Another Day in the Life

Today, I basically had FOUR hours to see ONE patient, present that one patient, and write a note on that one patient. If you guessed that I spent a lot of time perfecting that one note, you would be correct. 

I shared the note with my attending and at the end of the day, she provided me with some very valuable feedback that I shall share with you. 


Attending: You did a fantastic job today. You were very comprehensive and helpful, and you developed very nice rapport with the patient. 



My reaction:

Attending: You also wrote a great note. I didn't have anything to add to it.



My reaction escalating:

Attending: But, I changed everything anyway.

Patient Interaction of the Day

Dr: We’re going to turn on the Soothing Pandora channel, now. Although we question some of the choices of music that the play on there.

Pt: What do you mean?

Dr: Well, sometimes they play cricket noises. Or cow noises. Now, I don’t come from here, so maybe it’s different around here, but I don’t find cow noises soothing.

Pt: The only time I find a cow soothing is when it’s on my dinner plate.

Nicely said, good sir. 

I'M TRYING NEW THINGS AND I'M SCARED! Oh, and nipple twerking.

I just converted my blog to a tumblr. Why? I am not sure. The only reason I can think of is because it’s 3:25 am and, although my alarm clock will go off in less than 4 hours, my body still has not converted back to days after my stint on night shift during Labor and Delivery.

If you are also a tumblr fan, here is a link to my tumblr! I look forward to reblogging a lot of great posts and have already discovered some awesome tumblrs to follow! Now... I should probably contemplate the idea of sleep.

I shall leave you with two concepts that I discussed today, in great detail, both with physicians and patients, that you will only ever seriously discuss during OB/GYN. 

Concept 1. Nipple Twerking.

Contrary to popular belief and good timing, this is not a reference to Miley’s recent VMA performance. Instead, it refers to nipple stimulation to increase and continue milk production after delivery.

Get it, Miley!

 Concept 2. Perineal massage.

Enough said. No image required.

Yes. These were both the subjects of medical conversations. Serious. Medical. Conversations.

A Phrase I Could Hear All Day, Errday

So, this may come as a shocker to you... but, I do some pretty weird things. For example, I constantly play this game in my head where I see what prime numbers a sentence can be broken down into... Ex: "I am weird" can be broken down into intervals of 2, but not 3. I also count my steps a lot. Another AWESOME game that I play is what I call the "radio-knows-all-fortune-teller" game. I get into the car and say something like "The next song that comes on is going to reflect my day/explain my day/predict my day/etc."... you get the picture.

Tonight, I blasted on the radio, declared that the next song was going to be the summary of my day, and it was good ole' Travis Tritt crooning "It's a Great Day to be Alive." Thus leading to my blog entry. 

I am currently on my OB/GYN rotation and I spent the day at a high risk obstetrics outreach clinic. The only staff members were the maternal fetal medicine doc, the ultrasound tech, and myself. We had 10 patients and were basically just doing the standard growth and anatomy ultrasound checks. I got to see a few sets of twins, some benign anomalies, and become more comfortable with reading ultrasounds. With 9/10 patients down, I went to review my notes on the last patient. I remembered being confused about her earlier in the day because the only note I could find in the chart read "Fetal heart tone." I asked the doc for some more info, and the doc told me that the patient's first trimester ultrasound revealed marked nuchal translucency and cystic hygroma. Cystic hygroma is usually an indicator of Turner Syndrome, a chromosomal abnormality where the patient only has one sex chromosome, having a karyotype of 45, XO, instead of the normal 46, XX (female) or 46, XY (male). Unfortunately, 99% of conceptions with 45, XO result in spontaneous abortion or stillbirth. The surviving 1% of patients with Turner Syndrome are actually able to lead pretty normal lives, with the exception of some cardiac defects (commonly a coarctation of the aorta) and fertility problems. 

Anyway, back to clinic. This lady was scheduled as the last patient of the day, so that we could take the time to break bad news to her. If her baby had Turner Syndrome, there was an extremely high chance that it would be dead when we looked at the ultrasound. This would be the first patient encounter for me in which we had to break this kind of bad news, and I was nervous. The doc gave a quick practice speech to me, so I knew what to expect and how we would counsel the patient, what the next steps would be, etc. I went out into the hallway and was immediately relieved that she had brought a support team with her -- her husband, mother, and other children. I brought her back into the room and we all tried to maintain a positive atmosphere, like we weren't about to drop some of the most devastating news of her lifetime. I flipped down the lights, and the ultrasound tech placed the probe, and said a phrase that I will never get tired of hearing:

"Look! Here is your baby's heartbeat." 


Yes, Travis Tritt, it is indeed a great day to be alive!

Psych in a Nut Shell (pun intended)

Officially done with my psych rotation! I was on inpatient pediatric psych and it was truly an incredible and eye-opening experience. 

Here are some highlights:

Scenario 1: More Wise Words from My Roomie

Lecturer: Think back to college. This was really common in college. What did someone on your dorm floor have? Or what did one of your high school friends get? 

..... a few moments of awkward thinking silence....

Lecturer: Come on, guys! Everyone knows someone in college who had this!

My Roomie: .... STDs??? 

We all nod in agreement.

Lecturer: NO!!! Bipolar Disorder!!!!


 ... Oh. That, too.


Scenario 2: Rocket Science... aka ECT

During psych, we have to do a mandatory morning in Electroconvulsive Therapy (Think One Flew Over the Cuckoo's Nest...). By the 3rd patient, the attending decided I could run the ECT session.... which basically includes being the most Bad Ass person ever. 

Here is how it's done: 

Patient goes under anesthesia. You hook the ECT up to patient's head, preparing to induce a short seizure. And then....... drumroll please...... you get to say this:

3...

2...

1...

Treat.

And then you push a button and it makes noise and the patient has a seizure. 


Seriously, you probably read that and think it's pretty stupid. But no! Go back! Say it. Right outloud. In a Nasa countdown kind of voice.

3...

2...

1...

Treat. 

(Push button.)

PRETTY FREAKING AWESOME! 

Scenario 3: Are you the... Nevermind.

I'm sitting at a computer and an older doctor comes up to me and says, "Are you one of the pain fellows???"

All I have to do is turn around. He glimpses the length of my white coat and immediately gives me a "Oh, you're..... nevermind." Turns around and walks away. 

Yep.  I'm the med student.

Officially in da clinic, say whaaat!

Well..... after a long couple of months studying for finals and the dreaded USMLE Step 1, I'm back!!!! I'm alive!!!! I survived! Hopefully I am still saying that in nine days when I get my score. 

Today was my first day on rotations! 

Yesterday morning, I had the thought of "Wow, starting tomorrow, the next (at least) five years of your life are totally going to be dedicated to the hospital and real patients. No more sleeping in until noon. No more eating 80 times a day, whenever you want to. No more fake notes with fake responsibility. $hit is getting REAL!!!!"

In an attempt to avoid this last realization (which in reality I am extremely excited about, even though slightly terrified), I went on a massive cleaning binge - polished all of my jewelry, rearranged every dresser drawer, reorganized all of my pathology notes in preparation for tutoring, which won't even start until September. 

Today, I woke up bright and early. Packed my lunch. Walked to the hospital. Forgot my caffeine. 

Got pimped. Got the pimp question right! 

Got two keys to I don't know what. Got lost. Got found. Got caffeine. 

My first rotation is Psychiatry and I am on inpatient pediatric psychiatry for 4 weeks, with half a day at the local VA. It was an extremely eye-opening and incredible experience, which included: 

3 hours of lecture, which included completing a mental status exam on a Robin Williams clip

6 hours trying to interpret what my non-English speaking resident was saying to me

8 minutes for lunch
 
30 minutes trying to make a phone call on a hospital phone to an outside location

15 minutes looking up drugs that I have never heard of, such as Geodon, only to find out that I actually have heard of them, I just need to learn 3-4 Brand names for every drug I ever learned. No big deal. Geodon sounds exactly like ziprasidone, right?

40 minutes being an accidental gunner and staying longer than I had to 




At the end of the day, I came home feeling super excited, despite not having a clue about how to use the computer systems, phones, keys, doors, bathrooms (for real, I can't figure out how to work the door handles), ID swipes and dosage book. 

My fellow med student roomie summed it up perfectly: 

It is exhausting to feel stupid all day. 

The Dreaded Double Negative... English Rant

Did you ever have that one professor, one boss, one family member who just made everything more difficult? The one that could never be straightforward? The one that made you internally cringe every time his mouth opened because you feared what awkwardness would come out of it?

If you are picturing someone right now, well, that stinks for you! I have never known anyone like this (Please note my sarcasm...). 

I am studying for my clinical course... just diligently reading away at my notes... being bombarded by facts and dosages and numerical cut-offs and EKG algorithms... when I come across this sentence:

EKG at rest without angina present not uncommonly is normal.

While this makes complete sense to me, and I truly do understand the choice of words, I just want to throw it out there that double negatives, more often than not, are ridiculous.

Now, in this case, to take the double negative out and say that "EKG at rest without angina present commonly is normal" would be incorrect, therefore requiring the double negative. And this is just too bad, because that sentence stinks.

Thus, my entire studying game has been thrown off and I cannot get off my English language soapbox. Therefore, I will share with you two of my biggest pet peeves:

- Formal writing with CONTRACTIONS!!!! Just the other day, I read a statement written by a candidate running for an office at my medical school. Is it terrible that I saw the contractions, immediately stopped reading, and voted for the other person?

- SUBJECT/VERB AGREEMENT. Having grown up in the "North," I developed a whole new love and appreciation for my 4th grade English teacher and good ole' subject/verb agreement when I moved to the "South" to teach high school and on the very first day of class, the PRINCIPAL got on the loudspeaker and said phrases such as, "We was" and "They was".... NO, WE WAS NOT! THEY WAS NOT! 

If you, dear Reader, commonly do these things.... the English language would grant you great Karma if you stopped your crimes and became an English Language Law Abiding Citizen. (And all the Type A Weirdos -- me-- would be forever thankful!).