Two Hundred and Thirteen, Departures

I watch as some of my friends in the past month have proceeded to pack up their belongings and either move or prepare to move as their residencies begin, husbands return to jobs in other cities, and simple need to get outta Dodge sets in. Some of our crew here would fight this, the general erosion of our people out of the cracks of the city to other places. I say Go, Go Boldly and announce yourselves. Whether you go simply to the suburbs, to states a goodly drive away, or to the other side of the nation, Go! Chase your dreams and your education and your spouses. If you must return, come home with the knowledge that you lived while you were where you went. And always remember that we all love each other lots and we can draw strength from that wherever we are.

Two Hundred and Ten, Stagnation

It's not that life is stopping all around, it's just that my personal development has slowed down to a crawl. I see myself as the same person who entered medical school four long years ago. Have these years meant nothing to the personable side of me? Can that side really have remained unchanged as my professional side underwent immense challenges? I look around at people moving forward with their lives--their real ones that matter! and see that I will have to work just as hard at my life as I do for my future career. While I rarely assume things will fall in my lap in most things, I see that in this area I have remained quite naive. Things will work out as they usually do but I will have to help it along a lot. And that means I have to learn, and learn quick.

But what is it I need to learn?

Two Hundred and Eight, Progress

I know I'm a geek. My time goes into studying for school and Warcraft! On that note, I did want to say what a difference I see in myself ingame from when I used to play to the past few months. As part of a guild working together to beat all the challenges the game throws at us, I have really come to appreciate the bonds you form with your fellow players. Tonight I stayed up 2 hours past my bedtime because were were slowly making progress. We had reached a point our guild members had never reached before by downing the next to last boss in the current end-game content AND began working on our strategy for the final boss. Included below are before and after pictures of General Vezax! I realize you can't really see anything but dangit, I got the pictures on here! I'll see if I can't get on to expand later on.

Before

After

Two Hundred and Four, The Pit

I have interesting family dynamics which I might get into more detail down the road but suffice it to say, tomorrow I will enter The Pit and I don't know if I'll ever see the light again.  But as a member of this family, it's my place to try to change people's outlooks and reasonings.  We'll see how the progresses over the next couple years.

One Hundred and Ninety-four, Cardiac Arrest

I have been remiss from this forum for quite a while mainly because I did forget about it in the jumble known as life.  This entry doesn't herald my sudden return to all things blog but it is to point out a small event that occurred earlier today.

A patient in the hospital for whatever reason stopped breathing and pumping his own blood.  Doctors rushed in along with nurses, I stood outside the room with my three colleagues.  I hear different orders being shouted through the air, "Get the crash cart!" "You start compressions!" "I'll get the kit" "Push another atropine!" "Stop! Does he have a pulse?" "Rotate on compressions" "We have a pulse!" "Ok, he's stable" "I lost the pulse!" "Quick, start compressions again!" and on and on.

At one point, one of the residents turns to me, points, and beckons.  As I near him, he tells me to leave my white coat outside the room.  I hurriedly rush in sans white coat and grab the gloves he gives me.  

"You're going to relieve the guy giving compressions."

My mind's jaw drops.  My physical body continues as directed to the side of the room where the folks giving compressions are standing and doing their job.  As I stand behind the fellow whose shoulders are heaving as he pushes heavily onto the old gentleman's sternum, someone tells him to pause to check pulses.  They find one!  Everyone relaxes (again) as the people in the room prepare to move the bed to the ICU.  As the connections are dropped, they notice his pulse is gone again.  Matt, my resident, turns to me and points me in.  I step up, place my hands as taught and practiced on rubber dummies, and start counting while doing my job.  I count ~50 compressions when the lady next to me says, "I can feel your compressions, stop so I can see if he's beating on his own."  I halt.  She still has a pulse.  I step back after glancing at Matt as the bed is wheeled off.  As I exit slowly behind the bed and its horde of people, my two colleagues come up to me and congratulate me on saving a life.  I stutter like I always do when I get a compliment.  Jokes continue into the night about using the story to score chicks at the bar.  I'm just happy he lived.  And constantly reminding myself in my mind about how oddly the feel of the elderly gentleman's chest felt just like the mannequins we practice on.  The only odd part was the face staring up at me slowly turning first purple, then pink with compressions, and with a mouth slightly parted in the agony of the situation...

One Hundred and Eighty-nine, Passion

I had a surgeon tell me about a procedure he was going to help perform back when I was on surgery.  The procedure was the one mentioned briefly in this entry.  And while to you or I it might seem like a long, amazing, and possibly tedious surgery, to him it was why he lived.  The excitement on his face was a beacon for me.  As I go through pediatrics and look back on Ob/Gyn and Surgery, I realized that I want what he has.  I want to experience the same glowing feeling, the same Drive for a particular line of work.  Doctors are in their profession for life.  I want to do something that I will thoroughly enjoy for the rest of mine.  

One Hundred and Seventy-five, The Elderly

I went into a room to check on an 83 year-old man's progress that day.  "Good morning sir." I said clearly as I turned on the light and approached his bed.  His eyes perked up and his head tilted slightly towards my voice.  In the corner the television was blaring away on some news channel some family member or nurse had put on for him.  I realized as his eyes stared at the ceiling that he would not be focusing directly on me.  I involuntarily speak louder asking him how his night was.  In reply, a slew of noises issued from his toothless mouth.  I put my ear close to him to hear him better.  No avail.  How was I supposed to gather information from this fellow?!  I stood at the side of his bed despairing that this man with a rich history (all 83 year-old people have a rich history) couldn't communicate what he was trying so hard to tell.  I continued explaining my exam steps as I checked his heart and lungs and operative site and legs.  He never stopped with his trail of words.  In fact, I couldn't hear clearly at all in his chest due to his larynx sending sound waves down through his body into my stethoscope.  As I said goodbye and left, he quieted down in what I imagine was frustration.  He might have had a stroke, but he obviously was aware of people.  He just couldn't communicate effectively and that is what made me saddest.

In opposition to that experience, I met a nurse later on that day who was from the Philippines.  She had immigrated 58 years ago.  At the spry age of 79, she worked regularly in the operating room as a circulating nurse--the nurse who makes sure everything runs smoothly in the OR and gets stuff we don't have in there.  She was telling us stories about her younger days and stuff about her husband.  Her husband is Japanese and apparently when she married him, the Philippine government took away her Filipino citizenship.  She told an elaborate story about how she eventually kept from being deported to Japan through friends in high places and even getting her name on a bill that Lyndon Johnson signed.  And then there was the story about her husband who was to be deployed in the war "in just a few days when the war ended."  At one point a newer worker in the area, some nurse or tech, came by asking if she would help move the patient back to the ready OR.  The 79 year-old fixed a look on the intruder which clearly meant, "Let me finish my story, then I'll take care of it!"  She picked up where she was decribing a kamikaze's underwater counterpart, a Kaiten.  Her husband had been training as a pilot for one of these and was scheduled to be deployed a couple days after Nagasaki.  Her wrinkled face was animated throughout the storytelling.  Deep furrows appearing in her brow when reciting the parts regarding her possible deportment and the fact that her husband was a Kaiten pilot.  Wrinkles clearing out with her smiles when she reached the happy conclusions of remaining in the States and her husband not being deployed incidentally.

In one day I encountered two people who showed me the wide variability in human function and communication.  I also grew to appreciate different qualities in each.  From the gentleman patient, I had a glimpse of future disability that is more likely to strike than sudden death and the possibility of unheard stories.  From the nurse, I learned the richness of a life and the joy of knowing the lives others have lived.  In fact, it gave me hope hearing her realizing that the gentleman probably had regaled other people with his own stories prior to his mishap.  I hope those people take those stories and remember them time to time.  

What are we but the sum of our experiences and knowledge? 

One Hundred and Sixty-nine, Start of a Queen's Reign

"Go on, get in there!"

As I stepped forward, a fleeting moment of nervousness and panic entered me and left as I strengthened my resolve. I was ready for this. I'd seen it done many times by now and felt comfortable with the process along with the doctors there. I held the little girl's head as it came at me. I moved the head and the shoulders downward until the top shoulder came free. Then, before I could blink, she popped out! I wasn't prepared for the speedy exit she made so I was holding her with both hands as she started crying (the practiced physicians develop a one-handed safe baby-holding technique). The resident put the clamps on the cord and Papa leaned in to cut it with the scissors. Finally I handed the little girl off to the pediatric crew ready to assess her health.

Later on I asked the resident, "Does it ever get old?"

"No."

One Hundred and Sixty-one, Introductions

I still stop and wonder what the hell I was thinking when yesterday, meeting a young woman for the first time at the Contra dance gathering, I introduced myself and then continued with, "These hands have been inside women's abdomens this past week! ... Oh, in surgeries."

Tact I do not have. Still, it was an enjoyable time and my enthusiasm for the dancing overshadowed any odd worries she might have had that her abdomen would be dissected. She had the habit of staring me right in the eyes. I do not know proper etiquette for dancing so I'm just glad I was still learning and had a reason to look at other people to have an idea of what to do. $3 is well worth enjoying group dancing again, whether or not the acquaintances of the Kid are there.

In other news, I find out my Step 1 Board scores tomorrow.

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!

One Hundred and Fifty-eight,

Influence exists, there's no doubt about it. Up until now, however, its power over me has not been that powerful. My merits and personal traits have carried the day even in the face of influence at times. Going through medical school though, it's going to be tougher to fight influence. And I successfully made that fight tougher for myself by accidentally hitting "Reply All" to an innocent email. I'm clumsy, as my friends know. Apparently that conveys to mouse-clicking too at times.

I'm nervous, but I'll live. And whatever can't kill you, only makes you stronger. I heard that somewhere once.

One Hundred and Fourty-six, A Reprieve

The month of studying has begun! It's odd how I can get myself working hard but on the other hand, I also have to play hard. As many of my friend can attest to, I've been studying my requisite hours a day but I've also been playing games like a madman outside those times (I tried mixing the two and I realized it was a no-go). Hence anything that comes in the middle (like the news, this blog, sleep) suffers. It shall not always be so! But for now I will still be sparse.

One Hundred and Fourty-one, Surrounded Yet Alone

Back in October the Engineer celebrated his birthday far away from us all by himself in Texas. In February, the Beatnik looked like he would end up celebrating his birthday in Louisiana far away from us, but the Engineer went up to see him that night. Today I went out in the evening with Roommate, Amish Girl, and another classmate to dinner and dessert.

I didn't realize until today how awesome it was that the Engineer and Beatnik were able to hang out together over something as simple as marking the day one of them popped into this world. I didn't realize until today what it meant to be able to spend part of that day hanging out with each other. I didn't realize until today some part of what it might have felt like to celebrate your birthday on your own. I realized today that we've been celebrating birthdays together since late elementary school. This is the first year where we couldn't all be together for each of our days. I've been receiving endless phone calls today, but only four uplifted me: Valiben, Engineer, Beatnik, and Lord Chaos with the family singing Happy Birthday.

I'm surrounded by great people, but I can't change the fact that I miss the people I've known for most of my life.

One Hundred and Twenty-five, The Horizon Cometh

I've been very successful putting off any major decisions in my life. I had to choose a degree program back in high school so I chose "doctor" which gave me a minimum of eight years before I had to worry about the real world. On top of that I chose a five year Masters of Engineering program as my undergraduate degree choice so I had nine years of school to look forward to. In the deal, I got an extra year when I wasn't accepted to medical school my first go-around. Being denied to all my medical schools was one of the best things ever to happen to me! Managed to travel all over the place that year and get in medical experience at a local hospital. Now here I am approaching eight years since I graduated high school. Yes, the real world scares me.

I do have major decisions approaching fast these upcoming two years. They seem to be coming from all over. The largest one that's been staring me in the face and that everybody has asked me about is what specialty I'll pursue in medicine. Everyone tells me they get their ideas during third year when they begin actual rotations. I hope it comes to me as well during that time period.

It'll be a time of moving around and meeting tons of new people many of whom I'll end up forgetting (no matter how hard I try). I even have some away rotations in the works where I'll go to different parts of the state. While trying to learn as much as I can, I'll also be trying to figure out what aspects of each rotation grabs my interest and which goals in life I want to be able to do while working in a particular field. And therein lies the kicker. In my life, I will work really hard at being a doctor, but for me it will never surpass the goal of being a family man. So even if I find some field interesting or engaging, it will be for naught if I can't have a fulfilling home life as well. Again, I trust that the choices I make will be correct whether I agree with them at the time or not. I can attest to the fact that while I have no luck at petty gambling, I have all the luck when it comes to the big things in life.

One Hundred and Seven, What Would Brian Boitano Do?

Wasn't too bad. Odd? Yes, but I didn't freeze up or anything. I just went in and learned stuff and practiced it and came back out. I now know another little bit of being a doctor.

Ninety-six, Prostate

I just felt a prostate a half hour ago. Felt like a bump on the inside of the fleshy tube. Nothing that gross, nothing that amazing. Just was.

Ninety-two, Empty and Full

I don't really know what to write. I have successfully pushed aside myself in the past few days in order to properly cram for my exams tomorrow and Friday. My mind is filled with facts about Baclofen (CNS muscle relaxant), Hyoscyamine (Muscarinic Receptor Antagonist), Pemphigus Vulgaris (one type of blister), Bullous Pemphigoid (another type of blister), Ductal Carcinoma, Bowenoid Papulosis, Multiple Sclerosis, and more. I have spent quality time with some friends, and not seen others. I have talked with my family, but not for any long length of time. I have been playing games when I can, but not every day. I have been putting a lot into these exams. We shall see how they turn out.

Eighty-six, Medical-ese

"Morphologically, the major change in HD is loss of medium-sized spiny neurons in the neostriatum, manifested grossly by severe atrophy of the caudate nuclei and, to a lesser degree, the putamen. Cerebral cortical atrophy may also be evident, particularly in the frontal lobes."

The fact that I can read that and--outside of the fact that I read "spiny" and think Mario games--understand what it's saying to me means that all these years of schooling were worth something. As I try to figure that out, I realize that that "something" that I gained is the ability to speak in a new language. I wonder how useful this new language will be for talking to non-medical-ese people... I guess it's similar to being a translator. Except that it's involved translations where you actually describe what the words mean to each new person you meet (very few of whom will speak medical-ese). So yay! I'm learning a new language! Now all I have to do is spend the rest of my life explaining words from that language to people who speak English (and other languages).

Eighty-four, Pushing Hard

Every so often, I get these urges to perform well. Which usually means sleep loses. It's 1:03 AM and I'm done with my assigned set of "Learning Objectives" (fancy words for testable material). I'm about to go to bed and sleep (by 1:30 at the latest). I'm going to hope to get up by 5 AM so I can get ready and then start studying for today's quiz. Off I go for a couple hours to nap.

Seventy-six, Flames Git Higher!

I start practicing tomorrow. No, not actual medicine, chemistry. Aka cooking. I've cooked Indian items probably a total of 10 times in my life. I just need practice to ingrain it. I'll start simple either with potatoes or cauliflower. I'll just cook the vegetable so I can concentrate fully on it rather than worry about it and bhakri. Hopefully after a couple months of making one vegetable or another (overall, they all have the same set of steps for preparation), I can handle more than one thing in the kitchen (be prepared to run when that date comes Roommate!). My safety record is immaculate so no worries. =P

If you happen to see a column of smoke, pray it wasn't the apartment because by golly, my head will be rolling from all the angry people! On the upside, we might get new windows!