Aug 25, 2009

Shamelessly stolen...

from someone's facebook comments list, but let's just say it rings pretty true after over a week of morning reports and noon conferences. Also after two years of basic sciences and four years of undergrad.


Aug 20, 2009

Adios ER

Though thanks to being in the same hospital, I still get to see the residents around occasionally; even got a big hug from one I ran into in the stairwell.

The rotation itself was good, though as I mentioned before, I'm looking forward to seeing some of the end diagnoses for the more complicated cases, though half the patients still seem to walk out AMA, which I thought stopped down in the ED. The nice thing with the ED is you're pretty much allowed to do what you're willing and comfortable doing. The staff is pretty chill and I like the overall "ER personality". If you're at a hospital that has it as an additional third year requirement option, I'd definitely recommend it.

Now I'm onto Internal Medicine. It's much more lecture based now, which is both good and bad. Good because it keeps adding in new information, and it's important information, plus it breaks up the day. Bad because I'm still adjusting my schedule around, am chronically underslept, and having a conference right after lunch that involves the lights dimming is making for... difficult concentration, shall we say. But we're already seeing more diagnoses. Also difficult on IM is that due to the morning rounds involving a lot of people, the patients seem to grow frustrated quickly, with one walking out as he was sick of the "crew" and another ordering all "trainees" out of the room immediately.

But we're adjusting.

In other NYC news, it's been muggy and humid and nasty as all get out, which has some promise of relief next week. We had a really sudden storm blow through last night with high gusting winds that apparently took down a bunch of the trees in Central Park. It came through so fast that it went instantly from being nasty hot, then suddenly the wind blew through the windows, knocked everything off the refrigerator, and then started tossing the sign to the falafel stand under us around. Yikes!

But another day in IM tomorrow with bonus lectures, so we'll see how it goes.

Aug 16, 2009

Blair Witch Weekend

Another short post because I'm starting Internal Medicine in the precariously near future.

Speaking of precarious, never start hiking at 3 PM in a place called "Roaring Kill" that features a number of side trips the begin with the word "Devil's" lest you end up scrambling up boulders at 6:30 PM, realizing you're about to be in big trouble at 6:35 PM, hastily retracing your steps down the mountain so you can at least be on semi flat trail for when you are stumbling along in the dark using a broken digital camera as your sole source of light, and contemplating whether you're going to have to spend a hungry night sitting in mud while raccoons eat your face.

But we saw a porcupine!

Saturday night... well, I have rarely felt a relief and joy as pure and unadulterated as that which I found when we saw the car in the trailhead parking lot around 10 PM after finding the guest book we'd signed at the beginning of our adventure attached to a tree nearby. By that point, Stephanie's broken digital camera (whose cracked LCD had been shining a bright, trail marker finding light) was dead and my digital camera was out.

Sunday, we atoned for all of that by breezing through Woodstock for some tea and jam (the actual concert site is in Bethel, which was about 90 minutes away) and then went to a Bluegrass festival at the Saugerties lighthouse, which was awesome. Perfect way to celebrate the end of our respective rotations, complete with a bonus swim in the Hudson.

Now, though sad to see ED go, looking forward to the nitty gritty IM. Hopefully the enthusiasm lasts.

Aug 12, 2009

I love short notice...

We have our Emergency Medicine test on Friday, and got 4 of the 11 powerpoint lectures for it today, so that'll be some fun fast studying. Didn't get *any* of them until about two weeks ago, and it's like urgggh. One, would have liked to have more run time up to the test, but two, a lot of the stuff would have been useful for ER, specifically on splinting and wound management.

But no more EM as of Friday after the test, which is sad in a way, but I'm also looking forward to starting Internal Medicine, since that's the sort of bread and butter of things. It also might give me a shot at getting my schedule semi normal!

More info later; busy week.

Aug 4, 2009

Another trip to Jersey

And for a good cause...

That angry young man behind someone's miscellaneous devil horns is Maynard from Tool, aka "that band I've been wanting to see live since I was 15 and somehow never got to do so".

Oh yeah baby. I went to All Points West, which was a three day music festival in Jersey City that had a ferry leaving from Battery Park straight to the festival. I had to work Friday night to Saturday morning, meaning I couldn't go Friday (which is fine since they replaced the Beastie Boys with Jay-Z) and on Sunday (missing Coldplay, so sad) I was recooperating, but Saturday was mine. I got home from work, slept for three hours, and met a couple of friends in lower Manhattan at a bar that oddly has the original Magna Carta upstairs (??) and headed off to see Arctic Monkeys, Neko Case, Tokyo Police Squad, My Bloody Valentine, and oh yeah, TOOL.

Show was incredible. I love music festivals, even if they are a little tightly run now-adays. Woodstock, this is not. They have pretty intense security (largely to check for alcohol) and fenced off "beergardens" (drunk zoos, no real beergarden looks like that) where they charge 7 bucks for a Bud Lite and don't let you leave the fence for it.

Loved the whole scene though, despite that stuff. It had been raining quite a bit all week, though the day of the festival was sunny, but the place was mudded out. I deliberately wore flip flops and a dress I got at a craft fair so I could thrash both in the mosh pit, but they turned out to also be a good precaution against getting anything nice destroyed by mud.

I mainly pushed forward to see Tool, and got shoved, pressed, overheated, but it was all worth it. Oh, though weirdly some random guy came up behind me in a massive breathing throng of people and started telling me how I pretty I look, how I shouldn't be up here with all these men, and how he wants to kiss me. Ew. Has that ever worked for anyone? "Hey random girl who hasn't seen my face. I know you're busy worshipping at the altar of greatness and readily distracted by the mohawked, shorts-clad singer on stage, but wanna hook up?" He and the "Hey beautiful, why don't you get in my car?" guys from Grenada should troll for tail together. At least they'd have each other to go home to after they get summarily rejected by anything with two X chromosomes.

Annnnnyway. It was fun. And Tool is great, and so was everyone else. It was also at a state park that featured less flattering views of the Statue of Liberty.

All hail the freedom and glory that is... Statue ass. There's a NJ joke in that somewhere, but I won't make it. I haven't been in New York long enough yet.

It was a pretty view getting out there though.

Look, it's Grenada.

I did get soaked in mud, which was great because when we hit the train station back at Battery Park, you could tell everyone who'd been to the concert because they had mud caked knee deep. That was all well and good until I got on the express D train rather than the local D train because they were working on the R train and screwed up my mojo, so I ended up in south Brooklyn at 2 in the morning with the leaving-the-bar-for-home scene, who were all probably wondering where on earth I had been that I ended up knee deep in mud and smelling vaguely of sweat and cow crap.

Oh yeah, but that whole doctor thing.

I really like ER, and I definitely like the trauma cases, but on the medical cases, there's a sense of really wanting to know the end diagnosis that is infrequent for us because we send all the serious cases upstairs, so I'm like "Wait, was that actually CHF presenting atypically? Was it something else? What tests would be run to confirm something weird??" It's not necessarily that I want to get to know the patient over weeks or months and all that, but maybe just an email dropped from the medicine people going "Oh, turned out it was ulcerative colitis. Have a good weekend".

Having just gotten off the night shift, there's also the mystery patients that come in with something chronic that probably should have been seen in a general clinic two months ago, and there's been no worsening of symptoms, but suddenly they're like "I've been having this vaginal bleeding" (it's ALWAYS vaginal bleeding) and for some reason, it gets to around two in the morning, and they're like "And I want it taken care of now."

Which is fun since there's not as many staff on, and a lot of times it's male, which means the patient has to wait around while someone tracks me down as sometimes the only person that can serve a "chaperone" role since I'm female. It's not that I mind or anything and it gives me something to do, but it feels weird to be a necessary member of the medical team when the person doing an exam is an attending that's been a doctor for 20 years. "Sorry ma'am, I'd like to do this exam which I've done seventeen thousand times, but I just need to track down that third year medical student to make sure everything's kosher."

I'm also not getting too much of the sexism that I was expecting, which is fantastic, except for one patient that I kind of wanted to slap in the head, but that was for a number of reasons. I think it's the white coat. I'm getting called "doc" a lot, particularly when the police are around, and periodically get introduced as "the young doctor" by the residents and attendings because patients balk when you say "medical student", even if you're only getting a history and checking their heart and lungs.

I'm also learning the "I have a patient" doc-walk. When I first got in there, I had that sort of tendency to glance around at everyone smiling nervously, which made me target zero for patients that were getting pissed off about one thing or the other (and they all are) and saw me as a receptacle for complaints (see "white coat"), which would be fine, but I don't actually know much, and especially if I haven't seen the patient, I don't know what their problem is, who their doctor is, or how I can help them.

So I took a tip from a large part of the wait staff in Grenada (and the doctors and nurses) which is sort of a variation of the "subway stare" in which you're looking straight ahead but never actually make eye contact with anyone, nor let them observe that you know they're there. Walking quickly also helps, preferably holding a clipboard. WAY less stressful.

I'm also learning that for patients I actually have, reassurance that I haven't forgotten about them goes a long way. Stuff takes forever; labs being run, short staffed at night, etc, but most patients are okay so long as I stop by every half an hour and say "we're still waiting on your lab results, and I'm sorry for the wait, but just sit tight and we'll see what's going on. Do you want a blanket? I know it can be kind of cold in here."

So that's good. I've gotten some really good patients; I've gotten some really bad ones. I wish people would just be honest on their social history and pain level. The social history really annoys me. I drink alcohol. I don't care if you drink alcohol. Either 90% of Brooklyn is Mormon or they're all liars. If you drink a pint of vodka a day, I'm not judging you, but for the love of whatever, would you just TELL me that when you present with your legs swelling up so I can start following the "liver" pathway rather than the heart one? Por favor? And then they get pissed off that their issues aren't being resolved, and it's like "That's because I'm having to work you up for seventeen different conditions because you won't tell me anything."

But the pain, oh the pain. Everyone is a 10 out of 10 on the pain scale. I equate a 10 on the pain scale with being pretty much unable to speak and either screaming like a horror movie victim or being about to drop into unconsciousness. People are holding normal conversations with me and they're like "Oh yeah, my pain is a 10."

It's giving me a true love for the other type of patients though. The "I drink a glass of wine a day, smoke a joint or two on the weekends, and my pain level is a 6. You see, I had a little too much to drink tonight, fell off a balcony, and now the x-ray of my arm looks like a jigsaw puzzle. But take your time; I'm not going anywhere, and it was stupid of me to do it, so I appreciate you fixing me up. So you're becoming a doctor? That's really awesome."

*Love* those patients. They're honest, in the ER for a good reason, admit that some of the incidents that befall them might actually be a result of their own actions and not somehow related to me, and present interesting cases that allow me to suture or splint stuff, which is fun for me.

I'm also finding that the mildly inebriated (not fully inebriated; they are their own form of obnoxious) tend to be the easiest to do procedures on. Usually fairly cooperative, kind of sheepish about being a little drunk, and don't respond too badly to pain. Not that I'm advising people run out, get drunk, and injure themselves, nor self medicate injuries with alcohol; it's just been a limited experience run, and I like people that don't squall at me when I start IVs or inject lidocaine.

Well conference day tomorrow, so bed time to me.