Well, the holdiays are here and I'm on elective.
I'm doing cardiology which is cool and interesting, but also very advanced. I'm trying my best, I'm learning a lot. Of course I can't keep up with residents who have done this before and are trying to learn the best treatment etc.
I got to see coronary angioplasty with a stent being placed at the angiography lab. I got to cardiovert someone who was in atrial fibrillation, yeah, I got to say "we're all clear?!" and use the paddles. It worked the first time, so I have a 100% success rate hehehe.
I'm learning something about myself as well. I don't know if I'd want to specialize. It's really cool to be working with someone who knows everything there is to know about cardiology but I really don't know if I would be bored or not eventually. But a part of me is now thinking that I want to do internal medicine just so I would have added knowledge compared to doing only 2 years in family medicine. That's what I'm thinking right now, we'll see what I think when I get into family medicine.
Sunday, December 21, 2008
Monday, October 27, 2008
The night shift
The night shift. There's no other students. There's only one junior resident, one senior and one staff. I did 8pm-8am last night.
I saw a lady who went into labour at 24 weeks in her pregnancy. The baby was so tiny, 700g. The parents were pretty brave considering; they were taking everything with a strong face, even though I'm sure they were terrified. I mean, their newborn baby was so premature. It came out fighting, waving its arms and kicking its feet, it even tried to take a few breaths. The pediatricians took the baby straight into the resuscitation room to intubate it and get it to the NICU (neonatal intensive care unit). It had no 'meat' on it, no baby fat. I talked to the resident in pediatrics after, the baby was doing fine but these kids usually do okay for the first day and deteriorate after day 1.
I saw another baby born at 24 weeks during my last rotation. The mum had the baby come out, basically fall out, when she went to the bathroom. The baby was so hypothermic, temp was 31 degrees (premature babies under 2100g can't keep the body temperature up on their own). The baby passed away a week later.
Last night, around 2h45, I had a consult in the emergency room for a perimenopausal lady who had such a heavy period because of a fibroid that was basically making her bleed to death. She had passed out because she had lost so much blood. The messed up thing is that she came to the hospital around 16hoo. Our service only found out about her at 2h45!! She needed a blood transfusion because of the bleeding. It's not like we were so busy we couldn't have seen her earlier, we only found out about her at two in the morning. So here was the lady, basically bleeding to death in the hospital. She was still very pleasant with me, a real angel. People amaze me at how they're in such terrible situations sometimes and yet they still have it in them to be nice and polite. It's quite charming. There's also people out there who are monsters all the time, even when they aren't sick.
I helped repair a woman's vagina after it tore, very minimally, last night. The staff literally guided my hand through the whole thing, but it was still cool to stitch someone up. For the same lady, during her delivery, I applied "fundal pressure." This basically means that I stand beside the lady, put my hands on her belly and push down while she's pushing to help pop the baby out.
There's construction outside of my apartment right now. Oh! Oh! Guess what! There's construction INSIDE my apartment too! Honestly, I don't know how people work nights. Going to bed when the sun is up and waking up when it's setting is awful. Yeah, I know it's my first day, but I really don't think I could ever get used to this. Luckily, there isn't really an area of medicine where work is only during the night.
I also had to assess a lady with stage 4 ovarian cancer who was terminal, last night. She couldn't talk anymore, it sounded like she had bad pneumonia.
It's not all fun and games, but I'm still having a great time.
I saw a lady who went into labour at 24 weeks in her pregnancy. The baby was so tiny, 700g. The parents were pretty brave considering; they were taking everything with a strong face, even though I'm sure they were terrified. I mean, their newborn baby was so premature. It came out fighting, waving its arms and kicking its feet, it even tried to take a few breaths. The pediatricians took the baby straight into the resuscitation room to intubate it and get it to the NICU (neonatal intensive care unit). It had no 'meat' on it, no baby fat. I talked to the resident in pediatrics after, the baby was doing fine but these kids usually do okay for the first day and deteriorate after day 1.
I saw another baby born at 24 weeks during my last rotation. The mum had the baby come out, basically fall out, when she went to the bathroom. The baby was so hypothermic, temp was 31 degrees (premature babies under 2100g can't keep the body temperature up on their own). The baby passed away a week later.
Last night, around 2h45, I had a consult in the emergency room for a perimenopausal lady who had such a heavy period because of a fibroid that was basically making her bleed to death. She had passed out because she had lost so much blood. The messed up thing is that she came to the hospital around 16hoo. Our service only found out about her at 2h45!! She needed a blood transfusion because of the bleeding. It's not like we were so busy we couldn't have seen her earlier, we only found out about her at two in the morning. So here was the lady, basically bleeding to death in the hospital. She was still very pleasant with me, a real angel. People amaze me at how they're in such terrible situations sometimes and yet they still have it in them to be nice and polite. It's quite charming. There's also people out there who are monsters all the time, even when they aren't sick.
I helped repair a woman's vagina after it tore, very minimally, last night. The staff literally guided my hand through the whole thing, but it was still cool to stitch someone up. For the same lady, during her delivery, I applied "fundal pressure." This basically means that I stand beside the lady, put my hands on her belly and push down while she's pushing to help pop the baby out.
There's construction outside of my apartment right now. Oh! Oh! Guess what! There's construction INSIDE my apartment too! Honestly, I don't know how people work nights. Going to bed when the sun is up and waking up when it's setting is awful. Yeah, I know it's my first day, but I really don't think I could ever get used to this. Luckily, there isn't really an area of medicine where work is only during the night.
I also had to assess a lady with stage 4 ovarian cancer who was terminal, last night. She couldn't talk anymore, it sounded like she had bad pneumonia.
It's not all fun and games, but I'm still having a great time.
Sunday, October 26, 2008
Obs
This week, I work the 11pm-8am shift at the birthing center and answering consults in the ER.
My first week in Obs, I almost got amniotic fluid all over my shoes, I got sprayed with umbilical cord blood and had maternal blood splashed all over my scrubs when the placenta came out.
We had a baby born on the bed just minutes after we saw a lady and decided she was nowhere near delivering. We heard the nurse screaming over the intercom for help, but by the time we ran back to the room, the baby was lying on the table between the mum's legs, still attached, crying.
I had one lady look at me halfway through my questions with fear in her eyes and saying to me "I NEED to push and I don't know why!"
I watched one dad start crying when the baby delivered and his first words with his daughter present were "oh fuck!" Minutes later, watching her on the resuscitation table he looks at the mum and points to his chest and says "that's mine!"
I've seen fathers scramble from the baby to the mum and back not sure who to pay attention to.
I'll have more stories for sure, probably even by tomorrow.
Off to work
My first week in Obs, I almost got amniotic fluid all over my shoes, I got sprayed with umbilical cord blood and had maternal blood splashed all over my scrubs when the placenta came out.
We had a baby born on the bed just minutes after we saw a lady and decided she was nowhere near delivering. We heard the nurse screaming over the intercom for help, but by the time we ran back to the room, the baby was lying on the table between the mum's legs, still attached, crying.
I had one lady look at me halfway through my questions with fear in her eyes and saying to me "I NEED to push and I don't know why!"
I watched one dad start crying when the baby delivered and his first words with his daughter present were "oh fuck!" Minutes later, watching her on the resuscitation table he looks at the mum and points to his chest and says "that's mine!"
I've seen fathers scramble from the baby to the mum and back not sure who to pay attention to.
I'll have more stories for sure, probably even by tomorrow.
Off to work
Wednesday, October 22, 2008
Gyne
5:20: I rise from bed. Grumpy, but well rested since I went to bed at 9:30 last night. I make a pot of coffee, delicious, delicious coffee. Two bowls of cereal later, I shower, dress, groom, drink 2 coffees, read and print out a summary on endometriosis and head to the hospital
6:45: Arrive at the hospital, review the teaching case that we will go over this morning
7:00 - 8:00: teaching session on endometriosis (endometrial tissue normally lines the inside cavity of the uterus, sometimes we find it where it shouldn't be. It's been found in women's ovaries, tubes, ligaments, lungs, eyes, mouths, noses. So let's say it's in the nose, they get a nose bleed whenever they get a period. Thankfully it's rare in the nose, eye and lung; it tends to stay in the pelvis)
8:00 head to the gyne wards, rounds are over, divide up the scut and head to the OR.
9:30-11:30 watch a total abdominal hysterectomy, bilateral salpingo-oophorectomy and omentectomy. I don't get to scrub in because there's too many residents. I basically watched a woman's uterus, fallopian tubes, ovaries and her omentum (an extension of the tissue surrounding the stomach) be removed. Her ovaries are huge, they're bigger than any man's testicles but that's not good. She's menopausal, so her ovaries should be shivelled and small, and there's visible cancer eroding though the surface of both of them. After the uterus, ovaries and tubes come out, I go to the pathology lab with the surgeon to watch them measure everything and slice the ovaries open. It was pretty cool, but not very good news for the patient.
11:30 I head to the ER because I'm paged to see a woman with pelvic pain. I take her history, examine everything except her private bits (we have to be supervised) and head to class at 12:00. (don't worry, the resident ordered an ultrasound while I was in class)
1:00 No ultrasound for my patient yet. Things don't happen at the snap of a finger in our system. I collect more info from a patient's chart for a presentation on Friday for tumour boards
2:45 Head back to the ER to see the ultrasound results. Things look good. The resident and I basically decide that all we can do is examine her and get a culture to see if she has chlamydia or gonorrhea, but the patient took off. We wait a bit, going over the differential diagnosis and realize that she might have been abused, but we never got a chance to ask. We check the waiting room, she's nowhere to be seen. We document her disappearance and tell the unit coordinator to page us if she shows back up.
4:00 we get teaching from our chief resident.
5:00 head home to eat and prepare tumour board presentation
6:00 speak to the missus
7:00 buy coffee after remembering that I ran out this moring
7:30-9:00 prepare presentation. Wrap up as much as I can
9:30 Feeling sleepy... So sleepy... Feels so good
10:00 zzzzzzzzzzzzzz
6:45: Arrive at the hospital, review the teaching case that we will go over this morning
7:00 - 8:00: teaching session on endometriosis (endometrial tissue normally lines the inside cavity of the uterus, sometimes we find it where it shouldn't be. It's been found in women's ovaries, tubes, ligaments, lungs, eyes, mouths, noses. So let's say it's in the nose, they get a nose bleed whenever they get a period. Thankfully it's rare in the nose, eye and lung; it tends to stay in the pelvis)
8:00 head to the gyne wards, rounds are over, divide up the scut and head to the OR.
9:30-11:30 watch a total abdominal hysterectomy, bilateral salpingo-oophorectomy and omentectomy. I don't get to scrub in because there's too many residents. I basically watched a woman's uterus, fallopian tubes, ovaries and her omentum (an extension of the tissue surrounding the stomach) be removed. Her ovaries are huge, they're bigger than any man's testicles but that's not good. She's menopausal, so her ovaries should be shivelled and small, and there's visible cancer eroding though the surface of both of them. After the uterus, ovaries and tubes come out, I go to the pathology lab with the surgeon to watch them measure everything and slice the ovaries open. It was pretty cool, but not very good news for the patient.
11:30 I head to the ER because I'm paged to see a woman with pelvic pain. I take her history, examine everything except her private bits (we have to be supervised) and head to class at 12:00. (don't worry, the resident ordered an ultrasound while I was in class)
1:00 No ultrasound for my patient yet. Things don't happen at the snap of a finger in our system. I collect more info from a patient's chart for a presentation on Friday for tumour boards
2:45 Head back to the ER to see the ultrasound results. Things look good. The resident and I basically decide that all we can do is examine her and get a culture to see if she has chlamydia or gonorrhea, but the patient took off. We wait a bit, going over the differential diagnosis and realize that she might have been abused, but we never got a chance to ask. We check the waiting room, she's nowhere to be seen. We document her disappearance and tell the unit coordinator to page us if she shows back up.
4:00 we get teaching from our chief resident.
5:00 head home to eat and prepare tumour board presentation
6:00 speak to the missus
7:00 buy coffee after remembering that I ran out this moring
7:30-9:00 prepare presentation. Wrap up as much as I can
9:30 Feeling sleepy... So sleepy... Feels so good
10:00 zzzzzzzzzzzzzz
Tuesday, October 21, 2008
Obs, Gyne
Let's see, what have I done in the last 4 weeks. I've scrubbed in on several c-sections, a hysterectomy, a few prolapse repairs (read we made sure a woman's uterus or bladder wasn't coming out of her vagina anymore), I've delivered a baby myself, and I've been called wonderful by one of my patients. I got to hold someone's uterus in my hands, I've felt blood pouring over my gloves (it's weird how warm it really feels), I've held a baby as it takes its first breaths.
Obstetrics and gynecology may not be a career choice for me, but it is a fun specialty. There's oncology, surgery, medicine, and you get to follow women throughout their pregnancies and deliver their babies. It's interesting, but there's other areas of medicine that also interest me. I suppose that's why I like family medicine so much, it means that I can do it all except scrub in on surgeries. I mean, if they had some kind of magical specialty where you could be a surgeon and family doctor, that would be cool, but the training would be forever and you'd never, ever, be proficient enough at anything at all.
So, maybe I'll do some deliveries as a family physician. Maybe I won't. At this point in time, I can definitely see why people go into obstetrics and gynecology as a specialty. It isn't just STDs and looking at vaginas all day long. That is part of it, and yes, I am getting a skewed view of what this specialty is, but it's not as bad as I thought it would be.
I still get more excited about family medicine than anything else. Anesthesia is in the back of my mind still and I'm planning on doing an elective in it to either get it out of my system or determine if that's what I want to do for the rest of my life. Either way, that will be a fun rotation. I still think that I want to do family the most.
I'll admit that I've been very lucky in terms of staff and residents. Everyone since day 1 has been wonderful, even during my pediatrics rotation. It's easy to get lost in the scut work that we all have to do: follow up on labs, fill out consults, paperwork paperwork paperwork; but really, if people can't see past that, they really don't know what they're missing. I think this is the best job in the world and honestly, I can't imagine doing anything else.
Every day, I fall in love with what I do more and more.
Obstetrics and gynecology may not be a career choice for me, but it is a fun specialty. There's oncology, surgery, medicine, and you get to follow women throughout their pregnancies and deliver their babies. It's interesting, but there's other areas of medicine that also interest me. I suppose that's why I like family medicine so much, it means that I can do it all except scrub in on surgeries. I mean, if they had some kind of magical specialty where you could be a surgeon and family doctor, that would be cool, but the training would be forever and you'd never, ever, be proficient enough at anything at all.
So, maybe I'll do some deliveries as a family physician. Maybe I won't. At this point in time, I can definitely see why people go into obstetrics and gynecology as a specialty. It isn't just STDs and looking at vaginas all day long. That is part of it, and yes, I am getting a skewed view of what this specialty is, but it's not as bad as I thought it would be.
I still get more excited about family medicine than anything else. Anesthesia is in the back of my mind still and I'm planning on doing an elective in it to either get it out of my system or determine if that's what I want to do for the rest of my life. Either way, that will be a fun rotation. I still think that I want to do family the most.
I'll admit that I've been very lucky in terms of staff and residents. Everyone since day 1 has been wonderful, even during my pediatrics rotation. It's easy to get lost in the scut work that we all have to do: follow up on labs, fill out consults, paperwork paperwork paperwork; but really, if people can't see past that, they really don't know what they're missing. I think this is the best job in the world and honestly, I can't imagine doing anything else.
Every day, I fall in love with what I do more and more.
Tuesday, September 16, 2008
End of my first rotation
Alas, I am just about to finish my rotation in pediatrics. I learned the true meaning of "Terrible 2s" and realized that taking a history from a 14 year-old can be like pulling teeth, or more like speaking to someone in a different language. The nursery was one of the coolest places I've been. Everyone is happy. A lot of pediatrics outside of the hospital is stuff that parents simply aren't familiar with, preventative medicine and making sure that children are developing properly.
The wards was one of the strangest experiences in medicine I have ever had. We were all expecting what is referred to as "bread and butter pediatrics" but the wards did not deliver. I think all of us know how to deal with "rule-out sepsis" in the newborn now, but that might be the only common thing we saw. For example, my first patient had trisomy 21, AKA Down's syndrome, who also had a leukemoid reaction, axial hypotonia, chronic lung disease, pulmonary hypertension, and possible Hirschprung's. Quite the mouthful for my first patient. Even my staff told me that the pediatric wards have been filled with strange, bizzare cases these last few years.
As interesting as my experience has been, and as much fun as I've had with the children, I feel like I could do SOME pediatrics. The way things are going, I'm thinking more and more that I want to do family medicine. I get excited when I talk about family medicine, it's why I applied to medical school, it's what I think I would be happy doing. I found out that some schools in Canada have a third year for family medicine residents to do some extra training in pediatrics so they can better tailor their practice to children. It's not necessary to be able to treat children, but if ever I feel like I want to have better training in pediatrics, I could go do that extra year in one of those schools.
So as I prepare for my exam, and think about the gory gruesome joy of catching babies for a month in obstetrics, I have started to think about my career path as a family physician, where I will go for residency and what kind of practice I am going to have.
Back to the books
The wards was one of the strangest experiences in medicine I have ever had. We were all expecting what is referred to as "bread and butter pediatrics" but the wards did not deliver. I think all of us know how to deal with "rule-out sepsis" in the newborn now, but that might be the only common thing we saw. For example, my first patient had trisomy 21, AKA Down's syndrome, who also had a leukemoid reaction, axial hypotonia, chronic lung disease, pulmonary hypertension, and possible Hirschprung's. Quite the mouthful for my first patient. Even my staff told me that the pediatric wards have been filled with strange, bizzare cases these last few years.
As interesting as my experience has been, and as much fun as I've had with the children, I feel like I could do SOME pediatrics. The way things are going, I'm thinking more and more that I want to do family medicine. I get excited when I talk about family medicine, it's why I applied to medical school, it's what I think I would be happy doing. I found out that some schools in Canada have a third year for family medicine residents to do some extra training in pediatrics so they can better tailor their practice to children. It's not necessary to be able to treat children, but if ever I feel like I want to have better training in pediatrics, I could go do that extra year in one of those schools.
So as I prepare for my exam, and think about the gory gruesome joy of catching babies for a month in obstetrics, I have started to think about my career path as a family physician, where I will go for residency and what kind of practice I am going to have.
Back to the books
Sunday, August 3, 2008
My first night on call
Friday. Get to the hospital at 7am. I work on my patients. I manage to get follow-up for one of my patient's ten separate problems, this managed to take most of my time. My other patient's parents find out they get to go home out on pass if the patient is stable the next morning.
By the evening, I almost miss getting supper at the cafeteria, but thankfully my senior resident tells me to stop what I'm doing (paperwork) and go get my dinner. I make it just in time, and I order the pork and vegetables with rice and string beans. By far, the worst meal I have had in a long time. I should have taken salt and pepper. I wolf it down and rush back to the ward to get back to work. By the evening, the staff is still at the hospital. I find out my responsibility for the evening is to admit patients to the ward, nothing else. In the meantime, the staff and I go to assess a patient who hasn't urinated since 10am (very abnormal for a baby, it means she's dehydrated) and a patient who should have been going home that night, but we had to keep for the night because we only got to him around 12:30 because of the kid with the dehydration.
I write up some notes in the patients' charts and finish that by 1:00. For the next two hours I work on discharge paperwork on two patients I discharged this week. By 2:30, I'm done that and I'm told that if I have nothing to do that I should go to sleep. I head to the on-call rooms and find out that the combination that I have doesn't work. I get the right one from security and enter the room. It's a small room with a hospital bed. It's roasting in there, and there's no fan or A/C. I fall asleep around 3:30 but I wake up at 4:00. I check my pager, still no pages, and we stop admitting patients at 4:00. So, I haven't admitted anyone all night. I fall back asleep and wake up at 6:45 to go see what's up. I get out of the hospital at 9:00, feeling like I didn't really get a chance to see what call was like, but what can I do, it just worked out that way for me. I'm on call again Tuesday, so I'll update again then, and I'll probably have a story.
By the evening, I almost miss getting supper at the cafeteria, but thankfully my senior resident tells me to stop what I'm doing (paperwork) and go get my dinner. I make it just in time, and I order the pork and vegetables with rice and string beans. By far, the worst meal I have had in a long time. I should have taken salt and pepper. I wolf it down and rush back to the ward to get back to work. By the evening, the staff is still at the hospital. I find out my responsibility for the evening is to admit patients to the ward, nothing else. In the meantime, the staff and I go to assess a patient who hasn't urinated since 10am (very abnormal for a baby, it means she's dehydrated) and a patient who should have been going home that night, but we had to keep for the night because we only got to him around 12:30 because of the kid with the dehydration.
I write up some notes in the patients' charts and finish that by 1:00. For the next two hours I work on discharge paperwork on two patients I discharged this week. By 2:30, I'm done that and I'm told that if I have nothing to do that I should go to sleep. I head to the on-call rooms and find out that the combination that I have doesn't work. I get the right one from security and enter the room. It's a small room with a hospital bed. It's roasting in there, and there's no fan or A/C. I fall asleep around 3:30 but I wake up at 4:00. I check my pager, still no pages, and we stop admitting patients at 4:00. So, I haven't admitted anyone all night. I fall back asleep and wake up at 6:45 to go see what's up. I get out of the hospital at 9:00, feeling like I didn't really get a chance to see what call was like, but what can I do, it just worked out that way for me. I'm on call again Tuesday, so I'll update again then, and I'll probably have a story.
Wednesday, July 30, 2008
The wards
It's been a hectic first three days. I've left the hospital at 6:00 or 7:00 at least every day. We see our patients at 7:00am, round with the residents and staff at 8:00am and then do our work for the rest of the day, which includes scheduling tests, getting results, admitting, discharging, consulting the other services. All this normally doesn't take 12 hours, but we're still learning how to do the basic things. We don't even know how to document that we want a nurse to check a patient's vital signs 4 times a day.
I've had some interesting cases so far. I have a baby girl with Down Syndrome, an adolescent boy with septic arthritis in his knee and another baby girl with anemia so bad that she's lucky to be alive.
I'll post more when I have a story to tell
I've had some interesting cases so far. I have a baby girl with Down Syndrome, an adolescent boy with septic arthritis in his knee and another baby girl with anemia so bad that she's lucky to be alive.
I'll post more when I have a story to tell
Thursday, July 24, 2008
Begin Clerkship
Here I am, starting clerkship on Monday. If you're wondering what clerkship is, it's the phase of medical school where the students are constantly at the hospital. We sometimes stay overnight at the hospital and answer calls, and we stay some weekends and answer calls as well. We become an integral part of the medical team during this time. We're responsible for the patients that are assigned to us, and we're often the first person the patient sees when entering the hospital.
I have a lot to learn this year. It's no longer textbooks and multiple choice questions.
Sure, I'm scared, but the excitement to no longer be at a desk or a library is thrilling. Yeah, I still have to be studying, and spend time in the library researching, but now it won't be the only thing that I do.
My first rotation is 8 weeks in pediatrics, a topic we really don't learn much about during the first two years of med school. As a result, we're highly supervised, which decreases the anxiety a bit at the same time. On top of the medical stuff, I'm going to be learning how to deal with families during this rotation since, for neonates or infants, it's obviously only the family that can convey any information to me.
I'll be posting my stories, keeping everything confidential of course and at times just giving my opinion or simply letting everyone know how things are going.
I have a lot to learn this year. It's no longer textbooks and multiple choice questions.
Sure, I'm scared, but the excitement to no longer be at a desk or a library is thrilling. Yeah, I still have to be studying, and spend time in the library researching, but now it won't be the only thing that I do.
My first rotation is 8 weeks in pediatrics, a topic we really don't learn much about during the first two years of med school. As a result, we're highly supervised, which decreases the anxiety a bit at the same time. On top of the medical stuff, I'm going to be learning how to deal with families during this rotation since, for neonates or infants, it's obviously only the family that can convey any information to me.
I'll be posting my stories, keeping everything confidential of course and at times just giving my opinion or simply letting everyone know how things are going.
Wednesday, June 18, 2008
End med 2
I saw, by far, one of the worst skin lesions in my short time at the hospitals yet. A pleasant elderly woman came to the clinic today, battling the mid-stages of dementia. She had recently had two skin cancers, two different skin cancers, removed from her forehead. Her surgical wounds had healed up nicely. Unfortunately one of her cancers progressed and had started eroding away at her cheek. The lesion was reported to be over 6 cm. It was even starting to erode away at her ear and a part of her ear looked like it was dangling by a thread of tissue. She wasn’t in any pain, thankfully, it’s just that the lesion was ulcerated and was oozing blood and fluid, so it was a mess. The only thing they can do, apparently, is irradiate it, hope that it heals well and hope it doesn’t get any bigger.
I enjoyed my time in medical oncology. I thought it could be interesting before I got into it, and after seeing it, I’m convinced that it is still on my list of “maybes.” I’d naturally have to come to terms with not being able to halt the progression of a lot of cancers, but the field is really cutting edge and breakthroughs are being made all the time. I feel like it is a specialty that can give people a lot of hope, but one that can also crush all hope when we have to explain that a patient is palliative and all we can do is treat symptoms. Not that I think that that is the worst thing possible, I’ve even thought about going into palliative care but that was a short thought and I haven’t seriously considered it, yet. Naturally it isn’t easy explaining to a patient that all we can do is help make them comfortable until the end.
I am writing my presentation and report that are due at the end of the week. Then, all I have to do is wonder what the next two years of medical school will bring me
Thursday, June 12, 2008
The human side of medicine
I spent the morning in medical oncology. I was handed a chart and told to go talk to the patient and find out how things were. We glanced at the most recent biopsy report. It read "invasive ductal carcinoma, nuclear grade 2 of 3." If that scares you, it's supposed to. I was seeing my patient post-surgery for removal of the lump and dissection of her axillary lymph nodes (the ones in her arm-pit).
I enter the room. Her and her husband are visibly worried but they agree to be seen by me before the staff physician. She seems to be doing well. The two of them are very pleasant people, and they even crack a few jokes. She looks perfectly healthy aside from the staples that are still present in her almost-fully healed wound. They ask me if I have the results from her surgery. A part of my heart sinks. She already knows that she has invasive cancer but the surgery and axillary dissection are the only way to stage her disease. I tell her that I have some results but that I don't know if we have the most recent results from her surgery. I leave to get the staff physician.
It turns out that the results from the surgery aren't available yet. So she has to wait another two weeks; she's already waited two. The staff doctor explains that's all we can do for now because he can't begin treatment without the results.
Later that morning, I see a patient who was being very difficult with the other student, the resident and then with the staff and me. He's not satisfied with all the waiting that he's been put through; I wasn't there for the whole story. This is a patient who's caused another doctor to refuse to see him anymore. He's very angry and I understand that having a diagnosis of invasive colon cancer isn't the greatest experience in one's life but I've met plenty of very sick and dying people who manage to remain pleasant through till the end. What I'm basically saying is that I don't think it's the way this man has been treated or his illness that is making him miserable.
During the interview, the doctor explains that since he's failed the last two rounds of chemotherapy that there's no point in combining them and there's no point in doing anything until we see results from his CT scan (which hasn't even taken place yet). He tells the doctor that he's contacted doctors in an American hospital who say that what he's proposing, to combine the regiments, is legitimate. This patient is basically trying to dictate his own care. I fully believe that patients have a say in their care, but when a doctor tells you something is pointless and thinks it could only do harm, I feel that one should probably heed the doctor's advice. That is, of course, my humble opinion.
I saw another patient, a woman with colon cancer as well. She was, by far, one of the most pleasant people I've met in a while. My classmate had a good choice of words to describe her, my favorite of which was "Charming." This woman has disseminated herpes zoster, which basically means she had shingles all over her body. Despite this, she was still pleasant and polite with us. What a breath of fresh air after the last patient.
Today, I saw my staff be compassionate with the pleasant patients and turn his back on the unpleasant one. I'll say this: I don't know the whole story with the miserable patient. A part of me still feels a little dirty having seen what transpired in that examination room and how that man was treated. Will I ever know if it was justified? Probably not. Can I learn from it anyway? You bet
I enter the room. Her and her husband are visibly worried but they agree to be seen by me before the staff physician. She seems to be doing well. The two of them are very pleasant people, and they even crack a few jokes. She looks perfectly healthy aside from the staples that are still present in her almost-fully healed wound. They ask me if I have the results from her surgery. A part of my heart sinks. She already knows that she has invasive cancer but the surgery and axillary dissection are the only way to stage her disease. I tell her that I have some results but that I don't know if we have the most recent results from her surgery. I leave to get the staff physician.
It turns out that the results from the surgery aren't available yet. So she has to wait another two weeks; she's already waited two. The staff doctor explains that's all we can do for now because he can't begin treatment without the results.
Later that morning, I see a patient who was being very difficult with the other student, the resident and then with the staff and me. He's not satisfied with all the waiting that he's been put through; I wasn't there for the whole story. This is a patient who's caused another doctor to refuse to see him anymore. He's very angry and I understand that having a diagnosis of invasive colon cancer isn't the greatest experience in one's life but I've met plenty of very sick and dying people who manage to remain pleasant through till the end. What I'm basically saying is that I don't think it's the way this man has been treated or his illness that is making him miserable.
During the interview, the doctor explains that since he's failed the last two rounds of chemotherapy that there's no point in combining them and there's no point in doing anything until we see results from his CT scan (which hasn't even taken place yet). He tells the doctor that he's contacted doctors in an American hospital who say that what he's proposing, to combine the regiments, is legitimate. This patient is basically trying to dictate his own care. I fully believe that patients have a say in their care, but when a doctor tells you something is pointless and thinks it could only do harm, I feel that one should probably heed the doctor's advice. That is, of course, my humble opinion.
I saw another patient, a woman with colon cancer as well. She was, by far, one of the most pleasant people I've met in a while. My classmate had a good choice of words to describe her, my favorite of which was "Charming." This woman has disseminated herpes zoster, which basically means she had shingles all over her body. Despite this, she was still pleasant and polite with us. What a breath of fresh air after the last patient.
Today, I saw my staff be compassionate with the pleasant patients and turn his back on the unpleasant one. I'll say this: I don't know the whole story with the miserable patient. A part of me still feels a little dirty having seen what transpired in that examination room and how that man was treated. Will I ever know if it was justified? Probably not. Can I learn from it anyway? You bet
Monday, June 9, 2008
Oncology
Today we started a two week stint in oncology. Our first day we started in radiology oncology. You know when you hear about people getting blasted with focused radiation to treat various malignancies? Well that's what we were supposed to be seeing: the first presentations, the follow-ups, the complications, the improvements, etc.
Begin 9am in the resident's room where we are told that there isn't much to be done today despite being scheduled for the whole day. We force introductions upon the resident who seemed reluctant to tell us her name. Since two of us get stuck without anyone to follow who's actually seeing patients, we head to the lead-lined basement where the irradiating takes place. Here, we actually see how the patients are set up using their tattoos and lasers in the wall and machine to line them up in all three dimensions. The actual irradiating part takes less time than the setup most of the time. As interesting as it was, and despite the fact that every patient is different and requires a different setup, we realize very quickly that the radiation technicians are busy and have their own student to teach so we go search for a doctor to follow.
We get rejected with a shy smile and a slightly empathetic "Soon" from the other resident who forgets to explain to us that she has no patients to see until we ask what's happening. An hour before things are scheduled to wrap up, we are sent to lunch only to return in two hours.
Upon our return, this time all four of us are completely ignored. There's no test for this rotation, just a paper and a presentation but the residents are using the computers in the residents' room (makes sense, doesn't it?) and we discuss the weekend, the local restaurants, and the big debate whether or not to write a foreign medical licensing exam. One student decides he's going to leave, but backs out and jumps in on my action with a patient.
We interview my one patient of the day. He's a man with lung cancer. He reminded me so much of my grandfather before he fell ill. It was everything about him: the shape of his face, the big glasses, the clothes, the way he talked, his expressions. His prognosis wasn't good. The cancer had been eroding his ribs for at least a year now. There at least weren't any signs that the cancer had spread further, but sadly it's only a matter of time. The thing about lung cancer is that it just really doesn't respond well to any treatment we have, so the best thing to do is to not smoke, but that's a public health issue that I won't delve into right now.
We present the man's case to the doctor who goes in and sees the patient. Turns out there's a waiting list for radiation therapy. I cannot imagine how frustrating it is to have a malignancy and need treatment and then be told that there's a waiting list for radiation. At least chemotherapy doesn't have a waiting list. After seeing the patient, we head to the doctor's office to talk about the case. He rants a little about how he would rather be treated in Brazil because of our waiting times. We talk a little bit about staging cancers and that's it for the day.
We grumble. Make mental notes of everyone's names so we can give appropriate evaluations on our time well wasted (one patient in a whole day is not acceptable really).
Tomorrow we're off to the medical oncology department, which, from what I hear from fellow students, is a much more student-friendly environment.
Let's hope
Begin 9am in the resident's room where we are told that there isn't much to be done today despite being scheduled for the whole day. We force introductions upon the resident who seemed reluctant to tell us her name. Since two of us get stuck without anyone to follow who's actually seeing patients, we head to the lead-lined basement where the irradiating takes place. Here, we actually see how the patients are set up using their tattoos and lasers in the wall and machine to line them up in all three dimensions. The actual irradiating part takes less time than the setup most of the time. As interesting as it was, and despite the fact that every patient is different and requires a different setup, we realize very quickly that the radiation technicians are busy and have their own student to teach so we go search for a doctor to follow.
We get rejected with a shy smile and a slightly empathetic "Soon" from the other resident who forgets to explain to us that she has no patients to see until we ask what's happening. An hour before things are scheduled to wrap up, we are sent to lunch only to return in two hours.
Upon our return, this time all four of us are completely ignored. There's no test for this rotation, just a paper and a presentation but the residents are using the computers in the residents' room (makes sense, doesn't it?) and we discuss the weekend, the local restaurants, and the big debate whether or not to write a foreign medical licensing exam. One student decides he's going to leave, but backs out and jumps in on my action with a patient.
We interview my one patient of the day. He's a man with lung cancer. He reminded me so much of my grandfather before he fell ill. It was everything about him: the shape of his face, the big glasses, the clothes, the way he talked, his expressions. His prognosis wasn't good. The cancer had been eroding his ribs for at least a year now. There at least weren't any signs that the cancer had spread further, but sadly it's only a matter of time. The thing about lung cancer is that it just really doesn't respond well to any treatment we have, so the best thing to do is to not smoke, but that's a public health issue that I won't delve into right now.
We present the man's case to the doctor who goes in and sees the patient. Turns out there's a waiting list for radiation therapy. I cannot imagine how frustrating it is to have a malignancy and need treatment and then be told that there's a waiting list for radiation. At least chemotherapy doesn't have a waiting list. After seeing the patient, we head to the doctor's office to talk about the case. He rants a little about how he would rather be treated in Brazil because of our waiting times. We talk a little bit about staging cancers and that's it for the day.
We grumble. Make mental notes of everyone's names so we can give appropriate evaluations on our time well wasted (one patient in a whole day is not acceptable really).
Tomorrow we're off to the medical oncology department, which, from what I hear from fellow students, is a much more student-friendly environment.
Let's hope
Thursday, June 5, 2008
The Stroke Unit
I know, I've neglected my blog again. "Bad blogger!" you say, and I can't deny it, my cyber-etiquette never was perfected. I leave MSN on "Away" all the time, whether I'm home or not. I drop conversations because myself and the other person have run out of things to say, but alas, I am not alone for no-one on my MSN has good cyber-etiquette.
But I digress.
My addiction to caffeine has reach horrendous levels. Why the sudden change in my abuse of the world's most commonly abused substance, you ask? Probably from a lack of sleep and a pattern of behavior that I have adopted that involves staying up until 2 o'clock of the a.m., awaking at the un-godly hour of 6:00 and jump-starting my mind with two cups of what I like to call "The Elixir of the Gods." Quite the ring to it eh?
Ok, I know you all want to hear my cool medical stories eh? Well, you're in for a treat because I actually have some this week.
My two weeks began in Neurology and I quickly discovered that all of the inpatients that we would see were situated on the hospital's stroke unit. These unfortunate souls are usually the only people with physical findings. They make excellent teaching cases, but some of them break your heart.
So the first patient we see is a woman who came to the hospital with progressively worsening weakness. She couldn't get out of a chair or climb the stairs. This weakness eventually spread to her shoulders and even affected her to the point where she couldn't swallow properly anymore. A fascinating case, but a tough disease to have, albeit a treatable disease with possibility of a good recovery. Dermatomyositis was her eventual diagnosis if you care to check it out.
Ok, so I said I was on the stroke unit, so let me tell you about the first stroke patient we had. This woman had complete paralysis of the right side of her body. She was very pleasant with us and let us all examine her rigid muscles on her paralyzed side and see the hyperreflexia that had set in. Her possibility of recovery wasn't great, but at least she could do some stuff still.
The most tragic case I saw during my whole rotation was one that reminded me of the first stroke victim I saw a few months ago. This woman had an aphasia. I suppose she didn't just have an aphasia she had two. A little hard to assess because when a patient has Broca's aphasia. This basically means they can't talk. She couldn't even grunt, nothing, nada. What's even harder about this poor woman is that she had a significant lesion in Wernicke's area as well, which produces what's called a fluent aphasia. If someone had a pure Wernicke's aphasia, they wouldn't understand a word you were saying, they wouldn't be able to read, and their speech would be complete gibberish. Now imagine, this woman I saw can't speak, and is having a very hard time understanding anything. She can only understand simple commands like "Close your eyes" but anything more complicated like "Point to my watch" gets lost in translation so to speak.
Of course, there's always hope for recovery, but it requires determination. Just like trying to get muscle strength back with physiotherapy, this woman is going to require extensive work with speech therapists. It's hard though when a patient doesn't understand anyone because they have no idea what is going on all the time.
On a different note. When I was shadowing a radiology resident on-call, we heard the surgeons talking about a man who jumped off a third-floor balcony and his only injury was a ruptured scrotum. It still makes me shudder. No, I didn't get to see it, but the story is that his testicles were completely exposed.
With that, I'm off to enjoy another mug of the Elixir of the Gods and study neurology.
But I digress.
My addiction to caffeine has reach horrendous levels. Why the sudden change in my abuse of the world's most commonly abused substance, you ask? Probably from a lack of sleep and a pattern of behavior that I have adopted that involves staying up until 2 o'clock of the a.m., awaking at the un-godly hour of 6:00 and jump-starting my mind with two cups of what I like to call "The Elixir of the Gods." Quite the ring to it eh?
Ok, I know you all want to hear my cool medical stories eh? Well, you're in for a treat because I actually have some this week.
My two weeks began in Neurology and I quickly discovered that all of the inpatients that we would see were situated on the hospital's stroke unit. These unfortunate souls are usually the only people with physical findings. They make excellent teaching cases, but some of them break your heart.
So the first patient we see is a woman who came to the hospital with progressively worsening weakness. She couldn't get out of a chair or climb the stairs. This weakness eventually spread to her shoulders and even affected her to the point where she couldn't swallow properly anymore. A fascinating case, but a tough disease to have, albeit a treatable disease with possibility of a good recovery. Dermatomyositis was her eventual diagnosis if you care to check it out.
Ok, so I said I was on the stroke unit, so let me tell you about the first stroke patient we had. This woman had complete paralysis of the right side of her body. She was very pleasant with us and let us all examine her rigid muscles on her paralyzed side and see the hyperreflexia that had set in. Her possibility of recovery wasn't great, but at least she could do some stuff still.
The most tragic case I saw during my whole rotation was one that reminded me of the first stroke victim I saw a few months ago. This woman had an aphasia. I suppose she didn't just have an aphasia she had two. A little hard to assess because when a patient has Broca's aphasia. This basically means they can't talk. She couldn't even grunt, nothing, nada. What's even harder about this poor woman is that she had a significant lesion in Wernicke's area as well, which produces what's called a fluent aphasia. If someone had a pure Wernicke's aphasia, they wouldn't understand a word you were saying, they wouldn't be able to read, and their speech would be complete gibberish. Now imagine, this woman I saw can't speak, and is having a very hard time understanding anything. She can only understand simple commands like "Close your eyes" but anything more complicated like "Point to my watch" gets lost in translation so to speak.
Of course, there's always hope for recovery, but it requires determination. Just like trying to get muscle strength back with physiotherapy, this woman is going to require extensive work with speech therapists. It's hard though when a patient doesn't understand anyone because they have no idea what is going on all the time.
On a different note. When I was shadowing a radiology resident on-call, we heard the surgeons talking about a man who jumped off a third-floor balcony and his only injury was a ruptured scrotum. It still makes me shudder. No, I didn't get to see it, but the story is that his testicles were completely exposed.
With that, I'm off to enjoy another mug of the Elixir of the Gods and study neurology.
Tuesday, May 13, 2008
Shake down 1979, cool kids never have the time
Not much to report for the last week. With the gf here, I've been having a good ole time. Was stuck in the classroom all week last week, which totally sucked. This week we started back in the clinics.
I had my first family medicine clinic yesterday. It went well. I saw my first patient all by myself as the first person seeing her. It was pretty cool. There wasn't anything to find though because it turns out she had come in to see if she needed any vaccines; too bad, but I'll get to do more later. We saw a 4-month-old and right after a 90-year-old; quite the wide spectrum. Next week I'll be present during a walk-in clinic so that will give me a glimpse into a bit of emergency medicine. I am really interested in being a family physician, so this itsy bitsy glimpse into a family practice is actually exciting for me.
Tonight, I am shadowing in the psychiatry ER until midnight. I am obviously not alone. I'll be following a third or fourth year student and observing what the night call is like. I'll be doing this next year as a part of my psychiatry rotation. Tonight could be really interesting and hectic or it could end up being a bore, it all depends on whether or not there are people out there having psych emergencies or not.
As of now though, there's not much new to report really. I got out of bed at 11:00, said bye to the gf who went out to see her girlfriends, and I'm just passing the time trying to figure out how to rearrange my living room to accommodate the big-screen TV I inherited and waiting for my shadowing to start.
It's going to be a quiet week, but I'll post if something interesting happens.
I had my first family medicine clinic yesterday. It went well. I saw my first patient all by myself as the first person seeing her. It was pretty cool. There wasn't anything to find though because it turns out she had come in to see if she needed any vaccines; too bad, but I'll get to do more later. We saw a 4-month-old and right after a 90-year-old; quite the wide spectrum. Next week I'll be present during a walk-in clinic so that will give me a glimpse into a bit of emergency medicine. I am really interested in being a family physician, so this itsy bitsy glimpse into a family practice is actually exciting for me.
Tonight, I am shadowing in the psychiatry ER until midnight. I am obviously not alone. I'll be following a third or fourth year student and observing what the night call is like. I'll be doing this next year as a part of my psychiatry rotation. Tonight could be really interesting and hectic or it could end up being a bore, it all depends on whether or not there are people out there having psych emergencies or not.
As of now though, there's not much new to report really. I got out of bed at 11:00, said bye to the gf who went out to see her girlfriends, and I'm just passing the time trying to figure out how to rearrange my living room to accommodate the big-screen TV I inherited and waiting for my shadowing to start.
It's going to be a quiet week, but I'll post if something interesting happens.
Tuesday, May 6, 2008
Weekend break
I spent the weekend afar, attending a formal in the missus' honor. Good times were had, our bellies were filled, as we enjoyed our scenery and the company of others.
During the weekend, we hop over to a magazine store. I love books. Every time I get into a book store I light up. I have no idea why, I just like the idea of the possibility of so many books. Since I was a kid, I loved a good book, and I still do.
So while in this magazine store I'm like the proverbial kid in a candy store. This is the most extensive magazine store I've ever been to, even airports can't compete with this. I circle around once looking for my prey. I opt for the least medical things that I can think of that I love and I get The Hockey News and Forbes. Turns out Forbes has a piece on artificial heart pumps and how they could replace heart transplants; it's the only medical article and The Hockey News has nothing of the sort.
Fast forward to my apartment, with the gf (that's pronounced "Gee-Eff"), who's here for two weeks, where we settle in, grocery shop, etc. A big story in the news that catches my attention describing the Hand, Foot and Mouth Disease that is killing children in China. I cross my fingers that 2003 doesn't repeat itself and thank my lucky stars I'm not in the ER right now.
Monday. We begin our family med rotation. I'm particularly excited because family med was the reason why I ever entered medical school. I'm nervous because I hope it turns out to be as great as I thought it would be. Turns out, we don't actually see that much family med, but we do get a little taste.
Get home from school. Dinner it up with the gf and watch House and head to bed early to be at school for 8am.
During the weekend, we hop over to a magazine store. I love books. Every time I get into a book store I light up. I have no idea why, I just like the idea of the possibility of so many books. Since I was a kid, I loved a good book, and I still do.
So while in this magazine store I'm like the proverbial kid in a candy store. This is the most extensive magazine store I've ever been to, even airports can't compete with this. I circle around once looking for my prey. I opt for the least medical things that I can think of that I love and I get The Hockey News and Forbes. Turns out Forbes has a piece on artificial heart pumps and how they could replace heart transplants; it's the only medical article and The Hockey News has nothing of the sort.
Fast forward to my apartment, with the gf (that's pronounced "Gee-Eff"), who's here for two weeks, where we settle in, grocery shop, etc. A big story in the news that catches my attention describing the Hand, Foot and Mouth Disease that is killing children in China. I cross my fingers that 2003 doesn't repeat itself and thank my lucky stars I'm not in the ER right now.
Monday. We begin our family med rotation. I'm particularly excited because family med was the reason why I ever entered medical school. I'm nervous because I hope it turns out to be as great as I thought it would be. Turns out, we don't actually see that much family med, but we do get a little taste.
Get home from school. Dinner it up with the gf and watch House and head to bed early to be at school for 8am.
Wednesday, April 30, 2008
Hump day
I wake at 6:45, English muffin, coffee, school. We start relatively on time today and learn about hearing loss and ear infections. Give some stern feedback and constructive criticism at the feedback session for the rotation and head off to the next class at the other hospital.
We learn about plastic surgery: skin grafts, flaps. I head home to eat lunch and head back the original hospital only to find out that I read the schedule wrong and that I have to head back to the other hospital. Luckily, I still arrived on time. We learn about head injuries.
Head back (for the third time today) to the first hospital and get a lecture on neck masses.
I head home to study. I get all set up, books and notes everywhere and I whip out the question book I printed only to find out that my copy is missing half the pages. I go back to the copy store and they offer to give me a complete one tomorrow, no charge. I really wanted to study those practice questions, but that'll have to wait until tomorrow; at least I don't have to dish out the $18 again
I get home, again, and I settle back down (FINALLY) to study everything from hernias, to breast masses, to urinary retention, to transplant surgery. I have no idea what to really really focus on, but considering everyone is in the same boat and reflecting those feelings back in conversation or on MSN, I feel a little relieved. We have objectives, but there's 70 questions and they aren't distributed evenly through the subjects.
The clock strikes 10:30 and I head to bed to get a good night sleep before the dreaded last day of studying.
We learn about plastic surgery: skin grafts, flaps. I head home to eat lunch and head back the original hospital only to find out that I read the schedule wrong and that I have to head back to the other hospital. Luckily, I still arrived on time. We learn about head injuries.
Head back (for the third time today) to the first hospital and get a lecture on neck masses.
I head home to study. I get all set up, books and notes everywhere and I whip out the question book I printed only to find out that my copy is missing half the pages. I go back to the copy store and they offer to give me a complete one tomorrow, no charge. I really wanted to study those practice questions, but that'll have to wait until tomorrow; at least I don't have to dish out the $18 again
I get home, again, and I settle back down (FINALLY) to study everything from hernias, to breast masses, to urinary retention, to transplant surgery. I have no idea what to really really focus on, but considering everyone is in the same boat and reflecting those feelings back in conversation or on MSN, I feel a little relieved. We have objectives, but there's 70 questions and they aren't distributed evenly through the subjects.
The clock strikes 10:30 and I head to bed to get a good night sleep before the dreaded last day of studying.
Tuesday, April 29, 2008
The Juggling Act Schedule
Today, same routine. 6:45. Grunt. Coffee, juice, English muffin. This time I opt to shave. I have to put on the appearance that I take good care of myself so that it looks like I can take good care of other people; thank goodness patients can't see my apartment right now.
8:00am The teacher doesn't show up on time. So the junior resident decides to chat it up with us in the conference room whilst we wait for the glorious ENT surgeon. The resident is a pretty down to earth guy and he gives us a bit of advice on choosing a specialty; the first thing he brings up is lifestyle, THEN he mentions how interesting he thought ENT was.
8:40 commence learning about sinusitis. We find out halfway through the session that our class at 10:00 has been postponed until 2:00; this means that I'll be missing optional clinic. We leave the confines of the ENT conference room and are awarded with saline nasal washing kits for the next time we get sinusitis. I somehow end up with the one hypertonic one that is made from sterilized sea-water and comes in a pressurized can instead of the standard bulb that you squeeze yourself to get the saline up your nose. Hopefully it's just as painless as the others. I'll find out next time I get sick! Stay tuned.
I speak with my tutor, get a patient name and head home to drop off my notes. I head over to the other hospital and up to the ICU to see my patient. He's younger than me, which I find out after calling him "mister." I feel silly, but that's the way we're supposed to address patients until they tell us otherwise. Turns out, this kid was in an MVA (motor vehicle accident) involving a scooter and a telephone pole. I have no idea how you drive a scooter into a telephone pole; the things only go 60 kph! So he dislocated his knee, badly. They reduce it (put it back in place), but only to find out that he's damaged his nerve (not good, but not tragic since it could heal and won't ruin his leg) and that's he's damaged his artery. This needed surgery (hence why I'm seeing him) in order to save his leg. He had lost the pulses in his leg because of the accident and was at very high risk of having his leg go gangrenous and needing it to be amputated. You can check for pulses the old fashioned way and if you can't feel them, then we have this fancy little probe that uses ultrasound and applies the Doppler effect theory to figure out if there's even a tincy wincy pulse, but there isn't. Not good for him, but a cool medical case. During the quiet days at the hospital we say (and this isn't anything clever or unique to us) that it's good for the patients but bad for us. Anyhoo, the surgery went well and I could feel that his pulses were back. Vascular surgery saves the day.
I wrap up the interview, which doesn't have too much detail but has just enough that I can write up a report on it and beef up the report with some talk on the risks of losing the limb and I head off to the library. I look up some details on vascular injury following blunt trauma to the knee and I study until my hunger gets the best of me. I eat and head to my next class. We talk about appendicitis and small bowel obstruction and the teacher goes over his time by 30 minutes, but he showed up on time, so I find it in my heart to forgive him.
I get home and pass out for a 30 minute power nap before tackling my report.
I get writers block and start pacing. I'm pounding back Earl Grey tea like it's the last supper. Finally the words start to flow and it looks like I'll actually get to bed before midnight. I succeed and joyfully head to bed at 11:15
8:00am The teacher doesn't show up on time. So the junior resident decides to chat it up with us in the conference room whilst we wait for the glorious ENT surgeon. The resident is a pretty down to earth guy and he gives us a bit of advice on choosing a specialty; the first thing he brings up is lifestyle, THEN he mentions how interesting he thought ENT was.
8:40 commence learning about sinusitis. We find out halfway through the session that our class at 10:00 has been postponed until 2:00; this means that I'll be missing optional clinic. We leave the confines of the ENT conference room and are awarded with saline nasal washing kits for the next time we get sinusitis. I somehow end up with the one hypertonic one that is made from sterilized sea-water and comes in a pressurized can instead of the standard bulb that you squeeze yourself to get the saline up your nose. Hopefully it's just as painless as the others. I'll find out next time I get sick! Stay tuned.
I speak with my tutor, get a patient name and head home to drop off my notes. I head over to the other hospital and up to the ICU to see my patient. He's younger than me, which I find out after calling him "mister." I feel silly, but that's the way we're supposed to address patients until they tell us otherwise. Turns out, this kid was in an MVA (motor vehicle accident) involving a scooter and a telephone pole. I have no idea how you drive a scooter into a telephone pole; the things only go 60 kph! So he dislocated his knee, badly. They reduce it (put it back in place), but only to find out that he's damaged his nerve (not good, but not tragic since it could heal and won't ruin his leg) and that's he's damaged his artery. This needed surgery (hence why I'm seeing him) in order to save his leg. He had lost the pulses in his leg because of the accident and was at very high risk of having his leg go gangrenous and needing it to be amputated. You can check for pulses the old fashioned way and if you can't feel them, then we have this fancy little probe that uses ultrasound and applies the Doppler effect theory to figure out if there's even a tincy wincy pulse, but there isn't. Not good for him, but a cool medical case. During the quiet days at the hospital we say (and this isn't anything clever or unique to us) that it's good for the patients but bad for us. Anyhoo, the surgery went well and I could feel that his pulses were back. Vascular surgery saves the day.
I wrap up the interview, which doesn't have too much detail but has just enough that I can write up a report on it and beef up the report with some talk on the risks of losing the limb and I head off to the library. I look up some details on vascular injury following blunt trauma to the knee and I study until my hunger gets the best of me. I eat and head to my next class. We talk about appendicitis and small bowel obstruction and the teacher goes over his time by 30 minutes, but he showed up on time, so I find it in my heart to forgive him.
I get home and pass out for a 30 minute power nap before tackling my report.
I get writers block and start pacing. I'm pounding back Earl Grey tea like it's the last supper. Finally the words start to flow and it looks like I'll actually get to bed before midnight. I succeed and joyfully head to bed at 11:15
Monday, April 28, 2008
Mondays
Ah Mondays. How I loathe Mondays. I wake at 6:30am. The usual morning routine consisting of English Muffins, juice, and coffee, black. I skip shaving my teenage stubble. At the ripe age of 24, I still can't grow sideburns, a mustache or anything on my cheeks. I scramble to get to class at 8:00.
We wait, for about ten minutes to find out our teacher isn't showing up and that we're going to have to reschedule the class. Our test is this Friday, so that doesn't leave a lot of time to reschedule.
After studying for the next 2 and a half hours at the library I head up to my lecture on enlarged prostates. A gentle reminder of what all men will eventually deal with ensues.
Afterwards, I eat lunch and head over to the hospital I'm currently stationed at only to find out that my assigned patient was discharged this morning before I had a chance to interview him. I mutter under my breath and search for my tutor to be assigned another one. He's nowhere to be found, and he isn't answering his pages. Lovely.
I head back home, soaked by the heaviest rainfall we've seen all spring. My shoes and socks squish squash the whole way home. I change into some dry clothes, make a tea and proceed to write up the first case I interviewed. Not only are these things pointless to write up (the tutors don't even like reading/correcting them) but they waste a lot of time in the process. I love interviewing patients and examining them, but to have to write a report that does not resemble anything in any chart that I have ever read, quite frankly, seems stupid. I compare it to learning how to use a typewriter and all of its machinery when you know you're just going to be using a computer. Pointless.
I speak with the missus for a short while. Skype screws up and we have to switch to the phone.
After finishing the report, in what feels like eons but was really only 4 hours, I plant myself in front of my textbooks in an effort to not fail the upcoming exam. I become distracted quite quickly. I head to the washroom for a twenty minute relief and some recreational reading. I make some more tea and realize that my heartburn has returned but this time I have the antacids at the ready.
I watch the end of the hockey game (why are the playoffs always near exams?) and study some more before heading to bed surrounded by two weeks worth of unfolded laundry. The bed is cold and empty and the sound of rain outside is my companion instead of the gentle breathing of my girlfriend.
At 10pm, I get back out of bed after realizing that even though I'm tired, I'm wide awake (switched to decaf tea at 8pm). I hit the books in the hope that reading about liver disease will put me to sleep. I grind my teeth at the fact that tomorrow I have to interview another patient (which is fine) but have to write up another case report on said patient. I kept this last one short and sweet in the hopes that it will be adequate enough to please my tutor.
It's 10:45 and I feel the pass-out phase of studying sink in. It feels so good, almost naughty.
We wait, for about ten minutes to find out our teacher isn't showing up and that we're going to have to reschedule the class. Our test is this Friday, so that doesn't leave a lot of time to reschedule.
After studying for the next 2 and a half hours at the library I head up to my lecture on enlarged prostates. A gentle reminder of what all men will eventually deal with ensues.
Afterwards, I eat lunch and head over to the hospital I'm currently stationed at only to find out that my assigned patient was discharged this morning before I had a chance to interview him. I mutter under my breath and search for my tutor to be assigned another one. He's nowhere to be found, and he isn't answering his pages. Lovely.
I head back home, soaked by the heaviest rainfall we've seen all spring. My shoes and socks squish squash the whole way home. I change into some dry clothes, make a tea and proceed to write up the first case I interviewed. Not only are these things pointless to write up (the tutors don't even like reading/correcting them) but they waste a lot of time in the process. I love interviewing patients and examining them, but to have to write a report that does not resemble anything in any chart that I have ever read, quite frankly, seems stupid. I compare it to learning how to use a typewriter and all of its machinery when you know you're just going to be using a computer. Pointless.
I speak with the missus for a short while. Skype screws up and we have to switch to the phone.
After finishing the report, in what feels like eons but was really only 4 hours, I plant myself in front of my textbooks in an effort to not fail the upcoming exam. I become distracted quite quickly. I head to the washroom for a twenty minute relief and some recreational reading. I make some more tea and realize that my heartburn has returned but this time I have the antacids at the ready.
I watch the end of the hockey game (why are the playoffs always near exams?) and study some more before heading to bed surrounded by two weeks worth of unfolded laundry. The bed is cold and empty and the sound of rain outside is my companion instead of the gentle breathing of my girlfriend.
At 10pm, I get back out of bed after realizing that even though I'm tired, I'm wide awake (switched to decaf tea at 8pm). I hit the books in the hope that reading about liver disease will put me to sleep. I grind my teeth at the fact that tomorrow I have to interview another patient (which is fine) but have to write up another case report on said patient. I kept this last one short and sweet in the hopes that it will be adequate enough to please my tutor.
It's 10:45 and I feel the pass-out phase of studying sink in. It feels so good, almost naughty.
Sunday, April 27, 2008
A weekend with a beautiful woman and a Sunday of emotions
I spent the weekend with the love of my life. She's beautiful. I still don't understand how someone so wonderful could want to be with someone as jaded and bitter as I can be, but she does, and I count my blessings. We studied together, she happens to be an ambitious student as well.
Today, we woke up and spent the morning together, studying. I find Sundays hard. I always have. From when I was a child, when Sundays occasionally meant that long distance family would be going back to their lives, to more recent years when it meant I was nursing a hangover and wouldn't be seeing my friends for another few weeks because of school, to more recently where I have to say "goodbye until next time" to this beautiful woman who holds my heart. I usually spend most of my Sunday pretending to study while she runs through her notes, highlighting and adding words of wisdom in the side bars of her texts.
While this spectacle goes on, I sit, glancing at her more than my notes, my knee bouncing in anticipation, my feet shuffling with nervousness, my nails being bitten off as I slowly become a nervous wreck. I leave, usually in the afternoon, to arrive back downtown to scramble to do groceries, laundry and finish up any assignments or prepare for the next day's discussions in class.
So this Sunday, after sleeping and listening to my iPod the entire bus ride instead of studying, I again scramble to do my groceries and prepare myself for the week but I still can't concentrate.
I compose myself.
I reach for a tea and head outside onto my balcony. Something about fresh air and realizing that the world is still turning helps to sober me up and hot drinks always made me feel better.
I reapply myself to my studies, my profession, my life, since today, tomorrow, next week, I don't have the time to deal with emotion and distraction and I realize I am still the fearful 17 year-old boy that I was.
Today, we woke up and spent the morning together, studying. I find Sundays hard. I always have. From when I was a child, when Sundays occasionally meant that long distance family would be going back to their lives, to more recent years when it meant I was nursing a hangover and wouldn't be seeing my friends for another few weeks because of school, to more recently where I have to say "goodbye until next time" to this beautiful woman who holds my heart. I usually spend most of my Sunday pretending to study while she runs through her notes, highlighting and adding words of wisdom in the side bars of her texts.
While this spectacle goes on, I sit, glancing at her more than my notes, my knee bouncing in anticipation, my feet shuffling with nervousness, my nails being bitten off as I slowly become a nervous wreck. I leave, usually in the afternoon, to arrive back downtown to scramble to do groceries, laundry and finish up any assignments or prepare for the next day's discussions in class.
So this Sunday, after sleeping and listening to my iPod the entire bus ride instead of studying, I again scramble to do my groceries and prepare myself for the week but I still can't concentrate.
I compose myself.
I reach for a tea and head outside onto my balcony. Something about fresh air and realizing that the world is still turning helps to sober me up and hot drinks always made me feel better.
I reapply myself to my studies, my profession, my life, since today, tomorrow, next week, I don't have the time to deal with emotion and distraction and I realize I am still the fearful 17 year-old boy that I was.
Thursday, April 24, 2008
Studying day
I've been suffering recurrent reflux/heartburn and have hit my limit. There's only so much water I'm willing to drink to dilute out the acid in my stomach; it makes me have to piss every 20 minutes, which makes getting into my study groove a little difficult. I head to the local pharmacy and purchase myself some antacids, which I know are just going to make the problem worse but it's better than pissing every 20 minutes.
On the way back, my studying munchies get the best of me and I pick up 20 Timbits at the local Tim Horton's. I have a really bad habit of succumbing to my 5-year-old desires when I'm supposed to be studying.
I get home, munch on the Timbits and study for a few minutes only to have my IBS kick in.
Now I'm completely thrown off my groove and have to start all over again.
The heartburn returns after eating a spicy salami sandwich. I'm beginning to regret buying that spicy salami.
I think about calling the missus but remember that she's busy cramming as well and instead of sucking her into my procrastinating madness, I decide to return to my books.
After giving in to ridiculous IBS symptoms, I decide to finish the night off watching The Empire Strikes Back but the link breaks after about 40 minutes and head off to bed
On the way back, my studying munchies get the best of me and I pick up 20 Timbits at the local Tim Horton's. I have a really bad habit of succumbing to my 5-year-old desires when I'm supposed to be studying.
I get home, munch on the Timbits and study for a few minutes only to have my IBS kick in.
Now I'm completely thrown off my groove and have to start all over again.
The heartburn returns after eating a spicy salami sandwich. I'm beginning to regret buying that spicy salami.
I think about calling the missus but remember that she's busy cramming as well and instead of sucking her into my procrastinating madness, I decide to return to my books.
After giving in to ridiculous IBS symptoms, I decide to finish the night off watching The Empire Strikes Back but the link breaks after about 40 minutes and head off to bed
My return to the blog
sI know that I’ve neglected this blog for quite some time now. Truth is, I realized how boring my life actually is and didn’t see the need to torture my readers (whoever you are) with the mundane details of the life of a medical student. For the readers who are still intrigued as to what the life of a medical student is really like, here it goes:
6:00am: Wake to the harmonious sounds of construction workers, heavy machinery and the beginnings of rush-hour traffic wafting through the open window of my downtown apartment.
7:00am: Re-awaken to previously mentioned construction. Roll over and attempt to re-enter the frustratingly sub-erotic dream state that I was previously in.
7:15am: Turn off alarm on cell phone and deny that this moment in time ever existed.
7:30am: Turn off second alarm on cell phone and grumble about how annoying my obsessive compulsions can be when they require me to set three alarms
7:45am: Dammit! Turn off third alarm and stumble blindly out of bed
8:45am: After feeding and self-grooming, strut to the hospital bobbing to the tunes of 70’s rock band
9:00am: Arrive just on time for surgery lecture only to realize AGAIN that surgeons don’t like teaching… Or showing up on time
11:30am: Finish classes for the day, purchase sushi and study food and return to apartment
12:30pm: Head to local book store to purchase Kevin Smith diary
12:45pm: Bask in springtime sun and waltz to local Starbucks to study surgery out of a book and begin to wonder what life could be like as a farmer.
3:00pm: Purchase bananas at local market. Share smile and chuckle with cashier over woman who asks for a different pack of cigarettes because the warning on the first one has an icky picture. Head back to apartment to study on balcony.
So there you have it. My interesting life. Notice the lack of interactions with other humans. Aside from classmates and the interactions with the clerks of aforementioned coffee shops and markets, the life of this medical student is quite boring.
Cheers
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