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7 Weeks

December 11, 2011 By Leave a Comment

This week I am beginning my three weeks of Christmas vacation. Following those three weeks I have scheduled 4 weeks of vacation time. All in all, that’s 7 straight weeks off.

Upon hearing about my schedule, many residents have sighed and said, “Oh, the life of a 4th year. Enjoy it while it lasts.”

It won’t be all fun and games, though. This first week I’ll be studying for Step 2 CS and taking the exam on Thursday. The following couple weeks I’ll be finishing up my interviews. But then I will have a few weeks off at the end. I’m still not sure what I’ll be doing. There has been some talk about the possibility of going to Korea. My sister is leaving for Korea in about 1 week. She’ll be teaching English there for 4 months. She would like me to come visit. Well, I’d like to go visit too.

But I’ve also considered other travel alternatives. The others are all cheaper than a trans-Pacific flight. One option would be a road trip. I considered just driving east and just going for a week without any planned agenda. I considered flying out to the east coast and just wandering around for a while. I also considered trying to talk my parents into letting me use a week of their time share somewhere — perhaps I’ll go to Hawaii again.

Obviously my mind is all over the place.

We’ll see, though.

Whatever I end up doing, you better believe I’ll be posting about it!

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Veterinarians and Pediatricians (and Pediatric ER Physicians too)

December 4, 2011 By 1 Comment

I’ve always thought that veterinarians have it tough. They see patients who cannot communicate. Their patients don’t speak or complain of symptoms. So veterinarians have to go by what owners have observed and by the physical exam for most of their data.

It’s kind of like a pediatrician or even a Pediatric ER physician. Little kids might not be able to complain. And when they do, they may be very vague, unable to give a good description of what they are feeling.

I recently worked a Pediatric ER shift where I saw a 4 year old patient who was transferred from another facility. The other hospital wanted us to rule out appendicitis because the patient had abdominal pain and a CT scan that was equivocal.

I went in to see this little patient who appeared to be lying comfortably in the gurney watching the TV hanging on the wall. The patient, who I’ll call Joe, didn’t seem to be in pain. So I asked his parents what the problem was. It turns out that Joe had been vomiting — up to 10 times over night — and that was why he was brought in to the ED. I asked if Joe was communicative at home. His parents told me he was.

Was Joe a child who would normally complain of pain like a stomach ache? Yes, they told me. Did Joe ever complain that his stomach was hurting? No, he didn’t.

At this point appendicitis was getting knocked down lower on my differential (list of possible diagnoses). I proceeded to sit down next to Joe and say hello. He stared back at me. I told him I was going to just take a look at his stomach and started to pull back the hospital sheet that was covering his belly.

Almost immediately he pulled it back. Apparently, this kid liked his stomach covered up. I pulled back a little and pressed on his stomach. He started crying. I tried to observe how he was crying — to see if he was just being fussy or if it was really painful. I started pressing on the left side and worked my way to the right lower area of his abdomen (where appendicitis typically presents with pain) and tried to see if his crying intensified as I neared that spot.

I finally gave up and let him cover up his stomach. But I tried one more time. This time, I pressed on his stomach through the sheet. This time Joe did not cry. I was able to press fairly deep all over his stomach without eliciting any cries of pain.

That pretty much did it for me. And, after more discussion with the parents about Joe’s symptoms at home prior to coming in to the hospital, I concluded that appendicitis was not likely in this little patient.

In the adult world, most patients are able to communicate. Sure, I’ve had adults who were unable to communicate with me, but the proportion of patients who can’t communicate is much, much less. I don’t plan on going into pediatrics or emergency medicine. But I can appreciate how difficult it can be at times. And I am thankful that there are people who choose to do it.

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Why I Can’t Do Emergency Medicine

November 29, 2011 By Leave a Comment

I can’t do Emergency Medicine. I do not like the environment of the ED. I don’t feel comfortable there. It has nothing to do with the people who work there. It has everything to do with the system. Allow me to explain.

There are many great things about Emergency Medicine. For one, I love the shift work. It must be awesome to leave the office and never have to carry a pager or be on call. When you’re on, you’re on. And when you’re off, you’re off. The salary is also an overall plus for those considering it. I mention just a few of the positives of EM to make the point that there are things I do like about it.

But the reason I can’t go into EM is the system and how it is (poorly) designed. I realize that my impression of the system is based on my experiences while rotating as a medical student through local hospitals that include a level 1 trauma center and a county medical center. So the picture I have is probably not representative of all hospital EDs. But I hope to stay in the area. I would like to stay in academic medicine. So I think my sample size fits.

While rotating through medicine and surgery I would often be sent to the ED to admit a patient. While going looking for my patient, I’d have to walk through hallways and aisles lined by chairs and gurneys filled with patients watching my every move. They watched because they hoped that my eyes would meet thesis and that I would stop. I hated that feeling. I wanted to stop an help them. But I couldn’t. I had no idea what they were there for. And they weren’t someone I was asked to see.

Perhaps this is just a small thing. But to me it was huge.

The second reason I can’t see myself going into EM is that there are just so many non-emergencies. The system of healthcare we have leads to so many people coming into the emergency departments due to complaints that should be dealt with in the primary care setting — or even the urgent care setting. I can only imagine that I’d be frustrated dealing with this on a daily basis.

It may not be much. Some may see this and minimize my reasons saying that they are silly. But in the end, they are the reasons that pushed me away from emergency medicine. And it’s a personal process everyone must go through for themselves.

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Breast Cancer Awareness Month

October 12, 2011 By Leave a Comment

It’s been a while since I have posted here. It’s been stressful lately with application going out, asking for letters of recommendation, waiting for word from programs.

I’ll be happy when it’s over.

In the meantime, here’s a video I found and am sharing in honor of breast cancer awareness month — because early detection saves lives.

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That swell feeling…

September 27, 2011 By Leave a Comment

Today.. for the first time since I have been seeing patients… I felt like tears were possible; I felt that if I allowed it, MY tears would flow. Or at least trickle out. Not because I was being an idiot and getting berated by an attending. But because of the pain in the family members standing inside a dying patient’s room.

For a moment I felt the tears begin to swell. And I turned away, took a second, and kept my composure.

I have been in sad situations before. But this was the first time it (almost) got to me.

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My Weekend Rant

September 17, 2011 By 5 Comments

As I walked through the hallway of the Emergency Department, my eyes fell upon one particular gurney that was parked against a wall. It was a typical night in the ED. People were flowing through the doors and patients were being “roomed” in the hallways. As I looked at this gurney’s occupant, I cringed. The pale face with wrinkled skin and sunken eyes was all I could see. The body was covered up with a blanket. But that face was unmistakable. I knew the face — or at least I thought I did. I didn’t want to take the risk of being recognized so I quickly walked passed. I cringed, knowing that I’d have to walk back this way on the return trip.

When I passed the gurney for the second time I realized that the patient was asleep. This time I paused at the bedside. I noticed her wrist was exposed. And on that wrist was her identification badge. The name confirmed my fears. This was the very patient our team had discharged one week earlier and showed up in the ED the very next day with discharge papers still in hand. This was the patient whose medical record would reveal multiple visits to the ED for the purpose of obtaining meds.

If you’ve read this far and are wondering why I was so fearful, it’s because I feared that the patient would be a “bounce-back.” A patient becomes a bounce-back when they return to the hospital within the same calendar month after their discharge. When this happens, should the patient need an admission, they go back to the team that originally took care of them. The theory is that it provides continuity of care as the team is already familiar with the patient and his or her issues.

As I continued on with my work, I knew I didn’t want this bounce-back. I didn’t want the patient back on our team. She had been hard to work with in the first place. She had terrorized the nursing staff. She had frustrated her sitter. She had tried our patience. She had refused treatments. She was a difficult patient.

Like I wrote earlier, she was a frequent flier. I am not sure her repeated admissions helped her. Sure, she had physical ailments. And we could help the occasional exacerbation. But they were chronic conditions that we wouldn’t cure. To me, it seemed that the most pressing issue was her mental health. I suspect, and I’m no psychiatrist, that much of her behavior would improve with more attention to her mental health. But sadly, the system we are in affords little help to who need it, and even less to those who don’t think they have a problem.

As I begin to wrap up this post, I admit I am struggling. I don’t know where I am going. I suppose it is borne out of a frustration that is without an avenue of release. There’s nothing that I can do to help patients like the one above. And as I go into Internal Medicine, I am sure I will encounter many more people who, though suffering from significant medical and mental illnesses, will try the patience of those taking care of them.

Perhaps, this is just my weekend, off-day rant.

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Call Day

August 13, 2011 By 2 Comments

Our team was on short call today. The intern and senior resident were raving about ZDoggMD and his videos. This is his parody of Rebecca Black’s song “Friday.”

We watched it during lunch in the cafeteria. I think this version is better.

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