Sep 1, 2009

Sometimes a favor isn't a favor...

Hi again... still here trying not to violate HIPAA or torch my evals.

There's a couple other third year students from another school rotating with us. We had the last two just rotate off and now we just got two more yesterday. I had two patients and didn't really get a chance to get much of a history/physical on one yesterday because rounds started early, so today, since one of the students had no patients and wanted to do something, I asked if she wanted the one I hadn't done much on, since the patient had been really nice yesterday.

The other student enthusiastically agreed, so I talked to my remaining patient, checked the new labs and vitals and got ready to write up my progress note. I wandered by the other patient's room only to hear LOUD profanity carrying from the room as the student tried to get a history from a woman that was cussing the hospital and everything in it up and down.

Whoopsie. It's a testament to other student that she doesn't hate me now. I swear I didn't know!

In related news, I'm still not great at dealing with hostile patients when I actually have to talk to them. In the ED it's easy because you just walk by hastily while looking at a chart because you aren't charged with getting a 40 minute history and several follow ups while the patient screams at you.

On an unrelated note, I've discovered that it's only taken a few short months for me to be completely desensitized to genitals in all forms. I was pretty blasé about them before, but now it's just ridiculous. Fortunately this has taken place at the hospital and not in the subway. As I saw a man wandering naked through the halls dragging his bedclothes, my first thought was "Oh crap; I hope he doesn't trip over his blanket" the second "Oh crap; that means a decline in his mental status" and third "Oh crap; I hope Dr. X doesn't make us list all the differentials for mental status change. Where the frig is my textbook? Rounds start in 15 minutes."

Other things I'm learning as a medical student:
-With a few exceptions, you are In The Way. You will be reminded of this frequently.

-The thrill of the white coat wears off really really fast. At first it's a "I'm gonna be a real doctor!" The next day it's "Oh god, people are calling me doc and expect me to do something". The day after it's, "Hey, I can store all my crap in these pockets!" After about a week, it's "My shoulders are killing me! Why do I have all this crap in my pockets?" Yes, that's right... you can actually shove enough seemingly necessary stuff into your coat to cause permanent orthopedic damage. And Batman does it all with a belt. Git.

-The stethoscope does not grant status. What grants status is being so high on the totem pole that you just miscellaneously grab other people's stethoscopes and use them.

-No matter how much you read, any answer you give is going to be met with rolled eyes and "Oh my god". Lest you think that means not reading, think again.

-During conference room lectures on any floor, there are two temperatures: Balls-Hot and Tomb-Cold. Dress in layers and don't be too proud to grab a blanket out of the storeroom.

-Ramadan affords the opportunity to score free lunch tickets from fellow students; however, caution should be taken when teasing these individuals. Fasting + Getting Pimped = Cranky. Love ya, J ;)

-Noon conference = Resident/student naptime. Do not disturb. Those unable to sleep during noon conference due to a Mountain Dew bolus during lunch can entertain yourselves by taking pictures of your sleeping colleagues and superiors. Just remember to turn the flash off.

-If you forget to bring a 4X4 gauze pad into a patient's room when you do a blood draw or give a shot, the patient WILL bleed from the site of a tiny little needle hole as if you've opened up their aorta with a chainsaw. Sleeves, the bedsheets, or the packaging to the needle are considered poor substitutions for gauze. Crying, praying, swearing, and fleeing the room are also considered unacceptable.

-Protonix, Lactulose, Motrin, and Heparin.

-Kerley B lines are a myth perpetuated by radiologists to see how many medical professionals they can get to claim they see them.

-No, no one actually believes you're allergic to tylenol, toradol, motrin, aspirin, and codeine.

-Know all the system passwords. Know them early.

-Yes, it's exactly like Scrubs. No, it's nothing like House.


noname said...

I've had a couple of nurses flat not believe I'm allergic to pain meds. One gave me demerol (sp?) because she said she felt sorry for me (after a c-section). She was super lucky the next day, once I was over the reaction, that the pain from my c kept me from jumping her. Seriously. Another gave me vicodin (sp? again), told me it was just a tylenol, and then was the one chosen to hold the pans as I vomited myself into a bad case of dry heaves. Makes me itch so insanely bad I'll scratch the skin right off my forearms and stomach, too.

Most just think I'm a recovering addict. :(

Ishie said...

it's when tylenol and motrin get added that we begin to get suspicious.

Then there's the opposite patients whom we can't actually give anything. Tylenol worsens the liver failure; Motrin increases the bleeding problem; morphine increases the constipation which could lead to rupture.

high-enough-on-totem-pole said...

yayyy for never having to carry my stethoscope for past few years!