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!

ob

unfortunately for you dave - there is no punctuation in that abbreviation.  ob or ob/gyn or obstetrics and gynecology or delivering babies and looking inside vaginas.  whichever you prefer.  out of sheer laziness, i will mostly call it ob - but often when i speak of ob i am refering to labor and delivery or l&d.   i am currently on this clerkship, and i am definitely enjoying it.  it offers something that none of the other fields offer - clinic, l&d and surgery.  you get all three, and there is probably no other profession in medicine with that much variety.  like every job, medical specialties are repetitive, so you better like what you do, and i have been having fun on ob. 

mind you, not initially, but mostly because i had no idea what i was allowed to do and what i wasn’t allowed to do.  like is it okay to go into the pregger in labor’s room and stick my fingers in her vajay to check for cervical dilation - something that is standard to do every 2 hours?  the answer?  yes, so long as the pt has an epidural and another person is in the room.  makes sense - otherwise you’re the creepy medical student that sticks their fingers in no-no spots.

the highlight of my time on ob came when i was on night float (worked at night for 4 days) - which is when women deliver.  as a medical student, the one thing you want to see is a delivery, yet the one thing that consistently happens is babies delivery during lecture or once you leave.  awesome.  hence the purpose of night float.  on my last morning, i had the opportunity to deliver a baby which was nuts (for the record, i almost typed witch).  my heart was probably going the speed of the baby’s.  it was just amazing.  the babies are of course slippery and pretty gross initially when they come out, but after about 5 minutes, they are just beautiful. 

i’m not one of those people that gets redonk when i see a baby, but i doubt there is anything so beautiful as a newborn baby.  they are so tiny, and instantly consoleable once placed in their mother’s arms.

it is amazing that something that is so long (labor) ends with something so quick (delivery).  those babies just shoot out of there once the head is out.   the whole thing is still a blur.  I look forward to when i’m on l&d again so i can have another go.  i have also held the newborns when they come out of the uterus right after we do the c-section. 

overall, i still have no idea what i’ll do with my life, but i never expected to like ob one bit.  i really thought looking down there would be uber-gross - and it’s not like i love it, but i don’t really think anything of it.  and not to say that might not be gross (aka std central), but give ‘em some antibiotics and it’s all good.  er is still a top contender, but i still haven’t decided.  i’ll basically be looking into an ob elective in the month of october, just after my er elective - it will be easy to compare/contrast the two.

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.

oopsees

i have been rather deliquent again.  i couldn’t help it really.  i have been kind of miserable, which generally leads to me wanting to avoid rehashing those things that make me miserable.  that’s a cop-out though because i don’t even write about such things on here.  only the things that drive me bonkers (love that word) and the things that make me laugh.

so i will do a bunch of little short ones to keep you happy.  or miserable, my writing is pretty terrible.

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.

bitch please

how ironic that this would follow an article on drug seekers.  this afternoon i saw a patient who came in for gross hemoptysis (coughing up blood in chunks).  I read over his records and he had been there two days prior for the same complaint (usually doesn’t bode well in terms of what the patient wants.)

however, i look at some of his stuff (and his complaint is legitimate) and find he has possible bone cancer, and the man is missing an arm.  bearing all of this in mind, i tell the doc about him, and the patient at multiple points had asked for pain medication (bone cancer or any cancer = pain, lots and lots of pain).  so, a new nurse comes on the shift, and because of his long wait, the patient is cranky.  he sort of takes it out on the nurse.  she comes up telling the doc that the patient wants pain medication.

“is he a drug seeker?”

“yes.”

my jaw just about dropped.  i wanted to slap this woman.  i’m sorry, but were you hit by a train, only to lose your arm?  do you have some GI cancer that has spread to your bones?  are you coughing up blood?!  then shut the hell up.. you don’t know why he’s here, you didn’t ask, don’t answer that question you cynical bitch.

this isn’t a common occurrence, but boy when it happens…if i were the attending in that case, i would have probably gone back and said something to the wench.  like, before you tell me a patient is a drug seeker based solely off your pride and cynicism, maybe talk to the damn patient.

pain

drug seekers… most of the time, these people are very difficult to tell from people with real pain.  today, i had a blatant example of one.  and it’s not what you would expect - i usually picture a young guy.  not this one, it was a little old lady.  so how do i know?  well, here are the basics.

she comes in telling me that she fell, tripping over some carpet while trying to get a lamp.  she fell on her knee.  her knee hurts.  i physically examine the knee and i am pressing hard.  she doesn’t even flinch.  ooooh but it’s an 8/10 for pain.  well, because this woman is over 55 (thus, at risk for fractures), i need to xray her knee, knowing full well she doesn’t have a fracture, and she probably didn’t fall.

xray is normal.

i go in the room -

“well you xray appears to be normal, but i can’t be sure.  i am going to wait until the doctor i work with takes a look because i may be wrong.”

“oh, my ankle hurts too.”  as she points at her ankle.

“oh, really.”  i start pressing her ankle with no flinching.  “does it hurt more than the knee?”

“oh yes, definitely.”

i tell the doc i work for about this.  the pt is now clearly seeking drugs in my mind.  he goes in the room now.

“the xray is normal.  you just have some arthritis.”

“oh and my hip hurts.”

“what helps take care of the pain for you?  tylenol? motrin? vicodin?”

“hm…vicodin.”

peace out lady.  we give her the infernal vicodin and boot her.

there’s your tax dollars at work people…and to think - you want to make healthcare free for everyone.  because clearly it’s being effectively used now.