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??