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!