Monday, December 31, 2012

Medical Student Overload

Saturday evening I went out to dinner with a few friends. I'll save the details for the grand finale. After dinner, we made our way out and about and I amused myself by sliding around on a patch of ice. We then did some karaoke (at a place full of really bad singers, I can't see myself returning) and then about 1am I'd found my limit, and went home. 

Just after getting home I felt some discomfort in my abdomen. Discomfort quickly turned to pain. Somatic. PAIN. In my right lower quadrant. I freaked myself about thinking that I had appendicitis. Being almost 2am at this point I said, well I don't have a fever, no nausea, vomiting, or diarrhea, or fever, appendicitis is very unlikely. Given I had just eaten all-you-can-eat sushi, I also thought it could be a serious case of indigestion. I went to bed, actually got comfortable pretty quickly, and said if the pain hadn't resolved by morning I would have a friend take me to the hospital. Having done plenty of stints in the ER and night shifts on the floor, I knew I'd be lying in a bed either way for the next several hours. I then started organizing my thoughts and symptoms to be able to tell the doctor, and started thinking of how my mother was going to fly up to Chicago and cluck like a mother hen until her baby got better. 

Thankfully I woke up and felt much better, a little sore, but not painful. I'm convinced in my shenanigans on the sidewalk ice I pulled a muscle. 

Thursday, December 27, 2012

Today's lesson

The first good snow of the year in Chicago came on Christmas Day. I awoke to find a clear sky, and could see Indiana with no problem. I did some work on my computer and twenty minutes later looked up to find that I couldn't even see the wall next to my window, much less the street below. It was snowing quite heavily. I became unnecessarily excited. Later that day, a few friends and I were walking along the lake enjoying the snow, and I was still excited. One of my friends is from Northern Ontario, and she's looking at me bemusedly saying "This is nothing. I'm still wearing my high heels!"

This afternoon, I was at a clinic and had to drive through downtown to get home, and it started to snow again, heavily. I have never driven in snow so I was a little nervous. My dad tried to teach me, but I've never had practice. So I did what I could, slow acceleration etc etc, and got through a slick spot with little muss. After I parked my car, I quickly observed that I'd rather walk in snow than slush.

And thus today's lesson: Slushy sidewalks and dress shoes do not a match make.

Monday, December 24, 2012


After coming home yesterday morning and sleeping for a few hours after my overnight call (always the highlight of my medical school experience...), I went shopping with a friend of mine. Wanting a little bit of a scenery change and to catch a good deal we went to the outlets in Aurora, about 35 miles west of Chicago. We had a good time, did a little shopping.  I got what I was looking for for a good price (minus that ice scraper I just remembered I had forgotten). Then it came time to eat. We started to look around, and we quickly realized that, eh, we can wait until we get into the city to eat.  After all the amazing food that Chicago has to offer, Applebee's and On the Border just don't cut it anymore! We ended up at a fantastic Mexican restaurant in Logan Square. It was so good we had to speak Spanish to order. 

Friday, December 14, 2012

Bad Doctor! Bad Doctor!!

Sitting in a lecture about obesity. The presenting doctor provides a platter full of asorted Danish. This medical student also sucked down a bottle of Coca Cola with 65g of sugar.

Hi, I'm your hypocritical doctor. Please do as I say, not do as I do.

Sunday, December 9, 2012

Back to overnight kvetching...

Tonight is the first of what promises to be many overnight calls over the next five weeks for OB. It feels quite strange to be at the hospital at night (or at all rather) without Awesome Partner. We were partners for six months, side by side throughout the day. Awesome Partner has finished her scheduled rotations for now at Chicago Hope Hospital, and I remain. I miss working with her, because we worked well together. I made my way to the call room to deposit my things--not to sound lazy but I am not staying awake overnight if I don't need to, so if I can catch a few hours of sleep to guanratee I'll function the next day, I'm going to make use of the facilities provided--and the smell of the hallway took me straight back to working overnights during Internal Medicine, and all those quiet hours walking the halls and doing admits with Awesome Partner.'s to you Awesome Partner. Stay tuned for more kvetching...

You know you're old when...

Yesterday afternoon I received a text message from a friend saying "I bought you a ticket for the 9pm show at Second City." Ok, looks like I'm going to Second City tonight. Good thing I didn't have any other plans, haha. So we went to Second City which was a lot of fun and really entertaining. Afterwards we met up with some friends at a bar in Wrigleyville. Yesterday was the TBoX, or Twelve Days of Christmas Bar Crawl. Nonstop drinking from 8am to 9pm, and the revelry continued well past that. My liver aches just thinking about how much alcohol some of these people consumed. Anyway, we get into this one place I've never been before, and now I know why, it's crowded with mostly college students. Oh goody!. If my friends hadn't been there I would've left. 
So I take in the scene--I swear half of these kids had to have a fake ID--and start to notice how they're dancing...

You know you're getting old when you see college students dancing and you ask yourself "What the hell is going on here???" 

...I feel old.

Tuesday, December 4, 2012


Yesterday was my first day on OB/GYN, but all we did was sit through a day of orientation. As mind-numbing as that sounds it was preferable to the way I was introduced to surgery, when we basically had a twenty minute crash course and then were left to figure out what we were supposed to be doing, and then yelled at for not knowing what we should do.
One of the other students in the rotation has had the exact schedule as I, and we by far have done more rotations and knew the hospital whereas everybody else who came through had done at most one. It was an odd feeling, and we left the hospital feeling "like fourth years," and like we had actually accomplished something. It was a nice feeling because not too long ago I didn't know a thing.

Today was my first day on the floor, and quite frankly it was a bit boring. I got good practice filling out H&Ps, determining fetal heart rates, and gathering a whole new type of history. In twelve hours I saw two deliveries, ten minutes apart. The other OB student and I spent much of the rest of the time listening when we could to the attendings, trying to learn whatever we could, and basically just standing around. I spent a good hour pretending not to listen to the doctor and midwife talk about hospital politics and other such stuff trying to pick up a thing or two, and get a feel for who's who in the department. Afterward, just as it's time for another student to arrive and assume the evening call, the doctor turns to me:

Doctor: "So how many deliveries have you done?"
Me: "I've been in the two today. This is my second day.''
Doctor: "Oh well!!! Then it's time for you to do one! See one. Do one. Teach one!"
Me: "That sounds great."

So we talk about the patient that she was sticking around to watch, and I said I was waiting for the next student but that since I am post call tomorrow I'd be happy to stay for a while to assist in the delivery. We talked for a few minutes about fetal heart monitoring and accelerations and decelerations, and the doctor then said she was going to go check the patient. In one hour she went from 4cm to 8cm, and 90% effaced, with an IUGR, so the doctor said we're ready to push. She told me I could scrub in and I did. As the baby was coming out the doctor had me come finish the pushing. I held the head and caught the baby literally as it came out. Then, having seen previous deliveries, I went for the clamps for the umbilical cord, and ended up cutting the cord as well because the mom (who was alone!) didn't want to do it.

Monday, December 3, 2012


First day of OB/GYN, and already I have the best quote of the entire rotation:
"Almost all of your patients are going to be women who are pregnant and healthy -- well, actually they will ALL be women, whoops!"

Saturday, December 1, 2012

Le fin surgery

Yesterday marked the last day of surgery. Because God does have a sense of humor, there wasn't anything to do until 2pm. My rotation partners and I literally sat around and did nothing from 10am when we finished our exam and the pediatrics grand rounds we were invited to until almost 2pm. While we were sitting there (I actually fell asleep for a good half hour at one point) we were hearing rumblings about a small bowel obstruction that was put on the schedule. Grand. Just what I needed on the last day when all I wanted to do was get out of here on time.

Luckily the doctor showed up on time (Shock me!) and the surgery started on time (Please pick me up off the floor). I felt completely superfluous in the surgery. I had scrubbed with this same doctor the day prior and actually got to get my hands dirty. Not today. The first assistant wasn't really needed either. All the doctor did was run his hands along the entirety of the small intestine, lop off the obstructed segment, and sew it all back up. Mostly a one-man job. I just kind of stood there like a bored idiot, trying to think of questions, no matter how obvious the answer was, to remind the doctor that I was indeed there, and not just an ugly piece of art propping up the table. The only thing of real interest to me was the fact that this was the patient's sixth surgery for an obstructed bowel, and her abdomen was covered in flowery, vine-like tattoos. What a pleasure to close that back up.

So now surgery is done. I enjoyed the actual operations and procedures, but I can unequivocally say that I did not enjoy the very unpleasant lifestyle and environment that the high-stress OR fosters. I wasn't looking to go into surgery before I started this rotation but I did enjoy it more than I thought I would. I must say I grew tired very quickly all of the unnecessary and at times unprofessional drama and pot-stirring instigated by one individual in particular who seemed to have an unwavering need to make us feel as insignificant as possible. This same individual is also the type of person who when she feels is correct will say anything and shred you alive if you do not agree with her. I felt like I learned a great deal, not just about surgery, but about the associated clinical and physiological aspects of the cases that I had the opportunity to work.

After our last day, most of my rotation partners joined for an evening of celebration. I must say I enjoyed myself immensely from the conversation, to the food, to the company. It's not often I'm in a group of people with whom I feel so at ease and on the same page. We started our evening in Wicker Park, and (somehow) ended the evening at the Hancock Center's 96th floor lounge. This was a first for me, and I enjoyed it immensely. 

Wednesday, November 28, 2012

The Day Just Got Better

Thought the events of yesterday morning and the Coffee Caper were ridiculous and hillarious, the afternoon almost equaled it.

Dr. Simon (one of my favorite surgeons to scrub with) had a late afternoon AV graft case. After the patient was draped, the field sterilize, and Dr. Simon and Egyptian Assistant scrubbed in, Dr. Simon looks at the patient's arm and proclaims that they patient has not been sterilized properly/to his satisfaction, and that the entire setup must be repeated. Having irked half the surgery staff he proceeds to stand up, and turns around and walks straight into the cart that contains all of his sterile instruments, sending a bowl full of water and several vascular clamps crashing to the floor. He looked very hard like he was trying to blame somebody, but couldn't, because it was obviously he.

"This cart looks like it's missing a wheel!" The cart clearly had four wheels...Dr. Simon then left the room to wait for the patient to be redressed. Egyptian Assistant then looks at me and Awesome Partner, points to her and says with a smile, "You, you can come in. But he, he has to go home. Go away!!! He cannot come in! This never happen before! Ever! He is jinx!!!" It's understandable. Nearly every time I've scrubbed with Dr. Simon something complicated happens. Yet he continues to let me scrub in...

And that's a true story.

Tuesday, November 27, 2012

Patient of the Day!

My surgery partners and I were in the student lounge this morning along with the anesthesia and GI students, waiting for the morning's cases to begin. It was scheduled to be a very light day. 

Out of nowhere, a gentleman walks into the room, very quickly. Not really an unusual occurrence as from time to time patients miss the giant sign that says "Secretary"...Instead this patient proceeds to grab my partner's coffee that was on the floor, tore off the top, and proceeded to down an entirely full cup of scalding hot coffee in three gulps. This being a hospital, we were all a little confused and initially concerned that something my be wrong with the patient, like he was choking, or having a panic attack. The patient ignored all our questions and concerns, in English or Spanish, and continued to voraciously gulp down Ben's coffee, all the while we stare incredulously asking ourselves What exactly is going on here?? They didn't tell us about this in medical school.  After the second gulp, we hear somebody from outside the room yelling out his name. "Stop that!!! Not again!!" And then nonchalantly telling us that he does this all the time, stealing other peoples' coffee, and voraciously consuming it. Totally normal! The patient then bolts out of the room, frantically searching for someone else's coffee. My partners and I can do nothing but sit there with perplexed looks on our faces before what has just happened registers. When it does the looks of confusion turn into smiles and fits of laughter.

It would be seemingly harmless, were the patient not scheduled for a hernia repair.

Monday, November 26, 2012

Adventures in CTAing

Saturday morning I made my way downtown for a bit in a vain attempt to locate some Christmas ornaments (located the next day). I explored and shopped for a little, then decided my endeavour was futile and began to make my way back home.

Usually on the bus I either have a book or find something esoteric to read from Wikipedia. Today's topic was The Iron Curtain, and it's subsequent fall. Thrilling, no? As I was reading, the bus proceeds along its merry way. At some point I received a text from Awesome Partner's boyfriend. Not a daily occurrence but not unusual either, so I finished my article and answered his text.

Him: "So what are you up to today, sir?"

Me: "Hey hey. Just doing a few errands. Enjoying the cold weather and Christmas music. Yourself?"

Him: "Me not much. Riding the bus, check out this creeper." -- accompanying this text is a picture of me...reading his text message. 

He had boarded the bus and sat down about three seats away and I hadn't even noticed so engrossed was I in Poland's Solidarity movement and the Ceaușescus' execution. I took a second for me to register what was happening (I'm one sharp tack, let me tell you), and then I jumped and did a quick take, and he was there smirking at me from across the aisle. Such a creeper.

We had a good laugh about it and chatted until he alighted the bus. Creeper!

Sunday, November 25, 2012

I Never Want to See Food Again...

Having been Thanksgiving, and unable to go back to Atlanta due to the fact that I had to be at Chicago Hope Hospital the next day, I spent the weekend eating.

Thursday I made oyster dressing and mac'n'cheese for a group of eight. At the same dinner we had, for eight people, an 18lb turkey, brussel sprouts, mashed potatoes, mashed butternut squash, deviled eggs, my dressing and mac'n'cheese, and multiple pies and cakes for dessert. I ate until it literally hurt to move. Not the best idea, was it? The next day I ate a fair bit of dressing just because it seemed like a good idea. My friends and I then went to the Zoo Lights at Lincoln Park. It was very pretty.

Saturday, I met up with some friends from the island who were in Chicago for the weekend. We had Korean BBQ for lunch, ice cream, and then Polish food (a first for me) for dinner. If you've never had Polish food, it's very heavy and very filling. I have some leftovers that I'll take for lunch on Monday.

Today said friends and I met for brunch in Logan Square, and then explored the Mile for a bit, and then had deep dish pizza.

I never want to see food again...

Sunday, November 18, 2012

Vascular Surgery...aka sophisticated plumbing

The morning cases with Dr. Snarky Surgeon were cancelled, meaning I and my rotation mates schleped all the way down to Chicago Hope Hospital no later than 7am for zilch. Nada. Nothing. Lovely
At almost 2:00 pm I scrubbed in a mass excision case with Dr. Simon. Toward the end he said "Let the student close." And handed me a suture. The surgery tech asked if I wanted her to start it for me, but I said no, I'd prefer to try it myself. I've been practicing on banana peels and pig's feet, and have worried myself about how joyously I tie my trash bags with surgeons' knots...but I was still super nervous. Trash bags don't breathe and kick. Either way, I'm sure it wasn't the world's best suture job, but I finished before the surgery tech finished closing a wound of the same size. I was pleased with myself probably more than I had justification for, but hey, I just did my first suture from beginning to end. 

Later, a patient comes in with three week history of a blood clot in the R foot. Vascular surgeon, Dr. Simon adds this to the schedule and starts to do his thing. This surgery started late in the afternoon and this type of surgery typically lasts 3+ hours. None of us scrubbed into the case as typically he doesn't bring students into his cases. Four hours later multiple clots multiple inches long have been removed from the patient's arteries.  Look here for a description. It's basically a really small plumber's snake with grave ramifications should things go wrong. Patient is sent to recovery and back to the floor and everybody goes home except for the on call person.
Throughout the course of the procedure I banged my head at least five times on the lamps. I'm over six feet tall. The tech is maybe 5'5 (maybe) and the surgeon was seated. I'm 6-foot-not-5'5.  I was standing behind him, in between the lights, and was constantly re positioning myself to stay out of his light, in view of the procedure and they were constantly adjusting the lights as they were moving up and down the leg. What ends up happening is I smacked my head every time I turned around, in one case looking for the blasted light in order not to smack my head on it. I was getting rather embarrassed and was worried that Dr. Simon was going to ask me to leave. 

Dr. Simon rounds on said patient and does a Doppler test on the posterior tibial artery. He gets a result that does not please him. The patient has very faint posterior tibial and dorsalis pedis pulses and the patient's leg is cold. Dr. Simon sends the patient immediately to the OR. I was wandering around the OR with my rotation-mates dividing up the day's load when one of the surgery techs came up and said "you should scrub in with Dr. Simon, he likes you." So I stick around and help the patient in the room, get everything set up, and ask the doctor if he could use an extra set of hands with this procedure. He said "sure." So I scrubbed in. 

Since I'm on that topic, permit me to ramble for a moment about what "scrubbing in" entails:
- Placing a mask on your face, usually with an eye shield. For reasons to be explained later I put a shield-less mask over my mouth, and turn the face shield upside down and tie it around my forehand, resulting in it hanging down from my face. The face shield mask is designed to be a mask and a face shield in one, but I've yet to discover the spell that makes it function properly.
- Literally scrubbing your hands, fingers, elbows, arms, and underneath your fingernails with soap and very hot water. After that you cannot touch anything, and there are special sinks designed to facilitate this. 
- After "scrubbing," you proceed the room with your hands in front, ready to kill anybody who comes near you for fear they will touch you and require you to scald your arms again. You wait until the scrub tech (scrubbed in himself) opens a gown and you put your arms in the sleeves. The gown ties in back, which somebody else does for you. The scrub tech then opens a glove and you place the right hand in. You then use the right hand to help hold the left hand glove and in goes the left hand. If the procedure is going to be particularly bloody a second glove, half a size smaller is put on as well. The gown then needs to be tied a second time. The strings are held in front by a piece of cardboard. You take the first string in your left hand, hand off the cardboard containing the second to another person, then twirl around and find the string waiting for you ready to be tied. You tug the string from the cardboard and it gets thrown away, and you tie the bow at your side. At that point you are sterile, and I find the best place to be is in the farthest corner from the action possible, that way nobody bumps into you and makes you repeat the process again. When the table is sterile you go to the table, ask where the surgeon wants you, and place your hands on the table and do not move until told. Dr. Simon calls it "Simon Says" (hence his pseudonym). 
- Five minutes after you scrub in for what is at least an hour (and almost always more) your nose, eyebrow, eyelash, or scalp begins to itch. Madly. And you can't do a thing about it because the mask and your scrub cap aren't sterile. You just have to grin and bear it. 
- The few times I've attempted it, the blasted all-in-one face shield mask fogs up the first chance it gets. More often than not I've had to ask someone to rip off the shield and place another one on, upside down, in the aforementioned manner. Now I just spare myself the trouble and put two masks on. It makes life much less complicated.

So, we get started in Thursday's surgery. What starts off as a thrombectomy quickly spirals into an expletive-filled day of frustration. Two cuts become four, become six, become nine until one entire side of the patient's leg is split open and looks like hamburger meat. During this point I learned about a bear claw wound and how the skin in between the wound dies due to lateral perfusion of the skin. This was relevant (so asketh the doctor) as Dr. Simon was making multiple incisions...none of them parallel. The thrombectomy doesn't work, so Dr. Simon proceeds to bypass from the popliteal artery to the anterior tibial artery. Still the pulse and doppler is weak. He attempts to enlarge the vein with multiple catheters...nothing. He gets pulse and flow (at one point the flow shot me in the face, of course I was wearing glasses, so I was face-shield less. Nothing like hot, gooey blood on your face...) from the artery, but gets nothing in the foot. He isn't pleased. Around noon, during all this, I notice that he isn't even done cutting, and closing these wounds takes at least an hour, so I set myself to the fact that I'm probably not going anywhere any time soon. Just as well too, because this was a really interesting case.
Finally he finished the bypass, saying there is nothing else he can do but close and pray. We close and I find that the remainder of the day's cases have been completed and make a mad dash for my car.

The next morning Dr. Simon has another case on the board. I figured since I had scrubbed with him the previous two days I would give my colleagues a shot at working with him. I start the morning with a circumcision, and basically am a glorified scissor holder for that one. Either way I usually learn more about things other than the case when I scrub in, so it's a good opportunity.

After that case I had to use the facilities, and I'm in the locker room when my phone rings. It's my clinical partner, telling me that Dr. Simon and Egyptian-Assistant are looking for me. And want me in the case with them this morning. A good feeling, no? At one point I bumped the table and he says "that was almost really bad." And then proceeds to tell me a story about how he did something worse when he was in residency saying "see, it wasn't the worst thing you could've done.'' One thing I like about Dr. Simon is that as long as you don't make the same mistake twice he doesn't get angry. We're expected to make mistakes. How else are we to learn?  It's repetition that he dislikes. So I make quick note of anything and everything he tells me and do my damnedest not to repeat it! This particular case was a popliteal posterior tibial bypass, and on this day everything went routinely. The doctor was in good spirits, with Billy Joel setting the mood, he was singing along most of the cast. Afterward there were no cases, and I waited for a while since I was on call, but nothing came in. A friend had an extra ticket to see Les Miserables, so I went and it was a great show.

8am I get a text from a friend who was on OB call, at the hospital for OB surgeries. He informs me that the student scheduled to be on-call did not show up, that there was an emergency thrombectomy (again!) on the schedule, and that Dr. Simon was already at the hospital and not looking happy about having to be there. Having already had an a rather unpleasant encounter with Dr. InCharge about people not showing up, I immediately texted and called the person on call at 8:05. Nothing. I jump out of bed and into some clothes, and make a beeline for the door. Awesome Partner lives across the street and has been informed as well and tells me she's running to her car as well. I tell her I'm already downstairs and to just relax, I'll take care of it. She says "I'm the student coordinator and I'm going to get yelled at for this. I have to be there. Pick me up!!!" I said yes ma'am.

8:56: I finally get a text from the on-call student saying she's just getting in the shower. I tell her to just stay at home, I'm already at the hospital and scrubbing in. Another student scheduled for afternoon call says she is on her way in, but she's an hour away in the hospital in the suburbs.

12:30: The case is not going well. The doctor cannot get a pulse in the patient's foot after multiple thrombectomies, opening up all the incisions we spent an hour closing the day before. Lovely. He says it might go into another bypass. I look after at the Assistant and say, "I haven't eaten. If he's going to go into bypass can I go eat something quickly?" She knew I wasn't supposed to be there, I told her I made a mad dash to the hospital, and she said go eat. The afternoon call has arrived and has asked to scrub into the case as she hasn't seen many of his surgeries. I say bless you. And make sure everything is ok with Dr. Simon and the assistant. The asistant claims that she has told me to go home, and that they're closing. I go home.

Ten minutes later I get a text saying they're going to do another bypass to the anterior tibial artery because after closing the initial incision there was still no pulse in the foot. Lovely.

And that, folks, has been my week.

Thursday, November 15, 2012


I'm starting to have really odd dreams about being in the OR. Two nights in a row I've had this dream where I need to be scrubbed in (sterile) but I'm not needed, and all I want to do is go to sleep (it's about 2am when this is happening) so in my dream I have someone pull the covers over me and I position my hands such that they're still sterile. A few minutes later I wake up uncomfortable and grumbling at myself for being an idiot.

Wednesday, November 14, 2012

Gotta love it when you arrive at 7am for a day that doesn't have cases until almost 2pm. Coming in any later just isn't an option, so you chew on it, bring a book and just accept your lot as a peon. To stave off sheer boredom I went wandering the floor, chatted up my IM attending (who gave me an A+ and a stellar review) and learned a few things about Pulomnary emnoli, DIC, and "poor prognosis diagnoses." I am actually quite glad I went wandering, because it beat sitting around not doing anything.

Later, I was able to scrub in on a mass excision case. The doctor said "let the student close." So from start to finish I closed. I was ridiculously proud of myself.

Later in the day began the hours-long vascular marathon of popliteal embolism removal. It was so epic I was called to wipe the doctor's face free of blood...The surgery lasted almost four hours due to a host of complications and annoyances, such as luckyone banging his head no less than three times on the overhead lights. Blast ye short people!!!

Sunday, November 11, 2012

You Know You're in Medical School When...

...You use an expired suture kit to sew on a button. Yeah, I used double and single handed knots, too!

Thursday, November 8, 2012

Today's Dinner:

Rump roast. Well done. Whose rump? Mine and my surgery mates. I do not appreciate having to eat somebody else's crow.

Wednesday, November 7, 2012

Today's Awesome Surgery

Secondary to a pneumothorax, and emphysema, I was able to scrub in a thoracotomy. We removed the part of the upper lobe of the right lung that had blebs the size of golf balls. It was intense!! I loved every minute of it. I had never seen lungs in a living person before!

Election Night

It was a nasty night weather-wise in Chicago last night. I didn't want to go anywhere, and was fortunate that  a few friends and I watched the returns from my place. We were all over the place on our political ideas, and yet we all managed to get along and have a good time, understanding this is the process that has kept us going. I looked out the window this morning and the sky was still up there.  Life will go on, and the world will continue turning.

I can't recall how many people I wanted to smack over the last few months for various idiotic things posted on Facebook basically saying "You should vote for X because if you don't it will be the end of America" or "Well because your this, this, or that, then you should vote for Y because how can you vote for X if you believe what you believe??!?"  Really? You’ve apparently decided that I am incapable of making up my own mind. Elections and airport security highlight just how stupid and short-sighted people can really be. 

-- "Never underestimate the power of stupid people in large groups." ~   George Carlin

Monday, November 5, 2012

Good to know?

Incident from Friday night:

Mr. Nicks: "Hey man, you look like you know where to find good coke. Can you help me out man I'm dying for some coke." My first thought was dude just go to the bar and get one. THEN I realized OHHHH! he wasn't talking about the Cola variety.

Me: " Man I'm sorry I couldn't even begin to tell you where to find some."
Perhaps I should have sent him to Englewood or Gresham, where the cracked variety can be easily located at any street corner.

Saturday, November 3, 2012


My first Saturday off in a month. Wow what a difference! First thing I did this morning was to scrub my apartment top to bottom, and did it need it!!!!!!

It was nice to be able to enjoy my Friday night with friends in River North--though I stayed far longer than I intended and ended up taking a cab back home.

Thursday, November 1, 2012


It's amazing what you hear when people don't think you're listening. For instance, the first week of my ortho float the very Mexican Medical Assistants had no clue that this güero understands Spanish well enough to hear you slagging him from the other room. Obviously it doesn't dawn on these ladies that medical students become their bosses--shortly.

Ortho/Musculoskeletal Clinic

This is my last full week of ortho clinic. Because I'm nice and so are my rotation partners I've offered to step in and cover for them on two days when they need to be out of town. Because I've already done the rotation, two extra days in ortho clinic won't be a big deal. But I am looking forward to being done with it every day. It is long, intense, and has been a great learning experience, basically because we have been thrown into the deep end of the pool and told to sink or swim. So we started swimming. I think that's the best way to learn. The attending has laid out his requirements, and you do it. See one. Do one. Teach one. He's very hands off. If he doesn't want you to do it, he won't let you, but other than that it is basically we, the students, who are actually "practicing" medicine in the clinic, and the attending usually approves our choices. Maybe we're learning something??

I've learned how to do knee injections, shoulder injections, and trigger point injections on the back and neck. It's amazing how after doing it a few times, I don't think anything now of sticking a 1.5 inch needle into somebody's knee. The first time I was terrified. Sometimes I still need to stick twice, but I've gotten pretty good at finding the spot, even on tough knees. I've also significantly improved my radiograph reading skills. It's basically a necessity as when I present a patient to my attending he pulls up the radiograph and says ok, show me the problem. After a round or two of "uhhhh, I can't see anything" I started staring at them for a while, and started to see problems. Sometimes I still don't quite make out where the fracture is, or what the problem is, as on occasion they appear invisible to my eye, but I feel much more confident.

This has probably been my first no-holes-barred introduction into insanity medicine. We have easily seen 100+ patients some days. There are anywhere between 4 and 6 people handling patients in the clinic, so do the math.

Yesterday was quite hectic and frustrating because for whatever reason (cough cough lazy, overly-socializing receptionists cough cough) patients scheduled for 1pm, who had checked in at 1230, weren't brought back to the clinic until after 1:45. All the while we are literally sitting around twiddling our thumbs wondering where in the world our patients are, and having to accept the reality that we will not be leaving before 6:30. Oh goody. Throw on top of that the usual dose of hospital politics and drama from that person (and every group has one) and it was just a frenetic afternoon. Sometimes you just gotta dance. 

Sunday, October 28, 2012


I attempted to watch Yentl on Netflix today. It is a well-made movie, but the premise is just dumb. How nobody ever figured out that Yentl wasn't really a man is a bit befuddling.

Friday, October 19, 2012


Falafel sandwich - $5

Mocha latte: $1.95

QOTD from your colleague during lunch: "Due to some horrible mistake I was born to cold weather parents who had no money." -- priceless

Thursday, October 11, 2012

A Tour of Chicago

My current Musculoskeletal/Orthopedics float has me bouncing between hospitals and clinic locations between the North and South sides of Chicago. Today I drove through several neighborhoods that I had never spent much time in, and was pleased and saddened by some of what I saw. It is unsettling to think that people can be so negligent and destructive in neighborhoods that have absolutely beautiful greystones and historic buildings.

If you've never been to Chicago, outside of the Loop, or lived here (like me until this year) you might not know that this city (in the NORTH) is one of the most racially segregated places I have ever seen in my life--and I'm pretty well-traveled and from the South. The street grid system and a racially discriminate housing policy that wasn't ended until almost the 1960's (and has since been forgotten by many who criticize Southern racism) made it quite easy to cordon off people by race. Even today it can remind me of the Apartheid Bantustans in that literally entire neighborhoods are derelict and blighted (and black), yet all one has to do is cross the street and middle class wonder abounds. Frequently these dividing lines are major boulevards such as Western Avenue (which serves as a dividing line between multiple neighborhoods the entire breadth of the City of Chicago) or large parks such as Humboldt Park which conveniently divides the neighborhood of the same name into one side kitchy/krunchy white hippies and another of Puerto Ricans of mixed income. The far west of Humboldt Park is another few block of poor blacks that spills south and West into the even poorer (and quite frankly dangerous) neighborhoods of West Garfield Park and Austin. Not all black neighborhoods are poor and not all are dangerous.  But a few definitely are. There are also VERY rough historically Irish neighborhoods. 

Having said all that I continue to be amazed by the place I'm calling home.

Friday, October 5, 2012

Part of the job

As part of our surgery rotation we are requiered to attend clinic several times a week with different surgeons. Surgeons, in general, are a rather cantankerous bunch, with a quick temperament and not always the best people skills. I guess this makes sense considering most of the people they deal with are unconscious.

Yesterday I was working with Dr. Snarky Surgeon, and we had a morbidly obese patient referred in due to hernias. I spoke with the patient prior to the doctor, and it was obvious that this patient is very unhappy. Due to the patient's size, comorbidities, and the very low risk of the type of hernias she had, the doctor did not feel she was a good candidate for surgery. At this point the patient became very upset and visibly frustrated due to her situation. Though I agree with the doctor that most of her problems are not directly related to her hernia, but more likely related to her weight, I did not like the manner in which he lost his patience with her. In fact I felt very bad for the patient because I would not want to be spoken to in that manner. As such, I stayed back after the doctor and I tried to speak with her for a few moments. She discussed some of her problems in more detail, and it did indeed seem that she has some degree of depression. I can't say that I wouldn't feel the same way given similar circumstances. I listened to her for a few moments, and tried my best to reassure her that though at the moment surgery was not an option, that her primary could either give her some help with her frustrations and feelings of emptiness, and if he couldn't he could refer her to someone who could.

Patients like that are challening, saddening, and remind me of why I'm here. I hope I never forget that underneath medical problems are real people.

Today's patient encounter...

Patient: "What happened to your hair?"
Me: "It fell out..."

Wednesday, September 26, 2012

Cervical Lymphadenopathy

There's a gene on the Y chromosome yet to be discovered. I'm going to find it and call it the Me1. It is dominant, sex linked, and guarantees its owner to react to a simple virus like Ebola or bubonic plague and be foul and irritable. I will own it. I am a man. I am sick. Thus I am going to whine and pout and act like a total cranky baby. That is all.

Tuesday, September 18, 2012

Adventures in CTAing

Ahhh yes!!! Another instalment!

Several times over the past few weeks I have seen the same lady at the train station while I wait. At first I just happened to notice something isn't right here, and now I look for her. This lady will get off the train, headphones in tow, and proceed to beebop whatever music she's listening to. Seems normal right? Yeah I thought so too, until I saw her peer around a corner, and then cackle like a kookabura. Not so normal. Then I watched as she proceeded to stalk/creep/walk like she was imitating one of the dozens of pigeons that crowd the train platforms. Ever have one of those moments where you just look at someone and before you realize hey there's something not quite right about this poor lady you're thinking something is not right!!!! It's subtle but there is a difference!!

Do I Wet Myself...or Laugh?

While in Surgery Clinic today (an ever-fun game of peeing in the wind to see which doctor wants us where and when), I had this patient.

Me: "Good afternoon. I'm here with Dr. Snarky Surgeon. My name is Luckyone. How are you?" *Out goes the hand to shake*

Patient: "I have OCD. I don't shake hands."

Me: Oh goody. This must be good. (I've found the best way to handle patients with psychological problems is just simply acknowledge them, and move on with minimal to no pandering.) "Ok. No problem. What can we do for you today."

Patient: "I'd really rather talk to the doctor alone, is that all right with you."

Me: "Of course, absolutely. Whatever you are comfortable with."

Five minutes later: Surgeon to me: "She told me that since her operation she has needed to wipe more on the left than the right. What am I supposed to do with that?!?!"

Do I wet myself...or laugh??

Monday, September 17, 2012


Which would be the most appropriate "crazy" song? The one by Patsy Cline (that I sing in the shower to the distress of my neighbors), the one by Britney Spears (which is annoying) or the one by Gnarles Barkley. Decide and get back to me...

Anyway, I have noticed recently that crazy, immature and/or emotionally fragile people are attracted to me like a duck to a june bug. A friend of mine (my best friend, actually) tells me that to her and many other people I appear stability, solidity, and in her words "have your [stuff] together." I'm not here to laud myself, because to the contrary I don't see myself a particularly cuddly individual until I am beyond comfortable with another. I can be quite brash, blunt, brutally honest, and brazen. I'm well-known in my circle of friends for speaking my mind and not easily taken advantage of or trounced upon. What can get lost is the impression that I don't care about another's opinion or their right to have it (and to some people a lack of agreement is a total invalidation of their existence) because the thought of intentionally hurting someone's feelings actually makes me ill. If I recognize my own lack of tact I try to rephrase or address the issue. Sometimes it works; sometimes further discussion is required. At the same token I'm not overly influenced by most peoples' opinions of me (much to my mother's consternation) because hey, if you don't like me there are 6 billion people walking around the planet. I think I'll get over it. On the flipside, I am fiercely loyal to my friends, once we get there. But I'm slow to befriend, probably because of all the above "B" characteristics. I swear I'm not really this complicated...

Once the needy folk have found me, they STICK, and lean on me for support. Not being omniscient, I don't figure this out until I've nearly spent what little emotional resources I want to spare. They are clingy, demanding, and after a while insufferable.  At that, I'm sure I'm not the only one, and I'm sure said individuals lean on anyone, but I've had quite a few in the last year that just deem me "leanable." But there are a few problems:

1) I loathe whining and whiners. For this very reason I opened a blog simply as an outlet to avoid annoying people with whatever stupid problems I have. Read it if you like and keep moving if you're not interested and I shan't be offended. I especially dislike incessant whiners who have a daily conundrum yet can't and/or won't do a blasted thing to FIX said problem. Which leads me to...

2) They still come to me with their insufferable whining, yet don't listen, and expect me to continue listening. And we have found one of NotyetDr. Luckyone's serial pet peeves: People who do not listen or learn from their mistakes yet continually foul up their own lives. 

I don't mind listening if someone either needs to vent and move on. These folks usually just want to talk and don't really care if you're listening or not. An occasional "uh huh" or "oh my" will usually do the trick and make them feel heard--but at the end of the day most couldn't care less if someone is actually listening. This person doesn't care what you think, doesn't want an answer, and almost always is over their problem after the vent. Cool. I can handle it. It's harmless and have been there myself. 

Then you have the person who has a genuine problem, and seeks another's advice. Sometimes they take said advice, and sometimes they don't. Again, they usually solve the problem one way or another. Don't have a problem with either route, as they're actively solving the problem.

The aggravation is this person: The person who comes to you for the umpteenth time about some silly problem (at the start) that becomes idiotic after a few rounds, yet argues with any and all proposed solutions, and never listens to ANYONE'S advice because quite conveniently this person also indulges in pity parties. Frequently, the whiners begin to project their problems onto me, and begin blaming me for all their insecurities. Try as one may they typically don't stop until the connection is severed. It's quite frustrating. It is with these people that I reach the end of my (admittedly short) tether. Leave me alone if you're just going to whine. Callous it may be, but I simply don't care about the self-created, melodramatic little problems upon which you thrive. Leave me out of it. I am terribly sorry you have the emotional maturity of a 12 year-old despite being in your mid 20's. I am sorry you don't have the perspective God gave a goose. I am beyond at fault for all the wrong doing in your life. Yes, do please blame me for your lengthy list of insecurities. And yes do please not listen to anything I try to say to address your concerns, because naturally and invariably what I have to say isn't satisfactory and exacerbates your feelings of ineptitude. 

And now we see why luckyone did not pursue a career as a counselor or therapist.  

Who says people who need people are the luckiest people...what schmaltz. Okay, not always...

Friday, September 14, 2012

New Title

I finally changed the title of my blog.
1) It finally dawned on me that song titles have copyright and that's a hairy issue I'd rather not fool with.
2) As it was it was too cumbersome, but I left the original title in the description.

So I have a new working title, and it is so apropos: "I'm Not The Doctor Yet..." What happens when I do become a doctor? Well I'll worry about that another day. Maybe I'll change it to "I'm the Doctor, Yet..." and keep it educational, and make it a play on words.

Doctor?...Image is everything... sayeth Andre Agassi, at least in a 1990ish add for Nike.

While at the hospital, and for other medical student-related activities, medical students are frequently required to wear a short white coat. I personally despise the blasted thing because it's hot, doesn't breathe, doesn't fit and gets dirty if you even look at it. I have to bleach the silly thing at least once a week to keep it shiny and new (Like a Virgin...).

People's perception of the short white coat differs widely. In the medical student realm, it's a symbol of bottom-of-the-totem-poleness. Doctors and other people with initials after their name wear long coats. It is an indication--and constant reminder--of how low we as medical students are, as if we really needed a symbol for that. Nary a day goes by when we aren't corrected, reprimanded, or in some cases completely denigrated simply for breathing.  The corrections I don't mind. The reprimands aren't fun but are probably necessary. The denigration I could live without. It comes with the territory and though I understand it's "the system," I hope I do not ever use medical students as a punching bag.

To patients--and even some hospital staff--the length of the white coat means nothing. One of the hospital receptionists says "Good morning, Doctor" to me at least once a week and I frequently look over my shoulder to see whom she is addressing, because I do not expect it to be me. People see that white coat and their blood pressure shoots up (aka White Coat Syndrome), they expect answers, and they address me as "Doctor" or "el doctor" It makes me uneasy sometimes. Perhaps due to the constant reminders (it's all about the totem pole, remember) and student loans, I do not view myself as a doctor yet. I could probably stumble and clumsily work my way through many different patient scenarios and take care of a patient if I absolutely had to--but it would not be pretty and it would probably take me twice as long as an experienced physician.  I feel like I have learned a great deal, but still have so much more to learn.


Internal Medicine...Done

Last week I finished my internal medicine (IM for short) rotation. Twelve.weeks. It was long, varied, intense, but ultimately a really good experience.

The last four weeks were rather blah and mundane in schedule and in content because much of it was devoted to outpatient--a mind-numbing experience for a medical student, or at least the one in the mirror. I mean really, how many hypertension follow-ups can one see before becoming bored! One good thing, however, was my partner and I were the first two medical students in the hospital to use the Electronic Medical Records (EMR) system. Talk about intimidating!!! We were actually  able to log in to a patient's record, edit said record (though not completely), and hash out notes and templates. It was quite the learning experience that we shared with our attending. This was, for me, a rather unique experience because the attending is my teacher, but now we were learning together. In many cases I would be teaching her because I had seen the patient first and fought with the computer for fifteen to twenty minutes attempting to catalog and transcribe a patient's medical history from often-illegible charts. It was quite the challenge!

The rest of the experience was spent being much less hands on than the first eight weeks. Given that the first four weeks (lost yet?) were an intense crash course in writing H&Ps, SOAP notes, formulating your own A/P, and getting use to the intensity of rounding on a dozen patients first thing in the morning, having to write two "measly" H&Ps and present them to a doctor who might care, or might rather discuss her childrens' future medical education (the oldest child being seven...) wasn't much of a challenge. The challenge would come in trying to write down all her pearls of wisdom when she chose to share a week's worth of information in about four minutes. All the while pagers are going off like mad, ICU patients are hacking on their own phlegm in the next room, and bloody annoying nurses and respiratory techs are laughing incredibly loud about God-knows-what in your ear. I did learn about more about the care of ICU patients though. 
I learned how to read and interpret ventilator settings, pull a week's worth of patient history out of a forty-seven page chart and a patient in about ten minutes, and ever-improved my patient presenting skills.

Here are some of the things I saw:

Fecal Occult Blood
Multiple cases of Cocaine and heroin abuse and subsequent withdrawl
Alcoholic Encephalopathy
Pleural effusion
Gallstone Pancreatitis
Alcoholic Hepatitis
Decerebrate Posuturing
Cellulitis (including a particularly nasty bout)
Absence Seizures
Chest Pain
Chronic PUD
Lung Carcinoma
Acute Renal Failure

...and many many others!

Tuesday, September 11, 2012

Oh boy...

Doctor: "So, luckyone, have you ever done sutures?"

Me: Um, once, on a chicken breast many moons ago. "No."

Doctor: "No? Good. You're doing the next ones."

And such was my second day and first scrub in during my surgery rotation.

Sunday, September 2, 2012

Maybe we're doing something right!?!

Awesome partner and I were spoken rather highly of by one of our attendings to another the other day: "I don't know what to do with these guys. They already know everything."
Walking around River North last night with some friends, we come across a couple with three children. One of whom is having a complete and total meltdown. They were perfectly groomed, well dressed people. After we passed we heard the mother say "girl, please." I about shot my chocolate cake shake through my nose. Ahhhhh

Wednesday, August 29, 2012

Three Years Later

Three years ago today I began one of the most insane journeys ever. Three years ago I left for the island and medical school. It seems so long ago and yet just like yesterday. I feel like I've learned so much, yet  still know so little. Would I do it all again? No clue.
I feel much more confident, much more capable, even if I still feel like I don't know a thing! I've definitely learned that there is no way one can sit on his laurels and just watch life walk right past you. It will blow past you so fast you won't even know. Each day presents something new and unknown, and it is always a challenge. As soon as you think you're getting it, it's time to move on to something new and equally challenging and completely discombobulating. I could go on for hours but that's it in a nutshell!!

Thursday, August 23, 2012

annnnd the Psych students are where??

When finishing up with us, today's Pulmonary attending asked my partner and I to go to the Psych floor to write and H&P for a patient that had been in the hospital for two days. She needed said H&P to be discharged.
All we wanted to know was: "Ummm....where are the psych students? You know, the ones assigned to that floor?"

Saving lives

One of my favorite attendings has lectures/rounds with us twice a week. Every time he asks us "How many lives did you save?" He's awesome.

Wednesday, August 22, 2012


Let me introduce a special breed of patient: the obnoxiously anxious patient.

This is the patient for whom every word you speak is to predict their impending doom. They're so afraid you're going to tell them they have something earth shattering like high blood pressure, cancer, Ebola, or an ingrown hair that they start interrupting you asking "Do I have THIS!!!!???!! AM I GOING TO DIE"...
Uhh, no. I was only going to say that everything looks good. But suddenly I'm delighting in conjuring up ways to kill or maim you, and at the very least wish famine and plague on you and your house after this oh-so-thrilling time we've had to together. These are patients that when the attending is writing their obligatory Xanax scrip, you ask for two or three for yourself because this batsh*t person has just sent your normally fine BP through the roof, and incited a murderous rage within you.

What is it about anxious people that makes them seemingly insist on making you as crazy as they are!!

Saturday, August 18, 2012

New Rotation

My new rotation this week was a bit chaotic. The doctor my partner and I are assigned to on Monday, Wednesday and Friday mornings was not at the hospital this week. So they didnt' really know what to do with us so they put us with an APN and basically we filled out H&Ps Monday and Friday. Tuesday and Thursday mornings we were supposed to be with a pulmonologist, but Tuesday we didn't see him until we were almost due in our Tuesday (and Friday) afternoon clinic. Thursday I didn't even make it to the hospital when I got a call saying "I can't see you guys today, see you Tuesday." So I get off the train and turn around go home...where I don't do much of anything...
Tuesday and Friday afternoons we're in clinic (blegh) with an internist, who, I must say, is a hot mess. But she's hysterical.

Sunday, August 12, 2012

Night Call...DONE

There will be no more kvetching about blurred days, loss of orientation, and perpetual lethargy because two days ago I completed my last shift of four weeks of night call!!!

Wednesday, August 8, 2012


You'll never get someone to understand something when his salary is dependent on him not understanding it.

Friday, August 3, 2012

Just two more...

I'll say one good thing for being awake at 3am and sleepy...I did an entire interview in Spanish...didn't have to search for a word...and didn't even realize I was speaking Spanish until I left the room. Win?

Tuesday, July 31, 2012

Intense Night

My clock says 1715. I just woke up (from a fuzzy dream) about twenty-five minutes ago after about six hours of MUCH-needed sleep. I had an intense night at the hospital whereby we were on constant call until about 5am. We saw, among others:
A patient with DKA, diabetic foot ulcer, HTN, and an above-the-knee amputation
A patient with radiating chest pain an nausea with a history of three MIs
A patient with vomiting x 3 days, history of pyelonephritis and chronic kidney injury with a BUN of 51 and a creatinine of 3.44. No wonder she was loopy. Nephrology was consulted...
A patient with : SOB, chest pain, back pain a history of (take a deep breath) CHF, COPD, CAD, cardiomyopathy, chronic pain, HTN, depression, and the poor guy couldn't pee. When the patient was catheterized, 1600mL of urine came out of the bladder in about two minutes. Two minutes later there was almost 2000mL (that's a two liter bottle of coke folks!) in the bag. OUCH!!

Friday, July 27, 2012

Night float Update...with some kvetching

Yeah...even I'm annoyed that I keep writing about night float. I'm trying really hard not to be grumpy about it but it's consuming everything. I go in on Monday and Friday nights at 7. And leave the next day. I then have Tuesday and Thursday off. Why the kvetching so you say? Welllll, I also have to be at the hospital on Tuesday morning at 8am, Wednesday at 730am, and Friday at 8am. So, my sleep schedule is all farkakte. I get grumpy. I get disoriented. Days run together. I'm not a night owl. I do not like staying up late. I never have. So two more weeks of this unpleasantness. I am perfectly fine with being at the hospital from 7am to 7 or 8 at night. Not a big deal. Those hours between midnight and six...yeah, we've never been been properly introduced. I don't think we'll ever get along.

Saturday, July 21, 2012

Moment of the Day:

I was doing some shopping on State Street, and stood agape as I watched a guy start screaming (literally screaming) "WHAT DO YOU GET WHEN YOU GUZZLE DOWN SWEETS?? EATING AS MUCH AS AN ELEPHANT EATS!!! OOMPA LOOMPA DOOPITY DOO..." as he eats a chocolate bar...
I very slowly broke off in the other direction. And felt the need to call a psych consult because he was not joking.
And that's a true story folks.

Night rounds

First patient of the night: Doesn't speak English (nothing unusual). Doesn't speak Spanish, only speaks Polish (unusual in my hospital). Oh good.
What to do?
I speak maybe two words of Polish, neither of which is helpful in the hospital. Luckily, there is a telephone translator service. It was cumbersome, a bit slow, but we got it done. Now, some part of me wants to rotate through a hospital in a Polish neighborhood so I can learn Polish. That definitely appeals to my vanity. :p


I have decided NOT to change the address of this blog. Fouled up too many things!! Sorry guys!

Thursday, July 19, 2012

Night Call

So I'm sure anyone who actually reads this is dying to know how my first week on overnight call has gone. Truthfully? Exhausting.

My shift with Awesome Partner began at 7pm, and there were nonstop admissions until 4am. It was intense, but in a good way. We saw:

A patient who coded four times, going out on his fourth code. I got to practice my compressions on this way. It was a bit surreal. I had never done it before, and a real body has a lot more give to it than those plastic dummies they teach you on.

A patient who had asymmetric facial features due to half her face being smashed in an MVA. In addition, there were possible absence seizures (she went into one in the middle of my exam, which was bizarre), and a suspected TIA. Just a really interesting case.

Yet another pancreatitis case, which must've been about the fifth in a week.

The rest of the cases weren't remarkable enough for me to actually remember them, unfortunately. But I feel like I did learn a fair bit!!

The next two days however...I literally had to try to think. After a Tuesday morning lecture, we had the rest of the day off, during which I hoped to get some sleep. Alas, no. I got about two hours of sleep the entire day, and thankfully went to bed very early because I had to be back at the hospital at 7am on Wednesday for a day shift. Hence the inability-to-think part.

Monday, July 16, 2012

Let the night shift begin!!!

Overnight call has begun...and I have a pounding headache. Oh goody.

Thursday, July 12, 2012


May the powers at be at Penn State rot. It's disgusting, absolutely disgusting to let all that happen for a game. A GAME!!

Wednesday, July 11, 2012

Le sigh...maybe there's a lesson here.

After my royal hissy fit the other day about an absolutely BAD day I've had a chance to do a bit of reflecting. (This means I have thought about it constantly due to the fact that I wanted to be violently ill that entire night. Awesome Partner has said that she couldn't stop thinking about it either.)

So...with that in mind. I don't know why that day was just destined to be bad, but it was. Whoever coordinates the sh**list at Chicago Hope Hospital drew our names out of a hat on Monday and spread the word. You win!!!!!

I always try to say hello and be polite to nurses. I learned a long time ago, and have said so in numerous interviews and discussions about the practice of medicine, that nurses are a doctor's best friend on the floor. But I guess sometimes I slip, or people don't hear me, or I'm in hurry and I don't really care if I'm actually being polite because I feel like my bum is on the line. Not the best way to be, I know, but if I'm going to rant and rave about somebody else's shortcomings shouldn't I be at least marginally honest about my own? Something to work on...

The following day we indeed were working with Psycho Nurse Lady again. The next day was perfectly fine. I still don't understand WHY this nurse went off on us, because Awesome Partner said hello...and I hadn't even had the chance. I told my attending that, indeed, we were not given a chance to be polite. But it doesn't really matter does it? Perception is what is remembered--such as my perception of how I felt I was treated by the nurse and the doctor. Everyone is going to have bad days. I certainly do. But I think it's nasty how we take our bad days out on other people.

Tuesday, July 10, 2012

Why Did I Get Up This Morning??

10:15 this morning: My attending tries to call my partner...the call is dropped due to spotty reception on some floors at Chicago Hope Hospital. I was already going to move to a different floor, so I call her...then I lose signal. I call her back...this is what I get: "Luckyone, I'm really busy right now what do you need?"
...excuse me all to hell lady
Me: "Oh Hi Dr. Busy. Awesome Partner dropped the call so I was seeing what was up."
Dr. Busy: "Oh yeah...I haven't seen either of you this morning...I was waiting for you."
Me: "We had lecture at nine this morning. I wrote two of my notes before then, I didn't see you on the floor. I'm now on One Floor, Awesome Partner is on Another Floor.
 ....dead speaks to peeps in the back ground...blah blah blah blah CLICK!!
A fellow student informs me that just before I made this phone call, Dr. Busy (who is pregnant) drops her brand new iPhone (that apparently had its own drama) in between the elevator and the door...from a floor we do not round on with her. Naturally this must be my fault. It turns out she spends an hour trying to get her phone out of the bottom of the elevator shaft while I was seeing my patients.

An hour or so later (still no clue where this woman's been because both of us have been on the respective floors she rounds on) we're going to lunch and she sees us...on a floor that has nothing to do with patient care
Dr. Busy: I WAS WAITING FOR YOU IN THE ICU AT 7 AM FOR AN HOUR (PS We never round before 8, and are always called to round and FYI,  Luckyone was in the ICU at doctor)
This isn't how this rotation goes, you can't just write your have to round with me." (which we do, DAILY). At this point I want to say: um, but we were ON THE effing FLOOR WAITING FOR YOU WHILE WE SAW OUR PATIENTS and this is what we've been doing for three weeks while you run off god knows where while we see our patients, and at some random, magical time throughout the day we discuss the patients with you. But you can't say much as you'd love to...So you just smile and nod and feel your dignity shrink with the Greek economy...

So...that drama over with: 1pm, we get called (as usual) to the ER by the doctor to see two new patients. I go to one end, and come to find the necessary chart is at the other ER desk, where my partner has gone for her patient. I walk up to the desk, am there for about two seconds....we get accosted by one of the nurses at the desk: 
Nurse Psycho: "This just really bothers me about medical students. They just walk in and start going through things and never say hello and think they own the place..."
Awesome Partner: "Um, I'm sorry you didn't hear me say hello, I said it but you were talking and I thought you were ignoring me." 
We go see our patients and get out of the ER to get away from Psycho Nurse Lady, informing Dr. Busy that we've seen the patients, they're being admitted, and we're writing our H&Ps. She says she's coming to the floor. Half an hour later she shows up: 
"Why didn't you wait for me in the ER? Were you too afraid after being reprimanded??"


I'm so sorry, Dr. Busy. Yes I INDEED made your phone fall four floors down the elevator. I indeed prevented you from getting a protective case. I HAVE THAT POWER and I can SO read your mind when you do not inform us that you want us on the floor an hour earlier than you've ever told us to be there....I'M THAT GOOD. It, assuredly, is my fault that while we were doing what we were INSTRUCTED to YOU, you were worrying about your phone--a privilege I most assuredly would not be afforded--and thus I should wait to be reprimanded for not rounding and seeing the patients. I am SO sorry that I couldn't track you down by my powers of I had to call you to find you so we could round....and I'm on the RIGHT BLOODY FLOOR...while you are NOT
 while you drop your phone...which again is my fualt...because I HAVE THAT POWER. So sorry to interupt your day...that you then blamed me for not doing...CURSES AND ROT!!!!!! I'm so sorry that you're pregnant and ill. Even though said baby is clearly not mine...

At the end of the day, Awesome Partner and I just sat there looking at each other

I should've gone back to bed when I  rounded the corner this morning to find I would need to run to catch my bus...

Saturday, July 7, 2012

Wimbledon 2012

Dear Serena Williams...please stop thanking Jehovah...I didn't see any evidence of him when you were threatening to shove a ball down a line judge's throat...or calling an umpire unattractive...or muttering expletives in your sister's direction and calling her a "bitch" while you played each other. I'm not buying it.

Thursday, July 5, 2012

Well hello there...

As I was walking to a nearby friend's apartment, I walked past Mr. HAIR. That's three times now...

Did I miss a memo???

Freak thunderstorm of doom...
Obnoxious heat index (106 to be precise)...
Trains stopping in the middle of the tracks between stops...
Multiple buses not showing all (three to be precise, one this morning and two this afternoon)...
Why did I get up today!!! 

I think the whole city of Chicago is hung over from yesterday's festivities...

In other news, today's Patient of the Day was came in after 15 minutes of non-responsiveness following a suspected MI...Patient is still non-responsive and exhibiting decerebrate posturing. Not looking good. The neurologist suspects severe intracranial edema due to anoxia.

Monday, July 2, 2012

Interesting cases

Complicated diverticulitis with abscess
Several appendicitis
AMS due to alcohol intoxication -- hepatic encephalopathy with serum acetone very elevated -- Pablo Personality, too

Acute pancreatitis with possible cholelithiasis

Thyroid storm

Sunday, July 1, 2012

Just got back from a weekend trip to St. Louis with mom and the bro. I enjoyed it! I will hopefully have a chance in the coming days to detail it. At the moment the most prominent thing on my mind is the measly little thunderstorm that rolled through Chicago, closing O'Hare and resulting in me spending about two extra hours at Lambert International Airport. Which, if truth be told, is about three more hours than necessary...

Thursday, June 28, 2012

On to Round 3

This past week I began the third of my six rotations. This is a twelve week rotation of Internal Medicine. It is split up into three parts of four weeks: the first involves rounding with the hospitalist. The second night calls (can't wait). The third is ICU and outpatient. The first part, to date has been very interesting. Some days have more patients than others.
I am paired with the same person for the entire twelve weeks, and thus far I think we have gelled quite well. She is very knowledgeable and thorough, and has done a few more rotations than I have. This is good because she has so far pushed me a fair bit. I need that. I like that, and I appreciate that. We actually live a block apart so that's nice in the sense that it is easy to share transportation and study, as well as coordinate social activities as well. No complaints there. The hospitalist we are rotating with is terrific. She gives us a great deal of information and wants us to learn. I think that's great!

Monday, June 25, 2012

Adventures in CTAing...

Saturday morning I was on a bus that travels down The MAGNIFICENT MILE, which means on Saturday morning tourists, and their crap. And hilarious antics, that went like this:


"LOOK HONEY!!! IF YOU PUSH THE STOP BUTTON A BELL DINGS!!!" Good job ding-a-ling. Please stop pushing the damn button because the driver is stopping just for your ass.

Or my personal favorite..."Oh look Wacker and Wabash. We can get off there to go to the Art Institute!" Well...I guess you could, and walk about seven blocks. Or you could follow the directions in that giant book you smacked some poor lady's head with and wait two more stops and walk two blocks...but whatever.

Monday, June 18, 2012


Heard the song "Bathwater" by No Doubt for the first time in years...I'm just as creeped out by it as I was the first time around...I'm also significantly more grossed out than the last time...I mean really...who thinks about such things!


Last week on the pediatrics floor we had a patient with a syrinx. After checking the MRI it was plain as day, and looked REALLY cool. I so much better understand the disease now having seen the MRI. Lesson learned: check the blasted imaging studies!!
The mercury hit 97 degrees F today here in Chicago. Native Chicaaagans lost their minds. And when the wind kicked up to 30mph sustained with gusts substantially faster, blowing HOT AS A BLOODY SAHARAN SANDSTORM...this Atlanta native got a bit grumpy.

Friday, June 15, 2012

Adventures in CTAing

A: "Oh damn it's my anniversary tomorrow. I forgot!"
B:"It's fathers day this weekend too. You gotta do a little more."
A: "No I don't he ain't my daddy." day suddenly became much more amusing.

Wednesday, June 13, 2012

Doctorese Babble -- Fluids and Electrolytes

Fluids and Electrolytes

1.     Heat loss – insensible water loss – 50%
2.     Solute loss – urine (Na, K, Cl) – 50%

100kcal --> 100mL fluid

Neonates have highest BMR – require more fluids

1.     Weight – Holiday Seey
First 10kg
Next 10kg
Every subsequent kg

2.     Body Surface area – more accurate but takes much longer to calculate
3.     Calculations
a.     Maintenance
                                               i.     100kcal -- 100mL H20, 3-4 meq Na, 2 meq K
                                             ii.     <3 months -- D5% + ¼ NS + 20meq K
                                            iii.     > 3 months -- D5% + ½ NS + 20meq K
                                            iv.     Bolus fluids
1.     Normal Saline
2.     Ringer’s Lactate
3.     Blood
4.     Albumin
5.     **Gatorade or Pedialite are closest to NS
6.     Do not withhold feeding
7.     20mL/kg – then reassess and repeat if needed up to 3-4 times unless edema increases (adults are 0.5-1.0L)
                                             v.     blah
b.     Deficit

5% in neonates
3% in toddler and adults
10% in neonates
15% in neonates
Sunken eyes
Sunken eyes
Sunken eyes
Membrane perf.

Skin turgor

Decreased turgor with tenting
Decreased turgoor with tenting

Cap refill
> 3 s
Oral Mucosa

Urine output and spec gravity (1.010)

Decreased output and increased gravity
No output


c.     Ongoing losses – 10mL/kg extra fliud per loose stool
4.     I’s/O’s
a.     Urine (2:1) or specific gravity
b.     Blood à Hb, creatinine, BUN
c.     Urine osmolarity – 280-320
5.     Hypernatremic dehydration – give more fluids