House MD

picture this:

3 med students, sitting around the call room in the afternoon waiting for hospital admits and watching House on the TV in the corner.

Lots of debate and discussion about what they are diagnosing, tests they are ordering and treatments discussed. Its just like small group only much more entertaining. almost as good as studying i'd say...


Also, an observation: House and his 'team' look like complete assholes for talking about patients in mean ways. example from the show we were watching:
 they made a bet about what the disease would end up being and one doctor said cancer. he ended up being right and gloated about this, even though it was cancer and they basically gave her a death sentence....

 but really, we kinda do this all the time in real life as med students, residents, doctors, etc. obviously not this exact way but we still try to keep a distance and some humor about patients or else we would just constantly be depressed. I brought this up to the other med stuwies's as we watched and my friend greg said, "well yeah, it would be really depressing to think about how sick each person you see is, knowing that some of them are facing imminent death. i like to be able to laugh every once in a while."

suturing, finally!

central line assist and suture placement= check. its gonna be a while until i get to actually do one but the more i see the better off i will be! [side note: that was the first time i have sutured human skin. very surprised that its taken this long!]

in the afternoon i went to the ER to admit a normal CP patient and when i got there, she was already being wheeled upstairs to her room. i went with her and the nurses into the elevator and right away i noticed how upset and sad the patient was. we got to the room and a CNA helped me translate with her. we started asking about her pain while she was crying. she then kept repeating that she couldnt stop sleeping and all she had been doing the last week was sleeping. then she let out that she had taken some pills. first, she said she took sleeping pills, then she admitted that she had been taking tylenol with codeine and ibuprofens by the handful. she admitted to taking 12 at once.

we went on to interview her about everything. her home life was terrible. she lived with her husband and 2 sons who verbally abuse her. she was severally depressed and could not stand being at home anymore. she really did have chest pain but it was more so from anxiety than anything else. she was so scared that we would not let her stay at the hospital overnight. after i convinced her that she was staying, she calmed down a bit but was still very tearful. we got a psych consult for her who gave her information on battered women's shelters and referred her to a counselor. thats about all we could do :/

3 admits today. started at 8am, ate from 1-1:30, otherwise was on the go until 6pm. not complaining too much though cause i like staying busy. saw a 2nd year resident butcher a man's neck during a central line. lots of bleeding and 2 attempts later the patient had one in....

two interns today commented on my work, one said, "i hate to say it but your doing a really good job," and the other [the intern with asbergers] said i was the best student in the group because im thorough, efficient and are making my own A/Ps. that felt good.

I really want to bitch about these daily 11-12 hour shifts but I have no one to blame but myself

12 hour shift on friday makes for a boring and early to bed friday night

took out some staples today. it took like 10 seconds and a monkey could have done it but im still excited i got too.

then admitted a 30-something year old M with some major issues. his BNP was over 500 showing he was in heart failure...in his early thirties! he used to drink 30 beers a day from the age of 12 to 25 so that will do it. he also has some ridiculously uncontrolled diabetes and from it, his vision is almost gone and he is in renal failure.... in his thirties!! i have a feeling that this is the first of many of these to be seen in my career...

worked with a new intern today, she was impressed when i picked up a murmur, gallop and non physiologic splitting on this patient. she then asked me how i learned heart sounds so well and wanted me to email her the links i used to listen and learn them. thennnn she said she was going to steal me for the rest of the rotation to work with her :) things are looking up.

revelations

2 things i learned today:

1) the intern i have been working with is most likely autistic

2) the moment i cannot take care of myself and need to go into a nursing home I will sign a DNR

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.