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.



Enjoy!

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.

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.

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.

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.

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."

Outpatient clinic

Just finished three days of that... well, not today, more like Friday.

In psych, we do 6 weeks total, and the vast majority of that is at Manhattan Psych, which is an inpatient facility. Three days of the rotation; however, is at the outpatient clinic in Harlem, aka, right down the street from the Apollo, which is cool. Should have gone over there, but ended up wandering into H&M instead, and spent the evening at Arlene's Grocery over in the Lower East Side, the LES being "where I spend most of my time when I'm not at the hospital". My roommate's love of LES got me hooked and the music kept me going. So far it's delivered two fantastic live music venues, a 'burlesque' show that... uhhh... well, has a serious case of Glen or Glenda, a hookah bar, good food that isn't hideously overpriced, and so on.

Today, I caught a ride to and from Jersey to a wedding party, which was fantastic. I got to see the "Garden State" part of Jersey with winding green pastures going up through increasingly dense forests to arrive at a sprawling beautiful property with a salt water pool... and an open bar... and bbq. The bride is one of my sister Tori Amos fans and presented me with both the cd I'd lent her, and a jacket from Scarlet's Walk, which means if we're the same blood type, she's owed a kidney. I think I already owe someone else my other kidney, so if both collect at the same time, I'm going to be in some serious trouble.

But, going back to psych, because what continuity? Uhhh... outpatient clinic was interesting, but not interesting in the same sense as the acute psych ward is, which was not unexpected, which is why I spent part of Tuesday sulking that I had to spend the rest of the week doing outpatient. Then I remembered that since the outpatient clinic is in Harlem, that means not having to take the Ward Island bus, which means I got to avoid things like people that stare fixedly at you for forty minutes saying "Your skirt's chocolate brown. You like chocolate brown? Melts in your mouth, not in your hand... chocolate brown... yeah.." Fantastic.

Why are there weirder people on the buses than on the subways? Well, usually.

Being at the outpatient clinic also means we spent quite a bit of time between patients no-showing and such reading charts... which sounds uninteresting until the backstory on some of the patients is revealed, which is kind of like watching true crime shows. Even saw two charts for a serious case of folie a deux, which sadly, I know about because of the X-Files. This dorkitron knowledge bank did not start with House, nor will it likely end there.

Staying in tonight

At long last...

Sooo the stuff they say about the psych rotation is pretty true. I'm actually learning a lot, but it is still pretty much like being on vacation, particularly since it's my first rotation and I just got my loan check.

But where was I. Ummm... whew, awesome parties; awesome clubs; awesome bars; awesome restaurants; awesome sites; awesome free Fridays at MoMA; awesome friends; awesome experiences.

That sounds about right. But you people may actually want to know something about what I've been doing school wise.

I'm getting more comfortable in the psych hospital environment. I'm getting to know the patients on my floor and which ones are pretty benign and which ones it's a good idea to make sure I'm standing behind a nurse if I talk to them. Today, due to the rain and a bit too late of a hookah night, I walked in a few minutes late. My patient says "OOOOOOOOH, you gonna get fired! You late!" She then tells me I should have my hair in a ponytail and tries to sculpt it into one. Then, as I was being let into the morning meeting, she yelled "SHE LATE AGAIN!!!" over my head, to the staff's amusement.

There's a new patient who's apparently King Allah and a kung fu master. He's got crazy eyes. I'm looking forward to that transition.

The nearly catatonic man is actually making demands, claiming he wants to see the doctor because the man talking to him is "just a nurse", and upping his activities. The staff refers to this as "You woke him up; you fix him".

It's cool stuff. Nearly every day, our doctor gives us an assignment to read from the Blueprints Psych book, so we present, and then he gives us about an hour lecture on whatever the topic is. He's not a big fan of personality disorders, so the psychologist borrowed us yesterday as none of us had anything to do, so we got a close on personal contact on all the Cluster A, B, and C disorders, complete with him doing imitations of the patients. I really like the people at this hospital.

Oh, though there's one medical doctor that's after anyone with small obnoxious habits, so naturally I'm patient zero. He's grabbed my wrist once (I was playing with my watch band), my pen once (no bad habits in front of the patients!), and the psychologist's pen twice. Noooo idea.

We have some lectures; some of them are really good and helpful; some less so. They also have grand rounds and case conferences that a ton of people in the hospital attend, so I've been to a bunch of those. I've been up to the treatment mall to watch some of the patients' classes. We learned about some famous people that had gone through the program as well as the profiles of a few of the more... uhh... criminally memorable people in Kirby.

So no complaints! In my non hospital time, I've pretty much been finding a new venue every night, but tonight I needed a night off to catch up on sleep.

Favorite conversation of the week

Staff member, referencing a patient that keeps acting out and getting sent back to our floor: "What's wrong with this guy?"

Doctor: "He's an asshole."

Staff member: "Is that an Axis II diagnosis?"

Doctor: "It's Axis 6. He's an asshole."