admitted one patient in the morning. She spoke only Spanish. I think this is gonna be a trend...




Monday, 8pm [having finally sat down to relax]

First day down... I forgot how much the first few days of rotations suck. Its pretty difficult to get familiarized with a new hospital, new paperwork, new residents, and new attendings all while remembering that you are here to do a job and use the stuff we learned in school. I swear the first day always reminds me of how far away I am from being a competent and independent physician. How people remember everything amazes me. Only thing that makes me feel better is knowing everyone else feels the same way.

 The first week of every rotation is a steep learning curve. Trying to remember all the common medicine you should know but forgot. Then trying to not look as bad when you dont remember stuff by spouting random facts about the disease process or treatment plan.
For example, I admitted a patient today who came in from the ER with chest pain and back pain. She had a history of a ton of heart problems [CAD, atrial fib, valve replacement-- she basically had a plastic valve in her heart, a re-plumbing surgery for her heart and a pacemaker to make sure it doesnt ever stop because sometimes, it just decides to stop]. After seeing her labs I decided the patient was hyponatremic and that we needed to give her IV fluids. Next logical question from the intern was "ok, how much?" in my head went a few thoughts like "shit i dont remember, shit why cant i remember, shit what should i say, oh god now i am turning red, uh oh now ive paused for too long and he knows i dont know, shit he knows im incompetent." so after a long pause i say, "we should give her normal saline but im not sure how much because i know the pediatric equation not the adult one." next logical question from the inter was, "thats fine, its similar, what is the peds one and we can talk about how its different." well, again, lots of thoughts ran through my mind and i was already a lil tachycardic at this point and i couldn't figure it out so i just smiled and said "im gonna need to look that up but one we do that we should...." i rambled off some information so we didnt end the discussion on my obvious lack of knowledge.

i make this sound bad but it really wasnt. the intern we are working with is a really sweet guy who is really enthusiastic about helping us learn. i think its more the need to show you belong there that makes us all anxious when asked questions. its like "i studied a lot these last two years, please think i am worth teaching!"

we finished up the day at 5:30 and it took me an hour to drive home in traffic. tomorrow, and every other day after that we have to be at morning report at 6am. its still dark at 6am.

$$$$$$

financial aid came in today [they split it and give you half at the beginning of the academic year and half in the middle]. thats a lot of money sitting in my checking account right before christmas....

nicole went to vegas for the weekend, i made sure to text her this:

"seeing as though you are on your way to vegas and have a newly deposited large amount of financial aid in your bank account, i thought i would take this opportunity to remind you to be careful"

I've wanted to be a doctor since I was 14, you'd think I'd have decided on a specialty by now :/

Today we had a '4th year orientation' which was a 2 hour presentation about how to schedule our electives and such. 4th year requirements are

1) 4 weeks emergency medicine

2) 4 weeks sub-internship in any medicine specialty

3) 4 weeks sub-internship in any surgical specialty [a sub-internship is a 4th year clinical rotation done at a hospital with residency programs. A student will generally select an elective sub-internship, where the student will perform the role of an intern or first year medical graduate, under the supervision of attending physicians. In this way, the student can experience a glimpse of their future career without the burden of full responsibility.] 

4) 7 electives [4 weeks each] 

5) 4 weeks of vacation.

 the trend that connects all of them? NONE of these are actually scheduled by the school, they are just requirements. this is both the beauty and scary aspect of 4th year....we get to schedule the entire year based on our interests. With some rules and restrictions, I can pretty much do a rotation in any hospital in the country. sounds great... except that with that many choices i start to have a panic attack every time i try to think about making a decision. 

the biggest decision of them all...deciding what kind of medicine i want to do for the rest of my life. i thought by now i would have decided but i am still scratching my head, looking around wondering when im going to get that 'ah hah!' moment. its really scary to see my friends make decision and start to set up their audition rotations for next summer while i am still figuring out what i do and dont like.

Here is my list:

-i know i want to be a hospitals [or at least spend most of my time in the hospital...could be a clinic, OR, wards, whatever]

and

-i know i want to do procedures 

thats a short list but i guess i need to start somewhere. I think as i do internal medicine throughout the next 2 months and get to spend time in the ER admitting patients occasionally i will start to see if either of these could be somewhere i could end up.

and while i spend time deciding my specialty, i have to decide what city i want to live in for the 3-4 years after graduation. and while i decide that i have to decide what hospitals i would want to do my residency at in those cities so i can schedule audition rotations at those hospitals during july-october of 2012.

no pressure.

Blue Block

Daniel: r u studying right meow

me: nope

      christmas shopping online and watching mad men on netflix

Daniel: i can't wait for vacation block

officially half way done with 3rd year!

its ova!!!!
Last day came and went. it was actually a pretty good day. My last patient was a new patient to the clinic so i went through an extensive H&P on him, lets call him Matt. He was a 66yo guy who had tinnitus [ear ringing] that he couldn't get rid of. It started 6 months ago after dental work and it is driving him crazy. He was there with his wife and they were a pretty cool couple. They got married 10 years ago and she helped turn his life around. Matt grew up in Brooklyn and just like anyone from Brooklyn, he was sarcastic, witty and very funny. We talked about his childhood and his youth. He has lived all around the states, Chicago and Hollywood being his favorites. He used to work for nightclubs in LA and with that, did a lot of drugs. He had some good stories and some really tragic ones. Overall, he didnt regret a thing and i envy his life. He went through a lot of lows and highs but his life experiences can never be taken away and now, he is a happy, healthy and active person. It makes me laugh at how opposite we have lived out our 20s. I dont envy all the drugs and stupid situations he got into, but i do envy his unattached freedom. It would be nice to give up expectations for a moment and just live life instead of worrying about the future. Though in a sense i do have unattached freedom because i am a single adult with no family to tie me down, i have a lot of responsibilities, expectations to meet, and debt to pay off.

another highlight of our last day was when a patient came in just to show me her dog. this lady had been in 3 times throughout this month and i saw her each time. She got hurt badly when her dog [a 70 pound golden-doodle puppy] pulled her in her back yard and she hit her head and arm. She loved this dog and talked about him all the time. I wanted to see pictures of him and on her last visit she forgot so she said she would bring him in at lunch one day. Well, on our last day the dog walked her into the front door and we played with him for a bit. it was really fun.

At the end of the day, the doctor pulled everyone aside individually and went over our evaluations. She was really nice and gave me some compliments and constructive criticism. It all ended with, "you are going to be an excellent, compassionate physician."

that felt good to hear.

Getting to business

"Are you married?" - 68yo male OB physician
"No" -Sarah, third year medical student
"Well you better get to work. If you don't find someone by residency you never will. Men are intimidated by female doctors"
"Thanks..." -Sarah

2 more days

The doctor told us at the end of the day that she's going to miss us. I was flattered but really my only thought was "Sorry but I won't miss this place lady..."

Back to the grind

In response to an email requesting my work schedule over the holidays. I'll be doing internal medicine at a community hospital. 

Hi Dorothy,

All students are off on Christmas and New Years Day.  Half the IM students will be working on Christmas Eve (weekend hours are 6am to noon) and the other half will be working New Year's Eve.  I have you schedule for New Year's Eve, so you will be off on Christmas Eve.

scrubs + tennis shoes everyday CANCELED

My next two rotations are internal medicine, both being inpatient hospital rotations. I just found out that for the next 2 months during them I have to wear dress clothes....scrubs are only allowed for overnight call [basically after 5pm]. My heart just broke a lil bit....

Men

"my 90yo patient has implants" -one intern says to the other
"wait, she has them or she is getting them" -the other intern

accidents

On sunday i feel off a horse. it hurt. i went to the ER and had pelvic xrays because i thought i broke my pelvis or hip. x rays were clear and i was sent home with a bottle of vicodin. didn't go to work on Monday. went to work tuesday and wednesday basically because i had too. awesome. its kinda hard to treat other people when you can barely stand on your own....

 last week, i thought it was really hard to listen to patients talk about their back pain and headaches that they have suffered with "for 20 years" [how someone can have a headache for 20 years i have no idea, but apparently you can]. This week, i found it impossible to listen to the same complaints when i could barely move. It was an interesting position to be in as I tried to console a lady for her mild neck stiffness after 'sleeping on it wrong' while i sat there trying to cover up the fact that i could barely move, because when i did i wanted to die. it helped to focus on the vicodin i had waiting at home for me.

part physical treatment, part psychiatry

3 hours. i spent from 9am to 12pm with one patient. i came out with a whole new appreciation for psychologists, therapist, and psychiatrists. my appreciation stems from the thought "thank god" as in thank god they are around so that someone does their job cause i sure as hell am not going into that field. so far, i have dealt with patients that have chronic pain and im pretty sure 50% of them are attention seekers. or thats at least what it feels like. i know this sounds extremely insensitive but it is very mentally draining to speak to a patient for 2 hours and all they are doing is complaining of pain that is debilitating them. Noteworthy also is that most are on workmen's compensation even though they are sitting there smiling and laughing asking for their vicodin refill.

you may be wondering how this doctor makes a living spending so much time with patients. well, thats because she charges $350 for a new patient visit and anywhere from $150 to $300 for a return visit. Also, she is cash only meaning she takes payment from her patients right after treatment and then gives them a receipt so they can fight it out with their insurance companies [which do cover osteopathic treatment]. brilliant.

OMM [osteopathic manipulative medicine] also known as OMT [osteopathic manipulative treatment] rotation. Day 1. 
holy hell it is going to be a long 4 weeks.


i have nothing against OMM, im actually really excited to improve my palpation and rehabilitation skills. but damn am i spending waaaaay to much time with one patient and listening waaaaay to much spiritual babble along the way. most DOs that solely practice OMM will spend an hour with each patient. how did i get stuck at this clinic? at least im with 3 other students that i am good friends with


preface: learning OMM is what sets me apart from an MD. brief write up about it:
Physicians can have MD or DO after their names. This distinguishing acronym is an indicator of what type of medical degree they received. 

Both types of physicians are fully licensed and provide a full range of services from prescribing drugs to performing surgeries to using the latest medical tools and treatments. 

Many DOs offer a unique service called osteopathic manipulative treatment (OMT), a form of hands-on care which involves using the hands to diagnose, treat and prevent illness or injury. Using OMT, an osteopathic physician (DO) moves muscles and joints using techniques such as stretching, gentle pressure and resistance. 

OMT can help ease pain, promote healing and may increase mobility for those suffering from asthma, sinus disorders, carpal tunnel syndrome, migraines or menstrual pain. OMT can complement your treatment plan or even help deter need for prescriptive drugs or surgery. 

Every doctor is different but there are many more DOs that are holistic/naturopathic oriented than MDs. and apparently, i am working for the most unorthodox doctor. we spend about 2 hours with each patient. first, we chat about their chief complaint, get the HPI and then we spend around an hour treating them. think physical therapy, meets chiropractic, meets message therapist. really, there are some great techniques and i am really happy with how much i am learning but holy hell, 2 hours with one patient!? after an hour i feel like im gonna fall asleep from boredom. not to mention most people are those with chronic pain so as insensitive as it sounds, i get really jaded listening to people complain of their pain. 

everyone gets back pain, all of us have terrible posture and have very tight paraspinal muscles because of it which leads to a lot of uncomfortable sitting/ standing/ whatever. but not all of us complain constantly about it or need to pop 2 vicodin a day for it. granted, we [doctors] are the reason for drug addictions as we readily prescribe pain medication and then inadvertently create an addict, but when people demand drugs, how can you say no to them if they come to your office again and again asking for them saying nothing else helps? its unethical and malpractice to deprive them of medication that will stop their pain. but at what expense? 

anyways, i know im going to find this rotation challenging as i am much more fast paced and i am being forced to slow down and learn a lot of detail about each person i am working on. its emotionally draining to hear about every problem a person has and then be expected to start all over again and listen to more problems from your next patient. i barely have time to sit down and speak with friends and family for that long. i have never wanted to go into psychiatry and this rotation is a major wake up call for why i think that way. 

seriously, gonna be the longest month of my life. i would rather be working like a dog 12 hours a day in the hospital over this.

at least i get thanksgiving off...


and i dont have to work on fridays....

bye bye Portland

Week 4 of elective: Worked 3 days, had my normal wednesday off and then asked her for Friday off to start my road trip back to LA. She took me to lunch on Thursday and we said our goodbyes. I'll miss Portland, i'll miss her, i'll miss the free lunches and starbucks...won't really miss family practice.

Now what...

beth came into the clinic today and saw my doctor to establish her as her primary care physician. Beth moved up to Oregon and didnt have a doc yet so i convinced her that dr.x would be a great fit for her. thats how much i like this doc. best part about the visit was i got to draw her blood to run some labs :)

my interest in primary care is growing less and less each day. i find myself day dreaming while the doctor is counseling a patient on diet and nutrition. im pretty sure i have ADD and im pretty sure i need to be entertained/thinking at all times of the day or else ill be bored. damnit, i started out being so excited about this rotation and now im back to square one.

1) OB/ GYN
2) Pediatrics
3) Family Practice


ob/gyn still in the lead. i still havent been able to beat the rush of delivering a baby or pulling one out of a uterus during surgery. so rad.


the most interesting things i saw this week were:
-a 28yo M with major depression and insomnia who drinks a gallon of vodka a week [stated by him]. he came in with his wife who seemed oddly ok with everything. they had obviously been through a lot together.
-a 51yo lady who was following up on her strep throat and upper resp infection. she was really sweet and i learned a lot about her and her case.

another one bites the dust

While my doctor was talking to a patient [who clearly had a personality disorder] about abdominal pain which has been investigated by several doctors but yet no cause found, i started to day dream and nearly fell asleep because i was so bored. i know this sounds heartless but i swear this lady was either drug seeking or had munchausen syndrome [faking illness for sympathy]. either way, i was pretending to take notes and this is what i wrote:

12:10pm Nov 1, 2011
I just decided at this moment that i don't want to go into family medicine. im pretty sure i want to work in a hospital setting. this sucks.

today a drug rep came in and took my lunch order for thai food. that was cool.

2 hours later another drug rep came in and took my starbucks order. that was pretty cool too.

i cant help but feel corrupted.

pure med student joy.

This week i got to see and do a lot of stuff. Heres a breakdown:

we had a patient come in with an ankle injury. after hearing the story and seeing it, we decided to send him up for ankle x rays [its actually 3 views] to rule out a fracture. it was swollen but didnt look too bad so the doctor and i didnt think it would come back with anything remarkable. we sent him upstairs to get them and 40 minutes later he came back down with the x rays in hand. the doctor told me to look at them and tell her what i saw and sure enough,  i found a fracture...a couple fractures actually. i was pretty proud of myself. to be fair, my sister could probably have found the fracture also considering how large it was so im not sure this is the biggest accomplishment of my career [no offense anna].

saw a 75yo lady who refused any kind of screening exams because whatever happens to her is natural selection and if she is meant to die, she will die. then at the end of the visit she said she wanted one test and that was for alzheimer's because if she finds out she has that then “she has plans.” [in 1997 Oregon enacted the Death with Dignity Act which allows terminally-ill Oregonians to end their lives through the voluntary self-administration of lethal medications, expressly prescribed by a physician for that purpose.... im pretty sure this is what she meant]. to each their own, i guess. 

a pretty depressing patient i had was a 30yo woman who was thrown off her horse last year and is still dealing with the effects. she hit her head and wasnt wearing a helmet so ended up with major brain damage. she has had two surgeries and though she is still totally functioning, she just isnt all there and was diagnosed with major depressive disorder [though almost all the patients i see are so thats not to rare]. the scary part was seeing how much her life changed in one instance and though i will still keep riding, i will make sure to NEVER be without a helmet when doing so.

last patient of the week was a woman who had chronic bilateral shoulder bursitis [basically inflammation of the joint]. she was a fun patient and both the doctor and i joked around with her during the visit. we decided to do steroid injections into her shoulder joints to temporarily relieve her pain and the doctor asked her if she wanted to do one or both of her shoulders. the patient said both if thats ok and i jokingly interjected and said “only if you let me do one of them.” then very suprisingly she answered “yeah sure why not.” i looked over at dr x and she said “see one, do one, teach one. ill do one shoulder and then you can do the other.” 

pure med student joy.

 so we drew up 2 syringes for each shoulder, one of lidocaine and one of a liquid steroid. we used a 1.5in needle and entered the shoulder joint. it was tricky because after putting in the needle and injecting the lidocaine, i had to unscrew the syringe to inject the steroid using the same needle and then take it out again to use another cc of lidocaine. my hands were steady and neither the doctor nor the patient could see how scared i was! i was nervous but pretended not to be which makes all the difference. after, the patient said it didnt hurt [which i am sure was a lie because thats a big freaking needle.] she told me it didnt hurt anymore than when the doctor did it so apparently, i did a good job. i love procedures!

oh yeah, and i watched the doc do a prostate exam on a 70yo man. that was not fun.

panic and confusion

Last couple days have been a med student’s dream. Tuesday morning we had 6 patients and then there was only 1 person scheduled for the afternoon and it was the last visit of the day so my doctor, being the awesome person she is, asked me at lunch “so, how do you feel about taking the rest of the day off. i mean, this is your elective and your new to portland so i think you should go do something fun.” Naturally, my first reaction was to think ‘is this a trick?’
 i responded with “well, i dont want to look like a slacker... are you sure?” She was sure.

 i left at 12:30 and spent the afternoon hiking. I also had Wednesday off per her usual schedule so really the last couple days have been pretty great.

 When i got home, i spoke with a non-medical student friend [who is friends with a lot of med students] about this situation and his response was “it seems like every time one of you is asked to go home, your worried about going even though the doctor is practically pushing you out the door.” this is very true. So, just to clarify, if you ask any third year medical student what their reaction is when asked if they want to go home early the answer is always going to be no until you directly hear “yes its fine,go home” several times. You may think this question would cause a wave of excitment but really, it just provokes panic and confusion.You always have to balance how this newfound freedom will affect the rest of your rotation and of course, your evaluation. 9 times out of 10 the doctor really is just being nice and wants you to go home and relax because they know that med school sucks, but for some reason our thoughts are always geared toward several thoughts: 1) how is this going to make me look 2)how is this going to screw me over 3) will i look better than other students if i DONT go home. sad but true, we are a predictable bunch and we are scared shitless of admitting to a preceptor that we would rather be at home watching netflix than doing scutwork at the hospital/clinic. The cool part about this is that there are a few rotations that when asked if you want to go home, you actually don’t. and this my friends, is how we decide what kind of medicine to go into.

had an amazing weekend in seattle and went into work for 8am this morning. i was moving and thinking very slowly...so exhausted.


a drug rep brought in donuts. seriously, doctor's offices have the most unhealthy food of anywhere else i have worked. irony?

a married man came in to get an HIV test after having cheated on his wife with a woman who he hired to give him a massage. you cant make this stuff up.

family medicine, a form of psychiatry?

Today started out at 8am with me giving a pap smear to an OB/GYN... It was a crazy experience that I am not sure I will soon forget. The patient was a doctor [a DO] that was in for her yearly well woman's exam. We chatted with her for a while about OB and how she had her own practice and then after about 20 minutes Dr. X started to get into her medical concerns and did a breast exam. When that was over and we were about to do the pap smear she looked at me and said, "do you want to do it? i mean, would that be weird for you?" i laughed and said "no, would that be weird for you? if your ok with it im ok with it." So there i was, doing a pap on a women who was talking me through it/teaching me about it while another doctor stood behind me and gave me pointers. talk about being nervous. i def messed up a bit but what medical student wouldn't under that kind of pressure!

Another interesting part of my day was when a lesbian couple came in. one being pregnant and the other being our patient with back pain. the notable part about this patient was not the lesbian part [im not that politically incorrect] it was the fact that she is a chiropractor and we did OMM on her.... trying to adjust a chiropractor, thats pretty much what they do all day! we walked out and dr. X said "talk about intimidating, trying to adjust a chiropractor is pretty hard on the ego." we both laughed since both of us tried and neither of us were able to get any results in our attempt at lumbar HVLA.

in the afternoon we had a mom and daughter come in, each having their own separate appointment. First, we talked to the 18 year old daughter who had a history of severe cramps and the birth control we started her on were making her nauseous so we switched her to something else. I sat and listened to dr. X explain to our patient that she may have endometriosis and what that diagnosis meant. I worked in OB/GYN for 6 weels and never did i hear such a well formulated and easy to understand explanation of the disease. the more i listen to this doctor the more i admire her. she is SOOOO good at explaining things to patients but yet she doesn't make them feel stupid. she is great and i really hope i can be just as good at it as she is. she really is helping shape me into the doctor i want to be.

Then, we roomed the mom in the next room and had the daughter wait in the waiting room. The mom patient was in for a well women's exam and man was it an educational patient visit for me.
we started out the visit like we always do, chatting with them about how their lives are going and just getting a feel for their lifestyle. as conversation progressed, we slowly started to get into this woman's relationship with her daughter. it sounded like they had a healthy teenage daughter/mom relationship and that right now they were struggling with starting the conversation about the daughter's sexual activity. when we started to explore this area, we learned that this patient [the mom] had a lot of trouble talking to her daughter about self-respect and setting boundaries with men because when she was an adolescent her step-father sexually abused her along with his friends. because of this experience, she became very open sexually and for the rest of her adolescence whenever she liked a boy she would just have sex with him because that is the only way she she knew to be. so now with her daughter, she knows this is not the way to teach her how to be but she doesnt know how to express appropriate advice because it is so foreign to her.

being a doctor at this point in a visit is not about medical advice, it is about being a counselor/listener/advocate for your patient. we are the official 'secret keepers' and really, that alone is enough for some people. i think we helped this mother out extremely by giving her an open ear and also some advice on how to go about speaking with her son and daughter about their relationships and self- worth while also making the mother realize that she is a good person, a good mother, and more importantly, that she is doing a good job despite her insecurities and doubt.

Vampire Success!

Today i drew blood out of a patient for the first time! it went really smoothly and i got a 'flash' [flash of blood showing you are in the vein] on my first try. She didnt scream in pain at all so im gonna take this as a huge success! I found the vein initially and then when i actually went to put the needle in i couldnt find it again so i just kinda went in blindly and it worked :)

the rest of the day went just as well. morning started out with a representative from a diagnostic lab brining everyone a pumpkin spiced latte from starbucks [again, i have mixed feelings about this but they are just so good and i am just so poor/loaned out!]. After this i took a look at my own throat and my tonsils and pharynx didnt look too hot so i asked the MA [medical assistant] to do a rapid strep antigen test on my throat. we took a swab of the white stuff sittin in the back of my throat to make sure it wasnt strep. it came back negative so i now know i just have a lil virus that will go away with time. a very convenient thing to be able to do :)


We saw about 10 patients today. One patient i remember in particular because when i was reviewing her medical history i clicked on the 'medication' tab and saw a huuuuuge freakin list pop up. this lady had 30 prescriptions and was probably on around 20 of them everyday [the other 10 were PRN which means on an as needed basis]. This lady was on 4 different anti-depressants alone.... talk about medication management.

last patient of the day had scheduled her appointment in the early afternoon because she was sick for over a month and was starting to have chest pain. I went in and did a history and her physical exam was completely unremarkable. her lungs sounded fine. i went back and talked to the doctor and we both started to get worried about her heart. The pain might be from the previous virus she had because certain viruses can also attack your heart after you have been sick [pericarditis, myocarditis, cardiac tamponade can all be a problem]. we sent her upstairs to get a STAT CXR [chest x ray] which came back negative and then we did an EKG on her in the office which came back normal [though it was really badly done because the ekg machine wasnt working well so it wasnt very reassuring]. we sent her to get an echo [echocardiogram] at a cardiologist office tomorrow to make sure nothing serious was going on.

the more i work at this practice the more i love it. the doctor is great and the staff is so sweet. i am having a good time and learning a lot. im struggling with the fact that i really am starting to like family medicine because i just dont know how long i will be able to do it if i go into it...its great to know the patients well but i have to admit, i think i would get really bored, fast! good thing i have a couple more weeks to ponder over all of this!

family med- week 1 continued

My doctor has every wednesday off so consequently, i dont have to work on wednesdays. bummer. i spent the day a lil sick but still tried to see a little bit of portland. from what i have seen so far, i can definitely see myself living here in the future.

yesterday, day 2 of family practice, was a good day. We didnt see a ton of patients so again we had some down time [i had a 2 hour lunch] but i still enjoyed it. We started out the morning with another pap smear and spent a good amount of time talking with a very pleasant lady.

my doctor spends upwards of 40 minutes with some patients. She sits and talks with them for a long time and really gets to know them. Some people just need someone to talk to and she is there to listen. i really like this aspect of family medicine. i am curious if all practices are like this or if she is taking a hit on her paycheck by spending so much time with each patient? maybe its just because she doesnt have that many patients anyways so she can spend so much time with each one? i am still trying to decide this.... either way, i am finding a lot of patients are on anti-depressants or have anxiety and really just need someone to talk to and vent for a bit.

The next patient we saw was a patient i had just met the previous day. she had come in monday because of neuropathy in her legs. she is the sweetest lady and is an ovarian cancer survivor. she was just diagnosed and had chemotherapy last year and is in remission now. unfortunately, the chemo drugs are still creating side effects. she is mildly overweight and has apparently been pre-diabetic for a long time and when her blood results came back we had to call her to come back in on tuesday. her blood tests showed she was not pre-diabetic anymore, she now had diabetes. it was pretty rough having to tell her this and explain what this meant and how her lifestyle needs to drastically changed. she was very surprised and cried. i felt pretty bad for her. she kept repeating "i just feel like a failure" and im glad Dr. X was in the room because i really didnt know how to respond to this. i didnt want to give her false assurance [because she really did need to change her diet] but i also didnt want her to continue thinking she is a failure. we had to increase her medication and will continue to monitor her blood sugars and HbA1C.

the next patient was a 37yo women who had fallen on her elbow and wanted it looked at. dr X thought this would be a good patient for me to start off solo with so i went in first and did a history and physical and then went back, presented to dr x, and we then went in together. we did some OMM on the patient and also talked about medications because she wanted to go back on her anti-depressants. i wonder if she used her elbow as an excuse to come in as i think her depression was her primary concern.

after a couple other patients we had a 2 hour lunch and i did some reading. when i walked over to the area where the computers and nurses are i saw them just hanging out reading so i jokingly said, "oh do you guys have some down time? which one of you can i practice blood draws on?" and to my complete surprise, one of them got up and said oh i will, lets get in room 5. i was shocked and nervously laughed and said i was joking but Molly [the nurse] said nope, you got yourself into this lets do it. she apparently lets students practice on her all the time. so, we went into a patient room and she showed me how to use their needles and she was a pretty easy stick. got blood on the first try. their needles are called 'butterflies' and once you put it in the vein you can let it go [which is very different from what i learned on at school] so it really was a lot easier than i expected. hopefully i can do some more during my rotation there. i asked her how i did and she said, great. i told her she was probably lying and that she had a good poker face. either way, she completely increased my confidence on drawing blood so im very appreciative.

in the afternoon i started charting my elbow pain patient and dr. x helped give me some corrections/advice. we then saw some more patients, one of them was a couple and the husband reeked of cigarettes. it was awful. i was doing OMM on him and had to breathe out of my mouth a couple times to keep from gagging. not cool.

after a good day, i chatted a bit with dr.x and the nurses and the topic of having children came up. i laughed and said i didnt want any and she kinda smiled telling me she used to feel the same way and that once i am done with school and married, things will most likely change. i reluctantly agreed. I told her it was nice to see a female doctor working for herself but still being able to enjoy her family and home life. dr. x really does had a good balance. she does not do any charting at home and from what she told me, she basically leaves her 'doctor self' at the door and when she gets home all she is is 'mom.' again, it is very nice to see that this is possible. she gets most of her charting and paperwork done at lunch and before she goes home so that no work is brought back with her.

i asked her when she thought the best time to have children was and she told me after residency. she followed this with, "but make sure you work somewhere with benefits and save money, be a saver. dont be one of those doctors who graduates with a sense of self entitlement and buys a BMW" i laughed hysterically to myself trying to not crack a smile and just nodded. OOPS.....

Vacation is over, technically...

Well 4 weeks of vacation (and a US tour later) I am back to rotations but not back home. After going to Nebraska, Chicago, making a road trip from LA to Portland and going to Little rock arkansas, I am back in Portland for 4 weeks doing my elective in family practice and today was my first day....

I flew in last night at 11:45pm then by the time i picked up my car and got settled into my new place I got to bed around 1:15am. Then i woke up at 5:45am so i could be at the clinic for 7am only to find that the receptionist told me wrong and i didn't have to be there until 8. I sat and got familiar with the office and then had some coffee. The doctor came in at about 8, we chatted for a bit and then I shadowed her for the day to see how the clinic runs [and mostly learn how to fill out the electric medical recorded computer system...paperwork, charting, insurance, etc etc]. Dr. X [not real name...obviously] is an awesome doctor and a great lady. She went to Western and was an OMM fellow and is now working in a group practice. She did a residency in family practice and she also incorporates OMM into her practice.

We started off the day with a women wellness exam [a pap smear....like i haven't seen enough of those] and then had a couple older ladies come in to check on their blood work. they both had diabetes and high blood pressure...i think this might be a trend for this rotation.

Then the most important part of my day came... I saw my first adult male patient. Since I have only done OB/GYN, peds and then vacation...after 17 weeks of my 3rd year i finally was a student doctor to an older male. And when we asked what we could do for him today, the first thing that comes out of his mouth...he needs a refill on his viagra. and that was my introduction to males. haha

I was told for lunch a drug rep was coming and got excited cause that means free food...and its usually damn good food. Then, i was even more excited when the drug rep came and i discovered it was a very good looking, talk, dark haired, very handsome man in a suit. He was around my age and wasn't wearing a wedding ring....he taught us about a new diabetes drug and we ate panera. i can see why drug companies only hire good looking people and i dont think its a coincidence that this GUY came into be the rep for this clinic that has all female employees [except for one doctor]. they know how to play their cards right...

by the end of the day i was becoming more comfortable with the doctor and i think she was starting to relax a little more around me because we started to joke around with the staff. a couple patients cancelled so we had a lot of down time in the afternoon and got to chat a lot more. Overall we saw 7 patients from 8:30 to 1pm and then only 3 in the afternoon.

What i noticed today was most of the patients smoked, heavily smoked. It was interesting to see them truly struggling with their addiction. One lady was 14 days into quitting while another 68yo lady who was well aware that she needed to quit and sounded very logically about wanting to, just couldnt. it has such a grasp on people and even though they smoke over a pack a day and their health is drastically deteriorating over it, they just cant find the motivation or drive to quit. i am struggling with how i can counsel these patients in the future knowing it is such a powerful mental obstacle to have to overcome.

overall i really liked my first day and have yet to completely rule out family medicine. im wondering if as time goes by i start to really enjoy it. dr. x really knew each of her patients and couldnt stop telling me reasons why she loved her job.

i dont have to be there until 8:30 tomorrow but i think i will go to bed now so i can get a solid 10 hours of sleep :)

good quote from the day:
"Mr. X, Have you been short of breath at all?" -doctor
"no. Well... I was the other day, but that was after climbing a mountain" -patient

quotes

"finished call shift with a delivery. when it was over, i stood there thinking, "no way did that baby just come out of that small vagina. that was weird."
-Vince

"Jaw saw my first vaginal delivery! Holy shit!!!!"
-Sarah

"‎12 hour shifts Mon-Fri, 6 hour shift on Saturday, plus a couple 30 hour call-shifts = My Internal Medicine clerkship just started. (not to mention that I still need to study outside of work) — at Downey Regional Medical Center."
-Ryan

Chris: Sounds like a pumie question, except she'd have traveled to Indonesia and got bitten by ticks and mosquitos in every state. I'm going to go with C.

Bobby What's the answer!?

Danny: They forgot the meth addict in the woods that bit her.

Dorothy: answer is F. the meth addict

Kelsea: I know what they want me to say, but this is the real world and you always gotta be most careful of the ones that look the cutest. Thus I'm gonna put E. Chipmunk, just on principle.

Carrie: That is too much!!! I pick the skunk! :)

Beth: this looks to me like a case where you'd want to get to the root of the problem... who hunts chipmunks then makes their 5 year old girl gut them? and the whole bat in the girl's tent situation....maybe dad is the meth addict....

Vanessa: Yes, I think it's F, call CPS and get the kid out of there. Is selling these tiny animal pelts the family's main source of income?

Sarah: chipmunk ghosts.

Amanda: glad to hear someone's getting the necessary camping preparation at a young age..

Nikki: Camping will definitely suck for her! Who gives a 5 year old a knife and asks them to gut cute furry animals?

Dorothy: answer is C by the way...

Andrew: i would have also answered C but if it was a pumie question the answer would be G herpes.

Julia: dorothy...so does this mean you are set for shelf exams if you know the answer to this question? time to stop studying? yes?

Adam: is that the Polish Adventurers Club version of the exam???

Today we had our OB/GYN and peds OSCE exams. My first was a 27yo women with abdominal pain and the other was a lil girl actor playing an 11 year old with a cough. There was another actor in the room playing her grandmother. They both went well and now im back to studying for my 2 exams tomorrow.

Speaking of studying [on facebook]:

Laura to Sarah: is it thursday yet?

Sarah: seeeewww close. and by thurs you mean wed night? and by wed you mean freedom? and by freedom you mean bot shenanigans?

Dorothy: seriously. im really over this. especially because by wednesday you also mean dorothy's vacation starts!!!!!!

Laura: i just took a break to cover my step up to med with a paper bag.... someone is definitely needing some craft time obviously... ?

Nicole: Haha a "break" huh Laura? I'm dying. I'm done. Ima quit doing everything now. Oops guess I should go to my OSCE first before throwin in the towel?

Kelsea: Brian and I may have just spent the better part of an hour discussing the best way to fake our own deaths and flee the country. Brian was even ready to sacrifice his teeth to be left in his burnt down house....dentures aren't so bad...?

Dorothy: tell brian to stop bitching and just ask Gaga to pay his tuition off and then go on tour with her as a backup dancer

Sarah: he can burn our house down. The water bill is getting too expensive. I'll help with the teeth...

Kelsea: Haha Dot, yeah I suggested that a while back, (minus the back up dancer part, but he could at least be her pool boy...)

Kelsea: And Sarah, we opted for a plan that leaves less evidence...but if either of us disappears randomly just wait a few years for the postcard, probably in code with an beach address some where in columbia or the south pacific...

Kelsea: er colombia...

Laura: please kidnap me on yer way down kicka... for reals.

Nicole: Okay ladies, new plan for us tomorrow-- we are gonna go with the teeth idea as well. EXCEPT, instead of leaving them in Sarah's burned down house, we are going to leave one tooth at each station at hospital day tomorrow in place of our signature. Thoughts? Hopefully everyone has 17 teeth, because 16 will not be sufficient, per our last email.

Laura: bahahahaha, rollin cinna!

A preface, we have a shelf exam from 8 to 10:30 then have this mandatory hospital day from 10:30 to 12:30 and then we have our other shelf exam from 12:30 to 3. so they expect us to mingle and pretend to be interested while we should be eating lunch and relaxing a bit between exams.....

an email from school today:

Dear OMS,

As you know, Hospital Day is tomorrow and attendance is MANDATORY. Attendance cards will be available for you to pick up at the reception/guard desk on the first floor of the HEC when you first walk in the front doors. You will need to obtain signatures from at least 16 of the exhibitors who are here for the event.

The attendance cards will have more instructions on them, but we would like for you to keep the following points in mind while you are meeting with the sites that are on campus:
- Do NOT forge any signatures on your attendance cards. Students who do so will meet with the Student Performance Committee and risk being pulled off of rotations.

- Please remember to act professionally when obtaining signatures on your attendance card. Do not walk up to the site representative and ask for a signature and walk away. Make sure that you ask questions and show interest in their programs. Many of these sites are traveling long distances to come talk to you about their rotations and residency programs.


Cards can be turned in to the COMP Administration offices on the 2nd floor of the HEC by the reception desk. A drop off box will be available for your cards after Hospital Day is over.


20 minutes later we receive another email:

UPDATE!

Students will need to obtain 17 signatures, not 16.




17, not 16. what a JOKE

First Block COMPLETE!

well, my first 12 weeks of rotations are over and i have ended up back in the same room on the 2nd floor of school in 'my' study room. Back to the usual study-a-thon for my two shelf exams.

For each specialty rotation we have a nationally standardized exam. Each exam is 100 questions in 2 hours and the formatting is the same as our board exams. So i will be taking my OB/GYN and Peds shelf exams this coming Wednesday and being the good student I am, I am spending Saturday night in a little room that has no windows with my buddy Sarah studying.

The good part is that once Wednesday hits, I wont have another exam for 12 weeks :)

oh yeah, and my next rotation is VACATION. so starting Wednesday I am freeeeeeeeeeeee

The last week of peds was much more exciting than the previous ones. The fun parts included the intern we worked with, our attending, and the ridiculous moms we dealt with. All week we rounded with the Dr. C, the doctor that I originally hated/feared from the outpatient clinic. She pretty much shows no emotion except for a random joke every once in a while. But even so, she is easy to work with because she goes fast and gets done early.

The last week of newborn nursery we had a lot of mom’s who used drugs in the past or during pregnancy, a ton of teen moms and some other pts who were in jail at the time of giving birth. Each one of these patients is not allowed to leave the hospital until a social worker clears them for discharge.

The most extraordinary case of the week was a 32yo G24P6 female. Let me break that down...this 32 year old woman had been pregnant 24 times [Gravida 24] but only given birth 6 times [Paridy 6]. Go ahead and let that sink in for a minute....

I was the one to see the baby and present the case to the attending and i was looking forward to subtly add that into the history and seeing what her reaction was... When we got to my patient during rounds it went something like this, “ In room X we have Mrs X who gave birth to a full term AGA male last night via NSVD. Mom admits to alcohol use and 1 pack every 4 days of tobacco use during pregnancy. Mom is G24P6 and her labs were all negative except for GBS which was positive and 3 doses of antibiotics were given during labor.” Then I stopped after this sentence and looked up and Dr. C just looked at me with a puzzled face. “G what?” We all sneakered and after I repeated myself we went on to have a conversation about if this was really possible or not. We all agreed it probably was if she got pregnant twice a year since the age of 15 or so....that or she just lost count because really, who keeps track of their pregnancies, abortions, and miscarriages...

This week we had a lot of sick kids in the nursery, not sick enough to be in the NICU but enough to make rounds last a lot longer than usual. At a certain point during rounds this week Dr. C said “ok, any healthy normal babies here right now? i guess they dont make that model anymore, most have discontinued it.”

On Tuesday we had a set of twins born via C Section, a boy and a girl, and then Wednesday we had another set of twins. Ron got to go into the delivery on Tuesday and then on Wednesday we were on rounds and the intern’s pager went off [its actually a little speaker that they use in the OR to inform everyone that needs to be there. A nurse is heard over a little speaker the pediatric intern has on their scrubs saying “Pediatric and OB teams please come to OR number X for a twin delivery..[etc]” its pretty cool. I heard the speaker go off and i immediately got excited and asked if i could go into the C section...only problem was that my patients were next and i had to present them to the attending. i was so freakin bummed when the intern said, “no you should probably stay here and present your patients and then if your done you can come after.” I was so antsy and finally after rushing through my patients Dr. C said “go, go to your C section,” i couldnt tell if she was mad or really didnt care [again, she shows no emotion] so at first i was very hesitant but then Torey [another medical student] encouraged me to go so I did and i am very glad i did. I ran down the hall to get to the OB department and after putting on my hair net and surgical mask i walked into the OR to find at least 14 people in there-- 3 on the anesthesia team, 3 on the OB team operating, and the rest were nurses, respiratory therapists and the pediatric intern, NICU attending, and some others. The babies had just been born before i came so i didnt get to see them come out but I did get to see them get worked on. Both were very small and needed help breathing for the first few minutes of life. Right after birth they were wrapped up in what looked like a plastic bag to keep them warm and after they were stabilized and swaddled up, the intern took one baby at a time to go visit mom for a second and then there were both taken to the NICU in their baby warmers. I found out in the NICU that the mom was actually carrying triplets but one of them had died in utero about 1 month prior and the mom had been in the hospital for the month before this delivery. The fetal demise was born third and right after birth was taken out of the OR where it would go to the morgue to get an autopsy. The other two babies ended up being fine and later did i find out the mother had a history of meth use....

Two other interesting cases happened at the end of the week. One was a baby that was born and about an hour after delivery we were doing the newborn exam on her and she seemed to be fine. Her physical exam and vitals were unremarkable but yet she was totally unconsolable in the nursery. She just wouldnt stop crying. I remember this baby because I was studying in the nursery and mom called me asking me how my day was going and she could hear the baby in the background crying and said, “something is wrong, babies dont cry unless there is something wrong.” I laughed at this saying she was just being fussy and that she was fine. Then when I came in the next day we learned from the overnight intern that the baby was with her parents but still was being fussy and wouldnt stop crying. I thought it was pretty ironic that mom was right but it ended up that the baby was fine. We did a work up for a couple different problems that we thought she might have but everything ended up being fine. So thats good even though we never figured out why she cried so much....hope she lets her parents sleep at home.

Lastly, I will end pediatrics with this pearl of a story. I dont know too much about the mom and baby because she wasnt my patient but i heard about her during rounds from the staff. Ron had a newborn born to a mom who was a little...off. He said he would ask her questions and she would just look around the room and talk about random things. He said he got an odd vibe from her and let the intern and attending know during rounds. Also, this mom was refusing for her baby to get a neonatal blood screen [a screen every baby gets in the first days of life to check for genetic diseases that can be fatal if not caught early...and if they do have one they can be harmless if given the proper medications/diets]. While talking about this patient, the charge nurse came up to use and said she needed to speak with us about her. She wanted to let us know that the mom was saving the babies diapers and expressed that she was doing so so that later she could smear the poop on her body because it is good luck. All of our jaws dropped and the only words out of the attendings mouth were “Psych consult.” It was hysterical. Social services had to get involved with this case also and I actually dont know what ended up happening with this mom because she was still in the hospital when i left on Friday.

So thats it, peds is done and I could not have been more wrong about my interest in it. I am glad i found out early on in my 3rd year rather than later on. I now know that I need something fast paced in my daily life and even though this will likely be more stressful and tiring, I have come to realize that even though i hate stress and being tired, its something that keeps me going. I am a fast paced and outgoing person and I need to be challenged and most importantly, I need to know that my work is important and making a difference. When i was on OB I saw a difference right there and then. Wether it was a delivery, a surgery, or just a clinic visit. I saw the work I was doing was making a difference. In pediatrics you dont see the ‘fruit of your labor’ sort of speak. It may sound shallow but i need to be reminded of the importance of my job since i have sacrificed so much to get to this point. Thus right now I am still considering going into OB/GYN and I am also thinking about going into Emergency Medicine. Who knows, maybe the years of watching ER has subconsciously persuaded me into the field.


The past week we had our didactic week that happens after every 12 week of rotations. We came back to campus to do our OSCE’s, take or shelf exams [which sucked] and then have ‘plenary’ session for the upcoming specialties we were rotating on. Basically, it was a stressful Mon-Wed and then 2 days of relaxing. Next up, I have 4 weeks of a well deserved vacation. I have not taken time off since last summer and I have never needed a mind break more. Going straight from second year to board studying to 12 weeks of a demanding rotation schedule, I am going to enjoy and relax as much as i can for the next 4 weeks. Then its off to Portland, Oregon for my elective. I will be working in an outpatient family practice clinic and living with a good friend of mine who is also doing a rotation up there.

4. more. days.

screaming babies are getting old. C sections are fun cause right after they yank the baby out we get to be the first ones to clean them off, suction out all the gunk, and annoy them until they cry really loud [helps them to clear out their lungs and breathe better]. dont get me wrong, its a beautiful thing to see new moms and dads with their babies, but i need to be busy or else i get bored quick. maybe emergency medicine really is for me?

This week had lots of crazy moments amongst a lot of doing nothing and hanging out with newborns in the nursery. they are pretty fun to watch and test out reflexes on.

Monday started with me getting to the hospital at 6:45am and seeing a couple newborns and writing their progress notes. then rounds started at 9am. We saw a ton of baby humans, one of them had 12 fingers! its called polydactyly and we refereed him to an orthopedic surgery to eventually get them amputated. during rounds the intern got called to a CS [every CS has a pediatric team in the room just in case] and i got to join him. Being in there really made me miss the OR. I watched em yank out another baby [breech=butt first] and then the doctor walked her over and set her in the warmer. We immediately wrapped her in blankets and suctioned her noes and throat. she was having a hard time breathing so the respiratory therapist put a little NG tube down her nose into her stomach and pumped out all the amniotic fluid in her belly and airway. after that she was breathing fine. we walked her over to the other side of the curtain and showed her to mom and dad. its funny to see a mom with her organs out of her and then walk past the blue drape and just see her face smiling at you awake. anesthesia is a great invention!

after rounds we ate lunch and then hung around waiting for new babies to be born so we could do their initial physicals. we got home around 5pm.

Tuesday we came in a little later since we had more of an idea of what we needed to do. I walked in and the intern that was on overnight said she had a special patient for me that she needed to fill me in on. she said she decided to give her to me because i was easy to talk to and that i could probably handle the situation well. i felt really flattered until i heard about the case...

the baby was a newborn girl born to a women from Nigerian that was here visiting her family. she wanted to have the baby in the US and was here for about 7 weeks getting prenatal care. at this time she found out she was HIV positive, a sickle cell carrier, HSV positive and had immunoglobulins against toxoplasmosis. They tested the baby and found HIV antibodies and though this test is not very sensitive,it is still very worrisome. The worst part about this whole situation was the mother did not want to tell her family about her HIV status because she was scared they would kick her out. She was a very sweet woman and was unfortunately caught in a very hard position. SHe was so concerned about her baby and family and whenever i would ask about how she was doing she would dismiss the question and just say she was fine. I dont think she had slept for 24 hours.

I tried to do my best for her and the baby and we eventually transfered the baby to the NICU to get a more extensive workup and for infectious disease specialists to see her. I tried to counsel and inform the mother and grandmother as much as i could and of course, had to be very careful with what i said because the grandmother was always around and did not know the HIV status. it was both an emotionally challenging and intellectually challenging case and though i appreciated the experience, it was still a very hard day.

another case i had on tuesday that made the day pretty rough was a pt i had born to a 25yo girl who was in jail. i had to talk to the patient and get all her details about why she was in jail and who was going to take the baby and of course, it was because of drugs. she wasnt on drugs and to be honest, she wasnt messed up at all, but unfortunately she put herself in the wrong place at the wrong time and got caught with drugs in her car. for this mistake she will probably be in jail for 6-8 months and she was hoping to get house arrest so she could live with her parents and still have the baby. since she was still being sentenced at the time of the birth, the baby was going home with her boyfriend's parents.

there was another pt who's mother was in jail and had a baby and today it went home with her grandmother. sad thing is, the grandmother had custody of her previous kid also.

Wednesday and today have been a lot quieter with no other special patients. ive gotten more study time in and am looking forward to relaxing this weekend for my birthday.

"BOA: the mom ran into a snake on the way to the delivery room

or

the mom is also wearing a feathery neck garment"

-Torey

BOA: actual definition. Born out of asepsis...which still doesnt make sense to anyone

Last day of clinic was today and i am a lil sad that it is over. I had 2 doctors give me a 2 week evaluation and both said i did great and worked hard. a vast difference from 2 weeks ago for sure.

Something i have to share with you are the ridiculous kid names i experienced in my last 2 weeks. Some of the greatest have been:
Myson
Mylove and Romeo [twins]
God
Divine trinity
Bobyyz
Aquaneta [yes, like the hair spray]
Khriz

and my favorites:
La-a [pronounced La-dash-a..seriously]
Speedracer
and last but not least, the sisters:
Mauriahna'ju'nyse and Mauriaja ju'nay


Now that i have finished up my 2 weeks of peds clinic, i am starting newborn nursery on monday. that means i get to trade in my dress up clothes for scrubs....but that also means i have to trade my 8:30am start time to 7am. boo

Clinic Continues

Peds clinic has gotten much better and i am actually starting to enjoy my time there. i have started to realize that i need to not take things so personally and just get used to different attending styles. the same attending i was worried about last week is now someone i laugh and joke with. i guess everyone has their bad days and i shouldn't always assume things are about me. the more i get experience with this the better i will do in my future rotations and in my residency.

though i am enjoying the people i am working with, i still am no closer to wanting to do pediatrics in the future. the days are very monotonous and parents are idiots. every other kid i see is terrified of me no matter what i try and its starting to get annoying. that said, the days go by fast and we are learning a lot.

the most influential thing that happened to me last week was a 9 year old girl [call her Jane..not her real name] who came in for a well child care visit. she was very nice but very shy. i tried to get her talking to me and she eventually became a little more relaxed and talkative. Jane was a slightly bigger girl but by no means would i say she was overweight. she was at the higher end of the growth curve for her age but compared to the overweight kids i have seen at the clinic, she did not look it at all. When my attending came in we all talked and she mentioned to the girl and her mom that she should probably loose some weight. when Dr. C said this, the girl got quiet and whispered to her mom "see, i told you im fat."

my heart sank a little bit when i heard this because i could just feel the confidence leaving this lovely young lady. the attending kept talking to her mom and i felt the need to cut in [even though this was the same attending that put her hand up to cut me off before]. I looked at Jane and said right into her eyes "Jane, you are not fat at all. please do not think we are saying you are fat. we are just worried about what foods you may be eating and want to make sure you are staying healthy." I went on to tell her that maybe she could get more active at recess or school sports and then her mom admitted that Jane didnt have any friends and that she was worried about her. when her mom was telling me this Jane was looking at her mother and pleading with her to stop talking, that things were "no big deal." but i pressed on and talked to Jane more about how she was feeling with school, her friends, and her shyness. At this point my attending had left the room and i stayed for about 15 minutes and continued to try to raise the self esteem of this young shy girl. I told her stories of my own childhood and encouraged her to like herself even though she was different. I told her that she was not the only one that was this shy and that many other people feel this way and i think this seemed to help her.

after speaking with Jane for a long time, i gave her a hug and her mom gave me one of the most appreciative "thank you's" i had ever received. she shook my hand and i could see in her eyes that she was so happy to have someone reach out to her daughter like that.

in the moment i felt like a great mentor and for a moment, i really liked peds again.

just for a moment...

today was not much better in regards to my attendings. for the second time my attending put her hand up in front of my face.. yesterday she did it when i was following her into a room trying to ask a questions [she literally put her hand up in my face and then closed the door behind her] today it was in front of a patient [i was talking and she put her hand up to get me to stop talking so she could have the patient answer]. i dont know what kind of upbringing she had but i could not think of a more rude way to ask someone to be quiet. worst part about it is that being a medical student, you really are powerless. you cant say anything to them, you just gotta take it and shut your mouth so you dont get a bad evaluation. this whole situation makes me wonder why certain doctors work in teaching hospitals when they clearly have no interest in teaching and all they want to do is get through clinic days as fast as possible so they can go home?

if i ever become this rude, bitter or unkind when i am an attending i will know its time for a career change...


some humor from the day:

"man, the terrible twos really are the terrible twos" - Torey

"your japanese? so where did you get your eyes from " -attending referring to Torey's very light eyes
"lens crafters..."- Torey


"I saw Dr X in the hall and I could feel my adrenals pumping out the epinephrine"
-Ron [after seeing the attending that yelled/screamed at us last week]

"think costumer service. try to be like nordstroms" - one of the attendings to a nurse in the clinic [clearly trying to increase the amount of patients/money that comes in'

Peds Clinic

just got home from my first day in the peds clinic at the hospital. not too exciting but the day went by much faster than days in the inpatient ward. i will be working in the clinic for the next 2 weeks and luckily the doctor from friday [aka Judgement day] is on vacation for 2 weeks so i can start fresh with new attendings. clinic days are short- today we worked from 9 to 12, then 1:30 to 4:15. we basically do the same as other clinic, go in and do the initial history and physical, present to the attending and formulate your assessment and plan and then they go back in with you and do their own physical and ask more questions. today i saw a couple sick kids [ear infection, asthma, etc] and then did a couple well child exams. no wonder kids hate doctors, they have to get like 4 shots a visit every couple months for the first couple years of their lives!! that immunization schedule is no joke!

things i learned today:
1)if you take off your white coat before entering a room with a peds patient, you can delay crying for an extra 3 minutes than usual...though crying is inevitable by the middle of the physical exam
2) i had no idea kids could scream so loud
3) i think most children are bipolar. one second they are crying, the next they are laughing and smiling. if an adult were to do that, they would be in a psychiatric facility
4) little girls are like live dress up dolls for some moms... they can make their outfits as glamourous and girly as they want because they look damn cute and hey, they arent the ones that have to wear pigtails and huge bright pink puff scrunchies on their heads.
5) not so much what i have learned but what i predict: these same little girls that were dressed up as diva's by their moms when they were little are probably the same kids that grow up to be teenage diva's that demand things and wont listen to a word you say
6) thus, the last thing i learned today was that if i have kids, it will only be after i can genetically verify it will be a boy

Peds... lots of disney stuff around but not the happiest place on earth?

This has been a really rough week. I thought that peds would be filled with happy people and fun attendings but boy was i wrong...

On Tuesday, shit hit the fan when we got yelled at [more like screamed at] by the head honcho of the peds department. Reason being is that we are supposed to stay everyday until 5pm but since there isnt much to do in the afternoon, the interns AND the residents we have worked with have had one of us stay for the afternoon while the rest of us go home to use our time wisely. This worked all last week and then up until Tuesday when Dr. X [we will call him that for safety's sake] came in and found only Torey in the office. He told her to tell all of us to come back to the hospital by 2pm or else we will fail the rotation. SO we all came back and dr. X walked in at 2 and gave us a 5 minute speech that started with, " im gonnna make this short and to the point, you are all failing the rotation as of right now. you are going to have to work your way back up and bring your A game to pass this rotation. I have never be do disrespected in my life...blah blah blah." This went on for a while. he then just turned around and walked out the door. at first i really thought he was joking around because we rounded with him the week before and he asked a lot of questions but he still was fun to work with. i thought this lil rant was a joke and he was gonna stop in the middle and say, 'haha, just kidding' but he didnt. oh boy he didnt.

So this week we rounded with another doctor and boy was she a debby downer. this lady never smiled, made the meanest faces at you, and was not very fun to work with. She had her positive moments [telling me she was proud of me because i was 'teachable' because i went home and read about something she taught us the day before] but mostly, she was not very excited about anything. She was known to ask a ton of questions about your patients so we were warned to read everything about them and be able to answer her detailed questions. It was really hit or miss with her. Sometimes you would answer her question and she would be happy, other times you would answer and she wouldnt even look at you. Then of course, the times when you didnt know the answer she nailed us for it. Everytime i didnt know one of her questions she would tell us off about how 'you should know this and that' but she never gave you the opportunity to explain. She was ok at teaching but her accent kinda got in the way sometimes.

Anyways, on Wednesday I did a presentation [we have to do 1 every 2 weeks] and she gave me a good evaluation for it. But then Friday came about and she must have really changed her opinion on me. On rounds i guess i just didnt shine. She asked me what my plan was for a baby with a UTI and when i told her what antibiotics i wanted to put him on she said 'absolutely not, completely wrong' and went on to tell me why i was so wrong [even though my answer wasnt that off and i never got to explain why i chose them so really it just looked like i guessed an answer]. i mean, dont get my wrong, if i dont answer something correctly im not going to be upset at the attending for correction me because i am a medial student and i expect to be wrong most of the time, but the way she made me feel about being wrong was just really mean. then later during rounds i asked why she had decreased a dose of antibiotics and she said, 'no, i am not going to answer your question. we talked about that earlier in the week and you should know why.' So to prove i knew the basics of why and just that i was confused at why she was doing it that day instead of the next day, i ran through some of it with her but she still just looked at my like i was stupid. So, as we talked she told me how i shouldnt ask so many questions and that i should just look at the answers instead of asking people. That it makes me look stupid and when i get to other services people will pick on me for it. Yes, i am not shy and dont mind asking questions, but i have never been scolded for it. i guess i didnt formulate my questions right with her since she jut thought i was an idiot. but that doesnt make to much sense to me considering this is schooling and they are there to teach us. yes, i will look something up also but who is it hurting to ask a simple question during rounds to get the doctors opinion on the matter?

i wasnt too surprised when later that morning i asked her to do my 2 week evaluation and she pretty much just criticized me for about 3 minutes. She said i 'didnt know my patients at all' and that my knowledge was lacking. I need to read more and study more and that i have a lot of room for improvement [emphasis on the LOT]. I sat there just nodding and saying ok and trying to be as accepting as possible to her criticism. the part that made me the most angry is that she never gave me specific examples of what i did wrong and she never gave me any constructive criticism as how to improve. she just talked for a couple minutes, circled a bunch of low %s on my eval and then got up to leave. its like she just put me down, said [in not exact words] that i was stupid and that i needed to work harder. Oh, and then as she gets up and walks out the door she says have a good weekend, dont worry, you will be a good doctor you just have a lot of work to do. WHAT THE FUCK?

I may not have been a complete gunner on this rotation like that annoying girl [who at several times threw us under the bus and made herself look great on our expense] but i have still worked hard, gotten to the hospital early to read up on my patients and see them, and i worked hard to make the intern's lives easier. at this point i still dont know exactly what to do to make my grade go up because clearly my grade for this rotation is going to be at minimum passing level. on the bottom of the evalution she wrote 'student has much room for improvement over the rest of the 4 week rotation.' great...


i had to work this AM [saturday] and when working with one of the residents, we got to talking about that doctor and i told him what happened. he says she does that all the time and really does pick on certain medical students and residents and gives them really bad evals. so i guess i cant feel too bad if she does this to one person in the group everytime. but i cant stop wondering why me? i guess im just to talkative and normal...haha. this is the first time [of many i am sure] an attending has not liked me and i just need to get used to it and know that some people are gonna love me and some are gonna not love me and thats just life. i am able to kinda laugh it off today but honestly yesterday was a hard day. first time i have cried about rotations so far.

i worked all week, worked today and tomorrow [sunday] work all next week and then get saturday off. i will then work sunday- friday.

im really ready for vacation

I have officially become a germ-a-phobe. I find myself putting alcohol sanitizer on everything a child touches. I knew it has become more apparent when after doing a physical exam on a child with a viral infection and a rash, i washed my hands for at least 2 minutes and after drying them, used hand sanitizer [just in case]. Another strike against peds.


i miss OB/GYN a lot.... is this a sign? is there more meaning to this they i realize?

ok, time to go to bed. i need to get to the hospital tomorrow so i can write a progress note on [yet again] a child with a UTI that i admitted from the ER this afternoon. *sigh*

"Miss you, miss our group, miss ob/gyn. You off this weekend? P.S. I like PEDS but it is MUCH slower..."
-Nicole

Im not the only one that feels like peds is much slower than OB/GYN. i knew this was going to happen.

Today i got to the hospital at 7:15am to prepare for rounds at 8:30 because our attending this morning was the chair of pediatrics at the hospital [the 'man']. So i got there early to know my patient very well. I saw 2 patients, one of which was the 19 month old girl who i admitted from the clinic yesterday. She was doing much better and i have to admit, she really is adorable. I wouldnt mind seeing such cute faces everyday but as everyone says about peds, you spend way more time with the parents than with the cute kids. this is making me re-think peds a lot. its not that i dont like it, but its just something to consider. Oh, and another attending today told us she didnt recommend going into peds because she didnt want us to be poor knowing how high our school loans are, she said that we shouldnt go into it. So that was interesting....

Rounds too a long time today. The doctor came in around 9:30 and then we spent almost 5 hours covering our patients. It wasnt bad though, he asked us a ton of questions but also taught a lot. We all had fun also, talked about lots of things outside of medicine and made the whole morning very interactive. When we were in OB/GYN, rounds took about an hour and a half and it was just a small part of our day. On peds, rounding IS the day because after we can go home [one student will stay each afternoon until 5pm but since there are 5 people on our team thats only once a week!] Needless to say, the hours of this rotation are much less stressful.

Lastly, there are 2 medical students from other schools on our team, 1 of them is the most annoying girl i have ever met. Well, that may be an exaggeration, but shes pretty bad. She is very eager to demonstrate her 'abilities' and will cut off other people as they are trying to explain things. It is taking me a lot of effort to not say anything to her [knowing my personality]. It is a learning experience because for the rest of my career i am going to be working with people like this girl and i just have to learn how to keep my mouth shut. The problem is that everyone else feels the same way i do, i just express my feelings while other people remain quiet. I do have something positive to take away from working with her: it helps me to shape the medical student/resident/ physician i want to become by making sure to NOT be like her and others i have worked with in the hospital...

Things i have learned:
1- kids get a lot of fevers....and a lot of illnesses can cause fevers in children
2- it doesnt matter how many times i study antibiotics, they still get mixed up in my brain
3- reading a chest x ray is not easy

the nurses that dont know me call me doctor...

re-thinking my interest in going into pediatrics....

I have been on wards for 3 days now and though the kids are freaking adorable, its not much interaction with them so much as their parents. FOr the past 2 days we have come in around 7:30 in the morning, written progress notes and seen our patients (about 2 each) and then we round with the attending from 8:30 or 9 until almost noon! It is very different from my last rotation. Most kids are admitted for fevers of unknown origin and then stay a couple days to get antibiotics. Maybe its the fact that their arent many patients that make it hard for me to imagine going into the field. Also, its not a lot of procedures or excitement...

This afternoon i went down to the pediatric clinic to write an H&P on a 19 month old girl who was having fevers, one of which was 105.5! I went in and talked to her and her mom but as soon as i started doing my physical exam she started wailing. Imagine a 19month old crying refusing for me to look at her ears while i am trying to stick a pointy object with a light into her eye to see how her ear drum looks. It was not easy and dare i say it, it was not pleasant. No joke, in the 10 minutes i spent trying to figure out how the hell to look inside this little girls mouth, ears, and nose, i decided i didnt want to do this for the rest of my life....i think i was patient that at least understand me and sit still.

But then later in the day when i went up to the ward where she had been admitted, i went in to check on her and when i said bye she said bye back and waved at me with two hands that each had examination gloves on her [the nurse gave them to her to play with and they were about 30x to big for her]. It was the most adorable thing i had seen. She wasnt screaming and she looked very cute. Maybe peds isnt that bad?

I have another 5 and a half weeks to decide. For now, I am going to read up on the 50 million things that can give babies/children fevers...