Saturday, January 30, 2010

Falling off a cliff-the fun way.

As part of the Disaster Medicine course, we also got to haul ourselves up and down a nearly sheer rock face. You know, in case someone's life depended on it.

I say that only half-jokingly, because we actually trained with Albuquerque Mountain Rescue (they even had the shirts!), who, several times a year, actually do have to go get someone off the mountains surrounding the city. My personal favorite: A man and his girlfriend were hiking together when they were separated. Why? That was left out of the story but I imagine it's a good one. Man hikes off, leaves Girlfriend, who was probably only out there because Man dragged her out with promises of outbacky-togetherness and desert-bonding. At least, that's my guess because while Man made it safely to the car, Girlfriend got herself lost and panicked. I'm guessing he made it out with the map. And I'm guessing that's the last time she got herself talked into an innocent dayhike.

So yes, sometimes you have to clip in and climb. I hadn't rappelled since high school, several injuries ago and before my frontal cortex was fully developed. Now that I understood consequences a wee bit better, I was less the "fearless" Al and more the "You go ahead and do it first so I know it will support my weight" Al. Sometimes starting is the hardest. You have to back over a cliff, and with one setup, you had to do that clipped to a fixed rope before you got to the rappelling one. I'm not really afraid of heights, but I have a good healthy fear of scratching my pretty face on the cliff wall that is one misstep away. Yeah I'm married, but still.

Anyway, we practiced going up and down for a bit, which was fun. Then we had to practice putting a patient in a basket and lowering him down. Quite honestly, I was really over it by then, and I sure as hell wasn't going in the basket. Luckily, two guys on the squad and a very hardcore girl/woman were all about going over the edge. Unfortunately for everyone involved, the heaviest guy there that day volunteered to be the dummy in the basket. I have made my feelings on hanging out with people who can't carry me very clear. I guess this guy wasn't so discerning.

They finally get him over the edge with no small amount of scary near-tipping (yes, he's strapped in, but seriously. He was totally helpless in that basket, and they had crazy looks in their eyes). They were about halfway down when I hear, "Ashley wants to practice putting an IV in the patient". WHAT? Having recently had an IV myself, I knew that hanging off the side of a bluff was the last place I would want someone to attempt an IV. Then I heard someone else say she was a second year medical student. What a dumbass. Both her and the guy who agreed to let her try.

In a surprise turn of events, she failed miserably at her three attempts. This wouldn't have drawn so much ire from my colleagues and I at the top of the bluff if we hadn't been left to hold the belay ropes the whole time. We'd been on them for a good twenty minutes supporting four people's weight. We started to yell about how Evan's arms were turning purple and how we'd all had to wrap the ropes several times around ourselves, but Miss Action Adventure wanted "just one more try!" to do what she was going to learn next year with all the other medical students. Gunner.











In the end, the fact that we didn't have enough people to properly do the drill and it had gone so frustratingly off course is pretty typical for training...and I suspect sometimes rescues. Not to mention some of the people who are drawn to that field are the same ones who don't think twice about attempting to stick an unnecessary blood-drawing needle into a perfectly healthy someone's veins while swinging 25 feet off the ground. Which is maybe why I belong in the radiology department.

Thursday, January 28, 2010

Elbow deep in Pelvii

The party is about to stop.

Monday I start a gynecological surgery rotation. I have no idea how things are going to go down, but what I do know is that I have no intention of being in the OR when the nurses and techs prep the patient. At this point, I don't care if I whether or not I can put in a Foley catheter on the first try. And I'm not going to let the nurses goad me into either. Let the people getting paid wrestle their way down to an obese woman's urethra. I'll send them a nice card.

The good thing about the particular flavor of surgery I'm doing is that it's the only one that I can do off my medical school's main campus, and therefore away from the University Hospital and it's coven of evil lady surgeons. Now that I don't give two toots about grades and am *cross your fingers* almost matched to an entirely unrelated specialty in a city where I won't have to see them again, I don't think it would be quite the anxiety inducing experience it was a mere 12 months ago. But who wants to take chances this late in medical school? I was just at the dentist the other day, and we reminisced about how at the end of that rotations my gums bled at the slightest provocation. Like, opening my mouth. Fortunately for me, I didn't open my mouth much near then end of those two months for fear of getting "Work on professional demeanor" on my review again.

So anyway, what I really want out of this rotation is a. To remember internal female anatomy (I think I have the external stuff figured out) and b. To sew some crap together. I've been substituting my sewing machine, Fancy, for my love of all things suturing, but sewing placemats and tea towels ain't no substitute for making the edges of an incision come together as if they were never scalpeled and stretched so you could get at someone's innards. Ahhhhh.

Well on that note, gotta finish dinner.

Thursday, January 21, 2010

Disco Thursday

I've told some embarrassing stories that make patients look like idiots. It's probably time to tell one where I'm the a$$hole.

The other day I was in my doctor's office for my own annual women's exam. Which already put me in a great mood. Then the nurse mentioned one of my least favorite phrases, "There's a student with Dr. Poke'n'Prod today, do you mind if he comes in?" Yes, yes I do. I understand that I was in his position, waiting outside the door trying to make the time pass more quickly by reading all the STD posters in the office. But I also understand that the reason I go to another town to have this done is so that I don't meet one of my future co-residents business end first. I don't even want them in the clinic the day I'm there. Even if they don't see me, they read the name and reason for visit. And probably talk about it with the doctor after she's done. That's how I know a student in the class above me had an inguinal hernia. Just saying.

I used to be more open to the idea. When I was in college and knew I'd never meet those people again. My very first women's exam, for example. I had to go to the student health center just down the street from my dorm. I had taken a couple of Vicodin that I had leftover from a surgery. What the hell? I wasn't driving a vehicle, and I figured it was the best use for the stuff.

There was a female medical student with the doctor that day, and like I said I'd taken painkillers, so when the nurse asked I said "Sure." Then came the exam. It was my first time so I didn't know what was really supposed to happen. I figured they were quiet because she was pointing things out. Which is still weird to think about. Then the doctor asked in a puzzled voice, "Did you know you have sparkles on your...?"

I should interject with a backstory. My idiot friends and I were into themed days. We'd declare a catchy name ("Topless Tuesday"), wear or do something related to the theme, and giggle together over our hilariousity. That day happened to be Disco Thursday. And I happened to have a sequined pair of underthings for the occasion.

In retrospect, I should have thought about my wardrobe choices. It's not as if I expected that pair to be especially well-made. I should have known they could possibly shed their sequins, making me look like a fish in drag from waist down. Which, when that's all you see, would be pretty weird.

If that happened to me now, I'd say some smart-ass comment like, "Yeah, my crotch was the 100 customer at the new Price Chopper; she's also won a year's supply of pet food." But since I was 18, shy(ish), and on heavy pain medication, I just giggled a little a mumbled "Disco Thursday" without any other comment or explanation.

I'm sure that if that medical student has a blog; I'm a post in it. Which I totally deserve.

Tuesday, January 19, 2010

Rank-List

My interviews are finally over. I ended the streak in a place that, when I told people where I was going, they unanimously said, "Why on earth would you go there?" I didn't want to say, "Because findyourspot.com said it was a good place to live" which underneath a lot of other reasons is why I first considered it.

I got in from my next-to-last interview at 3am Friday, slept for as long as I could, then packed the car for the trip. I picked up a girlfriend along the way, and we didn't roll into town until midnight-not a good start for an 8am interview.

I wouldn't say any radiology interview has been malignant (do people outside of the medical field describe things as "malignant"?). It's not like surgery. These people like their lives. But sometimes you get some bonehead questions from interviewers. I count "Why did you choose radiology?" as a bonehead question because:
A. I already have an entire personal statement which explained it when I applied. Do they just want to see how much I remember?
B. Seriously, did you get that question out of Interviewing for Dummies? In my estimation, there are only so many answers to that question and when you interview 30 in a day, you are not going to want to listen to the same answer over and over. So the third time an unoriginal interviewer asked me, I said I was doing it for the hookers and blow.

As I mentioned before, what I really hate is when a program asks, "So where are you going to rank us?" Basically, they want to look the best, and everyone looks the best when the people they rank highly rank them highly. They don't want to put you as number one if you're going to put them in the "I'd rather sleep on a park bench for a year and try again than to go to this program" category. But to me, asking me that question, especially in a pointed, "You have to show your cards sometime Al" (actually said to me by one department chair) way is like asking, "So, I think you want better than this. Are you just pulling our....?" you know what I mean.

One interviewer last week was supposedly a "hard interview". As the attending who followed him said, he tries to get under each candidates skin and pick apart their ideas about how life works. I could tell he was watching me for a reaction, but I generally agreed with his assessment that I know about as much about life as Rush Limbaugh knows about moderation. Plus, as I so desperately wanted to point out, I've worked in a truck stop and I've been pooped on by a human. More than once, if you want to know the truth. It would take a little more to rattle me.

Like maybe making a big fat deal about my name change. One interviewer at the last place told me, "Don't you know you should never change your name in this profession?" Another, "I know a woman who didn't match because she changed her name." My match ID is the same under both names. If this department can't handle something as simple as a name change without lecturing me on the duality of my application and the future difficulty I will have in all areas of life because of it, it makes me wonder how they handle something really important. Like my vacation time.

Now it's rank list time. I will rank the programs in order of which one I'd like to spend the next five years at. They in turn rank their candidates. A computer will match us together. Kind of like e-harmony for THE FUTURE OF YOUR CAREER. And it doesn't even have a spot to check "Likes backrubs and wine". So I make sure to mention that in every interview.

If you don't match? I can't think about that right now. I'll write about that after I'm safely matched.

I can't believe four years of college and four years of medical school come down to a few minutes in a computer program.

Saturday, January 9, 2010

Knot my fault.

Since I've been on vacation now for a bit, I have a story from one of my classmates.

Another classmate of ours was on OB during a pretty busy night. I think I mentioned before that in our university hospital, the medical student's main job is to deal with the placenta. Which is totally gross. And smells like warm squishy bait. Sorry. I get upset every time I think about what they make us do.

Anyway, after you deliver it (which involves gently GENTLY tugging on non-baby half of the cord and mashing the heck out of Mom's lower abdomen), it gets thrown in a blue tub with a clear plastic lid. Why the emphasis on gently? Because our OB textbook specifically says that medical students pulling too hard have inverted uteri. Who wants that on their record?

Your job is to measure it, record that in the mother's medical chart, and if there is something particularly weird about it, or if the doctor says to, you send it to pathology. Some reasons include maternal disease (diabetes, preeclampsia), or baby pathology (two vessel cord, malformations, etc.) Otherwise it gets incinerated, unless of course the parents want it for eating or burying or...gross. I know it can be a cultural consideration, but part of me says that's just what a society came up with so that people saw afterbirth as a special sacred part of the process instead of a quivering, steaming nasty-sack. I gagged more than a few times dealing with that little part of the birth miracle. As for the hippies who want to make a necklace out of it...you must be first time parents. When I used to think of placenta I pictured something like the natural sea sponges you buy in Florida, only reddish-colored. You know, dry and inoffensive. Add a lot more hydration and a little more poop surrounded by a membrane and now you know why I can't get over it. I tried to think of something like that stalactite pic I came up with for HPV, but even that would be too gross to post.

I digress. So our buddy gets a placenta to take back to the measuring room, a small closet with a refrigerator and disposable measuring tape. You're supposed to get it out, but honestly I just poked it around the tub a bit to make sure it was intact. He starts to measure the cord, and what's this? A knot! I'm a little fuzzy on how the next part happened, but I guess he thought somehow during the acrobatics AFTER the birth one of the staff accidentally twisted the cord into a knot. So he untied it and went about his measuring.

It was only later when a resident was talking about the birth and said, "Oh yeah! That baby's cord was knotted; we need to send the placenta to pathology!" that the student realized he had in fact grossly misunderstood. Not one to panic, he went back to the room, retrieved said placenta, and re-tied the knot. Then I imagine he slipped it back in the fridge, dusted off his hands, and went back and acted like nothing happened.

Seriously, this could be a side-story in an episode of Scrubs.

Thursday, January 7, 2010

A Tale of Two Toenails.

I've been sitting on this story for a while, but I need a break from trying to quilt (sounded like something good to do with my free time, but apparently I'm a F#$#%ing terrible seamstress).

We just got back from a week of snowboarding in Colorado. My main goals were:
1. Have fun
2. Not get left behind by the boys
3. Not bonk my head into stupidity. After all, I'm not really skilled in anything...my brain is all I have, and it's currently in hock.
4. Come back with two normal toenails.

Last year, while trying to follow rules one and two, I got talked into a run I really didn't want to do. My boots weren't tied quite right, and my left foot REALLY hurt somewhere in the big toe area. The rest was numb, so I couldn't be more specific. I didn't want to hold up the party, so I did the run. At the bottom I could nearly stand up my foot hurt so bad. When we got back to the condo I took of the stupid boot to find this:

I know the pic is blurry; I can't find any others--this is probably for the best.






Anyway, you get the picture-black toenail. What I surmised was that since my foot was crammed into the toe of my boot, the force of snowboarding had lifted the nail from the bed, bursting a blood vessel until it filled the space and the pressure stopped the bleeding. Gah-ross.

The reason I'm talking about it is because had I known that's what was happening, I could have done something! When I was on family medicine I got to use the coolest clinic tool ever: The portable cordless bovie.


All you have to do is push that little white button on the top--then the filament tip glows red-hot and you can burn the crap out of whatever pinpoint sized thing you want to. You can order these online, but after seeing how excited I was, the doctor let me take it home. Score!


In the clinic I used it to burn through a guy's smashed finger--he had a pool of blood similar to mine. You get the filament hot-hot-hot, then tell the patient to take a deep breath (actually, that's what I did), and hold the filament straight down on the nail until you feel it "pop" through the nail and sizzle the blood. You shouldn't look too closely while you do this; if the blood is still liquid it could shoot out from the pressure. Which is a shame; my first instinct is to get up close and see the action.

This guy's blood had partially coagulated so the Bovie didn't do too much for him. By the time I saw my toenail nothing would have helped. (Otherwise I totally would have Bovie'd myself. I feel like I was too gentle with it in the clinic that day). I didn't have my Bovie at the time either, but you can do the same with a paper clip and a lighter. Not that I recommend that of course.

So, since I had no way to remedy it, I went through this past year, including my August open-toe-shoe wedding with one funky toe. As it grew out blood clumps came out from under it. The ladies at the bridal shop nearly fainted when I went to try on shoes.

I made it safely through this trip, though a girlfriend of mine started her Derm rotation with a black eye from a particularly nasty snow smash in the face. But you know what? I think it looked good. Tough. Definitely a good start for Dermatology :-)