Archive | January, 2012

clinical pearls

31 Jan

By nature, review books are dense.  10 pages/hour I think is my maximum rate.  Often, I find it not so helpful to read when I’m not next to a computer in order to look up all the vocab, jargon, or acronyms that I don’t know (most of which I doubt I ever knew).

And then I get something like this:

During a digital rectal exam, the “normal prostate feels like a thenar eminence.  Cancer feels like a knuckle.”

Palpates muscles at the base of the thumb, then knuckle of the same thumb.  Got it.  Cool.  On to learning about TRUS–transrectal ultrasonography…yeah…totally did not have that acronym filed away.

Also, apparently my long-standing use/abuse of coffee and artificial sweeteners puts me at increased risk of bladder cancer.  And circumcision is likely protective against penile cancer.

isaac’s lens

30 Jan

In the spirit of being better about posting pictures, I wanted to share some that I stole from Kathleen and Isaac’s visit over Thanksgiving.  It’s such a trip to see my home and city (plus Lancaster) through someone else’s eye, especially one as artistic as Isaac’s.

ninja vaca

29 Jan

I had mentioned a quick trip to Charlotteville John and I took back in November, but I have been horrible at posting (and taking) pictures (mostly out of laziness and the use of public computers).  Although I marvel at all the things we can now do with this portable phone of ours, I’m not convinced that the pictures are quite as good as when we used the antiquated camera.  Still, wanted to share documentation of our ninja vacation, first to a little cottage at the vineyard where we got married, then to Charlotteville, best city in America (USA Today agrees).

squirrel

26 Jan

Last night, John and I stumbled home exhausted, ate some fudgesicles and eggplant, and made a fire.

About 20 minutes into an old House rerun, “Honey, I think we have a problem.”  And a squirrel comes scurrying out of the fireplace!

Being deathly afraid of those needles they use to treat rabies, I, of course, shriek like a little boy as the squirrel beelines for the couch.  After I gather my wits, I proceed to defend the stairway as John swats the squirrel out the door with a broom.

We need a dog.

hardcore

25 Jan

I watched a 30-something woman voluntarily undergo a 45-minute long colonoscopy without sedation.  She didn’t make a sound, she didn’t move a muscle in her face.

An observational note about colon hydrotherapy, in case you’ve been considering it: 1) it does not work; and 2) those warnings about risk of bowel perforation ain’t playin’.

ekg

24 Jan

We have an EKG quiz on Friday.  Months out of our cardio coursework, and I still don’t really know what bigeminy means…and, yes, I’ve asked many different people, they all look at me like I’m a prize idiot, and then they each proceed to give me a completely different, oftentimes contradictory, explanation.  I nod and feign comprehension because I’ve reached that point when my image is more important than total understanding.  I’ve temporarily become an educator’s worse nightmare.

This morning, my attending whipped through (literally, whipped) six colonoscopies in a little over three hours.  As I became a little dizzy from watching hours of bowels swirling about, I noticed an unexpected pause in the otherwise steady beeping of the heart rate monitor.  Then the anesthesiologist said, “Good, your eyebrows should go up when you notice a screen of flat-line.  So, what do we give her?”

“Atropine,” I blurted before I had time to process.  It’s an anticholinergic drug that, among other things, makes your heart rate increase, and I’m sure it would be the obvious choice for most of my colleagues.  Still, as someone who’s never been the first to respond, it’s reassuring to feel like some things are starting to really become ingrained.  While it’s crucial for physicians to continue to think and be mindful, I think it’s similarly important for some measures of patient care to be like reflexes.

Shit, I can’t believe we’re sped through most of January already.

coffee

23 Jan

God, it even makes Acute Kidney Injury better.  Studying it, that is.  I don’t want to piece together what it does if you actually have AKI.

This morning, in the middle of the dark slush of the Presbyterian Hospital’s maze of driveways, a large coffee for $1.25 from Maria’s Lunch Truck felt as luxurious as the latte I indulged in at our local Town Hall Coffee this past Thursday.  The otherwise empty windowless work station where I’m currently reading patient charts is not quite as agreeable as studying at a table across from John at our coffee nook.

ladies who lunch

18 Jan

Today I saw a sweet little great-grandmother with every kind of colitis imaginable.  AND she’s had some of the most horrific reactions to the meds that were supposed to make her all–well, sorta–better.

As we were wrapping up with her, she said, “Well, I’m off to meet the girls at a luncheon…if I’m going to be uncomfortable and miserable, I can just as easily do so at a luncheon.”

I’d like to see her in one of those spectacular hats the Brits wear; she could absolutely pull it off.

first day on GI outpatient

17 Jan

I know my experience prior was minimal (as it still is), but I’m not sure I’ve ever tried so many variations of questions eliciting descriptors of patients’ stool.

Conclusion: Some people just don’t like talking about poop.  Others simply cannot stop.

the beatitudes

16 Jan

Arvo Part is a contemporary Estonian composer who has a way of weaving sacred text into eight-part harmony that leaves me without doubt that there is a higher being.  I swear, my heart literally heaves at the word Rejoice at 5:22.

Saturday night, I had dinner with Ahmad, Steffi, and their smart little girl.  We were sharing some of the struggles we’ve had over the last couple years, and Steffi asked me if I was religious.  I am not.  I do, however, find a great deal of magnificence in the faith of a number of good friends.

My best friend from middle school has a beautiful, deep spirituality.  Her father passed away quite suddenly on Friday morning.  On her blog, she posted a simple, perfect verse: “Blessed are those who mourn, for they shall be comforted.” (Matthew 5:4)

I was struck by those words when I first sang Part’s The Beatitudes, just as I am almost overwhelmed (in a great way) by them now.  A number of the patients I had the opportunity to know briefly in the last two weeks are likely to die in the next couple months.  I think about how much I love the hospital, it’s so easy to not always consider how absolutely un-comforting (to say the least) it is to so many.  I don’t know of a way to end this post without a weak platitude so, banally but sincerely, I hope their last days and those following include peace and comfort for them and their loved ones.  And, of course, for my dear friend, my heart is with you.