Win: Today I diagnosed a woman with Benign Paroxysmal Positional Vertigo. Then I watched her physician successfully treat her using the Epley maneuver.
Fail: It took me three (successful) sticks to draw her blood. I blame her adorable small children, who had apparently reached their witching hour. At every vial exchange, they decided it was the appropriate time to either crash into the table on which her arm was propped or propel themselves into her arms.
The family practice where I’m learning still provides home visits (pretty awesome, yeah?), and I get to make a few on my own each week. Right now, I’m following two patients regularly–one suffering from a disease of the mind, the other of the body. Not surprisingly, the priorities of these visits are different.
During one, I find myself answering, every two minutes or so, “Where are you from?” “Where in Virginia?” “How many children do you have?” I’m there to engage him, to change up the screen, though he won’t remember me after I’ve left.
The other, I’m checking for sites of infection, monitoring his airway, assessing level of pain and comfort and, as happened in minute one of my first visit, being the periodic target of projectile sputum via tracheostomy tube.
Sometimes I have a second to step back and think about what comes out of people’s mouths when I ask, “Anything else?” I’m on family medicine in Bucks County right now, and I’m seeing the full gamut, and I’m simply floored by some of of what these patients reveal during the “ordinary check-up.” At the end of the day, my head feels flooded by information these folks have likely never told their family, their best friends, their spouses.
This week I had an otherwise healthy patient with no previous health issues come in for a relatively innocuous concern, for which we able to quickly put his mind at easy.
Me: Is there anything else you wanted to discuss today?
Him: Well, actually…my three greatest concerns are as follows…
And that’s how my 7-minute appointment turned into 45, including a full neuro exam, EKG, and bloodwork.
Forgive my recent absence. It occurred to me that I’m taking two shelves two days in a row, and I’m trying so much a lot not to fail out of med school.
I’m not sure there’s ever been a time in my life when I’ve been so concerned about exams that were still two weeks ago. I’m trying not to be hysterical, but it kind of feels like someone dropped Harrison’s in my lap and commanded, “Learn all the things!”
Things are certainly not boring ’round here.
As I sat in the library, demoralized by my performance on practice shelf questions (shelf = standardized exam at the end of most clerkships), I got an email from John about fun cultural things we could/should be doing. (I’m acutely aware that my participation in/observation of local culture is in a very pathetic state.) You’ve heard me go on about my love of Philadelphia, city of murals. Just another case in point…
And to think, most of these are along my commute home!
Card for purchase here.
Remember when we used to bring in a decorated empty tissue box from home to use as a “mailbox” for valentines exchange in elementary school? I loved that. I think I almost always chose the Charlie Brown pre-made valentines from the local Giant Foods and taped a singular Hershey’s kiss to each because I thought the kiss was soo clever and appropriate for the holiday.
Happy Valentine’s Day!
Last night a patient came in delirious but pleasant. Today he woke up delirious and pissed as hell.
When I asked him if he would let me listen to his heart, he burst out, “YOU!!! I used to think you were nice, but I was wrong!”
And another patient sees the light…
Today an elderly vet nearly hit me with his new scooter.
Me, amiably: “You trying to run me over, sir?”
Him, sans dentures: “Doll face, if I was trying to run you over, I would have, and then I would give you mouth-to-mouth for FOUR HOURS!“
As John said, you can’t make this shit up.
And then my encephalopathic patient kissed me. I’d like to think he was just showing his appreciation for the 6 liters of fluid we drained out of his abdomen yesterday.
I think I’m in love. It must be love if 14 hours in the hospital flies by at the blink of an eye. If 5 hours of sleep feels like a total luxury. If I feel like an idiot 98% of the time, break down in tears of frustration at embarrassingly regular intervals, and yet still feel profoundly lucky.
(Rereading these last few statements, I notice how easily these could be attributed to those of the victim of an abusive relationship…now that’s a horrific, potentially accurate analogy for a medical student if I’ve ever seen one…llllllllllllll)
I’ve been at the VA Medical Center for the last week now, and I’m pretty thrilled that I get to be there for my last three weeks on general medicine. So much more to follow, but to note:
Today, the intern on service and I spent two hours draining over six liters of fluid from a man’s abdomen.
Oh, and this just occurred to me: one of my residents commented that I was good at explaining illnesses and procedures to patients in words they understand. I wonder if it’s because I try to do so here. This is important to me. The majority of readers are not in a medical career. If I say anything that needs further clarification, please let me know. I promise, the use of med jargon is not to make me feel smarter…when you’re saturated in a language, it becomes too easy to forget what words are those of everyday. My second day on the wards, I asked an elderly obese woman with a prior heart attack if she had a history of hypertension. “Oh, God no!” And then: “Do you have a history a high blood pressure?” “Oh yes, for many years!” My point being that, in this conversation, I was the idiot. So quickly we forget. I’m a college graduate, and I can honestly say that before post-bac and med school I had thought there was a difference between hypertension and high blood pressure. Otherwise, why would anyone choose to create a perfect synonym with the same number of syllables? You don’t even save on time by saying “hypertension.”
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.
anna in med school 