Here comes the blood

Med student: So what brings you in today?
Mr. Ejaculation (slurring and reeking of booze): Last night I came blood.
Med student: I'm sorry, how did you come...?
Mr. Ejaculation: Out of my pecker! I was on my computer and you know and then I you know and it was blood!
Med student: How much blood?
Mr. Ejaculation: I don't know I didn't measure it!
Med student: Has this ever happened to you before?
Mr. Ejaculation: No! Never! And I was so worried because I thought this is serious! So I sat down and drank all night long. I couldn't sleep because I thought, you know, this is serious! And then I came in this morning.

Decent

Overheard by a resident in the lounge:

"We make decent physicians. We aren't great physicians by any means, but we make responsible physicians."

Made me chuckle.

The emergency room is for.....emergencies

Working in the emergency room I've seen a lot of things that do not constitute emergencies even a little.

Sarah: So what brings you to the ER today?
11 y/o Kid: I had a fever.
Sarah: When did you have a fever?
Kid: Yesterday.
Sarah: How did you know you had a fever?
Kid: My mom felt my head and it was warm.
Sarah: Did she take your temperature with a thermometer?
Kid: No.
Sarah: Why did she feel your head?
Kid: I felt like I was hot and so she felt my head and it was warm so she gave me advil.
Sarah: How do you feel right now?
Kid: Good.

The kid didn't have a temp in the ER. He had subjective temp yesterday morning. No other symptoms. Nothing was wrong with this kid. At all.

I don't understand.

Did you do anything fun?

People don’t seem to understand what being in medical school entails. You can explain it to them frontways and backways over and over, but they still won’t get it. I remember when we were studying for the boards and my boyfriend had a conversation with his cousin while we were studying for Step 1. This is the most important exam you take in medical school. You study for around 5 weeks straight for it (and by straight I mean morning to night, every day, no breaks) and the score essentially determines what kind of residencies you can apply to and what kind of specialty you can do.

Cousin: So what are you up to now?

Joseph: Studying for the boards every day. It’s pretty rough. I have a few weeks left and then freedom.

Cousin: Oh that sounds rough. So like what else have you been up to?

Joseph: Well, nothing. I just study all day every day.

Cousin: Yeah, yeah, I get that. Did you do anything fun this weekend?

Joseph: No. I just studied. All weekend.

Cousin: Did you see that movie that just came out?

Joseph: No I haven’t seen any movies because I have been studying. I also haven’t watched TV so I don’t know what movies are even out now.

Cousin: Oh yeah, that makes sense. Doing anything fun this weekend?

Med students are so boring.

Iatrogenic

Today I heard a story at lunch. I wouldn't believe it if I hadn't seen things happen like this before. A woman came into a trauma and was pretty much gone. The details I don't know, but there really was no saving this woman. Yet the family wanted the doctors to "do whatever is necessary to save her." That opens up the biggest and worst can of worms.

One of the residents thought she had a pneumothorax. So he went to perform a needle chest decompression and there actually was no pneumothorax. Instead, with his intervention, he then caused a pneumothorax. So they decide to put in a chest tube. The resident was pushing it in and hitting some resistance so the chief resident grabbed it and shoved it in with force. They take the x-ray to look at the placement and see that the tube had been shoved in so hard it went across the mediastinum, into the other lung, causing a pneumothorax on the other side.

Yeah.

Everyone hates everyone else

I've noticed that, unfortunately, every field of medicine seems to really hate every other field of medicine. In addition to the hatred comes the stereotypes. Pediatricians and family med doctors are stupid, surgeons are callous douchebags, anesthesiologists are lazy, neurologists are useless, psychiatrists are crazy. And really, these stereotypes (like all stereotypes) are based upon an observation that then gets built upon. Pediatricians and family med doctors have some of the lowest board score averages. Surgeons do very quick exams and often are unreachable in the OR (which other specialties don't seem to understand). Everyone has looked over at an anesthesiologist at some point to see them on their phone or reading a book. The list goes on.

I'm not going to say I disagree or agree with the stereotypes. It is, however, detrimental to patient care when specialties bicker with one another or can't work together because one of them has a superiority complex. It also makes for a negative experience when everyone is always talking about how they hate someone else.

You know what? We are all the best. We are some of the smartest individuals in the nation. Yet for some reason, doctors still feel the need to define themselves as best, others as worst, and create a hierarchy within the medical field. It's annoying. It's like being back in high school again. You get sucked in so easily. You feel insecure because you aren't the best anymore like you were in college. Your potential field of medicine is being made fun of. So you make fun of other fields. Or you have someone standing in front of you who thinks they are so much better than you (and says it).

You hear the familiar statements. "Of course he did a CT when it wasn't necessary, he's an ER doc." "These pediatricians are incompetent." "Radiologists are so lazy." "Don't call the neurologist, there is no point." "Of course surgery won't come see him, they can't be bothered." "Don't become an anesthesiologist, they don't help anyone."

My personal favorite was when the pediatrician said, "That website is idiotic. It doesn't give any information at all and it's written in 4th grade english. That site is made for family medicine docs, not us." Uhhhh, you guys are both primary care and reaalllyyy similar. How can you guys hate each other?

My friends and I had an interesting discussion once. There must be ONE field that everyone sort of respects and leaves alone. I thought maybe cardiology. My friend thought hem/onc.

Thoughts?

Please just answer the question.

One of the biggest problems I have with history taking is that no one answers the question. I am unsure if it's because people are stupid or if the questions I ask don't make sense. Or something in between. I am not the only one who has this problem though because I have heard mention of it many times before. How difficult is it to answer "how often do you have the abdominal pain?" or "when was the last time you took tylenol?"

I had to work with this doctor for two straight weeks and he was, to put it nicely, an unpleasant person to be around. His bedside manner was crude, his personal interactions were awkward, and many of his patients switched to the other doctor he worked with for their care. I even had one patient in the hospital recently refuse the consult if he was the one on service that week. However, he did not let patients get away with not answering the question. He would say to them "No. That is not what I asked." and restate the question.

I have observed many interviews where the doctor lets the patient go on a tangent and things get muddled and the interview took three times longer than it had to. Obviously we learned in our "how to be a doctor" courses to ask open ended questions and not cut the patient off. That's another discussion for another day. In general, I have learned that while you should let the patient talk, you also need to be in control of the interview.

As an example, myself and another medical student were interviewing a patient and her mother. This patient had asthma and we had to figure out how often she was using her rescue inhaler to see how bad her asthma really was.

Sarah: How often do you use your inhaler?
Mother: It's only when she coughs a lot.
Sarah: Yes, but how often would you say that is?
Daughter: I only use it when I cough a lot and then I have to use it.
Other student: Right, but how many times do you cough a lot and have to use your inhaler? Once a week? Twice a week? Every day?
Daughter: It's really only when I cough. If I'm not coughing I don't use it.
Mother: She doesn't use it that much. Only when she starts coughing.

I give up.

Narrowing it down?

Based on my experiences so far (a lot of bad ones, some good ones) I have narrowed down my focus to two probable specialties: GI or anesthesia.

Discuss.

(Pro/con list to follow)

Rules of medicine

I think I'm going to start a little something I like to call "the rules of medicine." Maybe I'll change the title eventually. It's a working title. Anyway, here's one for now....

If your child is able to run around and play in the play room at the hospital, they are not sick enough to need to be in the hospital.

I should start posting again

I have a million stories from third year so far. The problem is I'm often too busy and too tired to want to update. I want to try to change that. I can't update you on the past 3 months. It's too much. I can, however, try to be better about posting even a little something every day.

University of Youtube

Fourth year: Oh yeah, I learn everything from youtube. During a trauma the other day the resident asked me if I knew how to do this particular stitch. I told her yes and then stood in the corner of the trauma bay and quickly watched it on youtube. Then I was ready to go.

Not safe to drive

Patient, after the procedure done under sedation is finished:

Patient: But doc, I'm still under the influence!
Doctor: Under the influence of what?
Patient: The happy juice.

Someone is gonna get hurt

Teaching hospitals are a funny thing. You are going to get the best, top of the line care at the forefront of medical research. You are also most likely going to get poked and prodded by less than skilled hands (ie medical students and new residents).

I'm on my anesthesia selective for two weeks. In the week I have been there so far, an elderly woman woke up with an extra bruise on her hand from a botched IV, another woman woke up with a swollen lip from a botched intubation, and still another woman woke up with the back of her throat possibly more scratched than it had to be from yet another botched intubation. I asked if I could practice intubations in a sim lab and was told that it isn't at all the same. In the sim lab, the tongue stays put and doesn't flop everywhere. I need to practice on real people, I'm told.

I watched the attending leave the first year anesthesia resident alone in the room for ten minutes. The apnea alarm started going off. I asked why it was saying that, he had no idea. If anything bad had happened in those ten minutes, that woman might have been dead. I watched the junior resident accidentally bovie the stomach serosa instead of the fascial adhesions. If you told patients during the consent that their surgery might have a few mistakes, the anesthesiologist is new and doesn't know what to do if anything goes wrong, and a med student is going to practice with their veins to put in IVs and try intubation only to probably just scratch up their mouth, I'm unsure they would consent.

It's a necessary evil of a teaching hospital. And you know what? If one day I need to wake with a few extra bruises and minor abrasions from a surgery that maybe didn't go as smoothly as it could have because a resident messed up, then so be it. That is what it takes to make doctors of tomorrow. We have yet to find a better way.

First day of surgery clerkship

My attending had wise words. He said that it is a guarantee that we will harm people and we will be an instrument of some people's death. He also said that this career is amazing. In no other career will someone meet you for 15 minutes and then agree to let you cut them while they are asleep and vulnerable. His opening speech was much more profound than I can summarize in a few words, but it made me both excited and scared for the upcoming years.

Two tips for those starting third year:
1. Always roll up the sleeves on your white coat when you eat. It will avoid ketchup vs. sleeve mishaps.
2. Always carry cash with you so when the cafeteria is cash only, the attending doesn't have to pay for you on your first day.

Other than that, I start my anesthesia selective tomorrow. We will see how that goes.

I'm back!

Well hello there, people. I'm done with boards. No, I don't want to talk about it.

In other news, I got a kitten! Apparently it's a thing to get a "board pet". I didn't just get him for the boards, I had wanted a kitten for a while and now is a time in my life when I can finally have one since I'm done living in dorm-like atmospheres. His name is Jack and he's adorable and full of personality and cuddles. Let the cuteness commence.

He sleeps in ridiculous positions.

I don't really have anything to update because nothing has happened other than the kitten and the boards. I'm currently trying to pack up my stuff and prepare to move next week, but motivation is low since pressure is low so I mostly spend my days laying in bed with Jack and watching HGTV. 

I'm going on a short hiatus

The reason I haven't been posting is because finals are coming up in 2 weeks and then I have 6 weeks of board studying which entails 10 hour minimum study days. I don't have time to blog and nothing exciting is happening to me anyway.

I'll be back, I promise. If you are a new viewer, you should stay tuned because I start 3rd year in July and if you know anything about 3rd year of medical school.... Well, I'm going to have some great stories.

Wish me luck!

Don't ask questions unless you have a reason for obtaining the answer.

One of the doctors who gave a lecture told us that there are only so many good reasons to do a test:

1. The result will change the management of the patient
2. Prognosis
3. Reassurance (only if not dangerous, painful, or costly)

The other poor reasons include curiosity, covering your ass (not a good reason, but necessary sometimes), and financial gain.

I think it's good life advice to follow. Don't ask a question that you aren't prepared to hear the answer to. Most importantly, don't ask a question unless the answer will change the way you do things.

Simple example: Do we have milk in the fridge? If the answer is no, do I plan on going to get milk? Was I planning on having cereal and this answer will determine whether I have cereal or toast? If not, then why ask? If the answer is no, it is only going to annoy me and bother me that I don't have milk.

And the reassurance thing, well, my philosophy is fast becoming if the possible bad news is worse than not knowing, I'd rather stick with not knowing.

The life I've chosen

I found this blog a few weeks ago through happenstance. I was looking for recipes and stumbled upon one for a basil and tomato risotto that looked delicious. It was. Then I poked around the blog some more and found another recipe for a basil, sweet corn, zucchini gnocchi dish which ended up also being delicious. 2/2 is pretty damn good for me when it comes to cooking. Usually I mess something up because the recipe is too difficult to follow/requires cooking skills I don't have or it just ends up coming out not nearly as tasty as the picture implies.

Anyway, I ended up poking around this girl's blog a bit more and learned a bit about her life. She's in her late 20s and seems to have everything figured out. I couldn't figure out what (if anything) she does for a living. I know she graduated college, but after that I am unsure. She makes delicious, healthy meals every day for every meal and prides herself on ensuring a home cooked, delicious meal is there for her husband every night when he gets home. She also runs a lot. She only got into running after college and yet she seems to be pretty content with it. She's gorgeous and skinny and has a lot to write about.

I thought a lot last night about the life I've chosen. The doctor life doesn't really leave room for delicious meals cooked and assembled three times a day. It also doesn't leave room for the exercising I'd love to do. My husband won't have home cooked meals delivered to him every night. My husband probably won't even see me every night. I wish I could exercise now, but the 1-1 1/2 hours it warranted just couldn't be given up. I wish I could cook lovely meals all the time. I take advantage of breaks like this to learn to cook new things that hopefully will be quick enough to throw together once school starts up again.

The horizon looks pretty busy for me. Boards are coming up. That means 12 hour study days for 6-7 weeks with barely time during the day to scarf down the microwave meal I'll probably make. Then 3rd year starts with clinical rotations. I'm sure some of them will allow me a month of more down time than others, but the horror stories I've heard about surgery and Ob/Gyn don't leave me with a happy feeling that I'll be able to be domestic. Residency should be fun. Thirty hour on call shifts and barely any time to shower and sleep never mind feed a hungry husband and take a brisk 45 minute jog.

I'm totally okay with the life I've chosen. I couldn't do a stay at home mom, domestic lifestyle. I do wish there were more balance. I wouldn't mind being a little more domestic. Maybe one day I'll figure it all out like that blog girl. I won't ever be able to cook all the meals, keep my body perfect, and maintain a blog in addition to my bustling career, but hopefully the balance I find will keep me happy nonetheless.

Making it better

Today is one of those days. It's pouring outside, I haven't slept well in a few nights and am therefore exhausted, I'm pretty stressed out, I also happen to be at that hormonal time of the month. Anyway, I was crying in my room (don't worry, I'm fine, I just do that sometimes on dreary, tiring, stressful, hormonal days) and Joseph walks in. He assesses the situation and then promptly tackles me onto the bed, licks my face and says "your tears give me strength!"

Love.

A gem from the GI doc

"Nothing gets your juices flowing like trying to save someone who is trying to bleed out all over your Gucci loafers."

H&P Fumbles: Wording

Med student: Okay, so now if you could close your eyes for me tight and I'm going to try to pry them open.

Uh, not quite what I meant

Doctor: How many sexual partners have you had in the last year?

Patient: At one time?

Pet peeve: speak up!

One of my biggest pet peeves is people who talk quietly when asked to speak up. In general I'm not a fan of quiet people. I'm a pretty talkative person and like being around people who also have a lot to say. I also enjoy people who speak at a volume I can hear them. I don't want to have to strain my ears to have a conversation. I don't want to have to ask you to repeat yourself either.

The biggest problem comes when people answer questions in class or even small group and you can't hear a word they say. Sure, you're shy, that's fine. But don't answer a question if you don't intend to throw your voice a little. Even worse is when the professor asks you to talk louder or asks you to repeat yourself. The volume at which you repeat yourself should obviously be louder than the volume at which you were unable to be heard the first time. These people, instead, answer with the exact same decibel level they had before. If the professor didn't hear you the first time, he sure as shit isn't going to hear you now.

I know for a fact that most of these people don't have laryngitis, or strep throat, or some restrictive lung disease preventing them from projecting their voice. We can all yell. We all have the diaphragm capacity to take a deep breath and force air out of it. There is absolutely no excuse for these people to not raise their voice loud enough for the professor, and those sitting next to them, to be able to hear.

H&P Fumbles: Vitals?

Me: The eye and ear exam were normal.

Partner: The pupils were equal and reactive to light. All cranial nerves appear intact.

Me: The heart sounded good with a regular rate and rhythm, no murmurs.

Partner: Lungs were clear bilaterally to auscultation....

Doctor: Hold on, back up, what were his vitals?

Partner and I look at each other frantically. Doctor mentally facepalms.

Winning the lottery

Sure, everyone wants to win the lottery. And while I wouldn't say no to winning a million dollars, paying off all my loans, and buying myself a new car and a house, it isn't necessarily what I want.

HOWEVER, I really would love to win $2,000. That'd be enough to buy myself some ski equipment, a nice pair or two of shoes I've been wanting, and go out to more sushi dinners with Joseph than we budget in (because damn, do I love sushi).

That sure would be sweet. Haha.

On my own

My dad always helped me with my math homework. My dad is really smart. Really smart. He didn't make it through college, but if he had I can't even imagine the places he would be right now. He found ways to explain academic topics to me in a way no professor could. Then there came a day when he couldn't help me anymore. He looked at my homework and I had, in fact, surpassed his knowledge of math. I was on my own.

This weekend, Joseph went on a ski weekend. He went to light the industrial stove that was in the cabin they were staying in and it blew up in his face. He's not burned too badly, just a few spots of missing skin on his nose and forehead and an overall "bad sunburned" look. Not to mention his eyebrows are gone and his hair is singed. Anyway, the point is my first instinct was to call my mom and ask for her advice. She's always been the go-to for medical advice.

Then I realized at this point I know way more about treating burns than her (which, albeit, isn't much). There isn't anything she could tell me that I wouldn't already know.

It's a weird thought when you're slowly exhausting all the things you need your parents for and gaining that knowledge yourself. But, let's be serious, I still totally don't know anything about taking care of my car. I still call my mom about cooking questions all the time. My dad still does my taxes. Oh, and that whole money thing. Still need them for that from time to time (including my phone bill and car insurance).

Parents will never go out of style.

Dreaming about eyeshadow

Most teenage girls go through a discovery phase. It involves experimentation with clothing and makeup and such. I never really went through that phase "properly" so now I realize I don't know how to do makeup. At all. Sure, I can throw on powder and eyeliner, but I don't know how to properly do it; especially eyeshadow.

So I decided I needed to learn. I've been looking up tutorials and bought a 22 piece makeup brush set on amazon that got good reviews, but didn't break the bank. We will see how this goes.

H&P Fumbles: just say it!

Med student: When you, uhh, go to the bathroom do you ever have difficulty starting or stop early?

Patient: What? I have been a bit constipated lately...

Med student: No, I mean the..uhh...other one.

Patient's wife: Urination.

Patient: No, none of that.

Med student: Now what about the, um, other side?

Gripes

Today has not been a happy day. I went to bed too late and had to get up too early. I spilled my tea TWICE all over the counter within a span of about five minutes causing me to have to remake it twice. I pulled a muscle in my neck somehow. My apartment decided to run low on hot water so I was forced to take a luke warm/boarding on cold shower. Then we got to our mandatory case discussions and were told the doctors would be an hour late. An hour I could have spent sleeping. The rest of my day thus far has been filled with studying. Needless to say, I am not a happy camper. So here are some gripes for the day:

1. The "high and mighty" attitude of morning people. I am not a morning person. A lot of people aren't morning people. For some reason though, morning people think they are better than everyone else. "Well, what are you going to do when you are on a surgery rotation?" "You can't be upset that you had to wake up for a mandatory class." I am so tired of hearing morning people declare statements of their self proclaimed superiority. I don't understand why it's unacceptable to be tired or to complain about morning class, yet if someone says they are tired after dinner that's totally acceptable. I don't understand why sleeping in late is looked down on, but going to bed early is a perfectly reasonable and responsible action. It's a preference. It's a body chemistry thing. Guess what? When I am on a late rotation at the hospital or forced to think at one in the morning, I am going to be totally fine. I get the same work done as a morning person, I just have my schedule shifted. It's the way I've always worked. So no, I am never going to be cheery and happy at 8am. Deal with it just like I deal with all you morning people being "too tired to go out" at 10 because its "past your bedtime" or "unable to study with you" because it's 9 and your brain isn't working anymore.

2. I know this has been debated before, but I don't like how some people pronounced centimeter. It isn't "sauntimeter". It isn't. I hope I don't have some attending down the road declare that it is and force me to change the pronunciation.

3. ESR and CRP tests. I want someone to explain this to me. I only recently discovered what these are and I still don't understand their point. The physician today even said there isn't much of a point to doing them because a positive test doesn't narrow down your differential at all. You have inflammation. Fantastic. However, every annoying medical student shouts them as answers like they are god. "What tests should we order on the patient?" "SED RATE" Great.

Best Valentine's Day (week) ever.

I haven't ever been a huge Valentine's day fan. I don't really know if it's because I've never had a good one (despite having significant others for most of them) or if I just don't like the idea of it. Whatever the reason, I spend the day pretending it doesn't exist.

However, this year, I really enjoyed Valentine's day, or rather, Valentine's week. Joseph and I are both impatient people. We both had bought something for each other and couldn't wait the 5 days or whatever it was until v-day to exchange. I had actually bought him my gift sort of on a whim. I got him a Beardo, which he had wanted for a while, and was planning on giving it under the pretext of joint v-day/1 year anniversary, both of which I don't love as celebratory holidays. He got me the most amazing gift - a coach purse. But not just any coach purse, the most perfect coach purse that I had been wanting. He had been paying attention when I scoured coach sales.

 

In addition, we decided we were going to go out to eat to celebrate. Before going out, he surprised me at the door with chocolate covered strawberries he made and gorgeous roses.

We had recommendations of a sushi place from some friends and so he made reservations for us. However, when I called to move the reservations back when we got a little lost, the hostess told me they are a new place. She thought they would be open for dinner (hence why she took the reservation), but now sees that they won't and that we should come back tomorrow. I was thoroughly confused, but it didn't really matter. We went to our normal sushi place which is delicious.

We ended up ordering more after this.

This was my first time trying sashimi. I only recently transitioned over from rolls into sushi. It's making my mouth water just to look at it all again.

All in all it has been a perfect week. Oh, and Joseph is beyond amazing.

The best way is the butt way.

Doctor: So say that someone did come in having ingested methanol. What would you do?

Student 1: Well, you'd give them alcohol right? Ethanol?

Doctor: Give them ethanol?!

Student 1: Well, yeah because, y'know the enzymes that break them down are the same so the enzyme would break down the ethanol and not the methanol.

Doctor: Okay, I guess they used to do that, but that isn't really done anymore. Say you were going to do that, what would be the best way to get it into the patient?

Student 2: IV?

Doctor: No. As it turns out you can only give someone IV alcohol to 10% which is about 20 proof.

Student 1: Enema?

My Jack of All Trades

My boyfriend does a lot of things. I'm sure a lot of them will come up on this blog at some point so I won't talk about what they all are. However, here are a few of the things he did in the last few days:

 He made marshmallows. From scratch.

 Then we obviously had hot chocolate with them.

He flambeed (for the first time) bananas to put on our pancakes.  

Oh, and he also built a snow fort adjacent to his apartment after we found the one behind my building earlier. His roommate came home and said to me, "You are dating a man-child." He's from California. He's never played in snow before. We will give him a break.

H&P Fumbles: pick your poison

Learning the history and physical is daunting. I'm sure once I get the hang of it and really learn the best way to ask questions and perform the physical exam tasks it will get smoother. Until then, I have a lot of stories about how myself or colleagues effed up the H&P or a patient made it difficult. When you practice on your med school friends who know the entire exam, they respond exactly how you want them to. Patients? Not so much. Therefore, I'm starting this series that will hopefully give those of you both with and without medical experience a chuckle from either silly patients or my own ineptitude.

Me: Do you drink alcohol?

Patient: I used to.

Me: How much would you drink? Maybe a six pack a night? (Aside: I read on a blog or heard from someone that it's better to start with a huge number and those who don't drink will be flustered and insist way less than that and those who are large drinkers won't feel like you are going to judge them since you threw out that number)

Patient: I don't drink beer.

Me: Right, well, the equivalent of a six pack?

Patient: [blank stare]

Me: [trying to decide whether to explain the 1 shot = 1 beer rule]

Snow day?

We got over a foot here. Here's the boyfriend who decided it was nap time and at his feet you can barely see the ruler we stuck in the ground proving my previous statement. I still have to study though all the same. Boo.

 

But we still had time to go out and have a little fun. We discovered a snow fort and took some pics.

Happy blizzard!