Sunday, January 31, 2010

Homey home home

Decided to go home to the 'rents' today. Was planning on making an early start, but my internal clock is all messed up thanks to my week of night call. So, instead of waking up @ 9am, like a good little boy, I didn't rouse until 1pmish. And to make matters worse, I missed my oil change appointment. GRRRR! Now I have to wait one more week to get this done. My poor Mahal (my car) needs some upkeep, bad.

On another note, my mother, bless her soul, is reliving her version of a medical nightmare... lemme 'splain.
She used to suffer from terrible trigeminal neuralgia...so bad in fact, that the slightest touch on her face would send her into agony. She would have good and bad days, and when they're bad...they put her down good (nausea, vomiting, and intractable pain). She was prescribed lots of drugs: from TCAs to various anti-epileptics, to no avail. Either she'd have rebound pain or the side-effects would be too much for her. So a few years ago, she decided to have Gamma Knife Surgery @ a prestigious NYC hospital, for which she paid a hefty sum of money, out of pocket I might add, since this type of procedure is not covered by normal health insurance...it worked. For 3 years, it worked.
Fast forward to now. She's been having bad bouts of TN and had to resort back to her meds, which zonk her out, preventing her from functioning during the day. Taking it at night is an option, but come morning, the effects wear off and she spends the rest of the day in pain. So, seeing that GK surgery was unsuccessful at permanently keeping her pain-free, and the drugs don't seem to work for her either...I have suggested that my mother see an Osteopath (DO) for some Craniosacral treatment. Being that I'm a soon-to-be DO, I want to see how this treatment, developed by my predecessors, stacks up to my mom's disease process and to prove or disprove (to myself) the validity of said treatment. We've explored all other non-invasive procedures. I hope this one takes, otherwise...it may be another expensive dose of GKS or worse, the real knife surgery.

Song of the day: "The Drugs Don't Work" - Ben Harper

Saturday, January 30, 2010

Conflicted

Is it wrong for me to hate Wegman's but love it at the same time?

Song of the day: "Cartoons and Forever Plans" - Maria Taylor

BTW, This is the type of doctor I want to be =)

Friday, January 29, 2010

4th day

Surgery day 4
6pm - New day, new resident. I didn't get to follow up on the patients I was with yesterday. I hope they're doing well after surgery.

8pm - Today was all about management. For the most part, the resident and I spent a good deal of the night trying to maintain people's blood pressures and hemoglobin counts until the next morning, where other surgeons can come in and eventually work on them if need be. So the night wasn't too crazy, but still we kept people from tanking, which is a very good thing.

My resident tonight was very cool. He started out as a flight doc for the air force, but wanted to be an ENT, so he had to go back and do a surgical residency, which set him back a few extra years. He's a family man and very easy going. He likes to teach and all the nursing staff seem to adore him. On the way to a call from another hospital, we were blaring Boston on his CD player! Heck, when we got there, my resident even ended up singing a country duet with the patient while he got blood and fluids. Did not expect to see that at all. So apparently not all surgical residents are bitter SOB's.

At around 4:30am, The resident and I caught a break and finally got a half-hour nap before radiology review @ 6am.

All in all a decent 4th day. Now I'm pooped and ready for a nice nappy nap. See you later.

Song of the day: "Submarine Symphonika" - The Submarines

Something New

Surgery day 3
6:30pm - Today was busy. Real busy. Started out with attending to a few patients in the ER. 1st was a middle-aged lady with a 3cm abscess on her left breast which needed some I&D (incision and drainage). She was a diabetic and her sugars have been running unchecked for a while. She was worried it was something more serious, like breast cancer, but luckily it wasn't. Nice way to start an evening with the resident, with a little procedure.

9pm - The evening continued on at another hospital...as my resident gets a call from another facility she was covering. So we take a ride to the town next door and check out another ER case. Another middle-aged lady, this time she's having nausea and some vomiting with abdominal pain for the past 3 days + a history of chronic constipation. Her belly was getting pretty distended and after further imaging/testing, it was decided that she needed surgery to decompress her abdomen, fast! So the surgeon and the resident allow me to scrub in with them. Mind you this is my first time scrubbing in, so I have no idea as to what to do nor do I have any clue about the dos and don'ts inside the surgical suite. I felt like a bull in a china shop.
Remember when I told you that surgery people are mean (see Jan 24th blog)...well this was not the case. The scrub nurse was very eager to teach and she guided me pretty well with scrubbing, gowning up, and keeping myself from messing up the sterile field. The surgeon was very cool and he let me assist as much as possible.

12am-ish - This ain't no cadaver. Everything about this is so different from anatomy class. Everything was so...Fresh! 1st incision was made, from the suprapubic, up around the umbilicus to the halfway mark between the xiphoid and the bellybutton...a straight vertical line going down the belly. Soon after, I was wrist deep in intestines, suctioning, retracting, and cutting sutures. At one point, I got fixated on the small bowel doing its peristaltic action (way cool).

2am - after much exploration and looking through every nook and cranny of that poor lady's bowels, we finally figured out what was causing this poor woman's belly pain...a small perforation, about a millimeter in diameter, located in her sigmoid was releasing fecal material in her peritoneum and this was making all sorts of abscesses all over her guts. We irrigated and washed all of her bowels for what seemed like forever. The woman got a hemicolectomy (the portion of the perf-ed bowel was removed) and the open end of the large bowel was made into a colostomy.

3am - Once the colostomy was in place, we began decompression immediately. There was no way we can put this woman's guts back inside because she was so full of S*%#! This was the REALLY MESSY AND GROSS PART. I'll save you the gory details save for one...the surgeon was milking and squeezing the large bowel like a giant tube of toothpaste. You can fill in the rest of the details yourselves (or not).

4:30am - The surgeon was finally satisfied that everything looked clean, that there was no more bleeding, and the ostomy was in place, so we finally closed her up. It was pretty impressive to watch both the surgeon and resident truss up the patient like a stuffed bird, as blunt as it may sound. But they did a very good job. The patient was brought out of anesthesia and was sent to recovery with no other issues at that time.

5:30am - My back hurts. My feet hurt even more. After that surgery, there was another emergent appendectomy that I got to scrub in on too. This time the surgery was done with a laparoscope so it wasn't too traumatic (only 4 dime-sized holes were needed). I got to hold the fiberoptic scope as the surgeon removed this thumb-sized appendix with pincers and cautery tools. The whole procedure took about 45 minutes. And the patient did well.

And so goes my 3rd day in surgery. Way cool.

Song of the day: "Jungle Drum" - Emiliana Torrini

Wednesday, January 27, 2010

Cut, cut...slice, slice

Surgery day 1
15 minutes late for orientation. Starting out real swell...
The Chief attending surgeon outlined what it takes to honor the rotation...in a nutshell, I'd have to be a soft-spoken genius/a subtle brown-noser extraordinaire/a dogged army private/a profssional slave...and to top it all off, I'd have to like it and ask for more of it.
Lovely.

Surgery day 2
I have night call from Tuesday to Friday for this week only (6p-6a). Mind you, this is followed by a lecture series from 6-9am...
So far, my ID badge won't let me get OR scrubs from the dispensing machine so that made me late. Again. Thankfully, another doctor (Anesthesiologist) was nice enough to pity me and loaned me a clean pair from his own batch! Also, my resident for tonight is a sweetheart and a half. She gave me an early break so I decided to hole up in the on-call room and study.

10pm - Hungry. My stomach is growling and I finished my 4th granola bar. The cafeteria is closed and I can't leave yet! I need protein. Or a tasty Greek salad (grape leaves, olives, feta, chicken...nummy...best stop before I faint).

So if all is quiet tonight, perhaps I can get some shut-eye before morning rounds and a 3 hour lecture series that's sure to titillate the mind...hurray...

Tonight's tunage is brought to you by the sassy Ms. Single and Picky. Enjoy!

Song of the day: "Why Try To Change Me Now" - Fiona Apple

Monday, January 25, 2010

Arghhhh!

So I have surgery rotations tomorrow...AND I CAN'T SLEEP!

Figures.

Multiple songs of the day (random tunes heard on the radio that made my commute home today a hell of a lot better):
1. Valentin Sylvestrov (Composer)


2. "You Send Me" - Sam Cooke


3. "Lisztomania" - Phoenix


4. "Drop It Like It's Hot" - Snoop Dogg + Pharrell Williams


5. "Kick Drum Heart" - The Avett Brothers

Sunday, January 24, 2010

Mack the knife

So, it's goodbye Internal Med, Hello Surgery.
It was fun while it lasted. I hope I did well in my exam...

I was prepped tonight over sushi by friends that being in surgery is a practice of patience, endurance, and ninjitsu (art of invisibility). It seems that a good deal of the surgical residents and attendings are douches (and that term is used in the most endearing way). They make you come in at 5:30AM, they make you stand for hours on end, they don't give you lunch breaks, they deny you catered food from their meetings (vs. Internal med docs who are nice and quite willing to share the catered goodness), and they treat you as if you're a lackey who is undeserving of their respect. Apparently these people are likened to the prototypical petty high school jocks and socialites who are highly prone to back-stabbing and trash-talking.

One must be blind, deaf, and mute to survive in such a rotation, so they say. Avoid the drama, if I can...but keep eyes and ears open for potential blog topics on this rotation. Wish me luck.

Hmmm...six weeks of this? At least I get to wear comfy scrubs.

Song of the day: "Slow New York" - Richard Julian

Friday, January 22, 2010

Moving right along

One of the few memories I take with me (for better or worse) as my Internal med rotation comes to a close is the story of Mrs. ___.

Mrs. ___, a 68 yo F. patient of mine a few weeks ago during my inpatient IM rotation is in the hospital for worsening SOB (that's Shortness Of Breath ;-)).

She claims that she was a stripper during her heyday and insists on sleeping buck-nekked underneath her covers hoping that her other "cute" doctor would examine her thoroughly!

Sure enough, after the morning labs came out, my attending sends me and another intern to her room to do a rectal exam on her (to check for occult blood).

Needless to say, it was quite disturbing for me...and my intern.
And the kicker was, after I finished the exam, she proceeded to thank me for it...and with a smile!

Never really thought that rectal exams warranted a thank you. What disturbs me is that I don't know if Mrs. ___ was being appreciative or inappropriate or both.

Sorry if this post sounds uncouth. Still, the humor of this situation wasn't lost to either my attending, her resident or my other fellow students. They just love bringing it up from time to time.

Hey, I didn't exactly say that this memory was all rainbows and bubblegums.

And on that note, I take my leave and wish all my colleagues taking the IM SHELF exam tomorrow the best of luck.

Song of the day: "Healing Hands" - Citizen Cope

Wednesday, January 20, 2010

Say What?!

A girl I had a massive crush on a few years ago, made a matter-of-fact comment about a song on the radio while I was driving her home from dinner. What she said absolutely floored me at the time (it was amazing that I didn't get into an accident, but I digress). The same song was on the radio tonight and I got all deja vu-ey.

Picture this...
End of a long, long day, and the one that you're pining for has nothing but smiles for you as the two of you lazily talk about nothing over a heap of disco fries and grilled cheese sandwiches.

Next thing you know, it's almost 11pm.

So you take her home and pop in the CD in the player to make the ride extra nice.

It's the Shins, playing "Caring is Creepy."

You stop at a red light and you just see her grinning mischievously under the streetlamp light.

You ask "penny for your thoughts?" (You're a sap when it comes to classic movie quotes, btw).

She doesn't say, but keeps on grinning. You figure, she's having fun, so you let it go at that.

You get to her house and just before she steps out of the car, she says "You know that song "Caring is Creepy"? I think that's a "Fuck Me!" song. Yep. That's my "Fuck Me!" song."

She winks, then kisses you on the cheek, then heads for the doorway. She blows you a kiss for the road, smiles once more then heads inside the house.

All the while you're head is reeling, questioning whether she was messing with you something harsh or was dropping a crazy-serious hint. Your cheek, memorizing the feel, the smell of her kiss. WTF.

Since then, I've discovered other songs with the same "Fuck Me!" quality as did that Shins song back then. These may be potential points of contention with you, but it would sure make for interesting conversation.

The list is as follows (in no particular order):
* "Vancouver" - Jeff Buckley
* "Let It Be Me" - Ray LaMontagne
* "Clap Hands" - Tom Waits
* "Watching The Detectives" - Elvis Costello
* "Searching For The Satellites" - Bleu
* "Gold Lion" - Yeah Yeah Yeahs
* "How Does It Feel" - D'Angelo
* "L'amour Ne Dure Pas Toujours" - Feist
* "Love And Happiness" - Al Green
* "Me And Mrs. Jones" - Billy Paul

These are just off the top of my head. Feel free to add. This would make for a crazy setlist.

Song of the day: "Caring Is Creepy" - The Shins

Thursday, January 14, 2010

Stating the obvious

Normally I have a very prodigious amount of patience for patients. I'll sit there and shoot the shit with them even though there are time constraints with their office visits. The stories they tell are amazing and everyone of them, priceless. The patients themselves seem to appreciate the banter and it makes their visit a little less stressful. Today, however, I could feel my blood pressure rapidly reaching critical, because of them.

How, you ask, did they manage to get under my usually tough outer shell?

4 words: "Why aren't you married?"

It's all together sad when all I can say was "I wish I knew..."

I must've been asked this at least a dozen times before quitting time today. I was clenching my teeth so much, I think I developed TMJ disease after all of that nonsense. Sometimes the questioning doesn't end there. Some patients like to probe a little more and make mindless suggestions like "maybe you should try those internet sites" or "I got a niece that would be perfect for you."

Sometimes I think that the doctors that precept my rotation judge me on my bachelorhood as well. They always seem so surprised after they ask when I tell them my age and that I'm single. It's even worse when there are other people around me who are my age or younger and they are already married and/or have kids of their own. Somehow, the comparisons are made automatically, but in the most "tactful" of senses, of course.

Then they end with, "Well, you're going to be a doctor soon. You'll find the right one, eventually."

It's quite demoralizing, really. It's gotten so bad that at one point, I was compelled to lie about my age just so I can dodge their judgmental questions. To me, it sounds as if they are implying my becoming a doctor is the only redeeming quality and selling point at this point in my life.

Can't I have at least a tiny iota of slack on this subject? Yes, I am getting older, but the church ain't goin' nowhere, either. And if I knew why I'm still single, we wouldn't be having this conversation in the first place anyways. I'm not that lucky like the rest of America's wedded sons and daughters are, but that doesn't mean that I'm broken. I'm 29 and single...and there's nothing wrong with that.

Give it a rest. Get a life and move on.

Song of the day: "You Don't Know Me" - Ben Folds feat. Regina Spektor

Tuesday, January 12, 2010

Bienvenue!


Say hello to Babe, my new Uke. Behind her is her lovely friend, Jolene! I got Babe this past Christmas thanks to my bro. She's a dream to play and she sounds so sweet. I <3 Babe =). I <3 Jolene too (just in case she gets jealous)! Jolene is my first guitar and we've been through a lot together. Song of the day: "Charlie Darwin" - The Low Anthem

Thursday, January 7, 2010

To sleep, perchance...

Last night, I dreamed that Paris and LA (Marina del Rey) were sandwiched together. It was 3 in the morning and I was on a wooden bridge overlooking one of the canals. In the distance, a few lamp lights were still burning in the windows. Who knows why those sleepless ones were awake. Perhaps we were sharing the same dream together and they were looking back at me. The night sky was littered with stars and the summer moon made the bay waters shimmer with every rhythm of ebb and flow. I had an overwhelming sense of nostalgia as I stood there on the bridge and took the scene in. Warmly and sweetly, the pacific breeze carried the scent of eucalyptus leaves and rain on its back and I was hypnotized.
I wasn't alone. A girl tapped me on the shoulder and brought me back from my deep musing. It was Rachael Yamagata, and she looked sad. She said "I think you need this more than I do" and she motioned to hang something on my head as if placing a hat or a crown. There was nothing there, but somehow, whatever she placed on my head made me feel lighter, as if more at ease. Then she asked me, "Now that you feel better, can you do something about the music?"
"It's depressing, I know," I said sheepishly. I ran to my bookbag on the bench and fished out a yellow plastic bag filled with CDs. I took out a John Coltrane album and gave it to her.
"Much better." She replied, then kindly smiled and kissed me on the forehead. I went to the CD player and stopped the sad-playing song. Hers.

Then my alarm startled the crap out of me and I almost fell out of bed.

Song of the day: "Elephants" - Rachael Yamagata