Dictionary definition update:

radiologist: a doctor who is mushroom-like, ie they sit in the dark and have shit heaped on them

Life Lessons--collect them all!

I've learned some valuable lessons thus far in trauma, and I'd like to share them with you.

• When riding a motorcycle, it helps to NOT be drunk.
• Diving from a trampoline into an above-ground pool is not a good idea.
• When hanging yourself, don't do it on your front porch so your neighbors cut you down before the job is done.
• If you're going to shoot yourself because the hooker said no, place the gun to your temple and aim towards your brain, not toward your eyeballs. Eyeballs explode.
• Wear your seatbelt--the repaired face will never be as nice as the original face.
• I'm going to spoil the ending of the thriller "Car Vs. 18-Wheeler": the 18-wheeler ALWAYS WINS.

Other than these fine pieces of advice, I'd like to offer this one: stay indoors and drive slowly if you absolutely must leave the house. That way, you stand a chance of avoiding being taped to a backboard, clothing cut off, naked in a busy ER, unable to move while we draw lots of blood, Foley your bladder, DRE your rectum, and generally try to make you as uncomfortable as possible.

Saddest thing I've seen yet: the above-mentioned dive into the above-ground pool resulted in a teenage boy who will probably be a quadriplegic for the rest of his life. He was fully conscious and aware in the ER while we stared uncomfortably at his belly-breathing and priapism (bad signs). It was one of those situations where you could cry, but you can't because you're busy and hot and covered in a gown and anyway there's no crying in medicine, silly little girl, just do your job and don't get involved in it.

Watch out where you dive, people. And wear a seatbelt.

Hospital kills sex drive, part deux

• I saw a piece of equipment today called a "rectal Foley". A normal Foley is a tube that goes into the bladder and empties into a bag. You can connect those dots. This particular rectal Foley wasn't working properly. Do I need to continue?

• I had to help hold a 400 lb man on the OR table while surgeons pumped water into his rectal wound to clean it. Turns out that the morbidly obese are prone to injuries that literally split the skin from the underlying muscles through the fat, so this guy had tracts through his fat. The elderly surgeon was sticking his hand into the hole going "look, I'm almost up to my elbow!"

• Same patient as before: When he was turned on his side, my friend holding up the abdomen was stuck with his face 3 inches from the guy's colostomy bag. We put a towel over it, just in case it popped.

• 400 lb men need special operating tables, as their belly and boob fat hangs off the regular OR table.

I went straight from that surgery to lunch.

What am I going to do when I grow up?

So 4 weeks into surgery, and I'm having to entirely rethink my career. I really, really like surgery, and I'm utterly shocked by it. I thought I would hate it! This brings up several dilemmas for me. 1) Will I still like OB/Gyn? 2) Is there a way to do surgery or a surgery residency and have any kind of lifestyle? (For that matter, how about in OB/Gyn?) 3) Would I be satisfied in general surgery, or should I re-evaluate the subspecialties? 4) Surgical subspecialties? HOLY GEEZ, those residencies are long! 5) I know I'm a *good* student and candidate, but am I an *outstanding* candidate? The kind residencies want to hire? 6) Back to subspecialties, would I be satisfied in a more narrow field? If I did just eyes, or just penises, or fixed noses and boobies in plastics, would I be happy? 7) If I choose any of these fields, will my kids grow up to know their mommy?

It's July 2006, and I have 1 year to make up my mind. I'm not sure now that a year is enough time.

A New ICD-9 Diagnosis

One of my classmates on the surgery rotation and I were talking the other day about surgery, and out of nowhere he says "I don't know what it is about the OR, but I always come screaming outta there because I've got wicked gas EVERY TIME."

Me: "DUDE! Me, too! I thought I was the only one!"

Big Med Student Guy: "It's worst on your call nights, about 2 am, the OR flatus hits."

Me: *snicker* "I wonder if it's bowel stasis? I always try to leave the OR and find an empty room to, uh, stand in."

BMSG: "It happens to everyone. Ask the residents. Everyone gets OR flatus."

Me: *nearly passes out laughing*

(I've pointed out previously that I am about 4 years old, and that Kevin Smith's axiom always holds true: all the money is in dick and fart jokes.)

So look out for the next publication of ICD codes, under GI disorders: OR flatus.

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I have been meaning to write that for weeks. My last call night, this cute anesthesiologist (attending, even, not a resident!) was supervising the nurse anesthetist while she intubated the patient. It was about 4 am, and we were prepping our 3rd butt pus patient. My fellow med student was watching the intubation as well, so they were clustered at the head of the patient's bed. As the cute anesthesiologist guy was bent over the patient, I heard an unmistakable *thhhbbbppptthhhh-squeeeeee* sound. As it was 4 am, and I'd been falling asleep for the past 3 hours, I thought I'd imagined it. No one else said anything; (for once) I knew it hadn't been me; but SURELY it wasn't cute anesthesiologist man! As the intubation continued, the noise came again, that strange combination of *ttthhhhhbbbbpppphhttthhhhhh* and a high-pitched *squeeeeeeeeeeak!*. This time, it came twice in rapid succession, and I KNEW I hadn't imagined it--cute anesthesiologist guy had just farted, loudly, and hadn't even flinched. At 4 am, this was fucking hilarious! The nurse anesthetist looked up at the 2nd one, and at the 3rd she made eye contact with my fellow med student, pointed with her head at the anesthesiologist, and raised her eyebrows. Thank goodness for those facial expression-hiding, ass gas smell-filtering OR masks.

Those two stories were a lot funnier in my head than they came out. Oh well. Farts are funny.

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So married life continues to be about the same as "living together in sin prior to being married" life. We went to the mall the other day, and as usual my massive iced tea consumption caught up to me, so we had to consult the map to locate the nearest restroom. After I was finished, I came out to find him waiting patiently for me. I kissed him and said "I hope you get used to that. The rest of your life is going to be spent waiting for me to get out of the restroom." He just said "I'm already used to it. I have a mom and a sister." True, but I just wanted to be SURE that he knew what he was getting into.

I married a very, very sweet man.

End of [County Hospital] Surgery

So I had my last day at the county hospital on Saturday. It was my first call night with no sleep; I promptly came home Saturday morning, ate breakfast, and slept for 23 hours. I missed all the rest of Saturday and woke up this morning. What purpose does taking call serve? I literally fell asleep STANDING UP in the OR at 4 am Saturday when we took our 3rd case of butt pus in for I&D (another was waiting, making the grand tally butt pus 4, med students 0). I'm sure I'll get more used to it, but still--how is it possibly good for patients to have a doctor who is that damn tired? Nurses take shifts, why not doctors? I've never heard any really convincing arguments for 30 hour shifts (unless it's for 30 hours versus a LONGER shift), and I can think of a lot of arguments against it. A lot of places are going to a night float system--I hope it catches on!

One of the saddest things I encountered at the county hospital was the ICU waiting room. Our surgery library was located right inside the ICU, so we passed the ICU family waiting room many times a day. I often went inside to visit ye olde Coke machine (I usually got water, thankyouverymuch). The problem was the people inside the waiting room. These people would eye us as we walked by, chatting or drinking a Coke or generally ignoring them, and the look in their eyes was pitiful. Please tell us something, they'd say. You look like a doctor, you might know something about my loved one, you might be able to perform a miracle and get them out of the ICU alive. I usually tried to avoid eye contact and walk by as quickly as possible.

My finger lost its virginity Friday night. Yessir, I performed my first DRE, Digital Rectal Exam. I'm sure you're all thrilled. I know I was.

In re: butt pus: Don't ever get diabetes. Not only will your feet fall off, you'll get butt pus.

I saw a woman in her 30's in the breast clinic the other day with breast lumps. She had stage 4 cervical cancer, a carcinoid lung cancer, and now breast lumps. I got to tell her the lumps in her breasts were benign fibroadenomas--no problem. I hope that made her day a little happier.

I think it's time to go cook dinner now.

Update

1) Still liking surgery. I thought the poo would get in the way of my enjoyment, but it turns out that bowel surgery patients get cleaned out GOOD. GoLytely is a misnomer; it ought to be GoQuickly, GoRapidly, GoHeavily, or some variant thereof. Even better, I don't have to do the bowel prep! (yet)

2) Got my USMLE scores. I did well, so that stress is gone. I'se gon' be a dokter!

3) Nickelback is singing "I wanna be a rockstar" on the radio. Chad, I'm sure you'd like to know what that would be like.

4) In Dr. G's OR, getting addressed as "Doc" is NOT a compliment. Every nurse, every scrub tech, every nurse anesthetist was called by name. Me? I'm "Doc", as in "Never give me orders in MY OR, Doc" (when I had to hand him the lap camera so I could get my step stool). I watched him treat a 3rd year resident the same way today, so at least it's not personal.

5) I've started choosing my footwear for work based on what I wouldn't mind getting bloody. I've started choosing my face covers based on the desire NOT to be splashed with urine (again) when the nurse or I d/c the Foley.

6) In reference to #3, that was an insult. I hate Nickelback. Just in case it wasn't as obvious as it seemed to me.

7) Two of my good friends are splitting up, which is sad. I was in their wedding. Another wedding I attended has already ended in divorce. I think I'm bad wedding karma--maybe I just saved all the good for my own?

8) This is some funny shit. When I read the part about getting reamed by a radiology resident because he was sent to get a film read without a history... tears of sympathy sort of welled up. I thought I was alone in the world with that experience. Bitch. How DARE I ask her to do her JOB??!

9) A patient came in last night with a GSW (gunshot wound) to the right arm. He said he was standing around when someone he didn't know started shooting, he began to run, BAM! This story is known by a couple of names. One is "SOTCMMOB"--Standing On The Corner Minding My Own Business. The other is "the two dudes"--it's always two random dudes who do the assaults on these totally innocent bystanders. My resident says if we just catch those two dudes the County Hospital ER would go out of business.

Perhaps this is overly cynical for you? Maybe I was making a stereotypical assumption, but the man with the GSW was COVERED in jailhouse tattoos, was wearing a nylon cap, and had capped all his teeth in gold. If he wasn't doing anything to deserve to be shot, he was probably in a place where getting shot is not an uncommon occurrence.

10) My friend is working with a liver oncology surgeon. After removing most of a man's liver, the grateful patient presented the surgeon with 3 bottles of rum. The surgeon says liquor is his most commonly received gift. Ponder that for a minute.

11) Working in a hospital is one of the fastest ways to lose a sex drive. Not only will the hours make you old, but you are constantly confronted with the worst human anatomy possible. A 10 lb scrotum? A naked 300 lb woman? Foley catheters? Bring it on! I now understand the sex parts of "House of God", and why they felt the need to fuck all the time to prove that they were alive. Sadly, my life at work is more nunlike than Grey's Anatomy-like.

Stay tuned for more exciting details!

What is she going to do with her life?

So a question I field all the time is "What kind of doctor do you want to be?" I figured I would write this out, since I'm not sure, and this way I can keep track of my current feelings versus what I feel like after I'm done with my rotations.

Heavy-Weight Contenders:
#1- OB/Gyn: I like taking care of women, and feeling like I'm involved in women's issues in whatever way possible. I know I like Gynecology, so it remains to be seen if I enjoy Obstetrics as much (it's pretty messy).

#2- Infectious Disease: I like bacteria. They are cool as hell.

Other contenders include:
Pediatrics, Internal Medicine/Pediatrics, Family Practice, Surgery (*new*), Emergency Medicine, and Maternal/Fetal Medicine

Absolute No-No's:
#1- Gastroenterology: I don't like poop.

#2- Urology: I don't like pee.

#3- Radiology: I don't like being stuck in dark enclosed spaces all day. Interventional Radiology might be cool, but the residency is like 6 years long.

#4- Internal Medicine: I don't like "tweaking" diabetes meds and blood pressure meds once a month to see how the numbers come out. I'd rather do a specialty like Endocrinology than just superficially tweak the meds.

#5- Psychiatry: the doctors are as crazy (or crazier) than the patients.

#6- Neurology: I hate brains. I've killed mine.

#7- Anything super super super specialized. I like routine, but not boredom. I don't want to do heart catheters and stress tests all day.

No-Man's Land (the waiting list; will they move up or down?):
Anesthesiology, Ophthalmology, Dermatology, Pathology, and other specialties I can't remember right now

Stay tuned!

June is Gone

June is gone and I have little to show for it, other than a wedding ring. My pictures haven't come back yet, so I can't show them off for all you losers who didn't come to the wedding. I didn't change my name (for professional and lazy reasons) and I'm wearing my engagement ring as my wedding band (unless I'm at the hospital, in which case I don't wear any rings), so a lot of people don't know I just got married. Or care.

At the hospital, you say? Why yes, didn't you know, I just began my MS-3 surgery rotation at a large county hospital. For 2 years now, I've heard the war stories from this place. Professors would say "you'll never see a presentation this severe unless you're at [County Hospital]". The other day, we had a case of tophaceous gout. The guy came in for something else; the gout was an incidental finding. Tophaceous gout is so advanced that the urate crystals are making rocks under the skin, for the (happily) uninformed. I'd also like to add that gout attacks (prior to tophaceous) are extremely painful.

We covered the ED (ER to the layperson) on Monday night and saw some wild shit. I saw a trauma call on a patient who rode his bicycle into a parked Metro bus while intoxicated. My fellow med student on call had to sew up a man's arm while a patient in the next bed shouted threats to an unknown party and about 7 police officers and sheriffs rushed in en masse. I saw a laparoscopic cholecystectomy (I got to "drive" the camera--woo!) and a toe amputation. I attempted to suture during said lap chole, but my pitiful knots came untied (I've practiced a lot since then, I swear), right in front of an attending and the chief resident. I've inserted a Foley catheter (fortunately, the patient was under general anesthesia) and palpated inguinal hernias. I've learned how to scrub into a surgery, so I get to walk around with my hands in the air like Turk. It's also a great way to exfoliate your hands and arms, so I have extra strength hand cream stashed everywhere.

When we started this rotation, someone told me that at the county hospital, our short white coats essentially make us doctors. In a way, it's true. Those white coats open any door, even the ones that say "Do not enter--restricted". The only doors they DON'T open are the doors to residents' call rooms. The heirarchy of lowly student, intern, junior resident, senior resident, chief resident, and attendings is strictly enforced here. One mark of how low we are on the totem pole is how far away our student call room is--it's on another floor--while the chief resident's call room is right outside the operating area. Often, we are simply referred to as "Student" by staff, attendings, etc. Perhaps I should include the fact that above the medical student is just about everyone else in the hospital, including (but not limited to) nurses, nurses' aides, scrub techs, janitors, cafeteria workers, etc. I don't necessarily work hard to suck up to attendings or residents (I'm just my usual cheerful self) but I consciously suck up to nurses and the like. I say "Yes ma'am" and "Thank you so much for your help" and "Are you sure I'm not in your way? Because I can move if I am", etc. Nurses are the LAST people you want to piss off, as they have to do nasty shit like removing Foley catheters, collecting specimens of every type of excretion the human body can throw out, bathing patients, emptying bedpans, etc. Maybe I just don't like pee that much, but I certainly appreciate what nurses do for us. I will kiss every last nursing ass if it keeps me alive while I ask retarded questions like "How do I turn on the BP machine?" or every damn time I have to ask "Where is the chart?"

I actually get to sleep in until about 5:30 tomorrow, so I'm going to take advantage and watch some TV tonight! Woo! TV! No thinking! No butt pus!