Oct 29, 2009

Brief advertisement...

If you live in NYC, the Steampunk Haunted House is definitely worth checking out, and it's only ten bucks for students, apparently including medical students.

Sadly, I don't have pictures because they don't allow them, and I'm not affiliated with them in anyway, but dayam. Awesome!

Oct 28, 2009

Pause for Fall...

Or in my case, spend 7 hours in Brooklyn Hospital's library OCDing all over your presentation, come home, and hastily tap out a case report on yet another Patient Who Has Everything and Complains About Even More Things.

Oh, and realize that when you spend as much time attached to your computer as I do, even 20 gigs of music isn't enough and your old standbys are starting to wane. Right now, I'm trying to re-stimulate my urge to care by combining Pandora's "Turntabilism and Beat Science" with "Bluegrass Instrumental". Ohhhh yeah. I can be a dorkitron AND sell out at the same time! Take that!

Speaking of music, I finally got out to the Bowery Ballroom on Sunday to see Thursday with Midnight Masses and Some Other Band. Now *that* was an old school show. A mosh pit even I was afraid to venture into, stage diving, crowd surfing, and lead singer sweat spray that got further back into the audience than a show at Sea World. Lest anyone think I'm being irresponsible, doctoring is fully destroying my love of things that are bad for me as I was thinking "I would join in the closer-to-the-stage festivities, but I don't want a fatal brain injury." Plus, I'm pretty certain that at this stage, if I got hit hard enough in the head, USMLE World questions would leak out, and then I'd get busted for violating copyright.

Still freaking awesome though. Thanks Patrick!

ANYway, as I was hitting Stumble around the internet today to give my tired eyes a rest from uh... the computer screen, I found a webcomic near to my dorkly widdle heart, so I figured I'd share its Autumn sentiments with you.

Oct 24, 2009

IM starts to near to a close

Oh yeah, I did the whole start ICU thing... er... let's just say I long for the unbridled excitement of the floor.
My day:
Ishie: "So, what brought you into the hospital?"
Intubated patient: "..."
Ishie: "No problem! I'll read your chart!"
Chart: (Unintelligible scribbling)
Ishie: "No wonder everyone whines about my handwriting."

ICU is also revitalizing my desire to fill out a "DNR/DNI/DNfreaking touch me under the following conditions: ___________, ___________ etc etc" notification with detailed, fact-checked data points that have been looked over by a team of doctors and lawyers, notorized, and then forwarded to every hospital in the country plus a bonus copy in my wallet, and heck, possibly tattooed across my back. This is not to discourage or dehumanize anyone, but the amount of unending human tragedy that has come about with the misinterpretation of phrases like "Do everything" is staggering. And trying to interpret pre-condition patient wishes from a host of subjective third party accounts and opinions is about as useful as consulting a magic 8 ball. Just saying.

It's also annoying when the lack of communication leads to very well intentioned family members trying to do everything to respect the wishes of hospitalized party, but the original intentions get lost in the medical mumbo jumbo so you end up with incomplete documentation that allows you to do sort of half a revival.

Bah, but anyway. I've been learning a lot, and with oral and written exams pending as well as my first Halloween in NYC, I'm trying to cram in a whole lot of study and 11th hour case write ups in a very short period of time. Because once a procrastinator, always a.. well, I'll get back to you tomorrow. Except that I won't.

In the meantime, I'm trying to get some semblance of a direction to go career wise. My current struggle is with my unending love affair with pathology and pathology-like subject matter, but then I find myself caught up in the general arguments against pathology (and radiology, but I suck at reading X-rays, and that's apparently important) which is its general stigma of individuals within the profession as maladjusted sociopaths that aren't real doctors. Not that I believe these arguments, but the potential future of having to qualify my job to everyone I come across is annoying. Of course, if I went into Emergency Medicine, Internal Medicine, or Surgery, I would just have to continue my same explanation which is "I am not a nurse. I am not training to become a nurse. No, I'm not planning on going into OB/Gyn. No, not pediatrics either. Because I'm not overtly fond of children. Why not? Because I'm a maladjusted sociopath that's not a real... aw man!"

Also there is the patient contact issue. I like some patients, and I like to help people (at least that's what my personal statement said), but as I've also said, I don't like mean people, and I don't like hurting nice people. My job description as a "seeing patients" doctor would generally involve either sticking needles, catheters, or scalpels in nice people and getting yelled at by mean people (while also sticking needles, catheters, or scalpels in them).

I also like to either see something and diagnose it or have something diagnosed that I can then remove manually. This pretty much limits me to pathology or surgery.

But we'll see. You never know, and I'm still keeping my options open.

In the meantime, since I'm busy writing up three case reports and bleaching the nastiness out of my white coat (I wish I could be hardcore and claim it's blood, sweat and tears, but I think the majority of it is curry sauce and balsamic vinegar), here's a video that's not related to anything, but I thought it was hilarious. Enjoy!

Oct 16, 2009

ICU next week

And woo hoo for I dunno, sicker patients?

MICU/CSCU will mark my last three week stint of Internal Medicine, meaning I'm going to need to make sure that I spend some copious downtime learning everything there is to know about... uhhh... medicine. Pathology, here I come. On the long term patient management contact, there seem to be the "Mean/Stupid; sometimes both" patients and the "Nice so I feel bad sticking needles into them or giving them bad news" patients.

Also the whole teaching hospital thing still feels ridiculously strange every time there's a patient with an interesting disease or pathogonomic symptom and then we all wait in line to interview/prod that person. On the one hand, doctors need to learn and having the first case of MS we see either lucked into by drawing the patient or actually being responsible for an MS patient AS a doctor would be bad. On the other hand, it's kind of like a carnival side show for the unfortunate. "Hey, those intermittent neurological symptoms that your husband thinks you're making up sure must suck. Mind if I smack you with a reflex hammer for the sixth time?"

Some of them are pretty cool though. We saw a case of Stevens-Johnson Syndrome, aka "holy crap, those antibiotics made my skin fall off" and the patient who was pretty much letting us do whatever we wanted in the interest of learning. That one fell under the "Nice so I feel bad sticking needles into them or giving them bad news" category. Wasn't my patient though, so I didn't have to do either.

I'm looking forward to ICU. OB/Gyn will be my next rotation, which I've actually heard is very cool despite my general dislike of humans under the age of 2. Not considering it as a specialty or anything, but hey... I get to wear scrubs.

In other news, NYC had about a 2-3 week period of "Wow, what beautiful weather and such a nice change from the unrelenting heat" right into "HOLY HELL, it's cold outside!". I expected a little longer of "long sleeved shirts" rather than hopping right into gloves, two pairs of socks, a sweater, a jacket, and a hat. But that should mean the ice skating rinks open earlier.

Oh, happy early Diwali to my Hindu associates.

Oct 13, 2009

Zombie hiatus...

Yes, in the eternity of excitement that *IS* Internal Medicine, I took a minute to find out how kickass Zombieland is after the good part of a day was spent with the roommate scarfing Indian food, costume-shopping, tea-drinking, and Times-Square-smack-talking.

Friday was kind of a crappy day at work, made better by having Daniel come home about 30 minutes after I did and suggest Maria's Happy Hour. Hells yes.

Saturday was shopping day; I have new clothes, shoes, and smiles. Then Saturday night with the Maenad and her fair god of wine at the Slipper Room (hosted by a Sealboy) followed by a wine bar. Good times.

Sunday, hit a travel expo with my mom after taking her to an awesome lunch in Nolita. The distinguishing part of the day after that was trying to zipline while keeping my dress "family friendly". That took some doing, and I'm sure there's some youtube videos showing where I failed.

Now, to undo the debauchery of the weekend!

Oct 1, 2009

It would take less time to treat TB than present it

Hi again, I'd have updated before, but uh... well, IM is IM. About 20 minutes of patient contact to 5 hours of lecture, so it doesn't make for interesting reading. "Saw a guy I can't tell you too much about because of confidentiality. Fell asleep during morning report. Rounded and learned about biased studies. Fell asleep during noon conference. Learned about DKA. Went home. Did USMLE World questions. Engaged in either the activities of A: "Going out" or B: "Staying home, drinking a glass of wine, and watching the Big Bang Theory/True Blood."

Rinse, repeat.

But now, I've spent the better part of two days doing exactly what I did in college when I needed to write a paper, which is consult entirely too many references, read them, know the first halves so well that I could reproduce them from memory into machine language, and extensively work up the first part of the presentation/paper before getting bored with the topic, stay up too late, and ram all the conclusions together, which is where the punchline of the study usually is. Thank goodness for abstracts and Mountain Dew.

Pretty much, I want this presentation to go well so I can both avoid boring the living crap out of my colleagues (a tall order after an entire day of lecture) and more to the point, avoid continuing to present the impression that I am completely useless to our chief attending. Thing is, since he makes me nervous, I don't tend to screw up in front of anyone else, but the second I get within shot of this guy, my (on vibrate!) cell phone starts pumping out the MP3 player at full volume with no discernible motivation, I lock myself in or out of conference rooms, and drop things. Oh, do I drop things... papers, pens, stuff out of my pockets while picking up papers and pens, books; I'm just glad I haven't been around him while trying to transport a patient or there'd be someone with a fresh orthopedic consult thanks to me.

Not like I can say I'm having too rough a go of it. I'm still enjoying my life; I'm still enjoying this big wonderful city, and I am absolutely giddy over the notion that it's *actually getting cold*. Maybe I'll regret this come February, but four months of unrelenting un-airconditioned-above kitchen mugginess was enough and I am basking in the fact that last night I got to sleep under that Ikea comforter I bought back in May, rather than relying on ice packs and fans.

What else... the loan checks came in just in time for everyone, though I made the mistake of hauling ass to a nice Wachovia branch (couldn't find one in Brooklyn) while looking scruffy. So naturally this prompted a full jeans-t-shirt take and an evaluation of my check. For reference, this check looks like it was issued by the federal government. It's got freaking heat and fingerprint sensors on it.

"Have you deposited these checks before?"
"No, they were being sent to my father and he deposited them."
"There's no Wachovia branch in Grenada."
"Is there a problem?"
"Well, does this check look different to you than before?"
"Ummm... I didn't see the previous ones, so no."
"Because they look completely different."
"It should be from St. George's University."
"No, it's from University Services LLC." (Oh, my frigging bad)
"When was the last check deposited?"
"One in May; one in December or November or something."
(Pause... she prints something out)
"You see? This is the one from May. It looks completely different."
"I don't know what to tell you. You can call them."

So she takes my driver's license, has a fairly hushed conversation on the phone to which I got hints of "No, she only wants to deposit it". At this point, I'm vaguely wondering if I'm going to have to explain myself to the police for daring to try to deposit a check of greater value than someone of my general appearance would get from a "Check into Cash" place.

All that and she got authorization, but then kindly but firmly tells me she's placing a hold on it until October 6th, which is one day after my rent's due, but whatever. I figure it's just the standard, but apparently the holds are determined by the branch, which meant after determining that I was not the world's most brilliantly stupid villain (I can create perfect heat sensor checks, but then choose to defraud banks by depositing them with no cash back to my verifiable bank account), she still thought I was so suspicious that we needed over a week to make sure I wasn't pretending to be an airline pilot from Pan-Am or something. So I'm gonna throw away those jeans, I think.

Uh oh; what's this? It's lecture time!