Two Hundred, Another List of Memories

• First season of Cylons with a friend
  
• Hearing the tuba again
  
• Spontaneous late-night table discussions with new people and old people
  
• Couch-crashing
  
• Baseball games
  
• Guacamole and taco salad
  
• Brownies
  
• Baking a cake
• Jesus loves this guy!
• A cave
  
• A museum and a shut-down factory
  
• Local eats
  
• Southern drawls
  
• A splinter in a little girl's hand
  
• Extremely thankful patients
  
• Gangrene
  
• Exploration of an old but new town
  
• One skittish dog
  
• One wonderful vegetarian restaurant
  
• Being reminded that time doesn't stop
• Writing that reminds me of my friend
  

One Hundred and Eighty-six, Patient Continuity

So this daily blogging isn't going to work as is apparent to all who read my last one and then glanced at the date on this one.  Ohwell, ONWARDS!  

Continuity of Care is important in medicine for particular doctors.  Mainly Family medicine, Ob/Gyns, Psychiatry, and Pediatrics.  You see the same patients regularly either for checkups or for sick visits.  Hopefully the former, but the world isn't perfect.  Friday closed a chain of events in which I had interacted with a particular patient through three separate events, as opposed to following a patient stuck in a hospital during my rotation.  The first encounter was during my Ob/Gyn month during clinic where she came in for a 28 week checkup.  I can recall the exacts of her circumstances, older mom, excited that she quit smoking during the pregnancy, and with a particular medical condition which required some vigilance on our part when delivery-time came but was not a major worry.After her checkup that day, I placed her out of mind and figured, like the rest of the patients I had seen during those months, that I would let her melt into the pool of faces and names and diagnoses that collects all the patients I see.

Ten days ago during Newborn nursery my fellow classmate was examining a baby who had just come from the OR where mom had just had an emergency Caesarian section.  I didn' think much of it as I was writing my note on another baby while listening to them talk about a medical condition plaguing some mothers when I happened to hear the baby's last name.  I glanced up and without thinking uttered a first name.  The attending glanced down and read the mother's name.  Perfect match.  Mom was not exactly with it since she was recovering from her operation so I didn't get a chance to congratulate her then.  I felt a little warm inside with this patient continuity but again I figured that this was it, the end of the line.  I was prepared to let her and her child melt into the pool of patients although I figured it would take a little longer due to this second interaction, however remote it was.

Two days ago in my pediatric outpatient clinic, again I found myself sitting writing up a note on a patient I had seen while listening to the residents and attendings interacting and teaching/learning.  This time I heard about how this newborn's mother had a particular medical condition but it had been handled properly and there was no sign of damage to the baby due to it.  This time I glanced over at the folder the resident was working on.  There was the last name again.  This time I did go in to say hi.  

I don't know what I want to do yet, but I do want continuity.

One Hundred and Eighty-three, Two Days

I joked with my friends before starting the Pediatric rotation on how long I'd go before I came down with something.  The results are in!  I went a paltry two days before getting feverish, having extreme cold chills, a headache, and some muscle aches.  In my defense, I do believe this is related not to the kids I saw yesterday as much as to the flu vaccine I received yesterday at noon.

One Hundred and Fifty-nine, Gyn/Onc

[Disclaimer: Medical terminology and surgeries are described here. No "graphic violence" or descriptions about how bloody it was or bodily juices, but relevant surgical terms are used]

Ok, where to start...[ponders]

Gynecology - the branch of medical science that deals with the health maintenance and diseases of women, esp. of the reproductive organs. (definition from here)

Oncology - the branch of medical science dealing with tumors, including the origin, development, diagnosis, and treatment of malignant neoplasms. (definition from here)

July 7th, 4:30 AM I met with my classmates in a dark parking garage. We walked to the hospital and changed into scrubs nervously. We learned.

That early in the morning we wake up old ladies and ask them whether their pain is controlled. Whether they are feeling nausea or have vomited overnight. Did they have any bowel movements or did they pass any gas (I always want to say fart but I have to sound proper even though the patients can say whatever they want). One lady talked about popping a kid off on July 4th and another mentioned she'd let rip a big fart just the past night. We proceed on with our exam.

The exam isn't anything horrific. I just listen to lungs to make sure there's no fluid buildup and listen to the heart. This is where I start practicing listening to normal stuff and might hear abnormal stuff time to time. Then I check the abdomen. There's a variety of abdomens. Some are pale and doughy, others are pinker and more rigid. I always get nervous poking near the site of the wound.

After all that, we sit and write our progress notes. Basically a distillation of all we learned from the patient and writing down all the pertinent lab information from the computer and from the nurses' vitals' sheets. We try to finish before the residents come in--I still find this morning deadline challenging. The residents then repeat everything we did except they go much faster and they have an idea about what treatments to follow for the day. The Attending doctor arrives at some point and we proceed to summarize all the patients for him (or her) and then go to each patient as a large horde. We talk to each patient and sometimes re-examine them telling them what we have planned for them and listening to their concerns.

One day a week I have clinic. This is akin to a doctors office and deals mainly with pregnant women coming in for regular checkups or post-operative patients coming in for 3 or 6 week followups. Women seeking contraceptive help can also come into the clinic. Here I brush up on interviewing skills and practice my physical exams steps of listening to heart/lungs, and checking the abdomen as well.

I have to dress up for this day. I still find jeans and a t-shirt more comfortable.

Outside of that routine, we get to scrub into surgeries our doctors perform. My first surgery was a 3 hour hysterectomy and bilateral salpingo-oopherectomy. Those are fancy words for "We took her ovaries, tubes, and uterus out of her." It was a surreal experience putting my hands inside her belly. I've been following her since her surgery and she's been doing alright. We're waiting for her to have a bowel movement. Yup, surgery is grand!

I enjoyed laprascopic surgery. I play video games. Controlling the camera felt quite natural. I was also controlling the lady's uterus so it stayed up and out of our way. The tension in my arms from these two actions used a lot of oxygen. I almost fainted. I'm glad I spoke up and sat down at that time. Falling down on a sterile field is definitely frowned upon in surgery.

Yesterday's surgery was to investigate a pelvic mass in a dear old lady who wasn't able to keep anything down. This was a neat surgery because as we delved down into her bowels, it was clear why she couldn't eat anything. A huge cyst had adhered to her intestines and then grew big enough to pressure the gut to close. We took out the cyst--it quivered as it came into the cold OR. It was black and blue and slowly dying (the cyst, not the lady). We're hoping she'll heal just fine now!

Today I will go to bed two hours ago. I will wake up tomorrow dark and early to go back to the hospital!

Twenty-seven, Heartbeat

She came in asking for a pregnancy test. The clinic director figured it would show up negative since all the previous ones requesting the test weren't really pregnant. The student assigned to work with her rushed back to the doctor with the news that she was. The doctor just took it in stride, possibly because it was her first day at the free clinic too. She came in to talk to the woman, who was obviously happy at her news. God knows enough young women in the same condition, finding out that they are pregnant at a free medical clinic run by students, would freeze and wonder what will happen to their lives. The volunteering doctor then rummaged around the clinic. She knew what she was looking for but wasn't sure if they had one. After scrounging through many cabinets, one yielded the medical equipment she was looking for. Going back to the pregnant lady, the doctor applied some gel to her and then gently placed the equipment's sensor rod against her belly. Suddenly, loud sounds began emanating from the box connected to the sensor rod. Oddly enough, it sounded just like what we hear in a set of stethoscopes except faster, much faster.

As I listened to this sound, I stood in awe. Here was the sound of something new, something untouched by the world I have come to call home in my twenty-five years. Its life could go anywhere, or nowhere. This holiday season, it will bring joy to its family. But as I stood there, I could think of little beyond how cool it was.

Here were the heartbeats of an unborn baby

Twenty-three, Late

It's been a long day, but Clinic was definitely something I'll write about more; Bioshock will also squirm its way into my entries as I'm currently slogging through it on a friend's PC.