Ok so this sucks

It's finally kicked in. Call nights that suck. Worked 16 hours, slept 4, working another 12 now.... t...i....r....e...d.....zzzzzzz...zzz....zzzz.z...z

First Patient Died

Well, it happened. I knew it would sooner or later. My team saw a patient in the morning. She asked for chocolate Ensure. Two hours later in the middle of rounds we heard a "code blue". There were 50 doctors and 20 minutes of CPR. Then that was it. And we finished rounding on our last 3 patients.

Yesterday

Was the day. The male UG exam. Remember how I said I was nervous? Well I wasn't nervous. I was really really nervous. So nervous I thought there was a grand possibility I might throw up or cry. I don't really know why. Not like I've never seen/touched a naked guy before.. even in the hospital setting. But the SP's make me nervous. And the cameras, and the possibility of getting a jackass for a student partner. Alas, all went well. I was originally assigned to a really irritating guy who was supposed to be my student partner... but the coordinator switched me to be with another girl in my class who seemed almost as nervous as I was. So it worked out well.

I'm not sure what I was worried about exactly. That I'd eff up and hurt the guy? That he would be so hot that I would get nervous and not be able to concentrate? That I would laugh? That he'd get an erection and I'd be embarrassed? I can say this is officially the first time I examined a guy's goods this closely while simultaneously praying he wouldn't get an erection.

Anyway, I survived. Lets just say I didn't have to worry about any of the things I originally thought... as I am fairly confidant my SP had no attraction to women what-so-ever... and when I began the exam without asking him to "bear down", he just shrugged and said "that's ok. I'm an expert at this".

Whew.

Tommorow

Doing my first Male UG exam. Ugh. Not going to lie... a little bit nervous. I just know I'm going to get the (really) old guy.

Oh My, Oh My

It was so much better than I expected. In fact, incredible would be an understatement. In a mere 5 hours I saw the following...

1. A multiple GSW victim (1 in the clavicle, 1 in the LRQ)
2. A stroke patient (activated @ hour 2.5)
3. 16 yo Peds epileptic seizure
4. Pulmonary Embolism
5. Sickle Cell
6. 2 belligerent drunks
7. 1 missing person from the other side of the USA found unconscious with a suicide note pinned to their shirt
8. Chest pain
9. Dehydrated
10. Gastric pain

It was awesome. And I loved every minute of it. We rounded lightning quick (no time to be bored), saw 30+ patients, 5 hours FLEW by in NO TIME FLAT, and all the residents and staff were super duper awesome cool. I'm so in love with EM it is ridiculous.

Bounce

I volunteered to help out over Christmas break in a clinic that does TB testing and reading for men who need PPD negative clearance to sleep in a shelter. No sweat, I figured. Pretty minimal learning curve. Inject a little PPD under the skin, it makes a tiny bubble, read it a few days later. Easy peasy.

Only when I showed up for my shift I realized it was Thursday. Vaccine day. Not PPD day. Hmmm. Ok, so I really don't know how to give IM injections... but again, I figured... how hard can it be? HepA/B twinrix and the seasonal flu shot. I quickly scanned the IM injection protocol flyer. Ok. Deltoid region. Clean the area and give a little poke. No sweat.

The first guy wanted both Twinrix and the flu shot. I tried to act like I knew exactly what I was doing so I didn't make the patient nervous. The seasonal flu vaccine went right in. "Hmmmph." I thought triumphantly. I am a total pro. I proceeded to inject the Twinrix exactly the same way in his opposite arm. Only this time, I swear to GOD the needle bounced off his arm like a basketball. I was so surprised I didn't know what to say.... so I just pretended like it didn't happen and used a little more force to pierce through this leathery skin. Eventually he made a sucking sound and a "wooo-hee, that hurt". I just shook my head like I completely understood cause it happens all the time and said, "Yeah, those Hep vaccines aren't for babies!"

First Time Being a Rockstar

Yesterday I went to visit my preceptor, the bariatric surgeon. One of his patients was having what they thought were complications from a procedure... so he sent her over to the ER. She had a gastric bypass 10 years ago... then a resectioning about 6 months ago. She started having complications so they put in a stent and a drain on the mid-axillary line. But that was a couple months ago. Today, the patient's chief complaint was that she was having increasing pain on inspiration, and the docs were thinking that possibly the stent slipped... or maybe she had an infection where the drain was.

When we visited the patient, the drain seemed to be ok. No obvious signs of infection, no pus, no fluid accumulation. Also the Chest Xray showed the stent was in place. So the doc was basically planning on waiting for the lab results and CT scan to come in.

So then my preceptor says to me "Do you have any questions you'd like to ask, doctor?" (LOVE it, by the way, when I get called doctor)

Which I did. So I asked the patient if she was having simply pain on inspiration... or if she was also having trouble catching her breath. She thought about it and said both. Which started recently. I suggested that she might have pneumonia. To which the doc said... "Maybe"

Before I left the doc said to call tomorrow for the results. I called today and he'd left me a message. I was right. Pneumonia. YAY!!!!! Well... yay for me not her.

Oh... so phe-nom-enal!!!

So I've seen patients in the past. Fake patients faking it. Fake patients with real scenarios. Observed real patients. But today, TODAY I had my OWN REAL PATIENTS.... with real diseases!!! It was awesome.

I work at a free community clinic started by medical students from my school several years ago. Essentially there are tons of medical students and 1 or 2 attendings supervising everything. First year medical students take on the role of 3rd years, and 3rd year medical school students take on the role of the resident. We work up the patient and present it to the attending... who just happened to be Dr. Kenton-Hadley. She's basically my idol (except for Carrie Bradshaw and Carla Bruni of course)... and I want to be her. Am I obsessed? Definitely. I don't think she's acutely aware of my obsession... unless she noticed that I was hyperventilating while I presented my cases to her. More on Dr. Kenton-Hadley later.

I had two patients today. One had gout. The other was not happy about what she suspected to be a possible pregnancy. She was pregnant. And I told her. (well sort of... through a translator bc she didn't speak English). All in all, it was awesome.

Not going to lie though, paperwork sucks. Guess I better get used to it.

That Feeling of Powerlessness....

If you asked my a year ago, I probably would of never guessed that I would ever feel this affected by the reality of powerlessness that physicians face. I probably would have brushed it off, and thought that it was just physician's egos getting in the way of reality... physicians trying to play god and not accepting the limitations of science and humanity.

But I had my first dose of powerlessness yesterday. The feeling that I have no good advice, no plan, no alternatives, and that I couldn't help a patient get better. No matter HOW much they were willing to help themselves.

Yesterday my group participated in the simulated case review of a patient. Only this time we had a "real" patient (standardized patient actor) in the room with us. 10 students, 1 SP, and our professor. The case (based off a real case from 10 years ago), was a 20 year old female, presenting to the surgery clinic with blood in her stool for the past 6 months and increasing fatigue. No other signs or symptoms, no associated pain, no blood in vomitus, no history of fever, alcoholism, etc. So we did all the normal stuff, CBC, stool analysis, urinalysis, the eventually a Chest Xray, EKG, and onto a sigmoidoscopy and colonoscopy. Turns out she has familial adenomatous polyposis... a genetic condition in which part of the intestines (in this case the large intestine) gets covered with hundreds of little sac-like polyps. These polyps are essentially just tissue growths, and while many or most may be benign, some of the polyps will most certainly become cancerous over time. Treatment options are pretty much nil (no drugs, no removal of the polyps)... so we had to tell her that she could either... 1) opt to do nothing and hope she doesn't die... not exactly appealing. Or 2) opt for surgical removal of her entire colon, thus requiring that she use an ileostomy bag for the rest of her life (a "poop" bag that hangs outside the body, that you must empty instead of passing feces through the rectum). Clearly... neither of the options were good.

As a group we had to break the news to her through one person we selected as a moderator. Frankly, I wouldn't have wanted to be him. I don't know his background, but I'm guessing this was his first time breaking horrible news to a patient... and he had to do it in front of all of us and our professor. Truthfully, he did a damn good job. Or maybe it just seemed that way since I was so relieved that I didn't have to do it. But you could hear every one of our hearts thumping through our short white coats.

It was really surreal... imagining a 20 year old coming in because she was concerned about blood in her stool and a little fatigue. And now her life is different forever. My pulse raced as I thought about how I would feel if it were me.... and all the things that I would eventually have to deal with and think about. Would it be painful? A poop bag? Would it smell? Would it leak? Could I swim? Would I be stuck wearing bulky clothes to cover it up? I guess my future wouldn't include any spontaneous sexual encounters with some hot guy I barely know. Would I even want to have sex? Would anyone ever want to have sex with ME? With an ileostomy bag? And what about changing my diet? And going to the doctor regularly forever.

Everything changed for her in just one doctors visit. Which certainly begs the question.... what if she simply ignored the signs and never went to the doctor? Is there a chance that she wouldn't have developed any more complications? That she would have lived a long life blissfully ignorant of her condition? Perhaps. Most likely the cancerous cells would have invaded some other important organ and she would have died at an early age.... perhaps suddenly, perhaps painfully.

First Day as a Real (Fake) Doctor

As my young classmates like to say "today I felt like a BAMF"... (apparently ?) a bad ass mother fucker. Yes, folks, I got to wear my white coat for the first time today for a PBL (problem based learning session) and for clinical practice in the standardized patient clinic. The clinic is set up as a floor in one of our buildings which looks like a real clinic (it does, really). There are real clinic rooms and "standardized" patients (meaning actors that present with a set of symptoms for us to practice on). Once we complete our history, exam, etc. the actors break role and give us feedback on our performance. It is also videotaped for evaluation. It was fun. I had a woman with a "cold" so they started me out easy... but I'm sure it will get more involved over time.

For the PBL session, we get together in a small group with a professor who gives us a case. Then we review it, discuss it, and give a differential diagnosis.

Overall a pretty cool day... because getting back to the BAMF part... Now on my first day of school the faculty warned us that our community now (immediately, today) views us as doctors. The general community makes little distinction between short coats, long coats, students, residents, interns, attendings, whatever. For all intents and purposes YOU ARE A DOCTOR... SO ACT LIKE ONE. Yada yada we all laughed and nodded... but essentially blew it off.

But today. TODAY, I felt it. It's a weird thing. Something like a mix of respect, or power, or something rather indescribable. I got into an elevator with three gorgeous "put together" women in suits. I was wearing my white coat. And they were staring. And smiling. Normally a bunch of beautiful women wouldn't even look at me. Why would they? I'm just an "average" woman in an elevator. Odd. Then I drove downstairs and a female doctor in a white coat waved to me. Another anomaly that I'd never experienced before. Then (just for kicks and to continue my experiment) I wore my coat into a little store by my house. Ahead of me was an urban mom, who looked like one of those "power mom" kinda chicks. You know the well dressed flashy kind that always has somewhere to be, and speaks a little too loud when she talks to her children in public? So she was ahead of me in line with her three kids. And she was actually "flustered". At one point, she looked at me in the middle of her transaction and said "Do you want to just go ahead, I'm sure you are really busy and have to be somewhere". I almost fainted in front of the cupcake display, I swear. I politely told her to please take her time, I wasn't in a rush.

Now please don't misread why I am writing this. It isn't about power, or getting privileges, or being better. But these are three things that have NEVER happened to me before... and then all three occur on the first day I wore my coat.

This must be what the deans meant during the white coat ceremony, when they spent 2 hours discussing the great responsibility that occurs with wearing the white coat. Holy smokes, I'll take it.

20 Things Happening in My Brain... and None of them Good

1. Did I do this just to prove that I COULD make it?

2. Do I not deserve to be here?

3. Did I try to manipulate fate by trying so hard to get into med school?

4. Can I even do anything else with my life at this point?

5. Did I waste my 20's trying to prove that I was good enough to be a doctor?

6. I don't know how to memorize this many structures

7. Can I make it?

8. I can't make it

9. No one else seems to be freaking out

10. I'm too old for this

11. I should have had babies and started an organic farm, made jam and grown herbs

12. I am so tired

13. I am so tired

14. My brain is stuffed

15. I AM studying, dammit

16. When is the refund/withdrawal date?

17. Am I the dumbest one here?

18. I am so tired

19. Two more weeks before the first block exam

20. How many fucking things can possibly be in an arm?

Anatomy. They don't call it gross for nothin'

I knew it was going to be bad. But I'd been trying to Buddha Zen Meditate Woosah myself into believing it wouldn't be so bad for weeks. I expected to feel kinda grossed out... but assumed I'd get over it quickly.

So we get the tank and everybody places bets on whether we have a male or female. Losers buy the winners drinks. I call female and we win. Yay! Best part of the experience is over.

So we have an old lady. Nice little old lady I'm sure. But upon the first few cuts we realize she has a lot of fat. Everywhere. She doesn't seem too fat, but there is fat piling up everywhere. We're starting with the back muscles, and one girl is dissecting the left side. And folks, she is REALLY into this. She is literally flinging cadaver slop everywhere... and I have to ask her several times not to fling on me. She actually has a piece on her face!!! And its all over her scrubs, and she is pushing her hair out of her face with her gloves. I was traumatized.

And did I mention the smell? I guess I don't have to. I'm sure you can imagine. Well, to say the least I didn't cut very much... I tried to... but I think it's going to take me a little while to get used to all of this. At one point I must have looked like I was going to pass out, because everybody looked really nervous and kept asking me if I wanted to sit down. I must have been green because I wasn't actually saying anything.

Well, I guess I'll have 3 labs per week until Thanksgiving to get over it. One down, like 65 to go. Crap.

A Wonderful, Wonderful Day!

So today was the day! My White Coat Ceremony. My family came into town and we made a weekend out of it. Yesterday I took a bus tour around the city to see six different community health clinics and centers that we will be working at... then I met my family (and everyone else's family) at the city park for a beautiful summer BBQ. The food was great, and I got to introduce my family to the Deans as well as to southern pulled pork sandwiches.

Then today we met up extra early for breakfast (I actually succeeded in not spilling coffee all over my outfit)... then headed over to the Hilton for the ceremony.

It was nice overall, but the Dean unexpectedly asked us to say one word that describes what brought us to this university to study medicine. Everybody was kinda freaked out, because the people ahead kept taking all the words. There are a lot of words in the english dictionary, but today I swear there were only about 80. Everyone ahead of me took my ideas... Adventure, Humanity, Exploration, so when it got to my turn I settled on Discovery. What other words did I hear? Caffeine, Luck, Stick-to-it-ive-ness, Bribes (?), and of course, Mom. I also got my white coat, which despite actually going in to try the sizes I somehow got stuck with a Medium (which I ordered) which I KNOW was actually an XXL (which I DID NOT order), and I was swimming in it. However, along with my white coat, I got an unexpected fabulous present. A Littman Stethescope... everyone got one as a surprise from the alumni association. Can you say A-W-E-S-O-M-E????? I was so excited during the ceremony that I could barely keep from bursting into tears of excitement.

Then after we went to lunch, and had so much fun. They still have 25 cent martinis... and needless to say we got a little silly with my parents and ate massive amounts of bread pudding.

White coat ceremony.... can't be beat!

Wired like a Xmas present from the Unibomber

Can't sleep, can''t sleep. Tomorrow is my first day of orientation... going to meet all my future classmates, meet the instructors, see the school.... OH MY GOD!! The facebook page for my class is lit up with all the insomniacs with the same problem.

Some of my friends who've been accepted to med school were like "oh, my acceptance was so anticlimactic" or "the novelty wears off soon". BS ! Since I was accepted almost a year ago I have become increasingly more and more excited. Tonight I am so excited I made chocolate chip cookies to celebrate and was so excited I forgot them in the oven. Ha! My boyfriend just shook his head and suggested that I get it together before I start medical school.

Getting Close...

I'm so excited today... This week my mom was in town and she bought me my first scrubs. Thanks Mom and Dad. So awesome!