Archive for the random rants Category

the whirlwind is over

Posted in medicine, random rants, tangential/circumferential on May 18, 2009 by whenispark

starting thursday, things have been complete and utter madness.  it commenced with going wedding dress shopping with rachel, which went well.  if not for her fiancee knowing about this site, i would consider posting photos.  i have no doubt she will look beautiful based on the preliminary search.  i rushed home to meet z where we did absolutely nothing (thankfully).

friday, i was up bright and early to go to my graduation rehearsal, and on to my “class day” which consists of the school giving us awards and money (yay!).  i won service to the class and college, which was an unbelieveable honor bestowed upon me by my classmates and some secret committee within the school.  i couldn’t believe i won one at all, let alone both.  z thinks this is ridiculous, but i remember last year han not winning it, so why shouldn’t i think ali or andy might win it.  anyhow, i couldn’t thank my class enough.  it was incredibly kind of them.  z and steve joined me at the function and it was a great time sitting at the table with erin and chad.   it was especially fun because z really likes them both so much (as do i, obviously).  we took pictures, hugged, blah blah, fun fun.  but the day did not end there… in painfully high heels i ran over to stan hywet and tadoro’s to look at the places with rach.  she ended up not choosing either one of those, but one she saw that evening for her wedding.  it will be just beautiful. 

we then went home, refreshed and headed back out to the school for a “commencement eve” dinner.  when i originally said i wouldn’t go to this dinner, it was before i knew that only a few students were invited.  i hadn’t realized i was invited for three reasons:  the student council and the two awards i won.

the dinner was mostly fun except when my parents starting arguing at the table only 5 feet from the professors and doctors and other administrative people who have watched me for four years.  sigh. it was nevertheless, an incredible dinner spent with my sister and dave, brother, aunt, grandma, parents and z. plus it was a free dinner.

the next day was graduation, with lots of people except me (and rachel) crying.  so here i am, an official md, which is just a little bit strange.  if someone gets sick suddenly out in the open, i can say, “i’m a doctor”, which did happen only 5 hours later to my friend sophie.  she didn’t have much idea of what she was doing, or as she put it “i asked him what questions i could remember from the mini mental status exam” and then she told him to go to er.  duh.  but still hilarious, and crazy that we can say that.

the graduation party was great to have all my family and friends around, and even better when we were all able to sing happy birthday to dave.  that cake was delicious, but prevented me from eating my delicious strawberry cake.  oh well. still cake.

otherwise, i have written all my thank yous, addressed the envelopes and stamped them.  tomorrow i will mail them, and only then will i deposit the gifts i was given.  i am a huge proponent of writing thank yous BEFORE you use a gift.  someday, when i manage to get married, i have promised myself ot do the same thing.  i don’t want them looming and i don’t want people to think i forgot.  and i dunno, i just think it seems tacky.  it doesn’t take that long to write a little card out thanking someone for sharing in your day.

and now for my very busy days painting, running, and reading, to which i must attend to now.

financial woes

Posted in medicine, random rants on May 12, 2009 by whenispark

what would life be like if your parents were doctors, and you didn’t have to pay for school up through graduate school? and what if you lived in a country where education was actually a priority? 

well, i can tell you, you wouldn’t be in debt with interest totaling almost a cool quarter million (this includes college).  you wouldn’t have standard government loans with interest rates of 6.8%. i find it fascinating that when i was an m1, the interest rate on my loans was 3.61%, and that is where they sit now, but after my m1 year, the rates sky-rocketted. 

it’s laughable to hear obama talk about having credit card companies lower their apr’s, but i don’t hear anything about the horrific rates our own government has.  it’s especially fascinating in a culture where people think it’s absurd that doctors make money.  well crap, at this rate, i will be lucky to ever be out of debt.  and even more fascinating when we are short on primary care doctors, and doctors period!  yet we have no incentive for students to go into medicine.  primary care docs have the lowest paycheck.

it’s amazing because i also was never the student taking out the full amount of loans.  i was always trying to find ways to cut corners and save money. oh well.  hopefully by the time i am out of residency, we won’t have a system of socialized medicine so i don’t get screwed twice. sigh. time to grow up, i guess.

scrabble is ruining my life.

Posted in random rants on May 1, 2009 by whenispark

you know what happens when you play scrabble a lot and you  play with your boyfriend who is also very competitive?

i will tell you.  i will be talking to people in conversation or writing in this blog, counting the letters in words and thinking about their individual value.  right there, so many good ones – value, blog, think, divide…

you get 50 points if you use all your letters.

tough

Posted in random rants on March 19, 2009 by whenispark

it’s tough when on one of the most important days of your life, more of your best friend’s family is coming to see you than your own.

i can make plenty of excuses, but with only my brother going, it seems like a poor showing.  some of it’s my fault by not telling people soon enough, but i did tell my father, and he won’t be there.

 

i don’t know how i will ever be able to sleep tonight.  i should have taken han up on her offer for a beta blocker.

step 2 cs

Posted in medicine, random rants on December 11, 2008 by whenispark

silliness.  i am sure i did just fine. 

what it entails:  12 standardized patient interviews – 15 minutes to see the patient, 10 minutes to write a note, including your assessment and plan. something like 98% of US medical grads pass it without a problem (it is pass/fail).

my only observation was the pattern of all the other students not requiring the full 15 minutes to do a complete history and focused physical exam on the patients.  the very idea of this blows my mind – as a medical student, you should have plenty of questions in your repertoire to take up 15 minutes… but these interviews didn’t just involve doing the aforementioned tasks – you also had to summarize and explain your plan… basically – it should take you 15 minutes unless it’s an unbelieveably easy case.

although i suppose it doesn’t matter.  we’ll all pass, and we’ll all be good doctors regardless of that test.   plus i am pretty sure they are not going to continue administering it next year.  stupid.  not surprised.

black friday…

Posted in random rants on November 29, 2008 by whenispark

is overrated.

the condition known as msc

Posted in random rants on October 9, 2008 by whenispark

also known as “medical student castration”.  it’s the position you are put in by the fact that you are not allowed to place orders and no one generally cares what you think.  if you’re lucky, you might be able to express your own opinion – that’s assuming you agree with everyone else.

you might be wondering where this newfound bitterness stems from – and it certainly is newfound.  it’s primarily from my chief resident right now.  as an m4, i no longer answer to an intern.  in fact, i don’t even see them.  this is a pretty major change from m3 year where the lower-level residents were the only ones you had contact with. 

here’s the problem:  we have a patient with a history of chronic pain who is on medications A, B, and C.  she had her surgery to rid her of one of her origins of pain – a retroperitoneal cyst.  there is no guarantee that this has been causing her pelvic pain, but it seems likely.  she had an exploratory laparotomy (the opened her up, unlike laparoscopy where they put in little holes), and we probed around in her bowel, took stuff out, sewed her back up.  regardless of her history, this is a procedure that inevitably will cause the patient pain, pain, pain.   any other patient with this surgery would be getting plenty of pain medication.  the situation become sticky because she is already on pain medication – which means, she needs MORE.  even though we have fixed a potential source of her pain, she’s still going to have pain just from the surgery.  so what do we do?  we give her medication A and B, and a mere fraction of what she normally gets of C.  this will inevitably amount to inadequate pain control.  so inadequate that i walked into her room with her hunched over crying in pain.  i tell my resident and what does he do?  brushes me off.  and therein lies the castration.  here is a patient in a lot of pain, and i can’t do anything to help her.  it’s keeping her up through the night, and she has no appetite.  but wait! there’s more!

she quit smoking about 3 days ago, and for those of you quitters out there, you might recall that counterintuitively, after you quit you have an increase in mucous production.  at face value it doesn’t make sense, but, when you realize that smoking paralyzes the cilia of the lung cells which move the mucous out, you would know that the mucous then accumulates.  when you stop smoking, those cells egt back into action, but now they have lots of catching up to do!  so lots of coughing up mucous.  this is her next situation, except guess what!  when you cough, you increase your intrabdominal pressure, which hurts alot when you just had an invasive surgery down there. 

so then i ask him if we can either give her a breathing treatment or something to help her with this mucous to loosen it up.  i don’t want to give an expectorant because then she’ll cough more and with her pain not controlled i hardly would want her to go through that.  and a suppressant doesn’t make much sense because it’s not a dry cough – we need that stuff out.  well he refuses the suggestion of a breathing treatment (in addition to any change to her pain medications), but finally after much nagging he does give a crappy suppressant.  hey hopefully at some placebo effect contributes.

so what’s a student to do.  like i said, i can’t order anything.  i can’t call the attending because i can’t go over my resident’s head, but here i am concerned about my patient who is entirely dissatisfied with her care (a large part due to her pain) and no one can explain to her what’s going on, least of all me because i’m definitely left out of the loop.  it would be one thing if i was doing this for some ulterior motive (although i can’t even fathom what one might be), but really i just want to help the patient and to learn how to take better care of them.  this isn’t a battle for who is right.  i just want the damn patient to be happy and as comfortable as possible after her surgery. 

fortunately, the patient asked if she should call her doctor, and i said, as a private patient, you are absolutely entitled to discuss your care with your doctor.  i wouldn’t have even said that if it weren’t for the advice of another resident i frequently turn to for advice. 

i guess ultimately it is just extremely frustrating when every effort you make to help a patient is not percieved as such.  he honestly just gets irritated when i make suggestions without explaining why not.  so really, what is a medical student to do?

 

i also should note that this same resident tells me NOT to write down what physical findings i find on a patient.  i am literally NOT allowed to write tender to palpation.  i have to check with him.  as though i can’t assess when it hurts to palpate an abdomen.  i am also NOT allowed to write down what MY assessment and plan is.  so really – why am i even writing a note.

honestly, i think tomorrow i’m going to talk to my favorite attending, because i am at my wits ends.  i have never been so stressed out about this kind of stuff.  fortunately, i have been able to hide it all and i’m nice as ever to the resident.  i’m more concerned about the other student who will be working with him in a matter of 4-5 days.  oh well – i will try to prep her before she starts.