A Day on Gynecologic Surgery

Blood.  BLOOD EVERYWHERE.

Usually for no discernible reason, because the uterus is a pear-shaped bundle of nothing but capillaries and spite.

Neurological Wizardry

Too many of my posts lately have been negative.  Here’s some positive stuff that’s been going on:

I was supposed to see a patient with Common Thing.  But I came away suspecting it was actually Uncommon Thing.  So, with the patient’s permission, I called one of their family members to confirm that the patient actually had symptoms consistent with Uncommon Thing.  And I presented my case to the preceptor, and he said, “I agree”, and he changed the course of the patient’s management, and then I died of shock, the end.

(To be fair, this was not a difficult diagnosis.  But people were nice enough to make me feel good about it because I called family members when no one else had the time to do so.  Because they were all busy doing actual work.
…  turns out my lack of any meaningful purpose is an attribute!  I’ll take it.)

Also, there’s a lot of psychiatry involved.  In one week, I’ve seen more Axis I disorders than I did in a whole semester of psychiatry proper – and I’m not sure there’s anything in life more satisfying than working up an undiagnosed Axis I disorder.

In conclusion, 1) Neurology is the most intellectual fun I’ve had in years, and 2) I am clearly getting cocky about it.

Even though 75% of the consult cases are requested in the spirit of “Hey, you know that WE know this isn’t neurological, but we want to cover our collective asses legally” – to me, each consult sounds more like “We have summoned you from afar to solve an intractable clinical problem with your wise neurological wizardry.”

… which I don’t actually, you know, have.  At all.  I have the opposite of that.

NEUROLOGY. The answer is CALL NEUROLOGY.

But I work for a doctor who does, and I’m armed with a tuning fork.

So, you know.  Samesies.

Pictures of Me on My First Day of Neurology

When My Preceptor Gave Me 4 Hours to Do An H&P On A Stroke Patient:

Actually Doing The History & Physical:

When Trying to Figure Out the Neuroanatomy of a Lesion that causes Vertical Diplopia and Nystagmus with Maybe Some Weird Disconjugate Gaze Shit As Well, And God Only Knows If I Actually Assessed Any of The Visual Field Correctly:

When My Preceptor Asks Me To Present My Findings:

And When He Asks For My Plan:

(Here’s to tomorrow, when I will bring a very thick neurology book and MY GAME FACE.

Grrrrr.)

To the left, to the left.

“That was an excellent physical examination, Action Potential.  Strong work.”
“Thank you, sir.”
“Of course, if you were a med student from my med school, I’d have to fail you.”
“…erm?”
“D’you know why?”
“… I… nope.”
“You did the entire examination from the left side of the patient.”
“….”
“We don’t do that.”
“… We don’t?”
“Of course not. It’s a tradition in medicine to stand on the patient’s right.”

I felt a little blind-sided by this conversation, but I chalked it up to my preceptor’s med school just being weird (and also possibly a totalitarian dystopia where people are failed for standing wrong) – at least, until I remembered an encounter I once had with my family physician.

Years ago, on an exceptionally busy day, her nurse had me wait in a different provider’s exam room.  So my doctor walked in, started to greet me – then stopped mid-sentence and physically rearranged the damn furniture so she would have room to examine me from the right side.

She had me hop off the exam table so she could pull the table away from the wall and everything.

At the time I thought she was crazy, but now I’m realizing that it’s more likely that it’s Medicine as a field that’s crazy and in dire need of loosening up a bit but DING DING command “LoosenUp.exe” not recognized by server:medicine.

Maybe I’m paranoid, but I’m beginning to suspect that it’s actually my school that’s weird for not requiring students to learn the physical exam exclusively from one singular, easily obstructed position with no versatility whatsoever.

Do you examine patients only from the right?  Did your med school tell you that’s the tradition?  Does your med school care about this tradition to the point where they’d actually make it a policy?  Do you want to fight?

I’m kidding.  Of course you do.  We have a difference of opinion here, and – as a med student – I know of no other way to solve it.  (Besides maybe just having an extended passive-aggressive Letters to The Editor war about it in a major scientific journal.  Also an option!)

Wikipediatrics

“Hey, AP!  How’s pediatrics going?”

“I’m so bored I nearly stole a mop from the cleaning closet.”

“… so no pediatrics for you, then?”

“I mean, it’s just boring right now because it’s all well newborn checks.”

“I thought you loved newborns!”

“Well, if the job involved holding newborns all day, it’d be awesome!  I’d sign right up!  But it doesn’t.  It involves consulting ortho for breech births and telling the moms about the new car seat law.”

“You’d get bored of holding them all day too, though.”

“I would not.  The fact that you’re even saying that means you’re seriously over-estimating my mental maturity.  THEY HAVE TINY TOES.”

“Uh, honey, if you wanted to be a daycare worker you were supposed to check the OTHER box on your college application.”

“Goddamnit, you’re right.”

Since this conversation, I’ve realized I would be a pretty lousy daycare worker, for a multitude of reasons (most of which involve Being Responsible and Not Letting Kids Play “Hunger Games” To Determine Who Gets The Last Graham Cracker), but mostly because as near as I can figure it wouldn’t involve obsessing about the kids’ electrolyte panels.

A day without a serious conversation about potassium is NOT A DAY AT ALL,

Saturday Round-up

Good morning, world!

1.  Drinking From The Firehouse – Are you following this blog?  You are probably not yet following this blog.  You should follow this blog.

(3rd year medical student at University Medical School.  Check out his/her post on Clinical Medicine Rules - it’s gold.)

2.  Would you like to bake an egg in an avacado?

3.  I may be in “slight-to-moderate” trouble.  I like to walk the fine-line between “doing as little busy work as possible” and “not getting kicked out of school”, so I only realized yesterday that the “2 required formal write-ups, corrected by your preceptor, then turned into Metropolis Med” were actually for-real required, instead of just.. you know, suggestions.

(I’ve been through 18 years of formal schooling.  That’s 17 more years than it takes to learn to differentiate “work that will be checked up on and/or useful” from “work no one actually care about”.  This is news to me.)

… It’s gonna be news to my preceptor, too.

Maybe I can just have him wave a red pen around in the general direction of some computer paper.

4.  I’m gonna go to work now.  That lecture on hemolytic anemia isn’t gonna present itself.

The Very Worst Day

… is the one that begins with a patient crashing and burning.  You’re confused because this patient was supposed to go home today.  And now they are being intubated as you watch, and you eventually realize you are supposed to be attending a mandatory lecture.

You stay with the patient.  It’s not a hard choice. You’re the only person in the room they know.  The patient is looking at you, bewildered.  You squeeze their hand while they’re sedated and paralyzed.  You are leaving for a new rotation, so you will probably never find out what went wrong.  Or if it’ll really be as okay as you’re promising.

You get an e-mail reprimanding you for not attending the mandatory lecture.  You now have to write an essay about your thoughts on the subject of the lecture:

The High Rate of Suicide in The Medical Profession.

You look up the statistics.

You read a depressing article.

You pour yourself a drink.

You decide this essay is a random decision that will never be checked by anyone of any importance, you say “screw it”, and you go to bed at 7.