Medicine Sub-I, Day 9

I'm gaining more confidence in this medicine thing. I say that with caution, however, knowing full well that I'm not even 10 days into the clerkship. However, I know that I can function pretty well on minimal sleep - okay, kinda well - I may drift off a little during walk rounds in the morning.

However, I'm getting very good reviews from my resident and attending. If I keep this up, I may actually feel pretty confident going into my interviews for medical residency.

Speaking of which, tomorrow our Dean's Letters go out to all the schools that we've expressed interest in. Ooh. Bad sentence, ending with a preposition. Umm, "Speaking of which, tomorrow our Dean's Letters go out to all of the schools for which we've expressed an interest." Better, not perfect, but good enough for this blog, anyway. At which point, word on the wards is that the bulk of interview invitations go out soon after this event occurs. I'm crossing my fingers as I feel my heart sink into the pit that is my stomach.

Medicine Sub-I, Day 8: Comfort

The team was on long call. I picked up a couple more patients. It's been 14 months since I've started on the clinical portion of the medical school curriculum, and I still haven't seen death. Not that I want to, but it's kind of an important part of our education. Not only knowing what happens to the human body as it goes into decline, but also in dealing with the families and helping them to cope with loss.

So, a patient was transferred to our service once it was determined that there was nothing else to be done for her. The letters 'CMO' are next to her name, standing for Comfort Measures Only. And here I sit looking at every resource available, and nobody in my books or on the web wants to talk about how we die. I need to know this stuff because inevitably the family is going to ask the rough questions. Every groan, twitch, gurgle or grimace could possibly be interpreted as a sign of discomfort. I need to be armed with the knowledge that we're doing everything to make sure that she feels no pain, that she's in no distress, that she is at peace.

Anyway, my research-fu is failing me right now. Search strings for 'death', 'comfort measures only', 'physiology of death', 'events in death' have pretty much been fruitless. Perhaps it's because I didn't get out of the hospital until about 2am today, but I think more it's because discussing death is still quite the taboo in medicine. Pretty sad considering we all hit the same endpoint, don't ya think?

Medicine Sub-I, Day 7

The team has the day off. So I get to catch up on sleep, which I kinda do, except my neighbor decided to blast his house music again, this time at 3am. All I can think of are the following two words:

Justifiable Homicide.

Medicine Sub-I, Day 6: Short Call

'Short Call'. Not 'Long Call'. In other words, the team admits new patients until noon. We luck out today because it's raining pretty heavily out, and people generally don't come to the ER on rainy days. Or so the theory goes.

Anyway, an up-and-down day for me today. I discharged one patient home, happy as can be. The other patient I had to sit down with and tell him about the 'interesting' lesion we saw in his lung on CT.

'Interesting' in medical-speak = 'Uh-oh' in lay speak.

Medicine Sub-I, Day 5

Day 5 of 30 of the sub-internship. And I still don't want to throw my pager into the river. Not to worry, there's still time...

Application Haiku

Personal statement:
Mikey will be a good doc.
Please interview me.

Medicine Sub-I, Day 3: Word of the Day

The word of the day is: elope.

e·lope
intr.v. e·loped, e·lop·ing, e·lopes

1. To run away with a lover, especially with the intention of getting married.
2. To run away; abscond.

For example: Mikey's patient eloped without even saying goodbye. Sniff.

Some people just don't want help.

Medicine sub-I, Day 2: Long Call

What the heck is long call? On 'call' days we admit patients onto our service. 'Long call' means that we admit patients starting at noon and up until 11 pm or until our team receives the maximum number of patients, whichever happens first.

I received my first patient today. My very own patient! He's my responsibility. I shall call him 'George', and I shall hug him and pet him and squeeze him. Figuratively speaking.

Then my second patient! I shall call him...'Curly,' but no hugging, petting, or squeezing, for he has Strep throat.

My third patient! I'm beating them off with sticks. I shall call her 'Casey', for she was given to me, then abruptly taken away, because she really didn't belong to me in the first place :(

Then I received my real third patient! Yay! I shall call him...'Barfolowmew', for he is vomiting blood, and I shall hug him and pet him and squeeze him, only when he stops vomiting, and not before.

Medicine Sub-Internship, Day 1

Well, that wasn't so bad. Our team wasn't on call, so I didn't get to pick up any patients. So they sent me home early this afternoon. The resident was fine about it, but said "Your day is going to be really long, tomorrow. Bwahahahahahaha!"

*******

So I've spent the last couple hours touching up my application for residency, plus blowing several more hundred dollars on flight and hotel reservations for when I go to Chicago in December for this really annoying USMLE Step 2 CS exam. In short, it's a test of the medical student's clinical skills with a bunch of standardized patients (read: mediocre actors). And it costs us a fortune. One thousand bucks to take this pass/fail exam plus travel and lodging.

The Step 2 CS has been required for about 3 or 4 years now - if I'd graduated with my original class, I wouldn't have to take it - Damn you dual degree! DAMMMMMNN YOOOOUUUU!! I'm not sure if it's actually been all they've hoped. I'll have to do a little reading - later - to see what The Powers That Be think about this exam.

*******

Right now I'm listening to: 10,000 Hz Legend, Air

Leftovers

I'm busy finishing my residency application, so here's a post from my OB/GYN rotation that never made it onto the blog on time.

*******

Phooey. Blogging about eating placenta isn't exactly the most original thought in the galaxy nowadays. (Damn you, Tom Cruise! DAMN YOUUUUU!!!)

Mammals are known to eat the placenta after the birth of their offspring - apparently some primal instinct drives them to do so because the placenta is full of yummy chemicals such as prostaglandins to help the uterus contract back to almost its pre-pregnancy size. Or perhaps after spending hours in labor, the mommy is like "Dang! I got me some hankering for some placenta!"

I especially like the recipe that is pretty much a placenta smoothie:

Ingredients:
1/4 cup fresh, raw placenta
8oz V-8 juice
2 ice cubes
1/2 cup carrot

Method: blend at high speed for 10 seconds. Serve.

Eewwww....well, I guess I shouldn't knock it until I try it. Umm, anyone know where I can find some Fresh. Raw. Placenta????

*******

Rarely, nowadays, do physicians get to do their own labwork. Notice the characters on House M.D. doing their own labwork in their sterile clean lab? First, physicians hardly have the time to do their own labwork (or no one will let us near the equipment), and second, no lab is that clean. Ever. However, in the case of bacterial vaginosis, we finally get to have fun. Three of the following four criteria must be met for diagnosis of bacterial vaginosis:

1. The presence of a thin, homogenous (non-curdy) discharge
2. A positive Whiff test
3. 'Clue cells' present on microscopy
4. Vaginal pH > 4.5

Usually, the patient comes in complaining of discomfort and vaginal discharge. That's one criterion down, two to go. So....we have to dive in and get a little sample. The first time I performed this, I looked at my mentor hopefully, and asked him who Dr. Whiff was, and was he still around curing women of bacterial vaginosis? My mentor only looked at my sadly, and said no, there is no Dr. Whiff, the Whiff test means you take the vaginal discharge and stick your nose in really close and inhale. If it smells like fish, that is a positive whiff test. The last piece of evidence we usually get entails visualizing the 'clue cells' which are basically vaginal epithelial cells covered with bacteria.

Now that is what being a doctor is all about. It's about getting in there, getting your hands dirty, and sticking your nose into someone else's...discharge. Yep, definitely worth the decade's worth of training so far.

*******

I'm starting my sub-internship tomorrow, which means for one month, I pretty much take on the work of an intern. The chances of my posting anything are pretty dim for the next 4 weeks. Which means that I'm going to make the special effort to post something every day. At least a word, anyway. At most, erm....possibly two words.