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July 28th, 2009
08:47 pm - Updates
A couple of updates from me . . .
Andrew Alexander Gomez is due Dec 2. Yes, it's a boy. He's started to kick, and I'm definately showing, so it's becoming a lot more real. The nausea is improved, but not completely gone. I've started to get swollen ankles if I don't wear compression stockings. Also find I need to go to the bathroom a lot more lately . . .
I intend to do the nursery in green, with turtles (which is harder than I thought it would be, given I'm avoiding frogs at the same time). Anyone seen the paint commercial, where the parents are painting the room "Spring Meadow," and it's supposed to be calming, and the wild kids sit right down and start reading when they run into the room? That's the green that I'm going for. Melissa is just about moved out of her room, which will be the nursery, and Victor is moved in all over the place at the moment. Honestly, I'm having stress dreams about organizing and baby-proofing the place.
Also, I was named Intern of the Year, out of our class of sixteen. Comes with a plaque and everything. Now I'm shooting for Chief Resident . . .
Tomorrow I'm headed to Kansas City for the National Family Medicine Conference, which is attended by all the residency programs and tons of medical students. I'm going as the FAFP rep for the program and as a member of the recruitment committee. Recruitment at a booth, sure, why not. Socializing is not my strong point, so I'll have to work on that. Also working on an 80's themed outfit for the one of the social events. Really? The 80's? Fortunately Melissa happens to own a pair of leg warmers and some jelly bracelets. I went out and bought a bottle of hair spray, and I intend to use the whole thing. I tried putting my hair into a side ponytail without any, and it was really pathetic looking.
Victor has officially moved to Orlando, and is jobless for the time-being. He took off for a week in Chicago almost as soon as he got here, so we haven't actually had to deal with each other on a daily basis yet. Honestly, I can't wait. He's planning on working for Habitat for Humanity to build some contacts and some local experience, and maybe get into real estate investing (urgh). He's also planning on staying home with the baby (his idea, I swear!). Given he hates getting dirty and finds body fluids repulsive, I'm very interested in seeing how this works out.
Jane is walking all over, and is starting to climb. She claps and dances some to music. She also can do this adorable thing where she puts her fists to her chubby cheeks in a "aren't I cute?" gesture. She isn't really talking yet, but we are counting "whoa" as her first word. She uses it in context! She can also sing "row, row, row," but she sings that for almost any song these days. So, still utterly adorable. Don't know how Andrew will manage to outdo her, but I firmly expect that he will. I know he'll win in the hair department. Jane isn't bald anymore, but she still doesn't have much to speak of.
I just finished a month of night float, which was actually a lot of fun, at least for the first three weeks. I liked the independence I had, and the lack of rounding definately helped. I liked my week on OB more than I thought I would. The C-sections weren't as bad as I thought it would be, I got three continuity deliveries during that time which was nice, and actually had a bit of fun problem solving and working with the attendings, who were more available than I thought they would be. Medicine was nice because I got to seriously focus on the assessment and plan portion (no dictations! yay for being a senior!) and be very thorough, which was a nice stretch. I also liked making decisions without always having to check with someone. Most of the time I wouldn't chief with the attendings, since I didn't want to wake them up for stupid things. I had three patients start to crash on me, two going septic, and have to be transferred to the ICU. That was a bit more nerve wracking, but a good experience. A bit scary when the decision comes down to you, but rewarding when I figure out that I made the right decisions.
Okay, I think that's about it. My sleep schedule still hasn't recovered, so I'm trying to adjust things so I'm not awake at 3am and dying to go to bed at 4pm. Have a nice weekend!
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June 7th, 2009
09:54 pm
I have no idea how long it's been since I last posted here. I do pop in to catch up on friend's posts every now and then. So, what's been going on with me . . .
I'm pregnant! 14 weeks and 4 days, to be exact. 5.5 weeks before I can learn if it's a boy or girl. I've been nauseated pretty much since I learned I was pregnant, which has been . . . interesting. I also have nasty heartburn and have developed gastritis, which is painful. The fatigue is better, which is nice. I'm still kind of early, but I don't fit my normal pants any more, so I had to go buy maternity clothes already. I'm going to have to go up in scrub pant sizes soon, I think. Basically, don't think I'm glowing yet. There is another intern who's 5 weeks behind me, and we comiserate about the side effects of pregnancy. At least I wanted to get pregnant this year--she was caught by surprise and I don't think it's quite sunk in yet.
In good news, Victor will be moving down from Jacksonville soon. He's going to be quitting his job, since there isn't any branch for him to transfer to down here. Although the evil boss, who's fired everyone on the original team except Victor, and has managed to get fired quite a few people who don't even work for him, loves Victor so much that he tried to get him transfered to keep him in the company. (I think either it means Victor is spectacular at him job, or he has incriminating photographs of this guy.) He's looking into getting in real estate, working for Habitat for Humanity, and eventually being a stay at home dad. I tell people that and the kind of laugh and ask how long I think that's going to last. I respond by pointing out that he's the one who thinks it's important for one of us to be the ones staying home with the kid (as opposed to getting a nanny), and there is no way I can stay home (I go nuts on a two week vacation), so it's his idea. Anyway, it'll be nice to have him in town.
As for work . . . I'm in my last month of internship! Definately looking forward to less call. I'm on my emergency rotation, which is pretty light comparetively. I have a bunch of OB call, but I'm feeling a lot more relaxed about that since my second month of experience. Plus, my first two calls are basically baby-sitting the East resident. For some reason, the DO program doesn't let their residents, who had an OB rotation in medical school, have a medical degree, and are as qualified as any of us are to be real doctors, take call on their own for the first two weeks of the OB rotation. They're supposed to "shadow" us. I wouldn't have a medical student shadow me for two weeks, much less a doctor who's less than a month from becoming a senior. Fortunately, the one on this month is really good about holding the pager. I mostly just have to sign off on his work and check his wet preps. It lets me practice for being a senior myself, which is good because I'm starting out on night float next month, and two of those weeks will be on OB.
I had a good intern year, I think. I got a lot more confident in pediatrics, and I'm getting more confident in OB. I have a pretty cool OB patient right now who I met last week. She's 22 or so, and didn't find out she was pregnant until about 4 months when she went for her physical to join the Navy. Oops. She went to the abortion clinic three times but couldn't go through with it, and is giving her baby up for adoption. I think that's pretty courageous, and I like her. She asked for a run down of the labor process with only a couple minutes left in the visit, so I think I overwhelmed her, but she was happy to hear she could get an epidural when she gets there.
I loved my medicine rotations. The attendings are all great. I'm also doing two research projects. One is a survey about the impact of medical missions on residents, and the other is the incidence of MRSA colonization during residency. We'll see if either turns out to be actually interesting.
My niece is going to turn one this month. She's have a "Super Sweet First Birthday" party in two weeks. She's having a grand entrance, a fancy cake, a surprise performer (her dad is doing a puppet show), and at the end she's getting a car from her parents (Fisher Price, of course). Should be very cute. She is getting more confident in her walking, although she still only takes a few steps at a time. We're not sure if "whoa" is a word, but she has that one down and uses it in context, so we're leaning toward yes. And she is adorable!
I do need to figure out how to incorporate theatre into my life next year. The Shakespeare Company and two community theatres are within walking distance of the hospital, so there's got to be a way to make it work.
I think that's about it for now. That's all the excitement here.
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January 23rd, 2009
03:37 am
I'm on peds right now. Night float, to be specific. Currently, I am bored out of my mind. I love coming to work. I love the challenge, I love discussing (arguing) with attendings, I love working with patients. But this week, I have spent every night up in the call room, trying to find something to watch on the computer (I've watched all of "How I Met Your Mother," "Pushing Daisies," "True Blood," and the most recent season of "Dexter") and I'm BORED!!!!! Plus, I go home in the morning, sleep the whole day, and get up in time to wave bye to my roommate before I go back to work. Ugh. Only one more night of this.
Not to say we haven't had some interesting patients. My first day in clinic last week we had a 14 month old girl come in with a week of easy bruising. Just putting on diapers bruised her. She had a bruise in the top of her mouth from her spoon. She'd falled the day before and given herself a black eye. (Note to parents out there--these are all bad signs--don't wait to bring your kiddies in.) We knew from looking at her that her platelet count was low. The only question was--were her platelets the only cells that were low? Or were they low because her white blood cells had infiltrated her bone marrow, making no room for platelet production or red blood cell production (ie, leukemia)? Her parents knew enough to know leukemia was in the differential. I can in early the next morning to find out what her labs showed. The average person has platelets between 150 and 300. We don't worry about bleeding until the level drops below 50. I recently had a guy leave AMA with platelets of 26 (and I worked hard to get him to stay). Spontaneous bleeding doesn't happen until aroud 15.
This little girl's platelets were 4.
It was the kind of lab that pops up and your first instinct is to run to the room to make sure the kid is still alive.
She was fine, in the end. She had something called "idiopathic thrombocytopenic purpura," which happens following an infectious disease (in her case, the chicken pox) that causes the development of anti-platelet antibodies. Her platelets were being attacked by her own body. Two days of IVIG solved the problem and she went home with platelets of 46, with good follow up. Pretty impressive, and a great lesson.
This morning, Sarah called me because Jane had yellow boogers when she woke up. Jane, in case you don't know, is my niece. She just turned 7 months two days ago. She's adorable. She is sitting up on her own and just learned to crawl. She eats baby food now, and apparently her own snot as well, which I learned when I went over to make sure she was fine (which she was). She does this nose-wrinkle thing that is so cute.
Anyway, hopefully I'll get to see Victor this weekend!
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November 30th, 2008
03:25 am
So, yes it is 3:30 in the morning, and no, I have not slept since I got a 30 min nap around 2pm yesterday afternoon. But I'm way too awake to sleep right now. That, and my pager will go off anytime I get close to falling asleep. Besides, if I stay awake, I can start rounding in 30 minutes.
Anyway, last year I did the play "Patient A," which is about a girl who dies of AIDS. And now I have an AIDS patient dying in the ICU right now. It's not my first AIDS patient, but he's my first patient who is really going downhill. I've had him on a couple of admissions, and happened to be picking up a couple of medicine calls this weekend and he came in again. On the day after Thanksgiving I put a chest tube in him, and tonight he coded and required intubation. I think the most frustrating part, and the saddest part, is that his mother is there every step of the way, and she isn't ready to let go. I mean, neither of them are. It's tough, because he's only 26 years old, and two weeks ago he was pretty normal looking, except for the big Kaposi sarcoma spots all over his face. But then his face started swelling and wouldn't go down, and now he has huge pleural effusions and pulmonary edema and he can't breathe.
"She had yet to experience the final effects of the disease: incontinence, incoherence, the intense pain. But these were coming they knew. She was dying. The only questions was: in how much pain?"
That line keeps running through my head. That and the sad little poetry line from the play as well. He's maxed out on two pressors. He is awake, but even if he recovers, he's just going to keep coming back here over and over until it really is over. Personally, I don't think he's going home this time.
His mom insists that God isn't done with him. Who am I to argue with God? But there are medical facts--you can't live if your lungs are filling with fluid and if you have no blood pressure.
Which brings me to another lady, who I have never admitted before but who is a frequent flier. She came in with difficulty breathing and had to be intubated this morning. Somehow she is still awake although she's maxed out on three pressors and her systolics are in the 50's. Her family insists that she would want everything done, but now she's telling the nurse she just wants pain meds even if it causes her pressure to bottom out and kill her. Her family is telling her to fight. I've spoken with them, and my resident has spoken with them, and we've told them it's very serious, but they seem to think she'll turn the corner. Again, in my opinion, that's extremely unlikely. Her kidneys have shut down. All day, she's produced about 5 ml of urine (that's really bad, by the way). Her bowels are probably dead. She's acidotic to 7.0 after numerous amps of bicarb. Seriously, it's amazing that she's awake and coherent.
Also, I do not want to be left on a vent if I'm in the same position. Give me the meds, let my pressure bottom out, and don't try to revive me.
Although, if she's still alive on Monday, I could drag my reluctant diabetic to her bed side and show her what she has in store if she doesn't take her medications and keep her appointments with me.
Anyway, I'm going to go round on my patients who are still alive. Hey! Some of them will even go home today to live long and fulfilling lives! That's exciting! And then Monday I go back to OB, where at least some of the mothers haven't screwed over their unborn offspring, and sometimes they don't even smoke!
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May 5th, 2008
10:36 pm
I saw "Wicked" on Saturday with Sarah. It was . . . amazing. I left the theatre wondering why I was still in medical school, and shouldn't I drop out to join the theatre? It was magical. Every single note was perfect. The set was fabulous, as were the costumes and the voices. And the lighting. Oh, the lighting. They made it rain on stage with the lights. It was so beautiful. Anyway, I'm seriously drooling over it, and I really am loving the theatre right now. I hope I'll find a way to keep it up during residency. I'll miss it my intern year.
Also, I have FOUR DAYS left in my formal education. 21 years of my life spent in school, and it's really almost over. Whooo!
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April 29th, 2008
11:18 am
So, really quickly, since House was on last night, and we were barely into the second act when I had to yell at the screen--VDRL is KNOWN to be a poor test for syphilis. Honestly, no one orders it any more because it has so many false positives. Lupus causes a false positive VDRL test. That's why all modern medicine docs order an RPR, which actually tests for syphilis. Also, did they not get a subsequent MRI with contrast to find out if the positive syphilis test actually correlated with neurosyphilis? I mean, just because the dude has syphilis doesn't mean it's in the tertiary phase, and even if its in the tertiary phase doesn't mean it's causing neurosyphilis. Way too many holes in it. And seriously, how can I trust House at all if HE didn't know about the VDRL stuff? Honestly, I learned about that as a first year medical student!
Also, while I don't know the answer to this, they already had a neurosyphilis patient. It was an old woman who was sexually inappropriate, and House convinced her to take her penicillin by reassuring her that it WOULDN'T change her personality because the damage was already done. And now they have a whole episode about how the treatment will reverse the personality changes? Do the writers see the old episodes?
EDIT: So, I looked it up. It doesn't take much, really. If the writers bothered to look at Up To Date at all, they would know the treatment is not, in fact, one pill daily for a month, but involves more than one medication or a shot for a few weeks. Also, they would have found that neurosyphilis is usually the cause of irreversible symptoms. Also, they would know that a lumbar puncture is necessary for the diagnosis. Given how often they enjoy sticking patients with needles, you'd think they'd love that opportunity.
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March 25th, 2008
11:18 am
So I should probably post that we had Match Day. I got my first choice, which is Florida Hospital at Orlando! Yay! Melissa and I have already found an apartment we want, and I got a bunch of paper work in the mail yesterday, so scary and exciting as this is, it seems it's actually going to happen.
Staying quite busy. Patient A is being performed next Friday, so lots of rehearsals/preparation for that. Beauty and the Beast is coming along, although I wound up having to do the set almost entirely by myself, so that's been a little bit stressful. The choreography is finally finished, thank goodness.
Sarah is getting hugely pregnant at six months. My start date for orientation is the day before she's due, so I hope she delivers early!
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February 19th, 2008
08:51 pm
From ![[info]](http://l-stat.livejournal.com/img/userinfo.gif) springdove
Here's how it's supposed to work.
-Put your iTunes on shuffle
-Post the first line from the first forty songs that play (no cheating!)
-Strike through the songs when someone guesses correctly.
-You must say the band name and song name for it to count.
-No cheating by looking it up on Google, people!
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February 12th, 2008
02:41 pm
Last Thursday, Victor's mom suffered a stroke. Her heart didn't beat on its own for 35 minutes. Because she did not have a DNR signed at the time, the doctors resusitated her, but she had already suffered severe anoxic injury. Her sons arrived, and the next day a little before 11am she was taken off the respirator and the medications that were keeping her blood pressure up. About 10 minutes later she stopped breathing.
The funeral service is this Saturday, with a viewing Friday evening. Kike and his wife, Esther, are in town for the week. There are a lot of details to work out (and funerals turn out to be very expensive). But the funeral home has been very good. All of her nurses were very kind. This came as quite a shock to my father-in-law, so if you could keep him in your prayers, we'd appreciate it. The rest of us are holding up okay.
Just wanted to let you know.
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February 4th, 2008
02:18 pm
The update on Victor's mom: she completed her chemo, and then developed an infection requiring her to be moved to the ICU last Sunday. Unfortunately, she developed sepsis, which means the infection got into her blood as was affecting her systemically. Currently, she is intubated (a machine is helping her breathe), she has had to undergo dialysis and is still connected to the machine since her kidneys aren't working in order to take off excess fluid, and she is still requiring two vasoconstrictors to keep her blood pressure up. They keep trying to take her off, and wind up having to put her back on. They've tried to wean her off the ventilator, but she had spells of decreased breathing and had to restart it. She is no longer sedated, and she will grimace with pain or movement, but has not woken up. She's supposed to be getting a CT scan today to evaluate for brain damage that would explain why she hasn't woken up. Her liver and kidney suffered from the septic shock, but her lab values are looking better. She has had to receive several platelet transfusions and at least 2 units of packed red blood cells. An ultrasound of her heart shows decreased functioning, although I suspect that may correct itself when her kidneys start working again and she isn't so fluid overloaded. What does this mean? There has been improvement since earlier last week. Her oxygen requirements have decreased, and she's not on continuous dialysis. Her numbers are looking better. Her chest xray is clear. However, she is still requiring medication to keep her blood pressure elevated, she hasn't woken up yet, and she has not been able to come off the ventilator. It's really kind of a draw at this point. She isn't actively dying on us, but she's not exactly making leaps and bounds in recovery either. She had a bone marrow biopsy last week, which will hopefully show that at least the chemo worked. And now it's just about waiting.
So, this week I was supposed to have only three lectures a week and plenty of time to focus on the yearbook and the musical. Instead, I wound up with jury duty and out of 130 people I was one of eight selected for a murder trial. Ugh. It's expected to run three, maybe four days. Ugh. I guess I won't have to worry about wasting my days now.
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January 28th, 2008
08:02 pm
I just got back from Portland. I went to a conference out there for student-run free-clinics. There is so much to do now! Our clinic has run very well for the past 15 years, but it really hasn't changed much in that time. We're still an acute care clinic whose goal is to transition people into the resources provided by the community. From what we heard, we're very lucky. We live in a place were almost all kids are plugged into good health care. We don't have a large undocumented community with pediatrics or geriatrics. We have the We Care program, which provides pro bono services to needy people.
But we also have (or think we have) a decent sized population that treats us as their primary care. These are people who have meet with social workers and either don't qualify or can't afford the options available to them. These are the people with chronic medical conditions like hypertension and asthma who need following.
So basically there is a huge list of things that need to or we want to have happen:
In other news, my sister is having a GIRL!!!!!!!! Jane Avonle Krones. Yay for pink and frilly and all that!
Also, Victor's mom has had a relapse of her AML (leukemia). She was in the hospital last week for chemo, which had to be continuous IV, so she was hospitalized. A known complication is infection, and she's currently in the ICU with sepsis and delirium due to infection. I don't know how she's doing. There is every reason for this to only last a few days, and for her to have a complete recovery when the antibiotics work, but understandably the family is pretty concerned. If you could keep her in your prayers, we'd appreciate it. Thanks!
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January 3rd, 2008
08:00 pm
I start work again on Monday, and I have to say, I'm actually looking forward to it. Six weeks, and I'm ready for a little more routine. Especially a routine that doesn't start until 9 in the morning, and which gives me a lunch break to do choreography for the musical.
I made a WONDERFUL batch of cookies over the Christmas break. I got a recipe for Cream Cheese Sugar Cookies and I tweaked it a little bit, and they turned out as heavenly, very rich, extremely tasty cookies. I'm a sucker for anything chocolate, and as long as they lasted I didn't touch the chocolate chip cookies I also made. Here's the recipe:
1 cup butter, softened
1 (3 ounce) package cream cheese, softened
1 cup white sugar
1 egg yolk
1/2 teaspoon vanilla extract
2-1/2 cups all-purpose flour Directions 1 Preheat oven to 325 degrees F. 2. In a large bowl cream together butter, cream cheese, and sugar until light and fluffy. Beat in egg yolk and vanilla. Stir in flour until well blended. Roll dough into balls and press flat on the cookie sheet.
3. Bake for 15 minutes in preheated oven. Cookies should be pale.
The changes I made were to increase the cream cheese to 4oz and about a tablespoon of lemon juice. Let them cook until the edges have just turned brown. They are delicious!
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December 24th, 2007
12:42 am
I haven't posted in a long time, it seems.
I've finished with the interview trail. Interviewed at Tallahassee, St. Vincent's, Mayo Clinic, Halifax, Florida Hospital, and Gainesville. I liked Tally, Gainesville, and Florida Hospital. Tally is too far away, although everyone there was really nice and it's an excellent program. I love the Gainesville program and almost all of the faculty (though I have to say Dr. Hensley did make it easier by questioning my ability to act independently on my interview day), but Florida Hospital is winning out by a landslide that includes primarily Mom, Dad, Sarah, baby-to-be-named, and Melissa. The program is good, although massive, it's in a place I'm comfortable with, I love the size of their medicine teams (one intern, one senior, and an attending). Plus, they love me there. It's always fun when they drool over your test scores and things like that. I'm going to try to arrange a second look before the holidays end. Melissa and I will be roommates next year, which I'm really excited about. We've never lived together, so either it will be a great experience, or our friendship will be sorely tested. However, I think even if there are problems, we're basically family so we'll work them out.
I also saw Sweeny Todd today! I've been waiting for it forever, it seems like. I've loved the musical since we did it at Stetson. I love the music, and I like the dark story line. I was thrilled with Tim Burton and Johnny Depp took it on. And then Alan Rickman was in the cast . . . It was great. There was quite a bit of squirting blood that may not have been strictly necessary, but the singing was actually quite good, they didn't really cut out a whole lot from the musical, and it was very nicely done. Here's to hoping Snape's exsanguination won't be quite that gory, though! There are two songs I never really stomached in the stage version we did that I liked quite a bit more, and Helena Bonham Carter was a very nice change of pace of Angela Lansbury, although it does take a song to get used to her voice instead of Mrs. Pott's.
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December 2nd, 2007
11:11 pm
It's been nearly a year since I've done any serious writing, and I'm really missing it. Especially since I've had some time to do actual reading for fun lately, and I've been starting "Jonathan Strange and Mr. Norrell," and listening to Artimis Fowel and The Golden Compass (I figured if I was going to talk about it intelligently, I'd better read it). Has anyone else who's read Strange noticed the character Childermass? I mean, I'm only 100 pages in, but seriously, it's more than a little erie. Has the mysterious man with the long greasy hair become some sort of archetype?
I've had two interviews so far, and they've both gone well. Tallahassee was great. I didn't think I would like the program much, but I was pretty impressed. They have a very strong medicine focus, and lots of procedure training, which I like. I didn't like the distance from Victor and that they don't have a whole lot of psychiatry training, but it is a place that I'll be seriously considering. St. Vincent's didn't wow me that much. Part of it, I think, was that they presented such a "laid back" atmosphere. After coming out of the academically intense but friendly TMH, I was disappointed. The location is good, they have a very strong psychiatry focus, along with excellent community involvement and training for being in the real world. They all felt their community was their strongest point. But something about only 10 weeks of medicine in the first year, coupled with a large OB component, and it just didn't click with me.
I have Mayo and Florida Hospital next week. On paper, Mayo sounds good. The thing I'm worried about with them is that they aren't unopposed and they've started losing residency positions to internal medicine. That doesn't speak very well for the program's stability or support from the hospital, I don't think. But I'll have to wait until I meet them. Mayo does sound awfully impressive.
Florida Hospital is my front runner for the moment, with Gainesville mostly due to location. They also sound pretty good on paper, so I'll be looking forward to meeting with them. I'm considering cancelling my interviews in St. Petersburg and Clearwater, since even if they're great programs the location isn't ideal.
The first years I was tutoring have finished the semester! (And I am so glad to be out of the anatomy lab again) One of them has managed to pass everything, and I'm going to call the other one tomorrow because I want to know how he did. I hope he survived, because he's in real danger of having to repeat again next year. I gave them both frog stickers, so if they actually did their magic, it'll be fine!
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November 20th, 2007
07:56 pm
Once again, I find myself mere hours away from a vacation, and my brain has already left the building. Yesterday I tried tutoring for two hours on embryology, and had to apologize profusely for basically just sitting there like a lump and letting him learn it himself. Today at work I was semi-capped (I have admitted six patients, but one is temporarily transfered back to the hospital) so I didn't argue when my resident said I could go home instead of doing the new admit. I'm already hoping they'll send me home tomorrow at 12:00 since it's my last day, and if I'm already capped today, I shouldn't have to do new admits. But we'll see.
And, of course, my brain is also caught up in Beauty and the Beast! We had auditions yesterday and today, and it was a decent showing. A good number of first years showed up, Meera auditioned, and two third years are interested in parts. We have a wonderful voice for Belle, and a great actor and voice for Gaston. We're also really happy with the Beast. Meera is going to be Lumiere. The others are a little unsure at the moment, but we're pretty happy with the cast. The chorus is going to be 7-9 people, which is a great number. I'm helping edit the script, and my mind is churning with ideas for the set, and I'm just hoping I know enough to get it all done.
Plus tomorrow at noon I have Patient A rehearsal, which I'm very excited about.
My interviews start next week! I'm starting to get a little nervous about it. Not super nervous, but just about having to answer questions like, "why are you a good resident," and "what makes you a good doctor," etc.
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November 11th, 2007
12:19 am
My ego took a bruising today. I read through the review the first years gave about me as a TA. I took the criticisms kind of hard the first time I read through them, I have to admit. One said I seemed just as confused as the students about the anatomy. Others said I gave them wrong information and never looked up the right answers. Many of them said I was too quiet in the prosection. One said I quized her when she wasn't ready and felt uncomfortable. A few said I didn't go up to students and offer them help when I should have. Ugh.
On the other had, other students said my prosections were the best ones. Some said I always looked up an answer I didn't know. I was congratulated for spending as much time as needed with students, and that I was always available to answer questions. One person loved that I quized during the prosection. One or two said I always repeated myself when I could be heard.
So I really have to take it all with a grain of salt. Can't please everyone (although, seriously, who gave me a 2/5? Mediocre? Seriously? I was only a mediocre TA to someone?). And what some people hated others liked. I also am not disappointed that they complained I didn't walk up to them and offer to help enough. I decided that they were grown ups, and if they wanted help, I was sitting about five feet away and they could ask. I didn't see any reason to interupt people who seemed perfectly happy doing it on their own. Also, I spent relatively little time wandering the lab. It usually didn't take too long to find someone who actually did have a question or wanted something from me.
The second thing was that I found out for sure that I am not going to be invited to join the Chapman Honor Society. Sigh. I knew I wasn't going to make AOA, the academic honor society. But I thought I stood a decent chance of being invited to join the group that invited people based on community service, professionalism, and humanism in medicine. I mean, Equal Access Clinic and WCC? Sigh. So I won't leave medical school decorated with honors. But that's okay. I'll have my degree, and that's the only thing I need to hang on my wall.
Did I mention that I liked my attending from the Student Heatlh Center? One son is in the GHS marching band, and he serves as the band doctor, going to all the games and competitions, which is awesome. His other son is active in the community theatre scene, and he drives him and picks him up after rehearsals and practices. I totally want to be that kind of doctor. Someone who does good work, and helps people, and then goes home and is totally involved in my kids lives. And I don't need to be AOA or a member of the Chapman Society, or even be loved by everyone to do that!
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November 5th, 2007
12:22 am
I hate these days. I thought, or I hoped, I was past them. You know those days. When you feel fat and friendless and completely impotent in everything you do. Mostly I think I've just been bored. I don't really have any motivation to study. I need to memorize lines, but that's boring to just sit down and do. I need to work on the yearbook, but quite frankly, until we get pictures scanned in at a good quality, that's kind of a moot point. That's just an excuse, by the way. I still need to sort through all of the messages and instructions I've been given to set up the pictures. I tutored today for a couple of hours, and actually managed, I hope, to convince the kid that peritoneum is made of a single layer, not a visceral and parietal layer (honestly, I thought we covered that in block one, but apparently it didn't sink in). The other student I've been tutoring is exhausted and took a well-needed break to go to a concert, but I'm tutoring both of them tomorrow after work. I have four baby blankets to knit. I wanted to go home this weekend, but I had stuff to do here, and I kind of feel like I've overplayed my welcome at home. Not so much with my parents, although maybe, but more with Sarah and Melissa. We'll see what a few weeks away does. Which reminds me that I need to look up ways to prevent a vasovagal episode for Sarah before she has blood drawn again. I wanted to see Victor this weekend, but he was up in Savannah with Spring to see some foreign film festival. I wanted to drive up after I tutored today, but I talked to him and he was going to go to bed early. I miss him a lot right now. Just some company would be nice. I was invited to the Diwali celebration, which I wished I could have gone too, but I got out of tutoring too late. Would have been nice to socialize a bit. I'm looking forward to work mostly because I have new clothes to wear (terrific JC Penny sale on Saturday--I'm still gloating over it). Work is good--I enjoy it, but it's still work. And I have a full five day work week (I know, I know, I hear the world's tiniest violin playing too). I've been working on the crossword puzzles since working with Kim on Dermatology. She's doing an externship that was arranged in record time. Hope we can still hang out some when she gets back and I finish interviews.
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October 29th, 2007
09:00 pm
Today I started my next rotation today, at the Student Health Care Center. My attending is a family medicine doctor. He's pretty quiet, but nice. I get to see patients on my own, and write my own notes that he fiddles with but essentially keeps intact, which is nice. It's like a fun, fluffy clinic. Relatively healthy patients, coming in with sports injuries (which is making me thing that maybe a sports medicine fellowship, even though I don't want to do sports medicine, but it's good for MS injuries), and colds. I missed a case of infectious mononucleosis when I wanted to give her antibiotics. In my defense, she had a significant nasal component, which was confusing. It was actually quite a bit of fun.
WCC had their meeting today! We're doing Beauty and the Beast. Megan is officially taking over the organization, so she's my new best friend. They're also going to do a project in November, reading stories to little kids on the pediatrics floor. I love the idea, and I hope it works out as well as it sounds it will. I volunteered to do sets and choreography for the musical. I'm looking forward to it.
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October 25th, 2007
10:51 pm
So just a couple of things. Scrubs usually gets things right, but the target lesion on Lyme disease is only present something like 30% of the time. There is actually a blood test for it, and that would be a better use of time instead of writing off the disease after a skin search failed to reveal a tick bite.
Secondly, Brugada? I've actually seen a patient with Brugada disease, but it's extremely rare, and I know I wouldn't recognize the EKG changes if they lept up and bit me in the nose. I do know the index of suspicision needs to be very high to suspect it, but I know for a fact that as an intern I will not be making that diagnosis (which means I now need to go review that EKG pattern). Anyway, random.
Why are the doctors advocating for a patient to his wife, insisting that he's changed? They've known the patient all of, what, two hours? And they understand what makes him tick? Not to mention that an addict lies as a part of the disease.
Also, I guessed two of the bacteria common in neonatal sepsis. Should have gotten the third one, but that's not bad. Maybe I'll remember all three next time.
Finally, even if a patient has a heartattack due to cocaine abuse, it's still a heartattack. There was tissue damage. They'd need to be observed, at least over night and possibly longer, to make sure no arrythmias develop and to determine the extent of the damage. Streeting anybody who's had a heart attack sounds like you're begging for trouble. On the other hand, simple angina secondary to cocaine abuse, that may be another story.
Anyway, last day of dermatology is tomorrow. I actually got to do two shave biopsies yesterday, which was a lot of fun. I liked drawing up the lidocaine and injecting it. I felt like I was accomplishing something. I haven't been particularly industrious on this rotation, mostly because I have no responsibility whatsoever. No one asks me to make a diagnosis, pick a treatment, or even interview patients. I've frozen a few things, and the biopsies yesterday but that's it. I do feel a lot more comfortable looking at dark lesions and making a call between benign and malignant, although actinic keratoses will just take a while and basal cell carcinomas remain slightly ellusive. But that's okay. I have a better grasp at least of how to perform a biopsy and when it's appropriate to do a shave versus a punch biopsy. I'm satisfied with it. I'm really looking forward to working at the student health center for the next two weeks, though.
Next week there may be a coup. White Coat Company has failed to actually do their job thus far, which consisted of picking a musical. They were supposed to have that meeting a month ago, but never happened. Meera has been pushing for us to take over the troupe since this summer, and I'm ready to listen to her. It's nearly November, and we need to have auditions soon if there's even going to be a musical. I've made renderings of the set and costumes, and I've watched the movie and listened to the songs. I'm prepared to choreograph everything, run auditions, even make it to enough rehearsals to direct, I think. Meera is ready to write a script. We're going to meet with them next week, we think, and make it clear that they either need to get their act together or we will do it for them. There are five of them. I know they're going to say they're busy, but I don't buy it. Meera and I were busy. Chad and Kyla were busy. We all managed to put on a musical. The Lion King was technically even more impressive than The Wizard of Oz. I'll be disappointed if I take over and it kills The White Coat Company's future, but I think I'll be even sadder if there isn't a musical and I'm a fourth year with the time to run it.
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October 23rd, 2007
04:20 pm
I love how the news articles are referring to "canny" fans who guessed Dumbledore was in love with Grindewald. Honestly! Every single possible pairing has been explored in fan fiction. That the slashers actually got one ship is less an insightful conclusion and more a statistical likelihood. Humph.
I think my frustration is more from Dr. Wesson's incessant talking. A first year was covering a second year clinic, which is hard because she isn't used to seeing that many patients today. Also, so was overbooked (two patients were scheduled at 8:30, another at 8:45, and two more at 9:00, so that's how we started out the morning). And then Dr. Wesson decided to lecture her on the diagnosis of the itchy patient, and then spend twenty minutes talking to the patient, followed by another twenty minutes with a patient with rosacea. I'm all for talking with patients and answering all their questions, but seriously! We were seeing patients with 10:30 appointments at 12:30! Atopic dermatitis and rosacea, while irritating conditions, are not lifethreatening, and when your clinic is stuffed, you shouldn't make the possible basal cell carcinoma patient wait for her biopsy just because you have to list out every single possible treatment for dermatitis and why you don't want them to do most of them!
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