The Waiting Room

Archive for the tag “Health”

Family Med in a Small Town

Today I saw a patient who was a 79 year old retired dairy farmer. Farmers really aren’t a fan of going to the doctors, and they pretty much think they are invincible. For example, his hemoglobin A1C was 10.9 which was excellent for him (the HA1C is a measure of long-term glucose control, normal is between 5-6). It had been as high as 14.7 in the recent past.

Anyway, I introduced myself and asked him how he was doing. He responded with the following:

“Listen kid, I done found myself the Fountain ‘O Youth, okay?”

“How so?” I asked, slightly bewildered.

“You know, I worked on a dairy farm for 50 some years, and I’m Italian. So I says to myself, ‘Them old Italians, they used to drink a couple a glasses of wine every day for health reasons’, right? So I says, I gotta combine this. So I goes up to the farm, and gets me some milk straight outta the cow. Then I mixed 2/3s milk with 1/3 red wine and drank it down. Now, it doesn’t look too good, in fact, it looks like someone done throwed up  in your glass. But lemme tell ya, it’s the Fountain ‘O Youth!”

Then he pulled off his cap and showed me his hair. It was white with patches of dark gray.

“See this here? My head used to be fully white! Now my hair is growin’ back in dark. I’ll tell ya, it’s the Fountain ‘O Youth!”

Getting impatient!

Our chapter of CMDA (Christian Medical and Dental Association) hosted a practicing gynecologist from the area to come speak about his medical mission work in Kenya and Haiti. It was so uplifting and encouraging – he spoke straight from his heart and even teared up a few times when recounting a particularly difficult case. It was also really cool to connect with other Christian doctors from this area who came out to hear his talk.

Hearing such stories also makes me super impatient for med school to be over with and residency to start so that I can get overseas sooner! :)

It’s gettin’ to be that time…

When I figure out what I want to do when I grow up…

Sometimes, I just wanna crawl back into the womb, and be all like, “Mommy, feed me!” Not that fetuses feed, but you get my drift… (I hope.) I also love that in this photo, “Doctor” is 7th on the list, and under LAWYER of all things. I’d much rather be a ballerina than a doctor if we are being honest here, but that ship has come and gone long ago. Plus, I just don’t have the legs for it.

Anyway, so the past 6 months or so have been kind of a whirl-wind immersion into “doctoring.” I’m a little over halfway through the 3rd year LIC model (longitudinal integrated curriculum) so by now I have a fairly good idea about all of the specialties and what they involve. Theoretically, I should have SOME clue about what I want to do, but I’m still wavering. Thankfully, I have discovered what I do NOT want to do (and that’s how all the experts say to pick your specialty, right?) So here goes…

I do NOT want to do:

1) Psychiatry: I love my psych preceptor, but I don’t get hardly any inpatient psych during this rotation unfortunately. We did a few consults at the local hospital (which was a 20-bed joint in the middle of freakin’ NO-where) and a bunch of tele-psych conferences with the local jail, and I even did one consult at the jail myself (with a convicted murderer which was fairly intimidating), but as much as I try to love it, I come home every day drained and exhausted. Listening to people with serious mental health issues all day requires a very VERY special person. I find myself wanting to pray with every patient, not give them more meds! That’s another thing – outpatient psych is 99% medication visits. My preceptor does very little therapy because they have counselors at the psych clinic I rotated through who took care of that. Sorry Lucy, but I think you and I both should find a different specialty.

2) Surgery: Ok, I love the OR. No really, I do. (This is coming from the person who used to pass out at the sight of a needle.) I have two surgical preceptors, an orthopedic surgeon and a general surgeon. I usually go to the OR 1-2 times per week, and do 1/2 day of clinic. My orthopod is a fabulous teacher, I love rounding with him and seeing consults and he usually lets me close most of his cases. (For the non-medical – that means he finishes the majority of the case, closes the deepest layer of tissue, then hands me the needle and is like, go for it.) I get a majority of my suturing experience with him. However, he only really teaches me stuff about ortho. My gen surgeon is a fairly crabby, unhappy person who really really REALLY enjoys pimping and watching me sweat when I don’t know an answer. He rarely lets me do anything too complicated (basically – I am a human retractor for the most part, except when he lets me staple). However, although the pimping is painful, I learn a TON from him – he’s seriously like a genius. And I think he is starting to like me more now that I’m not intimidated by him anymore. So between the two of them, I think I have a fairly good surgical rotation. The only thing is… I could never see myself doing the same thing day in and day out, over and over again, for the rest of my life. My ortho is basically a knees and hips guy – I’ve scrubbed into probably fifty total knees and hips, with the occasional fracture or dislocation thrown in. I could do it in my sleep. I honestly almost did fall asleep during some of those cases – so bored was I! The gen surgery is more interesting – we do everything from gallbladders, colon resections and amputations, to carotid endarterectomies and fistulas. He also does a lot of breast biopsies and colonoscopies. But still… I think I’d get bored after a while, because for the majority of the time it’s gallbladders, hernias and colonoscopies. I’m pretty sure my grandma could do a hernia repair. So anyway, I learned that I am ok with blood (Praise you JESUS!) and I do like procedures, but anything past half an hour long and I want to slit my wrists.

Not to mention that all my classmates who want to do surgery are like this:

   

well, let’s just say… I’m no gunner.

3) Internal Medicine: Ok, my internal medicine rotation is somewhat disappointing. My preceptor started utilizing the hospitalist program right before I started, so I had no inpatient internal medicine except for two 1-week “bursts” in the hospital. I loved those. But the clinic is just like my family med clinic. Don’t get me wrong, the preceptor is great, I love his staff, and we have a fabulous and fun time, but I don’t feel like I am really getting the “flavor” of internal medicine. The bursts were definitely fun – I spent two different weeks assigned to 2 teams with an attending, a resident, an intern, sometimes a pharmacist, and me. They gave me a 4-5 patients to follow during the week (I totally could have handled more, but oh well.) We did ER admissions too which was fun. The experience was great, but I think that chasing around labs all day every day on chronically ill patients would get rather frustrating after a while. I liked being in the hospital, but I think that might also get tiring (i.e. I wouldn’t want to be a hospitalist.) And I definitely am not really interested in being super specialized and never getting to do any procedures, so I think internal medicine was out for me fairly early on. Plus, I do want to see kids (at least some kids – more on that later.)

Ok, maybe that’s slightly unfair – but internists do seem to order an absurd amount of tests. Maybe it was just my experience…

4) Pediatrics: Ok, by FAR my least favorite rotation. I hate hate hate outpatient peds! UGH. Not to mention my preceptor can be really annoying. He is one of those people who is jolly and happy in the room, but complains about every single patient the second he walks out of the room. And it is so incredibly boring. A typical day is 5 well child visits, a few “cold-like symptoms” visits, more well child checks, a kid with abdominal pain that turned out to be gas or constipation, more well visits, and maybe some kids who needed ADHD medicine thrown in at the end. And every parent thinks their child is DYING. I do very little inpatient peds which is really frustrating, (the lack in inpatient medicine is one of the serious problems with the LIC model, and I think there may be some changes in store for next year’s class). I do round sometimes with my preceptor in the hospital nursery, and once in a great while, he will send me to pre-round on an interesting case that he had admitted the day before, but other than that, it is outpatient, outpatient, and more outpatient. He is a brilliant teacher though – and a grueling pimper. Every single time I am with him, he picks a topic and endlessly questiosn me about it. He also makes me write up a full H+P on every patient I see (which meant I see only a few patients per day because I have to go write up the whole thing, by hand, and present it to him). However, I am getting very good at my H+Ps. Anyway, bottom line: I like kids, I want to see some kids, but I could never see kids full-time!

Yeah. Peace out, pediatrics!

5) Anesthesiology: Oops, almost forgot about this rotation. We had a 1-week rotation in anesthesiology, and I thought it was fabulous! They just kind of stuck us in pre-op (2 students per week) and said, “have at it!” The anesthesiologists that were working were more than happy to have a student to teach, because they never have students, and all the nurses in pre-op were wonderful and so nice. The nurse anesthetists were a little more grumpy because of their insane work hours, but I found one nurse anesthetist who we referred to as “The Colonel” who kind of adopted me and showed me everything he knew. I got to do a bunch of intubations, started tons of IVs, pushed meds and everything in between. By the end of the week, the Colonel let me have complete charge of an entire case – I intubated, drew up and administered all the meds, kept an eye on everything, and then extubated when it was over. It was so much fun! However, getting to do short procedures was the fun part. Learning about all the meds and airways and stuff like that… not so much. And their hours are horrible! So although it was a great rotation, I have to say, I don’t think I could do that full-time.

Nerd moment: A sweet view of the vocal cords through a Glidescope – which is by far the best way to do an intubation. Just gotta stick your tube through those two cords and you are golden!

Ok, so I need to go do some studying, so I’ll leave it here. Stay tuned next time for the specialties that I AM interested in doing. Can you take a guess as to what’s left? :)

So sorry!

…For the long hiatus. To the 2.5 people who read this blog, I really really really do apologize. My 3rd year of medical school has been a lot busier than I imagined. It’s a lot more difficult to do 6 rotations at once than you might think.

Well, ok. Let’s not kid ourselves. I’ve also been INCREDIBLY lazy since boards. After I get home from clinic or where-ever, exercise, eat something, and study for a bit, it’s already 10:30 and I turn into a pumpkin. So the blog took a backseat to rediscovering what a normal life feels like again. And let me tell you, this year has been fabulous so far. I love all of my rotations, and I’ve had some incredible experiences.

The LIC (Longitudinal integrated curriculum) is tough and sometimes crazy hectic, but there are some really cool things about it. For instance, a few weeks ago I was scheduled to be with my orthopedic surgical preceptor, but he only had one surgery scheduled for the day. So after the surgery, I found another surgeon and asked if I could jump on the rest of his cases for the day and check out some ENT surgery. He said of course, and I hung out with him the rest of the day until I had to leave to go to a different hospital for my ER shift. Turns out he had a consult there anyway, so I went with him to see the consult, which was a girl with an infected ear from a piercing gone bad. He drained the abscess and sutured it up, and then I then finished my ER shift. The next morning, I rounded on the patient, then went to my pediatric rotation. Turns out the girl was a patient of my pediatric preceptor, who had seen her right after I finished rounding – so he saw my note and gave me some pointers about her case. It’s crazy how integrated all of my patients are. One of my ob-patients I’ve seen for obstetric visits weekly for about a month, I did her C-section, then I saw her in the ER for an acute GI viral infection, then at my pediatrician’s office for her kids’ well visits. It’s so cool to start recognizing my patients and have them recognize me!

Anyway – I digress. So as a way to catch up on the last couple months, I’m just going to jot down a few quotes from my rotations that I’ve been keeping track of in my handy-dandy little notebook.  Some are hilarious, some are sad, some are just ridiculous. I am finding that I love people more and more each day. They say the funniest things and make me laugh and cry at the same time. Enjoy.

“Doc, I’m so stressed out right now, and on top of all that, I’m trying to get pregnant. Do you REALLY think now is a good time for me to stop smoking?” (Doc: “…”)

“I can’t sleep good no more, cuz I’ve got that swollen prostrate, and I gotta wake up every five minutes to take a leak.”

“It’s better to be bored than agitated, aggravated and irritated by the TV.” – Patient with paranoid schizophrenia.

“I’m smoking about 2 packs a day, but it’s ok, cuz I’m on oxygen, you know.”

“Doc, aren’t panic attacks kind of like tripping?”

“If my kids get married, I don’t know that I’d want him to come to the wedding. I just don’t think he would know the first thing about renting a suit. But he’s not that bad looking once he gets a haircut. It’s just that, well, he’s a hillbilly, Doc.”

“demen-SHI-ah.” = dementia

“Aurther-E-itis” = arthritis

“Doc, It’s my youngest son. He’s got me all a mess.”

“If they videotape you when you are under the influence, well, there’s not all that much you can do about it.”

“Hey Doc, I got that di-ver-tic-LEE-itis, and it’s hurtin’ real bad. Can’t eat them seeds no more. Cain’t do nuthin’ no more. Jeepers.”

“Doc, it’s my stupid mental shit. They just won’t give me my licence!”

“She went and told me she was going off with another man. How can a woman you’ve been with for over 30 years do that to you? She killed me. So I shot her. Oh God, I shot my wife. It should have been me. Why wasn’t it me?” (5 minutes later…) “So, I should probably get a lawyer, right?”

Conversations with Food

Today when checking out at the grocery store, after picking up my week’s supply of randomness, I had one of the more amusing conversations I’ve had in this small town. Well, maybe not as funny as the woman who, after hearing that I was in medical school looked at me in disbelief and said, “OMG, you mean you are like HOUSE???” I’m sure a medical drama has never caused such consternation.

Anyway, here’s how my conversation with the 18-ish year-old cashier went:

Scanning my saltless pretzles – two bags.

Her: OMG, do you like, not eat salt? What ARE these?

Me: Yeah, I’m actually not a fan of salted pretzels.

These are basically my sustaining life-blood these days. I limit myself to two bags/week, but I could easily eat 5.

Her: REALLY? Omg, like, HOW do you not like salt? I could eat salt ALL day long! My boyfriend LOVES salt and since I like practically LIVE with my boyfriend, I have to eat salt like all the time. It’s SO awesome.

Me: I dunno, I’ve never really been a fan of too much salt. (Thinking to myself, hypertension, diabetes, metabolic syndrome…)

She continues to scan my assorted salad paraphernalia, cheeses, and fruit. Finally gets to the tofu and hummus. *Oh dear,* I think to myself.

Her: You eat like, SO healthy. Are you like, a vegetarian or something?

Me: Actually, yes I am (thanks to the dear sister, I’ve recently converted).

Her: OMG REALLY??? So, is it like SO HARD? Can you like, eat fish? I could NEVER do that. Well, at least you don’t eat the little piggies you know? I mean, cows are like SO ugly, so I don’t really care about them, but I’m glad you don’t eat the little piggies. They are SO CUTE.

I am not making any of this up people.

Latest Life Questions

Time for another list of Very Important Questions I have been pondering. This list is mainly due to the fact that I have reproductive block exam in literally 10 hours, and there are just some things about repro I simply do not (and probably never will) understand.

TOP 10 VIP QUESTIONS LIST

1. What (sane) doctor would ever, and I mean EVER, perform a “whiff” test for vulvovaginitis? (And yes, it is what it sounds like.)

2. Why is it that the more kids you have (and the earlier you have them), the less risk you have for getting ovarian cancer? (Apparently, I’ll be getting ovarian cancer within the next few days.)

3. Why is it necessary to classify cervical cancers into one system, then change everything up, combine and re-classify everything into a second system, and still expect us to know both systems?

4. Random non-repro-related question: Why do people keep publishing shoddy studies on chocolate and calling it “news”? http://www.cbsnews.com/8301-504763_162-57405100-10391704/eating-lots-of-chocolate-helps-people-stay-thin-study-finds/. MMMM chocolate…

Yes, this is a chocolate cake of a uterus. AWESOME.

5. Why do I have to keep doing Google image searches for any of the pathologies related to reproduction when I know it is a very very bad idea? (I’ll spare you the photographic illustration.)

6.  Why do pathologists have to totally ruin my favorite foods by relating them to disgusting reproductive disorders? (Chocolate cysts, “cheesy” vaginal secretions, “cauliflower” type papillary carcinoma, “grape-like” hydatidiform mole, etc…) Below is a hydatidiform mole. Does that look like grapes to you?

7. Why do ultrasounds totally not make sense to me? They say, “that’s the head, that’s the liver, that’s the pancreas!” I say, “that’s…a large fuzzy gray circle.” Below is an ultrasound of a pancreas. Can you tell that’s a pancreas? It sure doesn’t look like MY pancreas…

8. Why do I write in acronyms when I take notes? (For example, this is a line from my notes on preeclampsia: Increased SFIt1 = decreased VEGF + TGF-b decreases production of NO + PGI2 along with AT1 autoAb for ANG-R Type 1 + HIF). Yeah, I have no clue what any of that means either…

9. I know this is kind of stretching a bit, but why are pregnant women still referred to as “patients”? There’s nothing WRONG with them (usually), they’re just havin’ a baby! (On a count of three… everyone say, AWWWW.)

10. WHY did I decide to take this exam early?! (Oh right, because I’ll be on the beach in less than 48 hrs!!!) Yes, this is my happy place.

And finally… for your weekly jolt of Med School Humor (that only med students find funny):

Reclaiming Empathy

As med students, we are bombarded with daily reminders to be empathetic. In patient presentations, in small group sessions, in practical exams, it’s even snuck into pathology lectures. At my school, they call it FIFE: Feelings, Ideas, Fears, Expectations. It’s almost a joke now. As we leave standardized patient exams, we ask each other, “So, did you get your FIFE-ing in?” We get points if we ask specific questions about each of these, and if we forget the ever-so-important, “How does this make you feel?” we get blasted.

It’s kind of annoying.

I used to be an empathetic, sympathetic, caring person. They made us take this “Empathy Test” at the beginning of med school, and I scored quite high. I was full of empathy. Dripping with it. I wanted to save the world, one sniffly nose at a time.

I think I still am, to some degree. But in some very strange and twisted way, having these attributes forced upon me has made me rebel. I hate FIFE’ing patients. I feel silly, stupid, and dumb when I ask those questions. Part of this is reasonable. It is far less awkward to work empathy into a conversation in a natural way when you aren’t required to ask 12 specific questions that involve obviously artificial phrases like “Now Mrs. Smith, what are your Ideas Concerning your Sore Throat?”

Or even worse, “Mr. Jones, How do you Feel About your Scrotal Abscess?” (This has happened to me.)

But then there are those times when I find myself thinking, “Ok seriously? Isn’t this what psychologists do? This isn’t my job!” …And that’s when I start to get nervous.

For example: I volunteer at a free clinic for the underinsured one night a month. I usually love going there, but for some reason, this past week I was in a bad mood. The stress of boards studying is starting to overwhelm me, and all I could think about was the hours of study time that I was losing. It was a really busy night, and I was there till nearly 9pm. I was tired. I was hungry. I wanted to go home.

We were just finishing up, when the nurse came over and said, “Wait! There’s one more patient!”

The doctor I was helping agreed to take the last patient. He blended right in with our normal clientele: youngish (unemployed), jittery leg tapping annoyingly ceaseless beat on the floor, long greasy hair tied back in a ponytail, untrimmed, dirty nails, downcast eyes.

As soon as we walked in, he jumped up and began to tell us of his pain, (nay, his full-body pain), due to three separate car accidents five years ago. Unexpectedly, he dropped his pants to show us the long scar where a titanium rod was placed in his leg. Then he glanced over at me, seeming to realize I was in the room, and mumbled, “Oh, a lady is present.”

After a thorough explanation of every scar, bump and bruise on his body – he continued to try to impress upon us the magnitude of his pain by pulling out a list of medications that he had been on a few years ago. They were mostly narcotics – fentanyl patches, oxycodon, etc. “All I want is to feel good again,” he kept saying, over and over. “Can you just help me feel good again?”

I admit that the moment he walked in the door – I judged him (drug seeker) and my empathy ended there.

And then he started to tell us about his anxiety. His stress and anxiety levels were so high, he said. He has panic attacks. He can’t be in a room with people for very long. His palms start getting sweaty. He needs something to help him.

“What,” I asked with a condescending sniff, “Are you stressed about?”

“I have a kid,” he said. “And he wants to do things. All the time. And I can’t do all these things with him because I’m in all kinds of pain. And it stresses me out so much!”

At that point, I kind of lost it. In my head, I started berating him. ‘What do YOU have to be stressed about? So you have a kid! I know people who have 10 kids and they are keeping it together! You don’t know anything about stress! Trying going to med school! You don’t have a clue! Get a job! Get a life! Stop wasting my time!’

Wow.

I mean, wow! I am sort of at a loss for words at my own thought process. If I was a patient, and I had even the slightest clue of what was going through my mind at that moment, I certainly wouldn’t want me as my doctor. If I were to hazard a guess, I think the root of the problem is in the comparison. Whatever your profession, comparing your stressors and difficulties to someone else is generally a fruitless endeavor. Why? Well for one, everyone is different. My stress in med school is simply not comparable to that man’s stress dealing with his pain and trying to take care of a child. They are two completely different life situations. And if you start comparing too much, you start resenting other people.

So in terms of finding my empathy… well, I don’t think it was ever really lost. It just got pushed to the side and distorted by my selfish comparisons and stress. Now that I recognize the problem, hopefully I can keep the two separate. Because my stress should never influence the way I approach someone, regardless if they are a patient, a friend, or the Starbucks lady.

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