day 3

today was a better day. it started at 7am [like usual] for morning report. picture us all in a large room with a projection screen in the front and our attending standing in the middle of the room controlling the computer.  we started with the patient that i admitted yesterday, the spanish speaking lady. i was hoping he didnt bring up my H&P like he did yesterday [which he ended up yelling at the intern about. he started by pulling up her old echo records from her previous admission, it showed she had aortic stenosis. he then pulled up another cardio consult that said the same thing. "Now," he said, "lets see if the H&P accurately portrays this in the physical exam." he looked over at us [he didnt know i admitted this patient] and when he caught eye contact with me i said, "yes, i did." he smiled and looked surprised and said, "see, this is why i like med students. they always look happy about something." he pulled up the H&P and scrolled to the Cardiac PE and read out loud my documentation of it was read something like "regular rate at 85 beats per minute with a holosystolic murmur heard beast at the right 2nd intercostal space near the sternum." i got a lot of praise from him after he read that, it felt good. hopefully he remembers that for a long time. to be clear, this is something normally expected of me so im not sure why he found it so great but any praise from that guy ill take...

after morning report, we rounded on our patients and then did some other stuff. i had some down time waiting for an admit so i went to hang out in the ER and ended up helping 2 resident suture the lower lip of a 4yo girl who had fallen and cut it open pretty bad. i made friends with her and tried to calm her down as best i could but naturally, she was screaming her head off. she had some calm moments like when i asked her what her favorite color was and she said pink and we bonded over my pink clipboard and her pink shoes. but for the most part, she cried. hell, i would cry too and you put a large ass needle with lidocaine into me and then leaned over me with a needle for 15 minutes.

i had an admit after this on a lady with dermatomyositis. a pretty rare autoimmune disorder. that was kinda cool. then i went home, probably gonna go to sleep by 9pm again.

day 2...

yesterday was a bad day. yesterday was the first day of third year rotations that i drove home crying from pure frustration. i dont know if its some kind of hormone thing or what but the day just couldnt get any worse. this new hospital has the most melancholy staff and the intern i worked with today was a complete idiot and socially enept. that, along with the fact that i spent 4 hours admitting a patient because she only spoke spanish and she wouldnt stop talking long enough for me to hear the translator. she was also a very poor historian and her story was all over the place. when i was driving home i think it was the realization that i had to be there for 4 weeks that made me cry like a baby. its not the work because i have to work long days everywhere, its the fact that i have no one fun to talk or hang around. the interns are all depressed because their residency is terrible and the other 3 students i am working with are boring. people say you can do anything for 4 weeks...i better be able to get through this [not like i have a choice].

new everything

6 months of rotations and its always the same thing. just when you start to feel comfortable with the hospital and become friends with everyone you work with, you end the rotation and you have to move on to the next place.

its just like summer camp. you spend everyday all-day with new people and have some really good and some not so good times. you bond, learn new things and then at the end of it, leave with some new facebook friends. but really, you know you arent gonna talk to them very often anymore and its really just a quick hug goodbye and your off back to your normal life.

 today was my first day at a new hospital and it was a rough day. the last place i worked, the interns were fun to be around. they joked and laughed with us, all while teaching at the same time. we had a fun place to 'hang out' in between working and morale was high...the new hospital i am at is very different.

 the director/ chief of staff doctor is a real morale killer. we had morning report at 7 this morning and for the entire 1.5hours of going over patients, he pretty much just made the interns look and feel stupid. no wonder they all look like they hate their lives. the last place i worked the interns looked tired and overworked too, but they were still happy. no one goes into residency thinking its going to be easy, but when you have someone that makes you feel like shit all the time it really just adds to the stress of the situation. im hoping that i will slowly be able to become friends with these interns as i did the last ones so that my time here does not become completely melancholy. i really do miss my last interns and the friends i worked with there....

we spent the morning doing the obligatory orientation and learning the new system. we werent given very much direction, just thrown onto the ward and told to go see a patient. we also got to figure out the electronic medical record system on our own. went flustered around for a bit then gave up and had lunch around 1 [i was running on 1 tall starbucks coffee from 6:30 am...needless to say i was hypoglycemic and crumpy and about to snap at anyone that looked at my wrong]. we ate lunch and then i got a text from our intern about an admit from the ER.

 [side note: if its one thing i have begun to perfect...its adapting to new situations and environments without getting flustered. ive learned to be patient, breathe and just realize that at some point, im gonna do something wrong, screw something up, and get scolded for it. its just the name of the game and im prepared to apologize and move on. being a 3rd year is all about apologizing and moving on without taking criticism too seriously...but thats another topic for another day. lets just say my skin is a hell of a lot thicker than when i started this whole mess.]

they admit took a couple hours and then i dictated my admission history and physical over the phone. then i found out a resident was doing a central line down in the ICU so i jumped down to the first floor to see it. the other 3 students on my service were already there. they had just seen one done on a patient and then getting ready to do another one on a young guy who was under precautions for suspected TB. this was the first time i had seen a central line placed and it didnt go to smoothly. the pt had a big thick neck so even with ultrasound guidance, it was hard to get the needle into the jugular. we spent a while doing it and had to push 2mg of morphine while we did because of the pain we put him in [when i say we i mean the resident, we just watched and helped her]. its sad, but one of my thoughts was feeling sorry for this kid because he had such an unexperienced doctor doing it with no attending supervision and it could have gone a lot smoother if someone was helping her. when we were finishing up his heart rate was in the 200s and we had to push drugs to get it down. it wasnt as dramatic as it sounds but it wasnt an uneventful procedure either. i pray he doesnt get an infection but i would think the chances of getting one are pretty high. one of us med students got to suture the line down and i hopefully will get to do one in the near future [suture, not the central line. that shit is scary and i wanna see a lot more of them before i attempt one when im a resident. and ill make sure to have an attending there...] ok now im just rambling. i need to go to bed since i have to be back in the hospital again soon. 

last day of IM 1

today was our last day and it was a little anti-climatic. i went in to see Mrs. K this AM and sat and talked with her for much longer than i usually spend with patients. i enjoyed spending time with her.

she had an MRI done and unfortunately, i left before i found out the results because I went to the skilled nursing facility with brooklyn. i saw Mr. V, a patient i followed at the hospital there. after seeing some patients, i went home. i texted Dez in the afternoon and asked about Mrs. K’s leg mass.

 “11x9x9cm intramuscular mass compatible with neoplasm.”

 it broke my heart.

best. patient. ever.

in the afternoon we got an admit from the ER so i volunteered to do it. my intern Dez and I went to the ER together and starting to get info on the 80-something year old women that was going to get admitted. this patient ended up being the most fun, spunky, and crazy old lady i have had the chance to take care of. honestly, she was the best patient i have yet. she was hysterical and to be able to reminisce on this great time, here are some quotes:

"im going to start my physical now. its gonna be pretty extensive, im gonna start and your head and move down. is that ok?" -me
Mrs. K gave me a once over and looked a little concerned and then said:
"hell why not. im a bitch on wheels" -Mrs K
"[laughing hysterically] im sorry, what did you just say??" -me
"i ain't no sissy Mary"- Mrs K

"theres a tube in my vagina!" -Mrs K referring to her foley catheter [that was securely in her urethra]

"have you ever tried to make out in an orange field? there is no room to spread out a blanket. no room for any hankey pankey." -Mrs K referring to her first date with her now husband

"now how do you think that transpired?"

"I could use a drink right now" -Mrs K
"oh yeah, what kind of drink are you referring to?" -me
"oh you know what i am talking about"-Mrs K


Nicole got to experience all of this with me because she came out to the ER to help. so it was us 3 girls [2 med students and an intern] just chattin away with this 80 year old firecracker of a lady. we spent upwards of an hour and a half talking with her when we really could have finished everything in 20 minutes. when we got back to the call room, we were all giddy and excited over this fun lady. we told Brooklyn about it and he just looked at our disposition and was very confused “whats up with you girls right now?”

Mrs. K came to the ER by ambulance because she was found by her husband in the bathroom after falling. she was cleared by the ED, having seen that she didnt break any bones on X ray or have any brain bleeds by head CT. but, she did have a large, palpable, non-tender mass on her right upper thigh. the tragic point about all of this is that Mrs. K had dementia and though she was happily married and her husband had been taking excellent care of her, she never got her leg checked out by a doctor. so, we were admitting her for her leg mass, not the fall. this mass could be benign or it could be cancer. all we knew is that it had been there for about a year and it was growing.

i left the hospital that day in the best mood. it was a really fun afternoon. its patients and experiences like this that make medicine fun, exhilarating and tragic all at the same time.

"i would rather have my patient smoke pot all day then be an alcoholic. pot should be legal, not alcohol. when was the last time you saw a THC overdose come into the ER..." -intern

"We should gang-ascultate him with our stethoscopes."-Cardiology attending (regarding a patient with severe AS)
-Lisa via facebook

"stump pump" -our new OMM treatment....

drug seeking....

every morning we get to the hospital at 6am and whoever is there first prints out copies of the current patient list. then, we sit down and divide out the new patients admitted overnight and keep the remaining ones we have already. today, we had 5 new patients so we all kept the patients we had been seeing and then picked new ones to see, write progress notes on, and follow up on. today, i picked a 37yo F named Brandi [not real name but similar]. i thought her case looked interesting because her CC was abdominal pain and hematemesis [vomiting blood]. i thought it would be a change in the cases i had seen in the past so i said i would take her. after us 3 students divided up the patients, one of our interns [Dez] walked in and we went over who was covering each patient. amongst our conversation went:

 “who is taking Brandi?” -Dez

“i am” -me

“hahaha, well good luck because apparently she is a complete handful and is pretty much just drug seeking. i didnt want to take her because i can’t say no so im making A [other intern] take care of her” -Dez

“wonderful” -me

I went up and read the patients chart and the nurses were already talking about this her. she was requesting specific amounts of medication and was very attentive to when she was getting her next dose. she was also making demands of how much and what else to give her because ‘she knew what worked for her pain.’ granted, she has had a couple different spinal surgeries because of accidents and had nasopharyngeal cancer, so shes not completely pain free, but everyone knew the story was a little seedy. especially because she had been vomiting blood “for 3 days, and vomited twice in the ER” but no one has actually witness this...

My other intern [we’ll call him ‘young persian doctor from brooklyn who is obviously from brooklyn’] was my intern on the case. he knew exactly what this lady was up to and knew exactly how to get her on his side and sweet talk her. his mission= get her out of the hospital as fast as we can to free up a bed for a real patient. i tried to give this lady some credit and since i am a medical student and not completely jaded yet, i went in with an open mind and tried to listen as though she really had a problem.

 i went into the room and spoke with her and immediately she started crying. she was not rude at all, just very talkative. she was very ‘opioid educated’ as she called herself, since she had been on pain killers for at least a decade. we [all the docs] were sure she was just constipated from opiod use and her abdominal pain was due to a ‘back-up’ and she just didnt want to hear this. she really thought something was wrong. and when i looked at her stomach, i agreed that this could be something more. her stomach looked very distended and firm,like she was pregnant [and she was not an obese lady]. so, i asked her a plethora of questions and decided she may have some kind of ulcer, colon inflammation, etc. She insisted on getting a GI consult and i actually agreed. 

when i told the intern he laughed at me. he had already called for a GI consult, mostly to cover his ass because you cant ignore this even though she may be making it up. he laughed because he thought i believed her, which i could of did. so, we discussed it with our attending and we got a GI consult. i was hoping they would order an EGD and sure enough, later that afternoon we heard the consult ordered a abd CT and an EGD. 

the abd CT was done in the afternoon and it was clear. “no acute changes or pathology.”  “you still think there is something actually wrong with this patient?” -brooklyn asked

“maybe.....” -me

i went up to tell her the results and she just cried more because now she had no idea why she had this pain. then she asked me for a neuro consult for her headaches and a pain management specialist for her pain. at this point, i stopped feeling sorry for this lady. while she talked, i had to force myself to not blow her off and be rude because there was a chance there really was something wrong. but it was very hard to take her seriously when in between questions, she kept saying how much she needs her dilaudid, ativan and benadryl cocktail. 

i am keeping faith that she may really been in a lot of pain and that tomorrow the EGD shows something. but, i wont be suprised if it doesnt. she admits that she had a pain pill addiction but says that she ‘doesnt abuse pills because she really needs them.’ partially, this is our [healthcare’s] fault because during all her post op and chemo we pumped her so full of drugs that she probably got addicted, but then again, not all of us constantly pop pills for the pain we feel. everyone has some sort of pain somewhere, it may be chronic or acute, but not all of us need a norco or vicodin everyday to deal with it. 

i really hope im wrong on this one.