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.