Eavesdropping

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

Ortho/Musculoskeletal Clinic

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

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

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

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

Yentl

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

Giggles...

Falafel sandwich - $5


Mocha latte: $1.95

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

A Tour of Chicago

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

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

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

Part of the job

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

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

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

Today's patient encounter...

Patient: "What happened to your hair?"

Me: "It fell out..."

Owned.