Where to Start?

I just submitted a paper for my surgical rotation and decided to start writing a blog post (Note: I actually started writing this post on September 21st....this surgery rotation is keeping me busy!).  I didn't realize that it has been over a month since I've posted!  I have so much to write about, but I will have to be brief as I am in the  midst of my most dreaded rotation of my third year of medical school: Surgery.

A few weeks ago, it was Farley and my third year anniversary.  The actual anniversary date we had to be in the psychiatry unit, but after work we went to the gym then out to dinner.  There is an Italian resturant in Astoria that gets great reviews and requires a reservation (which I hear is unusual in Astoria).  Anyway, Farley got reservations for us.  They were running about an hour behind so we had a glass of wine in the wine bar, which was great because they had a pianist playing  Our dinner was fabulous!  The next night, we headed into Midtown  to go see "The Lion King" at the Minskoff Theater.  I really wanted to go see a Broadway show while we were in New York City, so we decided to go for our anniversary.  The only real problem we had was deciding which show to go to.  I wanted to go to the Addams Family, Chicago, West Side Story, Wicked or Lion King.  Farley on the other had, wanted to see the Phantom of the Opera, but he didn't really want to see a show at all.   I had seen the Lion King last winter in Spokane and loved it.  I thought it would be a show Farley would enjoy and so we finally agreed to get tickets for it.  Thankfully, I was correct: he enjoyed it.

The weekend after that was Labor Day Weekend.  We got to have a three day weekend!  We decided to go to the Metropolitan Museum of Art.  We spent all day looking around the museum.  It was such a fun day.  Here are some pictures:

Above and Below are pictures of The Great Hall, where you enter.

A sculpture from the European Sculpture and Decorative Arts exhibit

Below: are pictures from the Robert Lehman Wing Atrium.  

Above: They allowed people to go through the storage

Below: They had rooms set up to show what a time period looked like.  I loved those rooms in the American Wing.  Here are some pictures!

Below: They have a lot of Egyptian art work at the Met.  They even have a real life Temple!  Below is a picture of the Temple of Dendur.

They had middle ages weapons.  I can tell you which one of us enjoyed this exhibit more: Farley!

Here is a Chinese Warrior's uniform!

This is from the "Arts of Africa, Oceania, and the Americas" exhibit.

Locked Down

"How can you tell the difference between the psychiatrist and the patients? The psychiatrist has the keys!"

This is my third and final week on the inpatient psychiatry ward. Next week I will be moving to the chemical dependency unit and after that I will be in the consult and liaison unit. Anyway, I have been thinking about things to write about the inpatient psychiatry unit, but haven't had the time to compile my thoughts yet. I am having a lot of fun with the other medical students, maybe too much fun!

The inpatient until that we are working on is a voluntary lock-down ward, which basically means that the patients agree to come into the hospital voluntarily but that they cannot leave until (1) the physician decides they are ready to go or (2) they write a 72-hour letter (which is similar to when a medical patient leaves against medical advice, AMA, except that the psychiatrist has 72-hours to get the paperwork in place to involuntarily commit the patient if the doctor does not think the patient is stable enough to leave--they usually don't involuntarily commit until the patient is still extremely sick). Since this is a locked ward, we are also locked on the unit. Overall, it has been fun and some of the things I've heard on this unit have tested my ability to keep a serious face and not burst out laughing. Here are some examples of being on the locked ward...

Middle Aged Depressed Lady (MAD L): MAD L was telling me how she is so depressed that she feels nothing but hopelessness and emptiness. (This is a sign of severe depression and should be taken seriously.) Then she told me that she has hurt herself so that she can feel the pain rather than feeling nothing (also very serious). I asked her how do you hurt yourself and she replied, "I hit myself with a fly swatter until I bruised."

MAD L also is a bit overweight. She told me that she had hurt her knee at one point in the past she fell and with all of her weight she landed on this knee. Then she looked me straight in the eye and seriously said, "That is a lot of weight for one knee."

There is a younger lady who is going through a manic episode, lets call her Ms. Hyper. Because Ms. Hyper is manic, her thoughts race and she jumps from idea to idea. Some of the things she says are downright funny, but her disease is anything but funny. She is the patient that has bothered me the most because she is the only patient that I haven't seen get better...yet. I know some of the medicines that she is getting take a while to work (psychiatry medications may take up to 12 weeks to work properly--patients don't have to stay in the hospital that long), but I just wish she would start to show signs of getting better soon. Ms. Hyper has said a million interesting things, but I am not sure if they will seem funny outside of the locked unit. Her favorite word is "epic" so anything she likes, is epic. She really wants to get married and have kids "to get it over with already." Whenever, she says, " I want to get it over with, already" at least two staff, medical students, or physicians turn their heads so quickly that they get whip-lash because if you miss the first part about getting married and having kids, it is easy to think she is talking about suicide. It is amusing to see how quickly the heads turn, then realize it is just Ms. Hyper (she is one of the few patients who is not suicidal on the unit and she isn't talking about suicide). Recently, she declared that she had to get home because she has things to do and the energy to do them. She wants to clean out her parents basement to give things to the poor and so that she can have "the most epic house party ever." She told us that if we could help the doctor understand that she has things to do and is ready to go home, we could come to this epic house party.

Ms. Hyper has become friends with Ms. Wilderness. Ms. Wilderness is another young lady who is admitted to the hospital for depression. I call her Ms. Wilderness because she wanted to commit suicide by going to the woods, camping, meditating and not eating until she dies.

Anyway, we were in a group therapy session today. Ms. Wilderness said that she thinks she has four options when she leaves the hospital (1) Continue working full time (at her good job with benefits) and be stressed out working for "The Man" (2) Quit her job and move in with her parents then look for work as a gardener (3) Move to the wilderness, live a quiet, peaceful life and eat at food kitchens or (4) "try to become homeless"

After Ms. Wilderness mentioned the third option, of moving to the wilderness, Ms. Hyper went from sleeping on the table to jumping up and declaring that it was so obvious that Ms. Wilderness had to move to the wilderness because it would be "epic". Then Ms. Hyper fell back asleep on her arm. After Ms. Wilderness spoke more about living in the woods and "trying to become homeless" another patient decided to speak up, we will call him The Voice of Reason. I wish you could hear his voice. He doesn't have the deepest voice, but it is rough like gravel. He is a no-nonsense kind of guy, with a troubled past, who is trying his best to keep on the straight and narrow. I expect him to curse, but he never does; however, he always has a look on his face like he thinks someone in the room is crazy (and technically since they are in a locked psych unit, they are). He looked at Ms. Wilderness, while she was talking, like he wished someone would slap some sense into her and declared her "super crazy" for wanting to move to the streets. Despite the look on his face while she was talking, The Voice of Reason calmly looked her in the eye and told her about life on the streets. I think the look on his face made the situation more humorous in person. He looked like he had just eaten something very sour and was disgusted (in this case disgust with stupidity). Besides the fact, he (and the rest of us for that matter) were not sure what she meant about "trying to become homeless." I don't know how you try to do that....

Another middle aged patient was extremely mad at her family for not calling her for advice about family matters. It was all I could do not to start laughing when she said this in group therapy....this is a lady is a paranoid schizophrenic and she thinks "everyone is out to get" her. I understand that she feels left out of the family (and that isn't right), but I can see why the rest of the family doesn't use her as their primary advise counselor.

Another of my patients is a depressed gentleman. He asked me, "why are you here" and I replied "because I am a medical student." He then said, "But why?" and I told him that I wanted to be a doctor since I was a little girl. He told me, "but you could be a model....or an actress. The guys and I have been trying to figure out why you are here. We all think you could have been a model." I replied thank you (and obviously, I had a new favorite patient). Then he said, "You could have been a supermodel, but you are here. Wow, you must really want to be a doctor." If all of my patients told me I have supermodel potential, I think I would have no choice but to become a psychiatrist--it is great for my ego.

Now, being on the locked ward is okay overall; however, on Tuesday it was horrible. They are doing construction in the hospital and the fire alarms were set off. So, there are flashing lights, terribly loud sirens, and a ward full of psych patients. I don't think the patients knew it, but the door automatically unlocks (so they could escape), but there were three medical students guarding the door (but heck, if they all came at once, the three of us couldn't stop them). Anyway, this fire alarm went off for half an hour. I already had a horrible headache (it was so bad that Farley suggested that I stay home, but I didn't want to have to make up the day) and then this happened. To top it all off, the patients didn't try to leave, but they all started shouting about the noise and they got louder and louder. My headache got worse and worse, but I couldn't leave because I was guarding the door and once it stopped, the door automatically locked. Besides, they have cameras so they know when we come and go. So, I was stuck in my own personal hell...on the locked unit

Arriving in New York City

I was so excited by the time we were flying over New York City.  I've never been here before and I have always wanted to come.  I don't like sitting in window seats on flights because I get motion sick when I look out the window, but I couldn't help myself.  I love this picture of Central Park with the wing of the plane in the top left corner.  After taking a few pictures, my motion sickness kicked in and I prayed that I wouldn't get sick before we landed (I didn't).  After arriving, we waited for our luggage and luckily it all arrived then we found a cab and headed to Astoria, Queens.  Our landlord was waiting for us and we headed into our little two bedroom, one bathroom apartment straight away.  We decided to move around some of the furniture, which involved literally taking the furniture apart and putting it back together again.  Farley had a blast with this.  Then we decided to explore the area.  It is a cute and quaint area.  Apparently this is an area of town with lots of Italians and even more Greeks and the restaurants show the heritage of the immigrants who moved to this area.  However, it isn't just Italians and Greeks anymore: it is an incredibly mixed area of New York with just about everyone you can think of living in the area.  No one looks out of place. There are lots of fruit stands, bakeries, and butchers on the block.  The majority of the businesses are local, but of course, there are at least two Dunkin' Donuts within a two block radius of the apartments (I prefer Starbucks and there is one 1.5 blocks away.  There are also local coffee joints).

On Sunday, the 1st of August, we headed to Flushing, Queens to find the hospital we would be doing our clerkship at.  If we were driving, it would only be 15 minutes away, but since we are taking the public transportation, it takes us an hour.  I wish I was like a local New Yorker, who can read and be productive on the train.  I get too motion sick to do much of anything.  I don't think the New York trains make me as motion sick as the Miami trains or the BART in San Francisco.  I think the NYC trains move slower because there are more stops.  Anyway, we found the hospital and were ready to go on Monday.  After getting back, we joined a gym, which is just two blocks from our apartment, The Rock.  I don't love going to the gym, but I know that I have to work out and my apartment is too small to work out at home.  Besides, the fee is enough to motivate me to go.  I don't want to fee like it was a waste of money!

On Monday, we headed to the hospital.  We had to do a couple things with occupational health, before they would let us get started with our rotation.  First, we had to have another urine drug screen and second we had to get fitted for N-95 masks (masks that keep out T.B.).  I couldn't get an appointment on Monday, but accompanied Farley to his appointment and they decided to let me go on Monday as well.  After finishing up, we headed home to run more errands (you always need stuff when you move to a new place) and go to the gym.  We also walked down to Astoria Park.

Tuesday, we headed back to the hospital for orientation, which wasn't really much of an orientation.  Then, we were off to the psychiatry department to start the rotation.  Farley was assigned to the "C&L" department for the first week (consults and liaison).  I was assigned to the inpatient unit.  I will write more about the experience later.  The rest of the week, we just went to the hospital and the gym.  We have to be up at 6:00am, which I have not had to do in a long time so adjusting has been a bit difficult.  Overall, it was a good first week.

Finishing up in Miami Beach and heading to New York City

Getting ready to leave Miami was a pain. Farley and I were doing our ER month of internal medicine,which meant that we were doing three 12 hours ER shifts per week (our shifts were not at the same time and we had to drive each other) as well as doing two or three 8 hours shifts with private practice physicians.  Farley and I also had our presentations due the week before we finished up in Miami.  About 10 days before the rotation was due to finish, we were informed that we were going to have to take a shelf exam, which is an exam over all of internal medicine.  In defense of our rotation, they were informed by the school about 14 days before the exam that we would be having it.  Luckily, I did well and Farley did excellent.  We had both been studying  during the entire rotation, but unfortunately, I wasn't able to study much in the 10-days before the exam.  

During the last couple weeks, not only did we have to get ready for the exam, go to class, pack, clean the apartment, but we had to do all sorts of odds and ends.  I knew we would get it all done eventually, but it was sure stressful, especially when we had 6pm-6am shifts in the ER to work around.  After my 6pm-6am shift, I took a picture of the ocean.  It was a little past sunrise when I took it, but I still think it is beautiful.

T
he last Wednesday we were in town, we went down to Ocean Drive to get some pictures of the hotels and restaurants at night.  I don't think that the pictures really give the feel of ocean, but they are the best I can do.  You have to imagine that it is 9:30 or so at night, it is till over 90 degrees with 95% humidity and there is dance music playing all around.
One of the last couple of days in Miami Beach, Farley went out to take a few photographs of Indian Creek.  Our apartment was in between Indian Creek and Miami Beach (there is about two blocks between them).  I haven't shown in picture of Indian Creek, so here they are. It really is a beautiful area.

I haven't seen an iguana in Miami, but Farley found one right across the street from us.

Below is what we saw directly to the left once we exited our apartment building!

We had our exam on the last Friday of July.  We had to drop our rental car off after the exam, so we asked our friend if he would mind dropping us off after the exam.  We ended up going to dinner with many people from our class and then we decided to go to "Salt."  Usually, I am Ms. Responsibility, but for some reason I figured what the heck, lets go to dinner and a move.  Farley and I were up until 3:40 packing because we had to do laundry and the laundry in our apartment was very small.  The next tenets were meeting us at the apartment to get the keys and they ended up being acquaintances from the island.  It was fun to see them before we left.  I was so tired when we boarded the plane and I kept waking up hoping that I packed everything (which I did).  Here is a picture of Miami from the air.

We had a great time living in Miami Beach, but all good things must come to an end.  Goodbye Miami Beach, Hello New York City!

LOLNAD: Little Old Lady in No Acute Distress

There is a very famous book about on doctor's intern year of his medical training (the intern year is the first year of residency) called "The House of God" by Samuel Shem, MD.  Apparently this book is very humorous and exposes all of the horrible things about medical training, as the intern year is suppose to be one of the hardest years in all of the medical training.  Farley just finished this book and has been telling me about it, but I haven't had a chance to read it yet.  Throughout this book are many acronyms and other terms which have become part of the medical lingo.  They were probably around before this book was published in 1980, but they have become more popularized because of this book.  One of those acronyms is LOLNAD: Little Old Lady in No Acute Distress.  I think I have seen half of the LOLNADs in Miami in the last week and just about every one I saw was hilarious.

First there were the two sisters.  They were both madly in love with the doctor that I was working with.  The 89-year-old looked like she was in her late 50s and the younger one was in her early 80s.  The 89-year-old was giving lots of health advise, which maybe better than advise you can get from the average doctors since she looked 30 years younger than she was.  She said that the reason her younger sister had so many health problems was because she didn't exercise enough, drink enough or have enough sex.  The 89-year-old said that you must exercise regularly, you must have one or two drinks per day (she preferred wine or gin) and you must have as much sex as possible.  Then the 89-year-old decided it was a great time to hit on the doctor, whose wife was the office manager.  She said something like, "My sisters and I all love this doctor.  But I don't just want him for a doctor, I want him as a man."  It was a little awkward in the room with them!

Interns Give Me Hope

As many of you probably know, the end of June/beginning of July is an exciting time in the medical world: it is residency and fellowship start time.  Statically, this is when you do not want to be in the hospital!!!  There is a statistical difference in the error rates due to all of the newbies in the hospital.

Anyway, as a medical student, the idea of being an intern is exciting and a little intimidating.  I know that I will be ready when the time comes, but sometimes I wonder how anyone is ready to be a doctor.  No matter how many years of training you have, when something is new (your intern year, your fellowship, finally being an attending) it is a little intimidating.  The other day I heard a few interns that gave me hope: they didn't know exactly what to do either!  One had told the patient that they were going to hold his warfarin, the other had written a scrip for the warfarin and a third had told the patient that he would check with "the team" and get back to the patient with the plan.  I think they decided to talk to the resident before making the final decision.

I can do this.  I too can be an intern and work my way things to figure out what needs to happen....this is just another example that physicians in training are really in training and I am not expected to know everything in just a year and a half.

ER: Mean Doc

I was assigned to Mean Doc for my rotation this week in the ER.  He was nice to me, but he really did earn his title of Mean Doc with regards to how he treated everyone else.  There were two patients that he yelled at.  Yes,  yelled at.  It was all I could do to keep from laughing.  Now, he did have a few good points.  He was extremely good (shockingly good) with the patients that were not (1)  teenagers or (2) Old Feisty European Man.  He was happy to teach me things and explain things when I didn't understand and he was happy when I caught a minor (very minor) error he made.  He was mean to the nurses and ER techs.  In fact, I can see why they all dislike them.  None of the other ER docs are as rough when them as he is.

There was one teenager, who was in the hospital with psychiatric problems.  This teenager changed the answers to questions being asked.  I don't think the teenager did it intentionally or to trick Mean Doc, but he just blew up at her.  He started raising his voice (not quite yelling) and it was all I could do not to start laughing.  The look on both of their faces.  She was still completely confused and he was so frustrated.  I don't think anything was accomplished with their interaction.  It may have been one of the few times that I might have been able to get more information from a patient than an attending.  He wasn't patient enough.

Oh, and the Old Feisty European Man!  He was my favorite patient of the night.  He is a sort of regular at this ER.  He comes in so often that when fire and rescue brought him in, the entire staff started saying, "Hey Old Feisty European Man, how are you doing?  You haven't been here in days."  It reminded me of an episode of Cheers.  I don't know the whole past medical history, but I know he has chronic pain and he presented to the ER with chest pain.  Mean Doc wrote orders for pain medication for his chronic pain because they knew that they were going to have to do some things that would probably make the pain worse.  The only problem: Mean Doc didn't write the dose high enough for Old Feisty European Man (he has been taking this pain killer for a long time and needs more than most people would).  To make a long story short, Old Feisty European Man was yelling in his room for about an hour.  When the test results came back, he did have some problems and they needed to keep him in the hospital.  But by that point, Old Feisty European Man was so angry that his pain wasn't being controlled that he decided to go home and give himself the dose of pain medication (which was higher than the dose the ER gave him).  I volunteered to go talk to him and beg him to stay.  I let him know that Mean Doc ordered more pain medicine and that he would get it immediately if he just returned to his room and that he really did have some concerning health problems.  He said to me, "You are such a sweet girl, but if I have to die I'd rather go home and do it alone.  At least there won't be any morons there to bother me."  He then told me he wanted to sign the papers so he could leave.  Mean Doc came out and tried to get him to go back to his room, but Old Feisty European Man refused.  Mean Doc started talking as loud as Old Feisty European Man (which is loud because he is hard of hearing).  This continued to escalate until they were screaming at each other.  Finally, Mean Doc said that he didn't care anymore and would be getting the papers Old Feisty European Man sign out AMA (against medical advice).  I wish you could have heard them discussing how Old Feisty European Man was ill and that by leaving the hospital he could die.  It was like watching a poorly written comedy.  I think it was so humorous to me because it was so absurd.  I know that sometime things can get out of control (quickly), but this just seemed a bit crazy and I think Mean Doc added to the situation rather than being a calming force.  Oh well, no one is perfect and the rest of his 20+ patients were treated very well.  Shockingly well in fact.

Housing and Hematology

It has been a stressful couple of weeks. We are in the middle of Internal Medicine, which is going great. We thought we might be able to stay here in Miami and complete our third year of medical school rather than moving to New York City, but it looks like the clerkship agreements won't be signed in time for us to stay (the pediatric and surgery clerkships for third year students will probably be in place sometime next year). Anyway, now we are trying to find housing in New York. Now, finding housing isn't too horrible (it is a big city), but I have never been to New York so it adds this mystery, which makes everything more difficult. But heck, if I can live in Dominica, I can live just about anywhere. Besides, as far as I know, there are no herds of cows running free and controlling New York City.

Since I have been stressed, I have decided to study one of my favorite things in medicine this week: Hematology! I know this sounds nerdy, but I think the clotting cascade is just beautiful. I haven't looked at it in a while and I almost forgot how breathtaking it is! There are multiple checks and balances to ensure that we don't clot too much, which can kill us, yet we are able to clot quickly and efficiently. We also break down clots in a timely fashion. We are constantly clotting and degrading clots. When things go wrong with the clotting cascade, everything goes to heck in a hand basket, for example Disseminated Intravascular Clotting (DIC). Since I get so excited about clotting, maybe I am destined for hematology and oncology.

Isn't it beautiful?

Competent

I am about a year and a half away from earning my Doctorate of Medicine.  The end is almost within sight!  A year and a half is a reasonable amount of time--it isn't the far distant future anymore.  That is exciting on one hand and down right scary on the other.  In a year and a half, I will be one of the people who (should) stand up when someone desperately asks for a doctor on a plane or in a busy restaurant.  I will be responsible for others' lives.  I will be a doctor.  Granted, I won't be on my own for at least another 3-5 years of residency training and if I specialize, I will have another 3 or more years of fellowship training before I am solely responsible.  Nonetheless, I wonder almost daily if I am learning enough, if I am working hard enough, if I am competent enough to be a physician.  Am I smart enough?  I think so.  According to my board scores, I am.  For some strange reason that doesn't bring me much condolence now that I am trying to master the clinical sciences.  I feel like I am having a much easier/enjoyable time learning the clinical sciences (medical school years 3 & 4) than I did with the basic sciences (medical school years 1 &2), but am I learning enough?  From talking to residents and attending physicians, everyone goes through these feelings and most people have told me it will get even worse during the intern year (first year of residency).  But as my dear friend Mary told me, "If medical school was easy, everyone would do it."

I should get back to the books...

Three Day Weekend!

I have a three day weekend because the doctor that I am assigned to this week is returning from vacation tomorrow.  It is another beautiful day down here on South Beach, but am I on the beach reading a novel, playing beach volleyball at Lummus Park, jogging on the boardwalk or enjoying a tropical drink while looking at the Atlantic Ocean: NO.  I am inside studying.  I am reading on the Cardiovascular system, I know, you are jealous.  Once I finish that,  I am reviewing an article on carbon monoxide poisoning that a friend wrote (actually, I am excited and proud about that because she will likely get published--yupee!).  After that, I am going to review my notes on a an article that I read over the weekend, which are discussing in class tomorrow on GERD (Gastroesophageal Reflux Disease, aka, acid reflex).  Maybe, if there is still time left in the day, I will have time to write up a few histories and physicals onto "official H&P" forms from the doctors that I worked with last week.  If I am really lucky, I will get to work out at some point today so I don't become a tubby medical student....

Although this is not an atypical "day off", this would never make the cut for a Grey's Anatomy, House or even Scrubs episode.  I know, you are all wishing you were in Miami Beach studying medicine too.

Things all patients can learn from two of my patients...

I saw a young male patient, who spoke both Spanish and English, and since he seemed uncomfortable with me in the room and I offered to leave.  The physician that I was working with said, "She doesn't speak Spanish."  Thus, the patient decided that I could stay in the room and they would discuss his problem in Spanish.  To be honest with you, I really didn't care if I stayed or didn't stay because I already had this guy's problem narrowed down to two or three different things just based upon those two sentences...Now, if you decided to keep the medical student in the room and speak in Spanish, I suggest that you do not spend the entire time pointing toward your nether region.  Also, I suggest not pointing to your nether region then taking your hand from a vertical position and flopping it down at the wrist.  These signs transcend all languages and I knew exactly what was going on with this Young Buck.

Another equally animated patient provides some other advice.  Don't check out the medical student in the room and then ask her if she has a boyfriend after learning that you don't have HIV or any sexually transmitted infections (STI). Generally, knowing the HIV and STI status about a potential significant other is wonderful but I am part of your health care team and I can't date you even if you are the Prince of England after being apart of your health care team.  It just makes things really awkward for me, so please don't do it.  However, I think that it was fun when he gave the doctor, nurse and me hi-fives when he learned he didn't have HIV or an STI, so you can do that at your next doctor's appointment.

ICU, I love you!

I have been in the ICU the last few weeks.  I have really enjoyed my time in the ICU.  The patients are the sickest of the sick, which can be depressing at times, but that also means that we (by we, I mean actual doctors) can save lives of incredibly sick people who otherwise wouldn't survive.  It is exciting and as a medical student, it is overwhelming at times because I do not have the skills to manage cases with multiple co-mobilities and I am trying to learn as much as possible from these awesome physicians who do.

We have seen some very, very sick patients.  I saw a person with a tandemheart, which is a cardiac assist device that pumps the blood for the heart.  It isn't the same thing as an LVAD (Left Ventricular Assist Device--as seen on Grey's Anatomy).  Basically they do the same thing, but there are some differences, such as the tandemheart is attached to the patient's leg (yes, I said the leg) and the tandemheart is a short term solution (few days) whereas the patient can live with an LVAD for months (outside of the hospital setting sometimes) while waiting for a heart transplant.  We also saw a patient with anasarca, which is edema all over one's body.  It is one of those things, I read about in medical books and immediately upon seeing the patient knew exactly what it was.  But to be fair, it would be difficult to miss.

There have been a few deaths since we have started in the ICU.  I just hope that as a medical student, that my excitement for medicine has not been interpreted by patient's families as lacking compassion.  There was a woman this week in tears every time the doctor walked into the room.  I just wanted to go give her a hug and tell her everything is going to be alright, but I know that, for her, everything is not going to be alright (and she only speaks Spanish, so I can't even talk to her all I could do was to offer her a pat on the shoulder and a Kleenex).  Someone she loves is dying and at this point, all that is left is to keep that person comfortable.  I think her world is crashing down and there is nothing I can do to help her.

Despite the depressing aspects of the ICU when I left, I felt so alive.  I was more grateful for my health and opportunities I have been afforded, I was excited for the patients who got better and I was relieved that I was comfort some of the patients and family members.

7th Semester

Watch out world, as of today, I am a seventh semester medical student!  When I finish the end of the tenth semester, I am a doctor.  The finish line is almost within sight!

The Obdurate Opponent

I spoke with a good friend of mine from this island this weekend, who we will call D.C. An acquaintance of mine from the island, who is D.C.'s close friend., was recently diagnosed with stage three B-cell lymphoma. This acquaintance is a semester behind me in medical school and was getting ready to take her boards when she noticed an enlarged lymph node in her groin region. She went to the doctor and they worked her up, thinking it would be an infection or something relatively benign as she had felt fine; but, it was cancer that had spread all over her body. I suppose it could be worse, she could have stage four rather than stage three B-cell lymphoma, but this is really bad. She did her first round of chemotherapy and luckily coped well with the therapy, but it is too early to know if she is responding to therapy. I hope that she continues to do well and I hope that she successfully beats this cancer.

One of my colleague during my OB/GYN rotation just restarted medical school. He had been diagnosed with Philadelphia positive T-cell acute lymphoblastic leukemia after taking his first set of boards (that is a horrible diagnosis). He was told he needed a bone marrow transplant and that even with the transplant he was most likely going to die; however, he beat the odds and survived. It has been several years since he was first diagnosed. He is finally healthy enough to be back in medical school and doing great.

Both my colleague and acquaintance were in their late 20s, had just finished their second year of medical school and were given a diagnosis of cancer. I cannot imagine what their experiences are like. It makes me feel so lucky that when I had my surgery in January (when I too was in my late 20s and had finished my second year of medical school), there was nothing seriously wrong. I am so fortunate and I hope that my acquaintance will be fortunate and survive her cancer. I have a feeling in the pit of my stomach that she will be okay and I hope that I am right. I don't know her well enough to call, but I will keep her in my thoughts and prayers.

As strange as it might sound, hearing about my acquaintance and colleague made me remember why I love oncology so much. Cancer is a relentless opponent, but we (the medical profession) can fight it and we can win. I am proud of the pediatric oncology research that I help with. My input may be have been small, but I have already helped fight cancer. At this point and time, I wouldn't be surprised if I ended up in oncology or in obstetrics because I love them both. If I choose oncology, I will get to spend my life fighting with and for those in the most dire need--those with the obdurate opponent known as cancer.

Memorial Day 2010

I had to do a shift in the ER yesterday.  It started out slow, but after lunch a crazy number of patients came into the ER.  There were some interesting cases yesterday: a probable Steven Johnson Syndrome, a cachexic man who had terminal cancer and had an arterial block that turned his leg basically into a purple ice pop, stroke patient, and someone who almost drowned.  Now don't get me wrong, I love medicine; however, I don't love the ER.  I respect ER physicians and staff, but I don't think I have the personality that fits ER.  I really wouldn't be surprised if I went into oncology.  My favorite patient was probably the cachexic man with terminal cancer because I felt like I could do something to ease his pain by holding his hand while they had to examine him (even the smallest touches caused him pain due to the cancer).  Emergency medicine, obviously, involves a lot of stabilizing and admitting or discharging the patient.   I think I like being able to form relationships with my patients and being able to spend more time with them than is possible in emergency medicine.  There are so many of my peers who want to match in Emergency Medicine, but I know that I wouldn't be good at it and I know that I would make a great oncologist, pediatrician or obstetrician.  

Today, Farley and I decided to take a break and go to the beach.  Being a holiday weekend, it was much more crowded than usual but luckily we were able to find a little secluded place on the beach.  It was so nice to relax and read novels on the beach.  There was a breeze so it wasn't too hot and the water felt fabulous.  Being from the north, it always amazes me how warm the water is.  It was like cool bath water: perfect!

I started reading, "The Thirteenth Tale" by Diane Setterfield.  I started the book today and quickly read over 200 pages!  

Here are one of the airplanes flying banners over the beach.  This one is about a party at a club tonight. 

Farley enjoyed his time on the beach reading too!

I don't know how we were able to get such a secluded spot on the beach. 

This picture doesn't really show what I wanted, but it is suppose to be showing how many people were on the beach south of us.

This picture was suppose to show how many people were on the beach north of us.  It gives a little better idea of how busy the beach was.  There are usually just a handful of people near our apartment, but not today!

After we relaxed on the beach, we took a jog south to Lummus Park.  I did really well during the first mile of the job, but then it was like hitting a brick wall.  I was so hot.  I managed to make it back to the house okay and was able to jog part of the way back.  I probably was dehydrated from sitting on the beach all day, especially since there was a breeze and I was sitting in the shade: I probably didn't realize how much I had been sweating.  All and all, it was a great, relaxing day.

Internal Medicine: first few weeks

The first few weeks of Internal Medicine have been okay. Probably 80-90% of the patients in the clinic are Spanish speakers, so it hasn't been the best for me since I don't speak Spanish. However, the doctor that I am assigned to allows me a lot of physicals and I do get to do the whole history when the patient speaks English (or the doctor sends me into the room with the nurse, who can translate).

I had to do my first ER rotation last Sunday from 3pm until 2am and then I had to report to the clinic at 8:30 for my regular work day. It seems like everyone else is excited about these ER shifts, but I don't really like the ER all that much. It just isn't my favorite area in the hospital. In this Internal Medicine rotation, we are suppose to be assigned to an outpatient clinic for one month, to an inpatient physician for one month and to the ER for one month. I don't understand why they are scheduling us for the ER every month when we are suppose to have an entire month of ER. Also, the people doing the ER rotation are also having to go to some inpatient work. It would make more sense to me to do inpatient during the inpatient month and ER during the ER month. Even if I had to do four or five twelve-hour ER shifts per week, I think it would be better. I guess it doesn't really matter because I really don't have anything to do other than study and go to clinic so if I have to do ER for three months, I guess I do ER rotations for three months. Speaking of ER rotations, I was lucky enough to be assigned to an ER rotation this weekend. I really wish I didn't have to go into the ER this weekend because the traffic on Miami Beach is crazy. I hope that Farley and I have the weekend of the 4th of July off--not because I want to do anything all that exciting, I just don't want to drive anywhere!

Another Year Older

On the 17th, I turned another year older. I had to go to clinic, but it was an okay day. I really wanted to go to Espaniola Way for dinner, so we decided to get dressed up. I bought a dress on sale at the Nordstrom Rack when we went to Sawgrass Mills a few weeks ago and I finally had a chance to wear it! Here are pictures of Farley and I before we headed to dinner.

Farley bought me a pair of earrings for my birthday. Here is a close up of the earrings.

Here are some pictures of Espaniola Way. I know it is a tourist trap, but I just love it! I love the architecture and the feel. I just wish it was more than a block or two.

I wanted to go to a store that only sells linen, when Mom was in town, but we didn't have time. Thus, Farley and I decided to stop in the store. I have wanted linen pants since moving away for medical school in 2007. I have looked high and low and the pants either look horrible on me or they are expensive. I decided that since I've wanted a pair for so long, that if I found a pair I liked, I would go ahead and get them. I found the most beautiful pair of paints and I decided to buy them; however, I didn't have a chance because Farley got them for me as well as a linen shirt for him. This store was so much fun--I wish I remembered the name of the store. The owner was from France and all of her linen is from Egyptian cotton and made in France. Her store was filled with beautiful things and she was so interesting because she had lived all over the world. After shopping, we decided to go for Italian food. There were three restaurants, but we decided to go with one of the more inexpensive places. The food was great, but it started raining. It was the first rain we had in a long time. We were sitting under an awning and it was so nice to sit and watch the rain. Here are the pictures of the rain.

After dinner, we headed to a gelato place and had some yummy gelato. Here is a picture of the restaurant that we had dinner at dusk.

May 12th

This was a tough day for me. Despite leaving the Great Northwest for medical school three years ago, it is still really hard for me to say goodbye to my family. As usual, I cried when I had to say goodbye, but I am now used to it so I didn't' put mascara on until after Farley and I left for the clinic.

The rest of the week in the clinic was okay. Since I don't speak any Spanish and I was still getting over my illness, I didn't have the best week. The doctor and nurse I am working with are great, but I just wasn't feeling like myself at all. Luckily, they canceled our lectures for the first week and I was able to sleep a lot.

I decided to order "Instant Immersion Spanish: Levels 1, 2,& 3." I highly doubt that I will learn enough Spanish to really talk to anyone, but I am hoping that I will learn a few more words and that I might be able to understand a bit when people are talking. I never should have taken Latin and Ancient Greek in high school. Why didn't I just take Spanish like everyone else??

Mom's Visit to Miami: Tuesday, May 11th

Tuesday was my first day of Internal Medicine in the clinic. When I woke up, I was feeling significantly worse and within the first ten minutes of meeting my preceptor, she had written me a prescription for antibiotics. She did a physical exam and declared that my cold had progressed into bronchitis. Lucky me.

The clinic that I am working at has 80-90% Spanish speakers and I don't speak Spanish. So this first day was extra trying because I could barley speak, was coughing like crazy, felt horrible and couldn't understand what was going on. The doctor and nurse tried to translate for me, but considering how yucky I felt, it didn't matter all that much.

When we got home, Mom was down at the beach again and I decided to meet her down there. Here is a picture of her relaxing on the beach:

It was a little overcast and very windy, but Mom still had a great time on the beach. It was warmer than it looked!

Since I wasn't feeling too well, we decided to have a very laid back evening. We went to dinner at Cantina 27, which is less than a block from my apartment. The food was great!

When we got home, Mom and I decided that I needed a hair cut. Since she only took a carry on, she could not bring her hair cutting shears (they are too long). I had surgical scissors, so she decided to give it a go. Now, the surgical scissors I have are not very long and her hair cutting shears are 6 inches. This was the longest hair cut of my life, but it is straight! Poor Mom went on vacation and then had to work. We ended up taking 7-8 inches off my hair and I still have long hair!

Last Week of OB/GYN

I am really sad that my OB/GYN rotation is coming to an end. I have had so much fun delivering babies, helping with surgeries, seeing patients in the office, performing procedures in the office and all the people I've worked with (especially the other students--it was the most fun I've ever had in school). It has just been a blast. This week was a crazy week. Here are some highlights:

• I got to assist in my last surgery. A c-section. Everything went pretty well except that the surgical tech reached across the table and slapped me during the surgery. Dr. Hardcore didn't see it, but he wasn't too happy. This isn't the first time this surgical tech has hit one of his students during a surgery and in fact, she got in trouble the first week of my OB/GYN rotation because of how she treated another medical student during the surgery. At the end of the surgery, I waited until it was just the two of us and then I thanked her for teaching me about the different surgical tools, but told her it was not professional or appropriate to slap me during a surgery (especially since the patient was not in danger at the time). She has said some extremely rude things to me and the other medical students and I usually just ignore it, but I think getting slapped in surgery was just too much for me. I was really proud of myself for standing up for myself and for talking to her alone rather than doing something unprofessional. Dr. Hardcore asked me later in the day why I seemed upset and I told him what happened. He seemed pleased with me for standing up for my self and even said something like, "not again."
• I did an endometrial biopsy. I was the only student who hadn't done a endometrial biopsy. I had heard about how yucky they are and I wasn't mislead. I felt her pain just doing the procedure. Dr. Hardcore told me to toughen up because people come to the doctor to be treated and sometime to treat patients it does cause some discomfort.
• I got sick! I woke up at 3:45 am on Wednesday with a sore throat and ear ache. I just knew it was going to be bad. I almost fell asleep at Dr. Hardcore's office Wednesday evening! He sent us home early to study for our exam Thursday. We stopped and bought the sick person essentials at Walgreen's: chicken soup, night time and day time cold syrup, orange juice, and cough drops. I headed straight to bed. I was so tired that I slept for 15 hours and I was still tired when I work up.
• We had our exam on Thursday. I think it went okay, but it was very difficult.
• One of my patients that I have been following since the first week was induced this week. Unfortunately, she had the baby in the middle of my OB/GYN exam! I really wanted to help with this delivery so I was disappointed. She was a higher risk Mama, so I was excited and happy to hear that both she and her baby were doing well.
• Friday, we arrived for the last day at 8:00am for surgery. However, we ran into Dr. Hardcore in the parking lot and he had been at the hospital most of the night because of emergencies so we didn't get to do anything on Friday. It was probably a good thing though because I was really feeling yucky. I ran out of one of my asthma medicines so Dr. Hardcore sent me home with a prescription and told me to go to sleep. I slept for a few hours because taking Farley to the airport so he could go to his brother's college graduation. I also had to finish cleaning up the house for Mom's visit.

I am really sad to be done with OB/GYN. I think I delivered about 15 babies (both vaginally and via c-section) and there were only two boys in the group of babies I delivered! I just loved my OB/GYN rotation and I am considering it as an option for residency. I am still in love with pediatric oncology/hematology so it will be interesting to see where life sends me.