Archive for the ‘Uncategorized’ Category
I’m embarassed to admit this, but I just learned that I can post from the Android WordPress app even though I host my blog on my own domain. For months I’ve been thinking it’d be awesome if I could do that, as I spend much less time in front of my computer these days, and I miss blogging.
Last week I came home to find a small gathering of deliciously crunchy leaves by the stairs. Some trees are changing colors, and across the street from my building, one tree is already bare.
I can’t deny that it’s Fall already. That I’m 17.5 weeks through third year. That 2012 is fast approaching, I’m 25 years old, and I’m 19 months away from my MD degree.
Today Fall showed its unpleasant side. I had a cold and rainy bike ride to work, and all day a headache pulsed in the background. When I got home, I crawled into my bed immediately after my shower, and I guess I fell asleep because two hours later I woke up to my phone ringing and I know I wasn’t reading that whole time. I’m out of painkillers, somehow, but I dragged myself out of bed for a bit, and finally took proper advantage of having a gas stove. I made myself s’mores! (a s’more?)
And now, for once, I’m heading to bed at the proper time to ensure I might actually get a full night’s rest and wake up before my alarm.
Meet Mehmet. He lives on my bed and was a gift from my boyfriend Ahmet three months before we started dating. Should I ever end up staying the night in a hospital, or several nights, Mehmet will not be joining me.
Intern: “What’s the teddy bear sign?”
Attending: *turns to me* Would you bring a teddy bear with you if you were in the hospital?
Me: Probably not.
But to be honest, the reasons I wouldn’t are 1) because a stuffed animal I am attached to enough to want it in a stressful situation is probably one I don’t want to subject to the hospital environment and 2) I know about the teddy bear sign, and don’t want my doctors and nurses to assume I’m crazy.
Obviously, if you’re under the age of 13, no one is going to think you’re crazy for having a teddy bear with you, but by the time you hit 18? Your staff are going to be wary of you and on the lookout for psychiatric conditions.
Sunday was my birthday, and now I’m 25 years old. I should be getting my driver’s license in a few weeks, and I’ll still be younger than my mother was when she got hers. =D
Seeing as my Neurology Shelf exam is tomorrow, I didn’t do much to celebrate. I had a delicious brunch with my friends, hung out at one of their apartments briefly, then came home to try to study (sigh. Medical school).
One of the things I will always remember about my birthday this year is how on Monday, my aphasic stroke patient was able to sing Happy Birthday to me, even though he probably couldn’t have generated those words to just say them. There’s some touchingly amusing about your patient, his family, and your team singing happy birthday to you as part of a teaching moment.
On to the presents! My parents were going to get me an ipad for my birthday, but I’m still laptopless after kneeling on my netbook a few months ago and breaking the screen… So I’ll be picking out an inexpensive new computer instead, I think. To get a new netbook or something slightly larger though? Decisions, decisions.
They’re hard to see at this picture size, but I got some lovely new earrings from my friend Feiya for my birthday! Earrings, like socks, are not something I can ever have too many of.
And I got a beautiful new orchid from my friend Hao. It’s a different species from my others, and hopefully I can keep this one alive and thriving too!
Last but not least, Amrita made me a lemon poppyseed cake, at my request, as my birthday cake. It was delicious and I still have some leftovers. Cake for breakfast! (photo stolen from her website) Lemon poppyseed cake is very near and dear to my heart. It’s not the sort of cake that you put icing on, which is just fine with me. It’s soft, moist, bursting with lemon flavor and crunchy poppy seed goodness. I still remember the first time I had it. I think it was one of the first time’s I’d had something with lemon flavor that wasn’t sour, and it took me a while to identify what the flavor was (I was pretty young).
This is what happens when it takes me too long to get out of bed in the morning and I don’t have time to eat breakfast. I pack fruity pebbles in a tupperware and milk in a water bottle and steal some time between pre-rounding and rounding to eat. Fruity pebbles are an old guilty pleasure of mine, and I’m sad to admit they’ve begun to lose their appeal. I think this will be my last box for at least a year or two, probably longer.
Today was grey and rainy so I spent my down time indoors. Yesterday was beautiful, but I was busy all day until the end, when I sat outside to eat my dinner of yogurt and cheetos (…don’t judge), and saw at least four or five rabbits. They’re everywhere in this city! They’re also adorable, and probably delicious, except thanks to medical school, I know all about tularemia, so there will be no catching and eating of wild city rabbits for me. Not that I would catch and eat one anyway, mostly because I don’t know the first thing about catching a wild animal or about turning it into food, and it sounds like a lot of work to go through when grocery stores exist. I don’t cook meat very often either, so when it comes to home cooked meals, I’m mostly pescetarian.
Gratuitous second shot of bunnies! It’s hard to get close-ups of them.
I’m starting to collect patients in my head, people who I don’t think I’ll ever entirely forget. Their names will fade – most have already slipped away – but enough salient features will remain to distinguish them from the hundreds of others that will blur together.
One night on Orthopedic Trauma call, we were consulted to see a patient in the ICU. Nineteen or twenty year old male. In a coma after a very simple accident that could happen to anyone. Probably would never recover. He was so young, and more striking, he just looked like he was sleeping, but he was essentially dead. I wish I remembered his name because I meant to check if he did die, but I’ll never know for sure.
Then just recently, my Neurology team was consulted on a patient for something a little silly, but we all went to check up on her the next day when we were rounding. Near the end of the physical exam, her age came to light, and we were all shocked. 78! And so healthy! There are people her age who can end up in the hospital but be fine? Who can tandem walk and balance on their toes and heels and otherwise complete a full neuro exam? It was a little sad how shocked my entire team was, from us two medical students all the way up to our Attending. Seventy-eight, and many years ahead of her, barring any surprises.
I try to shy away from talking specifically about patients here, because HIPAA is very serious business, but I think every now and then I’ll share a little bit about these patients, the ones I won’t forget, and the ones I don’t want to forget.
That’s the only way I can explain how on my ENT rotation, Fridays have always been my longest days, and two of them have been my longest days in the hospital (on a day I wasn’t on call). Seventeen hour days are a serious test of endurance, but twelve and fifteen hour long surgeries probably go by a lot faster when you have more to do than watch and help retract. I did get to make the final cut that took out a tumor yesterday though, and was even allowed (under Attending guidance) to wield one of the electric cauterization tools for a few minutes while the resident scrubbed back in. So much fun! I was really disappointed when the resident came back and took over. :(
But mostly, my job is to help close the case. Put in a few of the more superficial sutures, cut the tails for the deeper sutures, and staple the main incision closed (which is a two person job; one person to hold the stapler, another to use tweezers to hold the skin together). The second year resident and I were complimented on the beautiful job we did with the stapling! She had really good technique; I don’t think anyone’s ever guided my stapling that specifically, and it wasn’t annoying at all.
Also, neck dissections? Pretty cool at the end! If you’ve taken a human cadaver dissection class, you might be thinking “Huh, a neck dissection? I’m sure it’s not actually what it sounds like to me.” Except it is! ENT doctors do neck dissections when someone has a head and neck cancer and they need to take out lymph nodes to look for metastases. This involves meticulously dissecting out the neck anatomy, because you can’t just haphazardly cut into the neck without damaging a large number of important nerves and vessels, so you need to clean and identify all the structures you care about before you can take out the nodes you want. At the end of the neck dissection, it looks a lot like a cadaver dissection, except it’s alive and oozing some blood, and things are intact because surgeons have far more skill than first year medical students.
I’m finishing my 10th week of surgery rotations today, so just 2 more weeks of surgery to go! It’s been hectic, especially during Colorectal surgery, but ENT has been better. I’m a little appalled by how much I like ENT. Really hoping I fall in love with a less competitive specialty.
Other than 70+ hour work weeks, things that make me unlikely to post in my blog include moving to a new apartment two weeks after starting to consider moving. Pictures of the new place once it’s a bit more set up!
And on the list of things that make my days better: the scrub jackets that the nurses wear. I learned where they are during my Spine Surgery rotation and they’ve been a blessing during the numerous ENT surgeries I don’t get to scrub into. I get cold really easily. Still cold in these jackets but at least I’m not shivering for hours!
I never thought I’d take this many pictures of myself in bathrooms but… well, it’s easier with a mirror and bathrooms tend to have mirrors. I need to figure out how to set my phone to take pictures with a button instead of tapping the screen.
Friday morning. Post call. Maybe four hours of sleep? Not sure yet if I’m going head down to the OR to watch a surgery before I’m supposed to leave by noon, being post-call and all. Rounds finally over, Intern gets a call asking for someone to go scrub into a surgery to drive the laparoscopic camera. Everyone with legit responsibility is busy figuring out why one of our patients has an Oxygen saturation of 50% (this is bad) so I get sent down. Never driven the camera before but I figure, hey, it’s good to try new things, and this is a routine procedure that’s supposed to be done by 11:30am. I hadn’t eaten since 9pm the night before, but eh, I’m not all that hungry now and this won’t take long.
Ah, how wrong I was.
It was stressful enough struggling to figure out how to use the camera on the fly. We’d had a workshop teaching us how to use them, but this was a different model, or I hadn’t paid enough attention, and I couldn’t figure out how best to hold it and it took me a while to get used to using the levers to look up, down, left and right instead of always moving the entire thing. So I’m trying, the doctor keeps correcting me verbally, and also by sharply taking over the camera.
And then we see blood. I mean, we were seeing blood before. We were inside the patient’s abdomen, bloated with carbon dioxide so we had room to work in, and we were cutting free his bowels that had fused all over the place due to his chronic disease. But no, we were seeing a lot of blood. Flowing blood. Not the slow welling up of blood when you cut a minor vessel, and not quite the torrential gushing of cutting a major vessel, but it was steady and rapid and while no one panicked, it was clear that this was a Problem.
My parents came to visit this weekend (which was wonderful, btw!), and we went out to dinner with a few of my friends. At some point it came up how I was a calm, easy baby, and my friends mentioned that they call me zen and wise because of how mellow I am.
And so I didn’t visibly freak out. I didn’t panic and ask for someone else to take over the camera, not that there was anyone else anyway. I suppose the circulating nurse could have scrubbed in and stepped in for me, but I would have needed to keep my cool until they were ready, because every second was important. Inside my mind was screaming with frantic thoughts. Was it my fault? Was I driving the camera so badly that they couldn’t see a vessel and cut it? What if I’m doing a bad job right now and wasting time so they can’t find the vessel and clamp it off? I desperately wanted them to switch the surgery from laparascopic to open, but they hadn’t thought they’d need any blood and they would if they switched to open, and the blood they’d called for as soon as this happened hadn’t arrived yet.
I don’t know how long this went on for. At least twenty minutes. Perhaps a half hour. Maybe longer. I kept driving the camera for fifteen more minutes until one of the other residents showed up and asked me if I wanted a break. My “Yes!” was perhaps a bit too desperate and enthusiastic.
They told me I did a great job for my first time. And that considering what happened, I’d done an excellent job. I’m not sure it was obvious, given the mask I was wearing, that even as I was laughing and saying that I was fine and didn’t take the harsh commands and reprimands personally, I was holding back tears. Tears of relief? Tears from the stress? I’m not sure. I kept them away successfully.
The adrenaline eventually subsided, and I stayed through till the end of the surgery, even though it ended past 2pm. I had come after they’d already started, so I hadn’t seen the patient yet as a person, only as draped body with a square foot of disinfected skin exposed to my eyes. I saw inside him, saw through him in ways I hope I never get to see through my loved ones, before I got to see his face, and two days before I got to see him properly awake and alert on rounds Sunday morning.
It’s my bedtime now, so I apologize for not editing this, but I wanted to make sure I write about it before it fades.
Been packing food since Monday and it’s working well! It means I still have to wake up a full hour and a half before I have to be at the hospital though, even though I’ve gotten better at getting out the door. Yes, I’ve thought about making everything at night; but I only have an hour or two of downtime at home before bed, and packing lunch for the next day is not what I want to do right then.
1 sliced orange
1 turkey sandwich
1 peanut butter sandwich
= majority of my daily food intake.
Posting from my phone. Hope this works! Maybe I’ll post more often if it does.