A Very Medstudent Thanksgiving

Or

“How am I ever going to decide if I can’t get past the first question?”

Oy, this month has got me leaning to the left.

Its funny the little rules we make in our head, or the things we keep telling ourselves and not really challenge.

I’ve been putting writing off for 2 reasons. One…I’ve been too busy, to state it plainly. Well, at least by the rules in my head. I figure if I have a case presentation and scholarship forms to do, I am too busy to write. I am also too busy to call anybody or to clean. But not too busy to watch TV. Funny how that works. Two…I don’t want to be one of those people who only write when they want to whine about something. I’ve had plenty of occasion this month to do so,
but not much to balance it out. I mean, there has been wonderful stuff, just in small doses compared to the econo-sized crankfest thats been going on this month.

Well, I overturned that rule in the last few days, starting with the cleaning. The place isn’t sparkling but hell, I vacuumed. That was like the 2nd time since we moved in. Today I’m writing b/c well, I need to. Its therapeutic for me, in that once I get out all those thoughts that
have just been rolling around in my head over and over again, it allows some new thoughts to finally break through. Many good thoughts, smart ones, with some wit and silliness, perhaps involving Johnny Depp or Heather Graham. Mmmm. Wait, what was I saying? Oh ya, too busy to call too. Ya, I’m going to try that this weekend, so if I owe you a call, be looking out for me. After I finish scholarships. Baby steps.

You know what’s also funny? How it is humor nature to only dwell on the negative. So, bleh, I am really tired of worrying in general. The 2 hour drive to the rotation site I took every morning and the drive home every night gave me ample quiet time to dwell on things. Things like getting kicked out of my rotation housing and the subsequent ass-raping of my integrity in the eyes of the dean. Things like how I am going to be fucked when it comes to the Internal Med test b/c I spend 4 hrs of valuable studying time in the car every day. And I especially dwell on the fact that the dwindling of my bank account by Dec is not likely to match up with the replenishment of loans in January.

Ok, bad things out of the way. Now, how to build up this month in my memory as something other than the month of ass-raping? Though that does have a ring to it, don’t you think? In the spirit of Thanksgiving, maybe I should focus on what I am thankful for this month:



1) Jesse came to visit me!

-She was here for a whole weekend and we rocked Boulder, I must say. We cruised the Pearl Street Mall, enjoying the local “color” (aka marveling at hippies & street performers), supporting the arts (aka buying hand-made greeting cards), and partaking of local fare (aka eating an orgasm roll at the BEST sushi place ever.) We finished outthe weekend rocking out to Guitar Hero III, laughing at the whitey white people dancing at the local bar, and buying Jesse a new wardrobe at Old Navy. Wow that weekend did my heart good. I am so lonely here, so the company was great, but talking to her was also an essential reminder that I am not crazy normally.

2) I was able to spend Thanksgiving with new friends.
-Just when Josh & I were wondering what we were going to do on the holiday, and how we could afford all the fixings we wanted, my 4th year mentor sent us an email inviting all stragglers to a Thanksgiving dinner at her place. When we got there, they had chicken instead of
turkey (we hate turkey!), homemade croissant rolls (that is our holiday tradition!), and real pumpkin pie with fresh-made whip cream (ohmigod, our fave dessert ever!)…it was amazing! How did they know?? Plus I was ecstatic to be talking to someone my own age, let alone fellow medical chica. I hope we can do something together again soon

3) Being poor brings out our creativity & makes us more thankful for what we have.

-Y’know, I talk alot of smack about how poor we are, but really, things could be so much worse, and in fact are worse for tons of people. We at least have a roof over our head, and no matter what, don’t ever have to worry about going hungry. Things are tight, but when they are, it makes a focus in on what we really need vs want. We get creative in how to stretch the most use out of something, and how to make a little extra money on the side. Most of all, it reminds me how close Josh & I are. We are both fiercely independent, and probably our biggest crime
is not really keeping eachother “in the loop” of what’s going on. We don’t plan dinner, we don’t call if we’re late, and we don’t go to bed at the same time. However, when things get stressful and money gets tight, we don’t argue or blame eachother. Rather, we band together and become a great team to figure out a way to survive and make our way out of it.



4) It was a great rotation!

-Almost worth the daily drive. I learned tons about medicine and its given me a new perspective on how to run a practice. Y’see, my doc was like an older version of the boss Michael Scott on the Office. He would waste 20min of a session just bullshitting with the patient, and make really corny and often times inappropriate jokes. His favorite was to diagnose an 80 year old woman’s problems as her being pregnant. His other one was to demand more complaints from the patient b/c he needed to make more money or else 1) he couldn’t afford the brothel he visits 3 times per week OR 2) he’d go home, beat his wife, and he can’t afford the alimony. But I did like him, and his patients LOVED him. Life Lesson #1, People like the abuse. They also were willing to wait an hour for him b/c they knew he gave them his undivided attention without any consideration of time. I also loved the staff. They said I was the first med student to treat them with any respect, so they helped me out and taught me things they flat out refused to do with other students. On the last day, they took my information and let me know that if I ever move back to the area, I’d have a whole office staff waiting for my practice. It was really sweet.



5) Friends, family, health, puppies, doing what I love…and all that other mushy stuff!

-I have the best friends I’ve ever had in my life, a family who loves me enough to visit me in Denver & nag me to tell them about whats going on in my life, a loving husband, 2 puppies I couldn’t imagine loving anything more until I have kids, Josh and I are both in careers we love, and we all have our health. I really don’t have the right to complain as much as I do!

Powered by ScribeFire.

Medical Divorce

Went to my first tumor board today. It was pretty cool, nice to finally see some real pathology from actual patients. One patient had Burkitt's Lymphoma with the classic starry sky appearance, that one was particularly interesting. They had her on some sort of a port through her head to give her intrathecal chemo, I need to look that one up and see why intrathecal rather than systemic. It was nice seeing actual doctors review cases together and ask each other questions about why they handled certain cases the way they had. Also need to look up EGFR.

There was one patient who had had 4 stereotypic screening biopsies in two regions of her left breast, and one from each region showed pretty severe calcifications. It was documented that all physicians involved independently recommended a mastectomy, and the patient refused. A girl from my class spoke up and said she'd seen her in primary care, and she was a very difficult patient. She's a smoker with emphysema and uncontrolled diabetes, and she also has temporal arteritis but refuses to get a biopsy done. Between that and the diabetes, it's only a (probably short) amount of time until she goes blind. My classmate said her rationale for refusing the mastectomy is that she saw a program on TV where a lady had a total mastectomy and then ended up being cancer free. She firmly believed that when the biopsies were done, the cancer was now gone and she was cured.

The oncologist in the room said that it was important for all docs involved not only to chart that she'd refused the mastectomy, but also have her sign a paper saying the same. He said that he'd divorced her. A ripple went through the crowd that each doc involved had done the same, and her primary care was getting ready to.

Such an interesting term to use for basically kicking a patient out, divorced. I've much more commonly heard it referred to as firing a patient, but that one doesn't make a whole hell of a lot of sense either. Where does the responsibility of the doctor end and the responsibility of the patient begin? And how is it helping the whole situation if the doctors involved switch from being primarily concerned about the patient's well-being to being concerned about not getting sued? I guess it makes them more aware that the patient understand exactly what she's turning down, but I feel like the system is forcing us to compromise our ethics at times. I mean, I know the responsibility of the doc can only go so far, but it seems wrong that good doctors need to "divorce" a patient when they realize that the patient is an idiot and their risk of getting sued is too high. I wonder if the older docs, or I guess the middle aged ones who've dealt with this longer even realize how fucked up it is anymore. I hope they do.

Addendum:

EGFR is "epidermal growth factor receptor (EGFR; ErbB-1; HER1 in humans) is the cell-surface receptor for members of the epidermal growth factor family (EGF-family) of extracellular protein ligands." Yeah Wikipedia. I thought it was some sort of growth factor.

And here it talks about why to use intrathecal chemo in Burkitt's, there's a high chance of meningeal involvement.

And bam I was right that the Burkitt's translocation is t(8;14).

Question

Me:
"What's a technical way to say that she feels pain whenever her buttcheek jiggles?"

The Attending (stifles laugh):
"I think you just said it."

What I Remember

I remember the look on her face, the pain, the fear she wouldn't be able to breast feed after the surgery.

The teenage mother with no car who walked her baby's stroller to the office for every checkup. How she would never become the inadequate mother that her mother or sister were. Knowing she meant it.

The cries of new babies. How deliciously unfair it felt to be able to sit in the nursery and rock them while their mothers didn't even know. The realization that they might not all be perfect.

My hand on her chest, holding the retractor. Making it through the first sight of blood, the pus and infection, but starting to pass out when I thought about her breathing beneath my hands.

The morning I first became a doctor. Being in the room with them when she came in the day before, "dizzy," in the middle of a stroke. Watching silently, taking it all in, then going to get her son from the waiting room. That next morning in the hospital. Not even in med school yet, no clue what to say. She thanked me for taking such good care of her the day before, for being such a good doctor, and being there when she needed it. The amazement of this woman, so much older and wiser than me, looking up to me as her caretaker.

The rush, the intoxication of the first time in an OR. Playing the passive student, but internal monologue racing, telling the surgeon why she had lost her bearings on the camera. Confidence I forgot was mine, confidence that used to define who I was. Flashing back to correcting the teacher who was incorrectly teaching the other students how to read. Knowing I could have, would have been able to do the operation better. The thrill of rediscovering what it felt like to be me.

The fear of the first cut. The fear I wouldn't be able to handle it, that I would pass out or be sick. And once it started, never wanting it to end.

The Amish baby boy's steadfast, determined grip on my finger during his circumcision. His strong resilient personality showing itself only two weeks after birth.

When the pain stopped and osteopathy started.

The girl who said nothing. The teenager, impregnated by her uncle, hoping to deliver before the beginning of her freshman year of high school. The anger that she wasn't ever allowed to make the choice, regardless of what it would have been.

How he saw tonight. He saw right through me, grabbed the thought, and realized he was right. The split second look across the table, when everyone else disappeared, and seeing that he knew. Looking in through a window, seeing decisions I didn't know I had made. His excited smile of realization, I had already began to fall for it. Feeling that fraction of a second, shared only between us, being etched into my life.

Constant, nagging thoughts that I will never be good enough. Always trying to suppress it. The inequality of test scores and real life interactions. Knowing that not only am I equal to them, I am better. The hope that someday someone else will also see that.

"I'm going out on an osteopathic limb here, but..."

So here’s the long-awaited recap of the FP rotation. Finally. I know.

I really didn’t think I would love family practice as much as I did.
Maybe its the particular practice I was rotating in. It was just such a
light, fun, unhurried environment. Sure we had non-compliant patients,
and that is frustrating, and we saw WAY too many people for simple
colds. I’m sorry, I still don’t know which antibiotic I should give
just to get the patient to stop bitching. This was a point off on my
eval. Oh well. When there was an indication for antibiotics, here was
another problem:

Me: “She has maxillary sinus tenderness, nasal congestion, and
fluid in the ear all on the left side…I believe it is classic
sinusitis…she does not smoke and is otherwise healthy, so I am not
worried about atypicals, thus I would go with the same thing we used on
the child with sinusitis this morning, Amoxicillin for the infection
and nasal steroids to open up the airway, let’s go with Nasacort.”

Doc: “Go for it! Dosing?”

Me: “Shit”

I’m sorry but I don’t know dosages off the top of my head. My usual
resort was cussing and quickly flipping through my Tarascon
Pharmacopeia. This got me another point off…the having to cheat part,
not the cussing. They thought that was endearing

I was happy I got to do OMM. Actually I did lots of OMM, maybe one
out of every five patients. Some of the more interesting cases:

-I did the GI release on a colicky newborn and I’ll to take her
word for it, but the mom said he looked like he enjoyed it. I even
showed the mom how to continue it at home. No word on any exploding
diapers, but no complaints either.

-A cop came in with lower back pain she’d had for 2 years with
no relief. I adjusted her sacrum and cracked her lumbars. The pain was
down to 20% and she was ecstatic.

-A woman who’d had upper thoracic pain since her car crash 1
year ago came in with sever upper thoracic dysfunction &
tenderpoints, and occiput “weirdness” that made her feel a click every
time she swallowed. She’d been to physical therapy, chiropractors, etc
who had fixed it, only to have go back to hurting the next day. I gave
her cranial, then kneed her in the back when I couldn’t get the worst
of her thoracics. They were fixed, but I told her to come back in a
week to make sure. She did come back, and after one more knee-ing, she
has been pain & weirdness free.

-My first follow-up, as in someone who came back just to see me,
not the doc, was an older lady named Coleene. We thought she might’ve
broken her rib the week before, but decided to wait and see how some
muscle relaxants & NSAIDs made her feel. After a week of no
improvement, she came back specifically for OMM. I got an Xray just to
make sure, b/c it was so exquisitely tender. It came back clear, so I
spent like 45 min doing soft tissue, muscle stretching, and indirect
techniques to slowly loosen the area. She was so pleased with the
results and the fact that is was done naturally, that she gave me an
angel pendant b/c she wanted to BLESS ME.

-A woman with long standing chest “discomfort” came in with a
clean Xray, EKG, and specialist referrals. Nothing got rid of this
“weird, fluttering discomfort.” I noticed it was over her left 5th rib
and that she was already on OTC heartburn meds. I approached my doc
with the title line, b/c this is going out on a limb, but I thought she
should try a more potent GERD remedy b/c the 5th rib is a neurosomatic
point for stomach acid. He said that nothing’s helped the chest thing
before, so sure why not. We gave her some samples and told her to call
in for a prescription if the chest pain went away or another visit if
it didn’t. She called in the Rx

By the end of it, they let me do a few more things than just H &
P and OMM. I analyzed rapid streps and urine samples; I removed skin
tags; I even did a digital block (before I even learned exactly what it
was I was doing in my anesthesia rotation). And I was officially the
ear lavage queen and the suture bitch. Its nice to have a title.

Generally it was the same old, same old. Not to say that was boring,
b/c I had a great time talking with patients either way, just that
there were generally no big surprises in my day. Except for the whole
blood thing…

-Chief complaint: “I ejaculated pure blood.”

-Differential: 1) Vigorous sex, 2) Prostate cancer, 3) VD, 4) HE’S THE DEVIL!

And so ended my foray into primary care. I promised to return to
rotate 4th year (so like in 2 years!) and left them an ear to remember
me by.

Love,

Lavage Queen

aka Suture Bitch

aka the girl who knees people in the back and calls it a VERY direct technique

Powered by ScribeFire.

Michelle's Rotation Journal

Hey everybody, I've been posting, I'm still around!

Ive just been doing it over at my website and have been lazy and/or too exhausted to hit ctrl-C to copy it over here, but I will from now on.

I'm actually off to St. Louis this weekend for a wedding and to party with my fellow Type B ladies, so that gives you a minute to head over to my site to get caught up before I start back up. Plus I'm sure one of us will report on the reunion. Us ladies haven't seen eachother since beginning of rotations!

Until then, I leave you with like 2 months of stuff to read on my site, plus this very, VERY inappropriately funny comic strip. Baby-killing is not funny, so don't laugh.



(HAHHAHAHAHAHAHA)

I'm going to hell.

~Michelle

My top 3 moments as a D.O.

#3-

Jesse and I hiding in a corner to look at our final anatomy grades

B/c my undergrad was stupid, pre-meds didn’t take anatomy and so my
first semester of med school, it was brutal. I knew it was down to only
a couple points. So close that I could only miss like 2 questions out
of 40 on the final practical. Once I heard the grades were in, Jesse
and I went down to the mailboxes and pulled out our grade slips. I was so nervous the my reaction was to ball it up and throw it in the corner! I
chased after it, hid in the corner, and uncrumpled the ball slowly,
revealing my passing grade of 70.5%, then screamed and jumped up &
down with Jesse.

#2-

Dancing to “Sexy Back” with the UAAO fellows

So it was the final night at the UAAO convocation in Colorado Springs
last year. They had their annual Fellows Banquet where all the fellows
converge and induct the new president and fellows. Its a big friggin’
deal, in the D.O. world anyway. All the top mindsy hold a dessert and
dancing reception. They played the typical music you play at wedding
receptions so every generation can dance. So, like, no rap or anything
beyond the 90’s. I’m bored after awhile, so, just to see if he’ll even
play it, I request Justin Timberlake. I didn’t think he would, and if
he did, that the older docs wouldn’t dance. But the next song up, there
it is! I wait for the dance floor to clear, but I actually see tons
more older docs getting up and joining in! By the end, they were not
only all dancing, but singing along! D.O.’s are so cool.

And tonight, I had my #1 moment…..

Getting shitfaced with my preceptors

I was invited to a dinner provided for by some drug reps, held at the
steakhouse up the street called Nine 75. Now, my docs are totally laid
back and lots of fun anyway, but over cocktails, they are a riot. I
walk in and one of the docs gives me a big hug, then hooks my arm to
head to the bar and gets me a martini. We stay hook armed, with me
introducing him to the 3 other med students from KCOM that showed up
(Yay!) and head to the room they’ve set up for the presentation. The
other 2 docs in the practice give me a hug and we sit down to
appetizers, like sushi and empenadas, and the waiter plies us with
wine. Our speaker is Sanjay Gupta (no, not the CNN doc, but you’d think
the confusion would have drawn more people in), an ENT surgeon who
presents on rhinitis. We get into a rousing discussion, interjected
with jokes and the occasional pimping. I get asked what the Kiesselbach’s plexus
is, and I have no idea, to which the doc replies “Oh man, you don’t
know the anatomy, your ass is grass tomorrow!” and I’m like, “I’m 3 drinks down and I got a 70.5% in anatomy, so no shit!”
Then we learned the best way to deal with rhinitis–> KY Jelly.
Remember, just don’t use the warming kind. We drink and eat and laugh
and tell stories for almost 4 hours, just enough time to sober up and
get back at a decent hour. God, that was fun.

Powered by ScribeFire.