Tuesday, May 30, 2006

Gotta Watch Yourself

There are certain people in this world, who, by virtue of their job or profession, are untouchable. And by untouchable I mean you can't treat them how you truly want or how they deserve to be treated. Examples include waiters, executive assistants, babysitters, and more. It's not worth it to be rude to a waiter if it means your sandwich will arrive with spit (or worse) hidden inside, or if your pancakes will arrive on a plate after having been sitting inside the chef's sweaty underwear as he did jumping jacks. Conversely, it is in your best interest to be a little more polite than usual if it means your resume for a job application will not "accidentally" be thrown into the trash. You get the point.

I have two specific people to add to this list, both recently involved with the same endeavor of mine. I am busy preparing the paperwork to send away my applications for rotations at other hospitals, and this, in turn, requires me to deal with our Student Affairs office. For the most part it is staffed by kind and friendly people, except the one woman in charge who is quite the rude and unrefined b****. I apologize for the demeaning comment, except that this woman is horrible and barks at people like she has never had any politeness instilled into her. She yells at you if you stand more than 3 feet away, and you can't ask her to repeat something unless you want an earful of loud "WHAT DID I JUST TELL YOU?" Unfortunately I can't speak my mind, lest I want my transcript and letters conveniently misplaced ... so damn you, you win this round.

Next up is the a-hole mother****** guy who works in a mailbox store near me (not the US Post Office, but some private mailbox store that is a pick-up station for FedEx, UPS, USPS, etc.) This guy, who I've interacted many times with before, is among the most terse, rude, and irritable POS's I've ever encountered. Ask for help and he gets visibly irritated because he has to interrupt whatever he's doing (often just text messaging) to help you. Or ask him how much it costs to send something overnight and he'll bark back "How do I know?". Someone needs to walk in, smash his hands with a baseball bat, and then tell him to treat customers.

That's all. (It's loosely related to medicine, no?)

Saturday, May 27, 2006

A Tale of 2 Hospitals

Like most medical schools, our university is associated with two hospitals: the university hospital and a large county hospital. They sit on opposite sides of both our campus and the spectrum of luxury.

The university hospital is the nicer, more luxurious private hospital while the county hospital is a large, crowded, and understaffed monster of an institution that serves anyone who walks through the doors. The large county hospital is where we do nearly all our clinical rotations, but occasionally, for certain rotations or events, we get to work in the university hospital. Being used to the county hospital, most of us students get used to its inefficiency and dark, depressing corridors; but when you come over to the university hospital you immediately realize what the outside world is like.

Even though this is our hospital, and it's a great place to get trained as a medical student, you can't help but wish the county hospital was a little more like the other. Exactly how are they different?
  • That hospital has way too much money; there are new fancy buildings being erected every year. This hospital has has government money ... which ends up meaning no extra money.

  • Patients of that hospital have tens of millions of dollars to spare and then donate. Patients of this hospital can barely find two nickels to rub together.

  • Patients of that hospital include prominent celebrities like athletes, actors, and government officials. Patients of this hospital are homeless.

  • In that hospital halls are brightly lit, and rooms are spacious and single. In this hospital, the lights are orange and dim, and rooms are packed with 8 patients.

  • That hospital has 2 CT scanners for its 300 patients. This hospital has 4 scanners for approximately 800 patients -- and 3 of the scanners don't work (no joke).

  • In that hospital, ordering a test as "STAT" gets it performed immediately; in this hospital, STAT ends up meaning do it in a few hours -- unless, of course, the nurses don't feel like it.

  • In that hospital has air-conditioning; this hospital does too -- except it doesn't work, it isn't repaired, and it makes the summer months sweaty and miserable.

  • The cafeteria staff at that hospital learns your name and makes dishes according to your preferences. The staff at this hospital will never admit to recognizing you if you forget your name badge, and they make you swipe your badge twice if you want extra portions of food.

  • That cafeteria is well-lit and lively. This cafeteria keeps the lights dim so you don't see the mice running around.

  • Those patients, when discharged home, invite you to Pebble Beach to play golf, and sometimes they offer you a new car. The patients here, when discharged "home", go sit on the stairs just outside the hospital because that is their home.
This listing isn't meant to be scathing or bitter; it's merely a factual comparison between two hospitals separated by one physical block but by worlds of money.

Luxurious as the university hospital may seem, you can't beat the training you receive at the county hospital -- in terms of patient load, exposure to obscure diseases, and responsibility. And believe it or not, if you spend enough time at this hospital you might even begin to enjoy all its "features".

Tuesday, May 23, 2006

Grand Rounds 235

The latest Grand Rounds is up at Parellel Universe. I'm pretty excited because it features one of my posts. Be sure to check it out!

Saturday, May 20, 2006

Hypochondria

Medical school is harmful to your health -- or, at least, it's harmful to my health. Thankful as I am to be in med school, this same education that is teaching me about the body and how to treat sick patients is, unknowingly, also teaching me the many ways in which my body can go wrong.

I can no longer experience even a simple ache or pain without thinking about the worst-case scenarios. I can't help but analyze my occasional random symptoms, and I usually misinterpret them as signs of an unlikely, horrible disease process. As an example, my hand occasionally shakes slightly. The moment I am aware of it my mind instantly shoots to Parkinson's disease, the neurodegenerative disorder characterized by a tremor, which actor Michael J. Fox has.

I know it's almost unheard of in someone as young as I am, but once the thought is in my head, obsessive behaviors begin. I once pulled a neurologist professor aside to ask her what she thought of my tremor; I had her attention initially, but then she thought was joking when I asked her if it was Parkinson's. This was years ago, and so I've forgotten about it for the time being. However, I ran across a brief mention of the disease online a few days ago, and I immediately reverted to my obsessive ways. Sneak up behind me and you'll find me staring at my hand in midair, trying to look for any microscopic movement.

That was by no means an isolated incident. Last year, early one morning about an hour before I was to wake up, I had to get up to pee. Seeing how that was not normal for me, I concluded that I must have new-onset diabetes. The next few days I was convinced that my vision was blurring and my feet tingling (which, by the way, are only long-term complications of diabetes), and so I sought advice from a diabetes expert (we were "coincidentally" learning about diabetes in the classroom). He said I had nothing to worry about, but was I calmed? Not really. Luckily in a few weeks, I had forgotten about it.

It's the classic medical student syndrome, I've been told, whereby we learn about diseases, and our vivid imaginations convince us we have them. Being a medical student, with our unrefined diagnosing skills, also predisposes us to conclude the worst, most rare diagnoses when evaluating a symptom ... as opposed to thinking of more common explanations first. As I sat in class one day my neck started to ache. Uh oh, is this nuchal rigidity? I must have meningitis, so I inched my way to the aisle in case I needed treatement quickly. Meningitis could have been the culprit, but so could those hard and uncomfortable lecture seats. Brushing my teeth one morning before school, I spit into the sink and noticed little reddish-browning clumps of stuff -- which I assumed to be blood. Coughed-up blood only happens with lung cancer, and so as I drove to school that morning, I tried sorting out what I wanted to do in the remaining 5 years of my life, before the lung cancer killed me ... me, a 20-something-year-old non-smoker. It turns out the Oreos I ate the night before caused the discolored sputum. Finally, I was sure I had an abdominal aortic aneurysm (aka, AAA, where the aorta, the largest artery in your body, balloons out and pulsates throughout your abdomen) because I felt abdominal pulsations the night before ... after I had finished a strenous workout at the gym.

As if all these incorrect interpretations of normal bodily functions weren't causing enough misery and distress, I've been known to start worrying even if I feel too "fine". Many diseases start out completely asymptomatic, I argued in my head, so why couldn't I have one of those diseases? Aortic regurgitation, where one of the heart valves doesn't shut tightly, is one of these diseases, and thus feeling fine doesn't rule out me having AR. Again, it was a "coincidence" I was in the company of a heart specialist, who examined my heart with genuine efforts and told me I was fine.

The only thing that comforts me is the fact that some of the diseases I'm convinced I have usually coincide with the topics of our classroom lectures. I had Parkinson's disease during our Neuroscience unit, diabetes during our Endocrine unit, and my aortic regurgitation surfaced during a rotation in cardiac surgery where I saw AR patients on a daily basis. Everyday a trip to the classroom revealed some new ailment I could have. At the end of lecture, most students lined up for the professor to clarify a confusing point; I got in line to ask if I had the disease they just taught us.

I don't know when this will stop, but I hope it's soon. So do many others, including friends, family, and roommates. It's one thing when I obsess in my head; it's another when I harass people I know and ask what they think. They always reply, "How do I know, you're the one in med school." Medical school, right. What can I say? Med school --- it's my gift and my curse.

Tuesday, May 16, 2006

Grand Rounds 234

This week Grand Rounds is being hosted by Doc Around the Clock. Go take a look.

First Penis in Awhile

With ob/gyn (my final 3rd year rotation) done, I am now doing an elective research block with an advisor I've been working with for several years, conducting research in the field in which I hope to end up.

Today I had the opportunity to scrub into a surgical case where the patient was a man. He was put on the table, the staff started to prep him ... and then I noticed he had a penis! No, it wasn't that it was deformed or that it was big or small, just that he had one. That's it.

This would have been a non-issue for nearly anyone else, but you have to understand ... I hadn't seen a patient with a penis in a long time. After 6 weeks of being up to my neck in vagina -- diseased vaginas and ones with baby heads prodding through them -- it was refreshing to see a robe pulled off to reveal male parts.

Once this hit me, I was pretty excited ... in a non-homosexual way, if that's even possible given the fascination with which I've written.

-----

With Ob/Gyn done, I also suppose I'm in my 4th year now. Fourth year med student. MS4. One more year to go ... exciting, yeah?

Saturday, May 13, 2006

Super Nurses

What is up with the nurses that work on this floor? I ask because they eat -- a lot. Work isn't their job, but rather something to do to pass time between feedings. There is no simple breakfast and lunch ... but rather breakfast, mid-morning snack, late-morning snack, and then lunch, lunch #2, and lunch #3. Breakfast and lunch are what you would consider reasonable, while their "snacks" are bigger, heartier, and even fattier than the main courses. Lunch can be a burrito, but not to be outdone, the snack might be a bucket of KFC chicken, or a big styrofoam container of fried zucchini sticks, or a mound of thumb-sized french fries.

Obviously, the food has taken its toll on their bodies. When one takes in 4000+ calories per day but doesn't exercise, one should expect to grow; one should expect their fat cells to become happy; one should realize they are bigger than two.

And that's just the start. These nurses are so gigantic that they can no longer even walk by themselves. Seriously, no seriously. The rare occasions that one of these nurses needs to get up either to go to the bathroom or leave for the day, what I assumed was a normal chair magically turns into a modified wheelchair/walker that they depend upon to be mobile. They rest their weight on this thing, then push. Rest and push. It's a very slow process -- and an even more frustrating one to watch -- but I doubt they are in a rush.

It's really quite sad, but it's also beyond sad at this point. These nurses must believe that their obesity, like an advanced disease (many even argue it is a disease), is at a point beyond which any treatment can help ... and it's just a matter of palliative care. Why bother losing weight when you can eat all your favorite foods, and walk with this walker? (To make it clear, their situation is not beyond treatment; no amount of obesity is, and I hope they've been told this by someone. With motivation, even they can lose weight).

Final words: don't get near their food -- lest you get chewed out how the food brought in by the pharmaceutical rep is their food.

Wednesday, May 10, 2006

Grand Rounds 233

This week, Aetiology is hosting Grand Rounds.

Bye Bye Ob/Gyn

If I play my cards right, I may never see a uterus again. Today was the last day of my Ob/Gyn clerkship, and not a day too soon. Ob/Gyn felt like the longest rotation despite being 6 weeks like all others, and I never felt less interested in a specialty. I wasn't a fan of the patients, the residents, or the nature of their work. The moment the words uterus, vagina, or cervix were mentioned, my mind zoned out and all I heard was "blah blah blah blah" . . . until I heard "you can go home now."

With plans to go into medicine or surgery (yes, a pretty non-specific plan), I hope never to deal with girl parts again.

Tuesday, May 09, 2006

Abortion Clinic

As one of the requirements of this clerkship, I spent the morning in our hospital's abortion clinic, amusingly dubbed the "Reproduction Clinic", which is ironic considering it's more along the lines of an "anti-reproduction" clinic. We were given a quick tour of the "facilities" (a big clinic room with 3 chair/beds, separated by curtains) by one of the family planning fellows and then participated in several cases.

The process begins with a patient coming in desiring to terminate their pregancy; most of the pregnancies are in their first trimester. The patient is then counseled to ensure that she is certain of her decision, and once she is, she sets up an appointment in the near future.

One of the most interesting things was learning that patients don't need to provide a reason why they want to end their pregnancy. Initially this seemed odd, but after considering that certain reasons offered by patients might lead to ethically difficult situations, I realized this was the best approach.

On the morning of the big day, the patient arrives, is put on the table, examined, and given a mild sedative (usually a benzodiazepine). An ultrasound is then performed to establish the status of the pregnancy. One of our patients was unknowingly carrying twins, one of whom was already demised.

The termination itself is performed with a procedure known as a D&C, aka "dilation and curettage". Dilation refers to the enlarging of the cervix (the opening into the uterus); curettage is the scraping of the insides of the uterus with either a large syringe or vaccuum pump.

What occurred next was both the most fascinating and eerie part of the procedure. The products of conception (POC), meaning the pregnancy itself, was run through a strainer and then dumped onto a lighted surface. Then, like anthropologists trying to reconstruct an old fossil, all the tissue were examined in search of identifiable parts. In what initially looked like a soggy, watery mess of shredded red tissue paper, with some probing, little fetal parts were soon surfacing and being identified.

Watching this part of the procedure, while interesting because I felt like a crime scene investigator, was also slightly disturbing because the parts being separating out in front of us were the same ones that, just minutes earlier, were seen moving around inside the patient's uterus. It's saddening if you think about it too much. This wasn't a high school biology dissection, it was a tiny human being.

This might seem as if I'm siding with the pro-lifers, but I am most definitely not. I'm merely conceding that the procedure is one that undoubtedly carries much impact on the patient, and having participated in this clinic's activities made it even clearer why this is such a controversial topic across the country. With that said, I still hold that it's better to terminate a pregnancy than to carry it to term and provide the child with a sub-standard quality of life.