Neurology 3 Days In

Tomorrow is day 4 of neurology. I don't have to be there until between 8-9 everyday! That is so late and I love it. Plus I get a 1 hr lunch in which I get to come home since it's so close to home. My preceptor is actually pretty fantastic but he is making me know the neuroanatomy of the upper and lower extremity. Now, this doesn't sound too hard except that when I learned this the first time, it was over 3 years ago, and well, it's not really that interesting. And he doesn't just want me to know the musculature, he wants me to know them ALL, their innervation, the cord, trunk and level of innervation. Oh em gee. And how does he pimp me? When we're doing an EMG on a patient (takes a while, lots of sitting down) and he asks the patient if they want a neuroanatomy lesson. Yup, the patient always says yes. So I'm stuck getting pimped in front of the patient for a good 20-30 minutes. Lovely. This means that my nights are spent studying....hard. I study harder right now than I did while on my audition rotations!

Update: Interviews, The Gunner, Holidays and Moving!

Since my last post, I have had interviews 3-6. All of them were very interesting, and I actually really liked them. I have been surprised with my happiness at the places. I was expecting to dislike some, but actually I've been pleased. What is not fun? The traveling. Ugh. I'm so sick of it. I sure have met some interesting people. In the beginning I expected to dislike all the other candidates, but I actually enjoy talking to them! In fact, I often find myself talking to them more than the residents!

I have run into The Gunner again. At Interview #4, we interviewed together. Let's see, she did not wear a suit. She invited herself to some food during the tour in the residents' lounge without being invited. She asked an inappropriate question while at the hospital (you can get away with some of these questions at the dinners the night before). Oh yes, and she seems to think we are going to be colleagues. And frankly, I'm getting a little concerned that we might be. Our top two choices are the same. Yikes.

I have moved! Well actually I'm in the trek across the country right now. My parents, sister and Jake spent this last week in Ohio packing me up (and man oh man what a job that was). I would have been screwed without them . Since my apartment was all packed up, we spent Thanksgiving on a dinner cruise on the Ohio River. It was okay. We all said that we'll probably never eat out again for the holiday. It just doesn't seem like it's Thanksgiving.

My mom, sister and I did get up to go Black Friday shopping. We had to shop in moderation since all of our vehicles were already going to be full. I did get an epic deal of the century on a mattress memory foam topper. I knew that all of them were 60% off. Once we got up to the aisle, the entire aisle was repeatedly marked $25.99, originally $89.99. While I thought that was strange, I grabbed the thickest one I could find and we got in line to check out, where we waited about 50 minutes. We get to the cashier and imagine my surprise when my topper rings up at $147, originally $350. My sister and I told the cashier, and she of course didn't believe me that it was marked at the price, so they were about to send someone up to do a price check. Well, the manager walked by and told the cashier that she had to give us that price. Plus my mom had a 15% off coupon. I got that topper for 94% off. Now I'm sure someone will be all up in arms about getting it for so cheap. Someone screwed up bad, because an entire aisle was marked for the same price.

Currently Jake, my sister, and I are at her house in Kansas. Tomorrow Jake and I are heading to his place in Colorado. My long distance marriage is officially over!!!!!

The Match

I don't believe I've posted exactly how the process works. Starting in the beginning of 4th year, I applied to all the programs I'm interested in. Then I continuously stalk my email waiting for interview invites. From Oct-January, - that's interview season. People spend a lot of time and money on traveling to these interviews (I have 3 next week), and time at home decreases....

On February 23, I have to submit my rank list. Basically, I rank the programs I interviewed at in the order I want to do my residency at. On March 14, I will get an email that says one of two things 1) Congrats you have matched or 2)I'm sorry, you did not match. Then on March 17th at 1pm eastern time, I will find out where I'm going. I think the worst part is finding out if I match.

There is so much more to this process than I had ever imagined!

The Scream

At my last interview, it was different, in that I interviewed with five separate people. I liked this method a lot better. Anyways, heading into my third interview, the coordinator tells me to go into the office. The interviewer is in the corner on the phone, with her back to me. She hangs up, smooths her hair, takes a drink of water, turns around, looks at me and screams at the top of her lungs for a good five seconds. People come running. I am wide eyed and apologetic. She had not heard me come in. Ok, so definitely a memorable start to an interview!
Throughout the interview, I'm having a hard time focusing because all I can think of is her screaming at me, and I have to bite my cheeks to keep from smirking. About halfway through, she asks me a question, I begin to answer, and then she doubles over laughing and says "I'm sorry, I just keep seeing myself screaming at you." At the end, she says "Hmm, maybe I should scream at everyone during their interview to see how they handle themselves. You remained very composed."

Well, that will hands down be my most memorable interview!

A Gunner story

Actually, I'm not too pleased with this one. At my last interview, one of the residents who I loved, says to me "So, your friends with The Gunner?"
Me- "Umm, no, she is not my friend. She is someone who I met this last year, and we seem to be on the same trail."
Resident-"I was wondering, you guys have very different personalities."

So the reason the resident knows The Gunner, is because we both have done audition rotations at this place. I just finished, she's on it right now. So it sounds like she is already effing it up there as well. The reason I'm not pleased, is that I don't want people at this program to think we are friends and that my behavior was anything like hers. I phoned a friend (a previous attending who knows some people) to keep her up to date on my thoughts, and she decided to make a phone call to make sure that no one confuses us. This makes me happy :)

My interview at this place went exceptionally well, I think. Except for the scream, which will be in my next post.

The Interview Trail

Since it's November, I'm currently in the midst of the interview trail. I've only been on one so far, and tonight starts another, but I think I get the idea. Typically, the night before I head to a dinner for mingling with the residents. Before going to my first one, I was looking forward to this part. After the first one, I realize this is the most nerve-wracking part. There are other candidates there, and we're all competing for the attention of the residents! No one wants to be rude, because don't be mistaken, that dinner is very much apart of the interviews. From what I can gather, the residents at the programs I'm interested in, get a pretty big say in who gets in. So it's important to fit in with them. And while it's important to impress them, it's also to determine whether or not I fit in with them. I do not want to work with residents for 4 years, 80 hrs a week, with whom I don't get along. So anyways, these dinners- they're typically at pretty upscale places with alcohol. My rule is no more than two drinks. This is the best time to get a lot of questions answered.

The next day, usually has some part where the program director gives a presentation on the program, we get a tour, and then the real sit down interviews. There are a few ways to do the interviews: at my first one, it was a panel interview, there were 3 attendings and 4 residents. At my next few, there are a bunch of one on one interviews with really important people.

The next few weeks are pretty busy for me with a lot of traveling. It's exciting/tiring/nerve-wracking. Oh and just because I think it's annoying but hilarious, The Gunner (who I have previously blogged about) is running into me all over the interview trail.

If you are wondering about what specific programs I'm interviewing at or am interested in, please email me.

Step 2

I passed. Woot woot. This means no more boards for almost 1.5 years. Suweet!

Post partum hemorrhage

Consider this a warning: this gave me the heebie jeebies, so if you don't like reading about kind of gross things, you probably shouldn't read this.

I have seen post partum hemorrhages before, and watched the dr explore the uterus, but last night I had the privilege of doing this. Basically, you put on a sleeve and a sterile glove and put your hand into the vagina up into the top of the uterus to scrape out the clots of blood.  And we are talking grapefruit and larger sized clots. It was a little creepy to know that I had my entire arm inside her and that I could see her belly moving from the outside as I was moving it from the inside. As I removed the clots of blood, her uterus and cervix started to clamp down and then I couldn't get back in.

So that was the exciting part of my night!

Step 2 Boards

I feel like I have been worried about boards for the last 1.5 years. Last July, I took Step 1. This June, I flew to Philadelphia to take Step 2 PE. Tomorrow, I am taking Step 2 CE, which is basically an 8 hour multiple choice test. Super fun huh? I cannot wait for this to be over. This has been hanging over my head for awhile and I'm looking forward to rejoining humanity tomorrow evening. My plans are to see a movie or two, get a pedi, and then a decent dinner. While I wish I could celebrate with Jake, he won't be here until Thursday. I suppose I will survive.

So the rest of my boards.....Within 1 year of graduation I will have to take Step 3. In my 3rd or 4th year of residency I will take my written Ob/Gyn boards. And then within 5 years of finishing residency, I have to take oral ob/gyn boards. How craptastic is that? Not every specialty gets to have the luxury of doing this, but of course I chose one that does. And then, every so many years I will have to recertify. Basically, what I'm saying is that I'll be spending loads of money every time I take one of these exams, and I'll be doing them the rest of my life.

So, wish me luck for tomorrow or at least send some good vibes to the Cincinnati vicinity :)

The Gunner

In the world of med students a "gunner" is a person who is always trying to make themselves look good by being obnoxious, making other people look bad, being overly aggressive, etc. Well, I've previously blogged about the girl on this rotation who I have met up with before and didn't like. Today, she was a super gunner, and it bit her in the ass big time.

For reference, I have a preceptor on this rotation who I am assigned to. He happens to be the program director. So it kind of sucks for everyone else on their audition rotations because they want to work with him and impress them, but I'm HIS student, so I get first dibs.

So, today in morning report, I found out that my attending had a woman who was going to deliver soon. I should get to do this delivery. The Gunner asks my attending if she can do the delivery with him. I was livid! I was sitting right there and she didn't bother asking me if I minded ( I would have said yes I minded). The attending hims and haws and says "I guess." For one hour of morning report, I am stewing. Literally, I'm sure there was steam coming out of my ears.  Report ends and I walk out of the room with my preceptor and one of the residents and I just ask "So is the Gunner (used her name) doing the delivery with you?" Well, the resident gets mad and says that it should be mine since I'm the student assigned with that dr, and that she's too dominant.

Ok, we get to L&D and the Gunner runs to the room. I casually let the resident know that the Gunner went to the room to start pushing the girl. She was LIVID. She said "She has been stealing deliveries from other students as well and that is not how we do things at this hospital." Then she went and pulled her out of the room and sent me in. OMG, I was floored. So, I got to do the delivery.

When I came out, her face was priceless. She was so pissed.

And that's why you should not be a gunner.

Weekend Day 1

I showed up this morning at 4:45 to help out the residents. I rounded on the post partum patients and then a resident sent me over the to the floor (post op) to round there as well. I was the only student who showed up!!!! Booyah. Yup that makes me look a hell of a lot better than everyone else, especially since I'm not really even on the hospital rotation while all the others are! I got to assist with a delivery today and a c-section. I told the resident that I would be there tomorrow morning to help out again and she seemed pleased.

Speaking of c-sections....As a student I usually get to help sew them back up. I'm contemplating taking a basic sewing class this winter out by Jake. I can't wait for them to ask what my previous sewing experience is: people :)

If tomorrow comes and goes, and I'm still the only student coming in on my time off, I'll just be a happy little camper.

Competition in an Audition Rotation

As I've previously mentioned, I was invited back to do another audition rotation at the place I did in June. When I was there at that time, I was the only medical student, so my time with the residents was all one-on-one, plus I had lots of attending time. THIS time, it's a little different. There are 4 other medical students on the rotation (3 of them want to go to this program) and 1 PA student. This means that there is lots of competition going on. Nobody is being down right rude or mean, but it's uncomfortable and I hate it. One student, who I have had a previous run in with, is there. She's not my favorite person and I caught her lying to an attending yesterday. I chose not to say anything because you're not supposed to ever speak badly about other medical students. But for anyone who knows me, keeping my mouth shut was super difficult. I guess the residents don't love her, so that's good. There's another student who I met while I was here before and I thought she was really nice, but yesterday she kept asking me when I was going to clinic (because I was in the OR and she wanted me out of there!). 

I'm holding my own and have been getting lots of compliments. But it's tough, because I know how badly the other girls want to come here as well. I've heard that none of the students have been rounding on the weekends, so I will be there tomorrow morning at 5 am with a smile on my face ready to work hard.

I just have to say that this entire process is really stressful and annoying. There is so much uncertainty that it makes things a lot harder than I want them to be. Is it spring yet?

It's Over!

Well, my dreaded rotation is over. That might have been the longest month of my whole life. It really was a strange month. It was very challenging, in that these patients were very very sick with multiple problems: acute respiratory failure, pneumonia, acute renal failure, NSTEMI (heart attack), and hypokalemia. And that's just one patient. The hard part is trying to figure out medication management: you have to make sure that the adverse effects of one medication won't make another problem worse, etc. Not so fun. The good news is that not a single patient died on our 1 month rotation! I was absolutely floored.

So in the last few weeks there, I was told by different preceptors that I should go into critical care medicine. The first time it was brought up was like this "I don't mean to be rude, but why are you going into OB/GYN? You are smarter than that. You should be a critical care physician." Ummmmm, absolutely stunned. STUNNED! Paul told me that my face was completely blank.

Of course on my worst rotation ever, I receive for the very first time an evaluation from the doctors to fill out about the rotation, with very specific questions. It took me about an hour to fill out. I wanted to be honest, but diplomatic at the same time to ensure that no connections were ruined. So on our last day, Dr. A had a sitdown evaluation with each one of us. I told him things that needed to be changed (which he did write down) and that it was such a challenging rotation. He told me that I did very well and that I was operating at least a year ahead of where I'm at. And one of my favorite comments: "The way you present is very unique. I've never seen anything like it before, and I like it." Okkkkkkayyy. I didn't think I was doing anything unusual.

Anyways, it's all over. I never have to think about it again. Jake is here and we have had an amazing weekend. We spent Saturday at Cedar Point (the number 1 amusement park!) with our friends Andy and Kara. It was basically one of the things that I've wanted to do since I was little. The roller coasters were amazing and everything I had hoped for! Today we are headed to the Ohio Renaissance Festival. What can I say? I'm a good wife.

Tomorrow starts the 8 week string of audition rotations. I'm not sure if I wrote about this, but the program in Dayton that I previously auditioned is where I will be for my next two weeks. The program director invited me back to his private practice.  If you ask anybody close to me, it seems that the only thing I am capable of talking about is residency. Ugh, I'm so over this process and it has only just begun.

The Flintstones

In my previous post, I talk about my one ICU patient. The other day he had a visit from Betty Rubble, AND she threw him across the room. I'm quite curious whether it was the cartoon version or the Rosie McDonald version from the movie. Either way, I wish I could have witnessed this hallucination.

In good news, I only have 3 days left plus Jake will be here on Thursday night! Super excited.

My ICU Patient

I have had this same patient since my 2nd day of my rotation. He was admitted with acute respiratory failure and in his time here, other diagnoses have included pneumonia, acute renal failure, urinary tract infection, hyperglycemia, and delirium. Since I've been with him so much, he and his wife have gotten to know me rather well. I spend more time with them than the attending physician so I feel like I have a decent relationship with them. Well, his delirium has gotten worse in the last few days leading to some funny sayings. Today he said to me "Can I interest you in a cold drink at my house, Madame." "It came on me like a panther, and then I was standing on a timestamp." Strange and hilarious at the same time. His wife and I were both laughing.

Hawaii Hawaii Hawaii

I get to go to Hawaii in the spring for one month to do a NICU rotation! I am flippin ecstatic! And I get to stay with my very kind friend Lydia :)

Best news ever!

Getting Sick in the ICU

This last week, I've been the sickest ever since starting rotations. Monday was filled with fevers, sweating, and chills. Literally, I was walking around the ICU wrapped in a blanket. I went home early that day. And crawled right into bed where I stayed until the next morning. Tuesday, I called in. Wednesday, I went back but my voice started to get froggy. Thursday, I had no voice. I was whispering. I whispered all my presentations to my preceptors. I went to the doctor that afternoon and was put on voice rest. So I got to stay home on Friday as well. Now, getting sick is normal. People commenting on how awful you look/sound is also normal. What is not normal is that my preceptors completely ignored the fact that I was sick. I was whispering to them on Thursday and they acted like nothing was unusual about that. The other odd part about this is that I don't really think a sick person should be in the ICU, examining patients. Not a thing was mentioned.  And just as a sidenote, I am absolutely convinced I have serratia, as one of our patients had it. Stupid med student syndrome.

And as for hating this rotation, it is slowly moving its way into the position of worst rotation ever. It's been in second place this whole time, but I'm beginning to think it will be taking first place. Seriously, I'm not sure how on earth I will make it another two weeks. These are the longest days of my whole life. After these miserable two weeks, I'll be on 8 weeks of audition rotations....while exhausting, at least I'll be loving what I'm doing.

ICU-The Rotation From Hell

I'm not kidding. This is going to be the longest month of 4th year. I'm doing this rotation with one of my classmates and good friends Paul. All I have to say, is thank God I'm not doing this rotation alone; I might literally die of boredom. Does that happen? I might have been the first. But, we won't be planning my funeral since I have Paul.

We have to be ready to go at 8:30 for rounds with the whole team (about 8-10 people). But, we have to be ready to present our patients in front of this group and have recommendations on a plan. So during the week, we are getting to the ICU at 6:30. From the time we get there until rounds are over, time flies. It's great. And then, we are supposed to read until the day ends at 5 pm. This can be anywhere from 10 am-1 pm. Seriously, 7 hours of sitting there and reading? While, yes, the study time is appreciated, it's a bit much. And I would much rather be studying at my house. Then we were also notified that we were expected to be there a few weekends. That's working 12 days in a row. Paul and I arrived at the hospital at 5:30 am today. MISERABLE. I had to break out the coffee pot this morning even though it's been so hot here. I didn't care, the diet Dew was not enough to support me through the morning. We were able to leave after rounds today, so it's not as awful. But still, it blows. I am absolutely exhausted. I took a 3.5 hour nap today. So like I said, not my fave. Plus, I'm supposed to take boards a week from Monday. I'm thinking I'll need to push those back since my studying hasn't been so great and I'm just so tired.

The good part is that the patients are mostly interesting and very complicated. Later in the week, I'll add some cases.

Hot Air Balloon Ride

Not medicine related, but I have pictures of something, so that's unusual for me. For my sister, Jake, and my birthdays, my parents got us a hot air balloon ride.I was very very nervous, as the the thought of flying around the air in a flippen basket didn't seem quite so safe. But, I sucked it up and did it. We had a lot of fun. The anticipation was the scariest part. The actual ride was calm and not scary at all. The landing was hilarious. We landed in a field of cows. They freaked out. First they all started running into one big crowd. Then as we got closer, they bolted in the opposite direction. Once we landed, they came charging at us. Thankfully they stopped before they got to us. My favorite part of the ride was the whole landing. The basket slams into the ground, bounces up and slams back down again. This happens a few times and I have the bruises on my knees to prove it. My sister and I could not stop landing. Then, after Jake pushed us into a non cow zone (yes I said pushed), we tip over. As you can see, Laura and I are climbing out. After everything was packed up, we went back to their business and had some champagne to celebrate.

More from Oncology

As I previously posted, my preceptor is flustered by me. It's been an odd interaction, but we came to a "disagreement" on Thursday, and I changed it up on Friday, making for a great day.

Thursday- I was scheduled to go observe an U/S guided breast biopsy at a different center. Dr. O had been on vacation and seemed annoyed that I hadn't gotten more written on my case report. (Hello, I was seeing and dictating all the NP's patients!) So I asked if he'd prefer I stay and work on that. He told me it was up to me. I finally just said I'd stay and work on the research, knowing that was his preference. Well, lunch time rolls around, and this conversation follows:
Him-"Where do you want to go?"
Me-"I don't care. Wherever you pick is fine."
Him-"Jenny, what do you feel like."
Me-"I will eat anything.
Him-"Jenny, why don't you have an opinion."
Me-"Haven't you been a med student? Whatever my attending wants, is what I want."
Him-"You are a 4th year medical student, about to be a physician. Now you should be having an opinion and disagreeing with preceptors. You're not a 1st or 2nd year. Tell me where you want to go."
Me-I finally picked a place and he was happy.
Fast forward to when we're eating....
Me-"Do you like the food?"
Him-"Jenny, haven't you ever been an attending? You like what your medical student likes." Booyah. yeah he totally mocked me.
So, I've recently made my opinions clearer and things are much smoother :)

My funny story of the week. The patient is in her late 90s and was just diagnosed with squamous cell carcinoma of the vagina. We walk in the room, and her daughter asks to speak to us outside. She doesn't want her mom to know she has cancer, and they are all using the word ulcer. Dr. O wasn't too pleased, but nonetheless continued with that word. This lady is very hard of hearing....so we think. Dr. O tries explaining things over to her and she just looks confused and keeps saying what. Then he is talking to the daughter, telling her that he will get some testing done for today so that they don't have to go back and forth. And what does Mz. Little Old Deaf Lady say "Oh yeah, I don't want to go back and forth." She totally heard him! He called her out on her selective hearing and she was smirking. The other funny thing about this interaction, was that I was in front of her, while her daughter and dr. O were on the sides of her. She would look at Dr. O and be looking nice, then turn to her daughter and squint her eyes and give her a dirty look. I was trying very hard to not laugh.

Oncology

Well, I'm back in WI, starting my 4th year out with Hematology/Oncology, working with the doctor that I previously did research with. I'm already halfway done, and it seems to be crawling by. I will admit this is not my favorite rotation. The days go very slowly. I'm working on some research as well: a case study on a patient. I forgot how much work goes into writing up a research article. My preceptor seems flustered in how to deal with me. And that's how I feel this last paragraph was written: flustered.

I'll just write about a few things that stick out in my head from the last two weeks.
1. I had to tell a patient the other day that his prostate cancer treatment is not working and that his cancer is progressing. It's hard to keep eye contact with the patient, but I did. That way I could see the look of absolute shock in his wife's eyes, yet the careful control in his face.
2. A 40 year old male who was just diagnosed with stage 4 lung cancer- Seeing Dr. O for the first time, both he and his wife admitted to still smoking. Dr. O laid into the wife. It actually made her cry. I was actually really happy to see a preceptor spend so much time on smoking cessation. Often times I feel that the doctors get resigned to the fact that patients are still smoking. Not Dr. O. We talked about it after the appt, and he said that he spends at least 5-10 minutes discussing it. When we saw them again 1 week later, she was down to a few cigarettes per day!
3. A bone marrow biopsy. For those of you who have not had the pleasure of observing one of these, I'll describe it here. I actually think this is one of the nastiest procedures I've seen. First, the skin is numbed with some lidocaine, and then a deeper injection of it, all the way down to the bone. Then this hugeass needle is driven into the hip, where he aspirates some bone marrow. Then he starts grinding the needle and spinning it to get a piece of bone. Now, this takes some effort. Dr. O is putting some muscle into it. Then he pulls it all out and cleans up. The noise is gross. You can hear the bone scraping and crunching.
4. Radiation oncology- I got to spend some time over there to check out how it works. I honestly had no idea what to expect. Well, there is this HUGE machine that focuses it's photon beam at, and radiates the tumor. The room is lined by 6 feet of cement and 1 foot of lead. They take radiation exposure seriously. As they were explaining things to me, I seriously just sat there wondering what language they were speaking to me. Honestly, it was like this horrible physics nightmare! This is the first time since my first year of school, where I really felt like I had absolutely no clue what was going on. I couldn't understand what they were saying, I couldn't think of any intelligent questions to ask, fearing that I would look like a complete moron.

Oh, and in good news, I passed those boards I had to take in PA. Phew. Next up, my written boards on Aug. 23rd.

Oh and in some other good news, the program director from my audition rotation invited me to come back and rotate in his private practice. I may or may not have been jumping up and down.

This Made My Day

One of my classmates posted this on facebook. I almost fell over laughing because it is so true. I mean, don't lose hope in your doctors, but for anyone who has a medical background, I hope I make you laugh.

And the OB/GYN one is absolutely perfect :)

Someday I'll write a post about my life again.

More Vacation Pictures

Found the camera: pictures are numbered from left to right top to bottom.
Picture 1-One of the Painted Pot geysers
Picture 2-Alpine Slide
Picture 3-The yummiest coffee drink ever. Coffee, amaretto, kahlua, baileys. Can we say calories?
Picture 4-Me and Jake on the balcony of our restaurant.
Picture 5-Jake in front of the Grand Tetons
Picture 6-Another geyser
Picture 7-Me and Jake in front of Morning Glory
Picture 8-Morning Glory
Picture 9-A cool picture in hot springs land
Picture 10-The wolves at the Grizzly and Wolf Discovery Center
Picture 11-Old Faithful

Vacation!

Jake and I just got back from vacation to Idaho Falls, Yellowstone, and Jackson Hole. We had an amazing time. Our first few days were spent with Jake's best friend Britton in Idaho Falls. I got to meet her and her family for the first time. It was such a fun few days. They took us out on their boat one day to go skiing and tubing. It was Jake's first time doing both. The water was freezing, since it's snow runoff from the mountains. Seriously, coldest water ever.

From there, we traveled to West Yellowstone, Montana. We spent the next few days driving around Yellowstone looking for fun wildlife and beautiful scenery. We were lucky enough to see 7 bears, a bunch of bison and elk, and bighorn sheep. We also saw beautiful waterfalls, geysers, hot springs, and of course the amazing mountainous backdrop.

Friday was Jake's 29th birthday! We started out the day at the Grizzly and Wolf Discovery Center where we got to see grizzlies and wolves close up. Then we headed to the Paintpots and walked around looking at more hotsprings. Old Faithful was next, and then I talked Jake into a 3 mile hike to see Morning Glory, supposedly one of the most beautiful hot springs. Then we drove down to Jackson, checked into our hotel, and then went to the Granary for a delicious mountain top dinner! The food and view were amazing.

Saturday we started out with white water rafting down the Snake River. I had rafted the same stretch when I was 13. Needless to say, it wasn't quite as scary this time around. Then we acted like children as we went down the alpine slide! It's a 2500 foot slide that goes down the mountain. Then our vacation was over as we began the trek back to Colorado.

Picture 1- Some of the cracked mud near a hot spring.
Picture 2- Jake working up the courage to jump in the water.
Picture 3-Our first black bear siting. There's a cub too, but you can't see it.
Picture 4-Jake and I in front of the Lower Falls.
Picture 5-Just a cool picture I took.
Picture 6-The hilarious sign warning people not to step off the walkways.

I left the camera in the car, so I'll add more pictures tomorrow, including Morning Glory.

Audition Rotation

I recently finished up my first audition rotation. This is basically a rotation at a program I'm interested in for residency, which means that the entire two weeks was an interview. I went in knowing that I was going to bust my ass in trying to impress them; what I didn't know was that I would fall in love with the program and not mind the busting at all. I rarely looked at the clock. I immediately clicked with the residents. I scrubbed on so many surgeries. I finally learned a one handed knot. My suturing skills improved. They let me deliver a baby (this is a big deal because I barely knew them and other medical students don't get to always do them). They complimented me everyday! I went in on the weekends to impress them some more (this is not a requirement of the rotation). My schedule was hard. I basically came home and slept every night.
Monday- 8:30-7:30
Tuesday- 6-6
Wednesday- 6-6
Thursday 6 am- 8:30 am on Friday morning (yes this is 26 hr shift)
Friday-day off because I took call
Saturday-5- 5
Sunday 5-5
....and so on.

I obviously did a good job because at the end of the rotation the program director told me I did very well, he heard nothing but good things, and that I definitely will be getting an interview in October!!!! I am so excited! I would love to match at this program, but I refuse to get ahead of the game. There are only 3 spots and one of them goes to a male. That leaves me with getting one of two spots. I know I did well, but there are other students who will be rotating through and who will do well. So this was the start of my residency application....there's still a lot that has to happen.

Boards Tomorrow

I'm in my hotel in Philadelphia trying to decide whether I want the time to fly by so that I can get to my dinner with friends tomorrow night or slowly so that I can still run over stuff tonight and get my brain all organized. Anyways, tomorrow is Step 2-PE. For those not versed in medical boards, this test is a practical. I will be seeing 12 standardized patients (they're actors, and unfortunately these are the people starving for money, not like Brad Pitt or someone there like). I get 14 minutes in the room with them to complete a history and physical and then 9 minutes to write up my note. I'm exhausted thinking about it!

So I'm about to head out for the evening....dinner (I'm thinking Chinese), grab some food for breakfast from Whole Foods, do a test drive to the exam location, come back to the hotel, review a few things and hit the hay. If anyone can muster up some good luck vibes and send them my way, I'd be very grateful.

Muah.

San Francisco!

This past week I flew to the other coast to attend ACOG. This was very exciting for me, as it was the first time I attended a conference that I would probably be attending the rest of my life. I met up with my classmate Annie who I haven't seen in two years! It was wonderful catching up with her and sharing this exciting time with her. I flew in Sunday, Annie met me at the airport, and we took the BART to the hotel. Since my flight was late, we didn't have much time to get ready for the first event. It was two round table events: the first was with program directors and residents discussing the interview and application process. The second was discussing CVs and personal statements. These were both very informative sessions. That evening we just walked around looking for a place to eat, came back and went to bed. The next morning we got up, headed to the Moscone center, registered, and listened to a talk on SSRIs during pregnancy. After that we started our journey through the exhibition hall! It only took us three trips over! Man, this was insane! I can't believe how big the booths are, and all the giveaways there were. I came home with a lot including: a textbook, three pregnancy books, many tubes of stretch mark and scar cream, lube, pens pens pens, maple syrup, many totes, vitamins, hand sanitizer, and a ton of papers! My suitcase weighed about 15 lbs heavier on the way home! I also delivered a baby with forceps on a simulator! That was definitely a new experience!

We headed back to the hotel to attend another med student activity. This one was two panel sessions about OB/GYN as a career and another on the interviewing process (this is a big deal). Again, very informative! That night there was a reception for the students and residents, which was kind of boring, but we met up with a new friend. After the reception, Annie, our new friend, and I took the cable car down to Fisherman's Wharf! We had dinner, found the sea lions, and just walked around.

Tuesday, we went to a session called "Stump the Professor." This is where residents present difficult cases to some of the renowned professors around the country and see if they can get them. It was a lot of fun, plus I learned a lot. The professors got 2/3 correct. There was a residency fair that afternoon, but only two programs that I'm even somewhat interested in were there. After that, Annie and I grabbed lunch and headed our separate ways. I hopped on the train to meet up with my old college roommate in Los Gatos. We spent the evening together and it was a total blast to catch up. I had a red eye flight out of San Francisco, which has totally screwed me up. So here I am, back in Ohio, awaiting my next insane trip.

Back to OB/GYN

Yes, that's right. I have manipulated myself back into my favorite rotation with two of my favorite preceptors. I'm already halfway through, so that's hard to believe. At this current point in time, I only have 4 weeks left of third year. Yikes, time is just flying by. I mean seriously, how is it the last week of May?

This time around has been a little different than the last time I rotated with them. They have left the practice they were with, and are on their own. Their new office is in the hospital, which makes it very convenient for surgeries and deliveries. I'm also gone a lot on this rotation. Last week, I missed three days because I was in San Francisco for the annual American Congress of OB/GYN meeting (I'll post about this next). The first week of June I'll miss three days where I'll be in Philadelphia taking the first portion of my Step 2 boards. I'm excited because I get to meet up with some friends Jen and Erika.

Labor and delivery has been a little slower than last time around. There have been only three deliveries since I've started. The first was a vaginal delivery that turned out perfect. The second was a delivery that I walked into the room as the baby was coming out. I was totally bummed especially since it was her first baby, so normally they take longer. Oh well, those babies come when they are ready. My third was a c-section. This was pretty uneventful. The mom just failed to progress.

So I apologize for no good stories. They just haven't been happening. My life has been busy as ever though! Residency applications start this summer. This requires a lot of paperwork. I have my first audition rotation in two weeks up in Dayton, Ohio. I'm both excited and terrified!

An Interview

 Studentdoctor.net is a huge resource that many students around the world. I was recently interviewed with two of my other classmates. Here's the interview:

http://www.studentdoctor.net/2010/05/a-better-method-for-medical-education/

I'll be back with more stories soon. I'm currently in San Francisco at the ACOG meeting with my friend Annie, who I haven't seen in two years. It's been fun, but I'm exhausted. More to come later...

Funny Quotes

I was seeing this older gentleman who is apparently quite the ladies man. I needed to examine his back so he took off his shirts. I reported to Dr. B, he came back in, examined him and then this conversation happened:
Dr. B: Ok, I'll go grab your medication sample, so you can get dressed.
We both get up to leave.
Patient: He looks at me and says "Wait, you're leaving too?"
Me: Well, yes I will let you get dressed.
We leave. He comes out when he's dressed, walks right over to me and says" When are you coming back here?"
I loved it. Dr. B told me that normally this patient likes to sit and talk with him, but today he had no interest in anything but me.

I was in the waiting room, waiting to see patients. The room was full. My next patient brought her sister with her. They were all wondering who I was, so I explained about my education, blah blah blah. The sister says "There are too many people in this world. You should be a bad doctor and get rid of a lot of them." I could not have been more shocked.

And then my adorable 3 year old nephew Will. We stayed with my BIL this weekend. As we were packing up to leave, Jake put on his hat. Will looks at me and says "Aunt Jenny, where is your hat?" Me- "I don't have one." Will- "Well, Uncle Jake can buy you one." Man, at 3 years old, he already has that all figured out.

Sad Alzheimers

The patient: an 80something year old male. He's had alzheimers for awhile, but his daughter and son in law brought him in urgently because he had an aggressive incident the evening before. During the visit, it was easy to see how confused he was. He would start a statement and not be able to finish it because he couldn't remember what he was saying. Dr. B was assessing how oriented he was. After asking the patient what state we were in, he couldn't answer. So Dr b gave him some choices. He correctly picked Colorado. Then Dr. B pointed to his son in law and asked who that was. He just looked at him blankly. After we asked several more times, he responds with "Well, that's a Colorado possum." We all busted out laughing. Definitely not what we were expecting. It was really really sad though. My grandpa had alzheimers and it was so sad talking to him. I don't hope this disease on anyone.

Oh and an interesting tidbit about the alzheimers medications. If you take a patient who has been on an alzheimers med, and discontinue the medication, the patient will rapidly progress to the point where they would have been without meds the entire time in a matter of months. So even though some of the side effects are vicious, many people will continue on them because of the ramifications of coming off.

My Amazing Patient and Pot

I saw a patient this week who is a spitfire. He's 80 and still works full time being in charge of around 400 people. And here's my favorite part: he does between 200-300 push-ups per day! *Jaw drop. Yeah, I was shocked. He was also a motormouth. I could barely get a word in, and his adorable wife just sat in the corner smirking. The whole thing was quite comical. I was kind of hoping he would get down and show me. LOL.

Being in Colorado, medical marijuana is legal. Dr. B has about 6 patients in his practice who he has on it. I think the whole thing is rather strange. I saw a 93 year old man this last week who has severe spinal stenosis. At his previous appt they had decided to give pot a try. His daughter came in to follow up with Dr. B. Well, they decided not to pursue using it because they don't think it really worked. The daughter says "We have had to change the music we listen to." LOL, I just had to hide a smile.

The Craziest Sinus Infection Ever

The patient- a 60 something year old male who for the past 4 years has had a watery right eye. He has seen ENT, eye doctors, etc. The eye doctor put in a stent to help the lacrimal gland tear correctly. Well, 3 weeks ago, the patient had a sudden onset of a horrible horrible headache over his right eye. He basically had it for 2 weeks, when all of a sudden a huge amount of puss came out his eye. The puss pushed out the stent. At the same time, a black jagged rock like thing fell into his mouth from the back of his throat. And then his headache stopped. Disgusting huh? He hasn't had a watery eye since that day. So basically this rock like thing was in his sinuses and pushing on his tear duct. Blech.

Internal Medicine Day 1

I started my internal medicine outpatient rotation today. I struggled to set this one up since my facilitators said I could do it out in Colorado. Everything I was planning on kept falling through. So finally, I went to the AOA's website, found Dr. B and called his office. He went to Kirksville, which is affiliated with my school. He said yes, thankfully. Anyways, I totally admire him. He has a private practice: just him and two medical assistants. He likes to take his time with his patients, so he spends 20-40 minutes with each patient. While I've done this with other doctors and hated it, Dr, B realizes that he can't do this and see a gagillion patients a day. His absolute max is around 20, typically more like 17. He says that he has done the 30-40 patients a day and was miserable. He makes less money now, but he's happy. We work 8:30-5 three days a week and 8:30-12 the two other days.

I try really hard to be fun and sweet to the patients. The medical assistant always asks the patients if they're ok with a student. Well one guy said no problem as long as he wasn't getting a prostate check. Well, I walked in the room and said "I hear you want a prostate exam today." He and his wife almost fell over laughing. I like making patients laugh. It lightens the mood.

Bestest Husband Ever

I am currently on spring break...my last one ever. It's kind of strange, but I'm enjoying it. And to make it even better, I'm spending it in Colorado with Jake. Oh yeah, and I'll be here for 5 weeks. I'm ecstatic. So I'm planning on spending my week reading, cooking, watching tv, and making a residency spreadsheet. Tonight's dinner is meatloaf muffins, mashed potatoes (real ones since the Kitchenaid is along) and a yummy salad. Jake is loving my spring break too because it means he has a stay at home wife.

Alright, so back to my title. On Thursday when Jake flew in, we drove back to my place and actually we fell asleep on the couch. When I woke up, he says to me "I know something you don't know." Ok, well I'm like a 4 year old and continued to press him until he finally sighed and got up. When he came back by me, his hand was clenched and he put a ring in my hand. He got me an emerald cut sapphire ring, exactly what I've been wanting for over a year. After bouncing up and down and shrieking like a 4 year old, I asked him for what reason he was giving this to me. His reply "Just because." Oh yeah, he's the best guy ever. 

So Inappropriate

Do you ever have a moment when people tell you a story and you're only thought is "wow that's so inappropriate?" Well, today I had one of those moments. We admitted a patient from the ER yesterday. He has pancreatitis. Yesterday, he was swearing up a storm and I kind of thought it was funny. Today, he was obviously feeling much better. He asked if I wanted to hear some stories and he looped in some kind of hook because I thought, sure why the hell not. First he tells me about how he had an Indian doctor and he asked her if she ever scalped white people. She kicked him out of her practice. Then he tells me about one time a girl was taking his blood, and when she bent over her boob went into his hand. What did he do? He grabbed it! He tells me "She wasn't even wearing a bra." I then proceeded to tell him that story time was over. When I told my attending all this he was not amused. And he apologized for making me go in there. The patient didn't harass me so I don't really care. I will know tomorrow though, that I will definitely not let him start telling me any stories.

What inappropriate stories have you heard lately?

My Final Week

I know it's been awhile. First, let me freak out for a second. Match day is less than a year away. Holy shit....how am I nearing the end of my 3rd year?
  Alright some updates: the patient who was hallucinating, the next day when I went to see him, he was lining up all the cords on his body and said "Now if I can just get these lined up, I'll get the clock to work." A couple days later, I saw him again and he told me that he was building a modular home in the room but he and Obama had gotten into a fight the night before about the house. Obama was taking the house away but making him pay $700,000; he was kind though and was letting him do a payment plan. Wow. So the diagnosis: pancreatic cancer. Bummer.....one of the worst cancers out there. I imagine he won't be with us too much longer.
   A 30 something female works out extensively on weekends. She did so a week ago. Monday, she woke up sore. Tuesday, she was feeling pretty weak. Wednesday, she couldn't move the lower half of her body. So she came to the ER. Her potassium was 1.6. That is the lowest value I've ever seen. It's supposed to be between 3.5-5. The next day that I saw her her K+ had increased to 2.2. I said something about it out loud in the dictation room and one of the other doctors was like "2.2 is not high." I was like "Well it was 1.6 yesterday so I'm pretty happy with the 2.2.  By the second day, she was able to walk again. It was one of the coolest cases ever. Not the normal heart attack, congestive heart failure, pneumonia, UTI patient. We had to consult heme/onc, rheumatology, and nephrology. She was gone today when I got there, so I was slightly disappointed but her K+ was up into the 3s.
   Last week, I had a new admit from the ER. He was an older gentleman who had a stroke. I had done his complete history and physical. He was sweet as pie. The next day I went to round on him, and he chewed me a new asshole. He was starving and was NPO because he was having a stress test. I walked in the room and quickly knew something was wrong since he started yelling the second I came in. I asked if he had his stress test yet and he yells back "You're giving me a stress test right now!" Okkkkkkkk. He kept saying he was going to refuse the tests and wither away and die. Drama queen much? And this man was not lacking for some body weight. He probably could have gone a lot longer and not withered away. Anyways, his daughter works at the hospital and she came and found me today to apologize for his behavior. Apparently the nurses called her after he yelled at me. LOL.

In Over My Head

Way over... Only one of my patients was still in the hospital so I had to see him plus two more. I randomly picked two more people, and oh man, did I pick wrong.

My normal patient (this is the guy with the abscesses who was in so much pain)- He was obviously feeling much better today because I walked in and he said "Well, hi honey." Normally, I walk in and he's grunting or groaning from the pain. He got discharged today. I'm sad to see him go, but glad that we were able to help.

New patient 1- older gentleman who was admitted for new onset mental changes. This history and physical took awhile as he was slightly confused and would got off on tangents....long ones. I asked if he was seeing or hearing anything that wasn't really there. His response "Well, just once this weekend. I was watching tv and the next thing I knew, the characters had joined me in the living room." LOL, man this could be really good or really bad depending on which show he was watching. So he has a huge pleural effusion which needs to be tapped and drained. And the really bad news: they found lung nodules. That's either lung cancer or mets from another cancer. After I got the news, I went back to see him to talk about the tap and to relisten to his lungs. His daughter asked to talk to me in the hallway and asked about the possibility of lung cancer since the ER dr had mentioned something about this. I was really trying to avoid the cancer talk since I'm the med student, but she brought it. So we talked about it matter of factly. I explained to her that we were unsure whether or not it was primary or mets. It went well, and I'm very grateful for that.

New patient 2- an elderly lady with new onset mental changes. Sound familiar? Yeah it does, but totally different case. She has a UTI (which can cause mental status changes in the elderly), stroke like symptoms, and a metabolic alkalosis. Oh yeah, and she can't really speak. So what does all this mean? I was way over my head. I told my attending that I was overwhelmed and I needed help. She was happy to help and then she became overwhelmed. LOL....We ordered a lot of tests. I look forward to seeing all the results tomorrow.

That's it for my patients, however one more story. One of the other hospitalists found me today and told me to go check one of her patient's feet for clonus (a neurologic symptom). The catch? He's a sexual predator. Her advice was to stay by his feet and prepare for him to say something inappropriate to me. All he did was call me sweetheart. I was prepared for way worse. I went in, checked his feet, and left quickly. No need to be in a room with a sexual predator by myself for more time than necessary.

Now That's some Real Back Pain

And I thought I had some bad back pain.
Patient- 90some year old man who gets admitted for uncontrollable back pain. Upon some work up, it is found out that he is bacteremic (bacteria in his bloodstream) but no source and a UTI. When someone gets an infection, the source has to be identified and in this case it proved to be difficult. his chest x-ray was normal, his MRI found a severe compression fracture but no cause of infection. We ordered an abdominal CT scan, and low and behold, bilateral psoas abscesses. That would definitely be the cause of a blood infection. Ok what next? They have to be drained. This is done by an interventional radiologist under the guidance of CT. I followed the patient to radiology and was in the room while he was transferred from his bed to the CT table. This might have been one of the most heartwrenching things I have been apart of since starting school. This very elderly gentleman who has a severe compression fracture of his spine and two abscesses in his back which are painful, has to be laid on his side on a hard surface. The process of moving him was just awful. He kept yelling out in pain and saying things like "Please don't leave me in here alone." The procedure went relatively smooth and the dr was able to drain a lot of puss.

On a side note, this guy had been prescribed a Fentanyl patch which is a strong pain medicine that is constant since it's attached to the body. When the nurse went to go change the patch Thursday night, the old one was gone, which means that his pain had not been adequately controlled for a few days.

I'm pretty attached to this patient, so I hope when I see him on Monday, he will be either discharged or a lot better. 

Me Likey!

Started at 9:30 today and done around 12:20. Love it. Today was a good day for that since there's a big ball of pressure behind my right eyeball. So I've been on the couch since I got home.

Let's see. ICU lady was still alive when I walked by. Apparently she is hanging on.

A man who probably has the worst luck ever. He developed kidney failure from his high exposure to chemicals in his job. Got a kidney transplant from his son. All of a sudden his abdomen was so distended he thought he would explode. They found a mass in his pelvis that was obstructing his GI tract and his bladder. He gets a colostomy because of the backup of poop in his system. They think the mass is coming from his hip that needs to be fixed. No dr wants to touch this guys insides since they all seem to fall apart. An orthopedic surgeon at our hospital decides to take him on. They did surgery on him yesterday and it seems that this pelvic mass is coming from his hip and it is a calcified hematoma. And that's how he ended up on our service. We're just managing his diabetes and blood pressure. He is apparently going back to surgery to get that hematoma out, but since it's calcified they weren't able to get it out the first surgery. Oh and because of his kidney failure, his adrenal glands are failed, so he has to get IV doses of prednisone for a stress reaction from surgery. Bad luck? I think so. Dr. N has made him one of "my patients" so I'll be rounding on him first in the morning.

Internal Medicine - 2 Days In

Well, I'm two days in on my internal med inpatient rotation. Life is already 100 times better. I start later and get home earlier. The doctor that I'm with this week is amazing. She is young, super smart, and very personable. I can't believe how much I've already learned. I feel very fortunate for this rotation. My days starts with getting our census, deciding which patients I'm going to see, go see my patients and prepare my note, find the dr and finish rounding with her, present my patients and go see them together. She told me today that I did a good job, so hopefully all will continue to go well.

And of course my stories.

Patient 1- she's elderly and in the ICU and on a ventilator. She's been there a few weeks and her family decided yesterday to withdraw care. While I rounded on her, I realized that it was probably the last day she'd be alive. I just patted her hand, knowing that her name will most likely not be on my list tomorrow. It's sad, really sad, but she's been miserable and she keeps waking up, feeling her vent and gagging. It really is no condition to live in.

Patient 2- brought into the ER because of coffee ground vomiting and hypotensive. Turns out, she has hepatitis C, alcoholic cirrhosis, and esophageal varices from both her alcohol disease and her eating ibuprofen like candy. She really has to give up alcohol, and she seemed like she was ready to make that move. But she refused a social worker to discuss AA. It's really hard especially since her husband drinks every night. In my discussion today, we talked about her hepatitis C and where it came from. She admits to using drugs and sharing needles in her past. "Well, it's what everyone was doing." Looking at her, you would never ever guess that she was an IV drug user back in the day. I mean, she could have been yours or my aunt. She told me that I will make a really great doctor. It's good to hear that even though I had that type of conversation with her today she was willing to look past my "lecturing" and see that I really care.

My Last Family Practice Post

It's over. Thank God. Jake visited this weekend, and we honestly just had the best weekend ever. I'm so much happier. And my good news is that our next visit begins in 3 weeks and 4 days. And at that point, we'll be driving back to Colorado where I will be for 5 weeks. 5 weeks with my husband!!! I can't even describe how much of a difference this makes in my daily happiness. I have something really great to look forward to!

Now, onto my last few stories of family practice.

Story 1: a mom is in for a physical and has her 3 year old daughter along. Now this 3 year old is absolutely adorable! She spoke just as clearly as your or I and her conversation skills were amazing. She came over to me and said "I have a secret to tell you." I bent over and she whispered, "I call my mom a banana." Oh my goodness, the secrets of a 3 year old are just the best. She then put up 5 fingers and said "I have this many secrets in my head to tell you." Sadly, I didn't get to hear the rest of them. She also told me that I was "the best doctor ever." Again, I had to laugh since I didn't even touch her. As I've said before, 3 year old kids are my favorite to talk to.

Story 2- I walked into a room and the man says "Wow, you are a lot prettier than Dr. D." I kind of laughed, and talked to him about his high blood pressure. When I went to take it again, it went up, way up. He told me that it was me. Dr. D comes in the room and the patient tells him that the scenery is getting better around here. Dr. D looks out the window and says "Oh yeah the sun is out today." That's not what the patient was talking about. So Dr. D takes his blood pressure and afterwards goes "Well, I must be uglier than the other two because it went way down." LOL.

Up next, internal medicine inpatient. I can't possibly tell you how excited I am to have an easier rotation. I don't have to be in tomorrow until 9 am! Amazing :) These should be happier times around these parts.

My Head is About to Explode

As if anyone didn't get how much I dislike this rotation, but I'll just blog about it some more. I got home at 8:45 tonight. I have to meet him in the hospital tomorrow morning at 6:30 am, meaning I have to leave my house at 5:45. Really? REALLY? You know I have a big exam on Friday. Apparently, you don't give a shit. One more day. One more day. Thank God Jake arrives tomorrow night. He's going to have to calm me down because I am strung tight right now.

That's all.

Some Sad Things

Today was a day from hell with the transition to EMR. I feel like it was a heavier psychosocial day. So the two combined made for an amazing day.

Sad story number 1- A 72 year old man came in for just a check up. He was just chatting away and then was telling us how his two kids don't come visit him anymore. They've only been to see him once in the last year. He goes "Well, I guess they have their own lives now. No time to see me." It broke my heart. This man is self sufficient in his own place. It's not like he's a burden to his family. Just one of those patients you want to adopt into your family so you can show them some love.

Sad story number 2- a lady who comes in for major depression, PTSD, and anxiety. When she was a younger woman, she was living at home with her family. She was going out to hang out with some friends. As she was getting ready to leave, some friends of the family came over to visit. She quickly said hello, and left. When she got home that night, her entire family was murdered. Great family friends huh? Isn't that just the most awful story in the whole world? I'm pretty sure my jaw hit the ground.

2 more days of this rotation. I can do it.

Almost Done

With family medicine that is. I know I've been slacking at blogging. Honestly, I'm just so exhausted by this rotation, that the last thing I want to do is rehash my day. I only have this week left, and actually only have to work three days. Tomorrow, we have off. And Friday is my shelf exam. So that leaves Tues-Thurs. The bad part is that we are starting EMR....electronic medical records. The dr I work with is already slow. I am betting I'm there until 8 pm every night this week. Jake comes on Thursday. I'm excited.

I can't really think of that many stories.

I went in to see a new patient who was coming for a physical. I introduced myself. She asked if I was a state employee. I said no. She insisted I was. I said that I do not get paid and am not an employee. Then she says "I refuse to answer any question and you can absolutely not touch me." I just walked out. Strange huh?

A man came in with extreme low back pain and pain down his hamstring. He was standing, slightly bent over with bent legs and he was looking at us and rubbing the back of his leg. This was one of those things that just totally caught me off guard and was hilarious. The man is almost crying and I'm trying my hardest not to laugh. Seriously, I was biting my cheek. I wish I could show you the position because it was just odd and very funny.

I had examined an elderly gentleman and Dr. D came in to see the patient. While he's examining the patient tells him that I can't be a doctor. Dr. D gets a worried look on his face and asks why. The patient says "Well, she's too pretty to be a doctor." Awwww, isn't that sweet? Kind of. It's a strange compliment. So because I'm pretty I can't be smart too? Well, it's a good think I don't get upset easily.

And one more. Dr. D was telling me while he was a med student on his ER rotation, he worked with this female physician. She would walk into a room to see a patient and tell them that their body was like a house. If your shutters aren't working, you go to the eye doctor. If your siding is falling off, you head to the dermatologist. If your plumbing isn't working, you head to the urologist. If you need maintenance work, you go to the family physician. I am a fireman and your house is not on fire. Then she would turn around and walk out. Yeah, that was back in the day when you could choose not to see patients in the ER.

A Reminder to do Boobie Checks

Ladies: this is your reminder to start doing monthly breast exams. If you're not comfortable doing them, ask your significant other to do them. Don't know how? There are plenty of materials online or you can ask your doctor. They would be more than happy to show you how.

What brings on this post? Well, today I had a patient who came in for a rash. It was the worst on her chest. While I'm examining her rash, I'm thinking "Hmm she has the strangest looking breasts with all those scars. I wonder what she had done." Well, ignorant me assumed since she was so young that it was cosmetic reasons. Actually, at the ripe old age of 26 she had breast cancer, needed a double mastectomy, and had reconstructive breast implants. 26? 26???? That is one year older than me. Seriously, that is scary. It is really easy to think that breast cancer only happens to older women. We are wrong. I saw it today.

So whatever you call them: Breasts, boobies, tatas, knockers....check them out. Be kind to them and practice good breast health. And seriously, if you really don't know how to do them and can't get any information, send me an email. I'd be happy to help.

Happy Valentine's Day

Well, it's V-day and I'm cooking meatloaf and asparagus for myself with the intent of eating leftovers for at least 2-3 days. Jake's in Colorado and he spent the day in his lab. Every time I called there was some very loud machines running. We celebrated last weekend while he was in town. I'm glad it fell on a Sunday that way I'm not out at work listening to everyone's plans and seeing all the flower deliveries. Our weekend was fantastic and it was the perfect V-day for us. Friday, I took my Ob/Gyn shelf exam and came home to a bouquet of tulips: my most favorite flowers ever! It's a bouquet of pink, red and white tulips. Let me make a shout out to Proflowers. Jake always gets me flowers from them and they are fantastic. Flowers easily last 1-2 weeks. Ok back to our weekend. Friday night we stayed in, and I made Jake a yummy dinner. Saturday morning we slept in, and headed downtown. We had lunch at Dewey's and then spent a few hours at Barnes and Noble. B&N is our favorite date thing to do. I am never bored there. Then we checked in to our hotel: The Cincinnatian. We exchanged cards and of course Jake didn't follow the no gift rule. He got me a purple pearl set of necklace, earrings and bracelet. They are beautiful!!!

Next up is dinner. We got the recommendation from one of the physicians in the area to go to Morton's. It's a fancy steakhouse. We had so much food....more food than I've probably ever eaten at a dinner. Both of us were in pain from our extended stomachs. LOL. The food was delicious. Like amazingly delicious.

So yeah, we had a good V-day. It was a really short trip though. It was the shortest amount of time we've spent together in about two years. Pretty crappy if you ask me. Oh well, November isn't that far away. We'll make it.

Week 1 of Family Medicine

I know I've been a slacker and haven't posted in awhile. I just haven't had any great stories. I finished up OB/GYN and just can't even believe 4 weeks went by so fast. The rotation was amazing; it's everything I hoped it would be and I am 100% sure I want to go into this.

I am one week into my second family medicine rotation. I have to say that I work harder and longer hours on my family rotations than anything else. I leave my house at 5:45 am, meet Dr. D at the hospital to round on our patients, then drive to our office and see patients until 5ish. Then I have to stay another hour to go through labs and phone messages. To be honest, I don't like it. It's really hard coming off the rotation that I love love love and going to one I'm not really interested in. I'm never home. The silver lining is that I get one day off a week. The doctor I'm with is great, and I'm working hard, not letting him know for a second that I'm not happy, but ugh. Our mornings typically consist of diabetes and hypertensive patients with a mix of a few other things. I'll write about some frustrating stories.

Story 1- female in her thirties who has been sick for over a week. She's had a terrible cough and her lungs are really wheezy. We give her two nebulizer treatments and her lungs sound the same. Dr. D really wants her to get a chest xray. She is self pay and doesn't want to spend $12 on an xray. So what does she decide to do? Head on over to the ER. Where she is then admitted. *BOOM* That was the sound of my head exploding. Really? Who is going to pay for that $5000 visit? Oh the taxpayers of Ohio, that's who. That is just so frustrating to me. Dr. D was less than pleased too.

Story 2- a 35 year old male who weighs over 320 lbs. He stopped taking his blood pressure medication a few months ago because he ran out and didn't want to refill it because he doesn't like to take pills. In the office, it was pretty high. He told me he didn't mind dying (not in a suicidal way, just in a lazy I just don't want to take pills way). Yeah dying is the easy part. The hard part is having a stroke and being in the hospital post stroke not being able to move or speak. We talked him into restarting his meds.

It's really frustrating to take care of people like this.

My C-Section

Dr. P, the doctor who took me to Brazil is back. She had gone back to Brazil and pretty much missed my entire rotation. I was really frustrated that she was gone since I feel like she is truly training me to become an Ob/Gyn. She told me today that by teaching me so much she feels like she's doing a service to women's health since one day that's who I will be taking care of.

She had a c-section scheduled today and this morning before we headed to the OR she told me that we were going to "do this." Not quite sure what that meant I just followed along. When we got in the OR, she told the surgical assistant that I would be taking her place. Actually, I did 98% of the c-section up until the time to imbricate (restitch the uterus over the first line of stitches). I made the entire incision, used the Bovey, cut the muscle, fascia, peritoneum, uterus, pulled the baby out, cut the cord, pulled placenta out, and stitched up the uterus. I was just amazed how much I got to do. While I was stitching up the uterus, I was going through one side, reloading the needle and going through the other. She stopped me and asked why I was not going all the way through. Well the surgical assistant last night wouldn't let me do it that way and I explained that to Dr P. Her response: "Excuse me, but I believe I taught you that way and I will be telling him that." Whoa. Yeah, surgery was over and she went and found him and told him exactly that. Shit...I don't want any drama. I wasn't trying to cause problems.

I got lots of compliments today. It makes me feel really good when everyone keeps telling me that I will make such a great doctor. It makes me feel even better when it's Dr. P. I know when I do something wrong because she has zero issues with telling me. The compliments from her are priceless to me.

Oh yeah, I tried to do my first laparoscopic tubal ligation. Notice I said tried. This was damn near impossible for me. Like the world's hardest video game. I was holding the camera in one hand and trying to clip the fallopian tube with my other hand, all while watching a screen. Since the camera and tool to clip are in different planes, it makes things much more difficult. I had to hand it back over to Dr. P. I can admit when I'm unable to do something. It stinks, but I really was fumbling.

Can I Close My Legs?

Well I delivered another teenager's baby. I feel like these deliveries are always the most entertaining for me. I broke her water and then she asked how long her legs would have to be open for the delivery. Her mom told her for as long as it took her to push the baby out. I would love to tell you I'm joking but seriously the girl was shocked that she had to push the baby out. It was like she just found out the stork doesn't magically drop the baby off. Fast forward to delivery: once the baby's head was out and she could see she just kept saying "eww eww eww." I could tell she did not want us to put the baby on her chest, but tough luck little girl, that's how we roll since the baby is still connected to you via the umbilical cord. So now she's totally grossed out that her gross baby is on her chest. She looks up at me and says "Can I close my legs now?" Umm, no, the baby is still attached and your placenta is inside. I always offer the new mommies the option to see their placentas. As I'm delivering her placenta I say "I imagine that you do not want to see your placenta." Her eyes got all big as she shouted "NO," then covered her entire face with her hands so that she would not see anything. I got her all cleaned up and finally she was able to close her legs. I hope she can continue down the "closed legs" path.

Getting Sad (and Happy)

This is my last week of my Ob/Gyn rotation. I really can't believe how fast it has gone by. Jake arrives on Thursday so I am very excited about that! We are celebrating Valentine's Day early and we got a room downtown at a swanky historic hotel. We also have dinner reservations at a nice steakhouse, so it should be good. We are planning a trip to Barnes and Noble since it just might be our favorite thing to do.

This last week, I had a bunch more deliveries, a ton of surgeries where I have learned to put in a trocar. That is scary. Way scary. Like palpitations scary. I had three deliveries in one day with Dr. M. By the last one, he wasn't even standing near me during the delivery. It made me feel good that he was trusting me enough. One of the earlier deliveries had a double nuchal cord (cord wrapped around neck twice). No matter what I did, I could not get that cord unwrapped. The nurse kept yelling "the cord is still wrapped the cord is still wrapped." I'm thinking "Lady, do you think I can't see that? My heart is about to come out of my chest I'm freaking out so bad. I do not need you to remind me every .25 seconds." Good grief. Anyways, I got it all unraveled. That was scary though. The baby is totally fine.

I had my evaluation on Friday. It went really really well. Like I was on cloud 9 afterwards. And they helped me start to sort out my big dilemma on residency.

Alright, hopefully I'll have some good stories this week.

Amazing News

I have received official permission that I can do 4th year rotations out in Colorado starting the week after Thanksgiving. That is under a year away. Excuse me while I jump up and down over and over. I have a lot to do between now and then, so hopefully the time goes by very fast, but I must say that it feels amazing to have an actual date. This means I have to get all my rotations set up and figured out on my own. I have some time though to get it all figured out.

At that point in time: it will be 4.5 years that we've been long distance. I'd say we've earned it.

Let's Talk About My Day in the Office

There were no deliveries today so I spent almost the entire day in the office (one surgery). I would like to give just a few highlights from my day.

Positive pregnancy test in a 14 year old.
Positive pregnancy test in a 45 year old.
(yes you read both those numbers correctly.)

A teenage pregnant girl came in for her first ob visit. She's already over halfway done with the pregnancy which means she came in for late care. On the first visit, you get a pelvic exam. Well, I was trying to get the speculum in when she starts to close her legs, lift her butt off the table, and say "I can't do it I can't do it." What does the dr say? "If you can get a penis in there, you can do a speculum exam." Thank GOD I wasn't looking at anyone because my head was between her legs, because let me just say I hate to bite my lip so that I would not laugh.

I had one surgery today with Dr. M. I thought that I would just observe since it was a hysteroscopy and laparoscopy and the surgical assistant does the extra work. Nope, I took her place and did the work. I was so excited!!!! He invited me to do an oophorectomy tomorrow at a different hospital. I'm pretty happy since I haven't seen one yet.

Today, at the OR, the surgery manager came up to me and said "You are going to make a damn good OB." It was totally out of the blue and made my day :)

I have two inductions tomorrow in addition to my surgery so hopefully I will have more stories.

Soaked with Amniotic Fluid

It's Saturday night around midnight, I'm laying on the couch reading, thinking I'm getting tired and it's time to go to bed soon. And then my phone rings. Lady in labor, plus someone who has been induced. I quick change and head to the hospital. Lady 1 is a primip who is almost complete, but she has this tiny lip on her cervix that won't get over the baby's head. Dr. V pushes it over while we hear a chain of obscenities come from the lady's mouth. All of a sudden, the baby starts moving down really fast and her pushes are good ones. (Yes there's a difference between a good and bad push. You want to push like you have to poop, but many women think they're going to poop so don't really do that. Oh yeah, and there's often pooping involved. Gross.) I get gowned up and sit on the foot of the bed. I get the baby out, hand her over to the nurses, and start working on the placenta. We have to draw blood out of the umbilical cord to send to the lab. Each doctor does it different and how I was taught was to drain it into the tubes. Here, they take a needle and syringe and draw it out from the cord. Well, I'm not very comfortable or skilled at this. LOL. I poked a hole through the vein and the poor lady had a nice splatter of blood all over her. Oops. Anyways, I get the placenta out and go stand up to take it over to the bin. This is when I realize that my ass is soaked. Now since I'm positive I didn't pee my pants, there is only one thing that I could be soaked with-amniotic fluid and blood. Here's the worst part: I can't do a damn thing about it until I'm done. So finally, a half hour or so later I get to change....have to go commando because my underwear is also soaked. Sweet.

Alright, lady 2 is not progressing very well and her blood pressure keeps spiking, so Dr. V tells me I can go try to sleep in the on call room. Well I tried, but it didn't work out very well. Around 6:30 I get up to go see what's going on. Lady 1 has a hematoma which needs to be evacuated in the OR. Ladies and gentlemen, her vulva was the size of a grapefruit. So we get to the OR and the chunks of blood that come out....wow...good thing this kind of stuff doesn't bother me.

We finish up with her and go check on Lady 2. Unfortunately, she is just not progressing well enough so we offer her a c-section. It is now 9 am. I came in at 12:30 with half ass sleeping involved for 2 hours. I'm exhausted. We're ready to start surgery when Dr. V hands me the scalpel. "Ok Jen, time to get that brain moving since you're about to cut into a woman." That's enough to wake up someone. Anyways, I got the baby out but it was difficult because he was kind of big and his shoulders were tough to maneuver. I did a lot of suturing although I was much slower than normal. After surgery, Dr. V offered me the opportunity to go home and sleep. I snatched that up really quick.

So here I am, back on the couch waiting for a phone call because there is one who is about 5 cm and I just know it will be another late night. I took a 4.5 hour nap so hopefully I have enough brain power to deliver a baby and not get soaked.

FYI- when I say ladies, for the most part these women are under 25. Once in awhile, I'll get an older lady.

Any questions?

I Keep Getting Better

Since I'm in OB right now, and I'm kind of obsessed with it, I am going to have a lot of posts about it. Hopefully the stories won't be too boring. Yesterday was a pretty good day. We started out with a c-section. She was 18 and it was her third baby....I'm not even kidding. Anyways, we're all set up and Dr. V hands me the scalpel. Lub dub lub dub. Yeah that's my heart pounding. I said in a super professional manner "For real?" And she responded with "Just cut in a straight line." Ok...I did. Phew. Alright, she made the rest of the cuts through all the layers. She popped the baby's head out, and told me to do the rest. So I suctioned him, pulled the cord from around his neck, pulled him out, cut the cord, handed him over to the nursery team, and pulled the placenta out. That's a lot more than the previous c-section! Oh yeah, I sutured her up quite a bit too. So exciting! If I get to keep assisting in c-sections, I imagine that I will be a lot better in three weeks when I finish this rotation.

Wiener wacker is back- I did my second circumcision. I did the entire thing with a few hints from Dr. V. The scariest part of all of it...there were three nursing students observing. I was very grateful that I had already done one. I'm not sure I could have handled cutting foreskin with three observers.

And some very exciting news! I have an audition rotation set up for a residency program in Cincinnati for October. My rotation will be in maternal fetal medicine; in other words high risk OB. I got all the paperwork today in the mail confirming everything, so I'm very excited. It's so hard to believe that this year will be spent figuring our residency stuff and that in a 1 year and 5 months I'll be a physician. Damn....

My First Week in OB

As you have probably gathered, I'm pretty sure I'm going into OB/GYN. So I am very very excited to finally be on my ob rotation. My first week has been fantastic. Tuesday, I had a c-section, and I got to suture up and that night I had a delivery which I did everything up until the baby needed to get out because forceps were needed. he pulled out the baby then I delivered the placenta which I have previously written about. There were two more ladies in labor when I left at 9:30 pm that night. My phone rang at 4:05 am with news that lady 1 was at 9 cm. I busted my butt to get to the hospital but because she was a primip(first baby) she took a really long time. That baby was born until 7:15 am. This lady required an episiotomy. This was the first one I had seen. Holy shit....I really hope that I never need one some day. Her mom, who was holding a leg, saw the whole thing, her eyes got huge, kind of rolled and then she looked at one of the nurses and said "I think one of you needs to come hold her leg." She almost passed out. So because of that, the dr had to deliver this baby too, even though I did all the 3 hours of pushing. Again, I was on placenta duty.

Lady #2 didn't really progress, so she ended up ina c-section last night. I actually was excited because I really like doing surgery and it's more experience for me to practice in the OR. Dr. V let me pull the baby out, which I have not done yet, so that was very exciting for me. I also got more suturing practice. So we get into the PACU, and L&D calls saying our 15 year old girl is complete. Yes I said 15. Her BF was too. She did not get an epidural because the anesthesiologist was in the OR with us. When I walked into the room, the only way I can describe her is that she was thrashing around the bed. Oh was I in for a real treat. We kept changing her position, and with that we had to keep moving the bed around. Anyways, I ended up delivering this baby (by myself!!!) on my knees. I found the entire delivery pretty amusing and was kind of laughing in my head from the things she was saying to just the entire situation. When this girl is my age she will have a 10 year old. Unbelievable.

Today I went back to go say hi to all the new mommies. C-section mom is so excited to see me and asked if I got to do anything new in her surgery. I told her that I was got to pull her baby out and that it was my first time. Her and her mom were just so excited for me. She asked me my name so that she could tell her son that he was the first baby I pulled out. I thought that was sweet. 3 hour pushing lady was happy to see me and is really sweet to me. 15 year old mommy doesn't even know who I am. I told her that I delivered her baby last night and she honestly did not know that. All I can think is....wow. Teenagers, please close those legs.