Goodbye IM
I'm rotating my way out of internal medicine this week. On my week off I will be visiting the Vegas w/the family for a bit, and then probably going to the county fair before I attend a blow-out Labor Day Party on Sunday. Even though I should be studying for the hellish IM shelf exam, I needed a few moments to reflect on my entire experience in these past two months. Consider them 'learning issues' as one of our IM attendings likes to point out, some of it don't have much to do with medicine.
1. Cancer=never funny. Delirium/psychosis(compared to cancer)=absolutely hilarious. It's alot easier and mentally less taxing to find a patients behavior funny rather than being depressed with terminal/chronic illness, because nothing you do seems to be making much of a difference.
2. When you get your newest attending, something will happen that will profoundly embaress you - be it falling asleep on rounds, having someone bring up your dating history, or failing to put in that NPO order for a surgery/biopsy. (It's a really bad day if all 3 things happen in one day.)
3. The hospital is inherently inefficient. Being mad at it won't make your 14 hour, 80 work week violating day any easier. Accept it for now, and hope no one enters you apartment and thinks you were kidnapped 3 weeks ago due to the lack of washing your dishes.
4. You cannot study the weird condition afflicting your patient and the required shelf board material. Pick one or the other and get some sleep. Or do neither and learn to rely on BS to make through.
5. Teams of any type need to be an even amount of estrogen and testosterone. Seriously. It doesn't mean that women or men are inherently bad, but there is a saturation point in which homicide seems feasible. (OB here I come!!)
6. If it is important, you will find a way to get it done - be it talking to a cute boy, making that batch of cookies, or helping a friend through a tough time. It doesn't matter if you haven't slept for days, you'll make time.
Call - AOx2
So I survived another night of call. It actually wasn't that bad of a night. I ran into various members of the anesthesia team, who don't seem to have a ton to do on the weekend w/o surgeries going on. They apear at Codes, intubate, and scamper away.
My intern - whom I love - told me a little after midnight to try to catch some sleep in the med student call rooms, and she'd page me if anything interesting happened. The med students call rooms are a total of 2 rooms with 4 beds in each room. So you are sharing 1 of 2 bunks with other people in the class, and when you drag yourself there late, you find an open bed, don't turn on the lights, and just collapse on that uncomfortable mattress w/o a pillow. You could be sharing your call room with your best friend, worst enemy, or love of your life and you wouldn't know because under NO circumstances are you supposed to wake up the other students.
After popping my contacts out and fighting to find a comfortable position while wearing my pager, I fell asleep around 1. Right before four I woke up with a page that said 'We're admitting a homeless bum. Help if you want.' So I shoved my contacts back in my bright red eyes, tried to not wake my roommates, and hoofed it to the ER. My intern wasn't there. I paged her, waited a while, and then walked back to our normal floor. She wasn't there. Then I remembered that she carries the team phone, so I could just call her. In fact, I could have called her the moment I got the page.
She told me she didn't page me, and nothing was happening. I looked at my pager and didn't see the page. However, in my half-awake state, I could have very easily just deleted the page, the same way I turn off my alarm clock. I mean, I forgot we had a team phone, and that the cancer service doesn't admit bums normally because most of them don't walk of the street with a cancer dx. Of course, I might not have been able to pass the mini-Mental Status exam in my just waking state. (Hmm, she appears to be AOx2)
Normally I would never think this, but maybe there just wasn't a page. Maybe I was that disoriented. Maybe I was sundowning . . .or since all our med school pagers have very similar numbers, it is very easy to mistype and send the wrong service the page. I know for a fact that a med student on psych - whose service regularly admits bums - is one digit from mine. I tend to doubt that I dream of hallucinogenic pages.
The key is not thinking
Things are better when you don't think about them. It's very tough to perform or assist in procedures if you actively think about the fact you are performing them on a live human being. I'll confess; I was a pretty grossed out when I helped put in a central line. Performing a bone marrow biopsy was pretty rough too.
But today, I did an ABG w/o flinching. I've attempted it during my first rotation w/o success, but my resident handed me the needle, told me to do it, and it just happened. I was too busy and too focused at that time to think about the times I hadn't done it well. The ABG needed to be done right then and that was the end of my mental discussion. I didn't have time to worry or be nervous.
So I guess the key is, grit your teeth, be confident, and go all
NIKE (just do it).
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For all the surgical junkies "It's like candy, but with blood, which is SO MUCH BETTER!" - Christina Yang on Grey's Anatomy
Cheating at IM softball is possible
Yes, I know that Intramural softball is only a game, and I know that I really don't like to play softball. (Why don't I like to play softball? I was on the college softball team, and I just didn't enjoy softball enough to want to play it 2-5 hours a day October-June and train for it on the off months.)
IM is different though. It's slow pitch, and everything I was good at is illegal. For example, any form of base stealing and bunting is illegal. I was taught multiple forms of bunting because I was small, lefthanded, and quick. All of those things are off-limits during an IM game. So basically, you hit the very slow moving ball as far as you can. Except I was trained to not do that in college, which makes for difficult batting.
Because of my somewhat apathetic attitude, in a generally amusing fashion, some people think I don't understand softball. Since I've been playing since I was 6, that isn't the case. I happen to not care about whether I get a free IM Champions Tshirt. It's slow pitch IM softball, not the
Rockford-Racine World Series game.
So it was the last inning or our playoff game, and I was up with one out. Someone tried to give me advice (again) 'Allie, all we want you to do is get on base.' That annoyed me. Since slap bunting and drag bunting were blatantly illegal; I dropped a swinging bunt on the third baseline. While not as obviously illegal, it was still illegal. However, I got on base, took second by correctly tagging up immediately when I saw the 2nd out hit on the air, and ended up scoring.
My team thought this was all great and they were impressed. It's not that impressive. It's what I was taught, and is technically - illegal.
It's been a nice day.
The past 24 hours have been uncommonly nice for me. First of all, I got off at about 8pm, and I had about 3 phone messages waiting for me. I called my brother, who is in the process of moving. Then I called my parents since it was their anniversary. Even better, my grandparents were at my house so I got to talk to them too. I'll get to see them in about 3 more weeks.
Then, I got to go out to dinner, that I didn't pay for. With cute boy in tow, I headed over to the med school social event at Skye Bar. For the hourish that I was able to stay awake, I saw a ton of people that I hadn't seen for a few months. Actually, more people wanted to talk to me than I could hold conversations with, which is a little odd to me. Unfortunately, I couldn't quite keep my eyes open and ended up heading home.
Since I wasn't on call, I got to sleep into a glorious - I tell you GLORIOUS - 10 am. Yes, I did wake up before then, but I was able to just keep sleeping anyway. When I did decide to get up, I did my laundry for the first time in 3 weeks. (I have discovered I have enough clothes to last 3 weeks) During laundry I stopped by Giant Eagle to pick up groceries, for the first time in 2 weeks, and got hit on by the bag boy.
I spent the rest of the day catching up on my phone calls, cooking, and studying. I ate my first fresh fruit in about 2 weeks. I had rootbeer floats and some delicious choclate milk, all things I've been missing out on lately. My studying involved me sitting outside and seeing the sun, which once again rocked. It wasn't too hot and not too cold. It was the perfect 'date.' (Have you not seen
Miss Congeniality)
And today I will book my tickets to the
AMA conference in
Las Vegas with one quality abstract behind me.
My day was definitely better than the one other people had in the
airpot today. Can't ask for everything I guess.
heal thyself or not
I'm actually ill. Normally that wouldn't bother me, but right now all of my patients are immunocompromised. I might be a little feverish and a little coughing/sneezing. However, you aren't allowed to really be ill during Med 3 because we have a limited number of days of illness - well, if any. Theoretically, I could have three days off.
Except I'm not going to take them. No med student actually takes them. You just can't. You don't know that much to begin with and every day is an uphill battle. There just isn't time to be sick.
Despite all of that, I am dragging my worsening self to the resident's clinic tomorrow. It's not really about me. It's really the idea of making my patients sick and possibly kiling them. That would be bad.
Still missing
Brian Shaffer is still missing. I can only imagine what an eternity it has been for his girlfriend, Alexis. If you know anything about this or just want to know more -
this site is where you want to go.
(I went to his church last weekend. His father got up and played this song: The Impossible Dream from 'Man of LaMancha)
To dream the impossible dream
To fight the unbeatable foe
To bear with unbearable sorrow
To run where the brave dare not go
To right the unrightable wrong
To love pure and chaste from afar
To try when your arms are too weary
To reach the unreachable star
This is my quest
To follow that star
No matter how hopeless
No matter how far
To fight for the right
Without question or pause
To be willing to march into Hell
For a heavenly cause
And I know if I'll only be true
To this glorious quest
That my heart will lie peaceful and calm
When I'm laid to my rest
And the world will be better for this
That one man, scorned and covered with scars
Still strove with his last ounce of courage
To reach the unreachable starHelp find Brian
Patient issues
As I rotate through Internal Medicine, there is a vast change of patient population between services. You don't really think about it, but it completely changes your mind set about your patients. I always worry about my patients, but I have totally different worries about each set.
Diabetes service: Many overweight patients who don't eat regular meals or take their blood sugars. Most people are chronic and will be in again when they don't do their follow up appointments. I know there are many accucheck using, insulin compliant patients out there, but those aren't the ones in the hospital. The more 'non compliant' you are, the more likely you are to end up here. You check every patient to see if they are going blind, losing their kidneys, or getting horribly deformed feet because diabetes destroyed their nerves. I worry that someday I will be saying that magic word - amputation.
Nephrology: Very few people are truly innocent here. A large number of my patients didn't take care of their diabetes, used drugs and destroyed their kidneys, or did not monitor their hypertension. The government covers the terribly expensive ESRD (end stage renal disease) so no patient worries about how to pay for this. Several of my patients had no desire to make life changes and seemed ready to sign out AMA because I could not fix their multiple health problems. I was more worried they would skip out, come back with sepsis from an infected dialysis line, get into the ICU (again for some of them), and end up back on my service to do it again.
Heme: Most of my patient historys sound a little like this - you've never drank, smoked, used drugs, and have been faithfully married for 40 years with 3 kids, 14 grandkids, and have lymphoma/leukemia. You are completely compliant with all medications and yet, medically, we have not been able to cure you. I worry that I'm going to give you some horribly immuno toxic drugs that will either destroy your immune system to the point that a cold kills you, or after feeding you these toxic substances, we will fail to cure your cancer and we tortured you for nothing.
It's night and day. One month I'm begging my patients and trying to convince them that being non compliant kills. Another month I'm facing the fact that being compliant may kill.
I have a name. Use it.
I doubt any actual doctors read this, but if you become a doctor and you decide to introduce someone to a patient, call them by their name. Not a name you made up, but their actual name. Particularly the one that is probably listed on their uniform or their ID badge if they happen to be an employee.
So I was taking a patient history and actually came upon some pertinent facts that had been missed in the original H&P. I had spent a good 15-20 minutes with the patient and had built a pretty good rapport. I'm just a med student so I introduce myself to everyone by my first name. Well, a doctor saw me and pulled me out of the patient's room because it was late. I shared my knowledge that actually got a diagnosis for the patient and led to an eventual discharge.
Now, most people would be happy about that - unless, of course, said doctor puts you back in the room that where you were just taking a history, introduces you by the wrong name, and then leaves you with the patient to explain his illness. This wouldn't have been an issue if
A)my name weren't written on both my white coat and my ID
B)I hadn't just spent a bunch of time w/the patient
C)the doctor hadn't been on my team for 1 week
I felt pretty disrespected and belittled. On one hand the doctor was expressing his confidence in my skills, while undermining it by failing to treat me like a colleague. It made both the doctor and myself look bad, since the patient was not only aware of my name, since I had told him it earlier, he could
read it!
When I'm feeling a bit sad about med school, or bordering a
TINY bit on bitter, I like to read
SDN and
Panda. I'm not alone.
And knowing that is half the battle. Well, maybe 10 percent. Or 4/32nds. Something like that.
