what are weekends?

So I worked both days this weekend to justify getting the Friday after Thanksgiving off (hahahaa...screw the "Only Thursday is a hospital holiday" rule!). Stuffed myself silly and played Balderdash with the Hasek clan, and partied it up with the Suzer and company. Good times all around!

Yesterday was a 14-hour day learning how to admit and present patients coming through the ER. I saw a guy with shortness of breath who, when asked if he'd had any prior surgeries, told me he'd had 4 hernia repairs. The last one "went all the way into my nut. So the doc took out my nut and replaced it with an onion. Now whenever I pass a hot-dog stand, I get a hard on and a tear in my eye." Followed by gales of laughter from the extensive family in the room with him. Included in this was the question "so how much alcohol do you drink?"
"Oh, not too much."
"About how much per week, on average?"
"Oh...about 20, 30 beers."

Later on, when my attending asked the same question, the family chimes in, "No no dad...try 10-12 per NIGHT."

Whooo! Got a benzo on board for those potential delirium tremens!

Today I encountered a patient with a very sad background and a dismal future. He is in his early 20s and had OD-ed on pills. Now he's dealing with all this residual multi-organ dysfunction; he'd gone into shock, and they had to give him so much pressors to keep his central blood pressure up for perfusion that it took all the blood away from his extremities. Now most of his fingers and all of his toes are completely necrosed. I saw his foot today, and was still surprised at the sight even after I'd been warned that it was gangrenous. His parents are trying to be "upbeat" (try crazy...really.). So the nurse unravels the bandage from his foot and all I see is completely black from the toes to the mid-foot, fade to reddish-pink, fade to skin-tone. "It looks a lot better! I think it's getting better," his dad says. Umn, that foot is DEAD. A dead foot on the end of a leg so thin I can see the veins. The feet are going to have to come off. Apparently all the fingers are the same. And this poor kid is just staring into space.

Internal Medicine. It really runs the gamut.

LOOK OUT!

Tonight I got to help out at a free clinic in Harrisburg. I REALLY liked it, even though I only truly saw one patient. To preface, I'd just spoken on the phone with a friend about how I've never given anyone a shot. It went something like this:

"Wait...you've never given anyone a shot?"
"No...but I've started IV's."
"You'd think they'd have had you practice giving shots before now!"
"Yeah, I think nurses practice on oranges."
"Oranges? I don't think that really mimics a human's skin and muscle."
"I guess not, but then why have so many nurses practiced on oranges then? That's what my mother told me to do. She said 'Katie, you should practice on an orange.' Maybe I should practice on an orange sometime."

Umn, no practice. No oranges. The resident says to me, "Do you want to give your patient a flu shot?" To which I think I responded with the color semi-draining from my face. And then he said, "You want to learn, right?" And I said, "Of course!"

Give someone a shot...someone I'd just told I'd never given shots before...

What a super lady she was. We were both a little nervous. I just kept wanting to be ABSOLUTELY sure that there were no air bubbles in the syringe after I'd loaded it with the vaccine. They both said to me "you're doing great!" a lot. Because I must've let my nerves show. Oops. Not the best way to put a patient at ease. But then the resident walked me through it and I grabbed her skin/deltoid, and just shoved the thing in real quick-like!

Orange-peel it was not.

This is why med school is so fun. At any second you're faced with something that makes you nervous, but you're also really intrigued by it, so you just go through with it anyway and find out that you CAN do things like insert needles full of fluid into peoples' skin!

I should've thanked that lady more.

Talk about a hiatus!

Well I seriously haven't posted in a loooooooooooooooooooooooooooooong while. It's ok, cuz I think I might be the only person who reads this (as I write this). HOWEVER, it is time to get back to it!

In shortest-of-all-recaps, Psych was great. It was very emotional to deal with teens who were so low that they constantly cut themselves, restricted food, and tried to kill themselves. But you could see what is basically a rescue occurring right before your eyes---adjust their internal chemistry, get them to open up and talk about their struggles, have them complete goals for the day, encourage working on the goals and good behaviors, etc---and you can really pull them out of a crisis. What was even better was to watch the continuation of the therapy in an outpatient partial program where they'd have therapy plus some school. My favorite is always Group Therapy times. These kids constantly surprised me with their insight into each others' illnesses and struggles, and their support for one another was seriously touching. But parents often made me mad. I'd say 75% of the kids' problems involved the parents' having problems in one way or another. It just about drove me insane. After my hardest day, I just had to say F it and go to the mall.

So for the past 3 weeks I've been on outpatient/ambulatory Medicine. Something new for our class. It is code for "vacation," what with maybe 4 half-days a week spent in one specialty clinic or another, and seemingly more half-days spent in lectures (some better than others). And then there's the FULL DAY OFF. I've had 2 of them so far. Did I study during them? Hell no. That's the rub. Everyone says "take advantage of the time off! Study for the shelf!" But when your days are severely unstructured, all you (I) end up doing is sleeping more and reading more fiction novels and taking people on crutches out for coffee.

But anyway. Today I had my last day with my "anchor physician," an amazingly smart and personable guy out in York, PA. I gladly drove the 50 minutes both ways to learn from this guy. It's not every day you find someone dedicated to teaching you a thing or two.

Today I saw a young guy who was bitten by a tick. How he knew so is because he'd extracted the tick from his underarm himself with alcohol and tweezers---and he brought it in in a baggie! The thing was still alive---BLOOOO!!! I don't like ticks much. This little guy didn't look too engorged, however, and not like a deer tick nymph either. Though the guy had a small circle around the bite, the fact that the tick was intact means it probably hadn't been sucking on him long (or else he'd have been more buried and his mouthparts probably woulda stayed in the guy's skin). But my Anchorman did drop the tick into a tiny jar of formalin to send to the lab for identification---he and I were kind of sad when he did it. "I hate even killing spiders now" he said, sheepishly. "That could've been your GRANDMOTHER!" I said.

We got along swimmingly, he and I. Sadly, my Anchor time is over.

Although this rotation seems like a bunch of shadowing sometimes, and a bunch of time off, at least I got a few quality experiences. I'm a curriculum rep so I get to formerly complain about this thing and how it robs us of 4 solid weeks in the hospital that would give us a better basis for treating people in the future. Any Hershey medical student reading this, send me your feedback!

And now it's time for more Dyspnea questions! I've studied something today, AND I'm going to study tomorrow...CAN YOU BELIEVE IT?

=D