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.

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??

Crazy...limitations...gahhhhh

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. I.am.not.interested. 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...

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...

...so 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.

Image...

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:

Syncope
Fecal Occult Blood
Multiple cases of Cocaine and heroin abuse and subsequent withdrawl
Pericarditis
AMS
Alcoholic Encephalopathy
Diverticulitis
Pleural effusion
Pyelonephritis
Pancreatitis
Gallstone Pancreatitis
Alcoholic Hepatitis
Thyrotoxicosis
Seizures
Decerebrate Posuturing
Hydronephrosis
Cellulitis (including a particularly nasty bout)
Absence Seizures
TIA
Chest Pain
AVR
Chronic PUD
Anemia
Pneumonia
Lung Carcinoma
CKD
Fistulas
Bacteremia
CVAs
Azotemia
Acute Renal Failure

...and many many others!

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.

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