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.