a little feel-good session

time for me to brag some:

so after revealing my concern about not doing well on my shelf tomorrow to my favorite ob/gyn attending, he pulled me aside and sat down with me.  He proceeds to tell me i am the best medical student he has seen in 4 years, and if it were possible, he thinks i should be hired as a resident now.  both major compliments.  we talked for a little while longer and i mentioned i may decide to stick around here to practice and all that and that i would give his group a call (just sort of being friendly, but i really would), and he got serious and told me he would absolutely hire me. 

i dunno, there is something crazy about this rotation.  i have wanted to do well, my motivation has been extraordinary even at the end of the rotation.  i feel so prepared, and my test questions have shown it.  on my past usmle world test, i managed a 74% and the average was a 54%, and it wasn’t a fluke.  i had other exams where i also did well.  now, the last step is hopping into bed and getting some sleep…after i finish this post.

another inspiring and wonderful event that happened was having the chair of the ob/gyn department page me to ask how my race went this weekend.  the same ob/gyn doctor who calls me “non-meg” or when he’s really into aggravating me - just plain meg.  you know it’s cool when an important attending goes out of their way to ask you about your personal life.

these two attendings are both attendings that i will have write letters of recommendation for my residency applications.  i will ask my clerkship director as well, but i really feel like these are the two that know me the best.  hopefully i will also be able to get one from an away rotation, which i mail in one of the applications tomorrow.  cross your fingers!

bowel or muscle

somehow, while on gynonc, i got suckered into seeing a patient that i never saw in the or.  in general, it’s my job to see the patients whose surgeries i went into.  well this lady is quite the case.   for her cancer, she had an ex lap (exploratory laparotomy).  nevertheless, i have sucked it up and gone and seen her every morning, checked out her wound and got the heck out of there before i messed something up.  since she had a pretty unusual case, the surgery residents were the primary docs for her, not the gynonc team. 

this morning i walk in, notice her bandages were looking a little gross, so i changed them after giving the incision a quick look.  when i looked, it looked like the days prior when i first saw her with my resident.  i didn’t give it much thought.  the surgery resident comes by, and i mention to him i have changed the dressing, but i left it on loosely for him to take a look, if he wanted.   he goes in, comes out and says…

“so did you notice the thing with her incision”

now, as any half-wit or above will figure - that means something is wrong with the wound and it is not in fact like it was before.  still, i say…

“it looked okay to me…”

“except that the wound has dehis’d and the bowel is showing.”

“oh yeah that… i didn’t exactly have the best surgery rotation.”

despite my idiocy of missing the bowel (it looked like muscle!), he still gave me credit for mentioning her bandage was loose, explaining that they were going to send her home today.  on the last day, he doesn’t check their wounds, and if i hadn’t done all that garbage above, she’d be at home.  instead, it was back to the or for her.  yikes.  could explain why she told me she was in a different city and didn’t know the month (couldn’t even guess).

“let’s call it as it is”

dicussing the topic of a working up an abnormal pap, i noted a couple concepts we didn’t quite go over.  i started asking about “CIN I” and how to work it up after you reach a certain point on the diagnostic and management algorithm.   CIN = cervical intraepithelial neoplasia - it’s basically what happens when you get one of the nasty hpv viruses (16, 18, the 30s, etc) and can’t fight it off yourself.   i should also preface this story with the fact that i pronounce acronyms, so CIN is “sin” - sort of ironic when you are talking about what is considered a sexually transmitted infection. 

“so after a patient has a repeat pap after their biopsy shows ’sin’ one - er, i guess i shouldn’t say that, i could really offend someone.” 

you know what a classmate’s response was (albeit joking - still not funny)?

“oh come on, let’s call it like it is.”

normally, this is the type of joke i might laugh at.   what makes this person’s joke not funny, is the person who made it.  she is one of my best friends (although a little less so now), who has known about my trials and tribulations when i went through having an abnormal pap, which was positive for hpv.  this was followed by a colposcopy and one biopsy (which made me hope it wouldn’t turn out bad), and was found to have probably CIN 2, which is moderate dysplasia.  then i underwent a leep, which is where they burn off half your cervix, which was a tough decision because it increases your risk for cervical incompetence (but the other option was worse).  cervical incompetence means my cervix in the future may not be able to support the weight of a baby and i will have an increased risk of preterm labor and miscarriage.  awesome.  

this ‘friend’ knew all this.  it doesn’t help that she has also lived an absurdly sheltered life.  she was married to her high school sweetheart and didn’t have sex until marriage.  she has never had that person cheat on her with another person - and her greatest difficulty in life is her mother driving her nuts, her husband being in another state, and now, she’s pregnant (although that garners less sympathy because it was secondary to her supreme laxity with birth control pills).   living this sheltered life, she continually makes inappropriate jokes around attendings and other people in general, such that she is bound to offend someone.  me in this case, but everytime she does it, i try and suggest her watching what she says.  she just brushes it off. 

well, that’s all fine and good, but i refuse to tolerate that kind of behavior.  no friend of mine has ever said anything so disrespectful or thoughtless regarding a disease i will probably have to worry about for the rest of my life.  a disease 60% of the population is able to fight off, but my body is apparently unable to (probably a lot to do with life stress). 

call it like it is?  okay:

people who contract hpv are not whores, and it’s not a sin to have hpv.  all it takes is to date a guy who has had sex with multiple partners, or basically anyone who has had sex with more than person.  it could be 2 people. your whole life.  or just one but that person was with more than 1.  that’s it.   and what super sucks?  you can’t test for it in doods.

and we definitely do not need future doctors out there propagating the social stigma related to it, when parents are already up in arms about the possible implications of giving their daughters the gardasil vaccine when it has the chance to spare a woman the stress and anguish of cervical cancer or its precursors. 

where the heck is number 3?

my main job on ob? deliver the placenta fool.  and like every good medical student, i must know the signs that the sack of blood that attached to the uterus for months like a parasite is ready to come out:

1. cord lengthening (duh)

2. uterus hardening

3. gush of blood

the other night i was on night float, and after having delivered the baby (wohoo!) it was time to deliver the placenta.  the cord started lengthening pretty quickly as i pulled, and i could feel her uterus contracting pretty hard.  after much lengthening, i saw lengthening no more.  and i was all like, where the heck is the gush of blood and why did the cord stop lengthening.  now my regular blog-readers (rachel and dave), i was no noob at placenta delivery by this point, i mean heck, they graduated me to real live babies.  i figured, this bad boy is probably stuck.  then a thought crossed my mind:

thank god i put the ugg boots on.  the ugg boots are booties that go up to your knees, which is sweet cause the gown goes past them, meaning i am covered in fantastic blue disposable fabric.

back to the situation - peek in the vajay, see the placenta hanging out, and give it a nice tug.  and you know what decided to show?  that gush of blood - except now, it was a damn geyser, because as i patiently waited for the placenta to come out, all that blood filled up in the uterus until it was ready to shoot out at me - me who was front and center.  needless to say, i was quite literally covered in blood.  at that moment you kind of just have to laugh.  especially when the new mom asks “is it weird to be covered in someone’s blood.”

my response?  you just kinda get used to it.  ha, used to it.

philosophizing

i know that’s not a word.  or at least, i don’t think that’s a word - it’s tough with medical school - grammar, spelling, etc all go down the crapper. 

so, i used to like ethics.  then medical school happened.  and not just any medical school - my medical school.  our primary ethics teacher would spend hours finding out what we thought about different issues as we sat in a classroom of 130 students.  she would only manage to get the same 5 people to debate (i was not one of them - mostly because i skipped these lectures once i figured out their stupid structure).  at the end of the hour and lots of “mm hmm” and “okaaay” ’s later, we would have no idea what was actually legal within the medical field, which is kind of important, especially when in one year you’ll be working in the field.  

well the horrors of those classes were nothing compared to the tard who came in and spoke with us last week.  her job was to be an ethicist for the hospital, and part of her appeal to us was that when something controversial comes up - consider also asking for her help, not just the lawyers.  bitch please - i’m gonna do what’s legal, not spend hours debating.  which is AGAIN what this new lady tried to get us to do. 

now, i dislike this woman very much for three reasons:

1.  she scolded some students for side conversations after she asked the class a question because she felt they were being rude after she strolled in 15 minutes late because of “traffic” - hey lady, who are you kidding?  it’s 2 pm and this school is in b.f.e.  (there dave).

2.  she had us debate over a case regarding aspects of neonatology when we are on ob, without any of us having peds yet.  none of us were even remotely qualified to be speaking on the topic.

3.  she pushed her opinion on us.  she was clearly biased.  when i stated that i believed there was a difference between removing treatment and never initiating it, she was like “are you sure?”  uh yeah.  “well, there is no difference.”  to who? (whom?)  you?   well, i don’t give a rats ass what you think.  i care what my patients think.  tell that to a patient.  tell that to parents of a baby patient.  she was rude and completely insensitive to any of our stand points unless they agreed with hers, and to me, that’s the worst sort of person to lead a debate in ethics.

and because i can, her clothes were too tight - whore!

c/s

aka c-section.  my first real day on ob consisted of me being privy to such an event.  it was pretty much utter craziness.  i’m scrubbed in, fortunately not retracting, but definitely getting pimped watching the whole thing with a phenomenal view.  basically after you have just let loose the ocean, aka the amniotic fluid, everywhere, there have a weird looking alien.  babies are actually pretty gross looking when born, which i know is decently well known now-a-days, and c/s’s are no exception.  however, once they’re pulled out, the cord is cut and they’re cleaned up (all of which takes about 5 minutes), they’re adorable and incredibly tiny.  i have seen new babies, but not newborns.  they are magnificient.  i don’t know that i would want my own, but you can see easily how beautiful and precious human life is.

it’s unfortunate when you see them and think of the hardship they will endure.  in that moment that you stand next to the incubator, there is nothing so beautiful as a new life.  they lay there wrapped up, silently wiggling within their blanket.  this one in particularly layed there opening and closing his mouth.

a woman’s climax

you dirty bird.  we’re talking life climax.  which according to ob/gyn books, is menopause.  the whole phase preceding and following menopause is termed climacteric.  because, you know, that’s when woman reach their peaks with hot flashes, headache, night sweats, irritability, mood changes.  the whole gamut.  not only that- basically, it’s saying, “well, it’s all downhill from here.  hope you enjoyed it cause it’s not gonna get any better.

abg like what

any day in the er that is a procedural day, is a great day in my book.  today was such a day. 

it started off slowly, i saw an old guy with sob (shortness of breath).  we get him all worked out, and i head over to another room with leg pain.  this guy ends up looking like a drug seeker, although his case was somewhat more complicated - he still ended up being a jerk…will talk about him later.  sooo, i am talking to leg pain and i hear my name paged to the front.  i walk out the room and dr. d awaits me, asking if i’ve ever done an abg (arterial blood gas) - i tell him once unsuccessfully. 

a few seconds after i say this, i remember the  thing i did unsuccessfully was actually an arterial line - but i was like, oh heck, he’ll still make me do it, and the process is similar.  i head over to the pt’s room (sob), and i did it.  did what you ask?

i found his radial pulse in his arm, cleaned it with alcohol, then prepped it with betadine.  then with a syringe, i stuck him at a 45 degree angle and up goes the blood.  i hand that to the nurse and i’m done.  it sounds so easy when i write it here, and realistically, they are easy, in terms of procedures, but today was my first day doing them.

dr. d walks in and asks if i got it, and with him, being mildly confident is a bonus - so i tell him, of course i did.  he laughs tells me his usual saying - even a blind squirrel finds a nut some days.  but then i got to prove my procedural ability:  i did two more successfully.   after our dialogue, he says, alright, no get over to room 2 and do another.

i walk in this pt’s room (another sob), and stick it right away.  these feats end up compounded because, really, if you think putting in an iv is bad, try going for something deep, that isn’t just below the skin. craziness.  thank goodness this woman was in a stupor.

when it was time to repeat room 2’s abg, the family was in there.  and when it comes to family being in a room for a procedure, let me tell you - lesson learned.  i should have known it wouldn’t go well when they instantly began harassing me about the procedure.  you know, the trained professional at these with all of 2 under my belt.  but dammit they don’t know that.  (which ps, is the hilarious thing about the hospital - you could definitely be a person’s first go at something).  through it all, i got plenty of evil stares (not exaggerating) and harassing, but through it all, i got her radial artery, and left handed no less.

 

a harmless trip to the chiropracter…

as i spend my enlightened days doing retrospective chart reviews for research, i see cases of stroke after stroke.  most of them are 70 year old men, but then i came across a 34 year old woman.  and, i stop and think to myself, wtf?

so i start reading about this woman.  and you know what happened?  she went to the chiropracter who was doing some “safe” manipulations on her neck - and she suddenly developed stroke like symptoms.  She chalked it up to a side affect of her migraines (not totally unreasonable).  She eventually got worried and came into the e.d..  after much imaging, you know what they found?

a vertebral dissection.  what’s that you ask?  it’s when you get tears within the vertebral artery - which coincidentally runs in the vertebrae in your neck.  she had a stroke at 34…thirty-four.  so, great - this 34 year old woman who just had a baby (yeah, didn’t mention that in the beginning, but yea - new mom) now has permanent disability because of high velocity neck-cracking.

boo alternative medicine.

hodgepodge

really the only reason i am writing is to procrastinate studying the physical exam of the hip and pelvis.  the doctor i work for insisted that i read this book, and while informative, it is most certainly dry.  i have since tried every form of procrastination, yet i am too efficient with procrastinating, so i am down to my final method, which is clearly writing in this blog.  i don’t have much of the book left, but it’s enough.

today, i didn’t go to church.  which to many, you might be like, so?  but i have gone pretty religiously (ha) since i started dating my boyfriend.  the last couple months i have been more deliquent, but i just haven’t wanted to go, and i am of the attitude that if you don’t want to do something, generally you shouldn’t.  (as proven by the fact that i don’t want to read this book).  mostly i didn’t go today because the church i like is a half hour away.  there is a closer one about 3 minutes away but i hate that hippie church with their guitars and tambourines.  nonsense.  how can you possible focus when someone is going to town on a tambourine?

yesterday i had the distinct honor of draining the biggest abscess i have seen yet.  there is nothing more gratifying than draining an abscess filled with pus.  numb up the area with some lidocaine, go at them with an 11 blade (aka an exact-o knife) and have fun squeezing that baby open.  pack it with some gauze and send the poor soul out.  i love it.