Two Hundred and Sixteen, Carburetors

     Puttering along. No, that would imply I work in a factory or office setting. Unfortunately the profession I'm in is increasingly being run like a factory improving efficiency however the acceptable losses is still considered to be zero. Unlike carburetors–of which the worst case scenario is a flawed shipment costing $$$–people are not expendable. When a carburetor isn't functioning properly the usual treatment is to replace it.  Not so with human beings. There is no reason for a mechanic to be on call to fix a car emergently in a night.
     It is enjoyable though and satisfying. That little part that glorifies in fixing problems while interacting with people burns brightly every day for me. Although every now and then I fix a problem or two and then my patient happens to pass away from something else despite the improvement he or she had shown.
     But those thoughts are for another day.

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-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 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-one, Everyday Doctoring Stuff

Last week Wednesday I received an email from the Beatnik.  He'd recently done 129 questions to see what Dungeons and Dragons character build he would be and was curious what our friend circle would get.  This was in the morning.  I set aside this task since I was heading into the hospital and decided to confront this monster of a quiz later on that day.

Wednesday continued and I learned that I would be participating in a big surgery starting at 2 PM called a "free fibula flap" surgery.  If you Google it, the second hit that comes up does a good succint job of describing it.  I describe it below in brief.  Anyway, we didn't finish the surgery and I didn't get back to the apartment until 1:00 AM Thursday morning from the hospital.  I had a pounding headache from lack of food and liquids but I had just seen an amazing surgery.  I saw a slew of emails from all of my friends who had replied their character builds throughout the day as they completed the 129 question quiz.  The last one was from the Beatnik again, addressing all of us.  Here it is, and pardon any language that might be offensive to you.

The Beatnik's question to the world:

"Well our party is pretty varied.  We have Drock as the all powerful wizard.  I'm the tree hugging hippy druid.  Crazy Blonde is the know it all Wizard.  Woodwind is the touchy feely Cleric and Lord Chaos is our soul devouring Fighter/sorcerer.  The Engineer is our totally not gay Bard.  And I know you are all wondering the same question I am,

 

WHAT THE FUCK IS DAVE!?!? TAKE THE GOD DAMN TEST!

 

Our group make up would put Lord Chaos in the front.  Me and Woodwind in the middle with the Engineer close behind (Dancing or doing whatever the fuck bards do), Crazy Blonde and Drock as our artillery in the rear (tee hee).  And I know you are all curious about one thing,

 

WHERE THE FUCK IS DAVE?

 

I know me too.  Kinda fun, maybe we should all cosplay sometime (shudder) 

love,

The Beatnik 

p.s.  TAKING THE FUCKING TEST DAVE! "

Reading this at 1:00 AM, I quickly sent out a reply to everyone:

"I just saw a guy’s left jaw taken out, then a bone from his leg taken and put in with a metal bracket to work as a jaw, then his pec from his left chest pasted over the bone, and then multiple skin grafts.  This morning I briefly read your email at 6:00 AM before running off to the hospital.  There I have been until 1 AM right now.  I don’t think I need a test to tell everyone that I’m some type of good cleric

I’ll take it one day. 

-Dave"

I felt that while this might be harsh, it helped explain why I hadn't replied and that I'd get to it when I had a chance.  Little did I realize but in the couple of hours of sleep I got, the Beatnik had responded:

"Lol, now was that so hard?  I kind of realized your crazy schedule after a little while.  You're doing something right now that I could never do.  I know that you're in a world of doctors and people who do this shit all the time.  But, those of us who don't have MD in front of our names are pretty impressed by what you're doing right now.  Just thought you should know. 

Keep up the good work Cleric Dave,

The Beatnik"

This was 6 AM Thursday morning after a 4 hour nap.  I paused.  

and continued to pause.

I have become so inundated with cholecystectomies (gallbladder removals) and hernia repairs (fixing weak areas of bellies and groins) and other surgical terms that I was missing out on the simple fact that the majority of humanity never sees the things surgeons and the OR staff do.  Yeah, during the surgery I wondered who the hell thought up taking someone's bone from a leg to rebuild a jaw, but the actual procedure never amazed me because it made sense.  To laypeople though, it's practically magic.  The patient sees the difference between what they used to look and feel like compared to how everything is after a surgery and it's amazing.  

That's what my two months on Surgery have boiled down to: Amazing.

One Hundred and Eighty, Surgery? Check!

I passed my Surgery clerkship.

Today at my oral exams, an interesting interaction occurred.  I was examined by two surgeons both of whom I've had some form of interaction with during my rotation.  At the start of the exam, one of them asked me in what field of medicine I was interested.  I'm not prone to lying for the sake of cozying up to someone so I stated the fact that I was undecided but was building an idea of what was important to me.  One of those realizations was that I did not feel I would be up to the lifestyle of a surgeon.  Hence I was thinking I'd end up in family medicine or pediatrics.  Then the examination continued.  I did fine in the exam and as I was shaking their hands in preparation to leave, the fellow who had asked me what I was interested in told me not to go into family medicine or pediatrics.  "It would be a waste."

One Hundred and Sixty-seven, Deliveries and Home

My days this past week included two Cesarean sections, one normal delivery, and one ectopic pregnancy. I've managed to find many babies' heartbeats while they're inside mommy using Doppler devices. I've met a woman who is pregnant for the third time after having lost her first pregnancy because the baby developed no brain and lost the second in a miscarriage. She and the doctor are ecstatic that this third pregnancy is going well and she's getting really close to term with a healthy baby growing inside her.
This past weekend I saw the Engineer and some other friends. I came to realize that while I had become slightly desensitized to bar smoke in the past, my year or so of abstinence from smoke-ridden air caused my throat to heal up and feel Friday night stronger than usual. My grandmother's birthday was on Saturday. And Valiben showed up just before I ate dinner and then drove off to my schooltown. Sunday I managed to get laundry done and I had some good chats with a couple friends.

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 Thirty-one, Four Weeks

I haven't seen some of my closest friends in person in almost a month... I miss them so I think I'll spend tomorrow (which means today since it is already Saturday) with some of them.

In other news, if I go into end-of-life health care it will be very difficult for me. I'd be honored to do it, but it would definitely be hard for me.

In final news, I'm bad at expressing myself. It's something I should figure out and work on but never really feel comfortable facing my own issues.

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, Hot Hot HOT!

Being a medical student, they tell you during second year is when you hit your hypochondriac phase. So far I've been good but I'll admit, looking over last night I could easily freak myself out. The fact that I developed a very strong fever out of nowhere is definitely a concern (don't worry, I'll be finding a licensed doc to get it checked up on) but what is even scarier are all the dozens of different conditions that could mean. A tad sobering if you ask me.

No worries for me today though, the fever departed as fast as it came so today I actually feel decent barring a slight left temporal headache. Nothing a Tylenol can't keep quiet while my body heals from the searing ravages of yesternight.

Eighty-eight, Metaphysical Medicine

Neo, there's someone who could be a great doctor (Spoiler: he did save Trinity!). Imagine having that power in the real world. Being able to scalpel cut someone open, treat them, and sew the patient shut all in a matter of picoseconds (0.000000000001 seconds). Before a drop of blood spills, you're sewing them shut. In my mind, this works in a similar manner to Fry's 100 cups of coffee. Except normal doses of caffeine have little effect on me so I might have to go even higher to kill myself, achieve a higher state of nirvana, and do super-surgery!

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, Toasted Cheese Sandwiches

I woke up today and throughout today so far have had that heavy sinus-filled feeling of doom which in my world means a judgment of a cold is about to fall upon me. Doesn't necessarily mean it's going to be a really bad one, but it's going to be one. The "filled-head" feeling (yes, that's doctor for the lay folk out there), the slight skull ache (specifically my maxilla!), and the low fever I've developed plus my loss of normal taste sense.

Mmmmm, soup and toasted cheese sandwiches (lazy man's grilled cheese).

Fifty-four, Kidney!

I had this in my "business" inbox today. Thought it was funny considering we just got tested on kidney pathology*!

*For the non-medical types, glomerulus is a functional filtration unit in the kidney composed of a small ball of capillaries.