Life as a Med Student

I Matched!!!!!

2011-03-14T11:25:00.000-07:00

Woohoo! I was literally jumping up and down, twirling in circles and screaming! I find out Thursday where we are moving.

The most exciting part of all this? I am definitely going to be an OB/GYN!

Update will be on Thursday!

Nervous With a Side of Anxiety

2011-03-13T21:29:00.000-07:00

Jake and Manda standing on the top of the bridge. Note that the wood is supposed to hit somewhere around the chest.

Manda totally biffed it by stepping off the trail of hardpacked snow, and stepping on the soft snow: where she sunk.

Lots of elk!

Manda and I standing on Bear Lake.

Jake took a pretty amazing photo!

Manda and I in front of the HUGE icicle!

I'm sitting on the trail railing.

I'm currently sitting on the couch, my stomach just churning in knots. I've been waiting for tomorrow for 9 months, longer really, if you consider how long I've been waiting to be a doctor. Tomorrow morning at 12:00 Eastern time, I will get an email that simply says one of two things. Option 1 "Congratulations, you have matched" or option 2 "I'm sorry, you did not match." On Thursday we find out where we are going. Obviously I have my preferences for where I would like to match, BUT anywhere is better than nowhere. Once I find out I match (I'm being positive here), I will be over the anxiety and just be excited to find out where! I have Benadryl all ready to help me sleep tonight because let's be real, there is NO way I'd be able to without a little help.

This weekend my BFF, Manda, came to Colorado. We had so much fun, and time flew by, which is exactly what I was looking for with so much going on this week. We went up to Bear Lake and Estes Park. Here are some fun pictures.

"Clear!"

2011-02-17T21:17:00.001-08:00

Everyone has seen somebody on tv yell "Clear" when a patient is shocked. I had the luxury of doing this yesterday. It was very exciting! A patient with atrial fibrillation had failed medical therapy and needed cardioversion to convert his heart back to sinus rhythm. Dr. T told me that I would get to do the case, as long as I knew the complications and how to treat them. I spent a good amount of time preparing all the possible complications and the treatment because I didn't want to risk not having the answers and therefore not getting the case. The biggest risk is asystole: completely stopping the heart. That's all he wanted to hear. So I was over prepared; but that is always better than being under prepared. So we set the patient up, the anesthesiologist sedated him and I started the defibrillator. On the machine, there is a strip where the heart rhythm is displayed. Dr. T warned me that while doing the shock, I needed to keep my eyes on the strip and not on the patient (who would jump off the table) to make sure that he didn't go into asystole. So, I set the energy to 100 joules, got the patient synced, charged the defibrillator up, and said "clear" and shocked the patient. I made sure to not even glance away from the strip. Luckily, he converted to sinus, and the cardioversion was a success!

Lub Dub

2011-02-17T21:10:00.001-08:00

That is the sound the heart makes as it beats. Or at least if there are no mechanical problems. I got to watch open heart surgery this week. I watched them saw open the sternum, spread the chest cavity, and cut into the pericardium, where inside was the beating heart. Lub dub, lub dub. This patient had an aortic aneurysm and needed an aortic valve replacement. His aorta was huge. I was shocked at how big it was. No wonder people die if they got shot in the aorta!!!! Alright, I watched the beating heart for awhile. Then they put him on the heart-lung machine so that blood could completely bypass the system. After that was done, the doctor paralyzed the heart. So at this point, it's flattened out because of no blood, and not beating. Then the aorta was cut out. I was actually very surprised at the length of aorta removed from the body. He then took the new aorta and put in the new valves. And then the most tedious part of the surgery: sewing the new aorta into the system. Both ends had to be attached plus the coronary arteries had to be routed to the new aorta. He was sewing forever. I think there was something around 160 sutures used throughout the case. After all this is done, they SLOWLY fill the heart with blood, 100 cc at a time, making sure that the system reacted appropriately and that there were no leaks. Then they inserted a chest tube, and began to close him up. They "sew" the sternum back together with thick wire, and then close the outer layers. Sounds easy right? Hah, it was 5.5 hours of stressful surgery.

I was amazed throughout the entire surgery. I'm fairly certain the smile did not leave my face for the first two hours. I think one of the weirdest thoughts was that this man's heart was not beating, his lungs were not inflating, yes his brain was intact and blood was circulating through his system.

This was definitely one of the most memorable days of medical school.

My Sister's Trip to New Zealand

2011-02-12T09:13:00.000-08:00

I don't know if anyone is interested in reading along about her travels, but she is studying abroad in New Zealand and just arrived this week. Her blog is:
http://mylifeinthelandofkiwis.blogspot.com/

I'm Scared of Dying

2011-02-12T09:11:00.000-08:00

This is actually something we hear every single day. New patients will come in because they are afraid of having heart disease, not knowing about it, and dropping over dead. When a patient who has heart disease says that to Dr. T, he has an interesting response. "Well , you might as well get over that right now. You are going to die some day, it will probably be from your heart considering it's the number one killer in America, and as far as I know, we have no say in when that will happen." The patients usually look shocked and then nod their head in agreement. That usually ends the discussion.

Dr. T is so amazing with his patients. He knows how to talk to them, individually, when to take a more holistic discussion (this is Boulder) without compromising care, and being very kind to them.

A funny story: he has a patient who is in her late 90's. I saw that on the schedule and said "Wow, our next patient is 97!" And he said, "Oh it's going to be a lovefest in there! An interesting fact about her, she doesn't dream." My response "wow that is interesting but how on earth did that conversation ever come out."
We walk in the room, he gives her a hug, we sit down and she says, "Dr. have I ever told you that I don't dream." I almost fell off the chair laughing. He looked at me with a look that said "that's how I found out."

I've Been Dreading it For a Year

2011-02-12T09:04:00.000-08:00

Cardiology. That's what I'm in right now. When I found out a year ago that cardiology was a required rotation of 4th year, I started dreading it at that very second. I'm now halfway done with the rotation, and surprisingly, I'm enjoying it. Like really enjoying it! My preceptor is AMAZING, and has taught me such interesting and applicable things that I enjoy going in each day. The week is split: 2 days in the hospital, 2 days in the clinic, Thursdays off, and we round every morning at the hospital. It's a great set up! So far, I've been in at least 8 angioplasties (heart catheterization with stent placement). It's very interesting to see the patient's and their family's reactions. For example: this last week a doctor from in the mountains called Dr. T to take a look at an EKG. The patient had some chest pain, had been ignoring it for a couple days, and finally came in. The EKG was abnormal, but nothing too significant. Dr. T wanted a troponin drawn, but because the patient was in the mountains, the blood wouldn't be processed until the next day. So he asked to see the patient the next day. The troponin was drawn and was VERY elevated. The patient and his wife were in complete denial that anything major was wrong. Dr. T had already put him on the schedule for an angioplasty because he knew it was bad. The patient actually sat there and tried to talk himself out of the angioplasty. We get back in the cath lab and he has a 100% occluded right main coronary artery. Not good. So yes, this guy was having a heart attack. The plaque actually was about 7 cm long. It was a tough case. Once, Dr. T saw the big blockage, he sent me out to talk to the wife and let her know that he was having a heart attack and that he'd be in the ICU overnight with a few nights in the hospital. The wife's response "A heart attack???? Really???" I mean, her husband is over 300 lbs and had bad chest pain and the cardiologist was very pushy to get him to the cath lab. What exactly did you think was going on?

So it's been an interesting two weeks.

Eyeballs- Week 1

2011-01-08T13:41:00.000-08:00

Well, I was definitely in for more than I bargained for! I've learned plenty this week, saw MANY procedures (who would have thought ophthalmology would be known for procedures), managed to terrify myself, and looked at lots of eyes.

I'll start with the things I've learned:
1. Take care of your eyes- there really is a point of no return. Pay attention to your vision, and if you note changes, call your eye doctor up. There are treatments within a reasonable time frame.
2. Contact lenses are really not that great for your eyes if you don't wear them the recommended way. I'll be honest, I definitely don't wear them the recommended way. You can get a corneal ulcer and then you won't be wearing contacts for months. I have been lectured by more than one of the docs already. For example, wearing them for 24 hrs a day, is bad. I don't do that now, but during residency I was pretty much planning on keeping them in since I'll be awake. Wrong. Apparently, I'll need to update my prescription so my glasses can be updated (they're circa freshman year of college). I'll be making a visit to these guys before I leave for residency.
3. The cosmetic side is very interesting. Botox, Juvaderm, facial laser treatments, and the surgeries. I'm seeing a blepharoplasty (eye lid tuck/brow lift) on Monday.

Ok, onto the things I've seen. If you are squeamish or hate eyeballs, consider yourself warned.
1. On my first day I was floored at the amount of things I saw. For starters, a man came in with a retinal detachment. This is BAD. Think of it as the back wall of your eyeball (on the inside) coming loose off the wall. The symptoms are a black curtain coming over your vision. The treatment is not nice. To start, the eyeball had to be numbed with lidocaine. This meant an injection onto the eyeball. The lidocaine made a bubble on the eye. (My mouth was hanging open). Then he froze the back of the eye with a cryotherapy technique, by basically shoving this thing alongside the eyeball. Then he injected a gas bubble inside the eyeball so that it would push the retina back up against the wall. This means that for 4 days, the patient has to lay in a position forcing the retina back where it should be. For him, it was his left side. Worst case scenario- laying on your face for 4 days. And yes that does happen.
2. Eye surgeries do not mean that the patient will have general anesthesia. For somethings, they just get a valium beforehand. In other cases they get some Versed. This means they can talk to you and move their eyes while operating. Very strange.
3. For wet macular degeneration, the only treatment is an injection into the eyeball. Some patients get these monthly. I was pretty disgusted by the first one, but they are SO common, that I now think it's a normal visit.
4. Lasik is pretty quick. It's not as scary as I thought it would be, but I'm still not interested for myself. I'll continue the road of cornea eating contacts.

The Eyeball

2011-01-02T18:25:00.000-08:00

The eyeball is the one thing that I think is pretty disgusting. I hate looking in them, and Lord help me if there is some sort of trauma to the eye or I need to go digging in the eye. Tomorrow I start my rotation in ophthalmology/facial plastics. I am going to have to keep my gag reflex under control and hopefully I don't pass out in the OR, when we operate on them. The worst part about all of this: I have to fake it to my preceptors. They cannot know for half a second that I hate eyes. So you might ask why I'm doing a rotation in eyeballs when I hate them so much. Well, it's 15 min from Jake's place (I guess it's ours now) and I needed a surgical elective. This counted. So I'm doing it.

Welcome 2011

2011-01-01T16:53:00.000-08:00

Happy New Year! This is a year I have been looking forward to for a long time. It's quite hard to believe that it's here actually. Here's the list of things I'm looking forward to this year:
1. Graduating medical school and officially becoming a doctor on June 3rd! This is something I've been dreaming about for a very long time. When I think about all the things I have learned since starting medical school, I'm amazed! My family is renting a house in Arizona for the event so we can party it up and celebrate for awhile!
2. Jake getting his PhD! We're not quite sure yet when this exactly will be since his boss decides, but we are sure it will be this year. Then he will find a job and make real money!!!! Jake is also contemplating starting a company based on his research.
3. Moving to an unknown place! As I've previously written about The Match, we won't know where we are going until March 17th.
4. Buying a house! This is very very exciting for both of us. I am looking forward to having our own place where we can do what we want. Plus we desperately need more space. I am constantly on realtors' websites checking out homes for sale.
5. Getting a puppy! Jake promised me that within 30 days of us living together in our new place, I will get a puppy. Our plans are to get a german shepherd pup. I have never had a dog so I'm sure I'll be jumping up and down like a child when I get it.
6. Finally starting my training in being an OB/GYN! If you talk to any 4th year med student, they will tell you how they are so sick of all the extra rotations, when all you want to do is start residency. I am enjoying my time off though.

I can't really complain about 2010. It was a good year. I learned a lot, spent a lot of time with Jake, celebrated Thanksgiving and Christmas with Jake and the rest of my family, and most importantly moved in with Jake. To celebrate NYE, we stayed in, watched movies and made cheese fondue! Today we went and saw Black Swan. My, this was a strange movie, but I'm so glad I saw it.

Anyways, I am looking forward to 2011.

Neurology 3 Days In

2010-12-01T20:50:00.000-08:00

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!

2010-11-27T17:10:00.000-08:00

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

2010-11-10T19:23:00.000-08:00

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

2010-11-07T19:09:00.000-08:00

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

2010-11-07T19:04:00.000-08:00

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

2010-11-04T08:14:00.000-07:00

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

2010-10-23T10:17:00.001-07:00

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

Post partum hemorrhage

2010-10-19T13:07:00.000-07:00

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

2010-09-26T12:48:00.000-07:00

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

2010-09-16T16:51:00.000-07:00

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

2010-09-11T16:43:00.000-07:00

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

2010-09-10T06:53:00.000-07:00

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!

2010-09-06T07:37:00.000-07:00

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

2010-08-30T13:34:00.000-07:00

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

2010-08-26T15:22:00.000-07:00

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

2010-08-25T18:15:00.001-07:00

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

2010-08-22T10:33:00.000-07:00

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

2010-08-14T18:51:00.000-07:00

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

2010-08-14T18:29:00.000-07:00

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

2010-08-01T17:43:00.000-07:00

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

2010-07-25T19:26:00.000-07:00

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

2010-07-16T15:11:00.000-07:00

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

2010-06-28T19:02:00.000-07:00

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!

2010-06-27T22:59:00.000-07:00

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

2010-06-27T22:22:00.000-07:00

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

2010-06-02T14:00:00.000-07:00

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!

2010-05-23T11:18:00.000-07:00

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

2010-05-23T10:58:00.000-07:00

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

2010-05-16T20:56:00.000-07:00

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

2010-05-10T19:20:00.000-07:00

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

2010-04-24T20:37:00.000-07:00

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

2010-04-22T20:27:00.000-07:00

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

2010-04-18T19:44:00.000-07:00

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

2010-04-12T19:29:00.000-07:00

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

2010-04-05T15:52:00.000-07:00

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

2010-03-30T15:41:00.000-07:00

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

2010-03-29T14:30:00.000-07:00

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

2010-03-16T16:47:00.000-07:00

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

2010-03-13T13:53:00.000-08:00

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!

2010-03-10T14:18:00.000-08:00

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

2010-03-09T16:53:00.000-08:00

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

2010-03-07T18:02:00.000-08:00

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

2010-03-03T18:03:00.000-08:00

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

2010-03-02T19:52:00.000-08:00

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

2010-02-28T13:02:00.000-08:00

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

2010-02-16T18:40:00.000-08:00

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

2010-02-14T15:48:00.000-08:00

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

2010-02-12T14:33:00.000-08:00

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

2010-02-02T19:39:00.000-08:00

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?

2010-02-01T18:32:00.000-08:00

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)

2010-01-31T18:43:00.000-08:00

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

2010-01-24T19:11:00.000-08:00

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

2010-01-19T16:22:00.001-08:00

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

2010-01-17T17:51:00.000-08:00

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

2010-01-16T19:14:00.000-08:00

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

2010-01-14T17:09:00.000-08:00

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.

Wiener Wacker

2010-01-14T17:05:00.000-08:00

That's what my mom has started calling me. I did my first circumcision last week. I kind of knew it was coming so I told Jake the night before that I might be doing one. He narrowed his eyes, looked at me and said "Be careful." LOL....I was careful and didn't cut it off :) I have to admit I was pretty nervous. It's a pretty small place to be cutting. For those who don't know, we do numb with a little lidocaine. We also give them Sweet Ease which is a sugar water that we squirt in their mouth. I love how they smack their lips when we give it to them.

I realized that I write a lot about wieners. Hopefully my readers don't mind.

Update on that Keloid I Cut Out

2010-01-14T17:03:00.000-08:00

The pathology report came back and it was squamous cell carcinoma! I'm pretty sure that I would not have been able to do that entire procedure had we known. Anyways, the margins were clear so that means I did a good job!

I Love Cutting!

2010-01-04T19:58:00.000-08:00

Today, I went into the clinic to work with Dr. M (one of my fave docs to work with!) since Dr. B was off. She had a procedure schedule to remove a 1 inch keloid from a man's lower abdomen. Basically, she told me I was going to do the whole thing while she assisted. I numbed him up. She showed me what margins she wanted on the incision, and then handed the scalpel to me. I did the entire procedure and it was so exciting! I was actually relatively calm and my hands weren't even shaking (yes I know that's a good thing). I did some of the sutures, but since I'm still a little slower at them, she did a bunch to keep us moving. I'm actually really proud of my handiwork today. I've done cutting, and surgery and all, but today's procedure was all mine. Dr. M complimented me and said that it was excellent. Woohoo!

I'm Too Harsh (apparently)

2010-01-04T19:43:00.000-08:00

This week I am working with Dr. B who I worked with previously in Colorado. This week she is on call at the hospital, meaning she sees no patients in the clinic. All the deliveries and admissions for this certain network, she takes care of. She asked me to work with her so that I could get more experience in the hospital. I had to work yesterday. We start at 7:15 and the hospital is an hour away....early mornings suck. Anyways, we had a bunch of admissions and discharges. An elderly man was admitted in the afternoon to the ICU for shortness of breath due to COPD and congestive heart failure. Well, Dr. B wanted me to go do his admission history and physical. I was warned ahead of time that he was grumpy and not very kind to the nurses. I went through a detailed history and physical. He kept telling me that he just wanted to die, blah blah blah. All was well, until the end when the following exchange went down:
Him: I suggest you get trained in something different.
Me: That's not very nice.
Him: Well, do you want me to be nice or honest?
Me: Hmmm, honest.
Him: Well you are too harsh in your approach.
What I'm thinking in my head: Well, I could hold your hand and sing kumbaya. Why on earth did you call 911 if you just want to die?
Yeah, I know...totally out of line, but come on. I don't want to toot my own horn, but I am a really nice person and am sweet to my patients. The nurses happened to walk in right before he said all that to me, so they quickly told Dr. B that I did a great job and stuff. When Dr. B went in and saw him she told him that she didn't appreciate him being rude to me and that I was just doing my job. He told her that I asked too many questions. LOL. I know that I'm not harsh, and it's the first patient who has ever said something rude to me like that, but it still bugs me a bit. Dr. B told me tht he's full of shit because she's worked with me extensively and that I'm one of the nicest people she's worked with. So I got a really nice compliment from a dr, but I had to get a rude comment from a patient in order to get it.

I will probably be seeing him tomorrow. Shall be interesting to say the least.

New Years and a Weekend With My Family

2010-01-04T19:15:00.001-08:00

Me and Jake before the sleigh ride.

The Nativity Scene my parents gave us for Christmas. Notice that Joseph is missing. He was crushed, so Mary was a single mom for a bit. We now have a new one who is in much better condition.

On Thursday, my parents flew in. We spent New Year's Eve dinner at Five Guys, but then Jake had to run into work because of a power blip. My dad and him ran down to Boulder, while my mom and I stayed home and had a few jello shots. Jakester and my dad got back a few hours later and we rang in the new year.

On Friday, my sister flew in. I spent the entire day baking an insane chocolate cake for my celebrating my dad's birthday. Everyone had a bad cold except me and Laura, so we all kind of just chilled out.

Saturday was a super fun day! My dad and I ran to Hertz to go get the rental car that we shared. I need a car for the rest of the week since I have to drive so far away for my current rotation. Then we went up to Estes Park for lunch. I found out that my favorite costume jewelry store closed. I'm so sad :( . Then we went on a sleigh ride. It was pretty fun but kind of short. Afterwards, we drove up to Bear Lake to show my family one of our favorite places to go walk around. It was snowing, but was still beautiful!. For dinner, we went to the Melting Pot and as always it was just fricken amazing. Yum Yum.

The Best Meal Ever

2009-12-29T19:23:00.000-08:00

With me being on break, I don't have any medical stories for you, so I'm going to post about the amazing dinner I made tonight. Since seeing Julie and Julia, I've been wanting to try some of Julia Child's recipe. In the movie, Julie makes this yummy creamy mushroom chicken thing. Well, I found the recipe and made it tonight. It was A.M.A.Z.I.N.G. I'm not kidding; hands down one of the best meals I have ever cooked. I don't have any pictures, but let me tell you that I licked my plate when we were done. Please, go out and get the ingredients to make this meal. Make sure you plan it for a night where you have some time....it takes awhile, but definitely well worth it. One bite in, Jake says "Umm you are making this again right?"

Supremes de Volaille aux Champignons

(Chicken Breasts with Mushroom and Cream)

Source: Mastering the Art of French Cooking, Vol. I by Julia Child, Louisette Bertholle and Simone Beck (Knopf, 1961)

Ingredients:

4 supremes (boneless, skinless chicken breasts)

1/2 teaspoon lemon juice

1/4 teaspoon salt

Big pinch white pepper (I left this out, we hate pepper.)

5 tablespoons butter

1 tablespoon minced shallot or green onion (I used shallot)

1/4 pound diced or sliced fresh mushrooms

1/8 teaspoon salt

For the sauce:

1/4 cup white or brown stock or canned beef bouillon (I used chicken stock)

1/4 cup port, Madeira or dry white vermouth (I used Madeira)

1 cup whipping cream

Salt and pepper

2 tablespoons freshly minced parsley

Directions:
Preheat oven to 400 degrees.

Rub the chicken breasts with drops of lemon juice and sprinkle lightly with salt and pepper. Heat the butter in a heavy, oven-proof casserole, about 10 inches in diameter until it is foaming. Stir in the minced shallots or green onion and saute a moment without browning. Then stir in the mushrooms and saute lightly for a minute or two without browning. Sprinkle with salt. (With being at Jake's, my kitchen supplies are limited. I used his large metal deep skillet and put that in the oven. Just make you remember that the handle will be hot (unlike me) because you will burn yourself.)

Quickly roll the chicken in the butter mixture and lay a piece of buttered wax paper over them, cover casserole and place in hot oven. After 6 minutes, press top of chicken with your finger. If still soft, return to oven for a moment or two. When the meat is springy to the touch it is done. (Please Note: Although Julia suggests to check the chicken after only 6 minutes, I (as well as other people on the internet!) feel that this amount of time is inadequate to thoroughly cook the chicken. I cooked it for closer to 30-40 minutes. I think my final time was 42 minutes, but some of my chicken pieces were really thick. I think at 30 min, I pulled them out and cut into them to check and there was still a little pink).

Remove the chicken to a warm platter (leave mushrooms in the pot) and cover while making the sauce (2 to 3 minutes).

To make sauce, pour the stock and wine in the casserole with the cooking butter and mushrooms. Boil down quickly over high heat until liquid is syrupy. Stir in the cream and boil down again over high heat until cream has thickened slightly. Off heat, taste for seasoning, and add drops of lemon juice to taste. Pour the sauce over the chicken, sprinkle with parsley and serve immediately.

Serves 4.

What's Coming in the Next Year?

2009-12-27T21:44:00.000-08:00

For those of you not familiar with the whole med school path, my next year will be insane. In July, I officially have to decide what I want to be when I grow up, and start applying to residency programs. Between now and then, I have to figure out which programs I want to apply to, sign up for audition rotations (I'm currently waiting to hear back from one), and take my Step 2 PE boards. This means on June 3rd, I will be in Philadelphia seeing 10 fake patients, examining them and then writing up a note. I'm not too worried about this test, but it was $1100 so I will be taking it seriously. Alright, so these audition rotations- basically it's my time to kiss ass and be a rockstar med student so that the programs realize how amazing I am and they want me to be a part of their program. I'm hoping to do 4 audition rotations...one at the end of 3rd year and three of them in the beginning of my 4th year. Ok, after I apply to all these rotations, I can be invited for an interview. So I will spend my fall flying around the country doing interviews. I'm hoping to stay in Ohio, so that wouldn't be too bad because I could drive to all the places. Just for example, I know a girl who is one year ahead of me and is going into OB/GYN...she has gone to 20 interviews this fall.....think of all those plane tickets and hotel rooms. $$$$$$$$$$$

I'm in a DO school. There is a DO match and an MD match. I can do either just one or both...I'm still deciding what to do. Anyways, if I do the DO match, next January I will rank all the programs I'm interested in. At the same time, all the programs rank the students. This company, figures out all the rankings and then does the Match. I will get a little note in February saying where I will be doing my residency (hopefully). If I don't match, then I would do something awful called the Scramble. I'm not even going to explain what it is because it's pretty much my biggest fear.

So yeah, 2010 should be super busy and expensive.

Oh yeah, we're hoping to go to Korea in June. Jake will hopefully be presenting at a conference in Seoul which means his trip would be paid for, meaning all we have to do is swing my way. We won't know until February or March though.

Merry Christmas to You!

2009-12-25T20:38:00.000-08:00

Today was the first Christmas I've ever spent with just Jake. We didn't go see anyone else...just us. I think other people should do this every once in awhile. Maybe I just appreciate it more because Jake and I are long distance, but today was a really great day. We started the day opening presents, although there should have been nothing underneath our Christmas tree. Lesson learned...don't trust anyone except my sister. Anyways, then Jake made me breakfast. Then we played Mario, snacked a bunch, went and saw Alvin and the Chipmunks the Squeakquel, called a bunch of family, made a nice ham dinner, and lounged around reading and watching tv. That was one hell of a run on sentence huh?

What did you do today?

Ronald McDonald House

2009-12-20T18:19:00.000-08:00

The famous Ronald McDonald at the entrance.

The entrance.
One of the guest rooms.

A local bakery donated cupcakes for dessert.

The lobby.

A local Hallmark puts up the Christmas village each year.

The dinner counter.

The amazing kitchen!

The dining area.

One of the women I went to Brazil with asked me to come with her yesterday to cook dinner for the families staying at the Ronald McDonald house. I jumped at the chance. The Cincinnati location is just amazing. I was just shocked and how big and fantastic this place is. There are 78 rooms, with huge kitchen facilities, laundry, a library, computers, and play areas for the children. The rooms are like hotel rooms with two tempurpedic beds. There are 25 transplant rooms which are a little more like apartments due to the fact that the children have to stay at a minimum of 100 days after their transplant surgery. They have a white board in the front listing where each family is from. There were people currently there from Russia, Romania, Puerto Rico and many states across the country.

The volunteering that occurs at this location is just heartwarming. There are only 6 employees with approximately 400 volunteers who run the place. Breakfast, lunch, and dinner are made by volunteers every single day! In fact, at the current time, new people can't even sign up because all the slots are full.

The group that I went with has been going for over 6 months so they really know their way around this kitchen (actually 6 kitchens in one large kitchen). Last night was casserole night, so everyone brought the ingredients for their meal and assembled and baked them at the house. Once dinner was ready, it all went out on a big warmed counter, and an announcement is made overhead that dinner is being served. Everyone comes in and gets in line to eat. I have to say that the atmosphere was happier than I expected, although most people really just kept to themselves. I am sure that this is a tough time of year for these people and it's hard to keep upbeat. One woman made up a plate and put it away for her husband who was at the hospital. They were doing shifts and she wasn't sure when he would get the chance to eat. In the past, the group has done soup night, baked potato bar, english muffin sandwiches and others.

We were all wondering what the House would be doing for Christmas. It's actually pretty amazing. In the basement, there's a room filled with toys that have been donated. Each parent can go down and pick out what they want to give their children. They can choose to have them wrapped (they are so busy some just don't have the time) or can do it themselves. On Christmas Eve, Santa will come visit the children. He will call up each family and visit with them and then give them their bag of wrapped presents.

I'm really happy that I found a way to give back this season. The group goes monthly and I am invited to come along as my schedule allows. I urge you all to check your local Ronald McDonald House (or other charity) and check to see if they need help. It really is an amazing program.

So The Nose Is Pretty Amazing....

2009-12-16T19:18:00.001-08:00

Yes I'm aware I haven't written in awhile, but to be honest, ENT is pretty boring and no good stories until Monday...so I've spared you from reading about my non exciting days.

Ok first i just want to say that the nose is not given enough credit. I just thought it housed boogers and did things like let you breathe. Well, it's huge....I guess I mean deep. Look at the pen on your desk, and now imagine a doctor sticking the entire thing up your nose. It would fit, I promise, but you would not like it very much. I was in on a sinus surgery yesterday and just sat there amazed! With the camera up the nose, I could see a lot more. The maxillary sinuses (ones behind your cheeks) drain into your nose via a hole....well that's exactly what it is, a hole. And in this sinus surgery, they take a balloon and use a catheter to get it up there, blow up the balloon, and BAM the hole is bigger, and your sinuses can drain better. It was so cool.

Story #1- 14 year old girl gets sent straight down from family doc because her newly pierced ear cartilage is mega infected...like so swollen you can't even see the earring because it's in between the front and back of her ear. The plan is to numb her ear with some lidocaine (this is done with an injection) and then make a tiny slit with a scalpel and pull out the earring. As soon as she hears injection...she freaks out...like screaming, telling him he's not touching her, telling her mom forget it, basically carrying on worse than any 5 year old I've ever seen. Dr. M gets mad because she's wasting his time....we keep going in the room and leaving...etc. We finally get to the point where he's about to inject the lidocaine and she flips her shit. And then manages to push out the earring through a non existent hole in her ear. Basically when confronted with a needle, she was willing to do anything. I can tell you that it must have hurt like a beeotch to push that out considering when he touched her ear she started crying. Can I tell you what would have happened to me if I had acted like that at the doctor's office? Something not good.

Story #2- 8 year old girl comes in because she failed her hearing test at school and needs to be checked out. She is all dressed up in a skirt and tights and basically cute as a button. Getting a good history, Dr. M asks her if she plays any sports and can she keep up with friends while running. She says she doesn't do any sports. Her older brother (maybe 11) says, "Well hunting is a sport...she hunts." Dr. M- " Oh really? Wow! Did you get anything?" Brother- "She got a doe and a 6 point buck." Her mom- "She did it with a crossbow." Little girl shrugs her shoulders like this isn't a big deal. Like holy cow! That's just awesome.

A Bit of a Mess

2009-12-05T18:49:00.000-08:00

The last few days have been crazy. That buttcheek spreading really threw my back and I ended up getting sent home on Thursday. I was hunched over to the side like an 80 yr old lady. It was a crazy day: one of my facilitators ended up taking me to her chiropractor (she got treated too), I was put on supplements, spent 2 hours at her house laying down, got put on a bunch of prescription medications, and have spent a lot of time on my couch. Today I had acupuncture done. My back is getting better, it's not good, but definitely better.

My next rotation was supposed to be urology....due to some affiliation difficulties that was canceled and I will be starting ENT (ear, nose, and throat) on Tuesday. I'll only be there for two weeks because of the holidays, but I'm actually pretty happy about it. This hospital is closer than where the urologist was, so my drive will be shorter. So you can all look forward to stories about boogers, ear wax, and thyroids. LOL. Seriously people, I wish you could see the size of the ear wax balls that get pulled out of ears. I know I just grossed out most of you, but it's actually pretty crazy.

Thanksgiving

2009-12-02T16:40:00.000-08:00

Laura reading on the couch.

The take a picture of myself photo.

Jake is cutting the turkey.

Our pies.

Yummy homemade crescent rolls.

Sweet potatoes!

I have to say that Thanksgiving was a total blast. My sister and Jake joined me on Tuesday. We spent Wednesday seeing New Moon and starting to prep some of the food for Thursday. Wednesday cooking included the pumpkin pies, the dough for the crescent rolls, taco dip, and a pumpkin dip. Thursday morning I got up early to drive into town to buy a paper since Black Friday shopping is one of my favorite activities. We made the turkey, crescent rolls, sweet potatoes, mashed potatoes, corn, gravy, stuffing and a caramel apple dessert. We had two mishaps- Mishap 1- I forgot to buy the cheesecloth which we use for the stuffing inside the turkey so Jake made a quick store run. Mishap 2- Laura forgot to add the butter to the caramel apple dessert- it ended up being just fine. So next year when I make this, I'll be halving the butter in the recipe.

Friday- We were in line at Sears at 3 am. Crazy? Yes yes we are. Jake bought me a treadmill though so I'm really happy. The gym here is too far away. I leave in the dark and get home in the dark and there are no street lights in my neighborhood. Plus he was nice enough to rewire the cable and move my tv in the office so I can watch tv while working out. Then after Sears we went to Dicks, Macy's, Target, and then JoAnn Fabric. Then they dropped me off at the hospital where I had to do a hernia repair and a wound debridement. They picked me up and we headed to the mall. Needless to say I was super tired and took a nap when we got home.

Saturday- Laura and I played Super Mario Bros on the Wii all day long. It was addicting and fun and reminds me of the one we played when we were little but this has better features!

Sunday- Laura left :( Jake went out with a friend to put up deerstands and four wheeling while I studied.

I Hurt My Back Spreading Buttcheeks Yesterday

2009-12-02T16:25:00.000-08:00

Yes, this is a true story. Most people know that I have a bad back, but it's been pretty dang good lately. Yesterday is was kind of sore but still ok. In the wound clinic, this woman had a sore in between her cheeks, so I had to hold it open. This wouldn't be too bad but I was in a very awkward position. She was laying down, I was sitting behind her legs and had to twist to hold her cheeks open because the dr was directly behind the sore. Now I can barely walk. Amazing. And yes I know this story sounds hilarious. I thought my sister was going to pee her pants when I told her what I had to do. It's funny because I don't even think twice about this stuff, but to nonmedical people it sounds crazy.

Another funny penis story. This poor elderly gentleman came in with his wife because he was having prolonged rash in his groin. His wife did all the talking since she's taking care of him. Well apparently this man is incontinent and refuses to have a Foley cath kept in, so his underwear are constantly wet, keeping it a perfect place for a rash. Well his wife tried using a condom catheter (I had to look this up). She said it was difficult to use on him because "His penis is just so flacid and the directions say to slide it (catheter) down his penis but it just gets sucked up there so all you see is his head and testicles." Okaaaaaaay. Super weird moment and this honestly took a lot of self control to not smile. Then she says "Dr, what size is his penis so I know what size to buy?" I felt awful for this man. It's one thing to have the male doctor here the story, but the young female med student, that kind of stinks.

Thanksgiving- I'm going to write a post about this later.

I Got What I Deserved

2009-11-22T18:13:00.000-08:00

Being the first student at a hospital is bound to come with some hiccups. Like every other day someone changes their mind about what I can do in the OR. Well, on Friday, after observing 10 or so lap chole's (galldbladder removal via laparoscopy) I asked if I could scrub in to hold the camera. Dr. H said yes, asked the charge nurse and she said no. So the surgery starts, I'm sitting on the stool all pouty, and Dr. H finds that his gallbladder is actually gangrenous (very bad!) and he can't distinguish the anatomy because it's so inflamed. This means that a conventional cholecystectomy has to be done (with a big incision). The charge nurse tells another nurse to call the HEAD NURSE to see if I can scrub in because well there isn't enough people and Dr. H needs another person's help. The head nurse says "uh yeah, she's scrubbed in all week" so I go scrub in. Well let me tell you, I had to hold retractors (which is normally med student duty) and I had to hold them for a long time and hard. My hand became stiff, my back hurt for hours, and yeah I got what I asked for that's for sure. This poor man ended up having gallstones the size of olives with a pitt. Mmmm hope you weren't eating olives for lunch today.
In the office Friday afternoon I got to help with two I&D's on patients. Then the office manager asked if I would take off all her skin tags. I'm thinking "You do know that there is a surgeon in this exact room that could probably do a better job than myself." She wanted me to do it. Thank goodness I've already learned how to do this because I might have turned the job down otherwise. Halfway through, Dr. H comes in to check to make sure I'm not screwing up. I'm thinking "Umm now's a fine time to come check. I'm almost done."

I know I need to find pictures because people like reading posts with pictures more than just text but it's kind of hard since I can't really take pictures of patients. That was a Brazil privelege only.

Disgusting Things That Somehow Don't Bother Me

2009-11-17T18:53:00.001-08:00

Medical school has definitely introduced me to some disgusting things. Somehow they don't really bother me.
Incident #1: ok this isn't really as disgusting as it is messy. A c-section is very very messy. Once you cut into the uterus, all the amniotic fluid and blood comes bursting out. Yesterday morning I scrubbed on two c-sections and at the first one, I just got sprayed from neck to toes....so happy that we're gowned up so well. We actually where booties that go up to our knees....making them more like leggings.

Disgusting incident #2: Being in my surgery rotation, I have to go wherever my preceptor goes. Tuesday afternoons, this includes the Wound Care Center. People come here with the most disgusting wounds I have ever seen. Some of them are small and getting better, but some of them are huge, gaping holes. There are some that are the size of a softball and are 3-4 inches deep. My job today was to debride them. This includes me taking a currette and scraping the wound. This one guy today had four huge ones. Two patients today had really smelly ones. I am perfecting breathing out of my mouth.

I have to say though, that if wound clinics didn't exist, these poor people would have no one who could help them. Their care is weekly, and they don't go away on their own; they just get worse. So Dr. H is a huge help to these people who are otherwise ignored from all their other doctors.

My First Week of Surgery

2009-11-15T17:49:00.000-08:00

Things haven't quite gone how I expected, but hopefully this next week the kinks will all get ironed out. I'm working with a really nice general surgeon named Dr. H. He is NOT the typical arrogant asshole who I imagined I'd be working with. He's hilarious, kind, and teaches me lots each day. The great part about this rotation is that I get to wear hospital scrubs everyday. This means way less laundry and way less thinking about my clothes. Oh yeah, and I get Wednesday afternoons off so he can go golf. Works for me.

Most of the surgeries this week have been cholecystectomies (gallbladder removal). I'm really interested in them mostly because I had my own out when I was 17. The coolest part about this surgery is that it is laparoscopic and it is JUST. SO. COOL to see the inside of the body that way. But because it's laparoscopic I don't really get to help. So that's a bummer. On Tuesday afternoons, we go to the wound clinic. Let me tell you, nothing can prepare you for these wounds. They are big gaping holes in flesh. Then you take a currette and debride the inside of the wounds. I was told this week, that is all me. Sweet. Actually, it will be good to do that by myself.

There was a little snafu this week regarding a surgery center that Dr. H goes to on Friday mornings and Monday mornings. I wasn't able to go with him so instead I went to a different hospital to go work with Dr. P (the dr who took me to Brazil) and was able to scrub in on all of her surgeries. We repaired a rectocele, did a laparascopic assisted vaginal hysterectomy, and a vaginal hysterectomy. Oh yeah, I also got to catch a baby! I love it. It seriously is a very fun thing. It was a girl and she was perfect. The mom had some issues with her placenta though and we had to take her to the OR to get it all out. Unfortunately, it came out in about 30 pieces and she lost a lot of blood. It was very messy. I didn't get home until 2 am and then I had to walk the dog that I am currently dogsitting. It was a long day.

Tomorrow, I'm scrubbing in again with Dr. P on some c-sections! Then I'll be heading back to the other hospital to see patients with Dr. H in the office.

My Grandpa

2009-11-11T19:37:00.000-08:00

This is not medically related, but today is Veteran's Day and I thought I would quick post about him. He served in the Korean War when he was a youngin :) Today at the place where he lives, the group hosted a veteran's party where they decorated, served food, posted pictures, and honored the men who had served. Each guy spoke and told his story. One of the local news teams found about this luncheon and came and "caught the story." They interviewed my grandpa and apparently they fielded phone calls all day since everyone they know in town saw it. So here's the video. He's famous :)

http://www.wsaw.com/home/headlines/69796597.html#

Thanks for serving Grandpa!

Last Week of Peds :(

2009-11-04T17:28:00.000-08:00

Yup that's a sad face. I hate leaving Jake. Bah. Anyways, this rotation has gone really well. I have to admit it was a pretty easy rotation. I mean, yeah I have to work hard and all, but my hours were amazing, and seeing only 20ish patients a day is pretty sweet.

I have some good stories from today.

Story 1- I'm in the room doing well child checks on siblings: 6 year old boy and 3 year old girl. I ask the 6 year old what he likes to do for fun. His response: "I like to throw fake spiders at my sister and make her scream." How fun! Seriously, it's pretty close to impossible to not laugh at these hilarious things. At the age of 3, kids should be able to answer questions like who's a boy or girl, hot and cold stuff, etc. When I asked if she was a boy or girl, she looked at me like it was the stupidest question in the whole and in a very exasperated tone: "Giiiiirrrrl." Like duh Jenny. When I asked if her brother was nice to her "Nope."

Story 2- Twin 4 year old boys. I asked them to each draw a picture: Twin 1 of his mom and twin 2 of his dad. At that age, it's really crazy, but they usually will not add the body. It's usually a head with a face, two very long legs OR arms (not both) and feet (or hands). So twin 1 draws his beautiful picture of his mom. Twin 2 draws his dad and then says "Oh wait, I didn't draw his penis." Somehow, I held it together and said "Well that's ok." He drew it anyways...right between his legs. Again, how do you not laugh?

Story 3- I'm doing a physical on a 12 year old boy. He's relatively overweight. We get through the history, and I tell him to take off his shirt so I can examine him. He starts sobbing. His mom tells me that he's very self conscious. Wanting to avoid all conflict and 12 year old sobbing episodes, I tell him to forget it, I'll just work around his shirt. Mom, however, disagrees with me and yells at him, saying that everyone goes to the doctor and has to take their shirts off. He ended up doing it, but was not a happy camper. I was just so surprised at his sudden outburst of tears. I'm used to the 2 year olds crying, not 12.

Story 4- We went to the hospital to go check on a newborn. I've seen this baby for a few days now so we "know" the family. When we walk in the hospital room, mom has her shirt around her neck, a breastpump connected to one boob and the other just hanging out. Now, being in medical school, I've seen a lot of boobs, but that was a first for me. It's just like one of those moments where you're thinking "WHOA!" but you can't show any surprise on your face. I see and hear the oddest things every day, and somehow just keep a neutral look on my face (at least I hope I do).

SNOW!!!!

2009-10-28T12:12:00.000-07:00

We are in the midst of a winter storm warning. The pictures are current, but it is still snowing and is going to continue through tomorrow night. We're looking at upwards of a foot. Jake was nice enough last night and let me park in the garage so I wouldn't have to scrape this morning! Love him!

So today I had two families that just totally made my dad.

Family 1- 12 month old check up. Grandma, mom and dad were along in the room. When we were all done, the grandma took my hand and told me that I would make a wonderful pediatrician. I said thank you and then the mom said that she agreed and that they really liked me. I love hearing stuff like that. The patients are the ones you want to like you.

Family 2- 9 month old little girl in for her check up. Mom, Dad, and 3 yr old brother in the room. The 3 year old climbs up into the chair and whispers something in Dad's ear. Dad says "What did you just say?" 3 year old- "She's cute!" Mom- "Great my 3 year old is hitting on your medical student." 3 year old- "Can she check me out too?" Watch out Jake! A 3 year old is moving in! LOL.

What's a Normal Family?

2009-10-26T21:07:00.000-07:00

The thing with peds, is that you establish a relationship with the child and the parents...so basically the whole family. Dr. S has been telling me lately that there is no such thing as a "normal" family. Everybody has shit that happens...bad grades, divorce, kid acting out, drugs, anxiety, depression...you get the drift. He told me that he used to be a lot more judgmental before he had kids. Because, things happen. You can't control every single thing about your children. And when these things happen, they happen to your entire household. Everyone experiences it...all from different viewpoints, but they all get to deal with it. Today we had two cases that I tried to wrap my head around. 1. a teenager who has been getting into drugs, truancy, failing...except an A in a science class. He's depressed...and Dr. S and the mom were talking today about sending him away to some military sort of school. My opinion? He's bored. His one A proves that he's interested in something...I think he probably thinks the rest of school is boring and a waste of time so he finds other things to do. Are they wrong? Of course. Why do I think this? One, Jake got D's in a bunch of his high school classes (including chemistry) because he was bored and didn't want to do the work. He's getting his PhD in chemistry now...I think he's bright enough. Anyways, back to this kid...yeah he's probably depressed, but I don't know if anyone has actually sat down and asked him some simple questions. Ok enough about him.
Patient 2 was a pre-adolescent who was having some behavior issues. I'm not sure what I'm getting to. But I don't judge these families. I do however judge the parents who don't immunize their children against anything. Why wouldn't you want to protect your children? The diseases that they protect against are ones that can kill you.

Ok this post was all kinds of random and if you can follow I congratulate you.

The Patients that Make it All Worth it.

2009-10-21T19:18:00.001-07:00

There are just some patients that make it all worthwhile. The ones that make your day better, make you smile and laugh, and the ones that you want to take home. I had the most adorable 3 year old little girl who came in for her well child visit. As I've said before, 3 year old kids are my favorite. Well, Dr. S and I walked in the room, she stops talking, looks at me, points and says "Umm I like you." So Dr. S told her that was fine and he left the room. She promptly climbed into my lap, told me all about colors and that she is a girl, her daddy is a boy, what she is planning on being for Halloween (a magenta butterfly), how my necklace looks like an "O," and on and on and on. She was pretty advanced too. She was able to draw a circle and a cross (the cross can usually be done by 4 year olds) and she could hop on one foot (also 4 year old thing).

During the course of the exam for the kiddos, I try to find out who their favorite character is. Well, her's is Ariel, so when I looked in her ears, I told her Ariel was in there. For the first time in a year, this backfired on me. She wanted to look and wave at her. We had to tell her I was pretending like she pretend plays. Anyways, this little girl was just so fricken cute. She seriously made my day.

I hope when I look back on this in a few years I remember her.

What kind of things make your day better?

Christmas is Canceled

2009-10-19T19:35:00.000-07:00

Well the present giving that is. Unfortunately, my next set of boards is going to cost a lot of money. The boards themselves cost $1700. I have to go to Philadelphia to take part of them. So I'm thinking at least $2000 for the entire ordeal. Jake and I decided with this extra expense we were just going to not do gifts with anyone this year. It really is ok considering neither one of us want or need anything. My parents are okay with it because they are coming out for New Year's to Colorado...so they look at the trip as their present. It will probably just be a little weird on Christmas morning to have zero presents under the tree. Normally, I spend Black Friday shopping for all my family members, but I'll probably still go out just because it's so much fun to me!

I'm not sure what we will spend Christmas day doing, but we'll figure out something.

Becoming a doctor is an expensive ordeal. There are so many costs other than tuition that no one tells you about. Boards are ridiculous. After all the core rotations we have to take shelf exams. In order to study for these shelf exams you have to buy all these books. Audition rotations are rotations that you do at residency locations that you might be interested in. Unfortunately, you usually have to pay for housing for a month in a new location. Money, money, money. Someday, this will pay off, but it sure seems a long long long ways away. So maybe Christmas will be canceled next year too.

Are you making any cutbacks for the holidays this year?

Pediatrics and the Swine Flu

2009-10-18T16:45:00.000-07:00

I now have one week of pediatrics under my belt, and I have to say my life is pretty dang sweet right now. We start at 9 am and are done sometime between 5-5:30. Oh yeah, and depending on how the morning goes...I get between an hour and 1.5 hours for lunch. And because the clinic is so close to home, I get to spend my lunch at home. It's great. Jake's actually been lucky enough to have a wife who can cook for him at night. I believe I have cooked almost every night, which is amazing! What else...I get my own tablet/pc to use. It's so much better than flipping through paper charts.

So what do I do in pediatrics? See a bunch of healthy kids for their well child exams and a bunch of sick kids. My favorite well child exams are the babies and the 3 year old kids. I love the babies because they are fun to play with, although as soon as I pull out the otoscope (look in ears) they begin to wail. The 3 year old kids just crack me up. They are into everything, bounce around the room and manage to tell you everything all at once. I'm just glad I get to leave them to their parents.

This clinic in particular has a wealthier and more diverse group of patients than I am accustomed to. For example, in the last week I have had patients from Russia, England, and Israel. I also have had two sets of lesbian moms (one set adopted the child and the other set used a sperm donor, used one mom's eggs and the other mom's uterus. Did you get that?). I'm also pretty happy with the acceptance that I have received from the parents. Typically, the wealthier the family, the less likely they are to allow you to touch their child. Now I know this isn't a black/white situation, but it tends to follow this path. However, I have had zero problems with parents, in fact, these parents are even more interested in me and my education process.

Alright, what everyone is waiting for...the swine flu. To be honest, I'm pretty sick of hearing people FREAK THE HECK OUT over it. And I also believe, that many people do not have all the facts. When people say the doctor says they have the swine flu, it is a most likely situation. For example, in the state of Colorado, there is only one lab in the entire state that is testing for the swine flu. The only places that are taking swabs from patients and sending it to this state lab are hospitals. You have to be an admitted inpatient to receive this test. So why are the doctors saying that you have the swine flu? Because that is what is currently circulating. If you have the correct symptoms (by the way, you need a fever for this diagnosis) then you are being diagnosed with the flu, probably the swine flu. Again, for everyone freaking out, I have been exposed to about 10-15 patients a day with this. I have yet to get it (hopefully I didn't just jinx myself). Wash your hands....a lot. Wipe down the grocery cart at the store. Get the flu and swine flu shot. For those of you with little babies at home, the CDC is advising you to get the shot not the nasal mist. I really encourage everyone to read the CDC's website for information. And before anyone gets huffy puffy at me about this, I am aware that people with low immune systems are more likely to have complications.

Oh yeah one more thing...the recommendations on when to go back to work/school are 24 hours without a fever without Ibuprofen/tylenol.

Ok, I think that's it.

I'm pretty lucky!

2009-10-06T16:41:00.001-07:00

I thought I'd put up a picture of me and Jake to celebrate my good news! This was from our anniversary celebration!

I don't think I've mentioned it on here, but I am going back to Colorado this weekend to complete my 4 week pediatric rotation! I'm so happy that the school was willing to let me do this again. The best part is that the clinic I'm rotating at is 5 minutes from Jake's and it's across the street from the hospital, so my travel time will be awesome! The thing that will be the strangest for me is that this office is not accepting new medicaid patients. All of the offices I have worked for are CHC's which means they are federally funded and accept ALL patients. I'm interested to see the differences in the office.
I need to keep making a good impression. I got this rotation because the last doctor I worked with in CO literally picked up the phone, called this pediatrician on his cell phone and asked if he would be willing to take her medical student. She told him that I was really good, and voila, he said yes. Seriously, the way to go far in medical school is to know people and make good impressions. That's how I got to Brazil, and that's how I got this next rotation. So yeah, I'm pretty lucky.

Surprisingly, I Like It and Some Humor

2009-10-04T08:25:00.000-07:00

I have surprised myself. I really enjoy my inpatient part of my rotation. The geriatric patients are so sweet and I love seeing them getting better! Most of the time, these patients get admitted because they are having "behaviors." These behaviors include things like: trying to choke a family member, grabbing a loaded gun and going through the window chasing a UPS man who is coming to kill your wife (who died a year ago), punching staff members at nursing homes, becoming extremely argumentative, hoarding things at home, accusing family and neighbors of stealing, and inappropriate sexual comments. Why do they act like this? Well, they usually have dementia, however most of them are being medicated and while they get worse, their family doctors just keep increasing the dose of their medications. Adverse effects of over medicating are irritation, agitation, and violent behavior. Simply tapering their medicine makes them so much kinder and sweet. I really really like seeing them get better. It is rewarding.

What's the hardest part of the geriatric patients? Since most of them have dementia, their short term memory is just shot. They tell you the same three things ten times in fifteen minutes. That's really sad, and frustrating when you're trying to get specific information from them. It's really hard to look at them and think that could me or Jake in 60 years. Scary.

Ok, this rotation has definitely left me with some laughs. This is more just for my own sake so that I don't forget them.

"Well, Christ, he had four testicles. And it was the Holy Grail."
"Vampires, dead people's ashes, the spirits in the cemetery, they all talk to me."
"The sky lab has created a pill that makes you fifty years younger."
"Hey, you got whiskey in there?"- to me as I walk in with my coffee cup.
"Jesus tells me to behave."
"You better keep your pants on."- to Dr. S as we walk out of the room
"Are you going to go put some clothes on?"- to me as I left the unit
"You're such a beautiful girl." - a few of the ladies told me this everyday. It made me feel really good.
"What are you, his sister? You look identical."
"I kept taking my cane and poking him in the foot. He was sleeping and not listening to me and well I get paid to talk."
Dr. S- "what year is it?" patient- "1970."
"Leave me alone. I'm sick of this crap. I exercise every day and I DON'T WANT TO DO IT."- this was after speaking to the sweet patient that she was in the morning. 1 hour later...totally different attitude.

The Saddest Day of Medical School

2009-09-24T19:16:00.000-07:00

If you are hormonal or don't want to read about a baby dying....this probably isn't the post for you.

Sunday morning I went to the hospital to round in the nursery with Dr. G because she asked me to. Yes, I'm currently in my psych rotation, but did it anyways because I like her and was anxious to show her how much I have learned since the last time I rounded with her. Well, I walked into the labor and delivery floor and the nurses told me there was an emergency and I better get back in the room with Dr. G. I hurried back to the room where she came running out with a 26 week gestation baby. We all run to the nursery where they quickly put me to work. My job was to pull air out of the baby's stomach through an NG tube. Because of the ventilations being administered, the baby's stomach was getting full of air. I was thankful for a job, because I was able to keep my mind on doing the job right instead of sitting there watching all of this happen. There were 5 of us working on the baby, plus the people in the room grabbing equipment for Dr. G as she needed it. The baby's heart rate was only in the 20's when it should have been over 120. Finally, after an hour, Dr. G said she thought we needed to stop. Nothing was happening, the baby wasn't getting better, and if he did survive he would have been in pretty poor shape. So she asked each one of us if we were okay with stopping. Every single person in that room had tears in their eyes while we had the internal fight of stopping to save a baby's life. So as we pulled everything out, they cleaned the baby up, wrapped him up and took him to his mother so she could hold him. The mother was crying when she gave him the baby. Then she asked her "So what now?" And Dr. G told her "You're going to hold your baby and he's going to die." That was pretty hard to hear. I had to walk away because I started to cry. It was an awful feeling.

So you might be wondering why this baby died. The mother was a drug user throughout her pregnancy. She admitted to taking heroin, ibuprofen, Klonopin, and flexeril during her pregnancy. Oh yeah, and the baby's urine had 3 units of alcohol in it. And what was the mother doing an hour after the baby died? Oh she was outside smoking.

It's a good thing I had five healthy babies to examine after that. They made it much better.

So yeah, worst day of medical school. I know that event will stay with me the rest of my life. It was my first baby death and unfortunately probably not my last.

The Crazies Week 1 in Psych

2009-09-15T18:52:00.000-07:00

Well, I'm in psych now. I'm back in Ohio and I'm stuck in this psych business for 4 weeks. Jake left this morning. Needless to say, I've been in better moods before. I spend my mornings at an inpatient geriatric psych ward and my afternoons in an outpatient setting with a different doctor. As of now, I really like the morning stuff. As of now, I hate the afternoon.

Inpatient: I have a schizophrenic patient who just makes my day. She's pretty old and looks really good for her age, but she has no clue what she is saying. I just laugh and laugh. Today she told me to go put some clothes on when I left. Yesterday, she told me that I look exactly like my preceptor so we must be siblings. (He's middle aged, Middle Eastern, and looks nothing like me.) Jesus also tells her every single day "To behave." She is constantly talking about inappropriate sexual things to the other patients and nurses, but she never speaks like that to me or Dr. S. She did hug and try to kiss him yesterday. It's very very humorous. And for everyone who is chastising me for laughing at a patient....too bad, it's funny. And she sits there and laughs right with us...she doesn't have a clue what she's laughing at, but it's ok. The doc I'm working with is fantastic. He sat down with me to make out a schedule for how we're going to go over all the material. I really am happy with him.

Outpatient: I hate it. I'm not too pleased with my experience thus far. I don't want to get into it too much on here, but I disagree with a lot that the doctor does. I dread going there and my afternoon drags on. Again, I hate it.

My Fave Thing to do in the Office

2009-09-08T19:08:00.000-07:00

I really do think this is my favorite thing. I just love finding the baby's heartbeat for the first time in new parents. They are always so excited and happy. It just makes my day! It usually takes me a few minutes in early pregnancies so I always warn them that it will take me awhile and not to freak out or think something bad has happened. Those 12 week fetuses are like little fishies swimming around so sometimes it can be really hard. By the end of the three minutes it takes me to find it, my heart is usually pounding just in case something really is wrong, but alas, I find the heart rate.

Fun Procedures and One Bad Story

2009-09-05T12:06:00.000-07:00

I'll start with my good story. On Wednesday there was a guy coming in for skin tag removal. I asked Dr. M if I could help and she of course said yes. So he comes in, and there are 25 skin tags to remove in his armpit and side area. We walk out of the room to go draw up the anesthetic and she asks if I want to go get started while she sees another patient. My first reaction "You want me to poke a needle into this man a million times while you're in another room? Hell no." So I went in the room to start cleaning the site up..and then waited, and waited for Dr. M to come in. Well, she took too long, so I decided this couldn't be THAT hard. Besides I've anesthetized plenty of times before...like 5 or 6 times. So I started numbing the guy up...and I did a good job. She came in the room and was like "oh you did get started?" So she took one skin tag off to show me how to do it. It's pretty easy. In fact, this is something you could do at home. You take a pick ups (medical version of tweezers)..pick up the skin tag, and take a scissors and cut it off at the base. The ones I numbed up didn't really hurt, but some of the smaller ones which couldn't be numbed he flinched at. I have to say that it's really hard to continue doing a procedure that I know is hurting the guy. So after they were all cut off, I applied silver nitrate to stop any bleeding..and he was ready to go on his way...25 skin tags less.

Delivering a placenta. Have you done this before? I delivered my first one by myself on Tuesday night. I've participated in a lot of deliveries but never have I delivered a placenta. So in case any of you want to know how to do it: you grasp the umbilical cord and gently use traction and pull. All of a sudden the placenta will plop out. Then you have to check the placenta to make sure it is all there and intact. It was awesome! I was a bloody mess.

Ok my bad story- we had a fetal demise at 37 weeks. It was awful. Especially because she was one of our patients who I had been seeing pretty regularly. The screaming and crying from the mother was enough to rip my heart out. I felt so bad for Dr. M as this had been her patient for those 37 weeks. I'd only known her for 3 weeks.

So this upcoming week is my last week in Colorado. I'm really sad about it. Oh well, what can I do?

Happy Birthday to Me

2009-08-25T18:58:00.001-07:00

Ok I realize this is like 4 posts in one night but I have a lot to catch up on!

So my birthday was August 11, but I was in Brazil so Jake and I celebrated on Saturday. He gave me my present right away in the morning and I must say I am a lucky lucky woman. He got me the new hot pink leather Tribeca Coach purse. I was squealing and bouncing like a 5 year old! I also got a bouquet of blue irises :) We spent the day in Rocky Mountain Park! We love being up there and it's so refreshing that we might go back up this next weekend! For dinner we headed to Carelli's which was yummers!

My new purse:

http://www.coach.com/online/handbags/-handbags_feature_tribeca-10551-10051-5000000000000045551-en?t1Id=62&t2Id=5000000000000045551&tier=2

My first week in Family Practice in CO!

2009-08-25T18:49:00.000-07:00

So my facilitators are awesome and got me a rotation in CO so I can live with my husband (you know like a real married couple). It's really great. The doctors I am working with are really motivated to teach and are doing a great job. On my first day, I was suturing up a neck! I have also put in a cortisone injection to the knee which was kind of freaky, but so much fun! My SOAP notes are getting better and clearer as the time goes on. Yesterday I was on call with Dr. M and had a good time at the hospital. We had a delivery, rounded on 5 babies, went and had lunch, then saw a 17 year old that had been admitted.

Today, my favorite patient was a 4 month old who was so happy and busy smiling and laughing at me. It might have been because I had a huge shiny necklace on, but I like to think she was enjoying me! I find that the hardest patients to work on are those who just cry and cry in the office. I'm not talking about children either. Adults who are so depressed that they can't even carry on a conversation without crying. I was told by my facilitators that I need to identify who those patients are and make sure they don't suck all my energy out because it can make you down in the dumps. It's very difficult to get through those conversations. Anyways, there's not many like that and most people are in pretty good spirits.

I've gotten asked so many times how old I am. Apparently, I look very young and they are always shocked I'm so far along in my education. What they don't know is that I will be like in my early 30's before I'm all done!

Ok, done for today.

Boards!

2009-08-25T18:43:00.000-07:00

So I passed! My heart was pounding and my respirations increased greatly, but I finally got the nerve to click submit. And there it was "passed."

Thank you to everyone for all the good thoughts and prayers. I know they all helped!

Brazil Trip

2009-08-25T18:20:00.000-07:00

My birthday where I have a pan of maracuja mousse.

Me in my rede!

C-Section baby!

Our boat!

Me with a scalpel, making my incision for a tubal!

So I've been a super slacker and never updated my blog since getting back from Brazil. Let me just start off by saying it was amazing. We flew in, took a bus to our dock, and spent a lot of time loading all of our luggage on the boat. Our boat was pretty cool and most of us slept on the top deck in our redes (pronounced hedgies...aka hammocks). We started out on the Rio Negro river and made our way to the Amazon river. We traveled all night and made it to the village of Sao Sebastiao in the morning. This is one of the larger villages in the Amazon and the mission I went with is very involved in that community. That afternoon we just sorted medicicines and got the boat ready for patients the next day. We also got a tour of the village.

So the next day we got up and traveled to a very tiny village where patients boarded the boat in families and went through all the stations. We even had our own dentist on the boat! That evening, the boat dropped the surgical team (5 of us) in Uracura where we stayed for almost a week in a hotel. There was myself, Dr. P, two nurses and our translater. The surgery days consisted of tubal ligations, A&P repairs (which is basically making them tighter), and hysterectomies. Many of these women have had 7+ children and their uteruses (uteri?) and bladders start to prolapse out. I also got to take part in a C-section. During the tubal ligations, I assisted on the first one, and then spent the rest of them acting as the surgeon! It was very exciting to do a tubal ligation almost entirely by myself! My first time with the scalpel was daunting though. It took a little while, but I gathered up the courage to do it and now I'm addicted. Don't worry, I won't become a cutter :) I have to say that these Brazilian women are just warriors. All they get are spinals for anesthesia and not once did I hear a peep out of them complaining. I hate how people in the US think pain is such an awful thing.

Moving on. So the food...which is obviously a very important part of my life. We had these awesome cooks on the boat. But I wasn't on the boat so much so we had to eat out a lot. We ate at the same restaurant for lunch every day and they told us what the menu options were each day. The food was ok, but in Brazil there are rice and pasta at every single lunch and dinner. And so within a few days I was a smidge sick of it...but you just suck it up and eat when you can eat. My favorite thing I ate in Brazil was maracuja mousse. This is basically passion fruit mousse. OMG it was the yummiest dessert I have ever had. Even better than creme brulee. They made this for me on my bday :) Also, I found the best soda: Bare. It's like a combination of root beer, creme soda and Coke all in one. It's made from a fruit of the Amazon. On my last day, I finally got my hands on a Caipirinhia - a yummy Brazilian drink. I was able to buy some Cachaca at the grocery store (a Brazilian rum) for a whole $2.50. It is currently in the fridge waiting to be put to use.

The heat: I have never sweated so much in my entire life. It was only in the mid 90's every day, but holy shit was it humid. Like my legs and stomach were even sweating! I didn't even know my stomach could sweat. I would get out of the shower and be sweating. I would be sleeping and sweating. I enjoyed walking more than standing still so at least I couldn't feel myself sweating and the air would be moving across my body! I can't even describe how hot it was, so I'll stop trying.

Overall, amazing trip! It was kind of hard because the group who went was all from the same church and knew each other very well so I was the outsider. Oh yeah, and it was a mission trip so there was a lot of praying and "Praise God." If you know me, I'm not into that so much, so I spent all of my down time reading. I think I got through 7 books in that time. I learned so much and moved very quickly on the learning curve. I would love to go back and do more surgeries.

Bon Voyage!

2009-08-03T04:41:00.000-07:00

I'm off to Brazil! I actually won't be there until tomorrow but my journey begins today. I'm heading over to Dr. P's at 4, and we have flights to Charlotte and then Miami tonight. We'll "sleep" in the airport and catch our early morning flight to Manaus tomorrow. Needless to say I'm pretty damn excited and just hope this whole trip runs smoothly. I'm pretty much packed and just have some last minute stuff to put. Jake has me so prepared for this trip it's pretty unbelievable. I have my own first aid kit complete with a snake bite kit. After reading on mission's website the other night that all the heavy rains are driving the anacondas into the villages, I dug my handy little kit out to make sure I knew exactly how to devenomize myself. I still can't believe I'm about to see things IRL like anacondas. I'm really going to have to internalize some freaking out with all the snakes and bugs.

I'll be there for both our 1st year anniversary (Aug 9) and my 25th bday (Aug 11). That's pretty bittersweet, but I'll survive. I'm hoping I can at least talk to Jake on both days. We bought an international plan for my phone so hopefully it works. If not, I have some phone cards for back up.

Alright, I need to get some last minute things done today so as I think they say in Portuguese "Adeus!"