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).