And Many More!!!

i hope everyone out there had a wonderful Christmas and is well-rested and fat like i am. we had a great week w/ family and will be heading back home after New Year's.

i start a pediatric rotation on wednesday at a local clinic. can't wait. snotty noses and vaccinations and foreign objects found stuffed in every available orifice.....so very excited. :)

So far...

so i've been reflecting on my rotations so far. i'm officially one semester down. grades are already in the bank and i'm moving on. two semesters to go and then graduation in august. it actually seems attainable now. i have 2 weeks off right now and then i start in a pediatric clinic. what have i been doing on my time off? well, i'm lying in bed typing right now, haven't gotten up other than to yell at the dog and tell her to lie down and leave me alone....that's pretty much what i've been up to. some lunches w/ friends, some shopping, some movie watching. generally just being lazy and happy. some of my classmates are using the time to get back in shape or to clean their houses. not so much on this end. that would involve getting out of bed, right?

on my rotations i've seen a lot and learned an incredible amount of medicine, exam skills, and patient interviewing tricks of the trade. also how to be a student out in the real world and to make myself useful.

this year is completely different from last year. my husband was reminding me recently how last year i wouldn't even go to the grocery store for an hour because i felt like i couldn't stand to lose that much study time. not so this year. we've had weekend get aways and i'm staying on top of cleaning the house, cooking actual meals at night. it's great. some of the rotations have long hours, and i haven't done internal medicine or ER yet, so i might still have some long hours ahead of me, but overall, i have so much more time to myself. and less guilt about not spending every waking minute reading/reviewing medical text.

and it's so much more fun to be practicing on actual patients with actual ailments than on our fellow students who are faking heart attacks and ear infections and such. it's really rewarding. i feel like this is pay off for all the work of last year. and i've felt very confident in my decision to become a PA. the more time i spend around medical settings, the more i want to be there. i have no regrets about choosing to be a PA instead of an MD or anything. most PA's are impressive w/ how much they do/know and pretty much practice like docs, but w/ a little less pressure and responsibility. i like that.

i do wish i had retained more of the knowledge i learned last year. there's a lot of reviewing and learning to be done right now. i think that's just how it works. with a patient sitting in front of you, it's a lot harder to come up with a diagnosis than it is when given a case study w/ all the buzz words of the condition.

overall, i'm very satisfied at this point. perhaps lying in bed all the time puts me in a good mood. that is entirely possible.

Fa la la la la.....

so my husband and i went Christmas shopping last night and i have two observations to make.

1- we went to our separate public restrooms down the mall bathroom corridor to do our separate businesses. upon walking into the women's room i observed a heinous, dead animal smell hovering over the baby changing table. the perpetrator was maybe 6 months old and even the mom seemed to be gagging a little as she changed his diaper. it was awful. i mean aw-ful. like dear God in heaven please have mercy on all of us in this shared restroom space and spare us from certain, slow odoriferous death. and it occurred to me that women's restrooms always have baby changing tables and i do not believe that men's always do. and that we women are ALWAYS lumped with the stupid children. it means we (womenandchildren) get to be saved off of sinking ships first and all that, but it ALSO means that we women are stuck w/ the children in all venues, including public restrooms. i think i would rather take my chances swimming to shore and let the men deal w/ the children just once in a while. thank you very much.

2- my aunt has always avoided shopping at a certain preppy clothing store that has been around for a while and is famous for its "layered look" and naked-ish photos hanging all over the store and in the catalogue. she has commented (in so many words) that a store that sells clothing should have models modeling said clothes and not showing off their ass cracks and that the pics are offensive and inappropriate for the eager youngsters wanting to buy their expensive, boring clothes. that being said, it's more the unstylishness (not a word, i get it) that revolts my husband about the store and when we walked by the store the first time last night he said, "ah! help! it makes my skin burn." so we quickly moved on. the second time we walked by it (we were at the mall for a while), he actually glanced in and said, "it smells like...date rapists in there." a very poignant and funny observation. the clothes do indeed smell somewhat of non consensual sex.

Off Subject

i am trying not to think about my exam tomorrow nor of my mixed feelings on this family med rotation. so....in the name of wasting time and avoiding my responsibilities, here are my top favorite characters on modern television. (i don't actually watch that much prime time tv during prime time...i catch up w/ the full episodes on the web on my laptop at random times throughout the week--independently causing the writers' strike-- while i cook/clean the house and stuff, i promise).

please feel free to leave a comment about your top picks...

1. stewie griffin ("family guy")


2. bob kelso ("scrubs")

3. joy turner ("my name is earl")

4. dwight schrute ("the office")

5. marc st james/amanda summers (as a comic duo, "ugly betty")

6. olive snook ("pushing daisies")


ok. i'm done. seriously. back to work. right now.

Well, hell.

so yesterday i was feeling a wee bit competent in all things primary care. i was thinking that as long as you have an infection of the sinuses, the upper respiratory system, the bowels, the girl/ boy parts, and possibly even the skin, i'm your man. i might even be able to help you a little w/ your diabetes and high blood pressure. heck, throw in a malfunctioning thyroid, why don't you. i might even consider fixing your kidneys and liver on a really good day.

but today- i failed at everything. every question asked of me i got wrong- sometimes waaaay wrong, usually just a little wrong. i scrambled for simple anatomy words, i mistreated ailments all over the place, and i generally just made an a-s-s out of myself. one of my professors once told us that we should expect brilliant days and idiot days. i just wish my brilliant days were a little more stellar and my idiot days were a little less durh-du-durh. (carlos mencia). i mean for pete's sake- i'm supposed to be able to treat patients on my own. and SOON!!!!

maybe i should have gone into sales. or miming. i would have made one heck of a mime.

growl growl grumble boo.

I Have No Patience for Patients

seriously. for the love of all things holy, when we tell you to take deep breaths, TAKE DEEP BREATHS...we're actually trying to hear something in that hunched over cage you call a chest. and when we tell you to "open wide" JUST OPEN UP so we don't have to stick that wooden thing all the way down your throat. thank you. hell.

this clinic thing is getting a little tedious. can you tell?

i got very frustrated (mostly internally, don't really think the patient could tell) at a little old lady who came in today for a first visit. she had a regular doctor of 30+ years, but decided she'd stop in to our clinic with the complaint of several months of pain and bleeding because she happened to drive past and saw our sign. she OF COURSE listed no previous health hx on her intake forms and could barely remember the names of her meds. then she wanted us to fix her today and was put off when we asked for some records and recommended she see a specialist. awesome. it's a bit like going to target and asking to see their vera wang line of clothing. target has some quality merch and is really good at covering all the bases for every member of the family...but you don't go there for the fancy duds. and you don't go to a family practice clinic when what you really need is a butt cancer doctor. can i get an amen? amen.

i kind of hate myself a little for having no patience any more. i used to be so tolerant and really was interested in all the details of a patient's dire life situation or confounding medical conditions. now when i'm stuck in non-productive, never ending conversations, i'm looking around the room for sharp objects with which i can carve my eyeball out of its socket. does this make me bad? or just more efficient. the docs have their patients booked something like 7 minutes apart and they still seem caring and attentive. they just don't get bogged down in all the minutia. that's a good thing. means they can help more people. yea, yea. that's it. i don't have a cold heart. right?

....i think i'm ready for a break.

Almost done

i only have 2 wks left of family med rotation and then i go into (tra-la-la) Christmas break. well, technically, holiday break. i made the huge mistake the other day of trying to make conversation by asking an MD if she was all decorated for the Christmas holiday and she said kind of snappishly, "i don't celebrate Christmas." i felt like an idiot and mumbled something about how it's a good thing she doesn't have to be hanging lights out in the cold and how it's all overrated anyway and how...um...cool dreidels look when they spin...and, uh, how adam sandler is the finest comedian on screen today, and that barbera streisand isn't THAT annoying.....heh.

she pretty much ignored me the rest of the day. cuz i'm not irritating enough, as a student following her around and slowing her down, i have to be culturally ignorant, too. awesome. :)

so other than that...things have been going pretty well. i've found i have a great poker face with patients. i've heard and not reacted to everything from a mentally ill patient describing in detail her fantasies about choking people (while she gazed longingly at my neck- i swear i wasn't making that up) to descriptions of the exact size, shape, consistency and color of feces, boogars, and kidney stones. also, issues of limp willies and decreased sex drive, fights between couples about whose fault it was they couldn't get pregnant for the 6th time at age 45, and tales of all kinds of home remedies for anything that ails you (and the consequences of using said remedies). and these are just the grown ups.

kids of course will say anything at anytime. and they see right through our bullshit. a visit can be all fun and games with stickers and hand puppets, but you mention the words "diphtheria titer" and they are packing up their things and thanking the nice nurses for their time and trying to pay the copay before the staff can get the vaccination tray out. they just know. and the doctors are sneaky. you'll notice they're never actually present when shots are given. they make the nurses and MA's do all the dirty work. and the students. i am often responsible for holding little legs down while multiple injections are plunged into little scared thighs. but the doctors get to be the good guys.

besides having a good poker face, i also have to fake confidence regularly. i was sent into a room by myself to give a steroid injection into a joint and when the lady asked me, "ok, so you're a student, have you done a lot of these?" the accurate response would have been, "i've seen 1 and done 1 with supervision. as far as i know, that patient wasn't paralyzed by my efforts, but maybe i should call to check first." but what i said was, "i've been a student now for a few months and have had many opportunities. i'm comfortable with this and it will be done in no time and you'll be feeling SO much better." smile. pause. proceed. i kept telling myself not to sweat too much on her or say "oh, snap" if i miss and hit an artery or something.

Playing Doctor

had an AWESOME holiday weekend at my parents' log cabin on the river. beautiful, winter-ish, relaxing and loooooots of good eats. my aunts and grandmas are some mean cooks & bakers, so it's easy to be indulgent. i am bloated and disgusting, but hella happy. i think over the course of the weekend, after many courses over many meals, i still made room for roughly 70 Christmas cookies. oh yes, 'tis the season. i have the greatest family ever. i really do. yours might be nice and all, and i don't mean to be rude, but mine win.

anyway. i started rounding at the hospital with my preceptor today and will do so in the mornings daily before going into the clinic. it's great. it's a sneak peak into internal medicine. she's good at what she does and it's wonderful to be in the hospital. i find energy in hospitals. i love the pace, the feel of it. even the sights and sounds (maybe less so the smells). it's just so comfortable for me there. i think your comfort zone depends on your background- mine was in an in-patient setting, and that's where i feel the most at home.

at clinic today it dawned on me once again what a fake experience this is. i'm seeing real patients, and even occasionally saying something helpful to them, but mostly i'm just practicing my skills for my sake. it's just part of being a student, and i certainly need all the practice and guidance i can get, while i have the opportunity. but it seems so totally ridiculous for me to look in a patient's ears and then have the real doctor come behind me and do the same thing. i'm like a little kid with her fisher price doctor bag using the fake foamy stethoscope on mommy to make her feel better (or using that giant 10 gauge plastic needle to stab her little brother in the name of medicine). it just seems goofy to me. the patients are all very kind about it and don't seem to think it redundant or lame. and it is a good education- the only way to do it, i suppose. when i find signs or acquire history from patients, i'm then able to put together a picture of what might be happening and come up w/ treatment plans and discuss these with the MD's, and that is very beneficial. i just feel bad for the patients.

so please, if you're ever in a teaching setting- don't let the student practitioners go nuts on you or your family, but do be patient and kind to them.

Why Do I Hate America?

Funny facts about Thanksgiving....

1. Turkey breeding has caused turkeys' breasts to grow so large that the turkeys fall over. Wild turkeys can fly for short distances up to 55 miles per hour but commercially raised turkeys cannot fly (primarily because they are too top-heavy).


2. Americans feast on approximately 600 million pounds of turkey on Thanksgiving (about 45 million birds)

3. The symptoms of Salmonella are: bloody diarrhea, fever,
abdominal pain, nausea, headache, and muscle pain

4. Each year, the president pardons 2 turkeys, named "Liberty" and
"Freedom," saving their little turkey lives
(I am NOT kidding). go to:

5. The chemical in turkey that makes you feel sleepy is called Tryptophan.
Go and impress your loved ones with that bit of knowledge. As an
interesting aside, it appears to effect men more than women, since
somehow the women are still cleaning the kitchen after eating the turkey
and the men are comatose on the couch. Perhaps this disparity in men
and women's physiological response would make for an excellent
undergraduate research project.

Bells Ringing, Holly Growing, Pumpkins All Dried Up

well, we're closing in on the holidays and i can't believe how fast this month has gone. there's Christmas music 24 hrs/day on one of the local stations and i'm starting to see lights out and about. if we're true to form to how we've been in the past, it will be december 20th before they go up, but to make up for our procrastination, we'll leave them up until at least early june. i love this time of year- it puts me in a great mood. even the novelty of holiday mall shopping hasn't warn off yet. it won't be long.

this week was better at the clinic- i stopped feeling guilty for not knowing everything and decided to just soak it in and get as much out of it as i could. i love the patient interviewing and exam part of things, and i'm picking up more on what diagnostics to order and am at least sometimes in the ballpark on treatment plans now. that's still rough.

what's amazing to me is how subjective everything is. if i happened to notice something while doing my exam, a) it may look/seem totally different to another practitioner and b) the significance of it as a finding can be dependent on how it is assessed (or whether it was found at all in the first place). was that just a normal looking shadow on the xray, or was that a lung tumor? did i really feel a lump in her breast, or did i convince myself i had because the patient said someone else had felt one there before? was that a tumor or an ovary on pelvic exam? is that an enlarged thyroid, or does the patient just have a huge fat neck? (referred to, in PC medical speak, as "increased body habitus"). was that a click or pathological S3 or just a normal split S2 heart sound that i heard? as a student, i take a guess at what i think it is/is not and run it by someone much more experienced. but in just a matter of months, i can't turn to my peers to look over my shoulder at everything and i'll be making these judgment calls on my own. i know that many new practitioners tend to order testing up the wazoo to help reassure them that their findings are accurate. i definitely understand why.

the worker's comp and disability stuff is tricky, too. i know there are people out there abusing the system, but in turn the system is virtually impenetrable for people who really need it. there are a few manual laborers at this clinic with these acute on chronic back problems who have zero income right now and can hardly sit or stand, much less resume lugging their big cans of paint or boxes of whatever they lug for work. and it's really on the practitioner and their documentation to prove that this person is legitimately wounded and warrants some benefits while they heal, or for the rest of their days. that's a lot of responsibility. and a hell of a lot of paperwork. these docs are cool, though. i see them calling insurance companies, pharmacies, etc on their cell phones in the exam rooms with the patients trying to sort things out before the patient even leaves the office. so at least they're trying to be proactive. but then you as the practitioner always have to have in the back of your head- what if this person is out for pain meds? what if they're shopping around town for someone who will agree w/ their claims, but they're actually ok and i'm just reinforcing the problems with the system?

so it's good to watch old pro's handle these probs. i'm learning a lot. and this stuff may not be as exciting as surgery or delivering babies, but it effects people's lives every bit as much.

Week 2 Family Med, Soapbox

better yesterday. i still stammer and grope for simple words and phrases, but my physical exam skills occasionally come up with something good. i caught 2 hernias yesterday (not the "oh, my" kind, but just umbilical ones) and a heart murmur that you could practically hear from outside the room... but i got a nod from the MD for catching it (and grading it correctly- woohoo!) anyway.

that one was funny because the little old lady i heard it on was a wee bit demented (but really charming) and said she had no idea anything was the matter with/different with her heart and if i just asked the doctor, she was sure he'd give me a clean bill of health. well, i did ask the doctor about it, and it was very much a known problem that had hospitalized her previously and one that they had discussed surgery to fix. we all 3 discussed it when the MD came in and she said, "well, i guess that's just something the doctor has been keeping to himself." i think things like valve stenosis get easily forgotten by patients if they're rarely symptomatic or don't require any meds to manage. it's not like they're listening to their own hearts. but, if she had gone to a clinic/ER that didn't know her hx and she'd told them she had never had a problem w/ a murmur, they would have thought it was new and done a complete workup, maybe focused on it and missed other things, etc.

this is why i strongly encourage all patients w/ a significant medical hx to keep a little list in their wallets of all their allergies, meds (up to date!!), MD names, known conditions, and past treatments/ surgeries with dates. i know this tirade is boring, and i apologize, my dear bloggies. but it's difficult and dangerous when a patient show up at a random ER or clinic where the practitioners don't know him from Adam and he doesn't have any of his health hx on him. that's all i'll say about that. maybe i'll write my congressman. :) or make a PSA about it. perhaps i can get one of the cast members from "grey's anatomy" or maybe hugh laurie from "house" would do it.... he could say something like "Figuring out a diagnosis is enough of a puzzle, it sure helps the doctors to have all the pieces. Carry a current health info card on your person at all times. it could save your life." ooh-i like that. he could really take home the last line by pointing his cane at the camera. hmmm....now i just have to figure out how to break into his house and convince him to agree to do it. hey, now...."kidnap" is such a strong word....

One Thing I Know For Sure

I am Not Smrt, I am Quite Dum.

i think i may have a leak in my brain. seriously. i get asked simple questions about bugs and drugs that i should know, or treatment plans that should be pretty obvious and i basically drool all over myself. all of medicine. 12 months of education plus all that stuff i never learned but should have, is all fair game to be presented with in this out-patient clinical rotation. and i'm so far something like 2 for 300. i have no earthly idea if all other students at my level are equally lacking or if i am the worst ever. i suspect that i am, in fact, the worst ever. i shall pout about it for a while, i think.

i just want to know it all and be comfortable and confident and not doubt my ability to practice as a PA. or to spell my name correctly. grrrr.

cute kids today, though. one 5 y/o little girl got her vaccines and was all tearful, but what REALLY set her off was when she was put outside the room with me and she heard her twin brother screaming from in the room when he was getting his done. she reached over to me and said, "go in there and make them stop. tell them to stop!!" it was really adorable. and kind of sad. we need to figure out how to give vaccines by dissolving them under the tongue or something.

so i'm obviously in a self-bashing mood, so my husband decided to make this weekend a mini vacation for us. so we went to a movie tonight (see side bar) and then to a brand new tapas bar for drinks (delicious chianti) and snacks (snobby cheese tray). now i'm feeling much more cheerful (drunker) than i was earlier, so that's good.

Getting Broken In

things are going pretty well. i love the hours- i work 9-5 (well, i've been there to closer to 6 both days so far and haven't really taken much of a lunch, but still beats getting up at 5am like my past 2 rotations). i will be working one day/week in the urgent care clinic, hours being 1pm-9pm...may get to do some suturing and stuff. we'll see. everyone's really friendly. i have now seen a few peds patients....a 2 y/o w/ an earache who i promptly made cry. have also seen a few cases of MRSA (it's really out there in the community, people- wash your hands!!)what else? lots of hypertensives, diabetic, and high cholesterol routine visits. some viral infections, knee probs, lots of back pain, post car accident pains, etc.

we students don't get access to the computer-based charting system (all the MD's, PA's and MA's carry around laptops and just put in everything as they talk to the patients...they even print prescriptions to the front desk for the patients, make referrals, receive emails from the MA's w/ vital signs, etc), so when we go in to see a pt before the MD does, all we get is their billing sheet on the door that gives a few word description of why the patient is visiting. it often says things like "6 week follow up" and you have no idea what they're following up for. or it will say "ill" and you have to find out what kind of ill. so far i haven't been caught too off guard and patients don't seem to hate telling a clueless student the contents of the chart that i could easily have with me but don't....but i'm sure someone really "ill" at some point will snap at my lack of background on their case. it's kind of nice for the docs for us to see the pt first, because then we present to them about why the pt is there and some background that we gathered and the doc can go in and cut to the chase and not have to hear the whole 15 minute discourse that we sat through on why they have been taking their antihypertensions every other day instead of daily as ordered because they have to share them with their cat...things like that.

i don't know any of my meds....it's embarrassing. as is my ekg reading skills. the MD's are pretty good teachers, though...so i think i'll pick up a lot while i'm there. it's a very different atmosphere than the hospital. i'm still adjusting, but it's early yet. i have 6 wks to get in the groove.

Family Medicine

...started today. i have a headache, so i won't write much now, but i will say that so far so good. (and that i think the headache is from lack of coffee, not from my first day at the rotation). it's a nice sized practice w/ a few docs and PA's and an urgent care clinic at night. there are 2 other PA students w/ me, but there's mostly enough patients to go around. i got to see a 6 yr old and a 79 yr old and everything in between. i helped diagnose diabetes on a patient (classic symptoms- frequent urination- polyurea, frequent night urination- nocturia, and lots of thirst-polydipsia). it was fun for me, hella shitty for him to find out he has NIDDM now and will be stuck on meds for the rest of his days.

more later.

Well, Sports fans, I'm All Done and Moving On (again)

(you really need to watch thursday night tv to get most of my references. calling people "sports fans" is from last week's "scrubs" episode. i am a devoted fan, even though i realize the show has long since run its course and should have wrapped up a few years ago...not unlike roseanne when it runneth over and we as a country collectively sighed in exasperation when the conners won the lottery and dan had a heart attack and all went into surreal crazy tv land...but dutifully continued to watch anyway because we knew at the heart of the show there was good(!) and we had been loyal all those years...)

so anyway...obgyn ended today. i'm feeling kind of sad. just as soon as i get settled in a rotation and feel like i know enough to do some good and to really get into the nuts and bolts of it, i'm moving on. and i'm petrified of family med. so far, with surgery and obgyn i've seen such narrow scopes of medicine. with family med, anyone any age with any problem can come in and i have to know how to find it and fix it. intimidating. so far i've been able to be the amazing ekg-less PA student and have been able to mumble my way through questions on drugs. not so for family med. but i'm hopeful i will get to do more women's health while i'm there.

my reviews were good from the obgyn rotation. i was told by a resident that i was better than 95% of the medical students who come through there (that SOUNDS flattering, but i have to tell you, that compliment has rather limited range) and by one of the attendings that i'm beyond most 1st year residents. that was nice. i guess if i pay attention, am helpful and friendly to the patients, and don't say too many stupid things (out loud), i get by. so far.

HAPPY HALLOWEEN!!

i love this holiday. it's warm and pretty this year and everyone's all a-buzz with excitement. i'm studying on my couch by the door so i can greet the tricker-treaters. so far the costumes aren't terribly original, but still cute. lots of super heroes. i just saw a banana. and a really precious curious george. there are of course the 13 year olds in sweat shirts pretending to be....not sure. hungry? a cute little orange witch just left. but apparently orange witches don't have any friends, because she was with her mom. (drag). speaking of moms and drags, can i confess a painful childhood memory to all of you out there? the halloween that i was in 2nd grade my mother actually gave out tiny boxes of raisins for halloween instead of candy. RAISINS!! as in dried fruit! as in to maintain regularity and provide you with essential vitamins but NOT to wish you a happy halloween. i was so embarrassed. it was so mortifying that i really thought i'd have to move. or change schools. i think i told my friends she was from latvia and didn't know any better. i guess i thought latvia sounded far away and plausible as a grape-growing nation of candy haters.

and so far, to my surprise, among the assorted candies i'm distributing, swedish fish is by far getting the most press. the kids are thrilled by them. in case you're unfamiliar, they are little red fish-shaped rotten banana tasting things, packaged in individual serving sized bags for halloween. who'd have thought any gummy candy could smoke baby ruths and twix bars in the ratings. my husband is strutting around about his candy choosing skills. i would never have picked anything non-chocolate, but i guess he was right on this one. curses.

not joking- just got hit up for money by a ninja. he had a little box for collecting donations for UNICEF. wow. i'm surprised these kids don't have web pages to which we can just paypal our candy and monetary donations. maybe his costume could have helped his cause. instead of being some sort of karate guy, he could have dressed up like a starving ethiopian or a homeless flood victim. he could have at least added a limp or a twitch.

and i am off to study now.

tomorrow is my last day in obgyn. i take my exam on friday and then i start family medicine in an out-patient clinic on monday. i have loved obgyn but am ready to move on. the gyn portion of the rotation is pretty boring- we only have 1-2 cases/day and otherwise sit around and study. which should be good, but i kind of feel like if i'm going to be at the hospital, i should be doing something patient-related. ah, well.

don't forget that tomorrow is el dia de los muertos. i plan to set a few minutes aside to honor my deceased family members' memories.

On a Lighter Note

so this weekend is designated as my test prep weekend as my exam is coming up at the end of the week. while i've learned a lot on this rotation, that means nothing when it comes to boards-type exam questions. more than anywhere else, in medicine academia does not equal real life. so i'm boning up on statistics and quirky rare diseases and such. those illnesses/mutations that you never actually see in practice but are assured to find on written exams are referred to as "zebras" in the medical community and everyday illnesses are the "horses" in the metaphor. for example, "pheochromocytoma" is sure to be found on a test but "pneumonia" might not make it. get it? i can't tell you how often professors and guest lecturers say, "you'll never actually see this, but you should know it for your boards..." i think they just make stuff up and feed it to us students so that when a patient comes in with an ear ache we say crazy, stupid stuff like, "oh, clearly that patient is suffering from an oligodendroglioma since she is 43 years old and from Norweigian descent and has visited the ocean exactly twice in her life and has a second cousin twice removed by the name of Ingrid" instead of being reasonable and saying, "ah, yes, it's likely an ear infection. give her a wet willie and see if she yelps." somewhere there's an ivory tower filled with retired physicians just making themselves giggle all day long by the stuff they put in the text books.

so anyway... i am meant to be studying this weekend but am instead celebrating my birthday. have actually been celebrating my birthday for the last week and intend to continue celebrating it for another week to come. i learned from some of the important women in my life that it is totally acceptable to have a birthday 'season' instead of just one lousy birth-'day.'

my sweet husband is building me a cake. i'm sure he'll do a beautiful job (he's a great cook) but sadly, i don't think it will look like this one. although that would be most excellent. (credit due: i stole this from someone smart on the interweb).

It was a Tough Day Today

i'm feeling pretty sad. i'm not as tough as i thought i was. in my previous work i saw a lot of death and dying and don't get riled by much, but today i found myself pretty shaken up.

we had a patient who came in to have a dilation and curettage for a missed abortion very early on in the first trimester of her pregnancy. she and her family were all visibly upset...they had wanted to be pregnant and had been preparing themselves for a new baby. it had been a hard few days after they found the fetus had stopped growing. she was nervous going in for the procedure, but held back tears as we took her to the OR. everything went fine, as expected. she wasn't out for very long and everything was "taken care of." i took her to recovery and as she was waking up and trying to talk, i could hardly understand her. i leaned in to listen more closely and she said plainly, "could you tell if it was a boy or girl?"

i choked out an answer and kept telling her how brave she was and how it was over and she could go home to be with her family and held her hand....

that was overwhelming. but something about these experiences, these moments is so intoxicating. i love the chances to give compassion and hear people's stories. i can't believe how blessed i am to be exposed to so many intense life moments, so much humanity. seeing people go through pain and loss like this or through child birth and the explosive joy of a new baby. it's amazing.

Back on Top of the Knife

another 24-hr shift yesterday. i'm in GYN now and was w/ one particular surgeon all day/night long. he's considered one of "the best." that usually, and certainly in this particular case, means very skilled and genius but also rather hard to get along with. he was friendly enough to me, because i was quiet and stayed mostly out of the way, but he was not as pleasant to the residents. it made for a long day. especially since we started at 7:30am and didn't finish the last case until 1:15am. not kidding. 18 hrs in the OR on my feet w/ only 10-20 min breaks between cases. never really ate a meal. it was nuts. but i got to see some fairly interesting cases and learned all the many ways that "that damned cancer" can mess a person up. he had an interesting communication style and was very passionate when it came to 2 subjects: people eating right and not getting "way too fat, too big bellies" and "that damned cancer." some of the tumors he removed were shocking to look at, but as i've grown used to, many times the most grotesque things the body grows are actually benign and have no real malignant potential...but we remove them because they may be causing symptoms just by being there. so anyway....

i was scheduled to be there all night and was to report to labor and delivery after i got done in the OR. i showed up there about 1:30 and was told to go sleep until 3. so i did....but kept right on sleeping through my alarm until 5:45. i felt like such an idiot. no one was mad, but i thought for sure i'd be fired (can they fire you if they're not paying you?). fortunately, as i came sprinting through the hospital back to the birthing department w/ one shoe on, one contact in, my hair all flying crazy all over the place and stethescope dragging behind me, i found that there was enough going on that i could pitch in and be useful for the last little while before i went home, but not SO much going on that they missed my presence. i still feel like an idiot. curse these basic human needs! they have no place for a student of medicine!

It's almost Halloween!! You are Now Free to Abuse your Children for Your Own Amusement.

Slacking off

i am on a jim and pam high right now and not even caring that i haven't studied for my practical exam i have to take tomorrow. i have become such a lazy student. i used to put a few hrs in every night even when i didn't want to. not so much now, my friends. i came home tonight, made a luxurious italian dinner for my husband and drank a little (glutton's lot of) wine and am now watching "the office" and basking in the clever risk-taking new character developments and camera shots they're taking. and tra-la-la all the lovey loveness going on between jim and pam.

i've been in a good mood this week. i really like obgyn a lot. i love not only the prenatal care and labor/delivery but everything from the first pap smear to postmenopausal issues to gyn pathology, everything. i've been officially in "ob" and i'll be starting "gyn" on monday, so will have more time in the OR. i could really use more time in OB. this whole rotation, only 4 wks long, could be much longer and i'd be fine with it. i'm hoping in family med/ER i'll have more obgyn opportunities. most of the male PA students would gladly trade me some of their obgyn time. they are all dreading it. i do feel fortunate as a female practitioner/student as the patients are clearly more open to me, ok w/ my presence than they are with the men. while i've never been pregnant myself, i think i have a little more cred in my empathy than the 23 y/o frat boy med students saying things like, "so, are your ankles always this swollen?"

it's almost the weekend!

i am not jack bauer.

i cannot keep going w/o sleep (and in his case, apparently w/o food or bathroom breaks) for 24 hrs at a time. i am just getting home, and while it was an awesome night w/ wonderful, kind residents who showed me a lot and were indulgent of all of my questions, i am exhaustipated.

and i have to say, when you're 30-some weeks pregnant, apparently you are all too willing to bring yourself, your man, and your kids into the labor and delivery triage in the middle of the night for any little pain or change. i guess the theory goes, if the prego lady is having pain and so can't sleep at home in her own bed comfortably, she may as well be in the hospital being monitored and in so doing make darn sure no one else in the family gets to sleep either. i can dig that.

speaking of the "man" in labor and delivery. dads come in all shapes and sizes- ranging from freaked out to loving and comforting to totally distant (...to not there at all, unfortunately). most of the dads are really great w/ the prego's. very loving, holding hands, brushing hair, soothing w/ wet wash cloths. but the ones that deserve killing are those who are ON THEIR FREAKING CELL PHONES DURING THE DELIVERY!! one guy had to cradle the phone on his shoulder while he cut the cord. seriously? SERIOUSLY? i only hear bits of their conversations, but i imagine it's something like,

"hey, man. nah, everything's cool. this is a good time. ('waaaah') what's up? oh, yea? you got the new game cube? ('honey, do you mind taking a picture of the baby?') hang on, honey. shit, always nagging. did you master level 7 yet? totally- that trogdor monster kicked my ass, too. ('honey, do you want to hold the baby now?') yea, that's rough- you just have to find the magic staircase and you'll have it nailed. ('honey?') yea, we're good. everything's fine. well, i'm kind of tired and have a really painful crick in my neck because i only slept about 6 hrs on this sofa chair in the hospital and i'm starving because i only got to eat 3 pizzas and 7 burritos during the night. i can't imagine any pain being worse than my neck hurts right now. i asked my wife to rub it but she was all like, "i'm about to deliver a placenta right now, can it wait?" geez. everything's always about her. earlier she was mad that she couldn't have any pizza, but she had ice chips- what does she want? what's that? yea, she was in labor for about 15 hours. no, no epidural. she didn't hurt that much. oh, what did we have? it's a girl...boy! it's a boy! and he's 22 pounds and 8 1/2 inches long. ('what? what are you telling people? are you crazy?') wait, that doesn't sound right....maybe i'd better go. later. "

it's almost 8am and i'm going to bed. 'night.

My Family is Staging an Intervention

late for church, so i'll be quick. i have already heard from my grandmother and mother-in-law about my last post and my hesitation (total paralyzing fear) of going through child birth. they both assured me that it is an amazing, worthwhile experience, one that i do not want to miss out on. i am sure i will agree. there is no doubt that at some point i will jump on that mommy train and squirt out a few of my own. perhaps i should pick a different discipline to practice in so i do not have daily reminders of the difficulty of the birthing process. if i was working in dermatology, for example, i would probably blissfully and ignorantly proceed w/ pregnancy without a second thought to the travails of childbirth.

also, i will not actually STEAL a child, so no one need put the amber alert people on speed dial. :)

addendum: i am on my first 24-hr shift tomorrow- meaning i will start at 6:30 am (regular time) and go until tuesday morning at about 8:00am (after the morning meeting). then i will go home to sleep. assuming i can still find my way home after that many hours w/o sleep. i'm actually really excited to get some 1-on-1 time w/ the preceptors and have more to do away from the abundance of other students. but ask me at about 4am tues morning if this is all still buttercups and roses and i'll probably throw my luke warm coffee in your face. do you think they'd mind if i showed up w/ a sleeping bag and pillow? i haven't stayed up all night since high school, and that was just at friends' houses at parties, never to do actual studying or work. i could never pull all-nighters in under grad and certainly not last year during my didactic work. i am a pro-sleep type of gal. i just remember at those high school parties getting really giddy and slap-happy around 2am and finding words like "pants" to be reaaaaaally funny. so if any of my ex-boyfriends get a call late tomorrow night and all you hear is giggling and then a dial tone, it's not me, i swear.

Thanks, Eve...Way to Take One for the Team.

i've now seen a few vaginal births and i must say that while God blessed me w/ a womanly body and the potential to bring forth into this world and nurture a tiny little version of my husband and me, i will decline, thank you very much and plan to adopt/steal/purchase one instead.

labor is a messy, painful (even w/ epidural-again, thanks for that, eve) experience and dear jimminy, that giant collapsable cantaloupe has to wedge through that tiny little unrelenting hole... good lawd. just seems like there has to be a better way. both births required episiotomies (cutting down a few centimeters from the entroitus- vag opening- midline posterior toward the bum hole) to jimmy the little sucker out. that is what i, in my maturity, refer to as "a butt baby." (for the record, the midwives all seem to give the moms a little more time and have better luck w/o tearing or need for cutting by careful positioning, pushing, and lubrication/massage).

i'm having to learn "baby talk" which doesn't mean goo's and ga's but rather the tricky lingo of the labor and delivery world. i am not even kidding that this is how everyone talks. for example, a report i give to a resident or attending, or a note i write might read,

" Pt is a 31 y/o G3P1011 (1 SVD at 38wks, 1 SAB at 34wks) at 35 1/7 wks with an EDC of 11/14/07 presenting with + FM, + CTX, -LOF, -VB. Plan to r/o PTL, she is + GBS, GDMA1. "

did you catch all that? it means she is 31 years old, this is her 3rd pregnancy, she has one living child who was carried to term and delivered vaginally at 38 weeks, another who miscarried at 34 weeks. She is 35 weeks and 1 day along and is due on 11/14/07. She is experiencing fetal movement and contractions but not loss of fluid or vaginal bleeding. We plan to rule out a preterm labor and she is positive for group A beta hemolytic streptococcus and has gestational diabetes mellitus managed with diet alone.

yep. nuts.

this rotation is pretty cool so far, despite the language barriers i am experiencing and the (cool) gore of the births. the actual deliveries were emotional, even not knowing the families. it's exciting and "beautiful" and "miraculous." but really, when it comes time for my husband and i to grow our little family, i am not above stealing one from a shopping cart at the grocery store to avoid the pain of birthing.

It's a......fhagina.

so obgyn started today and i think it will be good. i pushed my way into a c-section and that was pretty cool. i also did a few exams and histories. hanging around all these pregnant ladies makes me feel really skinny, so i think i'll go back tomorrow. there are about a million med students and residents in the department, so everyone is vying for opportunities. med students are funny because it's all about academia, not about patients. they have little sense but a hella lot of knowledge. the residents and attendings of course by then have it all together and are great to watch w/ their patients. things are so much more laid back in the labor/delivery OR than they are in the "real OR" of surgery. and a baby is a much cuter outcome than an appendiceal fecalith (a poop clog in an appendix- why you get an appendectomy). i was so relieved that the c-section baby was really attractive. so when the mom said, "oh, he's just gorgeous....i was hoping he'd be cute from the beginning and not all squished looking" i could agree and not have to lie.

my schedule won't be too bad. i will leave my house by 5:45am and get home by 5pm. i'm not yet sure about weekends. i will work 2 24-hr shifts over the next few wks, but then will have the following day off to sleep and recover. not bad at all.

All done and moving on.

just took my surgical exam and passed (not so much with flying colors, more like w/ weepy, crawling colors....what does that phrase even mean?). but whatever- i'm officially done w/ my first rotation and moving on to OBGYN starting monday.

i'm scheduled to be in a hospital, so i'm not sure if i'll get routine clinic days with gyno stuff at all, or if i'll be strictly labor and delivery. it should be cool either way. i know this hospital takes med students and residents and stuff, so my involvement might be limited to seeing what i can from the head of the table during births or catching the dads as they pass out or something. we'll see.

one of my professors said in all her rotations the goriest thing she ever encountered was a vaginal birth. and that her job was to examine the birthed placenta for missing pieces/tears, # of vessels, etc. everyone else in the room was fawning over the new pink baby w/ tiny baby features and that just-born new skin smell and she was poking at the veiny, slimey alien-like lump of tissue.

so that will be fun.

celebrating my anniversary this weekend. it's been a while since i've had any time w/ my husband. i'll have to practice pronouncing his name right before we go out to dinner- that could be very embarrassing. maybe i'll bone up on current events so that i'll have something to talk about other than blood loss and clostridial infections. not that those don't make excellent dinner conversations...

Recent Study Reveals Carob Chips and Ricecakes Cause Childhood Nostril Cancer

...not really. i just like to tease my "#1 bloggie" about the hippy healthy things she feeds her kids. carob is, in case you haven't encountered it, a chocolate substitute made out of hay or shoes or something. fake chocolate is kind of like fake sleep. just not satisfying. but my #1bloggie is another one of my very favorite people- in part because she is such a conscientious and amazing parent who is working hard to keep her kids healthy and happy.

but seriously folks, don't feed your kids carob. it's just cruel. trust me- i'm practically a doctor, practically.

so i'm wrapping up this surgical thing and it's been a wild week. i would tell you about the patient i had recently who i'm pretty sure is part of the mafia and was talking (wide awake while we worked on him-creepy) about "hits" and strippers and pizza pie and all kinds of big sounding guys like "little tony" and "joe joe" and how they get out of going to jail by paying people off/knocking them off, etc, etc.....but then i'd have to kill you. i just hope we did a good job on the surgery. i laid a little low in that one, as you can imagine. and when the nurse loudly asked me my name, i totally made it up. (don't leave a trail).

i did wound care today and it was great. i love wound care. lots of diabetic ulcers, venous stasis ulcers, a few abscesses. i got to debride (cut/dig dead skin off/out of the hole) and it was fantastic. sounds gross, smells a little gross, but is actually really cool and i felt useful. the body is incredible how it rejuvenates, regrows. the products available to encourage wound healing are really impressive, too. there are grafts made out of everything from pork (porcine), cows (bovine), and human tissue (even some infant foreskin- i am NOT making this up!) and there are dressings that contain antimicrobial agents with parts of human growth factors that hasten tissue growth. then there are wound vacs that suck the bad juju out and encourage vascularization.....and hyperbaric oxygen treatments where patients with terrible blood flow get in 100% O2 rooms and bask for a few hours so the wound gets saturated in O2 so the sad little new skin gets a chance to get strong and grow to close the wound. the list goes on. amazing.

so i'm bribing my surgical preceptors to give me a good evaluation by baking cookies for them (by this of course i mean having my husband bake cookies for them) and taking those tomorrow. my hubby just yelled in the kitchen meaning that he either burnt the cookies or burnt himself. if he burnt himself, maybe i can go practice my wound care on him...(i don't have any foreskin lying around, so i'll have to make do) but if he burnt the cookies, i'll have to have my new mob buddies take him out.....(the burnt cookies will prolly STILL taste better than carob chips do).

Only one week left!

i'm ready to be done. surgery was cool and a great experience to get me started this year, but i'm eager to try something else. i worked a few cases on friday w/ an OBGYN and he was very compassionate to his patients, extremely skilled and graceful and i was impressed...i really hope my experience in OB (starting oct 8) is a good one, because i could see myself really enjoying that discipline. studying this weekend for my exam coming up next week. somehow these hours + my being lazy and all haven't been very agreeable to studying, so i'm quite behind. but i shouldn't whine...one of my friends also in surgery now recently changed to the hospital's trauma team and has to start rounds at 4:30am!! and doesn't finish until 5pm or so. mad-ness. i would be so grouchy all the time, i'd just start kicking random people in the shins as they passed me in the halls.

i have to add something. one of the cases w/ the OBGYN i did was a dilation and curettage- where the cervical os is dilated and then all the tissue is sucked out into a container. an early abortion, basically. but it wasn't a fetus, it was a "blighted ovum" which means that the egg is released w/o a nucleus (so no mother's DNA) and gets fertilized by sperm and so only has the father's set of DNA growing in it. some placenta will start to grow and the pregnancy test will be + and the symptoms of pregnancy will manifest, but there's no baby. so this lady went in for her routine check up at about 8-10 weeks and there was no fetal heart beat and then no image on ultrasound. very heartbreaking and difficult to explain the biological mishap to a grieving family. but again, the MD was amazing. fortunately, it's a very rare, freak thing and doesn't decrease her chances of having further viable children. still pretty sad, though. a lot of trauma and disappointment. so incredibly many things can go wrong with fetus development and labor, it truly is a miracle when everything goes well and you get a perfect baby out of the deal.

Worn out on Wednesday

sleepy today. not sleeping well lately. on call tonight instead of tomorrow as tomorrow night is the season opener of "the office" and "my name is earl" and that seriously trumps someone's urgent need to get their appendix taken out or something. today was a good day. saw an interesting bowel resection w/ a rectal (up the butt) GI staple anastomosis. it was probably pretty obvious in my eyes that i was thinking, "you're going to do WHAT now?" when they explained it to me. but it was pretty cool, though a less than comfy recovery for the patient, no doubt.

Totally Twitterbrained on a Tuesday

i could write a "totally dumb" moment any day you ask me, but i thought since i started this theme this week, i'd make it today. so about 3pm today i was feeling like on the list of dull crayons in the box or blunted tools in the shed i was falling smack between paris hilton and anna nicole smith (may she rest in big blond peace).

the one lousy question i was asked on a thoracic case was, "where do the pulmonary veins empty out?" and i friggin' know cardiopulm anatomy and what did my stupid self say in my panic to say SOMETHING, "ummm...the subclavian vein." geez God. it's the left atrium, of COURSE it's the left atrium. grrrr. the subclavian doesn't even go the right direction for what he was asking and has nothing to do w/ the bloody lungs! stupid, stupid, stupid. i wanted to throw myself out of the window. but then i might get maimed and couldn't use my body to make money in a pinch when this PA thing doesn't work out and so would then HAVE to depend on my rapier wit. hell.

anyway. got to see 2 thoracic cases today and then a vascular case. so it was a cool day. i just need to learn to think before i squeak out an answer.

Meditative on a Monday

so i was reminded of something really important i need to reflect on by one of my all time favorite people in the world- how does my experience stack up to TV versions of the OR?

(side note: this favorite person of mine recently moved to a very cold, icy place in the far north and is writing the great american novel about her new life among the Inuit people and is also (in her spare time) being the lone voice of news (and hope!) for a rural fishing outpost all while wrestling brown bears and mining for coal...and oil...and gold...and riding whales and then burning their fat for fuel and using their umm....eyelashes for...er... ink.. i might tend to exaggerate her accomplishments and live her adventure vicariously through her and she most certainly exaggerates mine and lives my medical career experiences through me. she says she wants a boob job when i graduate and God save her, if she trusts me to potentially maim her for life, i say it's the least i can do. anyway....)

so she was musing today about how cool it would be if my experience was like that of gray's anatomy's interns' experiences. in that image, i would be getting shuffled into linen closets for romps with my attendings, i might fall in love with a patient and thusly cause his death, perhaps help my gimpy wounded hero/lover with intricate vascular surgeries as he recovers from neuro damage, maybe even fall madly in love with a married gay troll and lose all of my mental power and dialogue to the cause of winning him back....hmmm....

it is amusing to me how everyone looks so fresh and clean and wide awake on that show and in reality we're all without makeup, often covered in blood/feces, wearing masks and hair nets and shoe covers, and tired as hell. i don't feel much romance in the air, i tell you what. the only drama is work related from what i've seen, and there has yet to be a bomb or river boat collision. attendings are old married men none of whom can really be described as "Mc-anything appealing."

sorry to piss on your parade, if the plotlines on gray's made your life worth living or something, but i'm relieved to find my experience has been wholly w/o drama, sexual harassment, or manic muffin baking.

but this is still my first rotation, there's still time.

Slacker on a Sunday

i had a meeting on campus last week w/ all my classmates and our clinical rotations coordinators where we all shared our experiences thus far and got some updates/info from the professors. it was great to see everyone, but i'm realizing what a total slacker i am (scofflaw, if you will). some of my peers are working daily 12-16 hr days and THEN coming home and studying, giving presentations to their site preceptors, working weekends, etc. one even left our lecture friday afternoon and went back to the hospital to work. nuts. i've been practicing my sutures at home and occasionally reviewing anatomy, preparing a little bit for my upcoming surgical exam, but not a whole lot. i'm just tired (lazy) all the time and want to sleep (lie around and drink wine). i'm starting to wonder if my lack of motivation/fatigue perhaps means i have caught mononucleosis or that, the most dreaded of all human pathological parasitic infections, pregnancy.

i don't actually think i'm ill or prego. i'm just trying to find excuses for why they're studying circles around me and i'm trying to squirm out of the small bit of guilt i have that i'm not doing more work.

but i'm really enjoying not having to be in the books all the time- i am taking full advantage of it, for the record. my husband and close friend and i went to a national amusement park this weekend and rode all the new, scary coasters. funnel cake + french fries + elephant ears + caramel apples + spinny rides + heat stroke= a great day of fun. i am endlessly amused by what we humans do for entertainment. besides wearing tube tops and tight shorts w/ the words "cutie pie" written in sparkley letters across the butt, we also find it amusing to wait in line for several hours to be dropped from 100' just to get that WHOOOOOAAA feeling in our stomachs.

you know how babies/toddlers can be entertained for hours at a time by "dropping" them a few inches or supporting their heads and tilting them back toward the floor? these rides are basically giant mechanical simulations of that feeling. if we adults had giant huge parents who could throw us in the air and catch us or safely tilt us backwards like when we were kids, we wouldn't need these thrill rides. apparently the only fear we're born w/ is the fear of falling, so we're just trying to make our hearts pitter patter over something very basic and instinctive. that's all we're going for.

that being said, the rides were AWESOME and i totally thought i was going to die, but didn't. one ride you are strapped in (barely) in a (teeny tiny) harness and go way up to the top of the hugest height imaginable where i'm pretty sure i saw China in the distance and my husband and friend are like, "oh, isn't that sunset beautiful, gosh, it's so neat to be able to see across the whole park like this, blah, blah, reds and oranges, blah, blah" and i think that's about when i passed out. i went into a zen-like meditation on how my life had been a full one and i was prepared to meet my personal lord and savior Jesus Christ and that falling off a carny ride isn't THAT bad a way to go and that at least i'm with people i love....and then we were safely on the ground and i was like, "you wanna go again?"

hope everyone had great weekends....

Feminine wiles, oh what the hell....

so it's been a good week so far. i've gotten to do a lot of things i haven't seen yet, and my suturing is improving mightily. i am still breaching sterile field all the time, dagnammit, but even my awareness of DON'T PUT YOUR HAND THERE seems to be getting better. everyone is just so nice and supportive. while they threaten to throw sharp instruments at me when i do stupid stuff, no one has actually done it (or not that i've noticed, anyway).

so today i did 2 total hips in a row w/ the same surgeon. the first time, he told me to use the "bent" retractor....so i used it and didn't think about it again. the second surgery he asked me to tell him what kind of retractor i should ask for and i said loudly and proudly to the scrub nurse, "i would like a bent retractor, please." they all started laughing and staring at me. apparently the "bent retractor" is actually a Bennett retractor and is pretty common and something i probably should have known. so from then on he laughingly referred to it as the "bent retractor" and i just laughed it off. he then said that sometimes it's ok for women to be more whimsical and not always serious and just for the smallest of moments i was grateful for my feminine wiles and ability to charm my way out of sticky situations without being seen as a total boob...(every pun intended), and as long as he wasn't yelling at me, i was ok w/ the fact that he's probably sitting around the doctors lounge right now telling of this young female student with her bent retractor. but to be honest, there was a large part of me that just wanted to tell him to get.....you get the picture.

sleepy. several 12-13 hr days this week and i'm on call tomorrow night. sleepy and sleepy.

i've been hiding some embarrassing moments from you, bloggies.

some things i have yet to admit but feel i must at this time:

1. i have now TWICE grabbed a sterile drape instead of a gown out of the cupboard in the surgical suite and opened that and tried to find arm holes. the first time i wanted to melt into the floor, i was so embarrassed. the second time i just made a toga joke and kept going. i'm such an ass. they're probably each worth more than any item in my wardrobe and i am personally driving up the health care costs in America.

2. i have now TWICE lost items off of my person and had to be notified to find them at the main OR desk. one: a notebook with (THANK YOU GOD) no patient identifying info on it, but apparently distinct enough scrawl that someone in the department recognized it as mine. i just use it for notes to myself on what surgeries i need to prepare for the next day and questions i couldn't answer when asked, so want to do some reading on. (something like, "for tomorrow-look up what the "neck" is and figure out what it does for the human body. i think it has something to do with drinking or breathing or something." or " tomorrow you will be in on a nephrectomy (removal of the kidney)- find out what they do with it when they're done with it! is there really a special heaven for body parts like Dr. Smith said? i have a theory that they bronze it and give it to the patient on a key chain." ) not at all embarrassing to think that someone found and read all that i wrote.

and two: my PDA. i actually left it in the bathroom. it cost something like $400 w/ all the fancy medical programs (dictionary, drug reference, medical formula calculators, diagnostics and symptoms tool, etc, etc) and i left it in the bathroom. good lawd. but to be fair, it kind of deserved it. it's my son-of-a-whore-supposed-to-be-doing-all-the-work-for-me-and- leaving-me-hangin' palm device that freezes often, doesn't have info i'm looking for, and sticks out about 6 inches off my hip in its holster and knocks stuff off walls all the time. i think i might be leaving it in my locker from now on. the old paper kind of drug references work just as well and make me look studious when using at the nurse's station instead of like i'm texting friends on my phone or checking on the most recent celeb rehab scandals (which i totally am).

ok. i feel better. glad i got those things off my chest. and if you're wondering, playing dead did NOT work and i DID do yard work today...but my family did much more than i did and the yard looks gorgeous. it's about 600% nicer than it was when we started. we had become the rosanne conner house on the street complete w/ chicken wire and metal trash cans barring off corners of our yard and our only foliage was weeds that had won. pitiful. but now it looks organized, planned, and very un weed-like. thanks to my husband's wonderful family, we are no longer actively bringing property value in our neighborhood down. tra-la.

And we're half way done.

it's friday night and i'm drinking cheap champagne and listening to my family play nintendo wii in the family room while i attempt to focus on school work (while drinking... i know, i know) and failing miserably and subsequently writing the longest sentence to have graced the "pages" of modern "publication." i had a good week. i saw some really neat cardio, ortho, obstetric, and GI surgeries and am getting more and more competent. when rounding on pre and post op patients on the floor, i've been doing ok. i think i'm a total spazzy mcspazzatron and that i'm only getting 3% of the questions they ask correctly and only occasionally listening out of the correct side of the stethoscope, but apparently i'm fooling them good, because they've given me much praise. and my mid-rotation evaluation was really positive, so i'm flattered and happy and maybe will calm down a wee little bit. probably not.

i've been asked a few times if i'm interested in surgery as a career and the answer is still- it's really neat, and this is a great group of PA's, but i have NO IDEA. i want to leave my mind open to all disciplines, as i have many more to experience and i want to find the setting i'm most comfortable in and in which i can have the most impact. so we'll see. i like the working w/ my hands part of surgery, but it's a whole lot less detailed medicine and patient consultation time than other disciplines. and i'm a total sucker for patients who need a little lovin'. today i held the hand of a scared teenager w/o her parents and it felt great. i know, i'm such a softie. i felt like there should be a gruff, beer-bellied aging surgeon somewhere in the corner saying, "there's no CRYING in surgery!" anyway...

tired and satisfied at the end of week 3. next week i do some office visits w/ surgeons and have a day of class at some point, so it will kind of be an abbreviated surgery week for me.

sleepy...oh so sleepy. doing yard work this weekend but might play dead to get out of it. do you think that will work? i'll let you know if it does.

Seriously cool and oh, geez.

seriously cool: got to hold a heart today during a bypass surgery. amazing. so efficient and they make it look so matter-of-fact. but they stop the heart and lungs for over 30 minutes, sew pieces of vein from the leg to bad (crunchy atherosclerotic plaque-filled) coronary arteries (bypassing the plaque section), and then start heart/lungs back up and sew 'em up, shock the heart, and all is well. insane and incredible. so freaking cool.

oh, geez: the cardiothoracic surgeon i was working w/ was kind of drilling me about myself/my life the whole time during the procedure (because these open heart surgeries are so old hat to them that more interesting than savings lives is harassing the FNG at her most terrified moment) and by the end he'd concluded that i am a paul-mccartney hating vegetarian hippy comedian. paul mccartney hating because we were listening to the most recent album and it (kind of sucks) wasn't my thing and vegetarian because while he was reading me the riot act on potential heart risky behaviors i divulged that i eat healthy and mostly vegetarian. but i never claim to be a true vegetarian- i'm a pescovegetarian (figure that one out). hippy just because of the way i am. and comedian- i told him (oh, geez) that once upon a time millions of years ago i had done improv comedy (why did i say that? why? why?), so he asked me to do my "routine" for him. ummmm.....improv. so under immense pressure and against my better judgment i told him an off-colored joke to kind of test the waters. and then he told a much raunchier one and we were off and running. it was fun. but i was HOLDING A HUMAN HEART, so my hands were shaking and i was kind of all a twitter the rest of the day.

note to self: no matter how much you want to impress a surgeon, never admit to a history as any kind of performer or you will be asked to on the spot give evidence to your claim. i am a quick learner, though, since when he asked if i sang, i said absolutely not. i was not about to be the student everyone remembers with the story, "it was a normal afternoon in the cardiovascular OR when all of a sudden we heard a shrill voice echo through the halls, TOMORROW, TOMORROW, I LOVE YA, TOMORROW....and that was the last time we allowed PA students in this hospital"

Seeing God in the sterility of the OR. Who'd a thunk?

i just have to share this. i had a patient the other day who has been through more suffering and trauma in one lifetime than seems possible. early in childhood this patient was badly marred in an accident and so has lived into adult life with some debilitating and disfiguring effects and now 6 months ago was the victim of a random violent crime. the patient survived this attack against all odds and has been through something like 8 surgeries to repair and reconstruct what was harmed. not all of the procedures have gone well. it has been a painful and brutal process. we saw the patient for the latest surgery, one to clean up all the infection left behind, and when i visited the pre-op room, i found a cheerful, hopeful and funny patient ready to buckle down and face this next challenge. it was surprising and endearing, considering the history, to say the least.

but the thing that really hurt my heart was after the surgery, while we were getting ready to head to recovery and when waking up from the sedation, the patient kept saying to all of us, "God bless you." to the nurses, the MD, the PA's, me, "God bless you. Thank you, thank you so much." i could hardly breath. how could someone who has been drop-kicked by the universe so many times over be so gracious and loving and giving? amazing. it certainly made me curse myself for whining about the occasional stress or the flu. i want that attitude, that spirit and faith. that courage. all i could think to say was, "God bless YOU." and i believe that He does.

Heading into my 3rd week...

so this last week i started working on the floor seeing post-op patients in the morning, and then was in the OR in the afternoons. most surgical pts who aren't out-patient (where they leave straight from the recovery room the same day of their surgery- this is most common, and occurs surprisingly w/ even fairly invasive procedures) only stay a day or two post-op to recover and be monitored/managed. but some stay on forever while placement is sought or they develop more complications (emboli/thrombosis, infections, etc). this hospital has pretty good ratings for nosocomial infections (those that are developed while patient is in the hospital, thought to be spread patient to patient), but it still happens, so with this in mind, i am really encouraging those little old ladies who love the attention and companionship of being in the hospital, to get out as soon as they are able physically.

i have rounded on a few patients on my own, done my exam, asked my questions and written progress notes (subjective account from patient, objective vitals/lab values/exam results, assessment and plan) and i've done ok. i ask a lot of questions of my preceptor and have them look over my shoulder at all that i'm doing. but i've gotten good feedback. i'm also trying to learn staff members' names on the floors so that they will like me and help me when i need it. i made a room full of social workers and nurse case managers laugh the other day when one asked me if i was the PA on a certain patient and i replied that i'm just the student and there is about a 4% chance i can answer her question accurately. needless to say, they all seemed to enjoy that, but did NOT go ahead and ask me the question. perhaps i'm on to something...

it's neat to see the process from beginning to end. i'm obviously not in the surgeon's clinic when they're making the diagnosis and plan to take the pt to surgery, but i do see patients pre-op and get a feeling for how they came to need surgery and what their history involves, and then see them through the operation, and then see them post-op and how they feel/look, what kind of function has returned, etc. most of the patients i've seen are abdominal surgeries- so post-op you're asking a lot of "have you passed any gas yet?" type questions, which is interesting when the patient is hard of hearing so you have to shout it, or a non-english speaker, so you have to mime it for them. GI surgery commonly causes an ileus-paralysis of the intestinal peristalsis (normal squeeze/grind that pushes food down the way it needs to go) and so the patients are obstructed for a few days. they get very bloated and uncomfortable and what can't go down, may come up. so passing flatus (a delicate word that is latin for "big juicy fart") is a good sign that things are starting to move.

on the floor i've been able to do a few procedures, too...like taking sutures out and removing a jugular IV line, etc. pretty cool. all simple stuff, but again, super exciting to me to actually be doing hands-on work on real live patients.

toodles....

There's a sad sort of ringing from the clock in the hall...

it's amazing how much better my mood is when i only have to work 9 hrs in a day instead of 12. once my coffee has dipped below therapeutic levels in the afternoons, i start to whine inside my head a bit until it looks like i might be on the home stretch to getting to leave. when i got home tonight, i found that it had been a banner day at home, too. over labor day weekend we installed a doggie door for my crazy fool dog, so she is not trapped in a crate for 10-12 hrs at a time or a-crappin' on the floor if left to her own devices in the house. today she proved that she has officially and completely (tra-la-la) learned how to use the door independent of our begging/yelling/threatening/bribing, so that's one less worry. she was trouping around the backyard when my husband got home- scaring squirrels senseless and lying in her favorite spot on the cement porch (on the ground, immediately next to her fluffy expensive bed).

the last few days have been good. it varies a lot between surgeons and PA's in what they will allow me to do. today i was w/ a mercurial jekyl/hyde type MD everyone's a little afraid of, so i mostly watched and pretended to laugh at (the least offensive of) his dumb jokes. old hackneyed homophobic one-liners are apparently hee-larious if you're a surgeon. eck.

i guess i'm making notes on how i will and won't be as a practitioner. 1) WILL: When consulting w/ my patients pre-op, draw the intended anatomy on my scrubs to show the patient exactly where the incision will be and how the surgery will work, 2) WON'T: Make off-color jokes or gossip about co-workers while operating (especially when the patient is only under mild sedation and may be able to piece together the whole conversation). 3) WILL: Encourage loud rockin' music to be played when i'm in the OR, even if it means that my semi-conscious patient will wake up w/ an insatiable urge to mosh as soon as they can walk/hop. 4) WON'T: Fall for it when my patients are trying to get drugs out of me when their MD already told them "no" in no uncertain terms. i will be strong and vigilant and....what's that? oh you REALLY hurt? i will be strong and vigi....ok, maybe just one... (just kidding)

hope all is well with you all out there in the inter-world.

First week down.

surgery rotation: 1 week down, 5 to go. i still feel rather dumb, rather useless, and rather helpless, but i have a good attitude (can't you tell?). like the puppy who keeps coming back when he's kicked just because he doesn't know where else to go- i'm smiling and saying, "oh thank you for correcting me on that point- i was wondering how it was possible i had gone a whole 7 minutes without being wrong." they're letting me do more and more and i'm actually eager to try some things on my own. the surgeons haven't been the stereotypical ass-clowns that we hear about, but rather informative, friendly and generous. everyone in the room knows it's their job to stroke their egos, of course, but that's kind of true for all MD's, as far as i've seen in my professional and academic experience.

i have been involved in some really neat things now. all my preceptors keep apologizing that all i'm getting is "boring" general surgery stuff, but to me, since it's all new, i'm fascinated by it all. the things they can do w/ a camera are astounding (laparoscopic). they are actually throwing stitches internally only guided by the images they're able to see on the monitor over the table. unbelievable. i held a gall bladder w/ the clamps all laparoscopically and i couldn't believe how hard it was to manipulate them like that, and these geniuses are sewing in there! incredible.

so while i don't want to go under the knife myself since i now know how the tissue is twisted, bent, drilled through, burnt, and manipulated to accomplish what is needed during a procedure, i am feeling very pro-medicine right now and in awe of all we can do for people. for comfort, for diagnosis, for prevention, and then of course, for cosmetics. i haven't seen any tummy tucks or boob jobs yet (i will), but i did get to close an areola (the pepperoni under the nipple) where they had taken out a fatty lump directly under a nipple (gynecomastia). pretty cool. the little smiley faced scar on that patient's boob is because of me. alright.

anyway....my classmates all seem to be doing really well on their rotations. they're scattered in different disciplines and so we're all seeing/doing very different things, but for the most part experiences have been good. some are feeling out of their realm like i am, and some have crappy, angry, bitter preceptors, which sucks, but so far everyone is afloat. have i mentioned how much i love my people yet? these classmates of mine have quickly over the last year become some of my favorite people and i love how much support we provide each other. just a quick shout out to them.

more soon....

Quickie update

i have already become pro at coming home and ignoring my husband and falling asleep w/ my clothes on, so i'll make this quick since i'm still awake and he might want to see me conscious for a change. 10-12 hours on my feet and getting up at 5am....not my bag, baby.

anywho--things are going well. i'm terrified most of the time but have started to get over the EVERYTHINGHASTOBECORRECTANDPERFECTEVERYSINGLETIME thing and am relaxing and sponging up info. i HATE to be wrong, but such is life as a student. so even stupid simple questions that make me paralyzed in the OR when drilled by a surgeon and that i get wrong by stammering something like...."ummm.....blue?" don't freak me out as much now. i've had some great preceptors and they're letting me do SO much. i'm already first assisting and suturing closures and stuff (badly, still, but getting better) and have seen and participated in some really neat surgeries. i'm getting comfortable w/ the names of the instruments and procedure methods and know how to make myself useful in the room pre and post-op. i'm also starting to get the layout of the building so i don't keep having to ask janitors to point me to surgical suite #4.

more soon....

OH-HOLY-HELL-I-WAS-IN-SOMEONE'S-BELLY!!!

so first day of surgery today and everyone was splendid. very sweet, understanding, generous. the place isn't as far from my house as i thought and the hours are MUCH better than i originally feared. i'll be working mon-fri w/ one night of call (from home) each week and (tra-la-la) NO WEEKENDS! i'm actually on-call tonight....so might need to cut this short to go, you know, save lives and suture stuff back together....or something.

there is a huge surgical PA dept and they're all sweet, young, and seem to really enjoy what they do. many went to my school and know my professors, so we were able to share in that.

so that is how everyone around me was today. but you might ask, " my dear stressed-out-manic PA student, how were YOU today?" i was fair. i was friendly and out-going and not afraid to ask (unbelievably dumb) questions. but i yes very much indeed did almost pass out on my first case. like everyone warned us we would. i complied beautifully.

i got there before 7 and by 8:30 or so, i was in surgical scrubs w/ my dead sexy hair net and shoe covers, scrubbed in and working on a belly case. the incision under the belly button did me in. i felt sweaty and couldn't catch my breath, so i sat down and the nurses rushed over and fussed over me. as soon as i was sitting and my gown was off, i felt better. so i scrubbed back in and joined the team. then the little black confetti started showing back up in to my peripheral vision and eventually took over the whole visual field. so i sat down again. all in the room were trying hard to be sympathetic and not laugh at me, and were mostly successful. they were reassuring and not judgmental, but i was still pretty mad at myself.

we did a few more belly procedures and after the first case, i no longer felt dizzy and really enjoyed myself. i got to hold a camera (on a long tube, inserted deep into the abdomen and the image displayed on screens above our heads) and i also got to do some sutures. which were less-than. i will continue to practice on chicken breast, towels, my sleeping husband, etc until i get it right.

more later.....so sleepy.....

Last Day of Freedom.....(gulp).....

i am on my last day of vacation (which started last thursday) and i start my rotations tomorrow morning at 6:45am in a hospital 45 minutes from here. it's surgery, and it's supposed to be a really good rotation. but seeing as i have nothing to compare it to, a "really good rotation" may only mean they don't beat us w/ medical instruments and let us sleep on an actual cot when we're on-call instead of down in the morgue w/ the lawsuits.

i think it actually means we get to be involved in a lot of cases since there are no medical students at this particular hospital, so we're kind of the top of the heap of the student order. in many hospitals we're competing w/ the medical interns and residents for time w/ the attendings and opportunities to do procedures.

i've gone from feeling terrified to feeling inevitable about the whole thing. i only know what i know and can only be as charming and out-of-the-way as i can be, so that's what i'm prepared w/. i had every intention of re-reading much of my surgery text book this week and re-learning all of human anatomy, but this is not going to happen. it's been a very relaxing, enjoyable week. today is my day to get all my last minute stuff together (and to be totally honest, to pace the house in terror).

all of my classmates are feeling jittery and uncertain, also. the few of us who have surgery first have a lot of anxiety, since this will be the most new, most different from what we learned. and some of us have a bit of a woozy issue with body gore....so we'll see how that goes. working in a hospital i've had my fair exposure to colostomy bags and bloody emesis (puke) and feel ok about all of the smells and sights i'll experience, but i remember making abdominal incisions into the cadaver and 'feeling his pain' and so anticipate the actual scalpel to living flesh experience will be a bit nerve-racking. also, our professors have instructed us repeatedly on backing out of the sterile field and sitting down if we feel light-headed. apparently students drop head-first into sterile patients all the time. something about no sleep, no food, and a stretch of 8 hours on your feet in hot surgical scrubs and gown. go figure. i'll keep you posted. if anyone wants to start a bit of a wager on how soon/how often i'll bite it, i would not be the least offended (and only expect 20% of the winnings....i'm not to proud to go down for the right price).

anyway.....off i go. i feel like i'm jumping either onto a roller coaster or into a black hole. also, i am seeing that w/ only a week off, i head into a WHOLE NOTHER YEAR OF THIS. i am so aware what the last 12 months did to me...how long it was, how much work and angst and stress it was. i feel like i've been through the battle and should be able to sit it out for a while...but instead i have to be even more alert and vigilant as now there will be vulnerable patients relying on me. i have to keep my head in it and as one of my classmates rips off from "Finding Nemo," i have to "just keep swimming, just keep swimming...."

more soon.....wish me luck!

My Week Off

(in satisfied yawn voice) aaaaaaahhhh. sigh. this has been the best vacation ever. went to my parents' cabin with my lovely husband and parents and sister this weekend. we pretty much just slept and ate the whole time. that's what the fresh air is good for- puts you into a nice semi-conscious state of gluttony. yum.

it was good to get re-acquainted w/ my husband. i think last time i saw him he may have had a beard. and he seems taller now. huh. the poor guy. this year has been madness for our marriage. we've faired pretty well, but it's stressful for one partner to be so focused on something so all-encompassing as PA school. he's become the maid, gardener, chauffeur, cook, and ambassador (standing in as my representative for important family functions such as MY OWN FATHER's 50th bday party). he's a trouper, though, and is right there with me celebrating the success of finishing this school year. i think he's glad i have real patients to practice on now and won't come home to poke/prod/light up any parts of him any more. i'll never forget the first fundoscopic (eye) exam i attempted on him. in the pitch dark. without any warning. blinded him for an hour. he was so innocent and unsuspecting. not so much after that, though.

maybe eventually he'll stop adamantly denying that he has any hernias for me to palpate when i try to get fresh with him. :)

so this week off for me is all about relaxing and reading real books that can't be classified as text books, catching up on movies i've missed (see side panel of my reviews of the movies i watch) and getting ready for rotations. i'm cleaning my house top to bottom (while my husband may have been the official "help" over the past year, he's like the maid who shtups the boss and so the level of cleanliness ends up rather sub-par). and i'm practicing suturing skills on chicken breasts, since my first rotation is in surgery, and my dog won't hold still long enough for me to try my stitches on her. i'm pretty sure i won't know where the olecranon process is (it's part of the elbow, i just looked it up) so i better be really good at knot-tying and stitch-making to make up for my wholly pitiful lack of anatomy recall. i find that i have words like "olecranon process" floating around my head, but i can't always associate them with anything meaningful. perhaps in time.

Intro

hello, there. i am a physician assistant student and i finished my final exams of my academic year YESTERDAY so i am writing this in bed with a bit of a hangover. this is literally the first day i've been able to sleep in in several months....and i'm up and its not even 8:00am. awesome. i think PA school may have broken my head. :)

the last year was very intense. i had 5-6 classes/semester, which is madness in graduate school. the classes ranged from human anatomy with a cadaver lab (fascinating and so important for our understanding of the workings of the body...but every bit as unsettling as you're imagining right now), pathophysiology, research, pharmacology, howtobeanicepersonandnotkillpatientsonpurpose ethics and policy classes and then the nuts and bolts classes of clinical medicine, physical exam, and diagnostics. i'm in a great program w/ wonderful professors and i have amazing friends/peers alongside me. it's been good, but exhausting.

so a week from now i go into my rotations. they will last 12 months and will include all the major disciplines (surgery, ER, family practice, peds, OBGYN, internal medicine, psych and a few electives) all in 4-6 week stretches. this is like the internship year for medical students, except that since we will graduate at the end of our rotations year and get jobs and be responsible for human lives, instead of continue on for a few more years of residency, our preceptors treat us like 3rd/4th yr medical students. another difference betwixt us and the medical students is that we have no legal restrictions on our hours. you may recall legislation changes that determined that medical students are not allowed to work more than (something like) 80 hrs in a week and 30 hours in a stretch...with the hope that fewer students falling asleep while operating on their patients will result in few casualties and law suites. well, we PA students haven't quite gotten our lobbyists to pull that sweet deal for us...so we stay on after all the med students leave at night.

all i have going into this year is hearsay on what to expect. before starting the program last year i also read the books "The Intern Blues" by Robert Marion and "The House of God" by Samuel Shem, which i really enjoyed but also which gave me a sense of terror throughout this last year as i looked forward into my clinical year. most of my fellow students happily plodded along, just aching for the hard tests to be over, but i always kind of savored the classroom setting since the worst that can happen is you pick the wrong multiple choice answer or confidently announce to your professor and entire class that the 12 y/o kid w/ diarrhea most likely has colon cancer. in the safety of academia your misinterpreting lab values or inability to read an EKG only hurts your GPA, doesn't risk a life or cause a misdiagnosis or get you sued. that is my fear.

and yet i receive reassurances all around that we will have our hands held at first and will "remember more than you think you will" so i go forth with enthusiasm. i just really am hoping i won't be escorted out of my first rotation on the first day, tossed into the parking lot by angry red-coat wearing volunteer help desk old people saying, "you're the worst student we've ever had! did you sleep through the entire 12 months of classes? you are no longer invited into medicine." if that doesn't happen on my first day, i'll feel pretty good. :)

again, my purpose in this blog is to share my experiences and perceptions on my clinicals with my family and friends (who i won't see for long stretches of time, see above under Medical Students Have All the Luck) and for anyone else in PA school, considering PA school, or for those who are sadists and enjoy other people's woes.

hope you're having a pleasant friday....more soon.....