woooooooooooooooooooooo!

So yesterday seems like a very, very long time ago. I drove out to Lombard, Illinois to the extremely nondescript Thomson Prometric site...and sat down and took me a 9-hour test. Step 2: Clinical Knowledge! It actually was an 8 hour test with 45 minutes total for break time (skip the intro -- add 15 break-time minutes!).

At first things were going along rather smoothly. Either I knew it or I could narrow it down to 2. Got thru the 1st 46-question block with some minutes to spare, in order to hem-and-haw about a few answers. Hour 2, hey, this isn't so bad! Then Break:drink-eat-pee. Hour 3...huh, what on earth does patient #35 have? Hour 4...what is this talking about/maybe this is the experimental questions block/I'monquestion40andonlyhave4minutesleft!!!!!!!!!! didn't FINISH THE BLOCK. As I was going to guess on the last question, the stem of which I hadn't even read, I get the "This block has ended. You may either choose to take a break or move on to the next block of questions." I left one blank. Fine. Break, sonofabitches. Drink-eat-pee-walk-around-cursing-myself. Block 5, not bad. Break-drink-pee. Block 6, equally benign. Break-eat-eat-eat-pee. Block 7 and 8, well if you don't have the monotonous idea by now then go take a 9-hour test.

As I arrived home after texting WHILE driving with a fried brain mind you, I took note of the inhabitants of my childhood home: one wiggle-sausage waiting for me at the door (with my stuffed animal that he expressly stole from my bed hanging in his wet 'ol mouth); one father, half-asleep on the couch in front of the television; one mother, in bed already. PARTY. Damn my friends for moving so far away from the suburbs when all I needed was a frickin beer.

Aside from no post-party, I felt rather ok with this experience. I just find it extremely interesting that our tests are lengthy to the point that 75% of the battle isn't in testing the knowledge but the marathon of taking the damn things. Whinebitchmoan. I tell ya though, all for a worthy cause.

And now I can truly party for a bit! Like party in Mexico surprise-you're-a-last-minute-substitute-bridesmaid! party. That's going to be an amazing time! I can't wait.

Final report: SHMIFT IS AN AUNT!!! And her neice came out of her sister's vagina even though she was 10 lbs and 7 ounces! My word.

some things I saw today

So when I was driving over the majestic Susquehanna river into Wilkes-Barre from Kingston today, I suddenly was met by a horrifying image of a chopped up baby. And there were multiple signs! People were holding them on the sidewalk for the unsuspecting drivers going about their own business. They alternated between cut up baby with the words "Abortion" and cute little happy baby entitled "Life." Now, I respect people's right to have their say just as any other, but come on here people. No more dead babies first thing in the morning please.

I also saw one of those pick-up trucks with a confederate flag plastered across the giant back window of the cab. In Wilkes-Barre. Not even 2 hours later I saw another with a giant American flag + giant flying bald eagle proudly displayed. I hated them almost equally.

I saw a wife playfully kick her husband's shoe in the doctor's office today. You could tell they were best friends.

I saw a cute guy in the 20-items-or-less line who was struggling to hold his one item, a giant bag of dogfood. I told him he could put it in my cart to give himself a rest. We were in love for 2 whole minutes.

Then I watched a bunch of model wannabes call each other bitches on TV. And a Euromercial for Clearasil came on - no joke. These boys were not originally speaking in English. And now they were dubbed in. Clearasil couldn't afford an ad in English??

Finalmente, I just went on my MySpace and on the page was a Match.com ad "Show Me - Single Doctors in My Area" with a "doctor" guy, in fakey looking scrubs. He had some sort of stethoscope that had no bell but instead looked like it had a lightbulb filament on the end of it. Oh, he was writing down my history! And yes, trying to listen to me with his fake stethoscope. Match.com can't fool me. I know that same dude was the "Show Me Intellectual Guys In My Area" and "Show Me Single Musicians In My Area." He just had thick fake nerd glasses on in one and eyeliner in the other. Needless to say they are all very contrived.

See anything good today?

Onward! And..!

I didn't blog much during OB/GYN, although I should have. That rotation surprised me with how much I liked it. I got to work with women the whole time, so that was awesome; plus I was there to help welcome babies into the world. Even natural triplets! Delivering them via C-section was like working on an assembly line. And as one of the docs said to me, "You can always tell a Pediatrician by which patient she really wants to work with," since I was eyeing the baby-stuff going on nearby after a delivery.

I DO know that I DO NOT want to be a surgeon. Although I worked with the best surgeons I've worked with while on the rotation.

This past weekend I did a whirlwind tour of Chicago, as is my fashion: got off a plane and was driven straight to a Bachelorette Party that I helped throw together (as I am a maid of honor) - dinner, drag show, dancing! Three exciting D's. The next morning, get up 4 hours later to hit up the eye doctor, take a nap, prepare food, and go to a shower I also co-hosted for same blushing bride. THEN a date with a nice fun boy, drinks with friends, another nap, Easter with happy family times, flight back! Drive 2 hours, watch Eddie Murphy with dudes and then play Guitar Hero II WITHOUT the guitar til 3 AM. Nice.

So here I am in Kingston, PA. I will be doing a Primary Care rotation, and mine is in Family Practice. Then I will have my Family Practice rotation. So I will be a family practitioner wanna-be for 8 weeks in a row. I was SUPPOSED to be in Reading doing Peds, but someone dropped the ball. Lame.

So I'm in what seems to be an old farmhouse situated behind a medical center. It's nice; I'm on the third floor in my own room, although there is another single bed ominously looking at me from across the room at the moment. I'm with an Erin and an Aaron, so it makes it simple when I walk in the door. They are both nice people, and I think this should work out swimmingly.

I immediately found the nearest pizza place after getting settled in here, and then grocery shopping. It's weird to be out here by myself. I mean, I know no one for miles around, my only connections are to people I met a few hours ago. Med school is a series of challenges to your flexibility, and I'm also nervous for tomorrow just because it's a new rotation with a new preceptor who I'll have to depend on for 4 weeks. What if I suck?! What if the rotation sucks?!

I'll keep you posted.

such a trip, man

So I started out the morning by stepping out my door, walking 10 feet, and immediately falling ungracefully via the black-ice-slip. One leg straight out, one foot under my ass cheek. Nice way to start a rotation.

Thankfully the beginning of the day had no bearing upon the rest of the day. My OB/GYN clerkship director is a feisty Filipino who is, in a catch-phrase, ON A MISSION. He is going to be our FRIEND, he is going to GET TO KNOW US! He is going to give us all Honors granted we don't breech professionalism, he is going to keep us ACTIVELY ENGAGED! We are going to be AGGRESSIVE! Hell, it's a surgical rotation, and these are surgeons.

All in all, so far I enjoy this man. This morning in clinic he had me doing Leopold maneuvers and measuring fundi and pulling out C-section staples and guiding me through an ultrasound. In the afternoon things were a lot more chill; I worked with a nurse practitioner and was able to observe more in preparation for seeing patients myself in the upcoming few days in clinic, and doing things like pelvic exams and paps and cultures. We also did a lot of counseling on contraception, safe sex practices, smoking, diet, exercise---the primary care educational stuff that I like. It's all happening!

Honestly, I really enjoyed myself today. And that surprised me. I think the rotation will be a winner.

never a dull moment

So yesterday I finished inpatient Peds---on to the clinics! I did well-child exams today; and usually you're supposed to see one and do one, but the way the patients fell my preceptor said "Eeeehh, you're ready. The next check is on a 13 year old boy. You can't really mess it up. Go in there and then tell me how it goes; any questions?" And I said, "Well for genital exams, are we supposed to bring in a chaperon?" And he deferred to his female colleague who said "Well, sometimes I feel like bringing in a nurse = two women ganging up on a young boy. I find it better just to do it alone if they already decided they don't want mom in there with them."

So I go in and ask mom her major concerns, then kick her out and ask the boy his major concerns. And then I do my exam and get to the last part, the genital exam, and say, "Now, this next part can be kind of embarrassing for patients, but it's important for your health that we check everything." And so I get him up off the exam table and we get his pants down. And he promptly gets an erection.

So I'm down there like "ohmygoodnessnowwhat?" and feeling like laughing but of course NOT laughing because come on, how embarrassing is this whole ordeal for this poor kid?! So I basically mentally recover from the initial shock, do a sloppier version of what I'd normally do, brush it all off somehow, finish up, and report back to my preceptor. He says "Everything go OK?" And I just HAD to tell him. His response was: "Oh no! I'm sorry....well...uh...take it as a compliment!" But then when we BOTH went in, it happened again. "Well I guess it's just his reaction to being examined. And quite honestly, it doesn't happen that often."

To HIM maybe! First well child exam...check! My second was on a 4 month old. Not quite as shocking.

Then I was in at the tail-end of another visit, this time with 3 little kids in the room. And I'm herding these kids as they're trying to steal away through the door while my preceptor educates mom on a script when this angelic 3-year-old blondie says to me: "Why aren't you wearing SHOES?!" And I say "These ARE shoes." To which she retorts, "No they're not, they're slippers!" I say they're flats, and then we focus on brother's shoes a while. Then she asks me "Why is your hair fuzzy?" And I say "What???" So then I explain to this child with pin-straight hair and sibs just the same that it's CURLY. Not FUZZY. Thanks a lot kiddo.

The end of the day was the newborn exam in the newborn nursery. Which was just amazingly interesting of course. And of course the first thing I find when taking off her diaper is a big 'ol dark poop. And I learn that the rule is you find it, you change it.

So let's recap: I examined an excited 13 year old, was insulted by a 3 year old, and rounded out the day with a newborn diaper surprise.

Gotta love Peds =)

love it.

theme of the week...and year

So no one told us that the Pediatrics Ward A was going to have a string of similar cases. But on the floors, this seems to happen a lot---there are themes of the week. When I was on Medicine, it was obstructive jaundice and drug rashes. Oh and PRES, which I won't go into cuz it's supposed to be SO rare, but I saw 2 cases in like 4 days. So this week it is babies without brains.

Actually with malformed brains---no cerebrum, but yes brainstem. I think we have about 4 holoprosencephalic children. And then around the same time we had 3 cerebral palsy children too. So one night one of my residents said something like "over 60% of my census has no brains, and 80% have some sort of mental delay."

Now, if your baby does not have a brain you would assume that it cannot live very long---and that truly is the case. But end of life issues are rough no matter what age. We have a child, call him LM. When our teaching resident took us to listen to his breath sounds, he could not have prepared me for the sight; I was ashamed at my brief internal repulsion. He has no brain: his eyes are therefore pushed way out of their sockets; he has a total cleft lip and palate, and therefore no nose, just a bit of skin hanging over a mouth-nose-hole. His body cannot regulate his electrolytes---particularly his sodium. However, when his sodium gets really high, he does not seize...because you would need cerebral tissue to do that. He does have a brainstem though, so he breathes, his heart beats, the rest of his body is well formed. He's alive. His mother is a very young, and she is so devoted to him, which is why he's lived 8 months. She is at his bedside 24-7. But my Attending puts it best when she says "Oh, that baby just breaks my heart." Because if he goes on like this he will have to be intubated and ventilated. And it will be that much harder for mom to say "stop this machine" than to have her baby pass on with her at home comfortably. The nurses and some residents complain about it: "Just let that baby go to heaven!" But how do you say that to someone who carried him inside her body? To anyone who's loved him since the second his existence was known?

My only patient at the moment, TL, also has no brain. Every morning I come in and her head is ginormous---she also has hydrocephalus; her brain fluid was obstructed and so was just collecting, giving her a big 'ol head. She was given a shunt and hopefully it will go down. She too has a salt problem. And she too has a cleft lip and palate; so feeding her is insane and she's getting a tube placed into her stomach soon. And it makes me feel awful to think it, but I do; what is the end point? How long can she live like this? But she has very devoted parents who want everything done for her.

My roommate had a different perspective this past week. She is on OB/GYN and has had a lot of fun helping deliver babies, but last Thursday saw a baby die. The situation was very emergent, and they did all they could, but when the baby was delivered she crashed and could not be resuscitated. Now I've seen a lot of implied soon-til-death, and one patient already dead---but I've never seen someone be alive and then be suddenly gone. So later that Thursday night I'd gotten off the phone with a friend to find G WEEPING to Grey's Anatomy. I'd missed yep, all of it, and she was watching the end (and G never watches Grey's). Apparently George's father died, but what got her most was that HE KNEW the prognosis. Only he understood what was going to happen to him; his relative said "He's going to be alright, though, right?" So G turns to me with her eyes all red and says "Katie, what on earth are we going to do? What are we going to do when our parents are going to die, and we know the truth and no one else understands it like we do?"

Which reminded me of Psych class last year. We learned about the milestones of each med school year. Year one was dealing with a new workload and dissecting a cadaver. Year two was a time for hypochondriasis---studying diseases causes you to believe you have all of them. Year three is dealing with mortality.

This year has taught me that death is a part of life. Sounds simple and cliche, but if you understand me, I'm saying that after a lifetime of thinking it cruel and unfair, I eventually realized that sometimes it's OK to die. We don't really treat death like that as a society. It's never very happy, but it's just...there, waiting. But dying comfortably can be more important than drastic measures taken for a severely limited life.

It's a very hard lesson to learn. It's still getting mixed reviews here in H-town.