Moving the Rock and getting Out of the Hardplace

So I have to admit to something: I've been inordinately spoiled in my working life. I have had a variety of jobs that I loved going to and never felt like I had to drag myself out of bed to get to them. My Medicine rotation has been a bit of a rude awakening for me because of this. Oh, I still really enjoy taking care of patients and I've meet a character or two that have always managed to put a smile on my face at 6:30 in the morning. But I find the various rounds, sometimes up to four times a day, somewhat inefficient and impersonal to the patient we interrupt.

Added to that is just a general feeling of frustration. A lot of the problems which bring people to the hospital are problems they leave with. Yes, their acute issues are dealt with and for the most part they're stabilized back to baseline. But so often what we can do for them is only a small bandage over a hemorrhaging wound. Admittedly, today was a bad day. We essentially told a patient who came into the hospital, functional and relatively healthy, that they were probably going to die during this admission. Beyond supportive care, there isn't anything that can be done. I can only halfheartedly imagine what is going on in their mind. My own reaction to this has been more visceral than it should be: I like this person, I care about this person, and this just freaking sucks! A part of me longs for the caring but separated reaction of my residents and attendings, but I'm not sure if I'm ready yet for that kind of emotional detachment. I know that it has to come in order to develop the necessary professional objectivity, but getting to that point means that I have truly lost touch with the individual I was three years ago. And sadly, I liked that person quite a bit better.

Ultimately, I really admire people who can go into internal medicine, but I wonder how they can stand it sometimes. You loose the majority of your battles. People you've known for years die on you slowly and piece by piece till there is either nothing left of their body or their humanity. Obviously, this experience has been very disheartening for me. And yes, I realize that this is the reality even in surgery. But there you seem to win enough cases to give you some sense that hope isn't just a pretty word.

Ah well, tomorrow is another day and to paraphrase: If I can get one warm blanket I shall not live in vain.

If you can't say something nice....

I've been on my Internal Medicine rotation and I've come to several very important conclusions. One, I am definately going into surgery as a career. Which is a marvelous decision to have firmly settled. Two, I am running out of black inked pens. Which wouldn't be so bad if I hadn't already purchased a pack of 20 black pens. Are my residents 'borrowing' them? Nope, the truth is by far worse: I'm actually using the black ink up. Some how I made it through third year of medical school prior to this without writing an HPI that took up more than 2 pages. These days, that's a daily SOAP note. So sorry for essentially two month hiatus, but mum's been the word of late. On the positive note, I've gotten to see a side of the field of medicine which will make me highly admire the detailed driven folks who go into it~ I just really really don't want to be one of them.

Greatness

“It is not the strength, but the duration of great sentiments that makes great men”
Beyond Good and Evil, Nietzsche
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I think I’m continuing my trend for the oddest experience on general surgery that a third year ever had….Both my senior resident, Neo, and I are reading Beyond Good and Evil at this moment. Nope, we’re not involved in any odd duck book club. Its just serendipity at work, I suppose. We sort of got into a random discussion, of the above aphorism, while we were on call together today (yes they finally let me out of the Norovirus quarantine box of hell that I’d been living in).

I am a bit of cynic when it comes to the general goodness of mankind. I think that we all aspire to greatness, not for any benefit to society or others, but for our own selfish gain. I think that we start out saying grand things but as soon as we find an easier way to personal glory and fame we dump the grandiose society helping methods faster than a funnel cake goes down at my family reunions. In other words, I agree with Nietzsche.

Neo on the other hand believes that the existence of great sentiments makes all men great. In his opinion, ideals, though not always uplifted by everyone, exists to make everyone greater. The duration of an individual’s adherence to an ideal is less important to that person’s greatness than the actual purity of the ideal in question. In fact, that we are all great men and women because the ideals that we only transiently adhere to are so impressive.

Four hours later we took care of two teenagers that had beaten the snot out of each other to the point that they both required surgery. Following that up was a drunk driver and even drunker passenger who needed a few sutures and their child who had their spleen removed and a touch and go course over the evening. Some men and women are great. The rest of us just squeak by.

Norovirus=Devil's Plaything

I hate being sick. There is just something utterly vile about feeling as weak as a three month old. Not to mention the complete dissatisfaction that comes with missing out on the world around you as you lie ill in bed. Oh, and having projectile (sorry I hate this word too for all those in medical land~ but it fits!) liquid out of both ends of my digestive tract really hasn’t improved my disposition. Yeah, I could use this to reconnect with my touchy feely patient care principles that have slowly eroded over the course of third year (no my bed side manner doesn’t suck. I just no longer ask silly questions like “do you wear a bike helmet. If not, how does that make you feel?”).

The worst of it is that I’ve been feeling much better after the past couple days and am actually doing pretty good. Unfortunately, when I went in this morning for rounds every single person who took one look at me said ‘man you still look bad. Go home’. Which is not exactly what a gal wants to hear first thing in the morning. But home I went for a little more recuperative napping and orders not to return tomorrow morning unless I have a ‘little color’ in my cheeks. I think I might be breaking out the blush tomorrow if all else fails.

Boobie Bean Bags

I came across this article and the only thing I could think of was this: weird.

Now, I’ve used the nifty, if expensive, latex boobie to demonstrate lactation and breast feeding to a new mom. Which by the way was an absolutely hilarious experience given that the mom in question had had 5 previous breast fed children and I have never in the whole of my life lactated(thank God!). The situation was awkward enough with the professional looking latex fake breast that I was given to use as a prop. I know I conveyed the correct information, demonstrated proper technique, and came across as a professional and caring doctor (I was being assessed at the time by a midwife and a lactation consultatent on OBGYN~ two professionals who sort of have a hate/hate relationship with the OBGYN docs. They gave me the above written eval so I know that I did more than fair in my attempt). However, I got the direct feeling that both the new mom and myself were looking at the fake breast with the same ‘hehe’ third grade humor thoughts that most normal people have when confronted with a plastic prop of the human body. Not the most conducive to a professional conversation.

So after reading this article and looking at the models offered the only thought that ran through my mind was: ‘Great now they’re going to make med students play with sock puppets and attempt to sound and look professional’. Thank goodness I won’t ever be tossing around the boobie bean bag.

Call Rocks!

I am about to commit myself to dorkdom and more with the following: But I just love being on overnight call for surgery! Last night I got paged into a case of unknown bleeding. The patient had received 10 units of packed red blood cells and was still spewing red stuff from both ends. Pretty gruesome, even I’ll admit. We opened them up and found jejeunal diverticuli (which are not all that common and totally looked cool!). After running the bowel, which basically entails grabbing one end of the large tube and going to the other, we found an ulcer in one of the diverticuli that was the cause of all the patient's problems. A little bowel resection, a few packets of FFP, a little luck and the patient is going to be a ok. Man, I really love this rotation!!!

Scientific Hottie

Well, it looks like its offical: Dr. McDreamy beats the pants off that kid on Scrubs soley because of his career choice.

In what has got to be the result of a drunken bet: A group of hospital yokels in Barcelona Spain got together to decide, based on an attractiveness scale and height, if male surgeons were better looking than their non surgical doctor counterparts. The results of this undoubtably 'valid' study showed that McDreamy is in an entirely different sphere than poor old JD.














I think I might have to agree with the drivel on this one....

Wash Your Hands!!

Well, if social etiquette isn't enough to convince you to spend a minute at the sink maybe this will:

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Scientists have found that our skin is even filthier than previously believed. They've discovered several new species of buggies running around on our skin through the use of genetic testing (sound like a fun grad project anyone?) The best part is that they think we are each the host of our own particularily special buggies.

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Which is a delightful thought given that the average guy or gal is already carting around about a 100trillion bacterial buggies on an average day. I guess they'll have to up the estimate on this one. Doesn't that just make you want go rush out, kiss and swap skin flora with your sweetheart?

Saint in a Box

The world is a very strange place sometimes. An individual was apparently attempting to sell the remains of St. Philip of Moscow. Now, it seems that this nice little Russian lady saved the Saint's remains after the Soviet Union was going to liquidize the stock of a Moscow museum. So the Saints bones are hers free and clear and she was attempting to sell them to the highest bidder. Blanket financial need/greed I understand. Wanting a saint in the box...well that I think is kinda creepy.

One minute he’s holding a urine bag, the next minute he’s kissing me:

Alright, I'm going to let you in on a little secret: I'm never going to understand the human male. Oh, I get them on a physiological level, a pathologic level, and an anatomical level. But I ain't ever going to understand what goes on in the 'upstairs' brain. And I'll even gracefully admit that men probably don't understand women, in general and me probably in particular, for the same reasons that I'm utterly perplexed by the male specimens in my world. All I have to say is it seems like there is the good the bad and the ugly. The ugly is the guy you love as a friend who keeps trying to be something else or the guy you just can't quite stand who seems to care far more for you. The bad is the guy who you have that childish crush on but you know isn't aware of your existance. And the good....well I'm still working on that one. All I have to say is that he better not be touching a urine bag prior to kissing me (you know there IS spillage when the pee is drained don't you~ puts a whole new spin on that Grey's Anatomy moment doesn't it)

A Whole New World

Its amazing how a change of view can change your world, or at least your perception of it. I finished my last week of Trauma at BigWhig last Friday and this Monday I’ve started plain old general. And I have to say that I really love this part of my rotation. Admittedly, I’ve only had one day of it so it may be too soon to call, but if this is what actual general surgery is like I might actually have found something I can do for the rest of my life. Today started at 6am and was done at 4:30pm. My attending, Stone, is a wonderful lady who has a happy and fulfilling life outside the hospital. My resident, Neo, is a really nice guy who doesn’t seem to believe in scuttwork at all! All in all this seems to be cake compared to the last four weeks. I just wish I could commit 100% to surgery and not agonize over the decision.

My Goodness!

Its been more than a little crazy for me this past week at BigWhig. It seems like every consult that we’ve had on the Trauma team has gone back to the OR. Which is wonderful for me as a student, but I have to feel bad for my residents. Captain B has been especially swamped but she’s handled it with an amazing amount of grace. Though I’ve definitely seen her look at myself, Lurch, and Checkpoint (both third years as well) with a sort of ‘damn I’ve got to give these three some busy work to get them out of my hair’ glaze. This week was money though for me: I got to see a perforated ulcer and ruptured spleen!

Jigsaw

Do you ever have those moments when you feel completely and utterly inept? Like you are an extra puzzle piece that somehow has to fit into the picture? The other day on my Trauma Surgery rotation at BigWhig we had a fairly bad pediatric case. I wasn’t scrubbed in the OR at all, but I was there in the back watching. There must have been twenty people in the room fighting for this little one for hours. Several different surgical subspecialties were involved in this case and you had attendings as well as chief residents scrubbed in. It was a full blown effort on a somewhat hopeless situation. And I just stood in the back and watched. It feels wrong somehow to have been witness to this tragedy on such an intimate level with having no real role in it. I felt like an intruder in the OR and yet I was supposed to be there, I was told to be there. I was supposed to learn something from this situation, gain some nuance on how to be a better doctor, or simple be able to more succinctly describe a situation to a layperson. Maybe I will someday, but now all I have clearly from this case is an image of interosseous lines and rapidly decompensating vitals. I guess I also have just a deep sadness about what happened and I don’t know what to learn from it or do with this piece of the puzzle right now.

Top o' the Morning to You

As part of my surgical rotation at BigWhig Hospital we have an hour a week surgical pathology conference. The conference is located in the basement of the oldest part of the hospital. To get there I have to go through several doors marked ‘do not enter’. It is kind of a creepy trek most especially because, as you enter the final door, you get greeted by prosections of the brain. Not the most pleasant of sights.

However, the instructor more than makes up for the dank surroundings. He’s the quintessential professor portrayed by Hollywood. Dashingly intelligent, somewhat ethereal, white hair, grandfatherly form, and Irish accent (ok, so Hollywood usually gives them a British accent). He’s something from another era entirely. He’s a pathologist, who I believe is as passionate about his specimens as most doctors are about their patients. He forever quotes Robbins and refers to the students as ‘Doctor’ in a slightly cheeky and condescending tone that is adorable. He spends the time with us showing formaldehyde soaked specimens and quizzing us on what they are and the pathophysiology behind the disease. Honestly, it is ridiculously hard and somewhat useless, from a surgical standpoint, to identify a 40 year old specimen as its perfused counterpart in real life. And truthfully, I’ve not gotten much out of these sessions that has helped me in the rotation. But I love them. Each one makes me feel like we’re stepping back in time to a more bookish and slow paced era. And I feel lucky to be taught by this character of a man. He’s definitely an Original and these days I think that’s very hard to find.

The Incredible Edible Egg

I foresee that the people that brought us the above catchy phrase will soon be sitting around in a boardroom attempting to find a way to work the following bit of information into the new jingle.

The Roslin Institute, otherwise famous for bringing Dolly into the world, has given a press release stating that they’ve made anti-cancer chicken eggs. Now, first off, what they’ve done (which is pretty damn cool in and of itself) is found a way to engineer chickens so that they lay eggs which contain medically relevant proteins in their egg whites. This isn't going to cure cancer, but it is exciting! The extremely cool bit is creating these proteins for the price of chicken feed (substantially less than other current methods I assure you). However, I wouldn’t go out and buy chicken commodities anytime soon: it will probably be a long time before these tasty drugs are available in the U.S.

"Our lives begin to end the day we become silent about things that matter."

Martin Luther King Jr. (1929-1968)

Somehow, I believe that this man though no longer present among us lives more richly today than most. While I might argue the necessity of having a day off of work or school to celebrate his birth I will never question the dedication he had to the cause of true equality and freedom.

The Never Ending Pile

You would think with the fact that I’ve been wearing scrubs every day for work, my laundry load wouldn’t be so bad, right? That’s what I thought too, until this morning when I attempted to tackle the issue that I’ve been putting off for the past three weeks (ok, so I would have put it off longer but my supply of fresh necessities was running low). I woke up this morning at 7am (not on purpose! My body was just so used to waking up much earlier on this rotation that 7am seemed like sleeping in till noon) and started working on my mountain. FOUR LOADS later!!! And I’m almost done. Four loads people! I mean I live alone, am only doing laundry for one person, and have been wearing scrubs every day for work. What the heck is up with that? And I really hate laundry. Not to mention the fact that it seems to be laundry day in my building and we're all racing to get one of the three units in our building...Sweet little old ladies can become very cutthroat when they want their sheets washed.

Andreas Vesalius (1514-1564)

This was one Belgian that Galen most certainly wouldn’t have had breakfast with. He was a physician who spent years dissecting human bodies (nice thought that, right?) and proved that Galen’s ancient works on anatomy were based on the dissection (and sometimes vivisection~ fun stuff; especially when performed in front of a crowd) of ….drum roll please….apes. He compiled his findings into the texts De Humani Corporis Fabrica (if your Latin is a bit rusty that would be: On the Workings of the Human Body). This was a seven volume compendium that was based on his dissection of the human body. The volumes were artistically illustrated with a multitude of engravings that posed the corpse in a number of amusing and slightly ridiculous ways. The popularity of these revolutionary texts gave him enough fame that the Holy Roman Emperor Charles V ( He ruled Germany before it was German) appointed him as court physician. Like most men, he left his cushy job to go off on some midlife crisis. But this was the 1500s and instead of grabbing the nearest 20s something blonde secretary and high tailing it to Vegas he went to the Holy Land. Like most midlife crises it ended badly. In 1564, on his way home, his ship sunk off the coast of the island of Zacynthus.

The Cat Lady: Meow

After rounding yesterday morning at the hospital I decided to do some of the random everyday errands that can only be accomplished between 9am and 5pm. These haven't exactly been hours available to me during my surgical rotation. Luckily, the bank and various other places have hours on Saturday. After rumaging around the city for a couple hours I found myself at the local pet shop so that I could pick up food for my poor neglected cat who ran out of cat food a day ago (don't feel too bad for him, he's been subsisting on tuna quite well). After getting the deluxe 50lb bag of cat food and enough toys to clear my conscience for leaving Cat home alone so often I stopped to see the adult cats from the animal shelter at the front of the store. I've been thinking of getting another cat to keep Cat company during the day and I'd rather get an older feline that has less chance of being adopted by others. I was playing with a cute black cat when a very pleasant middle aged woman came up and struck up a conversation with me. I was in my scrubs and Medschool affiliated jacket so it was pretty easy to guess that I'm on surgery right now. Her daughter is a trama surgery fellow somewhere in the South, who apparently loves her job and couldn't imagine doing anything else. This very nice lady went on to say that her very pretty, funny, and wonderful daughter who I apparently 'reminded her of' was wasting her life as a cat lady with three cats, no husband, and an unhealthy number of work hours. I was firmly cautioned that I should find myself a man, go into something 'less demanding' and not get another cat. As funny as the encounter was, it sums up nicely some of my worries about choosing surgery as a specialty: I really don't wan't to end up as the cat lady.

What drugs will not cure, the knife will (Hippocrates)

There is something amazingly satisfying about surgery. Oh, the operations themselves are pretty darn cool, but the happy gut feeling goes beyond that obsession. You see a patient, determine a problem, and fix it. Ok, so sometimes is a heck of a lot more complicated than that, even a lowly Med3 can figure that one out, but the gist of it can be that straightforward. Take today: a very nice well mannered lady came to BigWhig Hospital cursing and screaming at the top of her lungs. Not that I know her well, but I’m fairly confident that this isn’t her normal behavior. She had an acute distended abdomen. It was bloated, could be played like a drum, warm, and just plain wrong looking. Not to mention that she was writhing in pain just from breathing. Added to that the CT scan was just plain ugly. Now, not to long ago (ok the measurement would be more closely related to centuries than decades) this lady would have been toast with jam. Today, she gets some happy meds and is rushed back to the OR~ much to the ire of the surgeon who got rescheduled~ and waddya know: her problem could be fixed! Although, I have to admit that her insides looked almost as knarly as her outsides. She’d had a perforation of a diverticula in the sigmoid colon. Brown alert all the way! But at the end of the surgery, her problem is fixed. Yeah, she’s going to have to get through a fairly tortuous course of post surgical recovery and has a super high infection risk, but still she’s fixed.

Can I please have a sandwhich?

Hard work is undesirable for the underfed.
(Hippocrates)

So, I have to admit it: I've got it pretty easy on my general surgical team. I drew the short (or long depending on how you veiw it) stick and was placed on the Trauma unit for my 4 weeks of nonspecialty work. And other than the fact that there really aren't that many surgeries that don't get transferred to a different unit I've got very little to complain about. Captain B and Flyboy are great, we never really see the attendings, and rounding doesn't take up the whole day. But my one complaint is that food sometimes needs to be scavanged and I get cranky when my stomach rumbles.

A rumor without a leg to stand on will get around some other way.

So today, I realized once again that the Hospital really is like high school. People still talk about who is sleeping with who, the popular girl, the weird guy and the teacher that everyone has a crush on. My Chief, Captain B, and junior resident,FlyBoy, who I really in general think are funny and brilliant people if a little on the sarcastic and bitter side fell into the easy trap this morning of propagating the rumor mill. Which I admit is damn easy to do at 6am. Its also damn easy to do at 8pm when chitchatting to a classmate and spilling your guts because your poor sleep deprived mouth doesn't know when to can it. Ah well, at least there are bigger things to worry about.

Hippocratic Aphorism of the Day

"Life is short, and the Art long"

I think the one thing that third year is really good at making you feel is inadequate. There is so much that you feel that you should know already, be able do do already, be able to explain already, that you spend half the time wanting to curl up in a ball and the other half wanting to cram (ok, so maybe the desire to cram only comes when you're being pimped). Somehow I find this aphorism especially reassuring: I mean the ancients didn't even have to contend with the biochemical process of disease and still they found medicine an overwhelming topic. Of course, they also went around tasting urine, so maybe I shouldn't use them as a gold standard.

When they let the Med3 actually do something...

In the Begining:

So I’ve just started my surgical rotation at BigWig Hospital. And yes, for those who have gone before me, I do realize that this is a terrible time to invent a new way to waste time. However, there is something cathartic about ranting in my own little corner of cyberspace and I’ve already done my required 2 chapters of reading for the evening so drum rolls please:

I have to admit that I’ve enjoyed it more than I expected. I went into medical school with a very nebulous idea of entering primary care. Approximately, 20 weeks of that in various specialties was enough to disillusion me out of that particular fairytale. And surgery is just fun.

The Medical Student's Prayer on General Surgery

God, today can I please not feel like a useless appendage.
Can I not get yelled at by the attending,
for the labs that weren’t ordered by the resident

Can I not get yelled at by the intern,
for the nurse who decided that only nurses can be ‘patient advocates’

Can I not get yelled at by the nurse
for the fact she/he can’t make anyone else’s life hell
as much as she/he can make mine.

Can I get something to eat
before I’ve gone hungry for 12 hours

Can I sleep for at least 4 hours

Can I not get splashed by urine/blood/worse

Oh, and if You could manage it:
Can I not spend 10 hours in the OR with
the surgeon who believes all Med3s
should know how to recite Netter in Greek.

Hall of Medical Quotes

1. Professor: Gene therapy might cause cancer, but its still really cool

2.Medical student : So you're saying that lack of sleep, binge drinking, and high stress are bad for you? Wait, isn't that my life??

3. Doctor to patient: You're 5', 350lbs, your blood sugar is uncontrolled, you refuse to take your meds, and now your upset with me because your joints hurt? Lets be a little more realistic.

4. Dr. House (from FOX's awesome show): Patients lie.

5. Relative A: So I have x, y, and z giving me trouble. What do I have?Relative B: I'm a first year medical student, they're still teaching me how to have social skills.

6. Lecturing Physician Assistant to First year medical students: You need to remember that during those years you went to medical school (4) and through residency (3-7) we were out actually working. So we will know more than you do at the end of your residency.

7. Backrow Medical Student to Lecturing Physician Assistant: Bullshit

8. Uh, what'd you do with the gloves?

9. We estimate that each of you will graduate with 130,000 dollars in debt at best.

10. Genital-Rectal Instructor: Starting in the middle of the penial shaft, gently bring the skin to the base. Then apply a firm, but gentle, pressure to compress the urethral meatus and milk the penis.

11. Me: What the hell have I got myself into!

12. OB/GYN attending: "and is this the babydaddy (one word)?"

13: Surgeon to patient with heart problem: " And if you keep on using cocaine you will die. Oh, and you can be discharged today."

14: Surgical patient three hours later to med3: "Am I being discharged to God?"

15: Doctor to patient: " You have a hole in your aorta from your motor vehical accident. Luckily, its a contained rupture. This is still very serious". Patient to doctor: " So other than this little hole I came out pretty ok. So can you take these wires off and I go home now?"