Friday, May 11, 2012
Thursday, May 10, 2012
Cheerleading
ending this rotation with nights. wednesday 8pm to 10am and thursday 8pm to 10am.
Today was my attendings last day. we would get a new one for tomorrow [Friday] morning. So, today after not too much sleep and rounding on our patients, Dr.R wanted to meet with me and the other guy on my team individually. I was nervous because she was pretty stoic and strict for the last 2 weeks. When i sat down, she smiled and started with, “I think you did a terrific job on our service and I am very happy that I was able to work with you.” Obviously, I felt much more at ease after this. She told me about my strengths and then spent some time giving my advice on how to improve my presentations and notes. It was just what i needed. A good self confidence boost with a realistic view of how i can make myself be even better.
medical school does not have enough moments of confidence building. we do not get enough people telling us that we are surviving, and doing a good job while surviving. as a future resident and attending, i plan on being a cheerleader to medical students i see. because really, we all need a cheerleader every once in a while.
Wednesday, May 9, 2012
a patient that will stay with me forever.
A 61 year old man who i admitted from the ER the first week of my rotation, Mr. L. He was having episodes of syncope due to bradycardia, turns out it was because of a large neck mass that had been growing for about 4 months. He came in with his son that was about my age. Mr.L did not look very worried, his son did.
they thought it was a neck mass but on my physical exam i found his tonsils and tongue to be huge. it was actually a throat and tongue mass that had gotten so large it was pushing on his neck vasculature.
Mr. L ended up in the ICU the day after we admitted him because he stopped breathing overnight and needed 1 on 1 care. He was a very sweet man. It was weeks of CT scans, cardiology consults, surgery consults, anesthesia and more...weeks of us knowing it was most likely squamous cell carcinoma but just needing to prove it with a biopsy. weeks of this man hoping it was nothing but knowing it was probably something very serious.
the biopsy was risky because his airway was so affected...it was eventually done but he needed an emergency tracheostomy during the procedure because his enlarged tongue and tonsils were impossible to get the endotracheal tube through. a tracheostomy that he eventually left the hospital with, prohibiting him from being able to speak.
the biopsy gave us a final diagnosis.....squamous cell carcinoma of the tongue and tonsils that had spread to his lymph nodes and lungs. stage 4 cancer.
i spent weeks seeing Mr.L because he needed a lot of care and preparation before he could go home and see radiation oncology as an outpatient for his daily radiation therapy. every morning i went in giving myself ample time to spend with him because he had to write everything down. and every morning he cried. and every morning, i had to fight to not cry.
my last saturday shift was from 10 to 11pm. we had a lot of time in the afternoon to relax, study, whatever, while we waited for admits. i decided to spend a couple hours with Mr.L. we chatted [well, i chatted, he wrote] he joked about how he better get good at spelling [he couldnt spell worth a damn] and when i asked him if he knew how to type he smiled and wrote, “a computer? whats that? i just conquered the fax machine”...we both laughed. he was in good spirits but he admitted to having a lot of ups and downs. he said he had experienced the death of both his parents and he wasnt scared. he wrote “i am not afraid of the outcome. i am just hoping for the best.’
after our conversation i went outside the hospital, found a secluded staircase and cried. i cried for Mr.L. but i also cried because of other insignificant things going on that same day, like getting in an argument with one of the guys on my team. he is another 3rd year who i have grown to despise... someone i have had many rotations with. he made me very upset. earlier that day we were discussing hours and i told him i was going to ask to leave early because i had friends in town. this conversion ended in him telling me to stop whining about hours, saying “why did you want to be a doctor? didnt you realize that you would be working a lot.” after analyzing this conversation, i realize now why i was so upset. i was upset because this guy was making me feel bad about the fact that i was having a hard time with long hours of work and isolation from friends and family. i hate that fact that he made me feel like its not ok to be sad. sad that I miss my friends, family and life. sad that i just spent an afternoon talking with a man that is a complete stranger yet i havent spoken to my best friends in weeks.
it was an emotional afternoon, one that my hormones probably didnt help.
that night, i got off at 10pm. i drove straight to sarah’s house. she was having a party and everyone was there, including beth kelsea and julia. the minute i walked in the door people screamed my name and i got a huge hug from 6 of my best girl friends...literally, we all had a big huddle. it was the best cure for a bad day. i love my friends and i love that they know exactly what i am going through. the best.
we discharged Mr.L on Wednesday of my last week. i tried to do a quick goodbye because i knew it would tear me up inside. he cried, of course, like he always did.
i hope he does well but realistically, he will not live to see next year.
they thought it was a neck mass but on my physical exam i found his tonsils and tongue to be huge. it was actually a throat and tongue mass that had gotten so large it was pushing on his neck vasculature.
Mr. L ended up in the ICU the day after we admitted him because he stopped breathing overnight and needed 1 on 1 care. He was a very sweet man. It was weeks of CT scans, cardiology consults, surgery consults, anesthesia and more...weeks of us knowing it was most likely squamous cell carcinoma but just needing to prove it with a biopsy. weeks of this man hoping it was nothing but knowing it was probably something very serious.
the biopsy was risky because his airway was so affected...it was eventually done but he needed an emergency tracheostomy during the procedure because his enlarged tongue and tonsils were impossible to get the endotracheal tube through. a tracheostomy that he eventually left the hospital with, prohibiting him from being able to speak.
the biopsy gave us a final diagnosis.....squamous cell carcinoma of the tongue and tonsils that had spread to his lymph nodes and lungs. stage 4 cancer.
i spent weeks seeing Mr.L because he needed a lot of care and preparation before he could go home and see radiation oncology as an outpatient for his daily radiation therapy. every morning i went in giving myself ample time to spend with him because he had to write everything down. and every morning he cried. and every morning, i had to fight to not cry.
my last saturday shift was from 10 to 11pm. we had a lot of time in the afternoon to relax, study, whatever, while we waited for admits. i decided to spend a couple hours with Mr.L. we chatted [well, i chatted, he wrote] he joked about how he better get good at spelling [he couldnt spell worth a damn] and when i asked him if he knew how to type he smiled and wrote, “a computer? whats that? i just conquered the fax machine”...we both laughed. he was in good spirits but he admitted to having a lot of ups and downs. he said he had experienced the death of both his parents and he wasnt scared. he wrote “i am not afraid of the outcome. i am just hoping for the best.’
after our conversation i went outside the hospital, found a secluded staircase and cried. i cried for Mr.L. but i also cried because of other insignificant things going on that same day, like getting in an argument with one of the guys on my team. he is another 3rd year who i have grown to despise... someone i have had many rotations with. he made me very upset. earlier that day we were discussing hours and i told him i was going to ask to leave early because i had friends in town. this conversion ended in him telling me to stop whining about hours, saying “why did you want to be a doctor? didnt you realize that you would be working a lot.” after analyzing this conversation, i realize now why i was so upset. i was upset because this guy was making me feel bad about the fact that i was having a hard time with long hours of work and isolation from friends and family. i hate that fact that he made me feel like its not ok to be sad. sad that I miss my friends, family and life. sad that i just spent an afternoon talking with a man that is a complete stranger yet i havent spoken to my best friends in weeks.
it was an emotional afternoon, one that my hormones probably didnt help.
that night, i got off at 10pm. i drove straight to sarah’s house. she was having a party and everyone was there, including beth kelsea and julia. the minute i walked in the door people screamed my name and i got a huge hug from 6 of my best girl friends...literally, we all had a big huddle. it was the best cure for a bad day. i love my friends and i love that they know exactly what i am going through. the best.
we discharged Mr.L on Wednesday of my last week. i tried to do a quick goodbye because i knew it would tear me up inside. he cried, of course, like he always did.
i hope he does well but realistically, he will not live to see next year.
Tuesday, May 8, 2012
fatigue
i have had 4 days off in the last 8 weeks of rotations...that is 4 days off out of 60 days. and that is average 12 hour work days....meaning some less, some MORE. im exhausted. i dont care if it sounds like im whining because i kind of am....because im tired.
i have a 'day off' tomorrow then go in for 8pm night shift, then same thing thursday night to friday and then this rotation is over!!!
i better get weekends off on my next rotation, but i am hearing rumors that i might have to come in on a couple saturdays.....
i have a 'day off' tomorrow then go in for 8pm night shift, then same thing thursday night to friday and then this rotation is over!!!
i better get weekends off on my next rotation, but i am hearing rumors that i might have to come in on a couple saturdays.....
Monday, May 7, 2012
Sunday afternoon ER visit...
I spent Sunday in the ER...literally. We rounded in the morning and then I went to the ER around 1pm and was there until my shift ended at 10pm...actually, i stayed a bit longer since i was learning and stoked to be there. [left to see my patients when needed and took care of other work...dont worry].
I met a first year ER resident [J] and stayed with him in the 'resource' room which is mainly where they do simple procedures like laceration repair, I&Ds, etc. first thing i did was bring in a kid who hit his head on the edge of a pool and had a bad scalp lac, probably 4-5 inches. we irrigated it, numbed it up, and J put in some staples. it was hilarious to watch this kid bend his head forward and hold a bucket under his head to let the blood and water fall into it. he was just watching the drips of blood hit the bottom of the container and didnt care at all. his mom on the other hand...we had to ask her to step in the hallway and take a seat. when we were done, i was about to clean up the kids head and hair [full of blood] when J said, wait, go show your mom first. cruel....but funny joke.
i saw a couple patients on my own, another peds patient [starting to like them a bit more when they dont cry...] and then J taught me a couple of other things. i gave some chick a shot of toradol, did some OMM on her neck because she had a major muscle spasm. it was all pretty hands on and all very fun.
at one point in the afternoon i ended up hanging out in another pod and met another resident. when i told him the deal [that i was on family medicine and spending my downtime in the ER because i am applying to the program] he welcomed me and said "great, wanna see a patient? go talk to bed 6 and let me know whats up." the best part about the people in the ER is there isnt much attitude. everyone gets along, laughs, treats each other as equals. such a good environment to learn in.
and yeah, best part of the day is J introducing me to an attending and then 10 minutes later, another attending walks in and that doctor says "oh, this is the man you want to meet. i am just a peon in this ER, very insignificant. HE is the man you want to talk to. the big kahuna." after looking at the name tag, i realized it was the program director of the residency. the man who makes the decisions about applicants. THE man. i introduced myself, told him i want to go to the program, and the first question he asked was "favorite food?" guacamole and chips... i think it was a good answer. he was very nice and before he left he repeated my name and tried to remember it. hopefully i get to work with him more on my actual ER rotation there in a couple months....
I met a first year ER resident [J] and stayed with him in the 'resource' room which is mainly where they do simple procedures like laceration repair, I&Ds, etc. first thing i did was bring in a kid who hit his head on the edge of a pool and had a bad scalp lac, probably 4-5 inches. we irrigated it, numbed it up, and J put in some staples. it was hilarious to watch this kid bend his head forward and hold a bucket under his head to let the blood and water fall into it. he was just watching the drips of blood hit the bottom of the container and didnt care at all. his mom on the other hand...we had to ask her to step in the hallway and take a seat. when we were done, i was about to clean up the kids head and hair [full of blood] when J said, wait, go show your mom first. cruel....but funny joke.
i saw a couple patients on my own, another peds patient [starting to like them a bit more when they dont cry...] and then J taught me a couple of other things. i gave some chick a shot of toradol, did some OMM on her neck because she had a major muscle spasm. it was all pretty hands on and all very fun.
at one point in the afternoon i ended up hanging out in another pod and met another resident. when i told him the deal [that i was on family medicine and spending my downtime in the ER because i am applying to the program] he welcomed me and said "great, wanna see a patient? go talk to bed 6 and let me know whats up." the best part about the people in the ER is there isnt much attitude. everyone gets along, laughs, treats each other as equals. such a good environment to learn in.
and yeah, best part of the day is J introducing me to an attending and then 10 minutes later, another attending walks in and that doctor says "oh, this is the man you want to meet. i am just a peon in this ER, very insignificant. HE is the man you want to talk to. the big kahuna." after looking at the name tag, i realized it was the program director of the residency. the man who makes the decisions about applicants. THE man. i introduced myself, told him i want to go to the program, and the first question he asked was "favorite food?" guacamole and chips... i think it was a good answer. he was very nice and before he left he repeated my name and tried to remember it. hopefully i get to work with him more on my actual ER rotation there in a couple months....
Thursday, May 3, 2012
Wednesday, May 2, 2012
party party
"That's right! The infamous KICKAPOO "KELSEA", BETH, JULIA LING LING are gravitating closer to that southern boarder.
In my mind this calls for a celebration. I hope it calls for one in your mind too. If not, we can arrange a thought insertion (hells yeah I'm on Patton Psych right meow) so we are all on the same playing field.
So let me take over your mind: COME TO OUR HOUSE SATURDAY NIGHT. IT's CINCO de MAYO for GODSAKE (this is god speaking), and this can only mean one thing. partytime.
Feel free to invite homies. But only the good ones. Porque mi casa es su casa."
-fanga
In my mind this calls for a celebration. I hope it calls for one in your mind too. If not, we can arrange a thought insertion (hells yeah I'm on Patton Psych right meow) so we are all on the same playing field.
So let me take over your mind: COME TO OUR HOUSE SATURDAY NIGHT. IT's CINCO de MAYO for GODSAKE (this is god speaking), and this can only mean one thing. partytime.
Feel free to invite homies. But only the good ones. Porque mi casa es su casa."
-fanga
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