affirmation

Jun. 7th, 2008 12:30 pm
jcd1013: (Med - Medical tools)
The sun peaks through the heavy clouds, shining through the large bay window of the neurology physicians work room. The room, as always, is bursting with people. Dr. Peltier is rounding with her team; they have just admitted a new patient who has been a diagnostic mystery--an illness that not only is causing neurologic deficits, but GI complaints as well. The team is discussing what tests should be ordered: labs for vitamin deficiencies for sure, but should they repeat the MRI and spinal tap or get an EMG? Would a biopsy serve any purpose?

Around the computers, the neuro ICU team clusters. A patient had been transferred from an outside hospital because of a head bleed. The patient is surprisingly stable with no deficits (alert, oriented, pleasantly conversant and able to move all extremities), a different picture than the transferring team had painted. The images show the real truth: a tiny little speck of intracranial blood from where the patient had hit their head--something that would resolve on its own, requiring no intervention and needed nothing more than closer observation for a few hours. The team is disappointed, not only because of the lost opportunities for procedures and action (for real head bleeds are usually the sickest patients we admit), but because now they had to write orders to transfer the patient out of the ICU--when they had just written the orders to admit.

I sit on the window seat, conversing with Dr. Lynch, the neuro ICU attending who had quickly lost interest in the CT images. He's my favorite attending and I've got a bit of a hero-worship crush on him. He's three-fourths of the reason that I'm considering a career in critical care--I admire his calm demeanor in stressful situations, the relaxed yet structured rounds, the evidence based approach the patient care, and his endless supply of random bits of knowledge. Today, the conversation diverges from discussion of a patient who had had another stroke to the origin and extraction of heparin and its antagonist protamine. It's a fascinating history lesson on 2 drugs that I've used commonly and had no idea how exactly they worked. I wonder if I'll ever have half the knowledge that he does. He teases me to remember this conversation so that in years to come, I'll be able to pimp my residents about it.

The conversations circle around me and I look around at all my colleagues, my friends, my teachers and a feeling of peace settles over me. I gripe so much about the endless paperwork and documentation, the senseless protocols and mandates, the increasingly demanding and ungrateful patients, the ridiculous phone calls in the middle of the night, the sometimes long and exhausting hours, and so forth, that it's nice to have these moments of confirmation. There have been times, many, many times over the past two years that I have regretted my decision to go into medicine, times when I wish that I had a time machine and could go back and warn 20-year-old me to think more seriously about pursuing a career in creative writing or genetic engineering or becoming a bum. But now, looking around the room, I realize again that this, this is the place for me, the profession for me, the life for me and I wouldn't change a moment of it.

***

It was the medicine department graduation last night. I almost didn't go--because of my failed camping trip last weekend, I was determined to take off last night. The thunderstorms put an end to that plan, so I dusted off my google maps and went to the ceremony instead. It was a good decision.

Several of my friends graduated last night, friends who were my senior residents when I started as an intern and who guided me in patient care. Jenn graduated, done with her 5 years of residency. I met her when I interviewed for the program two and a half years ago and she's the reason that I chose to do the crazy combination of two residencies in one, because she was doing it and was thriving. She rallied for me, told the program to pick me, and for that I'll be forever grateful.

The program was great and I had a blast. I stayed out late and chatted and caught up with all of my friends (and some of the conversations weren't even about medicine as well!). Now I've got to decide whether or not to go to the Neurology graduation this Friday. Normally, I'd just go, but my church is having a barbeque and a dance that night and there's a good chance a certain fellow will be there...
jcd1013: (First Impressions)
Hypothetical question (really, truly):

If you were trying to impress a young lad with your homemade cooking, what would you use as a side dish to complement my signature salmon recipe? (I was going to make it into a real poll, but I got lazy.)

1. Roasted Garlic Mashed Potatoes. What better way to get a man's affection than through the staple of life? Plus, the author promises that I can expect to be worshipped and kissed for at least 38 hours.

2. Crushed Hot Potatoes. It's got the potato factor in its favor, but it's simple, so it doesn't make me look too desperate.

3. Lemon Flavored Saffron Rice. I brought the saffron in Africa and carried it all the way back with me and haven't used it yet. I love lemony saffron rice and it would really complement the fish. Plus, Cleopatra reportedly had great success with her use of saffron um, probably not the kind of success that I'm really seeking at this time :D.

4. Other! I am obviously an inexperienced Kitchen Goddess and need to be taught immediately that the perfect side dish would be:______________

Your input would be invaluable. And needed before Wednesday so that I can go shopping. Hypothetically, of course.

(As an aside: I LOVE the Pioneer Woman blog. I discovered it a couple of days ago and have spent most of the day browsing through her site. The pictures are goregous and it makes me long for the small town life that I've left behind; I miss those times of absolute solitude. Another part of me is overwhelmingly grateful that Kris Hullinger and I never hit it off, because whoa, I am glad that ranching is not my life.)

***
This is my last month as a second year resident, can you believe that? It just incredible how time can fly and still seem so slow. I'm not halfway done with my residency yet... that endpoint still seems a long way away. I certainly down feel ready to be released on the unsuspecting world, but I find myself chomping to get done with this all.

I'm rotating on the epilepsy monitoring unit, which is a different experience. Basically we admit people and provoke them into having seizures and I'm learning how to read EEGs, which is really like learning how to read petroglyphs done in a 3-year-old's squiggly scrawl. I have no idea what I'm doing. The worst is that it really comes down to physics and electricity and currents and vectors, and man, that was my weakest point in all of physics. I could never understand it. I read and read this afternoon and I'm still confuzzled. But I'm excited about a new challenge, and the hours will be a little easier than a regular wards month (still have to do call, bleh)

***
I got my DEA license! And promptly had to renew a prescription for a patient, so I'm already being tracked. We won't talk about how much money this little "privilege" cost me, but all I can say is that the little bonus that they give me at the end of the year to cover licensing and exams(while supposedly leaving enough to fund a gym membership as well), didn't even cover half of what I've paid this past year for the honor of becoming a Real Doctor (like Pinocchio, but still with strings). But it's all done now.

***
I've had "There are no cats in America/and the streets are filled with cheese" running through my head all day today. I have no idea where that came from, as I probably haven't seen the movie (An American Tail, for those who are less Disney informed (and yes, yes, I know it's not a Disney movie, work with me here)) since I was 10. Weird, especially since I did give in and buy myself a copy of Mulan since I've had an inexplicable urge to watch that movie for the last month, so I should be having "I'll make a man out of you" there in my noggin instead. I did resist on buying the copy of Escape to Witch Mountain which is another one of my childhood favorites; luckily the store didn't have The Three Lives of Thomasina or Toby Tyler --those I could not have said no to.

***
I think I'm going for the hammock in the back yard, it would fit the space better. One of these days, I'll redo the front and make a real porch where I can install the swing. I've just gotta make sure that the side of my garage could handle the weight if I hook it there. I wasn't able to find a fire pit yet either, so my backyard beautification project is on-going.

***
And I think that's it. It's all I can think to talk about, unless you want to hear that I have dishes to wash and clothes to fold and my hair to cut and CuteIntern friended me on Facebook (mostly shaved now. Definitely cuter) and I've got a date on Thursday that might almost be called a second date and there's still about 5 clinic notes that I haven't finished. Yeah, you definitely don't want to hear about those tedious details about my life. :D

sundry

Apr. 10th, 2008 04:43 pm
jcd1013: (XF - medical opinion)
Another night on call. It's been a blue-soul kind of day. I've pretty much been cranky since I walked in this morning. We changed attendings today, to one that I've worked with in the past. Nice guy, but he's getting older (at least 5 years past the age of retirement, if not 10) and is becoming forgetful and very, very slow to round. I've got one patient that I'm convinced that has been misdiagnosed, and I'd love to have an attending that I could brainstorm with, so that we could provide the right diagnosis, but that's not going to happen with this attending. Instead we'll wait for the acute illness to pass and send [the patient] home without no additional answers. It's just frustrating. Neurology, I've discovered is 50% crazy people with all types of somatization and conversion disorders, and of the 50% who have real disease, the majority of those, we still can't do much more than just throw up our hands and say "dunno what you've got, but sucks for you." Even those we think we give diagnoses to explain things, someone follows in the footsteps and doubt even those.

I almost got to give IV tPA for the first time my last call night for an apparent acute stroke. So close. I was so excited, because I was going to do it. I called the attending, he approved it and told me to do it. Unfortunately (or luckily for the patient's sake), the patient woke up from the self-induced chemical high just prior to me pushing the medication into the waiting veins. Ah, well, I really wasn't wanting to deal with all of the complications that would have arisen if I had done so.

I got my schedule for neurology next year (the medicine portion is still pending). Two months of NICU (woohoo!), a couple of consult months and a couple of electives. No general ward months. SWEET! At least I'll have another year to perfect some of my differential diagnoses before I have to be in charge of interns and junior residents. Next year, I'll have to solidify my plans for my Real Career and actually decide what I want to do with my life and then start making steps to get there by doing research or whatever.

I think I'm running into problems with my licensure application. I submitted it weeks ago, and in typical Wisconsin fashion, I haven't heard one word from them. There's a website where you can check the status of your application.... it hasn't even been listed there. And of course, attempting to email gets silence and calling gets on a merry go round of automated messages and nobody real to talk to. I know that they received it; they deposited the application fee almost immediately, so at least I don't have to worry about it getting lost in the mail, but it's starting to get ridiculous. I'm giving them until Monday, before I start calling every day and harassing them. Since I submitted things in pieces, I want to know what they have and what I might need to go back and recollect (my med school verification for example). I have to have the entire process completed by June. I honestly thought that 4 months would be more than enough time, but I'm starting to get nervous now. I think I'll be saving my tax refund just in case the unthinkable happens and the paperwork doesn't get processed by June and I'm suspended for a month. I don't like thinking that, and I'll be fighting with claws to prevent it, but I'd rather not find myself with no savings and no employment.

My semiannual review is tomorrow, I swear I just went through that. I haven't seen any of the reviews I've gotten from the interns and medical students from when I was the senior resident back in February/March. I'm a little bit nervous about that.

My med students should be done seeing our ER consult, so I'd better get back to work. Ta for now!

seriously

Nov. 8th, 2007 11:02 pm
jcd1013: (M*A*S*H - party)
Life has been super busy and super boring. I think it's all because super cute intern has moved on to greener pastures and I'm mourning. :( While it may not have been true love, it was definitely TrueLust and made the entire month survivable and entertaining. The intern who replaced him is a girl and therefore not interesting.

CuteIntern's facebook profile reads this: "Custom has made dancing sometimes necessary for a young man; therefore mind it while you learn it, that you may learn to do it well, and not be ridiculous, though in a ridiculous act." Soulmates. Srsly. (Or not).

In more news, I have not talked to DateBoy since said date. I'm thinking about calling DateBoy and inviting him to my house for Thanksgiving dinner, which may be the most forward thing I've ever done. Or not, because I keep changing my mind.

I've put on weight this month because of all of the stress. And the easily available candy at the nurses station. I haven't worked out in a month. So much for the plan to be down ten pounds for Christmas, so I could finally, finally have a vacation without my mother mentioning how unhealthy I look.

I've had some very difficult patients that I've had to deal with that have sucked compassion out of me. I've realized that I hate treating migraines. But to make up for it, I've had 3 of the loveliest patients, including two who have made a romantic out of me again, because they (and their spouses) have proved that true love really exists.

My next day off is Thanksgiving, which happens to be my birthday. I haven't had a day off since the 28th of last month. I get four days off in a row to make up for it. I'm not sure I'm going to be able to come back.

I've been on call every Tuesday except one since the last week in September. Tuesday is clinic day, which means I have to see all of my patients before 8. Since I really shouldn't be in before 7 (therefore, having enough time to go to noon conference the next day and not break the ACGME 30 hour rules), it makes the morning incredibly hectic. What makes them even more fun: all of those Tuesdays, except for one, my team has been post call. So I have to hurry through clinic (where I always get behind), race through lunch, so that I can go upstairs and admit the 3 ER patients, learn about the NICU transfers, follow up on the stuff that the other intern wasn't able to complete, write my own patient notes that I didn't get to do in the morning, discharge the half dozen patients of the intern's (because my patients are all rocks which I collect) and then start getting pages every 30 seconds on 3 different pagers. Yeah, I loathe Tuesdays. Only a year left of clinic!

The best part: I'm still on call every Tuesday until the middle of December. And every weekend except Thanksgiving.

I'm still trying to remember why I loved neurology. I think I need to see David Renner when I go home so that I can be reminded. It's probably pathetic that when prospective interns come and interview here, I end up gushing about Utah more than the program here.

Susan and Bobby and Allison are coming for Thanksgiving. I'll be cooking something delicious, I hope. Should I ask DateBoy or is that really weird? I think I need more furniture if I do.

I spent the evening reading old Gilmore Girls fanfiction. Mostly general stuff, featuring townies, and it made me realize once again what a brilliant, wonderful show it once was.

I'm going to the opera next week with two of my girlfriends, Kristen and Erika. The Merry Widow. I was very excited when I first heard about it, because from the radio ads, it sounded like it was the translation that I fell in love with in high school. Alas, my sleuthing has proven that it is not so (although I think it'll be better than the San Francisco version), but I'm still ecstatic about it. I'm dressing up. I can't wait.

I'm also having a painting party involving my living room next week as well right before the opera. Need to clean the place before before then, I think. And I need to buy paint. And moth balls.

I'm totally addicted to this blog and have wasted away more of my evening reading her archives and laughing so hard I almost started vomiting.

I'm going to be 29 in 2 weeks. And I think that's enough to stop any more random musings.
jcd1013: (Med - Medical tools)
It's going to be a long month two long months. Rounds today lasted 6 hours. 6 hours to see 8 patients. No discharges. I didn't get notes in the chart until 5 pm. I didn't even have my morning orders written until 5 pm. Oh, and did I mention that I know nothing about my patients...why they're there, what kind of strokes they had, what kind of interventions, and what kind of work-up they had had. No clue. I looked like an incompetent moron (the intern who's gorgeous, btw, asked me if I was post-call. He was, and didn't act it at all), which got worse when my attending started pimping me on differential diagnoses of syndromes that I've never heard of. I've got families demanding updates on when their loved one is going to be discharged (no clue, sorry), juggling showdowns between dueling services (the neurosurg attending's opinion of me is even lower, but I don't care as long as he does something surgery-like), and trying to find social workers and case managers to see if I can't get somebody home tomorrow. It made for a very, very long day.

But my attending does one of the best neuro exams I've ever seen and he's unbelievably brilliant (and is starting to change my opinion that neuro docs don't know much about general medicine) and wow, I wanna be just like him.

I'm on call tomorrow, where the chances of me even getting 5 minutes of sleep are pretty slim.

Oh, and I really need a better reflex hammer.

*sets alarm for 5 am*
*crawls into bed*
jcd1013: (XF - medical opinion)
I hate the neurology department. I am so close to just walking up to them and just quitting, because it's been a long time since I enjoyed myself and I'm sick and tired of the laziness of the senior residents. The only part of neurology that I like is the neurocritical care and I can do just plan critical care from the medicine side and be done almost 3 years earlier.

"If a senior is delegated intern work from another junior resident because of a lack of their in-efficiency or work-ethic then perhaps we should re-evaluate who we are accepting into our program."

Bastards.
jcd1013: (Joseph Campbell Bliss by Fileg)
Because I haven't updated on my life forever, I owe a catch-up journal.

Since we last (truly) saw Julia, she was in the midst of her neurosurgery block, wondering what in the world she had gotten herself into. The hours were long, she limped home every night, and nary a resident acknowledged her existence. I fear many night, she cried herself to sleep, as the sleep-deprivation added to the stress. But, luckily that rotation only last two weeks, and by the end, she had made friends with two residents (one, very very cute, but rather too crass for her taste) and had impressed the attendings with random knowledge about a genetic disease that she knows all too well from personal experience. In fact, she had so much fun, that she almost convinced herself that maybe she could do surgery for the rest of her life, and never seen the sun for the next 8 years and have no personal life. Well maybe not quite. However, time goes by (...you're older than you ever were and now you're even older, and now you're even older... and even two long 5-hours-of-sleep-per-night weeks end, and we all must move on.

Our heroine, as you remember, managed to wheedle/cry/whine her way into neurology rotation. She had had inklings since the previous year, when none of her classes had intrigued her quite as much as the study of the brain did (I hear that she actually spent 6 hours a day studying--even when there wasn't a test the next day!), that perhaps a career in neurology might be nice, and while she was determined to keep an open mind when approaching her rotations, that little niggle of a thought was always there. Radiology was boring--except when she studied brain MRIs. Surgery, dreadful on the feet--but the cases were cool.

So needless to say, she approached the neurology clerkship with more than a hint of excitement.

Two days into it, she had found her calling. She tells me that she loves being with the patients and her neuro exam, while still jerky (and yes, she still forgets to check eye movements), is improving and she can't wait for clinic each morning, and, yes, the rumor is true, she stayed late on her birthday because she *wanted* to learn more about multiple sclerosis.

Of course, it still is too early to call--she has been known to be mighty fickle at the last moment, but you may be talking to a future neurologist here!



A big thanks and snuggles to my flist for their birthday greetings! *hugs* You are all fabulous, and every day I am thankful for the chance of knowing you and claiming you as friends.
jcd1013: (Joseph Campbell Bliss by Fileg)
...Try breaking down and crying!

Remember this post

Apparently sobbing about how your life is ruined works better than calm, rational explanations.

I got my Neurology rotation!! And I start tomorrow! I am sooo excited.

And yes, I survived neurosurgery and am much looking forward to sleeping in until 6.

Ta for now!
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