lose yourself

Oh! HERE'S my blog! I lost it for a while.

Things are rolling right along around here. I have a feeling that fourth year is going to go by very fast.

Today we signed up to have our senior photos (in graduation garb) taken... so that's basically the beginning of the end. The fun has begun though, with using interviews and board exams as excuse to crash with friends for weekends at a time. I'm going to try to enjoy this while it lasts :-)

Bring on the parties!

!

whose idea was it to take an 8 hour exam two days after a 9 hour exam?? well????

looking forward to being DONE tomorrow.

Redux

This time around, I hiccuped three or four times.
http://redheadmed.blogspot.com/2007/06/i-only-hiccupped-once.html

Let's go!

I have Step 2 (of 3) of the United States Medical Licensing Exam tomorrow. Nine hours of marathon testing fun.

When I took Step 1, it was this horrible annoying test that served as one final exam for the two hardest years of my educational life. It felt like a hoop I had to jump through. And I took it knowing there were two more parts after it!

This feels a little different. Step 2 is testing me on knowledge that I've already put to use on my clinical rotations, that I know the value of. Sure they love to test the rare stuff, but rare stuff does occasionally happen -- just in the past few months I've had a patient with neurofibromatosis and a patient with osteogenesis imperfecta. With Step 2, I don't find myself muttering that "I'm never going to need to know this."

And, now there's only one more of these tests in the sequence. And when I take that test, it lets me become a licensed physician -- that goal is actually in sight. So this feels less like a hoop and more like a step towards a goal.

...a nine hour, endurance marathon sort of step.

Oh yeah, and in between those two moments, this one.
(look for the rainbow)

after the storm.

storm.

A is for Alyson… really.

So… back when I was studying for Step 1, I had all sorts of crazy stress reactions, and even got a touch of dermatographia – I would break out in a stripe of hives whenever I got scratched or bumped.

I mentioned this to a family medicine attending who likes skin findings and really likes to take pictures of them for an online database that he uses to teach residents and students.  He told me that if I ever had it again, I should get him a picture.

This was fresh in my mind because I just finished a month-long course with another doctor who takes photos of any interesting physical finding he comes across… after 20 years of practice, he has a photo of everything.

So tonight, as I mentioned earlier, I was feeling kind of stressed out, and I started breaking out in hives.  This happens regularly, but it’s usually just a single  hive, maybe two.  But tonight I got four across my upper chest and shoulders.  I thought, oh!  Maybe my dermatographia is back!  I’ll scratch myself and take a photo. 

Dermatographia means skin writing, as classically one could use a pencil and write on the skin and it would appear as letters of red welts.  So I figured I would also use a letter for demonstration.  I figured A is the first letter, kind of the typical letter to use, and plus it’s my initial.  So I scratched myself in the shape of an A just below my collarbone and waited.

No hives.

…which, I just realized, is for the best, because I literally just attempted to emblazon my chest with a scarlet letter.

(there’s only faint scratch marks which I trust will be gone by morning… more of a pink letter.)

actually, it's me and a mountain the day before we got engaged.

:-)

Me and a mountain.

Today we went down to duPont Children's Hospital for computer training for our emergency medicine rotation. We also picked our schedule -- eight shifts for the month. I "back-loaded" my schedule, meaning I'm working five days in a row the last week. But this also means I have one shift per week for the first three weeks. Yeah, the fact that 'working five days in a row' is this ghastly fact is awesome. I did this so I could continue to study for step 2 over the next week... and then chill out for a week straight ;-) We're going to clean out the back room! Really! Seriously this time! I had come to accept that we don't have an "office" we have a "storage room" so I lost my motivation but we are going to reclaim this room by the end of October!

Then this evening I went to the wine and cheese internal medicine reception where all the fourth years interested in IM came and socialized with the big wigs of the Jeff residency program. I always walk away feeling like I couldn't have been more awkward, but I'm glad I went rather than not. At least they will remember my awkward face.

So, not much room left in today for studying. My studying has also been stifled over the past two days by some weird transient symptoms... gnawing headache, nausea, GI upset, malaise, lightheadedness. I feel sick, but it won't come on all the way. I could also attribute it not sleeping well... but when you put all that together, it really just sounds like stress, doesn't it? I can't wait for this test to be over.

This is my photo from Friday. It's a picture of our pet watermelon.

We've had it since... the first week of June I think. That was back when Glen and I were gung-ho about cleaning up the backyard and turning it into a usable space. We cut the grass, bought potted plants to hide the fact that it kind of looks like a construction zone back there, and even made a little temporary patio for our grill. We ate back there a bunch of times. And in the midst of that, Glen bought this watermelon, the perfect barbeque food!

Then, it started to rain. And it rained and rained and rained, and we didn't eat outside. Then it cleared up long enough to go on our camping trip... and we said hey! Let's bring our watermelon on our camping trip -- that will be perfect. And we forgot our watermelon at home.

Then when we came home, I'm told that it continued to rain for most of July, although I have to admit that most of the month is a blur. I do remember one walk to work where even with an umbrella I was completely soaked to above my knees by the time I walked the 5 blocks to the hospital, and it took the majority of the day for my leather shoes to dry out. (It wasn't even raining when I left the house, which is why I wore little leather dress shoes instead of my pink rainboots. Although, in that rain, my boots probably would have been full of water.)

Then August came and it was muggy. And I was on my sub-I rotation. And Glen was studying for the boards. And then when he finished, I started studying for my boards. So sadly, there haven't been many more barbeques.

And, our watermelon is still here.

It feels fine, still solid, doesn't smell bad. Somehow though I have a feeling that we're brewing watermelon liquor in there. Which could turn out to be awesome.

Or not. I'll let you know.

Hey! I just saw that the whole rest of my post got cut off! It went as follows:

It was the very deep photo of a man in short shorts with his stoagie that caught my eye, but if you'll notice to the right there is also a black fedora and beneath that a whole printer in a cardboard box.

I finished my Advanced Physical Diagnosis class today! I'm kinda sad it's over and I wish I could take it a second time and maybe soak up a little bit more of the tidal wave of information that came at me.

To celebrate, tonight Glen and I went out to the biannual movie shown out on the quad. It was "Up" which had recently been recommended to me... Man I don't think I've ever cried so much in the first five minutes of a film, let alone a cartoon!  It was vey sweet though.

Early to bed for me and back to studying tomorrow.

Of films and fedoras

This isn't my neighbor's, but I did pass this interesting pile of
trash on my way to class this morning.

(detail)

Same trip, following evening.

I'm supposed to be studying for Step 2, but I lost my motivation a few days ago.

Eight weeks until six weeks of vacation!

So my attempts at writing on here more often haven't been successful. The patient idea was good but A) I'm not currently seeing patients and B) that is really time intensive, and I haven't been able to give that much lately. The idea about documenting my neighbor's funny garbage would have been fun, but of course they stopped putting out funny garbage! (last week there was a single running shoe from the 1970s that looked like it had been keep in some sort of vacuum sealed time capsule, but it's not the first time they've thrown out odd retro running shoes, so I wasn't impressed.)

Now I'm thinking maybe I'll just try to post a picture every day of so, since I do get joy out of flipping through Picasa and playing with my photos. This is one of my favorites from our road trip through scenic western Virginia and North Carolina on our way down to Florida in August 2006. I think it came out pretty well considering it was taken out the window of a moving vehicle. I just got it printed to hang in a frame in our apartment.

study break

I’m currently studying for Step 2 of my licensing exam, so I feel like I have no time to blog.  It’s kind of interesting though, that this blog started while I was studying for Step 1.  The difference is that back then, June 2007, I had five weeks off to completely devote to studying – not only does that mean more study time but it also meant that I felt like I was going to go crazy if I didn’t pick up a side activity, but one that I could do without leaving my desk.  Now, I’m in a classroom-based rotation during the day.  Granted, it’s one of the lighter ways you could spend a rotation: I go and listen to someone talk from 9a to 3p every day.  But, nonetheless, the number of hours I can spend studying is greatly reduced.  So when I’m home I feel like I have to be productive.

I’ve been writing this entry all day – a sentence before returning to work or going out to do an errand.  I’m going to just say it’s done, so that when I take my other breaks I do some other non-work things I have lined up.  This includes getting some pictures printed at snapfish.com – they had free printing through tomorrow :-)

you spin me right round

So last year I remember all my med school friends being miserable around this time of year… and now I understand why.  This application is just… kind of mind boggling.  Thank goodness it’s nothing like the application to med school where you sent off the common app to your programs (thirty of them if you were me) and then they each in turn sent you back their own ‘secondary application’ which (a) asked you to write up to five new essays just for that school and (b) asked you to send them $100.

This time around it’s just this one common app.  But sorting through all the programs, selecting the right ones, clicking through all of the choice boxes for each of my (22) programs.  It just makes your brain spin.  Trying to decide with little to no information if I want to apply to program X.   Having to triple check everything you type in because you’ve been led to believe that a single typo will make you lose your spot at your favorite program.

The application formally opens tonight at midnight, but mine’s not going to be submitted.  I just can’t finish it tonight.

Looking forward for the interview season part of this adventure to begin.  Friends, get your couches ready.

Finally!

It had been a while since my neighbors had put out any interesting garbage. I think I jinxed it by promising to supply pictures. Also just past this, across Addison, were two sofas, the frame for a futon, and two full futon cushions! So, if you need to go furniture shopping today, come on down to 9th street!

You're charging me what now?

I haven't written in a while... in fact I missed the entire month of July.

I just wanted to say that I will have an M.D. in 9 months and I all but have an M.B.A. in Healthcare Management and I just had to call my health insurance company and the billing office at my doctor's to dispute a claim/payment/bill for the first time, and I have never been so confused! I just spent an hour on the phone with two people, a dozen pieces of paper in front of me, searching google in between. You bundled what CPT code what with what discount adjustment what?

This health system is broken.

But on the bright side, I was successful, and as Glen said I just earned myself $318 for an hour's work, the best wage I've ever gotten! (We'll ignore that it was really my money to begin with.)

case files

OK, gotta revive the blog.

I have two plans for this. The first is to start writing about my patients, who always turn out to be interesting people. This will also help me remember the ones worth remembering, as I think it will be one of those things that will fade with time even though when you're working with the person you swear you'll never be able to forget them or that experience.

The other idea is to start chronicling what my neighbors put on the curb on garbage night, because it is always amazing. This week it was an entire couch, with throw pillows. Often it is much more bizarre, like a single sneaker that was clearly purchased and worn in the 1970s. This section will include photos.


So I have this one 76 year old white female who came into the hospital with confusion. She had been babbling nonsense for an entire 24 hours before her family brought her in. In the ED they found she had a sodium of 118, normal being 136-144ish. This can make you confused. About two weeks beforehand she had been down to Hopkins to have surgery to repair a Zenker's diverticulum, an outpouching from your esophagus; the thought was that she hadn't been eating quite right before and since then and that's why her sodium was low.

We started trying to replete (replace) her sodium and it was slow-going. She stayed loopy in the hospital, frquently perseverating, meaning she would get stuck on one thing like wanting to take a shower and talk about it constantly, or more bizarre, just get stuck on one sentence that she would repeat over and over and over, changing maybe one word in the sentence every minute or so so that the sentence slowly morphed and made less and less sense. She also decided to repeat "You know I hate red hair" for a half hour one morning.

The lab work was confusing at first, but evertually led the kidney doctor to think this is SIADH, a syndrome where you secrete too much of a hormone that makes you retain water, thus dilluting your sodium. Surgery in the center of your chest, your mediastinum, (such as a Zenker's diverticulum repair two weeks earlier) can kick off SIADH so we thought it made sense. Nonetheless, the kidney doc wanted a CT of the lady's chest. We thought it was kind of pointless, but we got it... and there in her left lung was a big old tumor.

Meanwhile, the patient stayed loopy. However, it wasn't the typical just 'obtunded' mental status that you would expect with low sodium. Her behavior had changed from perseverating into what can only be called hypersexuality. The nurses often had to close the door to her room to give her privacy. We got stuck in a kind of catch-22: we needed more tests to work up this lung tumor as well as to work up this behavior but we were having trouble getting the tests because of the behavior! I'll just say it straight out -- my patient was kicked out the MRI suite for masturbating while INSIDE the MRI machine getting scanned. "Image artifact due to patient movement."

We discovered the combination of Zyprexa and Ativan seems to calm things down enough to get through a test, so we got the bronchoscopy today to hopefully pin down the lung mass. The sodium is being stubborn; only 3% normal saline moves it at all. We got her into the normal range for one day last weekend and her mental status did improve, which is our one shred of evidence that this behavior is sodium-related, since this isn't a textbook case at all. We had some improvement both in sodium and mental status today again finally. But, to my frustration, Renal stopped the 3% again today and put her on salt pills (something she could go home on if it works) but I expect her sodium to start sinking again tomorrow. Then we will go back to living in an X-rated movie. (I will spare you the words that come of our this woman's mouth!)

Tomorrow is my last day treating her, and I feel kind of bad saying I'm glad about this! Besides the red hair comments, she makes it very clear that she doesn't like me. I don't take it personally because usually she's too out of it to take responsibility for what she says, but it is kind of hard to walk into that every morning.

The end.

whiteheadmed

Happy May!

Things have been kind of quiet around here.  Just working and cooking and sleeping.  Twitter has proven a better vehicle for my random thoughts because they rarely require more than 140 characters anyway.  My 'tweets' come up on the right of this page anyway, so I feel like I'm being doubly-productive... triply if you count the ones that also go to facebook.  [wow apparently triply is a real word.]

I'm enjoying internal medicine, although I don't love being in the hospital, so I'm still pretty confused about what I want to train in.  Geography and logistics may play a big part of my decision, so I have a lot more research to do.

One random thing -- I bought reading glasses.  I'm actually near-sighted and I've been wearing my contact lenses all the time because... well, the last time I wore my glasses into the hospital, they fell off while I was changing a post-partum lady's diarrhea-filled .... ok I'm not going to bother finishing that sentence.  So yeah, my glasses are bent because they're 6 years old and they fall off way too much for the hospital.  But, happily, my glasses are 6 years old because my prescription hasn't worsened in that time period.  I believe this is largely due to that fact that I try to wear my glasses more than my contacts and either take them off to do any reading or typing or look over the rather thin lenses at anything closer than a few feet away.  I don't need correction for looking at things within an arm's length, and it's less strain on my eyes if I don't use correction for that.  So now that I've been wearing my contacts all the time and reading and writing and typing with them, I can feel my eyes straining and have noticed my vision is worse when I take them off at the end of the day.  Soooo I figured I would just cancel them out with some equally but oppositely powered reading glasses during those activities.  At this very moment I am wearing my contact lenses and my reading glasses.  I dont' have to worry about them falling off onto patients because I don't put them on then.  It's actually working out very well, and my eyes are starting to refuse to strain and read with my contacts in if I don't have my reading glasses on.  Anyway, I'm kind of embarrassed by this whole thing, because really, who does this?  I'm nervous about someone asking about them (what 26 year old wears reading glasses?!)* and me having to explain the whole story that I just explained above... and them thinking I'm a weirdo.  As you probably think now (but you knew that already, obvi). 

*the same 26-year-old who is going gray** apparently.

**white, actually.  Redheads can't go gray, we don't have that kind of pigment.  I'm going white.

Here are my pics from the crazy tree falling night, on Thursday.
By 6am Friday morning when I left the house, they had cleared the street so I could drive past. By the afternoon when I got home, there was hardly a trace!
I should take another picture of the tree where the branch fell off. Half of that surface is black, like it was dead there and not really connected. It's no wonder it fell.

Anywho, we're enjoying temperatures in the high 80s here in Philly -- almost too hot! It was 75 when we left this house this morning and that felt great. They're saying 90 for the high tomorrow. Where is Spring??

Timber!

Half of a giant tree just fell across 9th St, blocking the whole street, but miraculously landed into the alley Addison St. It may have scratched one illegally parked car, but overall no one and nothing was hurt!
Pictures to follow, tomorrow.

0.38!!!!!

For lack of original material (my inner monologue is currently a panicked yell) I will direct you to a recent post in blog that I follow:

One True PenI concur.

Yesterday I was driving home from Christiana on 95 in the center of three lanes and I had a truck in front of me and a truck behind me. There was also a truck right next to me in the right lane. I noticed that I was in a truck-sized space and thinking back to my horrific commute Friday evening when I got cut off and such so many times I wanted to scream, I realized I should make sure that the truck to my right knew I was there. I looked and I could see the driver's face in one of his three side mirrors, so I knew if I could see his face, he could definitely see my car.

So in the next minute or so I see him doing some looking around. Then I notice that one side light on the truck, parallel to me, is blinking. I check and none of the side lights on the cab are blinking. Before I can decide whether this one rogue light is some kind of turn signal, the truck starts PULLING INTO MY LANE. I quickly realized that his looking around was to see when the leftmost lane cleared up so I could pull over there AS HE PULLED INTO ME.

WTF.

He purposefully pulled into me! Thank god no one was speeding up the left lane at 95 mph, which is more common than not, or I would have been smashed.


Today was less danger-filled, but more stop-and-go filled. It should not take and hour and 20 minutes to drive back from Christiana Hospital. I could drive home from New York in that time period.

That was only day five of commuting. 2 1/2 more weeks to go now, and another 4 in late May / early June. Pray for my safety and my sanity.

Apples and Oranges

So I was sent to an Internal Medicine outpatient office on Friday to shadow the doctor. I was hoping it would be the first step in figuring out whether I want to train in internal med or family med.

When I did my family med rotation I was at Jefferson's offices... about 40 exam rooms, run by residents, in the middle of the city. Friday I worked with a solo practitioner with his two exam rooms, one nurse, one receptionist, and his wife doing the billing, with his office in a 'commercial park' that apparently was a cornfield two years ago. It was south of the canal in Delaware, which = middle of no where.

So I got some more data points to use in my personal life forecasting model. But all I've really seen are two extremes of practices, with no indication as to what should be attributed to the specialty training (probably very little).

How do I make this decision??

I love the bathing suits available at Victoria's Secret (they have hundreds... I like the super cheap mix and match tops and bottoms).... BUT, isn't this the same pattern as what is on every patient gown in every hospital you've ever been in? That pattern doesn't scream vacation to me.

Although, it did always seem weird that they put seagulls on hospital gowns. I guess they make a lot more sense on a bathing suit.


I want summer.

Turtle Cheesecake

You know what would be good?
An iPhone app where you could take a picture of something and it would
tell you how many calories it had.

And then it would yell at you not to eat it.

Oh well.

public service announcement

Dear world (and you know who you are),
We have started watching How I Met Your Mother. The first episode was good.
Thank you and good night,
Alyson

Glen, 10 days before graduation from Hopkins:

Superfresh on 10th & South just completely renovated, including getting all new signs.
1) that's not how you spell that.
2) these 'marshmellows' take up so much of the aisle that they get their own sign? or were there just that many customers coming in and asking for the 'marshmellows' that you thought a sign would be worthwhile?

OK, I'll head back to working on my overdue paper now.

Tomorrow is Match Day!

I feel a little weird. There's this sensation like it's graduation time, so I should be feeling all the graduation feelings -- excitement, happiness, and bittersweet sentimentalness... that's a word. So I am definitely excited for all of you who are matching, but there's really no happiness -- just the bittersweet knowledge that most of you will be leaving and going three states away or three time zones away. I'm starting to feel like it's going to be very lonely here. I've made some new class-of-2010 friends (and I have a best friend x12 years here of course) but there aren't going to be many more parties like my recent birthday party. It's hard enough managing a group of college friends who are spread out all over the east coast, but now a group of med school friends who are going to be all over the country?? I'm going to miss you guys.

Let's celebrate tomorrow, and party it up for the next few months... while you're all still here.

mildly interesting news

So apparently Jefferson changed their policy or something, and quietly gave me a new email address with my married name. This is good because everyone at Jeff just assumes your email address is the name on your badge @jefferson.edu. People could look me up in the directory under my married name, but I thought that they would get my maiden name email address.

Two things I think are curious about this situation are (1) they didn't tell me they gave me another email address. I just happened to notice that someone I just met emailed me at it. And (2) somehow emails sent to it ended up in my gmail inbox just like all my other mail. I assume that means that the two jefferson email addresses are directed to the same jefferson inbox, which is very nice of them, especially since they decided not to tell me I had the address. If it were going into its own inbox somewhere else, emails would just pile up there indefinitely without me ever knowing to check them!

Overall, it doesn't really matter though. Jefferson cancels our school email addresses six months after we graduate, so I only have ~2 years left with my jeff emails anyway. I don't really want to get too many people using them and then have to switch everyone back over. In the meanwhile though, it will be handy for all of the people who make assumptions from my name tag.

Today I had a patient with paranoid schizophrenia come in because one of his psych meds was messing with his blood sugar and we needed to rule out diabetes. He was a little socially awkward, and obviously anxious, pacing the exam room the whole time I talked to him. He was nice though, even cracking a very quiet joke or two.

He had also had some trouble with low blood pressure, so we decided to take his blood pressure lying down and then standing. We had him lie on his back on the exam table, and he suddenly says, "What's that button?"

He was lying under this special bright light that I've only seen used on a 4-day-old infant, I thought to help keep her warm. It had some tiny knob on it that looked like a button, so the resident explained the light and turned it on for a moment, trying to reassure him.

He then says, "No, that button." We look up, and then on the next ceiling-tile over is a coat button... like, round, with a rim, and 4 holes... stuck to the ceiling. Someone glued a button to the ceiling.

Things like that can make you think you're crazy!



(Or it was hovering. Or it was a bug that could disguise itself as a button. Or an alien that could disguise itself as a button. I don't even have a psychiatric disorder and I came up with those possibilities... or I assume I don't have a psy dx. Yeah, thanks in advance for the comments on that).




Also, my friend from my previous post isn't doing well. The diagnosis right now is transverse myelitis, which indicates it could be at least a few weeks before there is improvement. I pray that she and her family have the strength to carry them through this.

I can't believe it's the last full week of Family Medicine already! The good rotations go so quickly.

On Friday I was interviewing this 80-something year old lady accompanied by her daughter with very vague complaints of feeling unwell and clammy. I was excited to hear my first real crackles in her left lung -- both because I heard them and because it gave me a diagnosis (lobar pneumonia). I presented to my attending, and then she went in and listened too.

While she moving across the lungs towards the spot where I heard the crackles, I was thinking, "I hope she hears crackles too!" I wanted to be right. Then I realized I was hoping that this frail elderly lady actually had pneumonia, and I felt pretty bad. So I started hoping that my attending wouldn't hear crackles... but I couldn't get quite as much enthusiasm behind that.

Being a student unfortunately puts you in that position sometimes. Like on surgery, I occasionally found my self hoping a patient would get sicker so I could see what would be an interesting operation. (I have to say though, I never wished the Psych patients were any sicker than they already were.)

So yeah, the attending heard the crackles too and we gave antibiotics and asked her to get a chest X-Ray. And my wishing one way or the other really didn't affect the outcome.


On the flipside, I just found out that an old friend (my age) is very ill, on a respirator now. And I'm wishing and hoping and praying with all my heart that she gets better, and I have to believe that all of that is doing something, because at the moment, it's all I have to give to her and her family.

I got the best complement while in Walgreens yesterday.

I was waiting in line to fill Glen's allergy script (yay Spring!) behind a 4-year-old and his mom. While the mom was at the counter I chatted with the kid about these handheld back massager gadgets that vibrated and lit up when you pressed a button. The color of the lights matches the color of the gadget! It sounds like there's a fan in there! Why do they light up? Why don't you know why they light up?

They when I came back 15 minutes later to pick up the filled script, the mom and kid were in front me again. The boy says, "Hey! It's the nice person!" :-D

I also got to pick up some regular Claritin for myself (er, discount Wal-itin rather -- the stuff is expensive!) to calm my burning itching mucus membranes, so overall it was a successful trip.

Sorry I keep talking about mucus membranes.

Entering the second quartile...

That was the first birthday in recent memory where no one called me at midnight.

It was also the first birthday in recent memory where I was sound asleep at midnight and very glad that no one called me!

My conclusion is that we are all getting very old.

Seriously though, I had a wonderful birthday and I want to thank everyone who was a part of it, from the Wii bowling tournament to the facebook wall posts. Love you guys!

You don't often hear a patient complain about having a swollen uvula,
but boy was that one swollen uvula!

The email to take a snow day never arrived, so here I am. Let's see if
any patients show up for their appointments.

Is this not a weird poster? Why do you need a naked lady on a diabetes
poster? And why does she have the body of a pin-up from the 1940s and
the face of someone who was around in the 1940s??

Doctor: "Have you been taking your medications every day?"
Man With Alzheimer's: "When I remember."
Doctor: "Do you think sometimes you forget?"
MWA, very matter-of-factly: "It's possible."


I feel much better today, so who knows what that was the past two days. Also, apparently it takes Mono (EBV) 30 - 50 days to incubate, so I'll let you know in a month what happens.

Bleh

I'm getting some kind of sick, a headcold I think. The worst part is that I feel so weak and achy. I'm just praying that I didn't catch Mono from one of the three patients I saw with it last week. Not that I made out with or shared a soda with any of them, but one poorly timed spit particle flying through the air and landing on one of my mucus membranes...
It's weird because I'm not sleepy tired, but my body feels very weak. I'm sure if I lie here long enough illfall asleep though -- that's one of my many talents!

Chief Complaint of the Day: (as written by one of the medical personnel)
Headache, snizzing, and cough.


p.s. why is it so so cold outside??

Also, congratulations to Chuck and Carol! They have a brand new baby girl :-)
They are going to be wonderful parents.

and it's only Thursday...

quote of the week, in reference to my leggings:

"Do those come off?"

--A family med doc at orientation on Monday

I was wearing a dress with leggings underneath and he was looking for a volunteer to demonstrate the leg exam on, and I was the only person in the room not wearing regular pants. While I was explaining that I also had pantyhose on under the legging (he looked confused, I was blushing), Adnaan kindly announced that he had gym shorts on under his exercise pants and he could strip. Thanks again Adnaan! Besides the awkwardness of the conversation, I really didn't want to have to sit on a desk in front of everyone with a dress on, and no leggings. (Why couldn't have have demonstrated the exam over leggings?)

I'm breaking out in hives... must be time to jump into a new rotation! Yay odd reactions to stress!

I didn't accomplish much this weekend except A LOT of cooking. It's one of my favorite ways to spend my time. And with the money that Glen and I would have spent going to out to dinner for Valentine's Day, I was able to whip up an awesome three course meal. We had cheese fondue, crepes with lobster in champagne sauce (my own recipe), and chocolate fondue featuring pretzels, pineapple, banana, maraschino cherries, mini raspberry cheesecakes, and home made caramels. We actually spread the feast out over two nights because we got full in the middle.

I also cooked for some friends who I thought could use a freezer full of food right around now. They got beef and veggie soup, macaroni and cheese, and coq au vin (one of my favorite childhood meals), all en masse. All of those recipes came from our collection of Williams-Sonoma Food Made Fast cookbooks, which we got as weddign gifts and with our wedding money. They make the most amazing food! Although, "fast" is used loosely. I can't imagine the complexity of W-S's standard cookbooks.

So on a different note, I am currently taking suggestions for what I should do with the rest of my life. Preferably medicine.. or business.. -related. Please be nice.

Well, that was fun. There's nothing quite like taking a major exam to the steady sound of a urinal flushing on another floor. That is one busy bathroom.

Now I'm enjoying my inter-block weekend! And it's Valentine's Day, so we'll be cooking some goodies up over here.

I'll try to write more often, or at least post some amusing things..

My thoughts for today

There is a conspiracy to keep me and Glen from getting out of medical school -- every time we try to register for the next step of our licensing exam, our internet goes out for the night. Goodbye, Verizon.

It should not cost $1550 to take *one step* of your licensing exam. Or at least there should be some discount for couples, like buy one test date, get the other half-off.

In the shower just now I had a wonderful realization that with some careful electives selection and thoughtful career choice, I may never have to get up at 4am on a regular basis again!

If it were me scrubbed in at the operating table and my pants fell to my ankles, I would use it as one of the rare valid excuses to scrub out. I would not have the circulating nurse take my pants and then return to the table wearing a paper scrub gown and black knee-high dress socks. But I guess that's just me. Maybe that's why I'm not chairman of the department -- I obviously don't have the required dedication.

So I'm spending my last night shift sitting in the doctor's lounge. I just watched Armageddon in its entirety with a nurse... it's a little slow tonight.  I think my resident is sleeping in the call room which is a little weird because it's only 8:30pm, but she did have a huge exam today and she's not normally on nights so maybe she is try to stockpile any hour of sleep to help her get through the night.  There was a supposed to be a C-section at 7pm that I don't think has happened yet.  That patient was my first one this rotation who said no, she wasn't comfortable having a medical student observe her surgery, so I'm waiting around for that to happen so I can do some more waiting around.  Oh well, my other nights were pretty busy (which I like because it makes time go fast) so I can live with one slow night.  It's just that I'd much rather be at home watching tv than in the call room watching tv.  It would probably be a good idea to sneak in some sleep myself to help transition back to a normal schedule for Monday morning.. but after a full week I'm finally adjusted to being nocturnal and I'm not tired at all.  Today I was actually able to sleep solidly throught the day without waking up every hour like I had all week.  Not that I want to stay on nights by any means... it makes you feel very out of touch with the world.

 

That movie about the president being shot with Matthew Fox just started, but I'm afraid I'm not paying enough to watch it.  It looks like one of those focus-requiring movies.  Speaking of Matthew Fox, I didn't get to see any of the Lost episodes this week, so that is going to be a highlight of my weekend.  And I think Fringe started... yay TV!  And, real life again! 

 

Perhaps I'll write again if boredom hits.  Now, I'm going back to work.. watching my movie.

Monday the "small" scrubs were tight; bootylicious even.
Yesterday they were a good size.
Today they are making me look like MC Hammer.

The obvious conclusion is that I'm shrinking.

Another possibility involves three bears.

Oops.
Didnt mean to post my full name and email with those last two entries... they got auto added with emails sent from my phone. (I email my blog to post to it.)
But, I can't *edit* blog posts from my phone, only my computer, and as my Internet is still out FOR NO REASON, there they will stay until I get to a computer at work tomorrow. grrrrrr
In the meanwhile, don't harrass me ;-)

From my phone, because my Verizon internet is out for no reason (it's not even thundering!)

Three things that surprised me today:

1) Private practice obstetricians aim to complete a C-section in 15 minutes.
2) The "radio-controlled" "atomic-set" clocks in each OR and pt room of the labor and delivery suite are not synchronized.
3) West Jersey scrubs run a lot smaller than Jeffeson or VA scrubs.

So not only am I going to miss a friend's birthday dinner, the first meeting of a yoga class I signed up for, and the premiers of Fringe and Lost (also FotC?) next week due to being on night float, I am going to have my period all week. That's it, I'm quitting med school.

Quote of the day

"you have to go from man-on-man to zone defense." -a (female) OB
attending on having more than two kids.

Ol' Bloggy here got a makeover. Enjoy.

This morning when I left the house, I was upset to see a few bags of garbage out front. When other people leave garbage in front of our apartment, our landlords receive a ticket in the mail (and because our landlord is so sick of these tickets, she has sworn to schedule a hearing, come into the city, and fight each and every one). I'm supposed to call her when there's garbage so she's forewarned and can start fighting the ticket before it even comes.

This morning, though, it was 6am and I was running to the car and I was dreading finding time later to remember to call her. Before I had totally figured out what to do, I noticed that there was also garbage out across the street. Then I realized that we were actually the only people who hadn't put out the trash. Oh yeah, Wednesday nights are garbage nights. Oops. (At least I didn't have to worry about the phone call.)

Then this evening, at about the same spot in front of the house, on the way back from the car as I walked along staring at my feet trying to avoid any doggy doo or other sidewalk presents, I suddenly noticed that I had on two very different colored brown dress socks. I was surprised to notice it at that moment because it was twilight and probably the worst lighting of the day, because my socks had been quite visible all day, and mostly because during a contemplative moment during my solo lunch I had stared at my feet (or rather my left foot, I guess) and pondered the shade of my socks (sock) and how they really matched the paisley print of my shoes more than they matched my pants. I SPENT LUNCH STARING AT MY SOCKS AND I DIDN'T NOTICE THEY WERE TWO DIFFERENT COLORS.


These experiences have led me to two conclusions:

1) The spot in front of my house is some sort of Epiphany Spot where I reach a higher level of understanding than is possible at any other place during the day.

2) I am failing to perform basic functions of adult life, such as moving the trash from the inside to the outside of my home and getting myself dressed in the morning. I am starting to worry.


---
Chief Complaint of the Day: "I've been having heavy bleeding for 7 weeks. Is that normal?"

Stealing an idea....

Chief Complaint of the Day: "I'm dizzling."

So... I ended up in gyn clinic today.
After shadowing two prenatal appointments, I started seeing patients by myself. Then after a couple of times, the nurse practitioner stopped coming in to double check my assessment, she just took my word for it and signed off. Um, what about me looks like I know what I'm doing?

After the morning of prenatals, the afternoon was gyn appointments. I think I did six pelvic exams, having learned to do so <48 style="font-style: italic;">one other I have ever examined.

The nurse practitioner did check my pelvic exams up until the last one (she either assumed I had mastered it by then or did not want to stick her hand into that discharge-filled vagina... bacterial vaginosis is smelly. I don't feel bad saying that because the patient came in having diagnosed herself saying, "I know it's BV because it smells so bad.")

[Honestly, it was a really cool day. I love outpatient medicine, the patients were great and I really got to talk to them, and I got to do a lot of procedures. I'm looking forward to tomorrow.]


I apologize for the gross content of this post, but this is going to be my life for the next 6 weeks. If this wasn't your ideal reading material, you might want to come back Monday when I'm on the obstetrics floor and try your luck, but I can't promise it'll be much better. Week three I'm on nights, so don't expect much coherence.

Glen just compared me to Doogie Howser (in the medical journaling at night time on a computer way, not in the boy genius or Harold&Kumar sort of way), so I think it's time to go to bed.


P.S. The residents pretty much broke up the schedule for us, so there were no hair-pulling cat fights on the floor of the OB lounge this morning. To have a sample schedule to fit us into, they pulled out the schedule that had been draw up for Block 1 in the 07-08 year, and of the five people on that list, there was one of our groomsmen!

I love voting people off the island.

Tomorrow I dive into the unknown! Five of us are heading out to Vorhees NJ for our ob/gyn rotation. It's six weeks and we know we have to do two weeks of ob/gyn clinic, two weeks of gyn surgery, and two weeks of labor and delivery. However, we don't know which we're starting tomorrow yet, so I have no idea what the day will hold. The worst part for me is that the five students have to decide who's doing what when, and I just met these folks yesterday. Already I know that three of us want to do the surgery part first and only two may do it at a time.

The two weeks of labor and delivery involves one week of day shifts (6a to 6p) and one week of night shifts (6p to 6a) and usually someone will get stuck on the night shift the last week; the week when you take the exam. Luckily for us, what would have been our sixth person switched off the rotation so we are going to try to arrange it so none of us gets stuck, and have our five respective night weeks be the first five weeks of the rotation. So this means only one student will do L&D the last two week slot. To complicate things, the schedule choices make it sound like that same student will have to be the *sole* student to do surgery first. Who will it be? I see this whole thing playing out something like Survivor, Vorhees edition.

If I deliver a baby tomorrow, I'll let you know.

WC

I'm starting my ob/gyn rotation and tonight I had to go to a skills session where we (re-)learned to do the breast exam and the pelvic exam. It was my first time doing the pelvic exam on a person instead of a model. You see, this session was run by a group of medical professionals who teach the exam and females who volunteer to have the exam practiced on them... repeatedly in one night.

At the beginning the women went around and gave their name, their background, and how long they'd been involved in the group. The last woman had been involved only a few months, but she assured us it was enough: "This isn't my first clam bake."

I knew then that my vacation was definitely over.

***
("WC" was a hated comment I often received on my highschool English papers meaning "word choice")

Our first formal dinner party was a success! (Although I guess it's not too hard to impress your moms.)

Happy New Year!