The first sentence of a certain unnamed ob/gyn review book is "Pregnancy is the state of having products of conception implanted normally or abnormally in the uterus or occasionally elsewhere."
I invite readers to submit their own first sentence of an ob/gyn review book. First prize is a massage at Spa Brownie.
Mine:
Pregnancy is a total trip.
Tuesday, October 28, 2008
Wednesday, October 8, 2008
Two ways to make an Ob patient cry
1. Tell her the sex of her baby. Today was the first time I had seen that moment, and I teared up, too. Labia are remarkably distinct in a 20-week fetus! The couple was there with their daughter and had expressed wanting a boy, for variety, but when they heard they were going to have another daughter, they still got so happy. She went from an amorphous "it" to their little girl. I have always liked the wait-and-see, surprise route, but this was clearly very special, too, a moment when she became more real to them.
2. Tell her that her low-ish levels of amniotic fluid could mean a) her bag is broken and she'll have to be hospitalized until she delivers, b) her placenta is pooping out, or c) she's not even listening anymore. I don't know, it was this crazy example of how we freak people out over probably nothing and why I understand a minimalist prenatal approach without lots of technology and tests. OK, so this woman has a little oligo, but suddenly we're discussing what she would do if she underwent fetal non-stress testing and discovered huge dips in heart rate, and oh no, we're hypothetically discovering this when the baby is 25 weeks, which is technically viable but they baby could have lifelong health problems. Seriously, this doctor was conjuring images of her being ambulanced to UCSF from Eureka and even said at once point, "Now I know you don't want your baby to die..." (That sounds worse out of context than it actually was, but still!) I was like, how did we get here? With these tests that tell you your risk of Down's syndrome is now 1 in 690 instead of 1 in 200. What does that even mean? Even though this patient wasn't even being evaluated for Down's risk, she somehow still had to assert, "I would keep this baby even if it had Down's!" I don't know, it was a very confusing visit for me. We feel like we have to prepare patients for the worst, but what ever happened to crossing bridges upon getting to them?
2. Tell her that her low-ish levels of amniotic fluid could mean a) her bag is broken and she'll have to be hospitalized until she delivers, b) her placenta is pooping out, or c) she's not even listening anymore. I don't know, it was this crazy example of how we freak people out over probably nothing and why I understand a minimalist prenatal approach without lots of technology and tests. OK, so this woman has a little oligo, but suddenly we're discussing what she would do if she underwent fetal non-stress testing and discovered huge dips in heart rate, and oh no, we're hypothetically discovering this when the baby is 25 weeks, which is technically viable but they baby could have lifelong health problems. Seriously, this doctor was conjuring images of her being ambulanced to UCSF from Eureka and even said at once point, "Now I know you don't want your baby to die..." (That sounds worse out of context than it actually was, but still!) I was like, how did we get here? With these tests that tell you your risk of Down's syndrome is now 1 in 690 instead of 1 in 200. What does that even mean? Even though this patient wasn't even being evaluated for Down's risk, she somehow still had to assert, "I would keep this baby even if it had Down's!" I don't know, it was a very confusing visit for me. We feel like we have to prepare patients for the worst, but what ever happened to crossing bridges upon getting to them?
Saturday, October 4, 2008
To be known
Sometimes I feel like the worst part of third year, worse than the long hours and being "beaten with the idiot stick," as Chunk puts it, is feeling awkward and intrusive and out of place nearly all the time. People not knowing what you are doing there and what they are supposed to do with you. Which was why I particularly loved my OHNS (that's the new way to say ENT) surgical team on Thursday. They were just like, "Hey! Great! Check it out! Here's what we're doing!" Same with a neurosurgeon on Monday. (Yes, I saw cerebellum.) Every day I appreciate how amazingly nice someone is to me.
But then there was a day when I saw two people who really know the real me and care about me on a deeper level, and it felt so good to see them that it made me sad to think about the superficial level I survive on normally when I'm here. I saw Dr. Jeff from the Health & Healing Clinic, and he looked at me like my doctor dad and made me laugh spontaneously and genuinely. Then as I was getting on the elevator with my medicine preceptor, my stream of trying-to-sound-like-I-belong BS was abruptly interrupted upon seeing Holly, my body/mindworker, of all people! It was so surprising, and she is so intense, I was kinda speechless and dumbfounded. Having her see me in this context, having her presence pierce this place, really threw me. And made me want to have some more sessions with her!
Anyway, this is all to say that our coworkers can be the nicest people and most generous teachers in the world -- and we can be grateful for them! -- but they will never substitute for our true support system. I think if I ever saw Scott or Mom or Chunk within these walls, it would have the same effect: a direct comparison, collision, invasion. Confronting the difference between how I feel around them and how I feel around everyone else here.
Then there are med school pals, the bridge. The name of this blog has been modified to placate one of them, that's how important she is.
But then there was a day when I saw two people who really know the real me and care about me on a deeper level, and it felt so good to see them that it made me sad to think about the superficial level I survive on normally when I'm here. I saw Dr. Jeff from the Health & Healing Clinic, and he looked at me like my doctor dad and made me laugh spontaneously and genuinely. Then as I was getting on the elevator with my medicine preceptor, my stream of trying-to-sound-like-I-belong BS was abruptly interrupted upon seeing Holly, my body/mindworker, of all people! It was so surprising, and she is so intense, I was kinda speechless and dumbfounded. Having her see me in this context, having her presence pierce this place, really threw me. And made me want to have some more sessions with her!
Anyway, this is all to say that our coworkers can be the nicest people and most generous teachers in the world -- and we can be grateful for them! -- but they will never substitute for our true support system. I think if I ever saw Scott or Mom or Chunk within these walls, it would have the same effect: a direct comparison, collision, invasion. Confronting the difference between how I feel around them and how I feel around everyone else here.
Then there are med school pals, the bridge. The name of this blog has been modified to placate one of them, that's how important she is.
Tuesday, September 23, 2008
Talk the talk
Some amazing words, lingo, and phrases from the world of medicine.
tismus: I think it means you can't open your jaw because of muscle weakness. I can't wait to rhyme it with Christmas!
defervesce: a beautiful word with a meaning you can kinda deduce... to experience abatement of fever. I just like its sonic kinship with effervesce. I can picture your fever bubbling away. Also defervescence.
phlegmon: I can already hear Scott saying, "I am PHLEGMON!" in his bad-guy superhero voice. "Solid mass formed by inflamed connective tissue, such as forms around an appendix in appendicitis."
When my psychiatry preceptor was explaining the "kindling" effect of manic episodes in bipolar disorder, he said, "The more you have, the more you have."
Today we heard about "marsupialization." You figure it has something to do with, maybe, a pouch? Indeed! "Surgical alteration of a cyst or similar enclosed cavity by making an incision and suturing the flaps to the adjacent tissue, creating a pouch." It works when a single draining of a cyst wouldn't last or wouldn't get all the material out.
Evidence of my indoctrination into this sociolinguistic culture is that I have finally stopped abbreviating "with" as "w/" and have adopted the medical "c" with a line over it. Without = "s" with a line over it. Sort of espanoly in a couple of ways: correlates with "con" and "sin," and the line is kinda like an accent. I resisted the switch, but now I'm into it.
tismus: I think it means you can't open your jaw because of muscle weakness. I can't wait to rhyme it with Christmas!
defervesce: a beautiful word with a meaning you can kinda deduce... to experience abatement of fever. I just like its sonic kinship with effervesce. I can picture your fever bubbling away. Also defervescence.
phlegmon: I can already hear Scott saying, "I am PHLEGMON!" in his bad-guy superhero voice. "Solid mass formed by inflamed connective tissue, such as forms around an appendix in appendicitis."
When my psychiatry preceptor was explaining the "kindling" effect of manic episodes in bipolar disorder, he said, "The more you have, the more you have."
Today we heard about "marsupialization." You figure it has something to do with, maybe, a pouch? Indeed! "Surgical alteration of a cyst or similar enclosed cavity by making an incision and suturing the flaps to the adjacent tissue, creating a pouch." It works when a single draining of a cyst wouldn't last or wouldn't get all the material out.
Evidence of my indoctrination into this sociolinguistic culture is that I have finally stopped abbreviating "with" as "w/" and have adopted the medical "c" with a line over it. Without = "s" with a line over it. Sort of espanoly in a couple of ways: correlates with "con" and "sin," and the line is kinda like an accent. I resisted the switch, but now I'm into it.
Sunday, September 14, 2008
Weekends are the new vacation
Nothing makes a girl appreciate days off like never having days off. Hello, gentle readers. It was all hospital all the time there for a few weeks. Strangely, the longest week of my working life flew by the fastest. Saturday thru Friday with two call nights in there, but somehow being that busy accelerates time. I realized that my anxiety builds when I'm idle, when I'm waiting, when I'm thinking about work. But actually being there, in motion, well, it's not so bad! My dream team also made the week a joy. I seriously could not have hoped for nicer, cooler, smarter people to work with. I do miss my "family," that end of camp feeling. But I'll see them around. Now returning to regular pisces life seems so low-key.
All I can really think about right now, though, is David Foster Wallace. Infinite Jest means something in my life, as so did its creator. I was staring at his signature in my book today, and my heart hurt. Sure, he didn't seem like the most stable man ever, too much of a genius and creativity for complete mental health, but this? Who will write about tennis? Who will write 80-page articles in Rolling Stone? I will miss you, you crazy footnoting pomo freak.
All I can really think about right now, though, is David Foster Wallace. Infinite Jest means something in my life, as so did its creator. I was staring at his signature in my book today, and my heart hurt. Sure, he didn't seem like the most stable man ever, too much of a genius and creativity for complete mental health, but this? Who will write about tennis? Who will write 80-page articles in Rolling Stone? I will miss you, you crazy footnoting pomo freak.
Monday, September 1, 2008
q4
Julia was right: It is fun to be on a team. We pisces fish are so solitary that it feels good to have a little hospital family. I'm the "youngest," so everyone looks out for me and makes sure I'm not getting in to trouble. My slightly older sister, the sub-i, will arrive tomorrow. Our fraternal twin sibs, the interns, look up to our big brother, the R2, who is our bridge to "dad," our attending. Of course, my "dad" isn't much older than I am... The twins somehow remain sweet and smiley despite living at the hospital. They do remember what it was like to be me. D said he would never mind staying an extra half hour at the end of the day to help me out, teach me, answer questions... and this from a guy who is actively sad to be away from his young daughter. And C said my four favorite words to me early and often: "You should go home." Whenever someone said, "We are on call tomorrow," I was like, "WE!" That word that says we are together, a group, a mini tribe, a unit, with connections between us, roles, give and take, help and be helped, community!
When D the intern writes orders, he starts them with "please" and ends with "Thanks!" So cute. I gave him a little bit of a hard time about it, and he was like, "I know, and the nurse who carries it out doesn't even see what I write, but it still feels wrong to just write a command."
Similarly, I was so impressed how everyone kindly addresses the pretty-much-unconscious ICU patients. They are unresponsive, tubes and cords everywhere, and people still say, "Hi, Ms. Quiroga, I'm going to take a look at your leg rash now, OK?" Strong work, team.
Of all the patients we have right now, I instantly gravitate towards the ones who have psych issues. Spinal cord infarct? OK OK, but how is he adjusting to the fact that he is paralyzed from the waist down? I'm all about the guy's drug abuse and suicidal ideation. (I remember when "SI" meant Sports Illustrated to me.) Fast-growing neck mass? But he had a major depressive episode 6 months ago! Even though I didn't have the breakthrough moment about my specialty this year, I still have the small joys of confirmation.
Sleep time. On call tomorrow.
And a happy belated birthday to Ali!! Sad I couldn't celebrate with you yesterday, my dear.
And safe travels to Chunk, who heads to LA and then onto his great Latin American adventure tomorrow. A much-deserved, long-awaited reward for too much work of the grindstone variety. Buen viaje! I will miss you!
When D the intern writes orders, he starts them with "please" and ends with "Thanks!" So cute. I gave him a little bit of a hard time about it, and he was like, "I know, and the nurse who carries it out doesn't even see what I write, but it still feels wrong to just write a command."
Similarly, I was so impressed how everyone kindly addresses the pretty-much-unconscious ICU patients. They are unresponsive, tubes and cords everywhere, and people still say, "Hi, Ms. Quiroga, I'm going to take a look at your leg rash now, OK?" Strong work, team.
Of all the patients we have right now, I instantly gravitate towards the ones who have psych issues. Spinal cord infarct? OK OK, but how is he adjusting to the fact that he is paralyzed from the waist down? I'm all about the guy's drug abuse and suicidal ideation. (I remember when "SI" meant Sports Illustrated to me.) Fast-growing neck mass? But he had a major depressive episode 6 months ago! Even though I didn't have the breakthrough moment about my specialty this year, I still have the small joys of confirmation.
Sleep time. On call tomorrow.
And a happy belated birthday to Ali!! Sad I couldn't celebrate with you yesterday, my dear.
And safe travels to Chunk, who heads to LA and then onto his great Latin American adventure tomorrow. A much-deserved, long-awaited reward for too much work of the grindstone variety. Buen viaje! I will miss you!
Saturday, August 16, 2008
Therapeutic stabbing
I just did my first arterial blood gas draw! It's the thing about firsts, about being a beginner at everything: I want to be able to do it, but I don't want to do it before I know I can. And I don't know, the ABG is so built up to be difficult and painful. I just watched a Hopkins episode where the third year couldn't get it drawn, and the patient was all pissed off. So that was looming in my mind as the needle was poised... Now it's demystified. But the attending was an awesome, understanding teacher, which makes such a big difference. I love that he threw me in there but saw it through with me. Insert sigh of relief here. I'm glad I didn't have any coffee beforehand a) so that I didn't shake more than I already was and b) now I'm totally awake. On to the rest of my morning.
Monday, August 11, 2008
The Internet
My first neuro clinic last week ruled. The appointments are an hour long! And I finally get to start researching part two of my screenplay, which involves a character with some type of dementia. My favorite patient was this Spanish-speaking man who started having auditory hallucinations after starting chemo for lymphoma. He refers to the voices he hears as "the Internet." Like he says, "The Internet gave me the nickname Pito Loco." Or when he wife says that she doesn't hear what he hears, he says, "You don't have the Internet." I must sound like I'm making fun of him, but truly, I just found him to be creative and good-humored. He used to work as a dental technician and apparently invented some device to help people stop snoring by moving their tongue out of the way. People's lives are so much more rich than you expect at first look.
I really respected his wife because he kept relating dreams he had about beautiful young women who were in love with him and kissed him and wanted to marry him. She seemed very clear that it was a disease talking, very patient. Maybe it privately upsets her, but they also seemed like a long-time couple who had been through it all
Then I felt a lot of compassion for a woman we saw with a rare condition called formication. That's forMication. As in formic acid. As in ants. As in the sensation that ants are crawling on/under one's skin. It is seen more commonly in, like, opiate withdrawal, but as a primary thing, it's not often seen. The sensation is somehow a biproduct of her progressing dementia, and she truly believes there are larvae that go in her pores. It was sad to see the fear in her, and how much it simply drives her nuts. She says it is the cause of her depression and that all she wants is a doctor who can cure her "bichos." Dr. K. thinks that Lexapro could help her. I think he convinced her to stop seeing a dermatologist, even though apparently we have like the world expert in formication in the derm division. Surprise surprise.
And I learned that the UCSF neuro department is The Place for Cruetzfeld-Jacob (prion disease like mad cow). Random.
I really respected his wife because he kept relating dreams he had about beautiful young women who were in love with him and kissed him and wanted to marry him. She seemed very clear that it was a disease talking, very patient. Maybe it privately upsets her, but they also seemed like a long-time couple who had been through it all
Then I felt a lot of compassion for a woman we saw with a rare condition called formication. That's forMication. As in formic acid. As in ants. As in the sensation that ants are crawling on/under one's skin. It is seen more commonly in, like, opiate withdrawal, but as a primary thing, it's not often seen. The sensation is somehow a biproduct of her progressing dementia, and she truly believes there are larvae that go in her pores. It was sad to see the fear in her, and how much it simply drives her nuts. She says it is the cause of her depression and that all she wants is a doctor who can cure her "bichos." Dr. K. thinks that Lexapro could help her. I think he convinced her to stop seeing a dermatologist, even though apparently we have like the world expert in formication in the derm division. Surprise surprise.
And I learned that the UCSF neuro department is The Place for Cruetzfeld-Jacob (prion disease like mad cow). Random.
Wednesday, July 30, 2008
And I'm back!
The big first of the day? First Pap smear! Firsts are so crazy. I guess our real first time wielding the speculum was on our amazing saint of a pelvic exam instructor, but this was the first person who wasn't getting paid to tolerate my clumsiness. But it was pretty smooth. Got in, got that swab, got out. The patients were all so kind and sweet today, totally letting me participate and wishing me genuine luck. Thanks, patients!
Anna was there at ob/fyn clinic today, too, and it was fun to work side by side, scribbling our notes. Colleagues!
This guy was teaching us about heart sounds a few weeks ago, and we were all talking about how in real life practice no one really listens to every spot they're supposed to in the right way. He was like, "Ever see someone only listen to 'the sweet spot'?" And we were like, what's the sweet spot? "Where you can hear breath sounds, bowel sounds, and heart sounds all in one spot." Ah, the things I find funny.
Quick, what do these abbreviations stand for?
AAA
SOB
PDA
If you said abdominal aortic aneurysm, shortness of breath, and patent ductus arteriosus, you are a huge dorky medical person. If you said American Automobile Association, son of a bitch, and public display of affection, you are a normal person.
One more for extra credit: VPL.
Anna was there at ob/fyn clinic today, too, and it was fun to work side by side, scribbling our notes. Colleagues!
This guy was teaching us about heart sounds a few weeks ago, and we were all talking about how in real life practice no one really listens to every spot they're supposed to in the right way. He was like, "Ever see someone only listen to 'the sweet spot'?" And we were like, what's the sweet spot? "Where you can hear breath sounds, bowel sounds, and heart sounds all in one spot." Ah, the things I find funny.
Quick, what do these abbreviations stand for?
AAA
SOB
PDA
If you said abdominal aortic aneurysm, shortness of breath, and patent ductus arteriosus, you are a huge dorky medical person. If you said American Automobile Association, son of a bitch, and public display of affection, you are a normal person.
One more for extra credit: VPL.
Friday, July 25, 2008
Things you did
Loaned me books. Entrusted me with your overachiever, priceless notecards. Handed over your high-yield drug sheets. Loaded path lectures onto an iPod for me. Let me borrow said iPod. Left me messages that said I didn't have to call back. Didn't leave me messages at all. Generally excused me from social life. Bought and cooked all of my food. Came out to test eve dinner with me on short notice. Massaged me. Quizzed me in all of your free time from medical school. Beamed me brain power from 35,000 feet. Invented, "All I need is my pastry and my Foucault!" to help me remember Glauche's lysosomal storage disease and its accumulation of glucocerebroside. Told me I am smart. Made me a Boddhisatva wooden trinket that brought me strength. Sent me thoughtful text messages. E-mailed me encouragement from Costa Rica. Remembered the big day even though you just had a baby. Taught me that CO2 = acid. Never judged me for failing. Told me I will be a good doctor. Assured me that I will pass this time right when I needed a pep talk. Wrote me a song. Had my back. Agreed that the test is the lamest thing ever and has nothing to do with doctoring. Told me to stop procrastinating. Said you are proud of me. Brought over inspirational teen sports movies. Sent me a sympathy card that may be the most hilarious piece of mail I've ever received, comedy out of tragedy. Sent me large quantities of fish oil and adrenal supplements.
I really felt your presence on the big day last Saturday. During my break before the last section, I was in the spacious handicap stall of the restroom, acting out how I was rounding the final bend of my race, and all of you were along the sideline chanting, "Brownie! Brownie!" and I got super fired up!!!!! I would also take breathing breaks between sections, focus on my heart, let my love for all of you and you for me fill it up, which I believe entrains brain and heart to promote intuition.
But don't worry, I didn't rely solely on intuition this time. I do think I did better, and I barely had to do better. Let's hope this obstacle is truly behind me now. We'll celebrate when the results come back in six weeks.
Thank you all. I couldn't do what I'm doing without you. This experience really put the "it is not so bad" concept to the test, but with people like you around me, nothing can really get me down. I feel insulated by love. Nobody's gonna breaka my stride.
I really felt your presence on the big day last Saturday. During my break before the last section, I was in the spacious handicap stall of the restroom, acting out how I was rounding the final bend of my race, and all of you were along the sideline chanting, "Brownie! Brownie!" and I got super fired up!!!!! I would also take breathing breaks between sections, focus on my heart, let my love for all of you and you for me fill it up, which I believe entrains brain and heart to promote intuition.
But don't worry, I didn't rely solely on intuition this time. I do think I did better, and I barely had to do better. Let's hope this obstacle is truly behind me now. We'll celebrate when the results come back in six weeks.
Thank you all. I couldn't do what I'm doing without you. This experience really put the "it is not so bad" concept to the test, but with people like you around me, nothing can really get me down. I feel insulated by love. Nobody's gonna breaka my stride.
Thursday, June 26, 2008
MIA
Hello gentle readers.
I've been a bit off-the-set lately. We're in "intersession" this week, which is boring besides getting to see all of my classmates and hear how things are going for them. People look tired. We've lost our dewy youthful look, for sure. But people also seem enlivened and engaged, on the whole.
I was inspired yesterday by our talk about providing healthcare to people with disabilities. I want to see this movie "The Sound and the Fury" that has nothing to do with Faulkner and everything to do with cochlear implants for congenitally deaf children. Apparently there are whole intentional communities of deaf people who consider these cochlear implants "a form of cultural genocide," according to our lecturer. Piqued my interest, for sure, in that it's amazing how strongly people identify with a group, and how disabilities can be a primary identity for certain individuals and groups. I also respected the opinion held by some people that there is no such thing as a disability because if the world were resource-rich and accommodating enough, functional limitations could be essentially eliminated.
My reduced posting will probably persist through July, as most of you know that I have the pleasure of revisiting Step 1 of the boards. I'm feeling good about it this time around. I've traded in my "this is a pointless waste-of-time exam" attitude for "I have to do this to realize my dreams." And having seen any patients with any diseases is helping me to care about the material, too. Anyway, as usual, I am deeply grateful for the massive amount of support I enjoy. The TWIGs have been so nice handing over their resources; special thanks to Nicole and Jade for putting the Goljan lectures on to an iPod for me -- what service! And they see my retake as an opportunity to have another done-with-boards celebration. Second time's the charm...
So I won't be in the clinic very much for the next month, but I may have some good stories from the OR and other scattered patient time. In the meantime, send me hardcore study vibes, and I'll resurface after July 25, just in time for Julie and Arturo to arrive.
I've been a bit off-the-set lately. We're in "intersession" this week, which is boring besides getting to see all of my classmates and hear how things are going for them. People look tired. We've lost our dewy youthful look, for sure. But people also seem enlivened and engaged, on the whole.
I was inspired yesterday by our talk about providing healthcare to people with disabilities. I want to see this movie "The Sound and the Fury" that has nothing to do with Faulkner and everything to do with cochlear implants for congenitally deaf children. Apparently there are whole intentional communities of deaf people who consider these cochlear implants "a form of cultural genocide," according to our lecturer. Piqued my interest, for sure, in that it's amazing how strongly people identify with a group, and how disabilities can be a primary identity for certain individuals and groups. I also respected the opinion held by some people that there is no such thing as a disability because if the world were resource-rich and accommodating enough, functional limitations could be essentially eliminated.
My reduced posting will probably persist through July, as most of you know that I have the pleasure of revisiting Step 1 of the boards. I'm feeling good about it this time around. I've traded in my "this is a pointless waste-of-time exam" attitude for "I have to do this to realize my dreams." And having seen any patients with any diseases is helping me to care about the material, too. Anyway, as usual, I am deeply grateful for the massive amount of support I enjoy. The TWIGs have been so nice handing over their resources; special thanks to Nicole and Jade for putting the Goljan lectures on to an iPod for me -- what service! And they see my retake as an opportunity to have another done-with-boards celebration. Second time's the charm...
So I won't be in the clinic very much for the next month, but I may have some good stories from the OR and other scattered patient time. In the meantime, send me hardcore study vibes, and I'll resurface after July 25, just in time for Julie and Arturo to arrive.
Wednesday, June 11, 2008
Fascinating medical fact of the day
At pisces school yesterday, our Ob/Gyn instructor told us that women have been known to conceive when they have one functional tube and one functional ovary on the other side. Meaning that the left ovary pops out an egg, it conceivably falls into the cul-de-sac behind the uterus, and the right tube sweeps down, like a Gumby salpinx, and picks it up. Amazing! I had no idea that tubes are so mobile. I have wondered why the fimbrae of the tube is not firmly attached to the ovary, why we would risk having the egg transverse any area open to outer pelvic space, but maybe this is why! I ran the idea past Papa at mom's birthday dinner, and he was nonplussed. He has totally heard of this and finds it totally plausible. Apparently there are chemotactic factors -- meaning chemicals that attract one thing to another -- that help the tube find the egg. I would really love to see that live, the tube craning over like one of those claw machines that picks up stuffed animal prizes at Chuck E. Cheese.
Speaking of gyn stuff, it was pretty inspiring to see my own uterus on ultrasound for the first time today. We were practicing on each other in the ER. The uterus is very tiny when one is not pregnant! (I was thinking of a potential short story or movie scene in which a medical student not unlike myself finds out she is pregnant in that situation.) I also saw my abdominal aorta, liver, and kidneys, though we couldn't find my gall bladder. Maybe I don't have one. It was surprisingly cool to see my insides. I mean, I know blood is pumping through my abdominal aorta, but seeing it on the screen, having it externalized, it's like a different kind of mirror. The PET/MRI scans I have seen make haunting portraits, too.
I have a 16-hour day tomorrow, so I'm off to sleep. Hugs to all!
Speaking of gyn stuff, it was pretty inspiring to see my own uterus on ultrasound for the first time today. We were practicing on each other in the ER. The uterus is very tiny when one is not pregnant! (I was thinking of a potential short story or movie scene in which a medical student not unlike myself finds out she is pregnant in that situation.) I also saw my abdominal aorta, liver, and kidneys, though we couldn't find my gall bladder. Maybe I don't have one. It was surprisingly cool to see my insides. I mean, I know blood is pumping through my abdominal aorta, but seeing it on the screen, having it externalized, it's like a different kind of mirror. The PET/MRI scans I have seen make haunting portraits, too.
I have a 16-hour day tomorrow, so I'm off to sleep. Hugs to all!
Thursday, June 5, 2008
Abdomivision
I'm so happy that I'm doing these long surgery shifts during these glorious long near-solstice days. It is already getting light at 5:30 a.m., and here I am in the twilight at almost 9 p.m. My sanity definitely benefits from the rays bookending my days. The birds are very active early morning, too, though my weird bustopmate tells me they will migrate away soon.
Today I was wowed by laparoscopy. This woman had abdominal pain that no one could diagnose, so we stuck a camera in there to take a direct look -- a crazy yet brilliant idea, general anesthesia aside. I saw the appendix for the first time, an innocuous little pinky of bowel. Gall bladder was just chillin', too. So then we turn our scope towards the land of gyn, and what do we see but an inflamed Fallopian tube. Scopes out, sew her up, give her antibiotics, voila.
I've now seen the underside of the diaphragm a few times, and you can clearly watch the heart beating against it from above, which is that typical surgical combination of amazing and spooky. The heart moves around more than I realized, displaces more space.
I am grateful for my Dansko clogs; my back would hurt a lot more without them. But dang, standing for so long is surprisingly hard. I feel like we should have some extra bones from the bottom of our ribcage to the top of our pelvis for structural support. The spine shouldn't have to do it alone.
Sending well wishes to my two surgical patients of the day. May you rest and heal.
Today I was wowed by laparoscopy. This woman had abdominal pain that no one could diagnose, so we stuck a camera in there to take a direct look -- a crazy yet brilliant idea, general anesthesia aside. I saw the appendix for the first time, an innocuous little pinky of bowel. Gall bladder was just chillin', too. So then we turn our scope towards the land of gyn, and what do we see but an inflamed Fallopian tube. Scopes out, sew her up, give her antibiotics, voila.
I've now seen the underside of the diaphragm a few times, and you can clearly watch the heart beating against it from above, which is that typical surgical combination of amazing and spooky. The heart moves around more than I realized, displaces more space.
I am grateful for my Dansko clogs; my back would hurt a lot more without them. But dang, standing for so long is surprisingly hard. I feel like we should have some extra bones from the bottom of our ribcage to the top of our pelvis for structural support. The spine shouldn't have to do it alone.
Sending well wishes to my two surgical patients of the day. May you rest and heal.
Monday, June 2, 2008
Tumors are people too
I'm inspired that people are able to look at their own bodies when they are deformed in some way. These skin grafts for melanoma are not pretty. A rectangle of skin is taken off of your thigh and put through some device that turns it into mesh skin and then slapped on the site where the cancer was resected. And then a ring of staples is put around it. Some of these wounds are 8 - 10 cm in diameter. I flat-out asked this woman today, "Is it strange to see your body look like that?" and she nodded and even smiled, maybe slightly fascinated instead of grossed out. It takes humility, a check of vanity, and a buttload of acceptance.
I was also inspired that even surgery residents are willing to change course. One of the guys is bailing out after year two because he doesn't like being in the OR. Good call, bro! I just like it when med students are willing to step off the track, "waste time," and do what will make them happy.
Nurses, medical assistants, and administrators are my favorite people in the world, my collective guardian angel. There's this "don't bug the doctors" current throughout healthcare, but I have to bug people because I'm clueless, so I bug the non-doctors. They help me generously and gracefully. I was wandering around the ORs today looking for a bonnet when a nurse pretty much tackled me with one before someone could scream at me for not having one on. Thanks, sista!
Speaking of those bouffant surgery head covering things. I saw this woman in the cafeteria the other day wearing one over her epic afro. It filled the volume of the hat precisely, this globe of hair frosted by blue chiffon. By far the best surgical fashion statement I have seen.
i stapled skin and removed staples from skin for the first time today. My neck turned very hot and red when I was removing them in front of a bunch of people. The second time I was removing them, the guy kept wincing/flinching away in pain, which was very unnerving. I hate hurting people!
This tumor they took out today was a gnarly little bastard. Big bastard, I should say. It was the size of like a mini football, larger than a mango, but like a redwood burl, all knobby and irregular and angry looking. These masses totally have a personality. They seem belligerent, maniacal.
Do we acknowledge that everyone must have PTSD to some degree after surgery? As soon as I start feeling like the time I spend on surgery is totally irrelevant to my interests and future practice, I remember that people are going to need some serious somatic work and plant spirit healing before after and during surgery. I start fantasizing about a world in which surgeons and the whole OR staff take a real "time out" before a procedure to set a healing intention for the patient, create a healing field of energy around her, express explicitly that the trauma they are going to inflict has its root in therapeutic intention. If I had another lifetime, i would spend it creating a different kind of medical school with its own hospital. An integrative education, for reals. Not sure I'm going to get around to it this time, though.
I was also inspired that even surgery residents are willing to change course. One of the guys is bailing out after year two because he doesn't like being in the OR. Good call, bro! I just like it when med students are willing to step off the track, "waste time," and do what will make them happy.
Nurses, medical assistants, and administrators are my favorite people in the world, my collective guardian angel. There's this "don't bug the doctors" current throughout healthcare, but I have to bug people because I'm clueless, so I bug the non-doctors. They help me generously and gracefully. I was wandering around the ORs today looking for a bonnet when a nurse pretty much tackled me with one before someone could scream at me for not having one on. Thanks, sista!
Speaking of those bouffant surgery head covering things. I saw this woman in the cafeteria the other day wearing one over her epic afro. It filled the volume of the hat precisely, this globe of hair frosted by blue chiffon. By far the best surgical fashion statement I have seen.
i stapled skin and removed staples from skin for the first time today. My neck turned very hot and red when I was removing them in front of a bunch of people. The second time I was removing them, the guy kept wincing/flinching away in pain, which was very unnerving. I hate hurting people!
This tumor they took out today was a gnarly little bastard. Big bastard, I should say. It was the size of like a mini football, larger than a mango, but like a redwood burl, all knobby and irregular and angry looking. These masses totally have a personality. They seem belligerent, maniacal.
Do we acknowledge that everyone must have PTSD to some degree after surgery? As soon as I start feeling like the time I spend on surgery is totally irrelevant to my interests and future practice, I remember that people are going to need some serious somatic work and plant spirit healing before after and during surgery. I start fantasizing about a world in which surgeons and the whole OR staff take a real "time out" before a procedure to set a healing intention for the patient, create a healing field of energy around her, express explicitly that the trauma they are going to inflict has its root in therapeutic intention. If I had another lifetime, i would spend it creating a different kind of medical school with its own hospital. An integrative education, for reals. Not sure I'm going to get around to it this time, though.
Wednesday, May 28, 2008
The singular of feces
I was told today on surgery service that the singular of feces is "fex," but I didn't really buy it, and now that I look in to it, Wiki is telling me that in Latin, faeces is the plural of faex (with the a and e stuck together in that weird letter) but that there is no singular in English, making "feces" a plurale tantum (more Latin), like scissors and pants. (Pants!) Also, "fex" is not in the Scrabble dictionary, though "fedex" is. That made me like the Scrabble dictionary less.
But what does all of this have to do with medical school and its not being so bad? Well, one question is whether I correct them on this fex issue. Surgeons are the correctors, not the correctees. Though this is not about to turn into an anti-surgeon rant. I really like the people I'm working with. They are surprisingly supportive even though I am a certifiable moronic waste of space. They still try to sell me on surgery a little bit even though I can't comprehend why they would want to encourage someone as dense as I seem to go anywhere near their profession. Before you all start saying, "I'm sure you're not being that stupid," check it. When asked where the tip of a PICC line sits, I answered... the stomach. That is amazingly fundamentally wrong. Instructively, my first instinctual impulse answer was the correct one: in the superior vena cava. Specifically the caval-atrial junction. But I talked myself out of this because I couldn't wrap my head around the fact that we feed people through these lines. We put TPN (total parenteral nutrition) into people's hearts? But yeah, we do. Many questions, I psych myself out of the right answer. I assume that I don't know. I'm hoping to move out of that mindset because a surprising amount of the time, I do know. But yeah, stomach. I may not live that one down.
I did my very first stitches on a real human today, sewing the incision made to remove a lipoma. It's not easy wielding that needle driver and the pickups, very awkward, like doing everything left-handed. Practice. But I appreciated being allowed to try. I thank the patient for her extra minutes under anesthesia for my learning. The pros did everything cosmetic, I promise!
Bowel is pretty amazing to touch and watch peristalsising. It's like an alive sausage casing. I had to put my whole hand in our patient's abdominal cavity today, and her organs were so warm! That surprised me, though it makes sense. Just an unexpected sensation. But I saw all those abdominal organs for the first time today: liver, spleen, gall bladder (very small), stomach, duodenum, pancreas. So much better than anatomy lab.
I'm suddenly overly tired. I'm sure I felt inspired and grateful today. I did. Zonk.
But what does all of this have to do with medical school and its not being so bad? Well, one question is whether I correct them on this fex issue. Surgeons are the correctors, not the correctees. Though this is not about to turn into an anti-surgeon rant. I really like the people I'm working with. They are surprisingly supportive even though I am a certifiable moronic waste of space. They still try to sell me on surgery a little bit even though I can't comprehend why they would want to encourage someone as dense as I seem to go anywhere near their profession. Before you all start saying, "I'm sure you're not being that stupid," check it. When asked where the tip of a PICC line sits, I answered... the stomach. That is amazingly fundamentally wrong. Instructively, my first instinctual impulse answer was the correct one: in the superior vena cava. Specifically the caval-atrial junction. But I talked myself out of this because I couldn't wrap my head around the fact that we feed people through these lines. We put TPN (total parenteral nutrition) into people's hearts? But yeah, we do. Many questions, I psych myself out of the right answer. I assume that I don't know. I'm hoping to move out of that mindset because a surprising amount of the time, I do know. But yeah, stomach. I may not live that one down.
I did my very first stitches on a real human today, sewing the incision made to remove a lipoma. It's not easy wielding that needle driver and the pickups, very awkward, like doing everything left-handed. Practice. But I appreciated being allowed to try. I thank the patient for her extra minutes under anesthesia for my learning. The pros did everything cosmetic, I promise!
Bowel is pretty amazing to touch and watch peristalsising. It's like an alive sausage casing. I had to put my whole hand in our patient's abdominal cavity today, and her organs were so warm! That surprised me, though it makes sense. Just an unexpected sensation. But I saw all those abdominal organs for the first time today: liver, spleen, gall bladder (very small), stomach, duodenum, pancreas. So much better than anatomy lab.
I'm suddenly overly tired. I'm sure I felt inspired and grateful today. I did. Zonk.
Saturday, May 24, 2008
Live from 15 Long
It's Friday night! I have definitely never woken up at 5 a.m. and still been awake at 1 a.m. -- and still goin'. I'm definitely starting to get loopy. The best analogy I've come up with is an intercontinental plane flight. Cooped up, needing to hydrate, wanting a backrub, and willing the hours to advance. But there are four women on the labor board, and one just delivered, so it will likely be an eventful night. I'm trying to space out my snacks.
The two deliveries I've seen today have been stark contrasts. This morning, she was having a very difficult labor, unmedicated for a while, pushing like crazy and making no progress, partially because the baby was "OP" (code for "occiput posterior," better known as "sunny side up"). When they tried to flip the baby over, they felt the pulsatile cord out through the cervix ahead of the baby = prolapsed cord = obstetric emergency = crash C section. One minute we're in the labor room chillin' with the doulas, the next, residents are scrubbed and she's getting sliced. The time from detection of the cord prolapse to delivery was probably 10 minutes, and let's not forget this is surgery, people. The doctor who detected the problem never took her hand out of the woman's vagina as she got wheeled into the OR on her bed; she kept feeling the cord to monitor the fetal heartbeat.
When it was over, I cried. In the work room, not the OR, but still, my first tears of the year and certainly not my last. My classmate Chris, the midwife Susan, and the intern Melissa were all so nice about it. It just happened so fast, and I still find surgery traumatic. I had to keep telling myself that mom and baby were happy and healthy. I did like that the chief resident said to her as the emergency wheels went into motion, "You're in a very safe place." It was true -- they can totally handle that situation -- but it felt very scary to me. I saw her and her baby this evening, and they seemed so relaxed and content, no one would ever guess things had been so crazy. So that's a good reminder: People, even littles, are resilient.
So then this last woman made it look easy. She had an epidural and pushed maybe five times and poof! Here's your little boy. Her stomach went back to totally flat like immediately. She barely tore at all. I swear she could walk out of here right now.
I can't wait to sleep all day and all night tomorrow sleep sleep sleep I love sleep!
The two deliveries I've seen today have been stark contrasts. This morning, she was having a very difficult labor, unmedicated for a while, pushing like crazy and making no progress, partially because the baby was "OP" (code for "occiput posterior," better known as "sunny side up"). When they tried to flip the baby over, they felt the pulsatile cord out through the cervix ahead of the baby = prolapsed cord = obstetric emergency = crash C section. One minute we're in the labor room chillin' with the doulas, the next, residents are scrubbed and she's getting sliced. The time from detection of the cord prolapse to delivery was probably 10 minutes, and let's not forget this is surgery, people. The doctor who detected the problem never took her hand out of the woman's vagina as she got wheeled into the OR on her bed; she kept feeling the cord to monitor the fetal heartbeat.
When it was over, I cried. In the work room, not the OR, but still, my first tears of the year and certainly not my last. My classmate Chris, the midwife Susan, and the intern Melissa were all so nice about it. It just happened so fast, and I still find surgery traumatic. I had to keep telling myself that mom and baby were happy and healthy. I did like that the chief resident said to her as the emergency wheels went into motion, "You're in a very safe place." It was true -- they can totally handle that situation -- but it felt very scary to me. I saw her and her baby this evening, and they seemed so relaxed and content, no one would ever guess things had been so crazy. So that's a good reminder: People, even littles, are resilient.
So then this last woman made it look easy. She had an epidural and pushed maybe five times and poof! Here's your little boy. Her stomach went back to totally flat like immediately. She barely tore at all. I swear she could walk out of here right now.
I can't wait to sleep all day and all night tomorrow sleep sleep sleep I love sleep!
Thursday, May 22, 2008
Brain dead
Today I am most inspired by the woman police officer in China who breastfed babies orphaned in the earthquake. I've been seeing women breastfeed their own babies on the ward, but it's another level to give of her body that way.
I'm super grateful that I'm working overnight Friday instead of Saturday so that I won't be a complete zombie for Scott's birthday on Sunday. A real stroke of scheduling luck. I wonder what it will be like to stay contained in that world for so long. I'll probably report from the trenches tomorrow night. I told Scott I feel like I'm going backpacking or something.
I am surprised by how big a Fallopian tube is. That egg really has some diameter to travel in. And the fimbrae are very cool structures, feathery fingers to sweep that ovum up. Surgery still really trips me out. It's amazing how little blood our patient lost during her tubal ligation, probably only like 30 mL.
It's dinner time.
I'm super grateful that I'm working overnight Friday instead of Saturday so that I won't be a complete zombie for Scott's birthday on Sunday. A real stroke of scheduling luck. I wonder what it will be like to stay contained in that world for so long. I'll probably report from the trenches tomorrow night. I told Scott I feel like I'm going backpacking or something.
I am surprised by how big a Fallopian tube is. That egg really has some diameter to travel in. And the fimbrae are very cool structures, feathery fingers to sweep that ovum up. Surgery still really trips me out. It's amazing how little blood our patient lost during her tubal ligation, probably only like 30 mL.
It's dinner time.
Wednesday, May 21, 2008
Welcome to life as humans on earth
I got to actually catch a baby today! Beautiful little MZ. It has surprised me how slowly they emerge, even when the head is already halfway out. Though people talk about them shooting out sometimes, so I guess I can't base everything on the whopping two vaginal deliveries I've seen. I felt sad about how long she was taken away from her parents to be weighed and footprinted and banded. Can't that stuff wait? Her first half hour in the world, and she's lying by herself. I wanted to zerbert her, but I don't think people would be cool with that.
The little C-sectioned munchkin born yesterday now has a name, and she's going to be my pediatric patient with Dr. Miller. I met her big brother today, too, just one year old. He's not so sure about her yet. They are a great family, very happy and open. I feel honored that I saw her enter this life and that I'll get to follow along her path this year.
I've changed my daily questions, by the way. People agree with me that "moved" and "inspired" are too similar, so I'm combining them and adding "gratitude." I feel grateful for a lot today, especially to Judith the midwife for involving me in the labor and allowing me to do things. Of course, it was the laboring woman who really allowed me, so deep thanks to her too. I'm also grateful for Anna in PISCES with me for support and understanding.
Amid the general inspiration of birth, a small detail from today sticks out. MZ's mini pinky finger is crooked in the same way as her dad's. His has been that way since birth. The moment he noticed it, he realized she really came from him, too. The dads get so marginalized during labor, important accessories but accessories. Their shared "flaw," against her perfect perfection -- it got him. (And me.)
The little C-sectioned munchkin born yesterday now has a name, and she's going to be my pediatric patient with Dr. Miller. I met her big brother today, too, just one year old. He's not so sure about her yet. They are a great family, very happy and open. I feel honored that I saw her enter this life and that I'll get to follow along her path this year.
I've changed my daily questions, by the way. People agree with me that "moved" and "inspired" are too similar, so I'm combining them and adding "gratitude." I feel grateful for a lot today, especially to Judith the midwife for involving me in the labor and allowing me to do things. Of course, it was the laboring woman who really allowed me, so deep thanks to her too. I'm also grateful for Anna in PISCES with me for support and understanding.
Amid the general inspiration of birth, a small detail from today sticks out. MZ's mini pinky finger is crooked in the same way as her dad's. His has been that way since birth. The moment he noticed it, he realized she really came from him, too. The dads get so marginalized during labor, important accessories but accessories. Their shared "flaw," against her perfect perfection -- it got him. (And me.)
Tuesday, May 20, 2008
Tale of two deliveries
Yep, watched two babies enter our crazy world today. One emerged the old-fashioned way, down the shoot of his momma's vagina. And the other was not, according to Shakespeare, technically "of woman born," but rather "ripp'd" from the womb in a C-section. 15 Long is one technologized labor and delivery floor, they kid us not. Every single laboring woman had an epidural and a pitosin drip. (Pitosin, affectionately known as "pit," is a synthetic version of our endogenous oxytocin, which drives contractions. Personally, I think nipple stimulation is a much more pleasant way to achieve a similar effect.) I was thinking a lot about what Stan Grof and many others write about the inherent trauma of birth, being expelled from safe, serene environs out into the cold bright air amid squeezing and pain... I could see that it might be therapeutic and powerful to reenact it later.
Anyway, I was surprised how shell-shocked I was after the C-section. During my first OR experience, the hysterectomy, I was nervous and amazed and kind of giddy after. But something about cutting down to the baby and having it whisked away, then touching the woman's uterus after it had been hoisted completely out of her abdomen , with the woman conscious on the other side of the drape all the while, somehow added up to an unsettled feeling. I felt sad that the mom had to stay to be sewn up as her baby went to the nursery. It's also crazy how fast time passes in the OR. It feels like half an hour, but it's two.
I was moved by the care one woman's family was giving her as she labored. When I met her earlier in the day, a guided imagery relaxation CD was playing -- nice! The room was all aromatherapized and shit. (Sorry, I've been watching too much of The Wire, and I start talking like that.) Her mom brought this big ol' mirror to hold up at the big moment so that the woman could see her baby being born. Unfortunately, that moment seemed far off when I left, though she had been pushing for close to six hours.
I was almost too stunned to feel the full awe-inspiring weight of the first vaginal delivery. It was beautiful that they flopped him right on his momma's chest when he came out, and the dad cut the cord. (The cord is weird, dude! Rubbery and kind of spiraled.) Even though we had to sew up the mom and deliver her placenta, she could have cared less. She was bleeding quite a bit still but completely immersed in her baby.
An amazing, overwhelming day. Getting up at 5 every morning hasn't been too bad, but it's only been two days.
A special shout-out to Julia tonight -- I hope she gets good solid peaceful sleep tonight, Boards Eve. I know down to my core that she will prevail.
Anyway, I was surprised how shell-shocked I was after the C-section. During my first OR experience, the hysterectomy, I was nervous and amazed and kind of giddy after. But something about cutting down to the baby and having it whisked away, then touching the woman's uterus after it had been hoisted completely out of her abdomen , with the woman conscious on the other side of the drape all the while, somehow added up to an unsettled feeling. I felt sad that the mom had to stay to be sewn up as her baby went to the nursery. It's also crazy how fast time passes in the OR. It feels like half an hour, but it's two.
I was moved by the care one woman's family was giving her as she labored. When I met her earlier in the day, a guided imagery relaxation CD was playing -- nice! The room was all aromatherapized and shit. (Sorry, I've been watching too much of The Wire, and I start talking like that.) Her mom brought this big ol' mirror to hold up at the big moment so that the woman could see her baby being born. Unfortunately, that moment seemed far off when I left, though she had been pushing for close to six hours.
I was almost too stunned to feel the full awe-inspiring weight of the first vaginal delivery. It was beautiful that they flopped him right on his momma's chest when he came out, and the dad cut the cord. (The cord is weird, dude! Rubbery and kind of spiraled.) Even though we had to sew up the mom and deliver her placenta, she could have cared less. She was bleeding quite a bit still but completely immersed in her baby.
An amazing, overwhelming day. Getting up at 5 every morning hasn't been too bad, but it's only been two days.
A special shout-out to Julia tonight -- I hope she gets good solid peaceful sleep tonight, Boards Eve. I know down to my core that she will prevail.
Monday, May 19, 2008
Labor of love
First day on Ob/Gyn inpatient, but no deliveries. It'll happen sometime this week, for sure. Probably the coolest thing I saw was a "version," where they medically relaxed the uterus and then flipped a breech baby around, by sheer brute force, I'm telling you. No one thought it was really going to work. We were all in the OR all ready to rock the C-section, but that mom is probably laboring away at the moment. It surprised us all.
I was inspired that a woman who lost custody of three children because of substance abuse was now having a fourth child after seven years sober. People really do turn their lives around.
I was moved, once again, by my classmate Chris's life story. He's on service with me this week, and the attending asked us both what we did before medical school. (Apparently, we both look our thirty-something ages.) Chris dropped out of high school at 16 to work and help support his family in Turlock. Yeeeeears later, after working mainly as an electrician, he went back to community college, on to UCSC, and now to UCSF. I can almost guarantee he is the only high school dropout currently on doctor track. He's even considering psych!
Gotta be up early, so it's closing in on bedtime for me here at 8:55. Woowee wild times!
I was inspired that a woman who lost custody of three children because of substance abuse was now having a fourth child after seven years sober. People really do turn their lives around.
I was moved, once again, by my classmate Chris's life story. He's on service with me this week, and the attending asked us both what we did before medical school. (Apparently, we both look our thirty-something ages.) Chris dropped out of high school at 16 to work and help support his family in Turlock. Yeeeeears later, after working mainly as an electrician, he went back to community college, on to UCSC, and now to UCSF. I can almost guarantee he is the only high school dropout currently on doctor track. He's even considering psych!
Gotta be up early, so it's closing in on bedtime for me here at 8:55. Woowee wild times!
Thursday, May 15, 2008
fragment
I was very surprised to essentially be tutored by Dr. West in the ER all day. My tuition was really worth every penny, a six-hour running education dialog, the most practical stuff, hand-feeding my brain tasty medical nugs. I dressed a neck abscess that grew out, guess who, MRSA! Our pal. The docs don't bat an eyelash; apparently the stuff is our dominant SF flora.
Also today, the 16-year-old Spanish speaking pregnant diabetic I was following found out that her fetus had "demised." (I'm sorry to call her by her age/language/disease, just trying to be HIPPA compliant.) Ay ay ay, poor sweetie. It was a strange combo of the practitioners feeling sort of, dare I say, relieved? And of course really empathizing with her.
Also today, the 16-year-old Spanish speaking pregnant diabetic I was following found out that her fetus had "demised." (I'm sorry to call her by her age/language/disease, just trying to be HIPPA compliant.) Ay ay ay, poor sweetie. It was a strange combo of the practitioners feeling sort of, dare I say, relieved? And of course really empathizing with her.
Wednesday, May 14, 2008
Hello goodbye
This is an entry where my writing seems inadequate, and I don't feel I'm doing anything close to justice to the topic. I wish I could work on this a lot before posting it. But I'll capture the immediate thoughts from my time at the Women's Options Clinic today.
I was moved to see fetal parts in the tissue from a 12-week-gestation abortion. I touched the spinal cord with my gloved finger. The leg looked like one of those milagro arms, if anyone knows what I'm talking about, but even smaller, shrinkydinked. I wanted to cry for a second, but I wasn't sad. I felt that Shiva energy, the shadow power, and it shook me like a rattle. Seeing the fetus completely dismembered put me in touch with the violent therapeutic force applied. But then seeing something so small, miniature, invokes a wanting to protect, that affinity for cute -- in a context of blood and gore. Since I obviously don't do the procedure, I held the woman's hand, and from now on I will also do an internal memorial for the spirit that slips out of this world before it enters it. If I worked in an abortion clinic, I would want to do some type of service for the fetuses, the way Jette's hospice group did for their patients who passed away, even though the idea somehow starts sounding like something anti-choicers would do, a theatrical mass funeral.
I also got in touch with the awe of embryos and fetuses in general, how one cell contains the knowledge to divide and organize itself into this perfect structure, create complex, perfect form from almost nothing. The depth of that wonder is one of those automatic mind blower, degrees of magnitude larger than our capacity to comprehend.
I deeply respect abortion providers in so many ways, one of which is their openness about feelings that are non-peachy. It inspires me that they acknowledge the grotesque aspect of the work, and that their belief in the necessity of providing the service is so strong it can outweigh the very real personal difficulty. Because right, seeing a miniscule thorax is disturbing, but the woman did not want to be a mother. I have asked Julia if I can be a psychiatrist and also be trained to do abortions, and though she thinks I might be the first to do so, it could maybe be arranged. And then we can take our biodiesel abortionmobile to all of the unserved NorCal counties.
It surprised me how hot it was when I walked out of the ER tonight. Heat wave!
I was moved to see fetal parts in the tissue from a 12-week-gestation abortion. I touched the spinal cord with my gloved finger. The leg looked like one of those milagro arms, if anyone knows what I'm talking about, but even smaller, shrinkydinked. I wanted to cry for a second, but I wasn't sad. I felt that Shiva energy, the shadow power, and it shook me like a rattle. Seeing the fetus completely dismembered put me in touch with the violent therapeutic force applied. But then seeing something so small, miniature, invokes a wanting to protect, that affinity for cute -- in a context of blood and gore. Since I obviously don't do the procedure, I held the woman's hand, and from now on I will also do an internal memorial for the spirit that slips out of this world before it enters it. If I worked in an abortion clinic, I would want to do some type of service for the fetuses, the way Jette's hospice group did for their patients who passed away, even though the idea somehow starts sounding like something anti-choicers would do, a theatrical mass funeral.
I also got in touch with the awe of embryos and fetuses in general, how one cell contains the knowledge to divide and organize itself into this perfect structure, create complex, perfect form from almost nothing. The depth of that wonder is one of those automatic mind blower, degrees of magnitude larger than our capacity to comprehend.
I deeply respect abortion providers in so many ways, one of which is their openness about feelings that are non-peachy. It inspires me that they acknowledge the grotesque aspect of the work, and that their belief in the necessity of providing the service is so strong it can outweigh the very real personal difficulty. Because right, seeing a miniscule thorax is disturbing, but the woman did not want to be a mother. I have asked Julia if I can be a psychiatrist and also be trained to do abortions, and though she thinks I might be the first to do so, it could maybe be arranged. And then we can take our biodiesel abortionmobile to all of the unserved NorCal counties.
It surprised me how hot it was when I walked out of the ER tonight. Heat wave!
Tuesday, May 13, 2008
General Hospital
My first evening of family medicine with Dr. Shore was low-key but still exciting. Dr. Shore is from the Healer's Art camp of docs, attending regular Finding Meaning in Medicine sessions at Dr. Remen's house and everything. I told him about this blog, and he pointed to the same three questions written on his chalkboard. I think it will be a great year together. Not to mention he is the adviser of all the PISCES advisers, along with being my adviser. Score.
I interviewed a Vietnamese-speaking patient using the video translation service, which worked surprisingly well. What a life saver! And great application of technology. My first abdominal pain patient, but definitely not my last.
I was inspired by the beautiful AIDS memorial garden outside of building 80 at SF General. Roses, poppies, borage, smells and colors. I was moved by Dr. Shore's ease discussing the emotional side of medicine and medical training, and how he valued my input on that topic. I was also moved when we went to see one of his patients in the hospital how relieved and happy the man was to see a familiar, caring face. I was surprised by how much the hospital/clinic resembles a prison. Security guards, bullet-proof plastic, concrete. Unfortunately necessary, I guess. I was also surprised to hear that the San Francisco Health Plan is being challenged in court by small businesses.
I interviewed a Vietnamese-speaking patient using the video translation service, which worked surprisingly well. What a life saver! And great application of technology. My first abdominal pain patient, but definitely not my last.
I was inspired by the beautiful AIDS memorial garden outside of building 80 at SF General. Roses, poppies, borage, smells and colors. I was moved by Dr. Shore's ease discussing the emotional side of medicine and medical training, and how he valued my input on that topic. I was also moved when we went to see one of his patients in the hospital how relieved and happy the man was to see a familiar, caring face. I was surprised by how much the hospital/clinic resembles a prison. Security guards, bullet-proof plastic, concrete. Unfortunately necessary, I guess. I was also surprised to hear that the San Francisco Health Plan is being challenged in court by small businesses.
Thursday, May 8, 2008
Thank goodness I partied in Mexico for a while
Seriously, how could I have known that goofing off, barely working, and having fun would help me so much in my career? Today, once again, was all about hablaring. My newest patient is a 16-year-old diabetic girl from Ukiah who is 9 weeks pregnant and speaks only Spanish. I was inspired to see her baby's heartbeat on the ultrasound -- sure a cheesy moment to pick from the day, but that was my first live US ever, and it really is amazing. I was there for her first pelvic exam, poor sweetie, and she was very brave. They were so overwhelmed by information and scared about possible complications. The docs don't seem very confident in her, but I think she's going to step up.
In other teen news, I was moved by two sisters at peds clinic this morning who were the antithesis of the adolescent reputation, being conscientious, responsible, and receptive to adult input. And man, Dr. Miller really is a pro with the kiddos, firm yet friendly. She's had so many of her patients since birth; I remember from my interview day how her office walls are plastered with patient photos. Amazingly, she didn't make me wear my white coat today! After all our battles over that issue... It was cool to finally see her in clinical action. I swear they should really integrate clinical work into all four years of medical school; we had just token experiences, but it is so much better to have context! Not that I'm the first to say it. I heard that there are PISCES-esque models being developed that span the whole education. Hallelujah.
Hm, what surprised me... Surprised how freaking windy it gets on this hill. And by how thoroughly bored I am by epidemiological lectures and their graphs. I hate graphs. Boiling the complexity of life into a line. I was thinking that about EKGs, too, how the heart is so nonlinear, yet we make it spit out this single line. To be fair, we derive a lot of information from that line. Blathering today! What surprised me is supposed to be something more positive, but you know, I was talking to Ali today, and I think it can be just as unhealthy to be unduly positive about things that actually suck. Parts of this year will be crappy, and I don't have to dress it up with unflagging optimism. I've spent a lot of the last two weeks thinking about all the careers I should have pursued instead...
Especially because I didn't have as much fun at psych clinic yesterday as I had hoped. The offices are shoeboxes with bad paint, carpet, and wall treatments. And it's so about meds. The gratification of this path is just SO AMAZINGLY DELAYED, it pains me. The day that I'm really presenting at the psychedelic conference in Basel about MDMA and PTSD or doing dialectical behavior therapy (and/orthobionomy) with my borderline patients or tending my medicinal herbal garden in far NorCal is so amazingly far away. In the meantime, I have to do small amounts of what truly makes me happy and sustains me, as much as I can. This is a low point in many ways: the work so much harder and more time intensive, the goal not much closer. But getting closer every day, I guess.
In other teen news, I was moved by two sisters at peds clinic this morning who were the antithesis of the adolescent reputation, being conscientious, responsible, and receptive to adult input. And man, Dr. Miller really is a pro with the kiddos, firm yet friendly. She's had so many of her patients since birth; I remember from my interview day how her office walls are plastered with patient photos. Amazingly, she didn't make me wear my white coat today! After all our battles over that issue... It was cool to finally see her in clinical action. I swear they should really integrate clinical work into all four years of medical school; we had just token experiences, but it is so much better to have context! Not that I'm the first to say it. I heard that there are PISCES-esque models being developed that span the whole education. Hallelujah.
Hm, what surprised me... Surprised how freaking windy it gets on this hill. And by how thoroughly bored I am by epidemiological lectures and their graphs. I hate graphs. Boiling the complexity of life into a line. I was thinking that about EKGs, too, how the heart is so nonlinear, yet we make it spit out this single line. To be fair, we derive a lot of information from that line. Blathering today! What surprised me is supposed to be something more positive, but you know, I was talking to Ali today, and I think it can be just as unhealthy to be unduly positive about things that actually suck. Parts of this year will be crappy, and I don't have to dress it up with unflagging optimism. I've spent a lot of the last two weeks thinking about all the careers I should have pursued instead...
Especially because I didn't have as much fun at psych clinic yesterday as I had hoped. The offices are shoeboxes with bad paint, carpet, and wall treatments. And it's so about meds. The gratification of this path is just SO AMAZINGLY DELAYED, it pains me. The day that I'm really presenting at the psychedelic conference in Basel about MDMA and PTSD or doing dialectical behavior therapy (and/orthobionomy) with my borderline patients or tending my medicinal herbal garden in far NorCal is so amazingly far away. In the meantime, I have to do small amounts of what truly makes me happy and sustains me, as much as I can. This is a low point in many ways: the work so much harder and more time intensive, the goal not much closer. But getting closer every day, I guess.
Monday, May 5, 2008
MTF isn't "male to female" in the ED
It's "metabolize to freedom," meaning let the excessively inebriated sleep it off.
Day 1 in emergency was as expected: action packed. The early morning included some unexpected learning about mathematical functions and linguistic theory from some cuckoo-headed attending, attempting to penetrate my "false consciousness" and convince me that all medical records should be written accordingn to a strict template. I picked up my first Spanish-speaking patient, a beautiful 84-year-old woman from El Salvador. Say a few words in semi-competent espanol, and people are your new best friends, I swear.
I was surprised to hear "Dr. Brown to the clerks desk" on the overhead paging system and suddenly realizing they were talking to me. (Of course, it was because I hadn't written down which leg I wanted them to x-ray. Riiiiiiiiight.)
I was moved by a little boy I met whose dad was being treated. The kid had spent the first year of his life hospitalized at Parnassus for hypoplastic left heart syndrome. (He was born essentially without half of his heart.) Couldn't tell to look at him today.
I'm not sure I was inspired today. Maybe, to repeat, by the magic that happens when a provider can speak the language of the patient.
Day 1 in emergency was as expected: action packed. The early morning included some unexpected learning about mathematical functions and linguistic theory from some cuckoo-headed attending, attempting to penetrate my "false consciousness" and convince me that all medical records should be written accordingn to a strict template. I picked up my first Spanish-speaking patient, a beautiful 84-year-old woman from El Salvador. Say a few words in semi-competent espanol, and people are your new best friends, I swear.
I was surprised to hear "Dr. Brown to the clerks desk" on the overhead paging system and suddenly realizing they were talking to me. (Of course, it was because I hadn't written down which leg I wanted them to x-ray. Riiiiiiiiight.)
I was moved by a little boy I met whose dad was being treated. The kid had spent the first year of his life hospitalized at Parnassus for hypoplastic left heart syndrome. (He was born essentially without half of his heart.) Couldn't tell to look at him today.
I'm not sure I was inspired today. Maybe, to repeat, by the magic that happens when a provider can speak the language of the patient.
Friday, May 2, 2008
Narrative medicine
Today I met my medicine preceptor, and he reminded me why I love Brits: They are infused with literary-ness and see the stories in life. He's one of those clinicians who think you can diagnose pretty much everything by observing the patient and taking a detailed history, a philosophy I share. He wants my presentations to him to be narrative and engaging. "We're called attendings because we have a short attention span."
My other favorite quote of his was, "All my patients get better sugars in Hawaii." Meaning their diabetes somehow miraculously gets better when they're relaxing and swimming in the ocean. The vacation treatment, love it.
Today I was surprised to see a clinician actually take a blood pressure by palpation before doing it by auscultation. Miraculous.
I was moved by a five-year-old dumpling of a boy named Vincent who came to his dad's appointment and proclaimed, "He smokes even though I tell him not to."
I was inspired to hear that Dr. Masharani endorses fish oil. (But Kristin, he sends people to Trader Joe's for it. I gotta get him on Minami.) He also is researching chromium and alpha-lipoic acid in diabetes treatment. Go go complementary and alternative medicine!
My other favorite quote of his was, "All my patients get better sugars in Hawaii." Meaning their diabetes somehow miraculously gets better when they're relaxing and swimming in the ocean. The vacation treatment, love it.
Today I was surprised to see a clinician actually take a blood pressure by palpation before doing it by auscultation. Miraculous.
I was moved by a five-year-old dumpling of a boy named Vincent who came to his dad's appointment and proclaimed, "He smokes even though I tell him not to."
I was inspired to hear that Dr. Masharani endorses fish oil. (But Kristin, he sends people to Trader Joe's for it. I gotta get him on Minami.) He also is researching chromium and alpha-lipoic acid in diabetes treatment. Go go complementary and alternative medicine!
Thursday, May 1, 2008
I have patients!
In PISCES, we recruit a panel of patients that we follow throughout the year, and I landed my first two today! Both are wonderful women and very complicated medical cases, pregnancy + diabetes + other chronic diseases. I could spend all weekend reading about them.
I felt a "transverse" fetus in his/her mother's uterus today. (The little bug is sideways in there.) I was surprised that I could distinguish the head from the booty.
I was also surprised that I have been able to get up at 5:30 two whole days in a row.
I was moved by how responsibly many of the diabetic patients keep track of their meals, carbs, and sugar readings. I can't even record my spending for half a day.
I was inspired that the dietician at this clinic had written a user-friendly, comprehensive book about diabetes management through nutrition and exercise. Nice! Diabetes Type 2: Complete Food Management Program
I felt a "transverse" fetus in his/her mother's uterus today. (The little bug is sideways in there.) I was surprised that I could distinguish the head from the booty.
I was also surprised that I have been able to get up at 5:30 two whole days in a row.
I was moved by how responsibly many of the diabetic patients keep track of their meals, carbs, and sugar readings. I can't even record my spending for half a day.
I was inspired that the dietician at this clinic had written a user-friendly, comprehensive book about diabetes management through nutrition and exercise. Nice! Diabetes Type 2: Complete Food Management Program
Wednesday, April 30, 2008
"Mesosalpinx" has always been my favorite medical word
And today I got to see it! (The mesosalpinx is part of the broad ligament between the uterus and ovary.) Oh yes, scrubbed in on a total abdominal hysterectomy today, my first surgery ever! And right now, I can't imagine ever being jaded about surgery, though everyone seems to get that way. I tried to hold good energy for our patient, a very kind woman with a seductive London accent, as her body was open to the outside world and her consciousness was... well, I don't know where one's consciousness goes during general anaesthesia. Anyway, I held retractors and cut sutures and felt totally alert even though I had barely eaten or slept.
During another procedure, I got to "run the specimen down to pathology." Mind you, the following story is told by someone who has historically hated path. But when the surgeons found bizarre tissue in our patient's uterus and needed to know if it was cancerous, I flew downstairs with a bloody blob, saw it frozen, sectioned, and stained, and then looked at it on the cool double-headed microscope with the pathologist. It was my patient's very cells! And the results really mattered! (It wasn't cancerous. Not that I could tell.)
I was surprised by many things today, but almost most by a guy who suddenly appeared in the preop hallway playing acoustic guitar and harmonica.
I was inspired to be operating with three women and a woman anaesthesiologist.
I was moved by our beautiful British patient, who was in for her eighth surgery, with a bilateral masectomy in there somewhere, in not very much time. She was brave and composed.
Monday, April 28, 2008
The first day of the rest of my life
I saw patients on my own for the first time ever! It was a great half day at the Screening and Acute Care Clinic with an amazing attending -- he packed as much teaching as he could into every moment of our four hours together. Thanks, bro!
I was surprised by how open people were with me and how mellow they were about being seen by a student.
I was inspired by my preceptor's enthusiasm for teaching, and I appreciated his kindness in the face of my cluelessness.
I was moved by the fear that an undiagnosed health problem can cause someone, and the relief they feel to get an answer.
Sunday, April 27, 2008
The three questions
Third year starts tomorrow, and I'm working hard to keep my nervousness (dread?) in check.
What inspired me today?
What surprised me today?
What moved me today?
I hope it helps my friends and family keep tabs on me even though I might be less available for a while.
Special thanks to my support system this eve.
Subscribe to:
Posts (Atom)