hubris

I am 9 days from completing my internship, the first year of my residency. After this, it will be me in charge of the interns, directing the team, and helping the fresh-faced, confused recently-made-doctors in taking care of our patients, making sure that nothing is overlooked, that we consider everything that could be potentially causing our patients symptoms and that it gets worked up properly. A whole new level of responsibility. Instead of 5-10 patients, I'll be responsible for knowing about 15-20. It's the next step to becoming a Real Boy independent physician. I know that I have areas of weakness (still hate EKGs, still hate drugs), but overall, I think I'm doing pretty good. I've even gotten praise from my attendings and residents in reviews, stating that I'm performing above the level that I should be. Maybe I let some of that go to my head...

I missed the diagnosis of an aortic dissection yesterday. Completely and totally missed it. Granted, my patient didn't come in complaining of the classic symptoms and we thought we had the reason for the other chief complaints--once we got the blood pressure controlled, the headache disappeared and the abdominal pain was gone as well. I was ready to discharge, had all of the paper work ready and was rather upset at my attending for wanting to get an echo, and then a CT scan on a patient who already had a reason for a murmur and was doing fine. Eating, breathing, walking, with no complaints. But there's a reason for the hierarchy, and I got the scan without too much arguing (just a lot of internal grumbling).

Even then, I missed it. I looked at the scan yesterday morning, saw a little fluid at the lung bases and that was it. I completely missed the large bulge in the aorta, as the blood leaked out. I didn't get it, until the radiologist called and informed me what the pictures really showed.

Aortic dissections are deadly. They can rupture, causing instantaneous, massive blood loss. In medical school, it is one of the "red sign" diseases that are always top on the differential, as they are the worst case scenario.

And I missed it.

maps and globes

I spent most of the afternoon browsing around a map store. And oh, it was heaven. I love maps. Maps of places that I've visited. Maps of places I want to go. Ethnic maps. Topographic maps. I've collected a few - I've got a lovely map of the city streets of Antigua that needs to be mounded and a historic map of Ireland that needs a frame. I hope to one day decorate my upstairs (and most likely my bedrooms) with maps and frames pictures of all of the places that I've been to. In Kenya, I almost struck out. The only maps available there were road maps (and as good quality as the roads themselves). So instead, I had a map made for me, on a large plate. It's gorgeous (I shall definitely have to take a picture) and is hanging on my wall.

The map store was amazing. The owner, a grandfather type who followed me around, answering all of my questions, stated that they had over 6000 maps, and after seeing the place, I believe them. They didn't have a map of Kenya, however, their map of Ireland blew mine out of the water (alas, it costed close to $500!). And the globes! Oh, how I want a globe! In the end, grandfather-owner did manage to talk me into a shiny antique map based on some explorer from the 18th century's drawings. It's soo gorgeous and I can't wait to see it on my walls!

When I was in South Africa, I bought this map



It's lovely and exactly what I wanted. Problem is, it's huge (705mm X 670mm, which roughly translates into 27 X 26 inches). And rather square. And I can't find a frame to fit it. I tried to get it priced this afternoon. $160 dollars. For a frame. Of wood. Does this make sense to anybody else?? I've come across this problem before, because I've actually framed some puzzles that now serve as artwork, which were odd sizes (All the World's A Stage and Fairy Tales. Next I want to do The Oath) and I made the frames myself... went to Home Depot, bought the wood, sweet talked the salesboy into cutting it for me and glued, stained, everything. The first time, I used glass and my upstairs neighbors (I think they were the drug dealers) were having some kind of ruckus and it fell and shattered and I redid it in plexiglass. It was time consuming and it took me months (mostly because I'd lose interest). And Liz made me pinky swear that I would never do it again (I think she was really really tired of puzzles by the time she moved out). So I'm stuck.

Any ideas of where I can get a cheap (but decent) frame made?