Tuesday, September 23, 2008

NarcolepZZzzzzz

Occasionally, as a med student I am sleep deprived. By occasionally I mean ah-lot. I try to look on the bright side of it: I never have trouble falling asleep once I'm actually in bed, and I like to pretend that I'm training to be a Masai warrior instead of just a doctor. Some of my best naps are in lectures where I zonk out for a good 10 minutes, then have to snap back to full battle-ready attention when the mumbling neurologist points his arthritic finger at me and demands and answer to his unintelligible question.


There is one odd side effect of being sleep deprived--every night, between 10 and 10:30pm, I lose my God-fearin' mind. They are actually called hypnagogic hallucinations. At night, usually when trying to have a serious and meaningful conversation with my fancy-A, my mind is so determined to fall asleep that it leaves the rest of me behind, weaving in and out of dreams, mixing consciousness with the utterly bizarre. You know how you have crazy dreams where one minute you're climbing a fireman's ladder in a tutu and the next you're running from vampires? Now imagine having the things you would say in such situations actually come out of your mouth during a real conversation. That's what he has to put up with.
Most people have experienced this--it's the name for when you're about to fall asleep and dream of falling or having something thrown at you, then jerk yourself awake.
I swear he baits me sometimes just to hear the ludicrous crap I say. When we were very first dating we were having a great conversation about life when I interrupted him to ask if the "physics demonstration is outside". Awesome. Last month he woke up to find me laying on top of him with my face veryveryclose to his creepily saying "I just want you to know how much I love you" before dropping my head and snoring slightly (hey, I have allergies). He said he laid there quietly for a while wondering if I was planning to stab him before he could go back to sleep. Just this weekend I hallucinated that there were ants on his neck. I don't think there were, but I sure slapped the hell out of him just in case. I thought I was still dreaming when I did that, but the red marks backed his side of the story.
"This time, let's read him a story about the Loch Ness Monster and see what he does!"
Little did I know, these hallucinations can actually be a feature of narcolepsy. So can things like hearing your name called just as you drift off to sleep, or hearing a bell ringing (these are auditory only hallucinations, and could be pretty scary if you didn't know what was going on).

Even though we know what's going on, I think my future hubby prefers when I fall asleep first. Just so he can defend himself.

Saturday, September 20, 2008

A Good Day Starts With a Scalpel



Let me make this clear: I like to cut. Any day in the clinic that gets a scalpel or scissors or or a magic wand that either freezes or burns is a day that makes me think about actually going into Family Practice.

I've had to learn a lot about what NOT to say in a clinic procedure: Things like "Oh, well, I've stitched on a pig's leg, but this is my first human stitch," or "Oh--wow--that's the grossest/coolest thing I've ever seen" or simply "OOoohhhhhhhh". Not everyone shares my enthusiasm for pus. Especially when it's coming out of their own arm.

The other day I got to play with an entire styrofoam cup full of liquid nitrogen. Seriously! I was on a wart hunt. I dabbed a sort of giant Q-tip into the cup and then squashed it onto the wart, holding it there until it was good and frozen. My rule of thumb was, when the patient started squealing about the pain, it was down to the viable tissue. That's terrible. I don't really do it like that. But I did get too close to a guy whose head I was freezing. I pulled back and realized the cup had been up against his hair, giving it a nice frosted look. I didn't say anything until it melted and I was sure no permanent harm had been done. I already had a slightly frozen spot on my forehead from bending too closely over the cup, so I figured we were even.

A weird little fact that most people don't know is that if you have an abscess where you can see pus, incision and drainage is the cure. So you should be happy that I'm coming at you wielding a scalpel. Also, unfortunately, when I stick your abscess with a needle and inject anesthetic before I cut, all the pus in the abscess raises the pH of the anesthetic, rendering it somewhat useless. Sorry 'bout that. I've noticed men don't take that nearly as well as women. But that's a story for another day.

Friday, September 19, 2008

Test Post

We're trying out some new colors!

Thursday, September 18, 2008

Drug Reps-The Real Dirty

Today, as in most days this month, during lunch I head to the break room and get lunch. I never know what is going to be there or how terrible for me it will be, but what I do know is that it is provided by pharm reps, and in order to eat lunch, I have to leave the party of nurses and techs eating peacefully in the break room and go face the music in the conference room.

It's not that I think pharm reps are bad people. But why would I go through 12 years of science and medical training to listen about a drug from someone with a history degree and two weeks of "intense" training on his or her particular drug? One rep pointed this out and said, "I would be insulted if I were you. To think that we could come in and influence you; you're too smart for that." I said if it didn't work I'd have to ask why she was still coming and pandering to my ego.


Is this sub-sandwich worth my soul?

I feel a little like a lunch slut for eating. Most doctors use it as social time amongst themselves, making a game out of how they can thwart the sales pitches or poke holes in the studies presented by, funded by, and of course, favorably showing their company's product.

Blah Blah blah even writing about them is mind-numbingly annoying. But now I'm hungry. Thank goodness there's an "informational dinner" tonight.

Monday, September 15, 2008

M is for Muscle strain

Monday, September 15, 2008

So kickball is no place for sissies. Or has-beens. And last night, I think I proved myself both. The second play of our second kickball game found the red ball of death screaming off the way-too-serious former soccer great's electric blue cleat and right at me. I exploded in a blur of agile athletic movement, years of honing my cat-like reflexes about to pay off as I leaped toward the ball.

Or so it played out in my head the split second before I strained my right quadriceps.

The phrase "muscle strain" is too tame for what happened in my leg. Muscle fibers that had spent years working out 5 days a week in cardio, agility, and strength training literally tore themselves apart in my right thigh simply because I asked it to move a little faster than usual, please. Fast movement was no longer an option; I wasn't sure any movement was at the time. The damn thing is still killing me. I didn't hear a pop, and I could still move my leg, so I figured it wasn't a complete tear. But wow did I find out how often you use your quads without knowing.

Shame is a good way to describe my feelings last night. My fancy-A had to carry me back to the car after I stupidly refused the umpire's golf-cart offer. Luckily I've had this rule since college that I only date men who can pick me up and carry me. Just a lap around the bar or party will do, and we're not going for romantic. Utilitarian still gets the job done. It sorted out the bad sports and the L7 weenies. I'm now marrying a guy who can carry me a good 100 ft without a break. I can't believe my luck.

Aside from my patients laughing at my limp, a cross between shriveled old man and purpose-filled soccer mom (I needed arm-swinging momentum), it's nice to work at a doctor's office. This afternoon I got stimulation, heat, and some ultrasound action. AAahhhh. Tomorrow I think I get a pain relief patch to slap on it. I hope they don't make me drool.

I learned a little lesson: warm up Warm Up WARM UP and stretch before any athletic maneuver, even one so seemingly innocent as kickball. And if you strain a muscle (and can still walk, if not go to the ER): rest, ice (not on bare skin of course, and only for 20 minutes at a time), NSAIDS (ibuprofen), slight compression, elevation, and for heaven's sake don't keep trying to play in a hopeless game. By then you have nothing to prove.

Thursday, September 11, 2008

Bend over, por favor.


Once a week I volunteer at a free clinic here in town. We take the poorest of the poor, no copay required.


Though I usually feel a little in the way as I am only a medical student, I do have a talent which occasionally proves useful--I have a faint grasp of the Spanish language. Enough, anyway, to serve the purpose of explaining hypertension, understanding that instead of what I said in Ingles, the interpreter just told a patient I'd like to practice a gyn exam before the real doctor came in (NO is the same in both languages, by the way), and once, to explain a digital rectal exam. Though to be honest, that was more a matter of hand gestures. It's not really something one learns in Conversation Spanish class.

Senor, mi uno necessito ir en su....ahem....

Anyway, I was tasked to get more history from a man brought to town by the local meat processing plant. His address was a motel, the usual one the plant puts its workers up in before they start work. The problem? His blood pressure was so high I'm surprised his eyeballs hadn't started to bug out. Almost enough to put him in the hospital right there. (>200 systolic or >100 diastolic).

From talking to the nurses who had been there awhile, and to the interpreter who clearly cared more about the patients than the providers, I learned that's generally par for the course. The plant brings workers, often with no English, often with no Social Security number, to their plant. Once they have them there, THEN they do a health screen for a work release. Fail the health screen? Oh, well, you can't work. That's it. No job, no home, no bus ticket back to where you came from. This clinic could give the man medication, and I could interpret that he had been controlled on drugs before. But what if we weren't there, and supported by public funds? Imagine the drain on the town's resources. Workers with no jobs brought into a town and dropped there. What happens when the motel kicks them out? What happens when their English isn't good enough, or their immigration status isn't legal enough to get a job? What happens when they are hungry?

High blood pressure blows. I'm sure I'll preach more about that later. But high blood pressure in a foreign place with no money, no job, and no language skills is a teensy bit worse. I wish I knew more about the meat processing company to stop it. For now, I just hand out HCTZ and hope it makes enough of a difference to get the man a job. And then, maybe we can work on his health.

Tuesday, September 9, 2008

Melanoma-Holy Moley!


We have a lady in the hospital with melanoma in her chest. Melanoma is a nasty nasty cancer. It looks tiny and unassuming, but LOOK OUT! If it sneaks itself into your skin beyond 1mm, it invites itself to the rest of your organs. And it doesn't even bring a bottle of wine.

Seeing as I am myself covered in nevi (medicalese for mole), I always find myself eyeballing each freckle for the ABCD's (you know: Asymmetry, borders (irregular?), color (even? splotchy?) and diameter). Nothing exciting yet, but I just like to let them know I'm watching. Kind of a mole-standoff, if you will. But without the compounds and FBI involvement.


Is today the day Mole?

For those of you with a willing significant other, spice up your date night and check each other!

Monday, September 8, 2008

Kickin' it old school


Last night the fancy-A and I played in our first kickball game. A whole league of grown-ups playing kickball on a real field with a real umpire! Unfortunately, we lost. Big time. There's a rule about having to have equal numbers of men and women, and we were short on the lady side. And apparently I have a lot to learn about the subtle art of kicking the crap out of a big rubbery ball.

Things I learned:

1. Kickballs give a satisfying thwap when they tag a runner trying to make it to home plate.
2. You can't throw kickballs from center field to home, no matter how well you can throw a softball.
3. Most of the fun in adult kickball leagues is derived from watching grown men and women (esp. engineers) run around, arms in the air, faces lit up with apprehension and anticipation, right up until the ball bounces of their chest.


My pal Kristin sent me this from Mexico. I think it's the perfect addition to my kickball uniform. Nothing like a little intimidation to get the game going.