Rite of passage

There are a lot of important milestones during the medical student's career. The White Coat Ceremony, clerkship, getting our first pagers, being on-call, receiving our MD degrees. All things we experience as we journey on our path to full-fledged doctory-ness. But there are also those other things... other not so pleasant tasks that as medical students we must experience as well. Being pimped by an attending? Accidently oversleeping when being paged? DREs?

Well as luck would have it, I may now cross off the latter from my list.

DRE's fyi, is the fancy medical term for when a doctor inserts his/her finger into a patient's rectal canal. This way you're suppose to be able to feel the prostate, masses, cancers, etc. etc [I say 'suppose to', because let's face it, I didn't really know what I was feeling for and I think neither I nor the standardized patient wanted to prolong the procedure].

This week for clinical skills was our male reproductive health session. That meant having the SPs (I really hope they got reimbursed very well for this session) teach us how to examine the male patient's .. how do you say it nicely... 'tenders' (as said very apropos by Po in Kung Fu Panda) along with the DRE (Po, incidently has a very nice DRE face going on here).


We watched a video on basic how-to's, then were paired off (guy + girl) with a tutor and SP to practice what we learned.

Yeah, initially it was sort of awkward. But whatever, I man-ed up, put on my serious/professional look and just did it. To be honest, my guy colleague seemed much more nervous than I. The only thing was that I kept asking the SP "are you sure this is okay?", "this isn't painful is it?" because honestly, some of these things didn't look too comfortable (uh, inguinal hernia exam? 'Nuff said). Fortunately, the SP and tutor reassured the female half of the group that it wasn't.

All in all it went better than I thought. At least I remembered to use lubricant. Unlike poor 3rd yr med student Deb Chen (watch at 2:30 especially):




Countdown to X-mas Break: 1.25 weeks!

A Chicken a Day

...keeps the med students' stomachs happy. So on Monday evening, after the Nephro exam, our honourary class president, Dr. Kidney, held a dinner for all 100+ of us. As you might have guessed from my oh-so-subtle title, it involved chicken. Roasted chicken to be exact. It was very nice and yummy and VERY thoughtful of Dr. Kidney to sponsor this for us. This leads me to conclude that : a) he is awesome b) he is generous c) he also must have a lot of "disposable" income. (Actually, he was also nice enough to pay for our course manuals and course notes for this block, which is way more thoughtful than expected since I probably spend like 5 hours a week just printing those stupid powerpoint slides... grrr...sorry I digress).



Anyways, yesterday was our annual gingerbread house contest. It's held to raise money for our various class charities. This year Truffles, cramberry, Doodles and I went with a pink and blue theme (okay fine so this isn't a real theme... we admit that we went to buy candy 30 minutes prior... and this is what came out).


In honour of our nephrology block (and maybe to sway Dr. Kidney's opinion, seeing as he is the judge), I also created our very own gingerbread nephrologist! With glasses, kidneys and bladder! Yay! Notice the anatomically correct bladder, with trigone included! (some people have mentioned that it looks like he has ambiguous genitalia ... I beg to difer.. they're kidneys, ureters and bladder! Bladder!!)

Fun times all around. Almost makes you forget that finals are in 2 weeks. Almost...

Countdown to X-mas Break: 2 weeks!

CODE BLUE

It's going to be a very post happy day! After some nudging and hinting on Stuff's part, I've decided to get my act together and post (after a long hiatus - see Stuff's most recent entry for excuse) about the Code Blue event Cramberry and I just attended in the ICU department.

We walked into the ICU conference room to see 1.5 plastic dummies and 2 cookies on the table. The cookies were left over from another meeting earlier in the day and have no relevance here, I mention them only because I was near starvation at the time and couldn't stop looking at them as my blood sugars dipped into hypoglycemic territory. I say 1.5 dummies because one was only half a dummy: torso and head with no legs or arms. The other one (with all appendages intact) was lying next to a crash cart (defibrillator + pharmacy + medical supplies on wheels). There were 10 medical students in attendance, all there to learn how to 'run' a code blue from an ICU doctor.

Dr. B started by walking us through all the components of the crash cart: how to turn the defibrillator on, adjust the voltage, slap gel pads on the dummy, apply the paddles, yell "CLEAR!", press the orange buttons, check rhythm, etc etc etc. (You know, exactly like how they do it on TV). She also went through all the components of the drug box: atropine, epinephrine, amioderone, lidocaine... basically the entire pharmacology section of our cardiology block in a little metal box (Stuff would have loved this part. Me, not so much). There are also two little bright orange pylons on the crash cart to put outside the doorway of the patient's room - just in case the hordes of people within weren't enough indication of a code blue situation.

We then split into two groups of 5. Each group had a leader, a drugs person, the electricity person, a chest compressions person, and the airways person. We took turned running codes on the dummy (popular codes include... "patient is awake and talking with slow heart rate!", "patient has pulseless electrical activity!", and "patient has arrested and is in ventricular fibrillation!") for about an hour. I got to be chest compressions person and electricity person for 2 separate cases. Unfortunately I didn't get to do the "CHARGE UP TO 200V! EVERYONE CLEAR!" spiel all us baby-doctors dream of yelling out - the case in question was of a bradycardic (slow heart rate) patient who needed pacing... so all I got to do was unplug the paddles and plug in the pacing pads. Boourns.

On the plus side, I did get to practice intubating on the 0.5 dummy at the other end of the table - the trick with intubating is to slide the metal laryngoscope into the mouth and stop just in front of the epiglottis (flappy thing over tongue), then push out HARD without chipping teeth or breaking any laryngeal cartilages to expose the arytenoid cartilages, then slide the tube into the trachea without going into the esophagus. I did it! It was glorious. Hurray for me! Hurray for 0.5 dummy!

Oh, and in case anyone was worried about my hypoglycemic state, Dr. B ordered us pizza for dinner. It was good. And that my friends, is how a fake code blue is run.

Countdown to X-mas break: Still 3.5 weeks!

Everyone poops ... and pees too

...unless they have some obstruction or neurogenic condition, but then I guess it'd be more of a dribble, constant flow or... uh.. too much info?

So, as you can sort of guess, these past few months have been our bodily function blocks, otherwise known as Gastrointestinal and Genitourinary. Intestines and kidneys! Diarrhea and constipation! Poop, pee, poop, pee... and more poop! Hurray!

Okay, so I know there's more to it than that. Obviously... it's part of the reason why we've been MIA for so long. Sorry! We're okay, we've been here, just stressed and overwhelmed with lectures and assignments and exams and research projects, and life... but surviving though. The courses have been intensely detail-oriented, and GU especially has been particularly cerebral. Take today's lecture on proteinuria, or protein in the pee, as an example: there are two types, micro and macro, which may be transient, orthostatic or persistent. Now, persistent proteinuria can have 4 different kinds of proteins excreted, one of which is glomerular proteinuria, which can have primary or secondary causes which in turn have their own bazillion possibilites, etc, etc... You get the point. And that was only HALF the lecture! We still had to go through hematuria (blood in your pee) which had its own long, convuluted flow chart... kinda like glomeruli and nephrons! (Oh gosh, I'm nerdy). I felt like I was in a real-life choose-your-own adventure story, except every story seemed to end in glomerulonephritis. I guess it is as the docs love to say, "Clear as mud, no?"

Along with all these brain-frying lectures have been our clinical skills sessions. They've mostly been really helpful and help us consoldidate what we've learned (or were supposed to have learned last year... *cough* MSK *cough* anatomy) thus far. And all the docs (specialists in whatever speciality we're learning that week) have been really good... at least when we've had them (let's just say our pediatric sessions were spent mostly playing with the cute babies, and when asked by the parents whether we wanted to examine anything, it was replied with a prompt 'Uh no, that's okay.')

One thing about the ever-prepared medical student in clinical skills is that I get asked a lot for supplies. Paper, gum, pens, highlighters, and hand-cream. Yeah, hand-cream, because all that hand-washing and MRSA prevention does make one's hand get kinda rough. I shouldn't be surprised, but I just didn't anticipate from my guy colleagues (boo...how sexist of me!). At today's cardio session:

S
Hey Stuff, do you have hand-cream I can borrow?
Stuff
Sure... uh, but it's scented. Is that okay?
S [hesitating slightly]
Scented?... like girly scented?
Stuff
Um... yes, yes it is
S
Uh..... it's some fancy pefumey stuff isn't it? Okay, well thanks anyway.
[30 seconds later]
S [looking at his hands]
Actually, can I get some of that?
Stuff [handing over the lotion]
Sure!
Dr. Cardio
Okay guys, let's go examine the patient
[S walks out first, a scent cloud of Vera Wang by Vera Wang trailing]
S
Oh man
Stuff
Hey at least you've got supple skin now

So if you ever smell a bunch of med students smelling like Vera Wang, well you know where they go it from.


P.S. New skill I have perfected this year.... sleeping in lecture... I am awesome at it... Truffles, what with your grunting yourself awake and dreaming about clapping in class, have some practicing to do. =P

Countdown to X-Mas Break: 3.5 weeks!

Back to basics

Time flies when you're having fun... or are over-worked and stressed. Work was great, the research (though overwhelming at times) was interesting, the docs were awesome, etc, etc... But faster than you can say 'medicine' here we are back at school again. Summer sure flew by quickly and bam, before you know it, we're in second year. As in we've passed first year. As in WE'RE the senior pre-clinical med students. As in we're one year away from actually having to take care of REAL patients. Gah! So, so, so scary.

Second year has really started off like first year never ended. No intros, no 'hi, how are you's', just straight into endocrinology and all them hormones. I guess learning about stress hormones by getting the students to release their own endogenous cortisol is one way for us to learn.

Classes this year are now in the afternoons. Good news? More sleep time. Bad news? Less time and therefore inclination to study... ugh...

Yesterday, I had a little accident that lead to a huge query on stuff we learn in school. Let's just say it involved the kitchen knife, my index finger and lotsa blood. Needless to say, after my botched attempts at first aid I was left with the question on whether I required stitches or not [luckily I think not]. This left me with my question... When do we learn about these 'practical' issues in medicine. Sure, we've learned that Cushing's Syndrome is due to cortisol excess, and that there are two types of calcium channel blockers, dihydropyridines and non-dihydropyridines. But how do you set up an IV drip, or give a person a needle, and most importantly, when, WHEN does a cut require stitches?!

I know, I know. We're supposed to learn this all in clerkship. I guess it's true what they say, third year's going to be straight into the deep end, head first and all. Trial by fire, eh?

Ouch!

Bad news? I hurt my back yesterday. It was so bad that to bend, change positions, basically MOVE was excruciatingly horrible. I was going around like a 102-yr old man who needs a cane. Ugh.. so yucky.

Good news? I work in an office filled with docs who are very willing to give you an opinion/diagnosis/treatment all wrapped into one.

Yesterday when I went into talk with Dr. BossMan, I had to gingerly lower myself onto the chair. But even small movements like this caused me to yelp out in pain, which led to him asking what the matter was. When I said I hurt my back, he (so like a doc) did a quick HPI, then went on to tell me about HIS back problems last year where he had a herniated disc which led to an L5 radiculopathy and foot drop. Uh, not very comforting. Good for me was that I didn't have any neuropathic symptoms. So he gave me two ibuprofens and told me to take them (I'm a good patient so I did as I was told).

Unfortunately, this did nothing and the pain progressively got worse! Ugh! So I was hobbling around the place (trying to compensate for my weirded out back) when Dr. C, I guess noticed my strange gait:

Dr. C (in a super nice voice)
Did you hurt your ankle Stuff?
Stuff
No, I threw my back out.
Dr. C (again, super sweetly)
Oh... that's horrible. Do you want some ibuprofen? I have some right now I can give you?
Stuff (internally dying from the whole swoon-worthy conversation)
Oh no that's alright. Dr. BossMan just gave me two.

Okay, altogether now.... AWWWW... Gosh darn it...

Now brace yourself. It only gets better. Today, as I stormed into the office, being in a huff because I was slightly late, I rushed past Dr. C who was standing at the shiny, new espresso machine (daily ritual for all the attendings):

Dr. C (calling out to Stuff)
How's your back?
Stuff to self
Gah! He's talking to me again! Okay, no facial vasodilation allowed.
(gives pained look to Dr. C)
Dr. C
Oh no! Did you take ibuprofen? I can give you some if you want.
Stuff(swoons)
No that's okay, it didn't really work yesterday.

After said swoonage, and as I was coming out of the bathroom, I noticed Dr. C, the research coordinator standing outside Dr. Nice's office. Guess what they were discussing?..... Yep... my back

The RC & Dr. C seemed to think that I needed naproxen, or maybe try some more ibuprofen +/- acetaminophen (Dr. C, aka the human pharmacy it seems, tells me he has both). He also asked me to show him where the pain was & if it extended down the legs (see! see! so doctory). Dr. Nice, however, thought I should just try to rest & sleep it off. In the end, the consensus was to give ibuprofen another try...which I did.. and lo & behold... it worked!

So I've been (relatively) pain-free for the rest of today, and am crossing my fingers this whole business is not due to placebo.

I've said it before, and I'll say it again... I love me MY docs!

P.S. Truffles, I have one week to get over this 'sine curve' that is Dr. C =P
Please remind me next week.

Perks...

...of being a research scutmonkey? Free medical advice!

I kid, I kid. But really? It's that you do get (relatively) easy access to world experts on different medical areas. Want to know about ventilators? Last door down the hall. Subarachnoid hemorrhages? Right next to that. It's pretty cool, come to think of it. Just wish that I more time & ballsy to ask sometimes.

Today was what you call a two-for-oner. You see I'm currently doing work on a study on ARDS. Dr. BossMan is supposed to be a world-expert on this. I am not. This is why today I had an appointment with him to go over tons of patients chest x-rays (CXRs) to determine whether or not they actually had ARDS, so that I could start & finish data collection. As we were going through the first couple, he asks me 'if I want to learn CXRs or not.' Um... do you even have to ask? If you can't tell by now, I, Stuff, am a huge nerd. So given the chance to learn about reading CXRs with an expert? Of course! I was just waiting for him to offer.

It was good. He talked about air bronchograms, looking at the heart borders, lung volumes, atelectasis. Showed me what he was looking at (because honestly, those air bronchograms are tough to spot... Sometimes you have to squint really hard... I wasn't sure if I was imagining things or not at times... Kind of like the JVP huh?), quizzed me a bit, asked me what my diagnosis was before he gave me the answer (which was really scary at first, but it's actually quite helpful). Put up with my inevitable stupid questions. You know, all that fun stuff.

I was a lucky girl today.

P.S. Apparently doctors here hate getting their picture taken. I'm trying to update the research board and NO ONE at hospital número 1 is replying me

You know it's bad, when my admiration for Dr. C is going down because of this. Not replying to my email? Grrr...I'm offended. I think he's avoiding me because he doesn't want his picture taken. And Dr. BossMan has a million excuses for not giving us one. Double grrr...

Unluckily lucky

I must be a magnet for bad luck. Walking into doors, getting splashed by cars, gum on the shoe, that's me.

Today was out to lunch with Dr. BossMan again and us research assistants. It was a nice day so naturally we took a patio seat, under the sunshine, trees AND (duh duh duh - ominous music) the birds. Birds, or pigeons to be more specific, don't like me. They like to block my path along sidewalks, come up to me for food and fly over my head, dangerously close. So I should have known, or expected that together with my luckiness with the unlucky, something like this would happen.

Happily eating my sushi (comfortably this time, because Dr. C is on call this week and thus could not come) I did not realize that somewhere an evil, evil pigeon decided to have a BM right onto my chair, where in that exact spot my jacket was lying. And of course, being me, I did not notice said leftovers of that evil bird's dinner and touched my sleeve to it! All together now... EWWWW


Yup, I was pooped on. And as luck would have it, the ENTIRE TABLE saw it. Dr. BossMan, two of the fellows who'd come along, the research coordinator, ugh.

They say that getting pooped on by a bird is actually lucky. Tell that to my jacket, and my pride. I'm gonna go now to wash this 'luck' off. Hopefully, something better will fall on me tomorrow.

[Do you think I should buy a lotto ticket just in case? ]

P.S. Truffles, my dislike of birds does not extend to your bird. He and I like each other just fine. It's okay by me if he still flies on my head (so long as he doesn't BM me).

P.P.S Overheard one day while in office:

Dr. Nice [huddled around ultra-new 'espresso' machine (which apparently grinds, froths, steams, brews... I'm surprised it doesn't make a cake too!) with residents before 'teaching.']
So if you want to have an espresso, you add 30 cc's of water

Ah, sign of career melding into life.

A Jonah Day

Anne, by what somebody has called "a Herculaneum effort," kept back her tears until she got home that night. Then she shut herself in the east gable room and wept all her shame and remorse and disappointment into her pillows. . .wept so long that Marilla grew alarmed, invaded the room, and insisted on knowing what the trouble was.

"The trouble is, I've got things the matter with my conscience," sobbed Anne. "Oh, this has been such a Jonah Day, Marilla. I'm so ashamed of myself. I lost my temper and whipped Anthony Pye." - From Anne of Avonlea

Haven't we all had one before? A day like today, when nothing seems to go right. I should have known. I woke up with a weird nagging feeling that made me NOT want to go to work. Ahh! That never happens, eager beaver that I am! But the feeling was there, and I seriously didn't really feel like going in today [see Truffles! I told you I had ESP....we seriously need to do a case report on this instead of our ethics project]. But in I went anyway, and I was still excited and pumped to get some interviews today.

Alas, good plans are often laid to waste. Why? One condition of the study I'm doing is that we have to talk to the clinical team first before talking to the families. Fair enough, as 99.99% of the time they know a lot more than me and can offer a lot of insight into how the families are feeling at the moment. But sometimes (especially now, aka beginning of the 'school' year for residents when some residents are very new, and some have never been in this type of unit before, much less know or care about the study I'm doing b/c I'm sure they have much more important things to think about, like maybe saving lives?) it can be real pain to do this. Because like I said before, a lot of the residents are really new, some fresh out of med school, so they can't really answer my questions. Actually, some are really confused as to why we're asking (bugging) them with these questions in the first place. Another thing which is annoying is that when I want to talk to them, I can never find them. They're either (1) at teaching (2) eating lunch or and this is the big one (3) rounding. Yup, at the new place, it seems like rounds go on and on and on for the whole day. So much so that... get ready for this... I'm beginning to ... really... dislike them! Ahh! What's happening? But honestly, it's really frustrating when you want to talk to the family who's standing right in front of you, but can't because you haven't spoken to the docs who have been rounding since midnight or something. Okay rant done.

Yeah, so no interviews, who cares right? But if you're like me, when it rains, it pours. Our 'office' in the other hospital is actually a floor up from the unit. So when you want to go to the unit, you have to walk down some stairs and then unlock a door which will lead you right smack into the middle of the unit. Normally, very convenient right? So today (being the enthusiastic research assistant that I am) in my excitement, I ran down the stairs and flung open the door HARD... to find 6 heads turned in my direction, and on them, 6 pairs of M.D. eyes staring at me. Yup, I had walked right into the middle of rounds. What made it worse was that I had to walk into the middle of their little huddled circle, move in front of the attending, while muttering sorry, sorry, excuse me, excuse me, in order to get out. Oh the humiliation.

But I'm not quite done yet. Later on in the day, I had to go retrieve a poster from one of the attendings, let's call her Dr. NEJM. So I went to her office, knocked loudly. I peered into the window and to my horror saw that she was talking on the phone. At the moment, I thought of 3 options A) This was a nightmare B) Run away C) Hope that she hadn't heard me. But of course, she did, and she opened the door. Groveling began. Worse yet, she told me she was talking on long distance! But thank goodness Dr. NEJM is as nice as she is smart. Poster in hand, I walked/ran away quickly to my desk.

So pheww what a day. Of course you know what the only cure for a day like today is right?

A bowl of ice cream and window shopping on the net for Louboutin shoes

Dressed to Impress

Working in a hospital, or I guess any city urban-ish type building, in the summer is horribly confusing for one's central nervous system. I mean the axons from the spinothalamic tracts going to the temperature/somatosensory cortex part of the brain must be horribly confused.

Why you ask? What is the source of such confusion? Ah, well during this time of the year when the outside weather is sometimes ... how do you say... clothing optional, well the temperatures indoors are often hypothermic (is this a word?).

So the dilemma for me and almost all other office workers in the city is how to dress in something that won't give me heatstroke when I'm out and about, but at the same time will protect me from the sometimes Arctic-like temperatures at work. Temperature control is definitely not this hospital's best suit. Take our old offices from last year as an example. Since Dr. C's & our (research scut-monkeys) offices were joined and only separated by a temporary wall, you'd think they'd be the same temp no? Alas, this was not the case. While ours was often mind-numbingly cold, his was feeling hot, hot, hot, ole, ole, ole, ole. I guess that's why he found it weird that I was always wearing a scarf around the place.

I guess you could say that the new offices are an improvement. At least they're all uniformly cold now. So what's the solution? This is now where I, ladies & gents, introduce the concept of layering. Yup, winter sweaters are necessary work-wear at this office. Unfortunately, my sad hoodie does not exactly convey professional research assistant, no matter what I'm wearing underneath. That's why I've been looking to no avail for a solution to this problemo for awhile ...until now...

Introducing our official department fleece/sweater/saviour from the office AC that has a mind of its own. It's kinda like the one below, except it has our department logo and is therefore cooler, because you know we're the best and all.


The nurses and attending docs all have one. Dr. C has a red one that looked kinda like this, which I particularly wanted but I sadly couldn't get because I'm not part of their special club or something, something (so what if I'm not technically an MD. I'm 25% of the way there)...


But long story short, my problem has been solved! I'll be warm & toasty while at the same time looking like I actually work here and am not some random kid who just came from basketball practice or something. Woot!

P.S. Dr. C moment of the day:

Dr. C [with new swoon-worthy haircut]
So what are you up to these days? Entering data?
Stuff
Uh, well I'm doing some interviews with families, and yea I'm finishing up some charts.
Dr. C [with look of pity and empathy]
Ah [pause] good luck with that
Stuff to self
A doc who understands the toils of the underlings? [double swoons]

Inspired

Every once in awhile, something comes along that really wows you. A moment that you play witness too that truly, truly inspires you.

Where I work in the hospital is a place that's filled with the sickest of the sick. Incredibly tragic cases where sometimes there's almost no glimmer of hope left. Young, old, men, women, large families, or no one at all. I've seen so many. Heartbreaking. At times it makes you question, what's the point? It's hard feeling so helpless, when even the doctors don't know what to do.

So it's a wonderfully incredible surprise to see that sometimes there is a chance. Yesterday following rounds, a lady stopped one of my co-workers in the hallway, telling him that she knew his face. Apparently, her husband had been in the unit some time ago, and we had interviewed her for one our studies. He had been one of those cases. Where all hope seemed to have gone. Survival? Unlikely. A 'normal' life where he could live independently? Almost unthinkable.

But here she was, introducing this smiling, jolly and healthy looking man as her husband, the same person who 6 months ago had maybe a 10% chance to live. He had some residual problems from his illness, but here they were together, alive, happy and well.

The wife asked us to lead them back to our unit so that she could see the people who had taken care of her husband again, to introduce them to him, to show them that he was okay now, to thank them. They held hands as we walked there, and she especially was beaming from ear to ear. We asked them to wait as we went to tell the nurses they were here. She wanted to see one in particular. When he came out, it seemed all the emotions within herself poured out, not wanting or willing to be contained. The tears flowed from both, but they were obviously tears of joy, happiness and gratitude. They hugged each other for a long time. Other nurses gathered around and congratulated the husband, telling him he looked so well, telling him that his wife never gave up on him. Dr. C & Dr. Nice were around too. They were seemingly shocked by the situation as well. "You see," said Dr. Nice, "everyday we deal with survival, if they'll live, not necessarily how their lives will be after." So it's hard for these doctors, nurses or even I to picture how these patients do once or if they leave the unit. I was transfixed by the entire situation. Wowed and humbled by the fact that even with the knowledge we have today, things can still truly amaze you.

Being there that day, even though I didn't know the patient or his wife, made me feel very honoured. As an undergrad who was interested in medicine, and even now as a medical student, I was & still am often asked why. Why do I want to be a doctor? Why do you want to practice medicine? It's a hard question. I'm often at a lost for words when I get asked this. It's hard for me to really define or put into words what drew me to this profession. What I do know though is it has a lot to do with moments like this. The way the patient made it despite all odds. The way I felt then & there when I heard their story. And if I'm lucky, the bond the lady and nurse had as they hugged each other and cried because they had made it through together.

As Dr. C put it "it's not too often we have them, but sometimes there truly are miracles."

Breath of fresh air

Week 2 of being at the new hospital. Good news it that I found the microwave. Even better news is that there are TWO microwaves. Hah, beat that old hospital!

Okay I admit, I caved and went back today. But only because I forgot stuff there! Okay, so maybe I was a little lonely. Maybe a lot. It's ironic that at the new place I'm surrounded by people in cubicles but you feel so lonely. And the unit? It's not as cozy. Totally fish out of water feeling.

But going back today was not all wasted. Along our travels to track down a patient, we happened upon one of the RTs (respiratory techs) who invited us to observe them 'decannulate' the patient's trach tube (basically taking out a tube that they put into a patient's trachea - windpipe - to help them breath). Again, awesome because 1) I had never seen this before & 2) I had contact with people! Hallelujah!

So they take this tube out pretty easily (it just slides out) and apparently the hole that's left behind will close on its own, sometimes literally in minutes. Skin, cartilage...everything closes. Cool huh? What wasn't so nice was when the patient coughed during the procedure, shooting out some projectile solids, I'd say maybe 5 feet away. That's one strong cough reflex! Glad I was standing on the side for that one.

Another really young attending is on-call this week. Apparently he attended the same med school Truffles, Cramberry and I are at; went through the residency program & fellowship I want, where I want; and is now doing his PhD at some fancy-schmansy world-renowed American Hospital. AND apparently, we really want him back too! So basically, he's living the life I want. Gosh, I love this guy! I hate this guy! So jealous. Do you think I can be like him in 10 years?? He's exactly 10 years ahead of us in training. It's a lofty goal, huh?

The doctors are out...to lunch

Seriously!

Okay, so it looked more like this:


What's the occasions you say? Well, Dr. BossMan took us (research scut monkeys), plus research coordinators and some of the attending docs out for lunch because one of the RCs was leaving.

It was in this cute little café type place where I had some yummy, yummy pasta. Anyhow, Dr. BossMan was there (of course, since he was footing the bill). The RCs, us three little scut monkeys, Dr. Charming, Dr. Nice and two other docs from my new hospital site. Yup, 5 docs in this tiny little restaurant. Good time for any of the other patrons to have a medical problem... maybe not so good for residents left at work or the patients at the hospital

So, it was a lovely meal with lovely food but at the same time it was so awkward. Is it an oxymoron to say that it was uncomfortably good? Does that even make sense?

Like I'm sitting around here with FIVE doctors, one of which is my boss, another of whom I could not even turn my head in their direction, much less look at because they made the blood vessels in my face perpetually vasodilated and erythematous (think about it), who were all discussing I dunno what. It was so very awkward. Should I laugh? Should I nod my head? Should I make small talk? Am I talking too much?! Too little?!?! Am I eating too fast? Too slow?? Too much? GAH!!!

Basically, in the end I spent the time talking to one of my fellow scut-monkeys [who also agreed on the awkwardness of the whole situation] and trying to avoid looking at Dr. C because of the subsequent increased core temperature & all.

But I still enjoyed it. I'm never one to turn down food right?

So, thanks Boss!

P.S. Docs on call having beer? How shocking.

Ears, nose & throat

[N.B. Again people I did not steal this CT from work, tsktsk...what do you think of me?]

Another week, another round of.... you guessed it... ROUNDS (with sushi I might add)

Today was an interesting case - sore throat leading to (not very sure because I was too fascinated & confused by the CT images) a retropharyngeal abscess that somehow got infected and went into the mediastinum. It was complicated..so in basic terms the infection spread from his throat (they believe) down the prevertebral space into the chest and lungs. [Sorry I know there's tons of medical terms but I'm finding it hard to 'translate' them into everyday language]. Anyhow, what was cool about this was that - remember Truffles? - we had this discussion during the ENT block?? Danger zones, prevertebral space, hyoid bone, etc,etc. From Dr. Thyroid aka McSteamy??

Dr. WalkingEncyclopedia then started discussing how this could Lemierre's Syndrome - which to me soundly oddly familiar, because I thought Dr. Bacteria may have talked about this Truffles? - which he said was common in the 1920s. However, none of the (much younger) docs had ever heard of it so Dr. Charming looked it up on... shock upon shock...WIKIPEDIA! Wow. How much satisfaction do I find in this fact? Let's just say I was pretty chuffed.

So basically what I'm saying is that Thursday rounds never disappoint (and no, it has nothing to do with the fact that I can ogle at Dr. C for an hour - please I'm not that shallow). For example, next week, apparently we're having Mexican (okay so I'm not shallow, but I do enjoy free food).

In other news, I am now officially at the other hospital. This makes me sad. I feel very discombobulated with the new environment/people. I can't find my pen! I don't know where the bathroom is! Or how to work the photocopy machine! And worse yet, where the microwave (if there even is one) is! Oh no! It's like the first day of school all over again, except you're like the new foreign exchange student, who doesn't speak the language, and has no friends. Sigh... how lonely... Oh don't cry for me Argentina, hopefully I will pull through

...maybe?

Good to be back

(Last week on Stuff's first day back to work)

Nurse
"Hey"
Stuff
"Hey"
Nurse
"So what the?"
Stuff
"Whaddya mean?
Nurse
"I mean you disappear for a year and now you're back all of sudden?"
Stuff
"Uh, yeah I just finished school"
Nurse
"Oh, so you graduated?"
Stuff
"Uh no. I'm just done first year"
Nurse (looking confused - I don't look that old do I?)
Stuff
"Uh...I'm in med school."
Nurse
"Oh okay, that's okay then."
Stuff (jokingly)
"That's okay? Is it a legitimate enough reason?"
Nurse (thinks for a moment, clearly toying with me now)
"Yeah, yes that's okay."
Stuff
"Does it meet your approval?"
Nurse
"Yes it does. You can come back."
(pats Stuff on back)
Stuff
"It's good to be back"

It's a mystery!

N.B. This CXR of ARDS is from Wikipedia - so no I did not steal the film from work. Have more faith than that people!

Wow. Attending rounds today were...wow.

One of the cases today was of a patient who had sudden unexplained seizures, was subsequently brought to hospital where they developed aspiration pneumonitis. Now they are in our hospital where they have:

1) ARDS
2) Kidney/liver problems
3) Major thrombocytopenia (i.e. platelets - the stuff that helps clot your blood - was in the 20s to 30s, normal is ~140)
4) what they think is SIRS.
5) Is on so much vasopressors (meds that constrict your blood vessels so that your blood pressure doesn't fall to low, & blood to vital organs, e.g. heart, brain, is maintained) that their fingers & toes are actually blue, to the point they look black (I know because the nurse showed us)

In other words, they're pretty darn sick. And to top it all off, they have NO IDEA what is going on with this patient. What is the underlying cause? Could it be sepsis, suggested Dr. Charming? Unlikely, said Dr. WalkingEncyclopedia. They've been on broad-spectrum antibiotics for too long. Maybe TTP, said Dr. Nice (who btw is the only female attending, why are there so few of us??). No, because there were no RBC fragments on the blood smear. Hypertension?? Ischemic hepatitis?? Alveolar hemorrhage?? No clear answers.

This all led to a heated "discussion" between Dr. Charming & Dr. WalkingEncyclopedia (again?!?! I tell you this is a weekly thing) which was highly entertaining (imagine your head going back and forth like Pong but 100x faster, as they fire "constructive criticisms" at each other) but got sort of confusing because they started using all these terms & abbreviations that I recognize but need more time to be able to register in my head. I can't think that fast guys!

So unfortunately everything is just a mystery right now. Fascinating stuff, but tragic at the same time. But at the same time, these "discussions" between the two docs definitely add to the entertainment value. It's pretty funny because you'll know when Dr. WalkingEncyclopedia is really...uh...peeved by Dr.C. It's when he starts calling Dr. C by his full first name. Like Charmingson, not just the nickname Charms. Almost like he's a kid who's in trouble with his dad (probably doesn't help that Dr. C says 'dude' a lot, even during rounds, and sits on TOP of the chair back, tipping it back & forth). But honestly I think that most of these 'talks' are in good fun, and that they actually really like/respect each other. They just have a hard time expressing it. Like a real family!

My thoughts on the whole thing? The only thing I can say is that I hope in 12 years time, those same words and sentences that were coming out of their mouths will be able to flow out of mine as easily.

P.S:

Dr. Charming to Stuff
(who was wearing a particularly colourful pair of rainboots today - Truffles you know the ones)
"Nice boots"
Stuff
[swoons]

Round & round we go

I love rounds. You know on Grey's Anatomy where all the docs hundle in a group & migrate from patient to patient to discuss the case? I love that. In our unit at the hospital, the cases are really complex and you often encounter some exceedingly rare conditions. Like right now, there is are cases of Moyamoya and Lubag. I know right? What in the world are those?? I had to wikipedia them!! (Shhh... wikipedia is the ultimate reference for med students... just don't tell our profs) And it's pretty nice to just stand back and listen to the 'experts' talk. And not be grilled, as in how I was grilled while on a surgery observership:

Surgeon
"Stuff, tell me what muscles I am cutting through right now?"
Stuff to self
Crud, I don't remember any anatomy of the lower limbs.. oh no, he's glaring! Better say something quick..
"Uh, gluteus?"
Surgeon
Gluteus what?
Stuff
"Gluteus..uh.. gluteus maximus?" (aka J-Lo's most famous asset)
Surgeon (who clearly has a 6th sense for this)
"Is that a guess or an answer?"
Stuff
[hangs head in shame]
"It's a guess"
Surgeon
"I thought so"

But the best rounds, as in I have to go to or will be disappointed if I miss them even if when I'm on vacation, are the attending rounds. This is where ALL the all-powerful attending docs come in to discuss the more difficult cases. I love how they bounce ideas off one another, and sometimes even argue (which frequently occurs between the youngest, our very own Dr. Charming, & the most senior doc, Dr. WalkingEncyclopedia - whom we must always call "Doctor" because he's just that sort of guy). It's like House but with real doctors who know what they're talking about! Plus there's free lunch to boot! It's definitely my favourite perk for this job. Today was no different, with some strange cases & sweet Indian food [courtesy of a drug company... I know... but I will not be swayed to use their drug just because the samosas were finger-licking good. Actually, food is usually either provided by drug companies (that's when the food's the best, to be honest) or the attending who's on call for the week].
These are days that make me love my job.



P.S. Our 1st Dr. Charming encounter for the summer. He's dreamy [Stuff's eyes glaze over]. Sigh. a girl can dream can't she? He reminds me of the Sleeping Beauty Prince minus the fact he looks nothing like that, and is not actually a prince, & doesn't wear tights or wield a sword. But he DOES have glasses, & he IS a doctor. [Nor does he resemble David Beckham (who is dreamy in his own right)]

Learning for life

I think that working at the hospital this summer will be an experience. On the one hand, it's a really intimidating place where you're scared all the time if what you're doing is hurting or hindering the docs & nurses working there. But it's also an amazing opportunity to learn. And I mean really learn, and not just the usual textbook reading & memorizing of random facts like Pseudomonas smells like grapes in culture (yea, that's actually true apparently). You get to see the things you heard about in lectures in REAL-LIFE (again not on a power point slide or a pretend actor) and try to maybe just put it all together. Like today I witnessed the use of adenosine for a SVT, which is probably not the most exciting thing in the world but hey, I'm a girl that's easily satisfied.

But a lot of the things you learn at the hospital just can't be found in books or taught in the classroom. Take yesterday. One of my projects for the summer is to talk to the family of patients. It's an interview that's supposed to take 20 minutes max. But at the interview yesterday, talking to the aunt of the patient took much, much longer. At first she just answered the questions, but as she went on, she began to talk a lot more about her own feelings and what his illness was doing to her. The stress of the situation was evident on her face, and although she talked of keeping a positive attitude, it was clear that she too was suffering. She told us things she hadn't told anyone else. Not even her own family. But in a way, I felt that talking about it was therapeutic for her. And for that, I'm glad that I was there.

Today was also an, I don't know how else to describe it, but I guess 'interesting' experience. I witnessed my first brain-death declaration. The doc went through the entire process including pupil reflexes, caloric reflex test (which involved irrigating the patient's ear with 120cc of water), and apnea testing, etc, etc. I found it fascinating but at the same time difficult to witness. Because there was the patient, lying there, seemingly still alive. You could actually even SEE the heart still beating. Yet they weren't. There was no brain function left. The doctors proceeded with the testing, almost cheerfully it seemed. But I guess they were used to it?? It was a heartbreaking and confusing situation. I had no idea how to feel. I still don't.

But this is what I mean though. Learning this summer is going to take on a completely different meaning.

School's out for summer

25% MD!! And one-quarter done, not counting the small, miniscule issue of licensing exams or something. Ce-le-bra-tion time, c'mon...

We've actually been finished classes and exams awhile (May 30th to be exact) but between our rural community observerships, starting summer jobs and European getaways, there hasn't been as much time (or inclination sorry to say) to update.

Exams were, well...exams. Which really means they weren't all rainbows and sunshine, but more like 7 consecutive days of dreary, depressing rain. But at least they're finished with and if my school account is correct, then it actually looks like we survived them and passed! Meaning no summer school for Stuff!!

Right after exams our class was split into small groups and placed around rural communities for a week of clinical observerships and "wining & dining." Whether said wining & dining was not as good as expected because a certain group did not get to go to a promised excursion of theatre, well that's another story to tell (sorry Truffles, I really can't get over it, haha). On the 'medicine' side of things, my week was quite interesting with a fair number of weird & wonderful cases (an undiagnosed case of Raynaud's in an infant anyone or how about some IPF?), as well as some not so rare but nonetheless cool because maybe someone (I dunno who - looking around innocently) knew the diagnosis was pinworm? But I digress. In the end I didn't get to do as much as I expected (i.e. not monkey see, monkey do but monkey see, monkey see & don't touch anything especially anything green or blue) but I had a good time altogether. Some things surprised me, like the fact that I actually liked family med & peds more than I thought I would. Other thoughts on the otherhand were more or less confirmed, like I hate standing in one spot for 3 hours because I am afraid of unsterilizing myself or others who come within 3 feet of my vicinity.

So after this week came my long awaited trip where Stuff became La Stuffé. Get it?? Sigh.. I went to France okay??

And that brings us to today where reality finally sets in and work began with Dr. BossMan at l'hôpital. Apparently I'm going to be banished to work at our other hospital site for the summer meaning (un)fortunately I'll be a shuttle bus ride away from Dr. Charming! Oh no! Where will I get my weekly/daily giggles re his cuteness from?? Ah, c'est la vie... Can't win them all, n'est pas?

[please forgive the French, I am still jet-lagged]

P.S. I find it slightly disturbing that Dr. BossMan and I share the same taste in music. Highly weird feeling to discover that you & him are bopping your heads to a song playing on his CD player at the EXACT SAME TIME. Gah!

Examinating...

2 down, 4 to go!

Question on the Infection & Immunity exam a couple days ago:

Mr. X presents to you with eggs in his feces and segmented flatworms crawling out of his anus. He is otherwise well. Mr. X is infected with

a) Taenia saginata
b) Taeniasis soliem
c) Diphyllobothrium latum
d) Hymenolepis nana

Now, if like Mr. X you too have segmented flatworms crawling out of your back end, today is your lucky day. The organism in question is (a) and you get it from eating undercooked or raw beef.

Answer key:
Taenia saginata - found in undercooked beef. characterized by it's motility: since cows don't eat the grass around their poo, the organisms need to be able to move onto clean grass (after being pooped out) in order to complete their life cycle. hence, it has been known to crawl out of people's ... ahem... bottoms.
Taeniasis soliem - found in undercooked pork. don't need to be motile because apparently pigs eat *everything*.
Diphyllobothrium latum - found in undercooked fish.
Hymenolepis nana - transmitted through fecal oral contact... kids get this a lot.

Medicine is such a grand, noble profession. Apparently, finding cysts of parasitic organisms in stool samples is a lot like digging for a needle in haystack. And for some species, you need up to 5 negative samples before you can conclusively rule out an infection... so it's like looking for a needle in... 5 haystacks so to speak.

Everything comes down to poo.

A Real-y 'un-Real' Experience

The immunology exam is tomorrow. It makes me want to cry. Very much. Right now I’m banking on the fact that it’s pass/fail. Sigh…

On the more exciting side of things, we un-quarantined ourselves again today! Why at the 11^th hour did I decide to go out? You see, a couple weeks ago, we were given the opportunity to sign up for these ‘patient simulation’ experiences. Basically, it was a chance for us to practice our “clinical-decision making skills” on a robot – or SimMan as he is called.

I was scheduled to go into the robotics department at the hospital at 8:15 in the morning with three other people in my class. So I went up to this really swanky, modern office to sign in (clearly there’s some bucks going into this area). One of my group members was just behind me, so we went up together to the next floor where the simulation was to occur. Right away, it was very strange. Lots of computers, lots of medical equipment…essentially lots of expensive looking stuff with buttons that made me afraid to touch them for fear of breaking something. Stuff & computers don’t exactly mix. Anyhow, one of the admin people came to talk to us about the ‘case’ we were being given, as well as the introduction to SimMan. After watching a video, we were told we were going to be dealing with a trauma case, and were handed trauma/isolation gowns and gloves (ooo, how Grey’s Anatomy – I felt very Christina Yang-ish). Gloves! I didn’t know it would be that realistic. Then we were led to the ‘simulation’ area where the ‘patient’ was lying. Our facilitator, who was a doctor in real-life, was acting as nurse in this case. So first impressions? Extreme confusion. I had no idea what to do. And yea it was pretty dang realistic. Blood? Check. Patient talking? Check. Breath sounds, pulse? Check, check.

The ‘nurse’ right away asks us what we want to do. Uh….I gots no idea man! Luckily, some people in the group asked for IV lines, some EKG leads. And we were underway.

Throughout the experience, I had this weird urge to laugh. It was pretty realistic but at the same time, kinda artificial. I think this really was because I was completely LOST, and if this was truly real-life, we’d have killed the guy 5 minutes in. For example, the ‘patient’ was bleeding, and really tachycardic (fast, fast heart rate). When prompted how to deal with this, one guy answered – “um atropine.” Atropine? Guys, atropine actually has the exact opposite effect. We tried it out. The ‘patient’s’ heart began to beat faster and his blood pressure went down even more. So, atropine not such a good thing in this case. Another thing? I have no idea how to give meds. The ‘nurse’ got this syringe for morphine and told me to ‘administer’ it. I thought, yea, I can do this. So I happily started pushing down on the needle, giving the patient the FULL dose. Again, not the best idea. Basically, the whole thing was a lot of trial and error. And lots and lots of time outs.

But we weren’t complete dolts. When we were giving the blood transfusion, I noticed that two of the units had different names and ID numbers than our patient’s. Ah-ha! Can’t fool Stuff! Caught it in time so that we didn’t give SimMan a major haemolytic reaction. Hehehe…no, no. Truffles, wouldn’t Dr. RBC-transfusion be proud?

In the end we didn’t kill the patient. We actually managed to save him, I think. I thought it was a cool experience. I’ve never ever done anything like that, so it was sort of good to have done this before we actually try it out on a real-live person. A lot safer for the patient too I guess (uh, atropine?). It was sort of like throwing us to the sharks, considering I had NO IDEA what to do 99.999% of the time, but it’s part of the learning curve. I only wish it was longer…and not right smack in the middle of exam time. Anyhow, wish us luck for tomorrow! The bacteria are calling out to me.