Monday- i had to be at the hospital from 5am to 8am just to write notes and then had the rest of the day off...kinda put a damper on the day [it was the 4th of july!]
Tuesday was a pretty fantastic day. Tiring, but fantastic. It started at 4:45am when i got up and got to the hospital for 6:30am. I attended rounds and then at 7:45am headed up to the surgical ward to be in my first surgery [well, i guess 3rd if you are counting c- sections]. This was on a 26yo female who was having severe abdominal pains and was scheduled for an exploratory laparoscopy to rule out [or in] endometriosis. We started out by waiting for the anesthesia team to sedate the patient and then we set her up for how we wanted the body to be positioned during the surgery. Once that was done, I scrubbed in along with the resident and the attending. Again, I made myself look like an amateur. I am tellin you, getting into a sterile gown without looking like you are new at it is very hard to do...
Process is you scrub at the sink, keep your arms up above your waist and walk into the OR without touching anything [some of us have been caught walking like this well after the surgery has finished just because we are so trained to do this during the surgery]. You then walk to the scrub nurse who has already set aside your sterile gloves and gown. To my dismay, the attending and resident had already gowned and gloved so they just stood and watched me do it... Pressure was on... First the scrub nurse handed me a sterile towel to dry off...immediately i messed that up and the attending pointed out the proper way to do it next time [i was still sterile at this point though, just didnt do it the “proper” way], next the scrub nurse holds out the gown and you put your hands through the arm holes [thats an easy part... a monkey could do that correctly], after that comes the gloves.....this is where the pro’s are separated from us retarded medical students. The nurse holds out the gloves so all i have to do is put my hand in it and go straight down quickly so my hands slips in. Sounds sooooo easy but i swear its not. Every time i have done it my fingers end up in different finger slots and i have to readjust it once my other glove is on. Oh wait, did i forget to mention that when i put on my first glove this time but ungloved hand hit my sterile gown and the attending made me take it all off and re-gown? :/ oops. Though i am making the attending sound like a hard-ass, i really shouldnt be because she is one of the most patient, kind and helpful doctors i have worked with [in fact, i have gotten really lucky because all of the attendings at the hospital are like her...or at least most of them!]
So after all this, we began the surgery and on my mind the entire time was “dont put your hands down, dont put your hands down, dont put your hands down.” See, when you are sterile, you are only sterile around your chest and down to your belly button so if you lower your hands too low or too high you become unsterile and that is bad...very bad. The other thing on my mind was, “this is f*cking awesome.” We cut a small incision right under the belly button, stuck a needle into this woman’s abdomen to get to the peritoneum [where all your insides are], put some gas into it to blow it up and give us more room to work, and then stuck a camera down the hole. Then we cut two small incisions a little lower on each side so we could stick other tools. It is really that easy. Watching up on a TV monitor, I was so excited to see the uterus, ovaries, fallopian tubes, bowels etc etc. All things I have memorized the anatomy of and can finally put that knowledge to use! One of the coolest things i saw was when the turned the scope around to see the liver and you could see the ribs and abdomen above it. Basically, it was an inside view of the rib cage and it was gorgeous to see. The ribs were rising and falling with each respiration [being done by a ventilator since the patient was under anesthesia and a muscle blocker] and looking at all the arteries and such was just a really amazing sight to see [yeah im a science nerd, whatevs].
So the patient ended up having endometriosis [look it up] and we cauterized a lot of it, took some pictures with the scope [looked like lil blisters everywhere] and then finished up. As we closed up the very minimal incisions with sutures the pt started to come out of her anesthesia and began moving her legs around. it scared the shit out of me. i was so scared she was gonna wake up at the end and yell at us that she could feel it all but she didnt...dont worry. she did look like she was in a ton of pain after the surgery though...even if the incisions are tiny and minimally invasive she still had people rummaging around in her pelvis...that cant be pleasant any way you do it.
After the surgery I walked with the team and the pt [in her gurney] into the post-op room. Talked with the resident a bit about the surgery and then was told to get some food and go to the clinic for the rest of the day. It was about 10am at this point [the surgery started around 8]. I went down to the clinic still wearing my scrubs and pretty much felt like a bad ass for the rest of the day [i realize how stupid that sounds but it pretty accurately describes my mood]. I was on such a natural high from the morning surgery. Everyone i talked to and every patient i saw must have thought i was on prozac.
One of the first patients i saw was in her first trimester of pregnancy and had brought her 4 year old daughter who was the cutest lil girl ever. I feel like i spoke so comfortably and confidently to both of them that the little girl started to become less shy and started asking me a ton of question and the mom become very relaxed with me. After spending a lot of time talking to both of them, I presented to Dr.R and when we decided to do a pap smear he said ok, go do the pap. I was nervous as this would be my first pap smear alone [without an attending, though a nurse is always there assisting/chaperoning] but i was pretty happy that Dr. R trusted me enough and had enough of an opinion of me to think i was competent to do it alone [though that just shows that when you dont have insurance and you go to a county hospital you ‘get what you pay for’ sorta speak--- AKA, a medical student doing your pap smear by herself]. I ended up being able to do the exam myself and everything went well. I swear, scrubs make you feel damn good/confident [though they make you sweat a lot...those things dont let your skin breathe at all!]
Wednesday Clinic- Saw an 18yo bipolar girl with a very flat affect. Made me a bit scared of my future psych rotation.
Saw a 24yo G4P4 who nearly jumped off the table when i barely touched her with the speculum. She was deathly afraid of anyone doing an exam on her yet she pushed 4 babies out of her vagina?
Met a crazy lady who told me the airplanes in the sky are spraying aluminum on all of us and making us sterile. Very nice woman but a bit off...
End of the day I say a very skinny, pale 45yo women who had severe menstrual bleeding. Severe enough to decrease her hemoglobin to 6.4. We did an ECC/EMB on her and then I recommended that she be admitted and transfused because she was feeling so weak and dizzy after. The doctor agreed and I helped convince the lady to stay and be admitted because i was scared she could harm herself by passing out when driving home....she looked as white as a sheep. It was scary to look at her. I ultimately built a lot of repore with her and convinced her to stay the night to get a blood transfusion. When I came back to the hospital on thursday i checked up on her labs and saw that her hemoglobin had dropped from 6.4 to 5.6 in 2 weeks. This is a pretty severe decrease....made me very happy and proud of myself that I got her to be admitted to the hospital and taken care of.
Thursday and Friday clinic I saw a bunch more patients but the one i remember the most is a young hispanic women who had recently been told she had a miscarriage. She had gone to the ER when she started bleeding and they told her the fetus was gone and to follow up at our clinic. She was very upset and crying to me and it was very emotional. I had a hard time consoling her because we were using a translator but ultimately i think i did a good job by explaining to her that 1 in 4 pregnancies miscarry and that it is a completely natural event. I hope she will be able to get pregnant in the future. I was more affected by this patient that i thought i would be. When i went into the ‘hang out’ room i guess i was noticeably sad because someone asked me what was wrong. It was hard to let the emotions go and move onto my next patient.
things i learned:
-i miss men-- seriously, 95% of people i see everyday are female. or as Anna would say, every day is Vaginaday
-i realize i need to learn spanish but i have also come to the realization that my patients will hopefully be trying to learn english also
-lots of women CAN'T afford their birth control pills, but they CAN afford to get their hair done, nails done, and a cute new cellphone?
- its really hard to stay up past 9:30pm these days!
Thursday, July 7, 2011
Tuesday, July 5, 2011
Week #2
Last week:
Monday- Was on L&D today, saw one delivery in the morning and then the rest of the day I spent practicing my sutures as it was a pretty quiet day. I induced several lacerations to my banana and then sutured it up good as new
Tuesday- Clinic day, dont remember anything too special happenin
Wednesday- I slept all day as I had night shift that started at 5pm. I tried to get as much rest as I could since I knew I would not be getting any sleep that night...
When i got to Labor and Delivery at 5pm I was on the move until 8am the next day. One of the patients I admitted around 7pm was a 29yo who had come to the ER because of severe abdominal pain....she then found out in the ER she was pregnant...36 weeks pregnant. How one does not realize you are 36 weeks pregnant I will never be able to figure out but she seemed really surprised. We asked why she hadnt noticed missing her periods and she said they were really irregular anyways and that she was spotting a little so didnt take notice...she also had us talk to her sister because she thought she was playing a joke on her and wouldnt take her seriously. I dont know if this patient was just in serious denial or what but it was a pretty ridiculous story... she must have thought an alien was growing inside her because at 36weeks those babies are kickin!
Soon after we admitted that patient we had a scheduled C- section and though I didnt get to assist, I got to watch the whole thing. One of the nurses asked if I had been in a surgery before and I totally lied and said yeah [so she wouldnt be worried that I would pass out]. She gave me a lil speech anyways saying “dont lock your knees and if you feel light headed or woozy at all just walk right out, no one will say anything so dont be embarrassed”-- she was obviously still worried i would pass out and probably just didnt want to deal with it if i did. I had no idea if i was going to faint or not...i had seen some bloody deliveries and such but really, i hadnt had to smell a cauterizer before so who knows how i was going to react... Well, i was fine. Didnt feel light headed at all...i kept taking deep breaths and reminding myself to not lock my knees but really, i felt fine. It was very good to know that I can handle surgery. It was amazing to watch them yank a new baby out of the uterus of this women and then spend about 20 min closing up each layer of muscle, skin and fascia that they had cut through. While closing, the attending tried to ask me a question about the embryological origin of something. I couldnt really hear what he said so i asked him to repeat the question and he said, “no, no i cant...” He obviously was trying to stump me with a question but was so tired that he didnt remember what he asked.. we all laughed about it and a second later a big squirt of blood hit me, the resident hit an artery accidently and sent a small amount of blood my way. It got all over my scrub shirt. The resident laughed and said, “see, thats what happens here when you dont get a question right.” I laughed and asked if there was any blood on my face. She looked up and said, “oh im sorry did you actually get hit by it? I wouldnt have made such an inappropriate joke if i had known that...” Again, we all had a good laugh at my expensive.
The next delivery I saw was the first episiotomy I have seen. The mom was pushing hard and doing well but the baby’s heart monitor was showing a gradual deceleration and the doctor began to get worried about the baby. She told the mom she needs to get the baby out with the next push or she would have to cut her. the mom flipped out pleading the doctor not to do it. unfortunately, the doc had to tell the patient that it wasnt a question, more of a statement that she had to do it because the baby was beginning to be in danger. The resident eventually cut a lateral incision and the baby came out with the next push...the newborn had the umbilical cord wrapped around her neck twice and the resident and PA quickly unwrapped it, clamped the cord and gave the baby to the NICU team. The baby ended up being fine and we stitched up the mom while her epidural still worked and everything turned out OK.
The next girl I admitted was a 17yo pregnant with her baby [you may think this is young but i have already seen a 16yo deliver her SECOND child]. She was writhing in pain and her bf just sat in the corner of the room texting on his phone. When i asked her what her pain scale was she told me 9.5/10 pain. I then asked if she was planning on getting an epidural and she answered ‘hell yeah’. She hadnt taken any lamaze classes and i dont think she prepared for this delivery at all. im pretty sure she had no idea that she wouldnt be getting an epidural until she was almost completely dilated which could take 10-12 hours in a first time pregnancy. i definitely was not going to be the one to break that to her....
Around 1:30am I started to write progress notes on all the vaginal deliveries and C sections that had happened that day up until midnight. There were 12. I had to look up all their labs, go see them, ask a few questions and do a brief physical. I didnt get done until around 5:15am. Luckily must of them were up feeding their babies. I was glad i didnt have to wake em up because honestly, who is going to be nice to a student doctor that wakes you up at 3am to ask you about your gas, bowel movements, and what birth control options you want?
Rounds were supposed to start at 6:30am but the resident, attending and I got pulled into an emergency C- section. I scrubbed in and assisted on this one. It was the cooooolest. Well, minus the fact that i made an idiot out of myself while the scrub tech was helping me gown up in sterile dressing. its a tricky process. even more tricky when you are being stared at by your attending, resident and the anesthetist. lets just say i didnt make it look graceful. i dont feel too bad though since i am still very new at this and i was being rushed since it was an emergency situation. Anyways, after cutting through all the abdominal layers we finally got to the uterus and after making a long vertical incision I saw a little ear pop out. It took me a second to gather what was going on and then the resident pulled the baby out and layed it down. The surgical tech handed me a suction bulb and i started to suction out the mouth and nose for any mucous. About 30sec after being yanked out of the uterus the baby finally realized something was different and started yelling his head off. It was an amazing site to see and an amazing feeling to know i was one of the first people to touch this new mini-human. The mom consented for a tubal ligation before the c section so after the baby was taken out and the uterus was sutured back up the next job was to ‘“tie her tubes.” i was pretty shocked at how quick it was to do it. They just tie a robe around the tubes, then cut off the part that is tied off. I looked at the resident and said, “thats it?” and she looked at me puzzled sayin,”yeah, what else do you want me to do?” Again, laughter ensued at my expense [im getting used to it].
The attending has to wait until everything but the outer skin is closed and then he steps out. I helped the resident close up the abdomen and then helped clean up the patient. At this point the anesthesia is wearing off and the new mom was awake [getting some morphine of course].
By the time i was done helping clean up and move the c section patient, rounds had already started so i sprinted to the other side of the hospital where the OB and GYN patients are. I met up with the other students, residents and the attending. They were already half way done but I wasnt worried, i was just with this attending in surgery so its not like he thought i was late because i was slacking off...
After rounds we have mandatory lecture from 8am to 9 and i had to stay. I “listened” to the lecture and then took a nap in the on call room until about 10:30am. I drove home, made breakfast and slept all day. Then got up, tried to read, and passed out again for the rest of the night. Sleep is precious.
Friday I was in the clinic, had a couple of interesting patients, learned a lot and got to go home a bit early :)
Monday- Was on L&D today, saw one delivery in the morning and then the rest of the day I spent practicing my sutures as it was a pretty quiet day. I induced several lacerations to my banana and then sutured it up good as new
Tuesday- Clinic day, dont remember anything too special happenin
Wednesday- I slept all day as I had night shift that started at 5pm. I tried to get as much rest as I could since I knew I would not be getting any sleep that night...
When i got to Labor and Delivery at 5pm I was on the move until 8am the next day. One of the patients I admitted around 7pm was a 29yo who had come to the ER because of severe abdominal pain....she then found out in the ER she was pregnant...36 weeks pregnant. How one does not realize you are 36 weeks pregnant I will never be able to figure out but she seemed really surprised. We asked why she hadnt noticed missing her periods and she said they were really irregular anyways and that she was spotting a little so didnt take notice...she also had us talk to her sister because she thought she was playing a joke on her and wouldnt take her seriously. I dont know if this patient was just in serious denial or what but it was a pretty ridiculous story... she must have thought an alien was growing inside her because at 36weeks those babies are kickin!
Soon after we admitted that patient we had a scheduled C- section and though I didnt get to assist, I got to watch the whole thing. One of the nurses asked if I had been in a surgery before and I totally lied and said yeah [so she wouldnt be worried that I would pass out]. She gave me a lil speech anyways saying “dont lock your knees and if you feel light headed or woozy at all just walk right out, no one will say anything so dont be embarrassed”-- she was obviously still worried i would pass out and probably just didnt want to deal with it if i did. I had no idea if i was going to faint or not...i had seen some bloody deliveries and such but really, i hadnt had to smell a cauterizer before so who knows how i was going to react... Well, i was fine. Didnt feel light headed at all...i kept taking deep breaths and reminding myself to not lock my knees but really, i felt fine. It was very good to know that I can handle surgery. It was amazing to watch them yank a new baby out of the uterus of this women and then spend about 20 min closing up each layer of muscle, skin and fascia that they had cut through. While closing, the attending tried to ask me a question about the embryological origin of something. I couldnt really hear what he said so i asked him to repeat the question and he said, “no, no i cant...” He obviously was trying to stump me with a question but was so tired that he didnt remember what he asked.. we all laughed about it and a second later a big squirt of blood hit me, the resident hit an artery accidently and sent a small amount of blood my way. It got all over my scrub shirt. The resident laughed and said, “see, thats what happens here when you dont get a question right.” I laughed and asked if there was any blood on my face. She looked up and said, “oh im sorry did you actually get hit by it? I wouldnt have made such an inappropriate joke if i had known that...” Again, we all had a good laugh at my expensive.
The next delivery I saw was the first episiotomy I have seen. The mom was pushing hard and doing well but the baby’s heart monitor was showing a gradual deceleration and the doctor began to get worried about the baby. She told the mom she needs to get the baby out with the next push or she would have to cut her. the mom flipped out pleading the doctor not to do it. unfortunately, the doc had to tell the patient that it wasnt a question, more of a statement that she had to do it because the baby was beginning to be in danger. The resident eventually cut a lateral incision and the baby came out with the next push...the newborn had the umbilical cord wrapped around her neck twice and the resident and PA quickly unwrapped it, clamped the cord and gave the baby to the NICU team. The baby ended up being fine and we stitched up the mom while her epidural still worked and everything turned out OK.
The next girl I admitted was a 17yo pregnant with her baby [you may think this is young but i have already seen a 16yo deliver her SECOND child]. She was writhing in pain and her bf just sat in the corner of the room texting on his phone. When i asked her what her pain scale was she told me 9.5/10 pain. I then asked if she was planning on getting an epidural and she answered ‘hell yeah’. She hadnt taken any lamaze classes and i dont think she prepared for this delivery at all. im pretty sure she had no idea that she wouldnt be getting an epidural until she was almost completely dilated which could take 10-12 hours in a first time pregnancy. i definitely was not going to be the one to break that to her....
Around 1:30am I started to write progress notes on all the vaginal deliveries and C sections that had happened that day up until midnight. There were 12. I had to look up all their labs, go see them, ask a few questions and do a brief physical. I didnt get done until around 5:15am. Luckily must of them were up feeding their babies. I was glad i didnt have to wake em up because honestly, who is going to be nice to a student doctor that wakes you up at 3am to ask you about your gas, bowel movements, and what birth control options you want?
Rounds were supposed to start at 6:30am but the resident, attending and I got pulled into an emergency C- section. I scrubbed in and assisted on this one. It was the cooooolest. Well, minus the fact that i made an idiot out of myself while the scrub tech was helping me gown up in sterile dressing. its a tricky process. even more tricky when you are being stared at by your attending, resident and the anesthetist. lets just say i didnt make it look graceful. i dont feel too bad though since i am still very new at this and i was being rushed since it was an emergency situation. Anyways, after cutting through all the abdominal layers we finally got to the uterus and after making a long vertical incision I saw a little ear pop out. It took me a second to gather what was going on and then the resident pulled the baby out and layed it down. The surgical tech handed me a suction bulb and i started to suction out the mouth and nose for any mucous. About 30sec after being yanked out of the uterus the baby finally realized something was different and started yelling his head off. It was an amazing site to see and an amazing feeling to know i was one of the first people to touch this new mini-human. The mom consented for a tubal ligation before the c section so after the baby was taken out and the uterus was sutured back up the next job was to ‘“tie her tubes.” i was pretty shocked at how quick it was to do it. They just tie a robe around the tubes, then cut off the part that is tied off. I looked at the resident and said, “thats it?” and she looked at me puzzled sayin,”yeah, what else do you want me to do?” Again, laughter ensued at my expense [im getting used to it].
The attending has to wait until everything but the outer skin is closed and then he steps out. I helped the resident close up the abdomen and then helped clean up the patient. At this point the anesthesia is wearing off and the new mom was awake [getting some morphine of course].
By the time i was done helping clean up and move the c section patient, rounds had already started so i sprinted to the other side of the hospital where the OB and GYN patients are. I met up with the other students, residents and the attending. They were already half way done but I wasnt worried, i was just with this attending in surgery so its not like he thought i was late because i was slacking off...
After rounds we have mandatory lecture from 8am to 9 and i had to stay. I “listened” to the lecture and then took a nap in the on call room until about 10:30am. I drove home, made breakfast and slept all day. Then got up, tried to read, and passed out again for the rest of the night. Sleep is precious.
Friday I was in the clinic, had a couple of interesting patients, learned a lot and got to go home a bit early :)
Sunday, June 26, 2011
Thursday and Friday were both clinic days and I began to feel much more comfortable working there and doing exams. The attendings are warming up to all of us and probably don't hate us as much since we kinda know what we are doing now. On Friday I joked around with Dr. B and asked him when he was working next in L&D, he said he was working monday and i said well lucky for you so am i! Then later in the afternoon we chatted again and he asked if I had been reading up on how to deliver, I answered that i kinda had and he said "well you better if you want to deliver on Monday." I got really excited and I think he just kinda laughed when i couldn't wipe the smile off my face.
That day i also had a G1P0 19yo girl who was only spanish speaking. She was there for a prenatal check at 38 weeks and was pretty ready to deliver soon. She had a guy with her who i assumed to be the father and he translated for her. i was pretty much in love with him, soooooo hot. Well, i found out he was her brother not the father of the baby. Hopefully i can see him again when she is ready to deliver. fingers crossed i am working in L&D that day :)
Things I learned:
1- girls are really scared to get fat while breastfeeding, who started this stupid rumor??
2- its inappropriate to find your patient's baby-daddy to be attractive but the brother of the mom is totally free game, right?
3- It is ok for the patient to ask for the 'real doctor.' Nicole got a patient that when asked if she had any questions said, "No, but i would really like to see the professional." HAHAHA ouch
4- Residents have time to go to bars....I know this because I ran into Dr. B at a bar in Claremont Friday night. Sooooo random!
5- comfortable shoes make the day go by much smoother and faster
That day i also had a G1P0 19yo girl who was only spanish speaking. She was there for a prenatal check at 38 weeks and was pretty ready to deliver soon. She had a guy with her who i assumed to be the father and he translated for her. i was pretty much in love with him, soooooo hot. Well, i found out he was her brother not the father of the baby. Hopefully i can see him again when she is ready to deliver. fingers crossed i am working in L&D that day :)
Things I learned:
1- girls are really scared to get fat while breastfeeding, who started this stupid rumor??
2- its inappropriate to find your patient's baby-daddy to be attractive but the brother of the mom is totally free game, right?
3- It is ok for the patient to ask for the 'real doctor.' Nicole got a patient that when asked if she had any questions said, "No, but i would really like to see the professional." HAHAHA ouch
4- Residents have time to go to bars....I know this because I ran into Dr. B at a bar in Claremont Friday night. Sooooo random!
5- comfortable shoes make the day go by much smoother and faster
Wednesday, June 22, 2011
Clinic day
Got to the hospital at 5am. saw 2 patients, wrote their progress notes and then started rounds at 6:30. Its the same residents but a different attending, an older man with a very stone face that definitely made me scared. Rounds went much more smoothly this morning as i had just done them the day before and informed my other 3 classmates about what the protocol was. It made it a lot easier on all of us though since it was their first time on rounds but i know they were still terrified as i was tuesday morning. dont get me wrong, i was nervous too but not as much as yesterday. when my patients came up i presented quickly and then got asked some questions by the attending which [not meaning to brag or anything] i got right. He didnt smile or say good job but its ok, i know he was probably either thinking “GREAT!” in his mind....that or, “wow, shes not entirely as dumb as she may look.” After that, I got a little bit more confident and answered a couple more questions that he threw at us. Then, i even asked him a couple questions as well as the residents and i think i have really started to show that i have a major interest in this specialty. Actually, Dr. B heard me talking to a friend about how cool yesterday was and he laughed saying “so your on your 3rd day of rotations and you already picked OB as your specialty?” There is another resident, Dr. H, that has been a great teacher as well. I ask her a ton of questions and she definitely can see that I really want to learn. Honestly, I could not ask for any more at this rotation site. I am so unbelievably happy with it.
Today after rounds and lecture, I worked in the women’s health clinic from 9am to about 5pm. I saw a bunch of patients, saw them put in an IUD, did a pelvic, a bimanual, and many other basic physicals. I am astonished at how much more comfortable i feel today vs Monday. Monday i was scared shitless and had NO CLUE what was going on in clinic. It was like being thrown into the middle of a busy street and having to work your way across it without any direction except ‘get to the other side.’ Today, i remembered the nurses names [some of them even remember my name], i knew where to get what, i knew what the order of things was, etc. Its not just me that feels this way, every one of us discussed today how quickly we are starting to gain confidence and knowledge of protocols in the hospital. Its the 3rd day, I cant imagine what the 6th week is going to feel like!!
Lastly, i had to mention my most memorable patient of the day. I had her in the AM and she took about 2 hours of my time. Basically, she was a non-insured, unemployed 25yo who had a son 6months ago with a man she is now divorcing because he has been cheating on her throughout their 10 month marriage. Basically, she was a very immature women how was now using sex to ‘get back’ at her husband by sleeping with others even though she was still occasionally having sex with him. She had just had an abortion 1 month ago and then admitted to me that she was still having unprotected sex since one week after and thus could very well be pregnant and if so, would have another abortion. Oh, and the reason for her visit was to get birth control so she could continue sleeping around. Oh, and she was not breastfeeding her baby because she was trying to lose weight and didnt want to get fat [which is retarded for so many reasons, 1 being obviously choosing vanity over your freakin baby, but 2, because breastfeeding actually increases the amount of calories you burn and thus helps you lose weight...]. anyways, i obviously cant judge the patient...she can do what she wants. but i had a lot of trouble learning how to speak to her and counsel her without sounding judgmental. i asked the doctor for advice on this and she straight up said that i should give her as much education as i can about the risks she is taking on her health but ultimately she is going to be thinking ‘white woman’ and will probably just think i dont understand. realistic approach. so i am gonna remember this next time and try to learn a more humorous way to approach the situation, the doctor recommended using sarcasm [im serious!]. i laughed and told her to not worry, i think i can do sarcasm :)
Things i learned today:
1- a cervix can be very difficult to find
2- my new shoes suck-- thus i went to purchase special comfy ones after my shift
3- resident are awesome
4- nurses are still even more awesomer
Today after rounds and lecture, I worked in the women’s health clinic from 9am to about 5pm. I saw a bunch of patients, saw them put in an IUD, did a pelvic, a bimanual, and many other basic physicals. I am astonished at how much more comfortable i feel today vs Monday. Monday i was scared shitless and had NO CLUE what was going on in clinic. It was like being thrown into the middle of a busy street and having to work your way across it without any direction except ‘get to the other side.’ Today, i remembered the nurses names [some of them even remember my name], i knew where to get what, i knew what the order of things was, etc. Its not just me that feels this way, every one of us discussed today how quickly we are starting to gain confidence and knowledge of protocols in the hospital. Its the 3rd day, I cant imagine what the 6th week is going to feel like!!
Lastly, i had to mention my most memorable patient of the day. I had her in the AM and she took about 2 hours of my time. Basically, she was a non-insured, unemployed 25yo who had a son 6months ago with a man she is now divorcing because he has been cheating on her throughout their 10 month marriage. Basically, she was a very immature women how was now using sex to ‘get back’ at her husband by sleeping with others even though she was still occasionally having sex with him. She had just had an abortion 1 month ago and then admitted to me that she was still having unprotected sex since one week after and thus could very well be pregnant and if so, would have another abortion. Oh, and the reason for her visit was to get birth control so she could continue sleeping around. Oh, and she was not breastfeeding her baby because she was trying to lose weight and didnt want to get fat [which is retarded for so many reasons, 1 being obviously choosing vanity over your freakin baby, but 2, because breastfeeding actually increases the amount of calories you burn and thus helps you lose weight...]. anyways, i obviously cant judge the patient...she can do what she wants. but i had a lot of trouble learning how to speak to her and counsel her without sounding judgmental. i asked the doctor for advice on this and she straight up said that i should give her as much education as i can about the risks she is taking on her health but ultimately she is going to be thinking ‘white woman’ and will probably just think i dont understand. realistic approach. so i am gonna remember this next time and try to learn a more humorous way to approach the situation, the doctor recommended using sarcasm [im serious!]. i laughed and told her to not worry, i think i can do sarcasm :)
Things i learned today:
1- a cervix can be very difficult to find
2- my new shoes suck-- thus i went to purchase special comfy ones after my shift
3- resident are awesome
4- nurses are still even more awesomer
i could do this everyday and be happy for a very long time
3 deliveries- 2 of which i got to gown up and assist in, 1 of which i got to deliver the placenta. natural progression means i should be able to deliver the baby soon right?!
the day...
3:50am get up
4:10 leave the house in scrubs
5:00 get to hospital
5:10 want to take a nap but cant
6:00 see my patient on the antepartum floor, check in on how she is doing, do a mini physical and write her progress note into her chart
6:30 rounds... It is pretty much exactly what i though it would be. Scary and hectic. Picture the attending in the lead, residents a couple steps behind and then us 4 medical students running after wondering what the hell is going on. Each of us presented our patients and then got asked some questions and the attending ended up being very receptive to questions and was a very good teacher.
7:45-8:00 time to breathe, eat breakfast and then meet back at the lecture room in the labor and delivery ward
8:00 Our first morning seminar starts. its basically all of us med students, a couple PA students and some residents. This morning they were giving us an intro to the labor and delivery ward. Right as they were getting into the paperwork we are responsible for, Dr. B our resident’s phone rings and all i hear him say is, “right now? ok.” Then he hangs up and asks who is on L&D today. Kavitha and I raise our hands and he goes “k, wanna see a delivery. lets go.” I have never moved so fast....i laughed in front of everywhere and said “right now?” and he goes yup, follow me. I pretty much ran toward the door and didnt remember at all that we were in the middle of a lecture [though it was very informal, i swear] and as i was about to exit the door i stopped, looked back at the attending and said “wait, is that ok” and she just said yeah go. I ran after the doc and Kavitha was behind me. She was obviously moving slower because i was the 2nd one in after the doctor and immediately he starts to gown me up [i was very confused]. He hands me a sterile gown and once its on i look up and see a couple nurses and a PA resident standing in front of a very, very loud screaming mom. It was pretty much what i expected only i was a little more frazziled as i had no idea what was going on. All i knew is that Dr. B was dressing me up so i could assist the PA. After getting my gloves on I stood back and watched as the baby flew out of mom and got handed to the nurses to get checked out. With the baby clear, i was told to go help the PA and she explained everything from there on to me. She is awesome. I watched and learned about how she delivered the placenta and then examined it with her after to make sure everything was normal. pretty damn cool. and that was my first day on L&D, second day of rotations at 8:45am. The day only got better from there.That day I watched the anesthesiologists give an epidural, admitted about 5 new patients, saw a ton of baby ultrasound [and learned how to estimate the baby’s weight with it] and then saw 2 more deliveries.
The 2nd delivery i saw i also assisted on and this one i actually delivered the placenta. The baby’s name was Madison, I dont think i will forget that. The 3rd delivery was performed by the doctor because it was a more complicated delivery. The great thing about it was the patient was on the ward all day so i saw and talked to her and her husband all day. It was a great experience to then watch their baby get delivered at about 4:30pm. I nearly cried, it was so emotional to watch their facces as they started over at their new daughter in the baby warmer getting checked out. The baby’s name was Chloe. She was gorgeous! I even helped take a picture of dad and the baby before she was given to her mom :)
Both those moms had some minor tears that had to be sutured up and one of the residents told us that if we work on our suturing and show that we are competent we may get the opportunity to do some later in the rotation. Im gonna start googling practice suture materials cause i definitely want that experience before i leave! Other things i may get to do are artificially rupture a membrane on an induced labor and i will soon get to scrub into surgeries.
So the crazy day ended at about 5:30pm after we handed off our patients to Tan [another med student] and filled him in on what was going on. Tan had the 5pm to 9am shift so the next time i would see him would be the next morning...
the day...
3:50am get up
4:10 leave the house in scrubs
5:00 get to hospital
5:10 want to take a nap but cant
6:00 see my patient on the antepartum floor, check in on how she is doing, do a mini physical and write her progress note into her chart
6:30 rounds... It is pretty much exactly what i though it would be. Scary and hectic. Picture the attending in the lead, residents a couple steps behind and then us 4 medical students running after wondering what the hell is going on. Each of us presented our patients and then got asked some questions and the attending ended up being very receptive to questions and was a very good teacher.
7:45-8:00 time to breathe, eat breakfast and then meet back at the lecture room in the labor and delivery ward
8:00 Our first morning seminar starts. its basically all of us med students, a couple PA students and some residents. This morning they were giving us an intro to the labor and delivery ward. Right as they were getting into the paperwork we are responsible for, Dr. B our resident’s phone rings and all i hear him say is, “right now? ok.” Then he hangs up and asks who is on L&D today. Kavitha and I raise our hands and he goes “k, wanna see a delivery. lets go.” I have never moved so fast....i laughed in front of everywhere and said “right now?” and he goes yup, follow me. I pretty much ran toward the door and didnt remember at all that we were in the middle of a lecture [though it was very informal, i swear] and as i was about to exit the door i stopped, looked back at the attending and said “wait, is that ok” and she just said yeah go. I ran after the doc and Kavitha was behind me. She was obviously moving slower because i was the 2nd one in after the doctor and immediately he starts to gown me up [i was very confused]. He hands me a sterile gown and once its on i look up and see a couple nurses and a PA resident standing in front of a very, very loud screaming mom. It was pretty much what i expected only i was a little more frazziled as i had no idea what was going on. All i knew is that Dr. B was dressing me up so i could assist the PA. After getting my gloves on I stood back and watched as the baby flew out of mom and got handed to the nurses to get checked out. With the baby clear, i was told to go help the PA and she explained everything from there on to me. She is awesome. I watched and learned about how she delivered the placenta and then examined it with her after to make sure everything was normal. pretty damn cool. and that was my first day on L&D, second day of rotations at 8:45am. The day only got better from there.That day I watched the anesthesiologists give an epidural, admitted about 5 new patients, saw a ton of baby ultrasound [and learned how to estimate the baby’s weight with it] and then saw 2 more deliveries.
The 2nd delivery i saw i also assisted on and this one i actually delivered the placenta. The baby’s name was Madison, I dont think i will forget that. The 3rd delivery was performed by the doctor because it was a more complicated delivery. The great thing about it was the patient was on the ward all day so i saw and talked to her and her husband all day. It was a great experience to then watch their baby get delivered at about 4:30pm. I nearly cried, it was so emotional to watch their facces as they started over at their new daughter in the baby warmer getting checked out. The baby’s name was Chloe. She was gorgeous! I even helped take a picture of dad and the baby before she was given to her mom :)
Both those moms had some minor tears that had to be sutured up and one of the residents told us that if we work on our suturing and show that we are competent we may get the opportunity to do some later in the rotation. Im gonna start googling practice suture materials cause i definitely want that experience before i leave! Other things i may get to do are artificially rupture a membrane on an induced labor and i will soon get to scrub into surgeries.
So the crazy day ended at about 5:30pm after we handed off our patients to Tan [another med student] and filled him in on what was going on. Tan had the 5pm to 9am shift so the next time i would see him would be the next morning...
Monday, June 20, 2011
no sex in the on call room
I dont have internet at my apartment anymore so I am sitting by the pool write outside my building using the wireless from the complex. Im sitting here eating a bowl of ice cream watching people work out in the gym right next to me. hehehe oops.
thought i would just start with that. ok. so today...
5am- im up
5:45- pick up nicole
6:30- get to hospital
7am- orientation
7:08- ohhhhhh man, what have i gotten myself into
In a room full of 3rd and 4th year medical students, an administratior from the Graduate Medical Education Office has a few do’s and don’ts for us. Among the highlights, “no sex in the on call room, don’t pee in the trashcan, do not bring your pets to the hospital, do not bring your kids to the hospital, don’t put wet towels on the mattresses.”
Right,got it. so we learn the lay of the land, get our ID badges, and are given our schedules. Each one of us has different assignments for each day and the only constant is an 8am-9am lecture/seminar given by different residents or attendings each day. We are expected to be there for them every weekday. My schedule for the next 2 weeks is:
Tues- Labor and Delivery 12 hour call at AM. This means I will be at the hospital tomorrow from 5am to 5pm in the L&D ward with one other student.
Wed- Gyn notes/ Clinic. This means I will be at the hospital at 5am to see gynecology patients and write up history and physicals on them and then at 6:30am we will round on all the patients and I will present mine. Then from 8 to 9 I will attend the lecture and from 9am until around 6pm I will work in the women's health clinic on the first floor of the hospital.
Thurs and Friday- I will be in the clinic all day after 8am seminar
Monday-Labor and Delivery 12 hour call at AM
Tues- Clinic all day
Wed- Labor and Delivery 12 hour PM call but it is actually 16 hours at the hospital. THIS SHIFT SUCKS! I need to be at the hospital at 5pm on Wednesday, I stay there until rounds the next day at 6:30am and then have to stay for the lecture/seminar from 8-9am. At 9 I get to go home and then have the day to sleep and then
Fri- I have clinic
Sounds pretty fun, eh?
OK, back to our schedule today
8-9:45 we have more orientation, get our ID badges, and get a tour of the hospital.
10am- we get dropped off at the clinic and go to work... There are 9 of us total, all 3rd year students from Western. We are shown around a lil bit and then the next thing i know, I am in a clinic room. I saw 4 patients today, 2 of which spoke english. The other 2 did not...at all... God i wish i still remembered my spanish from high school. For those of us who cant communicate, there is a translator service.
There are 4 wireless phones and we use one to call up the serive using a code and then after a few rings we push what language we want and a translator will come on the line. We give them our name and the patients name and then you put the phone on speakerphone. From then on, you ask the translator to ask the patient a question and when they respond, the translator tells ya what they said. It is great! Very impersonal though, i really wish i didnt have to use it. The patients dont even look at you when they are talking, they talk to the phone. its kinda akward but very very useful. There are lots of nurses around that speak spanish but we are told not to ask them because they have enough work to do as it is.
12:10- you have 30 minutes to go to the cafeteria and get food. readyyyyy, go! [i have never eaten a chicken burger so fast]
the rest of the afternoon: patients patients patients. On the board that has all the staff names and doctors written on it that are working that day, it says how many patients are scheduled for the day. Today it said 66/46. That means 66 patients for the morning and 46 patients for the afternoon! This is going to be a loooooong month!
We got done around 6 and I got home around 7. I am tired, my feet hurt [note to self, why the hell did i wear new shoes???] and i have to be in bed pretty much right now in order to get a good nights sleep.
It was scary, intimidating, and thrilling. At some points I was so confused and felt very stupid and at others I felt great. I know I have the skills, now I just need to learn all the knowledge. I should already be reading some OB/ GYN books in preperation for the next couple weeks and to make myself sound smarter to the attending physicans but right now all i can think about is getting in bed and watching an episode of ER before I fall asleep.
1 day down, lots more to go :)
Oh and lastly, things i learned today:
1- nurses are a medical students saving grace. i love them. they are great.
2- an endometrial biopsy looks like the most painful thing a women has to go through and i refuse to ever have one done on me
3- i need to learn spanish
4- i need more nice dress clothes
thats all for now... im gonna get in bed soon and then wake up in the AM, put on my scrubs, and head to labor and delivery. eeeeee so freaking excited! :)
thought i would just start with that. ok. so today...
5am- im up
5:45- pick up nicole
6:30- get to hospital
7am- orientation
7:08- ohhhhhh man, what have i gotten myself into
In a room full of 3rd and 4th year medical students, an administratior from the Graduate Medical Education Office has a few do’s and don’ts for us. Among the highlights, “no sex in the on call room, don’t pee in the trashcan, do not bring your pets to the hospital, do not bring your kids to the hospital, don’t put wet towels on the mattresses.”
Right,got it. so we learn the lay of the land, get our ID badges, and are given our schedules. Each one of us has different assignments for each day and the only constant is an 8am-9am lecture/seminar given by different residents or attendings each day. We are expected to be there for them every weekday. My schedule for the next 2 weeks is:
Tues- Labor and Delivery 12 hour call at AM. This means I will be at the hospital tomorrow from 5am to 5pm in the L&D ward with one other student.
Wed- Gyn notes/ Clinic. This means I will be at the hospital at 5am to see gynecology patients and write up history and physicals on them and then at 6:30am we will round on all the patients and I will present mine. Then from 8 to 9 I will attend the lecture and from 9am until around 6pm I will work in the women's health clinic on the first floor of the hospital.
Thurs and Friday- I will be in the clinic all day after 8am seminar
Monday-Labor and Delivery 12 hour call at AM
Tues- Clinic all day
Wed- Labor and Delivery 12 hour PM call but it is actually 16 hours at the hospital. THIS SHIFT SUCKS! I need to be at the hospital at 5pm on Wednesday, I stay there until rounds the next day at 6:30am and then have to stay for the lecture/seminar from 8-9am. At 9 I get to go home and then have the day to sleep and then
Fri- I have clinic
Sounds pretty fun, eh?
OK, back to our schedule today
8-9:45 we have more orientation, get our ID badges, and get a tour of the hospital.
10am- we get dropped off at the clinic and go to work... There are 9 of us total, all 3rd year students from Western. We are shown around a lil bit and then the next thing i know, I am in a clinic room. I saw 4 patients today, 2 of which spoke english. The other 2 did not...at all... God i wish i still remembered my spanish from high school. For those of us who cant communicate, there is a translator service.
There are 4 wireless phones and we use one to call up the serive using a code and then after a few rings we push what language we want and a translator will come on the line. We give them our name and the patients name and then you put the phone on speakerphone. From then on, you ask the translator to ask the patient a question and when they respond, the translator tells ya what they said. It is great! Very impersonal though, i really wish i didnt have to use it. The patients dont even look at you when they are talking, they talk to the phone. its kinda akward but very very useful. There are lots of nurses around that speak spanish but we are told not to ask them because they have enough work to do as it is.
12:10- you have 30 minutes to go to the cafeteria and get food. readyyyyy, go! [i have never eaten a chicken burger so fast]
the rest of the afternoon: patients patients patients. On the board that has all the staff names and doctors written on it that are working that day, it says how many patients are scheduled for the day. Today it said 66/46. That means 66 patients for the morning and 46 patients for the afternoon! This is going to be a loooooong month!
We got done around 6 and I got home around 7. I am tired, my feet hurt [note to self, why the hell did i wear new shoes???] and i have to be in bed pretty much right now in order to get a good nights sleep.
It was scary, intimidating, and thrilling. At some points I was so confused and felt very stupid and at others I felt great. I know I have the skills, now I just need to learn all the knowledge. I should already be reading some OB/ GYN books in preperation for the next couple weeks and to make myself sound smarter to the attending physicans but right now all i can think about is getting in bed and watching an episode of ER before I fall asleep.
1 day down, lots more to go :)
Oh and lastly, things i learned today:
1- nurses are a medical students saving grace. i love them. they are great.
2- an endometrial biopsy looks like the most painful thing a women has to go through and i refuse to ever have one done on me
3- i need to learn spanish
4- i need more nice dress clothes
thats all for now... im gonna get in bed soon and then wake up in the AM, put on my scrubs, and head to labor and delivery. eeeeee so freaking excited! :)
Sunday, June 19, 2011
OMSIII
Not sure how, but I made it. I made it through what was quite possibly the hardest year of my life and the worst two months of my life. I have never been so mentally and emotionally challenged and although I broke at times and had to reach out for help along the way, I made it. I now know how strong of a person I am and that I can make it through anything, i’ve pretty much been through mental bootcamp and survived. After having multiple exams thrown at me at the end of the year and then given the task of studying for board exams, there is really nothing else I can imagine to be more difficult. I spent 37 days, approximately 11 hours a day, memorizing a book that was a culmination of information that was not just information for the last two years of medical school, it was a culmination of all of my years of science education. To understand and not just memorize but LEARN and conceptualize the vast amount of information that I was tested on, I had to pull from my years and years of schooling and to be honest, I believe my last 20 something years of schooling were preparing me for these two exams.
Correction, I spent 36 days studying. On Wednesday June 8th, after not taking one day off, my brain went on strike. I woke up in the morning and just could not get out of bed. I decided to let myself sleep in until 10am. Then after pressing the snooze button a bunch of times, I got out of bed around 11am. I made some breakfast, watched a bit of TV [first time in a month] and then decided I was not ready to study...so I went back to bed. Then, I went to sleep from 12 to 5pm. I woke up and my brain had re-set. So I went to school, put in about 5 hours of studying and then called it a day. Needless to say, my brain went back to working order the next day...
I still dont know how i did, i wont get my scores for about a month. But it really doesnt matter at this point as long as I passed both of them. There is nothing more i could have done, i could not have given more of myself to this subject and however I did i will be happy because i made it. I am here, a 3rd year medical student, having been taught as much as school could cram into my head, and I am now being ‘set free’ into the real world of medicine.
Tomorrow I start my first rotation...it is my first day of 2 years of clerkships in which I will trade in my books and powerpoints for patients. I will be learning from individuals who are kind enough to let a student learn on them. I will be supervised thoroughly and will never be completely responsible for someone’s help...so im not too scared. But, i will have input on their care and my opinions will be taken into account.
My first rotation is at Riverside County Regional Medical Center in the department of Obstetrics and Gynecology and it is 6 weeks long. Apparently it is one of the best hospitals to rotate at in the area because it is so big. I have to be there at 7am and it is about a 45min commute as the hospital is 40 miles away so I will be leaving at 5:45am to make sure I am there on time and where I am supposed to be. The best part about the whole situation is that my good friend Nicole is working at the same hospital, in the same department. Nicole and I studied for boards together for weeks and are very comfortable working alongside each other so knowing that support will be there is making this whole new transition much easier. We will be carpooling to the hospital tomorrow and will experience all these brand new situations together.
I am so excited for the USMLE and COMLEX to be behind me. I feel like a brand new world is opening up...a door has been opened to the next chapter of my life. I have been preparing for this day for so long....it is here. Student Doctor Dorothy is ready to soak up as much information as she can!
I cant wait to document all the new experiences!!! Should be some damn funny stories. Well, they may not be funny now but I know they will be funny years to come when I read this again...
"we're all set. 3rd year starts tomorrow. setting us free into the wild. now we just have to try not to look like idiots. IM SO EXCITED!!! :)"
Correction, I spent 36 days studying. On Wednesday June 8th, after not taking one day off, my brain went on strike. I woke up in the morning and just could not get out of bed. I decided to let myself sleep in until 10am. Then after pressing the snooze button a bunch of times, I got out of bed around 11am. I made some breakfast, watched a bit of TV [first time in a month] and then decided I was not ready to study...so I went back to bed. Then, I went to sleep from 12 to 5pm. I woke up and my brain had re-set. So I went to school, put in about 5 hours of studying and then called it a day. Needless to say, my brain went back to working order the next day...
I still dont know how i did, i wont get my scores for about a month. But it really doesnt matter at this point as long as I passed both of them. There is nothing more i could have done, i could not have given more of myself to this subject and however I did i will be happy because i made it. I am here, a 3rd year medical student, having been taught as much as school could cram into my head, and I am now being ‘set free’ into the real world of medicine.
Tomorrow I start my first rotation...it is my first day of 2 years of clerkships in which I will trade in my books and powerpoints for patients. I will be learning from individuals who are kind enough to let a student learn on them. I will be supervised thoroughly and will never be completely responsible for someone’s help...so im not too scared. But, i will have input on their care and my opinions will be taken into account.
My first rotation is at Riverside County Regional Medical Center in the department of Obstetrics and Gynecology and it is 6 weeks long. Apparently it is one of the best hospitals to rotate at in the area because it is so big. I have to be there at 7am and it is about a 45min commute as the hospital is 40 miles away so I will be leaving at 5:45am to make sure I am there on time and where I am supposed to be. The best part about the whole situation is that my good friend Nicole is working at the same hospital, in the same department. Nicole and I studied for boards together for weeks and are very comfortable working alongside each other so knowing that support will be there is making this whole new transition much easier. We will be carpooling to the hospital tomorrow and will experience all these brand new situations together.
I am so excited for the USMLE and COMLEX to be behind me. I feel like a brand new world is opening up...a door has been opened to the next chapter of my life. I have been preparing for this day for so long....it is here. Student Doctor Dorothy is ready to soak up as much information as she can!
I cant wait to document all the new experiences!!! Should be some damn funny stories. Well, they may not be funny now but I know they will be funny years to come when I read this again...
"we're all set. 3rd year starts tomorrow. setting us free into the wild. now we just have to try not to look like idiots. IM SO EXCITED!!! :)"
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