And work hasn't even started yet...

I'm happily cruising along at about 75mph, relishing the entire ride in a warm car (I garaged my car this weekend) and I hear something...odd. It sounds like the air is being let out of a giant balloon. I look over and I see a SmartCar whizz by me. I didn't think that was even possible. 

Then I walk in and see this on the table. There has got to be a better name.

Snap back to reality...

So two days after officially finishing my rotations (WHAT??!?!) I started work. It's hardly an ideal job, but the timing is indeed ideal. And it's a lot more than I'd make serving drinks or rolling burritos at Chipotle--because oddly enough nobody else is going to hire a doctor that just finished his rotations but is promising (hopefully!) to leave the job in June to start his residency. So basically I answer phones from people callings in about insurance, gather their medical history, and send them on their merry way and thank them for choosing Big Frickin' Insurance Company.

Training has been...interesting. Almost the entire week we've been doing mock calls with each other to ensure we've learned the script and I have to say I'm a bit over it. I can't think of anymore weird conditions to keep it interesting. We have also been observing live calls, which is fine.

I have to say the most frustrating part of training has been some of my coworkers--I know, what a great time to be irritated with your colleagues from the start! We have to do exercises to improve our medical knowledge. A friend and I are in the same training class and we just look at each other and ask ourselves why, when we've finished medical school do we need to do a worksheet to remind us what lisinopril does. The person who scored "the highest" on the worksheet also took 35 minutes and google to answer the questions. Somehow I doubt live phone calls with allow that. But what I find the most frustrating is the lack of medical knowledge from seemingly "medical" people. Like why a nurse doesn't know that a dislocated shoulder and shoulder dystocia are the exact same thing in a newborn. Grumble grumble grumble. Or why some people seem incapable of listening. Or why one particular individual feels the need to voice his/her opinion about every single thing. Or asking about, "well what about this [insert obnoxiously far flung idea about a caller asking about something ridiculous like life on Mars].  Here's the thing: I expect medically miseducated, uneducated, and ill-informed people calling in. That's why I was hired...because I am medically educated (whoa...that sounds weird!). What I have found frustrating is the people that I'm supposed to work with, many of them don't have a frickin' clue.

Medical School: Done

It's so weird to say that. After everything, that good, bad, ugly, and sleep-deprived indifferent, like *that* it's all over, and three days later I've started what is (hopefully) a temporary job until residency starts in July. 

I don't think I know how to process it all at this time. 

Lots of bad moods, a few bad days. Long long long long long long long endlessly long study sessions. Several really big exams. Distance from family (though that also had a few pluses), travel, concerns about finances. It's all over. Over. I have to say it's a little anticlimactic, because all I can think about is how much I want to go to sleep.

I...um...need caffeine??

Standing at the counter waiting for my bagel, I hear this, in a thick Chicago accent:

"I'll have one of deese here naked guys with my bagel." Say what?

It took me (and the cashier) a minute to figure out he was referring to the drink, Naked. 

Holy Cow

Yesterday was my penultimate shift in the ER...and medical school. I walk into the unit and the first thing I hear was "She's trying to start a fire with her cigarette!" Welcome to work!!! This was a very challenging patient! She had been brought in the ambulance, for a reason we weren't sure because the report had the wrong name, ethnicity, and date of birth on it, so we couldn't trust it. As soon as she got put in the room she decided she wanted to leave,  so she lit a cigarette and tried to set her bed on fire. Her mood depended on the moment. She could be very nice and cooperative or completely belligerent. She hated blacks and Filipinos, but being gay was ok as long as it was your business. Her family had all been murdered by doctors. Her mother had been beaten to death at a nursing home. She was an atheist. Then she wanted her Bible and was going to forgive everyone because she was a Christian and would forgive. She was verbally abusive the entire.night.

We had another patient who came in because she was experiencing seizures. She was telling us that "I'm having one right now." While she's wide awake and walking. A quick check to her record reveals a diagnosis of paranoid schizophrenia. She was also a real pain in the ass. She was belligerent until the nurses made it clear that she was not going to be allowed to be disruptive. Sometimes dealing with these patients is like dealing with a six year-old.

Most of our patients that night were serious. Which is a bit out of the ordinary. In the ER a lot of the patients really don't have emergencies. Mexican moms in particular bring their kid to the ER every time they throw up. This is not an emergency. Kids get sick, and they throw up every once in a while. If it does not stop or is accompanied by a very high fever, and cough, or the vomit looks weird, that's different. But one episode of vomiting does not an emergency make.

Aren't They a Gem...I'll drink to them!

Ok, so I took the title of this post from a line in the song "The Ladies Who Lunch," of the musical Company. I'm not a theater geek, but I do enjoy it from time to time, and particularly the snarky variety. Anyway, the song itself is a snarky swipe at judgment and cynicism. For me that was a bit of the last couple shifts. I've found myself using the word "gem" over and over again. Perhaps just a little too much.

I've had some terrible patients in the ER, and a further taste of what's to come. I've certainly seen psychotic patients, so their behavior wasn't new, but it has actually been a while, so it was a refresher.

One patient had left his nursing home over ten miles away and had bounced from hospital to hospital, subsequently signing himself out. By the time he got to Chicago Hope's ER it was later in the day, and after a short while he it became apparent he had missed his afternoon medications because he became what is referred to medically as acutely psychotic. In layman's terms he flipped his lid. He started calling everybody a "fucking nigger." Security had been called and one of the security officers simply looked at him, smiled, and said "thank you!" Brilliant, I thought. I'm going to have to remember that.

The next day another patient came in, and we had just gotten him discharged when he decided that he could not find his wallet. Not only could he not ifnd it, but he insisted that somebody had reached into the back pocket of his pants, while he was seated in a wheelchair the entire time, and taken his wallet. And he was not leaving until he got his wallet back. That certainly was interesting.

That same day we had a patient who was brought in by his mother. He did not want to be there. He kept telling his mother how he was going to get his wallet, go down to the club (I didn't find out which one...) have him some BEER, and hang out with some GURLS. This was a 30-something year-old man. I felt sorry for his mother.

It's just been interesting. We also had a patient with a rotten foot. Over half of it was black. Oh my god did it smell. The smell stayed in my nostrils most of the night. I felt like dipping my head in a vat of rubbing alcohol to see if that would kill the smell.

What a gem of a day!!

Today was my last early (6a-2p) shift in the ER...thank God. I'm sure there will be periods of time when I'll need to be awake that early for residency, but I guess I'll have to cross that bridge when I get to it. A friend of mine is doing a surgery rotation in California and he has to get up every day at 4:30. Excuse me?? Je ne comprends pas!  That hour does not compute. And you want to go into this field why?? But I'm getting off track. Today was an interesting day.

For starters, I had a new attending today. Always awkward. He spent twenty-five minutes lecturing my fellow students about brevity...

I walked into a room to find that both people in the room were expecting to be treated. This isn't exactly typical, so I just hopped back to the desk to make sure that both patients indeed were registered before I went through the rigamarole of examining both of them. I don't typically read too much about a patient before I see them because I want to see them from scratch. Good thing I did that, too. Both patients, indeed, were registered. For genital discharge. Oh goody. I must've made some sort of face, or audible expression because half the staff at the desk and the attending started to laugh. It became clear at that point that the attending was purposefully not seeing that patient before whichever schmuck of a student got lucky and took that patient. Thankfully a thorough examination was not necessary. What I did observe however, was that the female (aged 21) had this ever so sexy habit of sucking on her thumb while she was talking. Yes ma'am. Nothin' says sexy more than a 21 year-old who can't speak English properly AND sucks her thumb. Mmmmm baby. Oh, and by the way, soap is cheap. Please use it more than twice a month. You reek. The 20 year-old guy in the pair was clueless. Or stone. Or perhaps both. I don't know. He just kept walking around like he didn't realize he was in a room...with walls. I kept waiting for him to hit a wall and then bounce off of it in a daze. Really, a real pair these two were. What a special time I'm sure this was in their relationship. Getting treated...together...for the clap. They got sent home with a shot of ceftriaxone, and scrips for azithromycin and doxycycline. Please don't ever come to the ER for STIs again. I will hurt you. And I have the right to do so, since I'm paying for your ER visit. Also, wear a damn condom because I really don't want to have to pay for the baby you two chuckleheads will invariably make...and not know how.

I also correctly diagnosed a migraine from presentation! Thank you neurology and awesome neurology attending. I'm not sure I would have recognized it as a migraine off the bat without that experience. Go me?

I diagnosed several URIs in kids under two. It's that time of year folks. I understand love for one's children, but I also think that when 16 year-olds start bringing their 19 month-old children into the ER because they are PANICKED because they have been coughing for six hours...that it's time to stop letting uneducated 16 year-olds have children. This brilliant girl didn't grasp, despite several declarations, that a bottle, is indeed feeding a child. Oy, some people. 

I had more than one patient whose parents didn't speak English. And I found myself rattling off Spanish like I actually knew what I was saying. Weird. I have days like that every once in a while, but few and far between.

Emergency!!

I'm about a week into my last (!!!!) rotation: Emergency Medicine. I figured that this would be a good one to end with because my interest in doing another rotation is pretty much nil, and this would at least keep me moving and doing something. And so far that has indeed, happened which has been great. The schedule? Not so much. Because of interviews (mine and everyone else's) what is normally four or five overnights in a row, followed by the name number of morning shifts, and the same number of day shifts, and totally been thrown askew. Everybody is gone at random times, and as such the schedule is totally random. It messes with my sleep schedule (I know, I just have it so rough). 

Got to incise and rain and abscess. Had done it before in surgery, but they patient was unconscious. This guy was awake.

Had a rather strange occurrence, a patient came in for whatever reason with her mother. Mother had been there for about four hours (and I saw her sitting more or less content and comfortable) when she decided to inform the staff that she had been suffering from gastritis for about a week and needed to be seen. I'm not sure what to make of that.

So a full-blown tonic-clonic seizure, which was kind of cool.

Had more than one schizophrenic patient (one with pronounced tardive dyskinesia) who proceeded to make their presence very well known, which for me as a future (hopefully) psychiatrist was good experience and a bit interesting.

I've been on the interview trail for the past month as well...and goodness between the travel and the interviews themselves and working that around my rotation schedule it has definitely been interesting. They have for the most part been fun and enjoyable. But there's always this feeling of inadequacy within me, and I have no idea how it's going to turn out. Stay tuned for updates.

This and that...

Just some random thoughts from my patient encounters in the past week or so.

It's realllly bad when you let out an SBD and the room suddenly smells better than it did a second ago. Why? Because the patient in the room smells like a rabbit cage. I used to have rabbits and their cages had a very distinct smell.

Why do you need to ask someone who smells like an ash tray, with wheezing you can hear from across the room, whether or not they smoke?!? DUH!!! Of course they smoke! The better question is probably how many cigarettes they smoke per day!

A patient's spouse commenting on one of the side effects of ketoconazole, which is being used for a patient's prostate cancer: "Is that why he don't get horny? You gotta do something about that." Do I laugh, or wet myself??

Heme/Onc...

...not really my favorite I have to say. The subject matter is somewhat interesting, but at this point I must confess to some senioritis and I just am not interested. To boot, I work with two different doctors, both of whom can annoy me in their own special way. The first is an older doctor who thinks he is absolutely hilarious, and can talk up a storm about absolutely nothing. I swear I spend an extra hour at the hospital than I need to just because he's yacking about nothing. The second thinks he's really hilarious, and likes to joke in the form of harassment. At 7:15 in the morning I'm not always in the mood for it...really not in the mood for it.  That's not to say I'm complaining, but with the first doc especially I don't feel like I get to do anything. I just follow him around the clinic and the hospital for about eight hours. And I don't get to even write a note, or listen to a heart. I'm six weeks away from being done with medical school. I would like to think I could at least do something that simple.

Coke dadgummit!

At an awesome sandwich shop. 

Waitress: " I get you something to drink?"

Me: "Could I have a coke please?"

Waitress: "Is RC ok?"

Me:(For a second I flashed back to the South where "what kind" is your response to requests for a coke. Note: Pepsi is a perfectly acceptable answer. But, my cola of choice is coke, and pretty much nothing else). "I'll have a ginger ale thanks."

Sad...but true

...that I recognized the music playing overhead as the theme from On Golden Pond. 

I Didn't Know Carrots Were Served That Way

Had one of THE most interesting cases in the OR today. I was going through pre-op and saw a patient who wasn't on the schedule (always a good sign) so I asked the secretery. 

"Removal of foreign body from the rectum," was my answer. Oh goody! We had one of those last year and it was a Starbucks frappucino glass bottle. Genius. I asked the patient, discreetly as possible, what happened. He states that he was drinking Saturday night and does not remember much of anything. He states that his friends must've inserted whatever the object was into his rectum. Ummm, ok, sounds like a stretch but let's keep everything open to possibilities. Said patient also knew his birthday, but was seven years off on how old he is. So we're looking a patient with memory (likely related to alcohol) issues. Which means he's going to need higher doses of anesthetic. 

The ER report made note of an X-ray that indicated the foreign body so I finished my pre-op stuff and went to have a look. I wish I could post it but blast that HIPPA. What we saw was a rather non-descript but definitely distinct object that did not belong there. We all took guesses (yes folks medical students do discuss their cases).  Some said a bottle. Some said dildos. One person even said a plastic bottle (which I'm not sure how that would work). Anyway, it came time to take it out. After a few attempts the doctor requested that the patient be completely paralyzed because he just couldn't get it to come out. He could feel it, however, and said that whatever it was it was "wrapped in a condom." By this point half the OR staff and all of the students within earshot are in the room (the poor patient), waiting for the moment when it is extracted. It finally came out, and it turned out to be a carrot, and a rather large one at that. 

Yeah dude...your friends are such douches that they'd shove a carrot up your ass but they were nice enough to bag it up. I'm not buying it. 

Rolling right along

Anesthesia has been ok. Nothing terrific. Nothing that I really feel has been overly enjoyable (or unenjoyable for that matter) so I'm just kind of getting through it. Meh. What can you do. 

I don't have a ton of stories to tell, because a lot of the patient interaction is short, limited to pre-anesthesia stuff (I'd love to but I don't have time for your story today, I just need your meds and surgical history, kthnxbai that's all). I frequently get called to help out my partners because neither of them speak Spanish and at least half of our patients only speak Spanish, and I speak enough to get through an interview. So that's that.

In the OR I've tried intubation almost every day, but it isn't clicking yet. IVs I've been pretty successful with, but the tricky ones still prove...well tricky. Beyond frustrating are the IVs where I get the needle in the vein, but then lose the blood flow for various reasons such as bad veins, collapsed veins, the needle going through the other side of the vein because I inaccurately anticipated a curve in the vein. When such events happen I have to inform the patient that a nurse will be sticking them a second time, because I the lowly student am only allowed one stick. 

Mad Men

Thoroughly enjoying this show. But why is every man a louse. And every woman a bitch? Is it just period satire or a metaphor for life?

Interview Season Has Begun!

...and I'm (predictably) a neurotic mess on the inside. I try to contain it outwardly--because who really cares. I make little jokes about myself and how I check my phone all the time like I expect to get an email from a program. I have a few interviews lined up, but I always want more (insert laugh here). 

In reality there is no rhyme or reason to which program selects me for an interview as opposed to programs that have chosen to decline me for an interview. And that drives me nuts. 

In local news, anesthesia is rolling right along. And I find it not my favorite. But it's still somewhat interesting. I'm trying to do more intubations and IVs. I'm attempting more difficult ones so my success rate has gone down. On Friday I attempted one with tiny veins, and I ended up going through the vein. Today I tried one that not only rolled, but only half of it rolled so a straight line turned into an S. I have a new respect for nurses.

Anesthesia...but I don't feel anything...

The past week or so I've been back at Chicago Hope Hospital. It's been quite nice, and a little surreal. I spent close to a year at this place, being here every single day, and then I left for quite some time, to return and have a lot of things look, sound, and smell the same. A lot of memories came flooding back. It's quite rare for me to return to a place once I've left it. I must say it is a much more pleasant environment than Chicago Memorial Hospital. Getting here is much easier and/or pleasant than Chicago Memorial because I can take an express bus to an el line, and it moves much quicker. The staff is infinitely more pleasant and friendly, and much more open to interaction than the staff at Chicago Memorial. I'm glad I decided to schedule my last three electives here. 

So...now to anesthesia. How boring can one discipline be?? The science is indeed quite interesting, the practice of it does nothing for me. It's about ten minutes of work, then over an hour of doing nothing in the hopes that indeed nothing happens. The anesthesiologist and CRNA spend a lot of time on their eReaders and what not. I've been able to do a few things such as:

 Insert an LMA

Attempt an intubation -- due to uncertainty I haven't quite landed one yet.

Successfully figured out how to insert IVs

Spinal

Induced with general anesthesia, which with the IV isn't that thrilling.

Observed a prostate ablation -- which looks quite frightening when done with a laser.

All in all I'm confident in saying that I'm glad I didn't  choose anesthesia or ever have strong interest in it.

I am one sharp tack...

- Wow look at this!! My phone screen has all this gunk on it! Let me wipe it off.
- Wow it looks so clear!
- Wait, where are the bubbles??
- Oh...so apparently my protective screen that has been falling apart finally decided to kick the bucket, and fall off without my knowledge.

...I am one sharp tack let me tell you.

Application Time!!!

Applications for residency went out yesterday morning. Can you say freak out?!? I certainly did! I was a nervous wreck most of the morning as I went over my list one more time (and good thing, too, I changed and added a few programs). It was not cheap. And the whole bloody thing is reminiscent of the medical school application process, which wasn't a barrel of laughs either. I was almost shaking as I pressed "Apply." I then spent most of the day worrying about whether or not I get interviews. Sometimes I have zero confidence. It didn't help that it basically rained all day yesterday so I couldn't go for a walk or bike ride to help clear my head.

Adventures in CTAing...

A first! A mechanical problem has stranded me on the Red Line. Oh joy!!

Neurology...DDDDDDDONE

Finished my neurology rotation. I must say I thoroughly enjoyed what I learned and working with this particularly attending. I didn't care so much for his preferred hours. I'm an early bird. I don't mind waking up at six to get to work by seven, or earlier, and leave so I can eat dinner at a reasonable hour.  Dr. Brain is a night owl. He prefers coming in at 11:30 and staying until 8 or later. That means we stayed with him until 8, 8:30 most nights. I felt like I learned A LOT. I got my neuro exam time down to less than thirty minutes. The first time it took me well over an hour. My attending offered me a letter of recommendation. I didn't ask for one. I had planned to, but he offered before I had what I thought was the appropriate chance. So woohoo!

Next up for me is a two week break (what WILL I do with myself??) and then I have three more rotations. I'm going back to Chicago Hope Hospital, and I'm looking forward to it. Chicago Memorial Hospital was a good place to learn, but the nurses there, particularly in the ICU can be real curmudgeons. 

Let's Geek Out!!

Neurology is rolling right along. Yesterday I was basically one-on-one with my attending because my partner took two (yes TWO hours) to see and write a report on a patient who is for all intents and purposes braindead. I have many questions...but moving along. The first patient had an array of symptoms that were fascinating to observe as a student. He had a present Babinski sign on the L, a L ankle clonus, and diminished L knee reflex. I became unnecessarily excited when I observed the Babinski: "Um, doctor, I think this is an upgoing Babinski. Do you want to verify?" I was indeed! Same with the clonus. I didn't see it, but felt the ankle jerk an extra time after the initial reflex, which I initially didn't think anything of, but after a second I asked the doctor to verify that as well, and indeed, I was paying close attention! Go me??

Later, we had a patient who has a history of thrombotic thrombocytopenic pupura. She had significant neurological damage. She had a rubral tremor, and noticeable cognitive impairment. Getting her to do Serial 3's (1, 4, 7, 10, 13...etc), you'd think I was asking her to do quantum mechanics. So all in all the doctor said I did very well with those cases.

Fast forward to today. We had a patient come in who on top of being hard of hearing didn't speak English as her first language (not unusual). We knew ahead of time that she had a pontine lesion, so the attending asked us to pay special attention to her cranial nerves. I noticed what I found out to be square wave jerks in her eyes. The doctor did not notice that immediately while my partner was doing the exam, and appreciated me calling it to his attention. Also this morning we had a patient who was known to the doctor. He had me examine her cold and to find her abnormality. I correctly diagnosed her problem as an ulnar nerve neuropathy. She had a noticeable left palpebrae that wasn't equal to the right, and I noticed she also had a slight left-sided mouth droop while the doctor was addressing a sensory complaint in her arm. I was able to bring that to his attention. I felt unnecessarily accomplished, and totally geeked out. 

I'll leave with some awesomely bad jokes from my attending:

Did you hear about the Invisible man ? He married an invisible woman. Their kids aren't much to look at.

Disgruntled patient who just happens to be an NRA member: "If another doctor tells me there's nothing wrong with me I'll kill him."

Doc: "There's definitely something wrong with you." 

A big giant WHY...

This morning my attending asked my partner and I to evaluate a seizure patient...but wait!!! The patient is sedated. Hope the attending doesn't mind ten pages of "unable to assess."


Follow up!!: As I was reading through the previous notes (the patient has been in the hospital for quite a while) I came across a real gem. According to a wonderfully written progress note: "Pt had this morning that lasted for 30 min..." Pray tell what did he have? Seizures? Vomiting? Headache? Fits of rage? Priapism? I'm all ears doc...

Traveling

I'm flying back to Atlanta this weekend for a family function. For those unaware, parts of the Blue Line leading to O'Hare run in between the Kennedy Expressway, and this includes the platforms. I was standing on the platform waiting for my train and watched the cars fly by in both directions. This is a rarity on the Kennedy as it can logjam at any time of day simply because somebody in Idaho sneezed.  It was rather exhilarating to see and hear the cars zooming by in both directions. People moving into the city, going out of the city. All at 80mph. Either it really was that cool, or I was just awake and at it way too flippin' early this morning.  

Today's Observations

1. It's 85 degrees, unless you're from Saudi Arabia and find that cold, why are you wearing a scarf??

2. Anyone attempting a left turn at Addison and Clark on Cubs game day needs their head examined. And deserves to be tazed for backing up traffic even more...because you know they're never going to get to actually make that turn.

3. I like neurology. My attending says I'm doing well and has allowed me to do exams on my own. However, I was thinking about going into neurology before this rotation. I find it interesting, but I am no longer considering neurology.

The TVs at the gym just happen to be playing Maury...apparently his people have found and exhausted the available supply of no-good baby daddy's, because today's topic was "I'll prove my *dead* son isn't your baby daddy"...

Neurology

This week I started my neurology rotation. It's been interesting, but also a lot of work. I don't really mind it. I'm not crazy about the hours, however. They aren't long, but they are late, so they might as well be long. I haven't been getting home until after eight most evenings. I'm accustomed to getting up and out early, and doing my errands in the evening. This means I have to reverse that pattern for a few weeks, which is kind of weird.

The doctor is nice, but sometimes the way he talks makes him come across as a bit of a jerk. For example, yesterday he was quizzing us about random neurological signs, and I hadn't the foggiest clue what the sign was. I asked him if he could spell "Lhermitte's" sign, and he just replied "No."...Thanks dude. I've never heard of that, or if I have it has long been forgotten.

I'll be the first to admit neuroanatomy was not my favorite or best subject. I think you have to be a witchdoctor to understand a lot of the pathways and crossings.

Yesterday we had neurology clinic, and we have several new patients. The first patient of the day, the doctor said "Okay luckyone, you're going to do the exam. Unless you would prefer me to do it, this might be a difficult case." Well, of course I'm not going to back down from that. Sink or swim I told him I would be fine to do the exam, even though I was indeed nervous. I started taking my history, and not too long after I started he suggested that I not ask quite so specific questions, which threw my rhythm off a bit as I was trying to ensure that I didn't get reprimanded for asking "too specific questions." Nerves, but oh well. I'll get there. So, I was trying to concentrate on asking broader questions, and it needed a bit of work. Some of the things he noted that I didn't ask or facts that I didn't obtain I recall indeed obtaining. Perhaps not the proper way or to his liking, but I did get that information.

My exam was fine, I think. A bit unorganized, but I have never done a complete neuro exam before and I didn't want to do it by the list because the order looked a bit weird to me. Maybe I'm slightly dyslexic, but I stay on track easier if I do things in groups. I only had to be corrected on one task, and that was just a brainfart.

QOTD

"I had a patient once who tried to commit suicide by shooting herself in the neck. She missed everything. When I asked her about the pain, she described it as a shooting pain. I had to excuse myself from the room to avoid laughing."

Moral of the story: when you attempt suicide either make it count, or at least work on your descriptors.

Good to Know...

Patient: "Please leave the room and close the door. Lucifer is trying to have sex with me." Patient is actively simulating the act and mentioning how delicious Lucifer's penis apparently is.

Sure, no problem. Mad dash for the Haldol. 

Say What??

This is an actual experience of mine from just a few days ago. We had a new consult in the ICU. The patient was brought in for acute respiratory failure and had been intubated. By the time I and Airhead Partner went in to see the patient he had woken up and was stable. We start to question the patient. The patient had a bilateral lower extremity amputation. We were trying to get to the bottom of why, but the patient couldn't talk very clearly because of the endotracheal tube, so here's how the conversation goes:

Me: "Sir, how did you lose your leg?"

I barely finish my sentence and Partner quips in: "Was it drugs?"

Patient: *shakes his finger no and draws his finger in a line along his arm* Ahh ok, something to do with circulation, as is usually the case. Now, was it an arterial thrombus, chronic infection due to his diabetes, injury, or poor circulation?

Before I can even finish my thoughts, as the patient is still pointing to his vessels...Partner: "Oh was it meth?! An explosion in a meth lab??!"

....Say what????

Me: After wiping what I'm sure was a befuddled look on my face and resisting the urge to tell my partner to S.T.F.U, I just took over and said "Sir, before we go any further do you think you could just write it down for me?" He wrote "Pore blood."

Me: "Thank you sir." And with that I walk out, wishing I was capable of conjuring up Petrificus totalus. If anyone could explain how Airhead went from the patient pointing to his wrist to the implication that his lost both of his legs in a meth lab explosion, never mind that most meth users are white and this guy was black...I'm all ears. 

An awesome quote

"Of religious people, there are some who feel that their religious beliefs make them better people. There are others who feel that their religious beliefs make them better than other people."

It brings to mind a passage in Romans 2:1-3

You, therefore, have no excuse, you who pass judgment on someone else, for at whatever point you judge another, you are condemning yourself, because you who pass judgment do the same things.  Now we know that God’s judgment against those who do such things is based on truth.  So when you, a mere human being, pass judgment on them and yet do the same things, do you think you will escape God’s judgment?

What a Day!!!

My day began with a patient that has been driving nurses crazy since she walked in. A 29 year old with End Stage Renal Disease, morbidly obese, enlarged heart (duh) and BAD attitude. Hardly ten minutes would go by when she doesn't need something completely unrelated to her health. I need a pillow. This is too many pillows. I'm hungry. (Family brings two slabs of ribs and a bucket of mac'n'cheese). My stomach hurts! Well no crap Jessica Fletcher, you just ate an entire cow. I wanna go home, let's get me home. I don't care if this medicine is supposed to get me better, let's fix the immediate problem. I don't want to take that medicine, I doesn't work. No I've never taken it before but I know it isn't gonna work. I don't mean to be overly cynical, but honestly half of this chick's problem is her attitude, and a likely diagnosis of Borderline Personality Disorder!!!

After THAT, my partners and I got stuck in an elevator for about ten minutes. And one had a panic attack. Oh, and did I mention the A/C wasn't working very well so the ICU got uncomfortably hot with two dozen people stuffed in there, computers running, and people running about. What.A.Day!!!

Paging Mother Nature

It's 56 degrees, like a November or December day in Georgia. I feel like there should be football on TV. It is literally 50 degrees cooler than this time last year. I vividly remember for about three weeks I would be getting on the bus about 6am and it would already be over 90 degrees. Some days there would even be a very hot wind blowing off the lake. Give me 50s and 60s in July any day of the week. Of course, this may mean that we are in for a very cold winter. Every month this year in Chicago has been colder month over month from the last two years. This past winter it didn't start snowing regularly until January, quite late from what I understand. I had OB/GYN in December with a Chicago native and he said he couldn't believe how warm it was for December (it was below freezing most every day). I found that I did not mind the cold one bit. So I say bring it on! This weather reminds of me of fall, my favorite time of year, and it's a nice-weird feeling to have in July. 

In other news, my ICU rotation has been going very well. I have to go in six days a week (we have arranged it so two of us get one of the weekend days off). Yesterday I was up at five and after taking a very long shower which mostly consisted of standing there and whining I don't wannnnnaaaaaa go in todayyyyyyy I was at the hospital by 645, seeing a few patients that were my parters'. I was done by 8, anticipating that's when the doctor would actually show up. Oh nay. Apparently there was a health fair at the hospital that Governor Quinn made an hour-long appearance at. My attending being the chief of staff naturally had to make an appearance. That would've been nice to know as we sat around for three hours until he showed up. On top of that, he is Muslim and it's Ramadan. Your breath starts to stink when you don't eat as your metabolism switches a bit. I spoke about this with another student who is Muslim, and apparently some people won't put anything but water in their mouths. As a result, a good four feet were needed between my sensitive nose and the attending.

What a Day!

Nurse: patient came back positive for TB. 

*everybody freaks*Nurse: Oh sorry I misspoke!! HepB. Positive for HepB!



Then later on...

Partner 1: Is he French or French Canadian?
Partner 2: I don't know. He has an accent he must be French. 
Me: Celine Dion has a French accent, though. 
Partner 2: Yeah but she's American. 
*Facepalm*

I'm trying really really hard not to be judgmental...

...but even I have my limit.

Loudspeaker: RAPID RESPONSE ROOM 123. RAPID RESPONSE ROOM 123! RAPID RESPONSE ROOM 123.

Me: "Oh, partner, that's your patient."

Partner: "What? Who? Where? What are you talking about?"

Me: "Never-mind." For the third time this week already I'll go take care of your patient because you were either an hour late getting here, and apparently don't listen when a code or rapid response is called. *Gets up and heads to telemetry.*

Said partner is actually a very nice person, but working with her is exasperating. She is an airhead and has yet to show up at the hospital before the doctor. Another partner has mentioned that she's losing patience with her as well. I have the best life, don't I??

Surprise!!!

The attending shows up an hour earlier. Only two of the four medical students are even here. Good job guys!!! I'll be happy to pick up your slack!!!

Blah Blah Blah...New Rotation

Started my new rotation yesterday: Pulmonary/Critical Care. It's going to be a lot more intense than ID was. Unlike ID, we actually have patients, sometimes over twenty. So we have stuff to do, every single day. And it's awesome. There are four of us to split up the patients, but it's still enough to keep me busy and thinking. Plus throughout the day there is at least one admission so it's definitely been cool to be able to integrate what I've (hopefully) learned over the past year or so.

Today was quite intense, and a bit frustrating. I've spent enough time at Chicago Memorial Hospital that I now have developed a rapport with some of the nurses, which is always a good thing. I've also had the chance to follow several patients over the course of several months, in several different disciplines. It's been fascinating. Today a patient came in that I had seen for several weeks during my Renal rotation. Patient has a history of bilateral breast cancer with mastectomy, urinary outflow obstruction causing chronic kidney disease and hydronephrosis, which lead to the placement of several stents, all of which became infected. All the while her kidney numbers are shooting up like crazy (of course, the woman can't pee!!!). At this point the nephrologist looks at me and says "Something else is going on here. I'm not sure what but this just isn't right. Something bigger is going on." Later, an ultrasound and a CT demonstrated metastases to the liver. Boom. Cause determined. Patient gets sent elsewhere to resume her cancer treatment, and I go about my business. Fast forward many weeks, and I see this patient's name on our consult list and I just know it cannot be good. As it is, I am not assigned to follow her, but there is probably some counter-transference going on here and I just can't help but feel sad. This is a sweet lady and all the cards are going against her all at once. Suffice it to say the cancer has spread and she's taken a turn for the worst.

Later in the day during clinic I encounter something that I'm not sure whether it should make me laugh or angry. An obese man who is so fat that he cannot breathe simply because he's too fat comes into the office. He's bound to a wheelchair. Who's pushing the wheelchair, ask ye? His wife. Who's fatter than he is, and carrying an oxygen tank around. You interpret that as you will. 

Over ID

It's been fun, but I'll be glad to move on to something else. My attending is just a smidge more scatterbrained than I'd care him to be, and he never, absolutely never runs out of things to say--useful or otherwise. As a result he's constantly late and rushing because he stops to talk to everybody, and then makes a running commentary about everybody. It can be exhausting just trying to listen for that long. It doesn't help that he's not the most organized person in the world, and as such we are running every which way trying to get things done. Ok, done kvetching.

On a better note, summer finally showed up in July. I've enjoyed being able to wear shorts, finally. I've also pulled my car out of the parking garage and park it on the street. It can be a bit hectic sometimes finding a spot, but I manage. With an awesome transportation system if I don't need the car, or know that I will be arriving home at the same time as everybody else in my neighborhood and will thus have to fight them for a spot, I plan better. It also encourages me to get back to using the bus and train. Odd as it may seem I had missed it. It's much less stressful and you get a little more exercise. It's incredible how something as simple as just driving to work encourages one to be more sedentary. 

Don't Know What to Do with Myself

It's been a little over two weeks since I took CK, and true to form I'm still unwinding from it. I'm only recently becoming aware of the levels of stress and pressure I experience and impose upon myself when I prepare for and take an exam like that. Well it turns out I'm still unwinding. I don't really know what to do with myself, and I'm still trying to piece my routine back together. It's weird. There is still a pile of laundry waiting to be folded because I got out of the habit of folding my laundry for about a month. My floors have been vacuumed and cleaned, but I still feel like what am I not doing??? It doesn't help that I have to be a bit stingy with my cash for the next few weeks. Blargh.

Infectious disease has been interesting and simultaneously boring. It's been more discussion than medicine, but at the same time that's important in this field. My attending must have been vaccinated with a phonograph needle because the man can talk. And talk and talk and talk and talk. He spent nearly half an hour talking today about seemingly everything and nothing. Topics seamlessly shifted and blended together. All the while I couldn't help but thinking that this is a man who mentions he doesn't get home until after 9 some nights...and in the four hours I spent with him today almost half were just mindless talking. He'd surely get home at a "normal" hour (should he want to) just by halving the chatter. 

Milwaukee

Saturday, a group of us decided to escape the city for the day. One of two Pride Weekends was this weekend in Chicago. Obviously I have no qualms about gays. What I do have qualms about is thousands of drunk gays blocks from my apartment, many of them behaving obnoxiously. I have many gay friends who feel the same. So we left before the insanity of the middle of the day festivities could get moving. We went to the Miller Factory, which was fun (and free...). Then we went to the Harley Davidson Museum, which was very much so not free, so we elected not to go in. I may save that one for my brother. Afterward we went to the Milwaukee Public Market, which was very enjoyable with enough esoteric food and snack options for just about any foodie. We took our food to a nearby park. At which point it was getting later in the day, so we headed back to Chitown. The festivities were still in motion, including a never-ending thump thump thump thump from a techno tent, but as I was tired and there was a Blackhawks game on, I was content to stay in my living room without feeling as if I were confined. And I happily watched the Blackhawks win. 

Expect the Unexpected

I'm currently in my first week of Infectious Disease. I've found it interesting, but at the same time just meh. I'm still in the post exam I don't give a flip. The doctor I have been assigned to is relatively new to Chicago Memorial Hospital and as such doesn't get quite as many consults as the established doctor. He makes up for by doing a great deal of administrative and policy development work. Because he felt bad that my partner and I haven't been getting quite as much hands on exposure he invited us to accompany him to another hospital where he rounds. My school used to send students to this hospital, but about nine months ago ended the affiliation for reasons that rumors still abound. The most consistent rumors focus on the fact that there are just too many students at said hospital, and that the standard of care is lacking. I had never been able to confirm it, nor did I see any chance, and quite frankly it wasn't something with which I was overly concerned. 

The hospital is nowhere near where I live, but I had known a handful of people who had rotated there. Getting there was a pain. It took close to an hour due to traffic on not one, but two expressways. The reception staff just gave us a visitors sticker without vetting us as students and away we went. When the (creaky) elevator doors opened BOOM MEDLAM!! People were everywhere. Nurses hollering out orders. Charts being whisked every which way. Medical students all over the place--seriously this place was overloaded with medical students. There were nine of us surrounding the one doctor huddled in a corner trying to get notes done. All the while this one resident on call would come over the doctor looking completely overwhelmed (not an unusual feeling for a resident I'm sure) and just stand there and want him to listen to her. At one point I thought she was going to cry and was basically just begging for someone to hold her hand. I could sympathize with her but once she stood there for thirty minutes telling war stories. At that point, we have five more patients to review (and the doctor likes to go off on rabbit trails) and I'm just thinking It's almost 6pm. I live over an hour from here. Please go away and do your job so we can do ours. I'm happy to be here to learn, but you're not helping me learn. I finally got home close to nine. Since I have been getting home at like 3 or four I hadn't made any preparations for things like thawing meat, so I just went to Taco Bell, watched the Blackhawks game, and called it a night. What a life I have sometimes!!!

Wimbeldon Is Around the Corner!!!

...and I'm not thrilled about the men's seeding.

1. Novak Djokovic
2. Andy Murray
3. Roger Federer
4. David Ferrer
5. Rafael Nadal.


Make note that two-time champion Nadal is seeded behind the guy he just trounced in the Roland Garros final. Behind the guy (Ferrer) that has only ever been the quarters at Wimbledon once, much less a final. Bad form All England Club. Bad form.

Pressure is a Privilege

The test is over. An immense weight has been removed from me. I realized that I am not a particularly pleasant person when I have to study. Why it took me ten years to make that connection, I may never understand. 

Medical students are an odd bunch. We have to be to want to do what we are trying to do. Something pushes us and makes us keep moving forward no matter how unpleasant it will be. That can have unpleasant ramifications for those around us, especially those who have been authority figures in ours lives. We are thinking "marathon." They are thinking how they don't like what's happening right now, though who could blame them. 

I spent most of my life until 2012 with my nose stuck in a book, always another test coming up. The myriad standardized tests through primary school, the PSAT, SAT, organic chemistry tests, biology tests, PCHEM evals, the MCAT, umpteen medical school exams, Step 1, Step 2 CS, Step 2 CK. It just never quit. But such is life. After Step 1 I had an extended break where nearly all of my learning was hands on, active--and I loved it. I became a much more relaxed person, a much happier person, and a much more pleasant person. What would my late teens and early twenties have been like if I weren't always in the testing frame of mind??? I can only imagine. A great deal of that nauseating tension went away for a very long time, and I became a freer person, a more honest person, simply because I didn't have that pressure and tension weighing me down. I didn't realize it until it was gone, because it had been constant, my reality, since I was a teenager. And I'll be honest, I was a mostly unhappy teenager, ready to get the hell away from a set of peers I had little to nothing in common with. People who only cared about the typical teenage interests, which I didn't or couldn't grasp.

All of that came rushing back when I started to gear up for CK: the constant edginess, the anxiety, the tension, the pressure, the desire for an emotional release in any way, shape, or form (a few of those nasty fights with the parentals all of a sudden came shining into focus, not all but certainly a pointless few), sleep becoming delayed. Maybe it all came into view because (fingers crossed) this is the last test I will have to take before graduating. Because I can see the proverbial light at the end of the proverbial tunnel. 

As I write this I'm reminded of a quote by Billie Jean King: "Pressure is a privilege." So I can only complain so much. I have been provided an opportunity that few other people have. So what if it means a little work. So I sat down to my exam Wednesday morning knowing I was in for a very long day. The first few of eight sections (one hour each) went fine. I took a break for a snack and hydration after the second, and took lunch after the fourth. After the fifth section I started to get restless...jeez three more hours of this nonsense. The last section was a struggle. A real test of will. It was ten questions fewer than the previous sections--and thank God it was. More than once I had to reread questions because somewhere between the beginning and the end of a sentence my eyes lost focus. I literally had to uncross my eyes at one point. Sometimes my brain just checked out and I had to read those questions again because I realized I hadn't the foggiest clue what was being asked.

I was the next to last one to leave the testing center. I went home and crawled into bed and slept until 10 the next day. Much needed.

PS: Hopefully I won't be kvetching any time soon!

QOTD

Friend: "Why is it that evolution has made us the only species that has to wipe our ass?"
...I have absolutely no idea.

Less than a week until I stop kvetching so much...

I have less than a week until I take my CK. I am completely and totally over it. But I keep doing questions. I have one (ONE!) more section of UWorld to go. The downside is it's 350 questions. But I can do it. I figure I can do half tomorrow and half Friday. Then I have four days to do nothing but review, and maybe do a few more practice questions from a MCQ book I have stashed away. The excitement is palpable isn't it? The problem is there are 5647465 things I would rather be doing than endless sets of multiple choice questions. It's particularly frustrating when Patient comes in with seven completely vague and nonspecific symptoms. Yet I'm given answer A-H and one of those usually closely related answers is the question. In the real world of medicine the treatment for two of those is usually the same, and therefore if you just so happen to be slightly off the patient is still helped -- disturbing as it sounds it happens all the time folks. On the test? Oh nay. Gotta have the exact answer. 

Kvetching...

Officially completely 100% bona-fide OVER studying, Kaplan, UWorld, and any other form of MCQ...Kan eye just bee a doktir now pleeze, kthnxbai...oh right...ten more days to go...

Blargh!!!! BAD Morning! -- Kvetching

I had a lot of difficulty falling asleep last night. Two coffees and a healthy dose of increasing nerves will do that to a body. This morning for the life of me I couldn't focus on anything. So I figured I'd do my errands that I'd scheduled for tomorrow today. Sounds innocent enough, no?

For starters, the temperature has been jumping around lately here in Chicago, and the last two days have been sticky. So sticky that my feet feel like they've always got a layer of goo on them. Not a pleasant sensation. I also figured that since I had to go out I would go ahead and pull my car from the paid garage I had it in during winter to street parking--saves a lot of money. With this in mind I went in the late morning as I wouldn't have too difficult a time finding a parking spot near my building upon my return. 

I get to the store and for the life of me I cannot focus. I ended up walking down the same aisle no less than three times because I kept remembering things I wanted or needed. Fast forward to checkout, and I do my thing, and it's even warmer. I swing by the tennis shop to get my freshly strung racquet and proceed to crawl down Fullerton because there was a giant pothole in the middle of an intersection. I also managed to catch every single stinking light. On my first pass for a parking spot, I got behind two dingaling drivers that kept stopping every five feet to evaluate if a space about six feet long was big enough for their car. Errrm, sorry. I ended up finding a spot on my building's block. I get upstairs to find that somehow all of the meat I had purchased did not make it into my bag. Most likely I forgot it in the cart. Annoyed that a) I have to go back out, and b) I have to give up my AWESOME parking spot I go back to the store. They were very nice about it and I got an equal valued selection of meats. It was uncomfortably hot and sticky by this point, so I get moving back home and I get stuck in Cubs traffic. I'm basically annoyed at this point because I've practically wasted half a day of studying. After one round I find a decent spot, only to notice that the wheels are curbed just a bit more than I like. I forgot to put a belt on this morning so my wallet and phone weighed my shorts down. I stepped up into my car and rippppp went my shorts. Lovely. Somebody please shoot me now.

I Hate Studying

I have been gearing up for my USMLE Step 2 CK (say that five times fast) in a few weeks. I have been  doing multiple choice questions, ramping up more and more each day. I purchased a 30 day subscription to the UWorld question bank (if you're a medical student you probably just shuddered subconsciously, if not, know that medical students do) and it has been making me work very hard. The questions are quite difficult, and only remind me that I despise hours of studying. I really and truly do. I always have.

It makes me anxious. My eyes hurt from doing so much blasted reading. I start thinking about everything that I either don't need to be thinking about, wish I weren't thinking about, or hadn't bothered to think about because it doesn't actually matter. I go from being quite busy and tired every day, to bored and having a bad case of cabin fever. I try to intersperse my studying with activities with friends and whatnot, but that isn't always possible. And until that time is available I am at home...all day. I become restless and bored, and then I want to eat because I have nothing else to do to distract me from studying. It is just not healthy. I hate studying. I like being active, being in the hospital. Being on my feet.

Patient QOTD

"I am mad at the fish. It doesn't want me to eat it."

...how much can on really say about that.

Lost all dignity...

So, that song What Makes You Beautiful, I've totally been jamming to it when I hear it on the radio. Today, I learned that it is sung by a group of British boys...none of whom is over the age of twenty. I have lost all my dignity. And I still like the song...sadly. AND, I am that lame, I looked up the song live, and to their credit, they at least sang the stupid thing live. There is no hope for me. That is all.

In other news, I finished my Renal/Nephrology elective today. Now back to your regularly scheduled programming. 

Oh What a Day!

What.A.Day indeed! Today (technically now yesterday) was planted by a seed on Friday afternoon, at 5:01 EST. The registrar's office of my school sent out an email notifying students that the electives available after September (that's in about three months...) would finally be available to book beginning the following Monday. How kind of them to send that out after the office closed at 5pm, for the weekend.

Fast forward to Monday. Every senior student has of course read that email, and is ready to jump the phone lines first thing that morning, including yours truly. I needed three, three, measly little electives and I would be done. I just wanted (granted only wanted, not needed) them to be in Chicago so I wouldn't have to pick up my life any sooner than necessary. One of the many reasons I moved to Chicago in the first place was to avoid doing just that. I wanted to stay in one place for monetary, personal, and stress reasons. So I start dialing. The first three times I'm told the circuits are busy. After that I perused through my emails and found a different number, and back doored my way into the holding queue. I was intercepted by student services, who suggested I leave a message, but I firmly maintained that I wanted to be in the queue. By the time my message was answered and my email request received everything would have been taken. So I waited. I waited a total of NINETY minutes, before I finally spoke with an advisor. In three minutes my schedule was set. I'll recap that for you; I waited ninety minutes to spend three doing my business. I got my last three electives, in Chicago. Woot. It looks something like this.

Early Monday morning I decided that I would be late and just accept having to rush through my notes before rounding in order to get my stuff done, so I left about an hour later than I normally do for rounds. On top of that, my partner, for the fourth day in a row, notified me mere minutes before rounding was scheduled to begin that he was unable to come. His reasons have varied by the day, and apparently it reached a head such that the medical education director called him and said unless he was in the Emergency Room he was not too sick to come in. I honestly could not care whether he showed up or not. I just did not appreciate, repeatedly, not being informed of it until it was too late for me to do anything about it, so half the patients didn't get rounded on until the physician arrived--which is bad. Usually I finish rounding forty-five minutes to an hour before the doctor arrives, and I spend that time either studying, reading the news, or gabbing with my fellow students about God-knows-what. However, I could also be using that time to see more patients.

WTF Mate...

While burning through a chapter of Harrison's in order to make a presentation in as little time as possible (it corresponds almost exactly with the amount of notice I was given to actually prepare it...) I came across this little gem...
Estimated GFR (mL/min per 1.73 m2) = 1.86 x (PCr)^1.154 x (age)^0.203...What schmo came up with this equation??? And why did Harrison even bother to include it in his text book...I don't know about you but I do not carry around a Ti-80something capable of doing exponents just to calculate GFR...esoteric knowledge Mr. Harrison!!!

Welcome to My World

“Critics are our friends, they show us our faults.” ~ Benjamin Franklin
...I must have a lot of friends. Many of them my attendings.

Renal Exam in a Nutshell

"Hi how ya doing. You're peeing? Awesome. Ok I'm gonna go sort through your 14000 lab results now. Maybe I'll figure out how to tell my attending why your 0.1 drop in magnesium is significant.  TTYL."

Best patient of the day..

"I need clothes to cover up my body!!"

*lifts up gown showing us all the goodies*

Patient has a sitter and a football helmet.

This Makes Me Angry...

An 80-something year old Patient has been at Chicago Memorial's ICU for close to two weeks now. Patient has been demented to the point of being legally incapacitated for at least the last four years. Patient has congestive heart failure, renal failure, and arrived with a collapsed lung because there was so much gunk in the lungs. Nurses have been removing not just secretions, but wads of mucus for over a week via suction, and there's a lot that even the suction can't even get out. Patient has coded, been intubated, was extubated, coded again, intubated again, extubated again, coded again, and has again been intubated. All the while there is NO advance directive from the family, who just sits there and looks at Patient plugged up with tubes. There is absolutely nothing that medicine can do except kept Patient alive by inches. The only way this poor patient will stay alive is via a ventilator (ever try moving hooked up to one of those things?), and if, only if, the lungs happen to clear up Patient will go back to a nursing home to lie in a bed, still demented...

Madness and cruelty! Perhaps it's countertransference, but I would never let my grandmother or either of my parents be subjected to that. 

Long long week

The first week of my Renal/Nephrology rotation has already been more intense than the entire cardiology elective combined. First and foremost there are about 723,645 things that can go wrong with a kidney and each one of them is dependent on a different set of parameters, each affecting a different part of the kidney. The heart is much simpler. It's function is pretty simple, linear. It either works or it doesn't, and most of the problems can be observed by simply following the conduction. The kidney...not so much. Electrolytes that we were never asked to pay attention to in Basic Sciences (oh how long ago and far away that seems) can wreak havoc on the kidney with even the smallest changest. It's interesting, but a real challenge to keep it all straight. Potassium, magnesium, phosphate, sodium, BUN, creatinine, albumin...and the beat goes on.

This week was particularly intense as it is the first week. I haven't been asked to write a progress note or do any sort of real physical exam in months (since OB). The first morning I had to rock my brain a bit (anyone smell smoke?) to remember how to go about it! Then I had to figure out which lab values were more important to focus on (all of them, and none of them are important, completely dependent on the patient), and then I was brought face to face with an attending who can remember about forty-six sets of lab values per patient. I, personally, have difficulty remembering phone numbers unless I've used them more than twenty times...Wednesday my partner couldn't make it, and of course that would be the day we had our highest census. I had to round on, and note eleven patients, and then get pimped solo by the attending. All in all a busy day! I didn't get home until rather late (I left smack in the middle of rush hour traffic, oh goody), and then had to do a presentation. It was a bit of a tiring day and definitely will be a more intense rotation but I am liking being busy again.

Updates of Recent...

This past week I had more time off yet again. I can't say I was overly thrilled about. I know...what right do I have to complain about having time off. But such is the case, I had very little to do besides laundry, cleaning, vacuuming, and other mundane thrilling tasks. The thing about having time off is that most of my friends and acquaintances did not have said time off. So in essence I muddled about the house, studying for an upcoming board exam a bit less than I probably should have, watching The West Wing on Netflix a bit more than I should have, and went to the museum once or twice. It didn't help that this past week the weather was bloody awful. It rained pretty much every day for a solid week, culminating with Friday (in April) where it literally snowed all day. Thankfully it didn't stick, but as I was driving home from a friend's place visibility was noticeably diminished it was snowing so hard. Also, said friend lives well away from the lake, while I live right on it, so the nature of the snow was quite different after having traversed some five miles back to my apartment. While I entered my car with giant gloppy snow flakes, I exited my car and walked half a block being pelted with about eighteen septillion little bits of ice. Did I mention the wind was blowing about 20mph??? My face felt like I'd been sand blasted.

Back to boredom, I have to work myself into a study mode, which I'm getting better at I must concede. But there were times when the last thing I want to look at is another bit of nephrology!!

My Renal elective at Chicago Memorial Hospital starts tomorrow. I'm looking forward to it. I may eat these words soon, but I hope I spend more time at the hospital than I did during Cardiology. Sitting around the house all day long is a recipe for teeth-coutning boredom and unnecessary Calorie consumption (yes I capitalized that for a reason, look it up!!).

I've confirmed what I've suspected over this past year--that I enjoy being busy. I typically don't mind working long hours as long as I'm actually doing something. Sitting around counting my teeth doesn't really do much for me.

Best Moment of the Day Thus Far...

Podiatry Resident: "So I got to thinking did anyone tell you that you look like Leonardo DiCaprio?"

...Oddly enough the answer is yes. I will only accept this as a compliment!

Looks out the window...sees snow...checks the calendar...sees April 13...perfect excuse to stay in bed

6:25 this morning...

I am dressed, about to put on my coat, and walk out the door. I check my phone. I'm greeted with a text message saying I do not have to be at the hospital until 2pm. Well grand. Glad I'm not already wide awake. Somehow going back to sleep didn't quite seem like an option, so I parked myself on the sofa and proceeded to watch Kaplan videos.

I have also discovered that my DVD player that also plays Netflix also plays YouTube and any video files that I might have on a USB storage device. I have a ton from my days on the island (fr
equently that was the only way to access new stuff, pirating). 

Not All Medical Students are Created Equal...

...and some of them annoy the living daylights out of me.

Like every normal human being, sometimes other people just irritate me, no matter how hard I try to be nice and overlook the blithering idiots. Case in point, one of my rotation partners in Cardiology. This is a fellow MS4, yet has less professionalism than a middle school baseball game concession vender. She uses words like "thingy," "like you know," or "you know what I mean, that thing." Some days it's all I can do to not explode (I have to share a degree and profession with you, you dingbat). Other days I can be passive aggressive, and say things like "Thingy? That's so professional of you! Could you be a little more descriptive please." On top of that she insists on talking like a five year old. "Are you going to go poopy?" Gahhh, just shoot me!

We review EKGs every.single.day as part of Cardiology at Chicago Memorial Hospital. She still does not use the approach requested by the cardiologist. He requests that we first check the rate, then to see if the rhythm is sinus (negative p-wave in aVR, positive p-wave in I, boom. That simple). Then whether or not the rhythm is regular, or irregular. Last the morphology of the elements. Three weeks in she still hands him an EKG and simply says "T-wave depression." Great, what does that mean? One day he had given us several EKGs to take home. She came back with sticky notes with a diagnosis for each one of them. They were all correct, but she couldn't detail why for each diagnosis, which means she just looked them up and compared to an EKG catalogue. One of the ones she had been given was Dextrocardia, a condition where the heart is reversed from it's normal positioning in the chest. Given eighteen hours of course she came across the diagnosis, but when questioned, her response (in a very squeaky voice) "because it is!" Then, after probing and pointing out that she probably didn't have the firmest grasp as to what she was saying, he confirmed that the diagnosis was indeed correct, to which she said, in a squeaky voice "Yaaaayyyy." Shoot me. 

I'm glad I only have the rest of this week with her. First thing in the morning is too much to put up with an adult who insists on acting like a child. Give me an asshole any day.

Adventures in CTAing

Two in one night folks!!

For starters, I'm taking the El downtown to meet a friend for dinner then head to another friend's for a birthday party, when I see two guys board the train at opposite ends and start yelling and swearing at each other in what appears to be a rather heated argument. My first thought was oh crap I'm going to be caught in the middle of a fight.
Guy One: Why you fuck her?!?
Guy Two: 'Cuz it's free easy pussy!!! She ain't got no teef, she suck dick real good. At first when took out dem teef I was like whoa, but then she suck my dick so good I had to fuck her.

...at this point I'm stunned. And haven't a clue what to do. I am trying very hard not to laugh.

Later, my friend and I are waiting for our train, when we come upon this gem: two elderly Chinese people playing Hava nagila. It was awesome

Have a better understanding why I hate taking my car in Chicago??

Cardiology Update

Cardiology at Chicago Memorial Hospital has been a pretty intense challenge thus far!! We only meet for a few hours a day, but a lot is packed into those days. I knew going into this that my knowledge of EKGs could use some improvement, and I have been given a crash course in EKGs. Apparently not one to baby us, the attending gives all of about thirty seconds to review and EKG, which has really made me realize how much sharpening I need! I have gone home every day reviewing the days topics and researching the homework assignments, and some of it is starting to make a little more sense. Some of it is going to take a little more review. But that is why I chose this rotation at this point in my schedule. I knew that going into my USMLE Step 2 CK there would be plenty of cardiac cases, and an intense Cardiology elective would only benefit me. During the Basic Sciences part of my curriculum EKGs were certainly introduced, but mostly the theory behind them. Very little was discussed regarding the interpretation of them. Obviously that is of equal or importance to the theory. Until this week I hadn't received much instruction in it.  

We have also reviewed a lot of echocardiograms, which I have had zero experience with. That has been an equal challenge as well!

It has been an interesting experience and odd feeling thus far being scheduled for electives and as an MS4. It means I've come a long way, and am on the "downhill" slope to my MD. It's a little overwhelming to think of everything that I've forced myself to do over the last few years!!