Wednesday, June 30, 2010

Tomorrow, Life Is Over...

Or it begins. I suppose that's how I should look at it.

A short list of things I know or assume:

1. I'm telling myself someone will die tomorrow. I start in the ICU; it's a fair guess and maybe this way I won't freak out if it happens.

2. I'll probably feel like I'm drowning all day.

3. I'm pretty sure I'll see someone's ass. That's just the way it happens.

4. It's cruel that the department didn't think to give me access to patient charts until MIDNIGHT tonight....meaning I'll have to go in around 6 (or earlier depending on when I wake up) to get started.

5. Thank God I get to wear scrubs. I don't intend to look good this entire month.

6. I have a long coat!!! Finally, after years of that dorky short coat that made the word "Eager" come to mind whenever I saw someone wearing it. And I hate the word "Eager".

7. Even after a tour I STILL don't know where I'm supposed to go tomorrow.

8. I think I'm going to throw up.

Thursday, June 24, 2010

Another One Bites the Dust

I'm about to start residency. It is a mix of joy and nausea to be honest. Nice that I can finally answer the phone with "This is Doctor...." when telemarketers call ("I'm sorry, I can't talk about new siding, I need to go back to SAVE SOMEONE'S LIFE! ). Really nice that I'll finally FINALLY get paid. As one of my friends said, "It's your first real paycheck of your whole life!" I'm 26 years old. How sad is that?

I start out in the ICU however. I'm mentally preparing myself for the idea that someone's going to die every day. Then when it happens, maybe I'll remember that they were in the ICU because they were very sick, and 30 years ago they probably wouldn't have made it anyway.

Of course, if any of you are my patient, you should know that's not a treatment goal, that's a consolation so I don't go crazy when people smoke their last cigar on my watch.

I have to brush up on ACLS. It's the algorithm and protocol you follow when running a Code Blue. It involved drugs and electricity. On the surface, it is awesome. In practice, I should probably avoid caffeine and/or wear a diaper. Btw, some things that I find hilarious:

I kid you not, I am authorized to shoot you with this.

1. The advice old hands give to interns regarding Code Blue: "If they're in Code Blue, they're already dead anyway. All you can do is help; you certainly can't kill them twice."

(btw, far fewer people survive Code Blue than Grey's Anatomy let's on. It's not a 2-for-3 thing, it's more like a 1-in-4 thing. And even then they ain't always right. Could YOU go 30 minutes without a heartbeat or proper blood flow to your brain without being a little "off" when you came back? It's rare.)

"If this were Grey's, I'd be using my tongue."

2. Chest compressions are one hell of a workout. Especially triceps. And again, what you saw on that episode of Saved By the Bell where Zach and Slater do CPR on a homeless man that happens to be the father of Zach's new (also homeless) love interest who only eats apples for lunch is crap-ola. You don't just shrug your shoulders up and down while your hands happen to be on someone's sternum. It's as if Death himself were stuck under that ribcage and your hands are the only thing than can unlodge him.

3. In order to help the people doing the compressions to keep a correctly timed rhythm (ie a regular heart rate), there is a song you're told to sing in your head: Stayin' Alive by the BeeGees.
"Aren't we worth coming back for?"

4. Unfortunately, there is another song with the same rhythm: Another One Bites the Dust.

"Give it up and you could look like thissss YEAHHHHH!!!!"

Thursday, June 17, 2010

Did you say, "Caulk Gun?"

More adventures at Home Depot.

I needed to buy caulk and a gun to seal our screened-in porch so I of course went down the street to HD. The very friendly hippie behind the paint counter showed me to the section, and then helped me pick out caulk and a gun.

"It doesn't really matter which one you pick. They're all pretty much the same," he said. "You have no idea", I thought, as I picked up one resembled the Crap-o-matic we had to use last year for defecography. "Just write 'Surgical Grade' on the label and you got yourself...well, disgusted is what you got yourself."

He went on to describe how to use it, and as he mock squeezed the trigger I couldn't help but flashback to the poor lady who was up in the air with a bowel full of putty just as the x-ray camera went on the fritz.

"Oh, I know how to use it." Then my face turned very red and I snort/laughed while simultaneously trying to decide if I further explain why I knew it. I decided that it was a little too much for a Sunday evening, thanked him, and walked away with a huge grin on my face hoping he didn't think I was laughing at him.

Unfortunately, though I thought I knew what I was doing, caulking a seal requires a lot more finesse than caulking And there's the line.

Monday, June 14, 2010

All Bats Have Rabies.

I am a new homeowner.

It's pretty great, actually, especially considering that I've moved 12 times in the past 9 years. I no longer qualify as "transient/homeless" at free clinics (good thing since I'm the doctor), and I think for the first time in my life my checks, driver's license, billing and mailing address will all be the same...and current. Also, my parents took the opportunity to get rid of all evidence that I once lived in their house. If anybody wants a Ginger Spice barbie doll (New in the package!) or a collection of floppy disks, let me know.

Of course there are downsides to being a new homeowner. Well, let me put it this way. There are downsides, especially if the homeowners are a doctor and an engineer. One is a "can't see anything but the repairs necessary to make the house the most efficient structurally sound environmentally healthy protected against any future wear or problems "Preventative Maintenance" is my middle name" kinda guy, and the other is a "Maybe you need protective eyewear for this and full coveralls for that don't cut yourself and I will absolutely not go into the attic because it probably has bats and all bats have rabies" kinda gal.

There are many reasons I believe medical school has scarred me, but when it comes to bats, I am absolutely certain it has. Our house is old. It has a comical amount of insulation. We would save at least half the cost of insulation if we put it in ourselves, but I will not WILL NOT go into that attic.

During the first year of medical school the Infectious Disease docs get an open mic during a series of lectures on viruses, bacteria, and general pathogens. They use it to scare the bejeezus out of us. For one thing, I don't know if I've mentioned it before, but something is wrong with those ID folks. I don't suppose I could volunteer in an STD clinic every Tuesday night without coming out a little "off" either. One of them has made it his mission to mention the how the HPV test should be used on men as well, the punchline being "I'd call it a "Crap smear!" He then pauses for effect and looks at the students to make sure they aren't total idiots and understand his humor. After that he goes and takes a smoke break.

Another colleague gave a speech at our senior banquet last month. He took the opportunity to get buzzed and click through a powerpoint presentation made up entirely of drunken facebook pictures he'd apparently found by befriending the one person who takes all the stupid pictures in our class. While providing a running commentary ("Hello ladies!"). My husband, who I don't think really understood me when I'd tried to explain these people before, alternately laughed his ass off and asked me, "What does this guy do again?"

Anyway, I digress.

I don't remember which one it was, but one doc gave a speech on viruses that included the rabies virus. I still remember him saying "All bats have rabies," probably because he repeated it OVER AND OVER and finished the lecture (which had moved beyond the rabies virus) by repeating, "Get checked for STD's, and all bats have rabies." There might have even been audience participation: "What do all bats have?" "Rabies." "What do you do if someone has been in close proximity with a bat?" "Treat them like they have rabies."

In case you aren't familiar with the details of rabies, it travels up your nerves until it gets to your spinal cord, after which it travels everywhere your CNS goes. So everywhere. It then makes you bat-shit crazy and afraid of water. You are delirious and in pain. And then you die. The treatment is to get shot, but you have to have it before the virus reaches your spinal cord. If you get bitten on the toe you have a little longer than if you get bitten on the neck. Once you have symptoms, it is almost always fatal. 3 people survived in the 1970's, and one 15 year-old has "partially recovered" (their words, not mine) from a case in 2004.

These guys generally work at the Veteran's Hospital. They actually tell a story about an old veteran who DIED of rabies after being bitten by his "pet" bat. His family did not bring him to the hospital immediately because it was his "pet" bat.

I hope by now you understand why I asked my friends at Home Depot if they sell bat-proof coveralls. And I call them friends because by now the guys in Paint recognize my voice on the phone. As I explained to anybody willing to listen, I am not necessarily afraid of bats. I am afraid of the rabies virus. With good reason!

"I repeat, we are ready to move in; let's insulate this attic!"

Point being, I'm taking bids to insulate that attic.

Another thing you should know: Raccoons actually have the highest incidence of rabies. Yet another reason to hate those rat/bear trash-eaters.

Sunday, June 6, 2010

And How Many Drugs Have You Taken Today?

I try to leave work at work when I can. Though I fail miserably in inopportune places (I'm pretty sure I haven't gone an entire family dinner without saying something disgusting in 4 years), I don't go around shopping malls diagnosing people under my breath, "Parkinson's. Neurofibromatosis. Chronic alcoholic. Teenager."

Unfortunately, when I turn off my medical mind, I generally revert to the naive small-town idiot I am. Whereas in the hospital or office I don't trust anything, if someone I meet in a coffee shop tells me he's the prince of Nigeria, I won't give him any money, but I will probably go home and tell my husband about the nice man I met. This baffles him. "Al, our kid could smoke pot in the room next to you and you'd have no idea." How can you play "name that drug" in the hospital and not be able to smell the weed in a snowboard shop?

I do not know. Apparently it's an all or nothing switch. If I turn it on, I'll know that the shifty-eyed loon in the corner is on PCP, but I'll also tell the donut shop lady to have that mole on her neck checked out. Which, unless you then follow up by saying "I'm a doctor" (which will either make you look like a pompous ass or the Prince of Nigeria) is not socially acceptable. I'm finding out.

When I was on Family Medicine this April, we got some strange ducks. It was in an older low-income part of town, so even the attendings saw a lot of new faces (as opposed to the usual way clinics in teaching hospitals run, with the residents getting the patients with lackluster follow-up and the attendings having a relatively cush patient roster). I was always sent in first to scope out the situation and listen to the wandering complaint list. My job was to find 3 specific things the patient wanted out of that clinic visit.

One time I had a patient who looked like Diana Ross. Just as the 80's would have left her. I actually thought maybe I had found a rip in the universe and had time traveled back to the 80's by walking through the door. She had enormous hair, false eyelashes, gold eyeshadow, and a spandex/sequin outfit that would have made Freddie Mercury cry with Jealousy. Her eyes bugged out of her head. Not in a thyroid-problem way (I checked anyway), but like someone kept simultaneously pinching her and yelling "BOO". She would gaze off in the distance, but every once in a while decide to pay attention and freak out. Even once the attending got in there, anything we said what greeted with a "WHAT?" and that spooked expression. I couldn't figure out what drug she was on, or if she was mentally ill. I guess she had paranoia with a severe case of disco fever.

I don't know how else to describe it. Imagine if you had a Solid Gold dancer in your examining room and every time you said something as innoculous as, "sinus drainage" she acted like you'd just told her disco had been murdered. She was just bizzare.

I think if I'd seen her on the street, I would know something was not right. That's pretty hard to ignore.
"What do you mean, colonoscopy!?"