Spanish lessons from the Emergency Room

"Tengo que poner un dedo en el ano para sangre."

So, how was your night?

Requisite blog post

Hi ya'all and welcome to another installment of Ishie's blog. It came to my attention that it had been quite a while since I'd had one, giving that whole third year absentee impression that actually seems to be more due to living in NYC than it does to the actual work load of third year, though I'm sure, once I get to my surgery rotation, that impression will change.

Speaking of change, it's pretty remarkable the ones that I've embarked on since I decided to embark on this little venture called "medical school". I feel like I've grown up, grown down, been dressed down, and probably caused two decade's worth of liver damage in a short period of time. Medical school, as an entire experience, including the whole "in the Caribbean" thing, is probably the best and worst thing I could have ever done.

But I'm liking it, facilitated by starting off my third year existence with psych and then transitioning to ER, which keeps things fun, but is also a P/F class that doesn't require *that* much studying. The med surg people seem far less enamored of their lot in life.

Problem with ER is it lends itself to a TON of stories, most of which cannot be relayed on the internet, at least until several months have passed so I don't risk encroaching on the sacred HIPAA rules (man sprayed with mace by drag queen posse) that would risk casting me to the streets loans unpaid.

So that leaves me pretty much regaling my stories of living in NYC for the first time which consists of "spend too much money. Indulge in excess. Spend too much money. Go off on some alcohol fueled Nick and Nora fantasy with a waxing and waning group of friends. Convince one virginal satellite friend to try absinthe. Find exciting new venue you'd never heard of. Spend more money. Repeat. Go to work at 11 and regale the missing medical students and residents of the times you had in your down hours. Repeat."

Oh, and jog. I'm training for a breast cancer fundraiser 5K in September, which goes a small way towards physically and karmically repairing the damage I've been doing otherwise. Monica's helping keep me honest.

On the ER side of things, as mentioned, I finally got my IV sticks. I got on this kick where I could do ANYTHING so long as it didn't involve a vein. Arterial blood draws? Sure! NG tube? Sutures? Staples? No problemo. Simple butterful stick off a vein? Put an IV in an unconscious person? Problem. Complete failure to perform.

But finally kicked that in the ass so now I'm at 3 successful IV pushes to 1 unsuccessful in the last two days. The unsuccessful was on a woman with notoriously difficult veins, whose daughter decided to help me by saying "This experiment is OVER". Can we have a barb wire enclosure where we keep family members? That'd be super awesome. Better yet, if you're going to backseat doctor, how about taking your loved ones to something that isn't a teaching hospital? Mmkay, bye.

Oh, I also won a suture-tying contest, which meant someone else had to do the Guaiac on my patient. Gotta love the small victories.

Short one

Work schedule's a little buggy this week. I've been working the 11 PM to 7 AM shift for a week, had Friday off, and work Saturday Sunday, so I'm leaving for work in approximately (checks watch) 15 minutes.

Uhhh... ER is cool. NYC is cool, though nasty muggy hot lately. Training for a 5K in September with my co-conspirator, Monica. Dog died three days ago, so much crying, staggered by working, staggered by going out drinking with friends. Got two successful IV sticks (FINALLY), and doctor that seemed to hate me now being nice, so hooray.

Ta.

Conference? Nah, let's go to the beach

So because I'm incredibly lucky, yesterday, instead of having to show up for case conferences starting early (which sucks after a 3-11 shift), the residents had a beach BBQ at Jones Beach for the interns, and the medical students were invited. There was a great deal of humming and hawing on our parts since we weren't sure if it was a true invite or a "Oh... um, yeah, if you want to come, that'd be fine or something", but the Resident In Charge Tuesday night was like "You should go. You should totally go", etc, so we went.

I had gone to Jones Beach on the previous Saturday, but really wanted to even out my sunburn since my last trip left me white in the front and red on the back, so I looked like a playing card. Mission accomplished. Now I have a pretty even burn down the front, so no places on my body will have a melanoma advantage over others. I like to be fair.

So that was fun. Doctors aren't as scary when they're in their bathing suits playing volleyball.

But the rest... hmm... still have managed to avoid sticking my fingers up anyone's butt, but have had to do a pelvic and watch two of them. The joys of being female. I've given a couple of shots now, screwed up a couple of IVs and blood draws (I used to be able to do them; what happened??), patched up some superficial wounds on a fall victim, and helped splint a leg. I've also helped dissect a pizza that was brought into one of the patient cubicles and screened off, so when I was told to come up, I thought I was being called on to help with a procedure, but turns out I just got first crack at the dinner special. Niiiiiice.

So I'm having fun, feeling more comfortable, and so on.

You know you're out of shape

when you're huffing and puffing while jogging along in the park and you glance over at your (much fitter) roommate and realize he's walking along side you. Time to step up the yoga classes!

Case conferences today topped off by a rousing game of resident jeopardy (med students had the job of sitting there going "Holy crap; am I supposed to KNOW that in two years??), so not a lot to report.

In other news, a lot of people can attest to the fact that I'm not a giant stickler for being clean; I'm not that worried what's in my food and will pretty much try anything no matter what rat-infested street cart it came off and I've been caught sniffing shirts to see if they have another day's wear in them, but that being said, doing real medicine is giving me a serious case of OCD. Yesterday, we had a patient that was... uhh... oozing out of several orifices, one of which she wasn't born with, and stuff was going everywhere. At the time, I was thinking "Wow, this is intense" and also that doing stuff like running to get bedpans and helping do damage control on cleaning up a mess of substances that is too revolting to detail on this blog would help endear me to the nurses, so no big deal; had gloves on, didn't get stuff on my clothes, and did the normal hand wash/hand sanitizer afterward. Got home and started to make dinner... ten minutes later, I'm still scrubbing my hands in the bathroom "Unclean!! Unclean!!!" Go back to the kitchen... nah, probably not clean enough to touch my food. Granted, on a dare, I once ate an ant off a floor, but still don't want to touch my food.

Also, I'm already extremely appreciative of chill patients. When I was giving the tetanus shot and being instructed on technique by the other third year medical student, the patient is saying "Now don't you worry honey. I have had medical students practicing me all the time when I had the surgery, so don't you worry none about hurting me. Yup, you're doing great... heh heh, listen to me telling the medical student what to do." Thank you, incredibly chill patient. One of my friends when she was working prior to medical school had her first blood draw patient tell her something to the effect of "if you screw up, I'm going to sue you", so I know how lucky I am.

Stat!

Started ER yesterday and it's an experience quite removed from psych as anyone can tell you. I also keep introducing myself that way as "this is my first MEDICAL rotation" lest anyone thinks that 6 weeks of dealing with schizophrenia entitles me to put in an IV.

There are two sides to this particular ER: Acute and Urgent. Acute is for people that have complicated diseases, may require being admitted, and may be in danger of dying if not treated fairly immediately. Urgent care is your broken bones, lacerations, stomach pains, throat aches, and that sort of thing. I spent yesterday in Acute care being terrified and trying to elicit a history from a 105 year old without full uhh... mental acuity. I also got seriously pimped for my first time ("This may be your first medical rotation, but I assume you know BASIC physiology?") and learned how to do and somewhat read EKGs.

Today I was on urgent care; saw viral pharyngitis and a corneal abrasion, the latter of which I got to not only examine but say "Uhhh yeah, there's something in his eye" because I could *see* it. They saw it and confirmed with dye and a Wood's lamp, but I suppose I'm not as useless at eye exams as I thought. Either that, or it was a really big piece of something. Then I screwed up by taking the patient's charts up to ophthalmology but not the patient, because I didn't know I was supposed to, so he was like "you forgot me", and it's like "no! I'm just an idiot!"

Then bounced to acute care for a while and had a patient that was kind of a mess, with ulcers, a serious UTI causing sepsis, and a whole host of other problems, so I hung out there for a while, helped the nurse and CPA clean up the mess (don't ask; let's just say, I'm still washing my hands) and in return, got to see a Foley cath and a wound cleaning, which was cool. Came back to urgent care and got to do a tetanus shot (woot!) before interviewing an ob/gyn patient and getting a crash course on pelvic exams (I get to do the next one) and starting IVs (I get to do the next one).

So it was an interesting day. I feel like I know absolutely nothing and somehow manage to forget to ask the most basic questions that the residents then immediately ask about like "does the pain radiate to her back?" "Uhhh... no? Okay, I didn't ask. Even though I know to ask."

Oh, now that I'm back at Brooklyn instead of MPC, I get to use meal vouchers, so that should shave a significant portion off my costs. Unfortunately today, I was spectating through lunch and by the time I got to the cafe for my free meal, they were closed. So sad!

Favorite interchange of the week

Situation: Fire-breathing, leather-clad Scottish man, making his way around the audience putting his fire torches on people's tongues, shows hesitation to fully dip a flaming torch into a conservative looking woman's mouth...

Conservative looking woman: "Oh, don't worry; I've done this before."