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.

The n00b Files - Weeks 1 and 2 of Emergency Medicine

Working in the EC of my school's county hospital was a welcome break, to a medicine-minded (as opposed to surgery-minded) girl like me, from being in the OR a lot. It was also an opportunity to learn yet more things, some of which I shall record here:

Lesson 1:

Sometimes patients flirt with you. This can lead to very conflicting emotions. On the one hand, these patients are often people with debilitating, chronic illnesses, and you can see that this is an exciting interaction for them--and they don't get very many of those. On the other hand, you kind of want to clock them super hard for hitting on you in your workplace.

Lesson 2:

Apparently, as women progress into the later stages of pregnancy, their bellies get so heavy that if they sleep on their right side, their inferior vena cava (IVC) is compressed by the uterus, and they can't breathe well at night as a result. So a lot of women who are pregnant end up preferring to sleep on their left sides or backs instead. I found this news a little upsetting, since I LOVE to sleep on my right side. Does this mean that if/when I am pregnant I'll have to switch sleeping sides? And if I do switch sleeping sides, will I find myself continuing to sleep on my left side after delivering, or will I switch back to my old habit? There's so much uncertainty in my future!!

Lesson 3:

It's amazing how quickly two days off from work can make a person feel lazy to the bone and utterly useless. It's also amazing how one 12-hour shift in a county hospital's ER can make a person feel like they've worked for days on end, even when they've just come off of 3 days of vacation.

Lesson 4:

Turns out I'm pretty interested in women's health issues. I saw a lot of interesting OB/gyn cases while working in the ER, and I found myself really wanting to follow up with those patients and find out what happened to them. Kinda cool.

Lesson 5:

Altered mental status sure can sneak up on you. I had a patient who just seemed to be in a lot of pain and probably had strep throat with complications. A couple hours later this patient started acting strange and forgetting simple things. BAM, the patient is transferred to an isolation room and I'm sitting around worrying that I have meningitis droplets all over myself and my white coat. Thankfully, the patient probably didn't have bacterial meningitis. Something weird was definitely going on though, and I totally didn't realize it at first.

Lesson 6:

A lot of people show up in ERs for completely non-emergent reasons. Some people just call ambulances when they feel lonely or are suffering from slightly-more-than-normal pain from their arthritis. While it can sometimes be gratifying to help these patients by giving them some human interaction (which I'm pretty sure is all they're really looking for), it can also be frustrating to see them taking up beds in the ER when patients with actual medically urgent ailments are still in the waiting room.

Lesson 7:

I put in an IV while I was in the ER! I know this isn't a lesson, but I was kind of proud of the accomplishment, so I decided to count it as one. Here's the lesson: with a good teacher (a really nice nurse showed me how), even a daunting task can be accomplished successfully. Of course, it didn't hurt that my patient had really nice veins, too.

Lesson 8:

If a patient complains of generalized throat pain that gets much worse when you push posteriorly on their hyoid bone, they might have epiglottitis, which is a pretty scary thing to have, indeed. Most young people can't get it, since it's caused by a bacterium that people have been immunized against for decades now, but patients 50+ are still at risk.

Lesson 9:

Learning the dosage of narcotic pain medications is worth one's while. I'm sure most people have it completely memorized by the time they finish med school, or at least intern year, but here it is:

for morphine, give 0.1 mg/kg

1 of Dilaudid is worth 8 of morphine

for Fentanyl, give 1 microgram/kg.

Keep in mind that Fentanyl is really short-acting, despite being very strong.

These lessons may have been a little boring...

The n00b Files - Week 1 of Transplant Surgery

More things I've learned, some more pleasant than others:

Lesson 1:

One of the best things about being a surgeon is that you get to make people listen to your favorite music when you operate, if you're so inclined.

Lesson 2:

One of the worst things about being on your surgery rotation is that you have to listen to your attendings' favorite music while they operate, if they're so inclined. Sometimes you like their music, and you jam out to Chumbawumba and Third Eye Blind and Hootie and the Blowfish behind your mask. Other times it's lots of Nickelback and Lifehouse and really bad Top 40 and you feel like your ears are bleeding.

On a related note, it's funny when middle-aged white surgeons have club music on their playlists.

Lesson 3:

LUNGS ARE HUGE. I'm talking, each lung is like twice the size of my face. On the real. They're all puffy and somehow remind me of two large-ish Teddy bears. I saw live lungs for the first time last night. Crazy thing.

Lesson 4:

Organ transplantation, when successful, is a wonderful thing, giving recipients a new lease on life. What one often doesn't think about is organ donation, which almost always happens when a patient dies. I came face to face with that part of the equation last night during an organ harvest. It was surprisingly disconcerting to see the patient wheeled into the OR, and then to see the patient's vital organs being removed and the patient's life blood being flushed out. All a part of the circle of life, to be sure, and organ donation is a way to make a senseless death worth something more to others. But all these things being true, it's still a difficult thing to stomach, at least at first.

Lesson 5:

I apparently have a tendency to experience dysphagia (ie, difficulty swallowing) and subsequent throwing-up on mornings after I've had very little sleep the previous night. I've had two such nights in my 5 weeks of the surgery rotation so far, and I've thrown up on both of the following mornings. This has happened to me in the past before, too. This can't be good, as I'm sure residency will put me in this very situation many, many times. Must learn to pace oneself in the morning instead of trying to nom after a long night.

Lesson 6:

If you don't watch sports, it might be smart to start doing so in order to interact with a large number of patients during semi-awkward situations. One of my teammates last month could always talk to patients about sports while changing their bandages in order to distract them from the pain. I usually stood mute, especially when the patient was a man and I was pretty sure we had nothing in common. The talking-about-sports route was much better.

Lesson 7:

When asking questions to attendings, be careful not to ask too many questions that reveal your lack of knowledge. Otherwise you might find yourself being told to research your own question and report back to the attending the next morning. Which is what happened to me today when I asked one too many questions about the steps of a kidney transplant. Drat!

Lesson 8:

Sometimes people are just kind of crabby and prone to snapping at you. That's pretty crummy.

Lesson 9:

You know how on Grey's Anatomy, whenever they're doing a transplant they anxiously wait for the organ to "pink up" while thoughtful music wells up in the background? Yeah, that happens in real life, too. I got a bit of a kick out of that.

Lesson 10:

You'd be amazed how quickly a pink bowel turns white when it's not getting blood flow anymore. Conversely, if you look away for a second after a kidney transplant has been attached to the recipient's blood supply, you'll miss the magic moment when it goes from being white to being a rich purplish-pink. Blood flow is cool.