The n00b Files - Week 3 of Pediatrics

I'm on my third week of Pediatrics, which means I've completed 2 weeks of Pediatric ER, and am on my first week of outpatient pediatrics. I've also fully completed 8 weeks of Psychiatry, during which time I neglected to write down any n00b lessons. But never fear! More lessons await, below:

1. Turns out it's not that hard to look into a lot of infants' and children's ears as I had previously feared. More kids than you'd expect are pretty calm about the whole thing, which makes life a lot easier.
2. On a related note, you know how you're taught to pull a patient's ear back and up in order to straighten out the canal and take a good look at the eardrum? Yeah, with infants and young children, it's a LOT easier to see the eardrum when you pull straight back. Now that was a revelation.
3. The great thing about psychiatry is that you get to spend a LOT of time with patients, just talking to them. I like talking to patients, so I liked that aspect of it. 
4. After seeing a patient who suffered from debilitating generalized anxiety disorder, I'm starting to believe that having severe anxiety may well be much, much worse than having severe depression. I actually felt like crying while talking to said patient, whereas I don't think I ever got emotional while talking to depressed patients.
5. Um, apparently you're not supposed to feed your baby any plain water until he or she is at least 6 months old. Babies are not good at regulating their water balance until then, so if you give babies water, their electrolytes can go all out of wack and then they can have seizures. So, don't feed your infant water!
6. ^Then again, very shortly after I wrote this, I heard my preceptor tell a mother of a 4-month-old that she can give her baby water if they're outside for a long time....so I guess the other lesson here is that the advice that doctors give can vary from doctor to doctor.
7. Subsequently, it's amazing/borderline scary to think how much of my behavior as a full-fledged physician will be directly influenced by the training I receive. For instance, I've learned at school that it's best to hold an otoscope with the handle down when examining ears. My preceptor last summer said that holding it upside down was the "weenie" way, and I had been taught well. Then last week, another pediatrician demonstrated a really adept way of examining an infant's ears...holding the otoscope upside-down. It was just crazy to realize that, more than likely, the way I ultimately do things (including the advice I give parents on some topics, the way I do physical exams, and probably more) may well be determined simply by the last way I was taught to do said things.
8. You can learn a LOT by watching the way your superiors interact with difficult patients and other medical teams. I was super impressed by the way one of my psychiatry attendings handled small and large annoyances. That dude had an amazingly cool head.
9. Psychiatry can really be a very amusing rotation. When I was on inpatient psychiatry, my team and I had many a laugh-filled morning of rounds while discussing some of the unusual things our patients said. For instance, this exchange:

                    Did you sleep well tonight?

                    I was 14 once.

          Or this one:

                    Can you tell me a little bit about your childhood?

                    Absolutely not. 

          ...Okay, so maybe you had to be there.

Ticking Time Bomb

In roughly the last week, I've lost my apartment, a great deal of my freedom, and my boyfriend. (To be perfectly honest, I "lost" all three of the above mainly of my own accord.) To say that it hasn't been an easy week would be a great understatement. Then yesterday, a male, Mormon, future OB/GYN classmate of mine and I were talking about childcare, and he asked me if I have a significant other. I said no, and he assured me that it was "okay" that I didn't have one at the moment, that I have "time" to find someone, but then again, my ovaries are "a ticking time bomb" because, hey, those things poop out eventually, and who knows if I'll still be fertile by the time I find someone with whom I want to procreate? (Again, to be perfectly honest, this is actually a really nice guy, and I don't think he meant any malice by what he said, none at all.)

The weirdest part of the whole exchange? His comment didn't even bother me. I don't know if that reaction was due to something awesome, like the idea that I'm well-adjusted and modern enough to know that even if I couldn't have biological children, I'd still be equally happy with adopted children; or something not-as-awesome, like I am just completely numb right now. Maybe it's just that I feel as if lots of people around me have been encouraging me to find a guy to marry/settle down with in the near future, for various reasons, and this is just another ludicrous one being presented to me. If I want to have biological babies, I better delve into the finding-a-life-partner thing with gusto!

I just feel like my life is changing rapidly, and the short-term future taking shape resembles a life I never thought I'd live, and that makes me deeply uneasy in ways I find difficult to explain. I'm glad I'm currently on a rotation that I really like, so that going to work can at least bring me some satisfaction instead of more frustration.

Spinning My Wheels

I went to my first spin class ever today (today being Wednesday July 18), and something about the class, and the music played in it, and the fact that I heard someone talking angrily about "spinning my wheels" at his current job on the lightrail last night, made me feel like the universe was telling me to blog about the experience. Or maybe I just feel like writing something.

It's a rather illustrative concept, isn't it, "spinning my wheels?" Generally, people resent finding themselves exactly where they started after expending a great deal of effort. That's why so many people I know say they hate running on treadmills; that's why "I'm just spinning my wheels at this job" was the Lightrail Guy's way of saying how frustrated he was about his work environment and lack of upward mobility. And yet.

During the second song in my spin class, the instructor was telling us to imagine ourselves coasting down a hill at full speed, 30 MPH, when we were spinning at low resistance, and I frankly was frightened at the thought. I was just fine with pumping my legs hard and fast but not changing my position at all. By which I'm trying to say--I don't mind moving fast, but staying in the same place. Is that bad?

I suppose it's a good quality for a person in medical school, which, if you enter it right after college, keeps you in a state of woman-childhood (or man-childhood, as the case may be) well into your late 20's. You learn how the human body works, how to fix it when it stops working, how to make people stop bleeding when they start and start breathing when they stop, and yet for years, you're always listening to what someone else tells you to do. You're not given true power until you're nearly 30, if not older. But I'm okay with that. I'm okay with treading water while I get my mental footing.

Last night, my second-grade teacher, who found me on Facebook about a year ago, sent me a message saying that her son possibly has a rare condition that she'd never heard about before. She asked me what I knew about it, and I was able to use my limited medical school knowledge (and the resources of the Internet) to give her some information. In a week that seems full of circles, it felt pretty great to have come full-circle enough to impart knowledge to a woman who once imparted knowledge to me. So do I mind spinning my wheels for a while? Not one bit.

I Win

Sometimes I hear about the problems my peers worry about and claim as their very worst experiences ever, and I feel so incredibly condescending. Few of my peers are experiencing the types of things I am. 

The n00b Files- Week 3 of Infectious Disease Consult/Week 11 of Internal Medicine

I'm now approximately one week away from finishing MS2 and becoming a wise 3rd year. In preparation for moving onto the second half of my medical school career, I am frantically gathering yet more knowledge as I wrap up my last month of the Internal Medicine rotation. Here's the low-down:

Lesson 1:
Being on a consult service is frustrating in that you make recommendations and write notes and put in orders, but ultimately the primary team makes all the decisions, and sometimes even decisions in your field of expertise. For instance, the primary team stopped an antibiotic on one of our patients without consulting our team first. They stopped it for a good reason, but stopping it without letting us know beforehand was kind of a crazy thing to me. But I get the feeling this sort of thing is not uncommon when you're consulting on a patient.

Lesson 2:
One thing that makes me really, really happy is talking to people in their 60s or so who've already made it through all the hurdles I face now as a 20-something. Most of them have found their life partners, borne and raised children, and had their careers. In a time when I feel like very few things about my future are certain, it gives me hope to look at others who have come before me and made it through and are still smiling. This is probably why I like working with the Alumni Association at my school so much.

Lesson 3:
This is not a lesson by any means, but I took a picture with one of my patients this week, by her request. It made me feel really happy (she was a sweet, short elderly lady who reminded me of all kinds of grandmas), and it also made me realize that doctors take pictures with their patients all the time--and this was hopefully the first in a long line of photographs to come.

Lesson 4:
I may never get over the mental/emotional trauma of seeing patients in the ICU. I know it's a bit rich to say that when I'm, oh, less than 6 months into many, many years of working in and around hospitals. But seriously, how does anyone look at a patient, legs sprawled about awkwardly, mouth open with an intubation tube and orogastric tube hanging out, and catheters and lines coming out of necks, arms, and you-know-wheres, and not shudder, even if for a millisecond?

Lesson 5:
One of the toughest things about being a student is having patients with complex medical problems, whose prognosis you can't predict. Heck, who even knows if the attendings can predict some patients' prognoses? But what I'm getting at is, it sucks to walk into a room in the morning and examine an unresponsive patient while said patient's spouse sits in the corner in expectant silence, hoping you'll tell them something about the patient's progress. Unfortunately, being as inexperienced as I am, I have no useful information for families in a situation like that. It's rough to walk out without exchanging a word with others in the room, but doing that is better than trying to exchange pleasantries, or worse, telling them things about their loved one's medical problems that simply are incorrect.

Lesson 6:
There are 14 specific "systems" that Medicare and Medicaid look for on a Review of Systems; you have to hit 10 to get full credit. They are: Constitutional, Eyes, ENT, Cardio, Respiratory, GI, GU, Musculoskeletal, Neurological, Derm, Endocrine, Allergy and Immunology, Heme/Onc, and Psych. Isn't that wild?

Lesson 7:
I'm really grateful that I don't have inflammatory bowel disease. That stuff sucks.

Lesson 8:
Learning where all the free food is in any given hospital is a worthwhile endeavor. It feels good to walk around with ice cream and smile mysteriously when others ask you where you got it.

The n00b Files - Week 3 of Internal Medicine Wards

I've made it all the way through my Surgery rotation (a 3-month slog!) and I'm 4 weeks into my Medicine rotation (another 3-month slog...what was I thinking?). I'm still learning something every day, but I haven't been very good with recording my discoveries. So here's a braindump of lessons from the wards:

Lesson 1:

Your first shelf exam will crush your soul. Twice. First, you will leave the exam hall wondering if shelf exams are supposed to feel the way you feel at that moment. Then, you'll get your grade and wonder if you've been learning anything at all and/or whether you're cut out to be a physician or if you should just quit now with fond memories of pre-clinical success to look back on. Unfortunately, there's no way to go back and change your performance on your initial shelf, and as Abraham Lincoln (or someone) said, If at first you don't succeed, try, try again. Learning during clinicals is a whole different ball game from learning during pre-clinicals. All of a sudden, you have to not only work all or most of the day (and often 6 days a week), but also go home and study. It's kind of a cruel joke, really. But I figure if thousands of doctors have done it before me, I can do it too.

Lesson 2:

It's really difficult to deal with emotional patients. I like to think of myself as a compassionate person, but I find it hard to comfort a patient when he or she is crying, or talking about how rough life has been lately. It just feels very strange.

Lesson 3:

On wards, you'll probably work with pretty darn awesome scientists/clinicians without even realizing it. In the past week, I've worked with one doctor who was instrumental in discovering the connection between H. pylori and ulcers, who is now working on curing C. diffcolitis, and another who may have found a cure to Hepatitis C. No big deal. [For those of you not in medicine, those are both really big deals.]

Lesson 4:

I've said it before and I'll say it again--having a good team makes all the difference, for real. I have some pretty darn sweet interns, a friendly upper-level, and a couple of great fellow students on my team right now, and if I have to spend the day in the hospital, it's fun to talk to them while I do it.

Lesson 5:

A lot of the time, when it rains, it pours.

Lesson 6:

You're more likely to hear an Internal Medicine resident complain about a pointless admit (for instance, a patient with a history of cancer who's had a 12-hour history of nausea and vomiting and shows absolutely no signs of dehydration) than a very complicated patient. I found that pretty interesting: residents prefer not to have a really "easy" patient who doesn't really need to be hospitalized. They'd rather take care of patients who really need tertiary care, like a hospital provides.

Lesson 7:

When you're a medical student, you can't do a whole lot to help your patients. You can suggest lab tests or imaging studies to your residents, or perhaps pick up on the fact that a patient isn't receiving an important drug to prevent blood clots. But not really much else. What you can do is simple things for your patients, like getting them a toothbrush when they ask, or helping them take their hair out of a ponytail (which was placed when the patient was intubated). Patients tend to be pretty grateful for these sorts of actions, and if something so simple can brighten a hospitalized person's day, it's worth doing, especially when, as a student, you have many fewer constraints on your time compared to your residents.

Lesson 8:

That being said, there will always be patients who seem to need to complain about at least one thing every day. And sometimes you can't do anything to address their complaints, and you don't really want to stand around and listen to them. But like most people who are venting their frustrations, many patients benefit simply from having someone commiserate, if only for a little while every day.

Ups, Downs

It was a day of ups and downs.

On the one hand, my beloved yellow netbook Sunbeam is almost certainly irretrievably dead. On the upside, I should be able to salvage all my data, and my sister has a pink version of Sunbeam that she's going to let me use, so all is not lost. Still, I liked my little yellow netbook. It won't be the same.

Went to Macy's with my mom to shop the clearance and "one day sale," ostensibly to find some professional clothes for my medicine rotation, which begins in about a month. Here's what I discovered: the clothes at Macy's are almost all ugly. I'm better off buying random things off of the clearance racks at New York and Company and Express and Ann Taylor. I did, however, buy myself a little sweater dress for $4.99. Oh how I love cheap things. Sadly, the clearance shoes were neither cheap enough to buy nor comfortable or professional enough for clinics.

Spending the weekend at home for the first time in a while gives me plenty of time to watch I Love Lucy with the parents and eat too much Indian food. I realized last night that if/when I get married, I will most certainly put I Love Lucy on DVD on my bridal registry. It might sound weird, but I know that show will be a central part of my future family's traditions, so it's of paramount importance that I get a copy when I strike out on my own--or with a husband, as the case may be.

Lastly, listening to John Mayer's Battle Studies while reading Pestana's surgery review makes studying that much better.