"If you're treading water, you're losing ground."
That's me. Right now. My head's still above water, but my legs are quickly getting tired of bicycle kicking.
I have one week to get myself caught up with everything. GI physiology, endocrine physiology, and about a million biochemistry lectures. Yikes! The reason for the pressure is that on Friday, we have four people coming into town: Eric's parents, to watch him run the Derby Marathon, and our friends Duc and Joel. Duc is going to run the marathon, and both guys are staying a week until Derby. So next weekend is shot, since we'll be entertaining, and a lot of the following week is going to be shot, since I'm going to be hanging out with the guys. Hopefully I'll get some studying in that week, but there are no guarantees, and so that's why I've given myself this coming week to get my act together. Easier said than done, but I'm going to give it my best shot. Derby weekend is probably shot in terms of studying as well, since we're going to Derby (my friend Marjorie is coming in for that as well) and most likely recuperating on Sunday. Unfortunately, that only leaves me a week to study for finals on the 12th, so this week is really important.
Yesterday was Thunder Over Louisville, the country's largest fireworks show. It was preceded by the Thunder Airshow, which is one of the nation's top 5 airshows (all of these superlatives are provided by the Thunder producers, not me). The airshow was pretty cool; the Blue Angels came, and they always put on a good show. The fireworks were absolutely AMAZING. They set up on the 2nd Street bridge and a site in the middle of the river, so there are two sets of fireworks. At one point, they had fireworks raining off the bridge like a waterfall of light. And the finale was so huge that I could feel the vibrations in my chest. I can't wait until next year's show! I'll post pictures when I get a spare moment to do things like download photos from the camera, or do laundry, or cook dinner...
In the meantime, it's time to hit the books. I just have to tell myself that I need to do this because I WANT to become a doctor. Really. I do...
Sunday, April 23, 2006
Saturday, April 15, 2006
Surgery and Tacos
1. I spent 11.5 hours in surgery yesterday. By choice. I'm not on rotations yet. But now I'm dreading them even more. My feet, calves, knees, and back still ache. Were the surgeries cool? Yeah -- a C-section, two thermachoice procedures to destroy the endometrium, two different types of bladder tacks, a hysterectomy with left oophorectomy, and an exploratory surgery for cystic ovaries. The hysterectomy ended with a surprise diagnosis of a rock-hard colon, so they ended up doing an emergency right hemicolectomy, and after they took out the bad part of the colon, I got to open it up -- the tumor was really gross. And the patient had had a normal colonoscopy four months ago... so either someone missed something really obvious or that's a super-tumor. The exploratory surgery was mildly interesting because the cystic ovary they ended up removing was adhesed to the bowel, and it took them forever to figure out how to cut them apart safely, but they ended up nicking the bowel anyway. But then it was still bizarre, because the bowel didn't look right -- it ended up that the patient had a bowel resection years ago, so the ovary had adhesed to all the scar tissue. The nicked part of the bowel was actually a blind pouch created by the bowel surgery, so it was all OK -- it just took FOREVER to get the ovary out and get the bowel stitched up, and my feet were hurting so badly already that I wasn't really paying too much attention. I was also standing at the patient's head with the anesthesiologist, so I ended up talking to the anesthesiologists a lot. They seem to have cool jobs, also (and their pay isn't bad, either!). Can I see myself doing surgery? Yes. Can I see myself doing anesthesiology? Yes. Can I see myself doing OB? Yes. But, I knew as much already -- I think I'm going to like all my rotations. Sigh.
2. We drove through Taco Bell today after taking the kittens to the vet. All over the windows were signs advocated the "4th meal" -- the meal you eat BETWEEN dinner and breakfast. Yes, Taco Bell is open late. Yes, if you're up that late, usually while being drunk, Taco Bell can be quite good. But does it need its own advertising? Probably not. In fact, you're not supposed to eat within two hours of going to sleep if you want to keep a healthy weight, so you definitely shouldn't be scarfing tacos and then hitting the sack. Ick. But also so yummy.
2. We drove through Taco Bell today after taking the kittens to the vet. All over the windows were signs advocated the "4th meal" -- the meal you eat BETWEEN dinner and breakfast. Yes, Taco Bell is open late. Yes, if you're up that late, usually while being drunk, Taco Bell can be quite good. But does it need its own advertising? Probably not. In fact, you're not supposed to eat within two hours of going to sleep if you want to keep a healthy weight, so you definitely shouldn't be scarfing tacos and then hitting the sack. Ick. But also so yummy.
Tuesday, April 04, 2006
Need an OB? Paging Dr. Cummings.... not!
This semester I need to shadow a primary care physician, and I've been working with an OB/GYN, Dr. B., across the river in Jeffersonville. He's a really nice guy, with a solo practice, so I feel like I'm getting a taste for small-town medicine. I mean, really, when was the last time you went to a doctor's office where there was only one doctor? He has quite a busy practice, though, so I've seen numerous annual gynecological checkups and regular obstetrics visits on women over a large age range. I've also seen a number of older women being evaluated for incontinence, which the office screens for in every woman over the age of 35 with two or more children.
The first thing that strikes me is the number of women around my age who have had multiple pregnancies. It IS southern Indiana, I know, but it's still ... weird. At 25, these women are on their second or third pregnancy and look like they're in their 30s. I wonder about their lives -- what is it like to be a stay-at-home mom married to a blue-collar husband? Did they want to get pregnant? And why did they choose a male gynecologist? (That part really gets me... I think I wouldn't mind seeing a male obstetrician, but I wouldn't want to see a male gynecologist... not that you can really separate the two, I know. Therefore, I always choose female physicians. But I know my mom likes male doctors. Is it a generational thing?)
The second thing that strikes me is that staring at female genitalia all day is a little bizarre. I've now seen more vaginal canals and cervixes (cervices?) than I thought possible -- and I've only been working with him for 6 hours over two days! Women look surprisingly similar -- the only differences come with having had children -- whether your cervix shows signs of childbirth, and how stretched out you look. I've also noticed that Dr. B. doesn't put KY jelly on the speculum before inserting it. From personal experience, I thought using KY was the norm, but I don't know if his not using it is due to age (he's in his 60s at least, so he trained a long time ago), gender (maybe it wouldn't occur to him that having a speculum inserted is uncomfortable?), or training (I've only ever seen nurse practitioners for my annual exams, because I like their caring attitude in this area; maybe physicians really don't get that empathetic training?). Nevertheless, it's the cause of a lot of grimaces, which I don't think he notices, but I certainly do!
Anyway, a couple funny stories. Last week, we saw a woman in her 50s being evaluated for urinary incontinence. We were performing a urodynamic flow study, which consists of four parts. First, you spray a stream of water at the urethra to see how much pressure it takes to breach the sphincter from the outside. Second, you insert a small catheter and see how much urine is left in the bladder when the patient thinks she's emptied it (she urinates before the test begins). Third, you slowly fill the bladder through the catheter and record the volumes at which the patient reports sensing there's "urine" (really saline) in the bladder; sensing that she's going to need to pee sometime soon but she can still hold it; and sensing that she has to pee so badly that she'll drop trou on the side of the road in front of the president and the pope to do so (that was Dr. B's actual analogy, which I thought was hilarious). Fourth, you drain most of the saline out and then have the patient cough hard, and you record the pressures produced by coughing and see if she loses any urine while doing so. This woman, when she coughed, did lose a little bit of urine from around the catheter, but Dr. B had her keep coughing harder and harder, to see what the pressures would max out at. On the final cough, the lady coughed so hard, a huge stream of water flew out threw the catheter all over Dr. B, who was still sitting in front of her. How disgusting! And embarrassing! I was mortified just watching it happen.
The other story isn't so much funny as it is an illustration of my poorly developed ear. Dr. B is awesome in that he lets me evaluate the pregnant women myself first before he goes in. These are the women who are having their monthly or weekly OB visits to make sure the baby is growing appropriately and things like that. So I go in first and listen to the fetal heart tones using a small ultrasound machine, then measure the uterine fundal height (to get the baby's crown-rump length). I'm pretty good at finding the fundus (the top of the uterus), although it's definitely easier on thinner, more pregnant women than on heavier or less pregnant women. So this one lady asked me if I knew which way the baby was lying inside her. Every other pregnant woman I had examined so far, the baby was lying with its back (and therefore heart) on the left and butt up on the right (head at the bottom). On this lady, it didn't really feel that way, but she wasn't THAT pregnant, so it was hard for me to be sure. Plus, I don't really know anything about obstetrics -- if the 20 other babies had been lying that way, why wouldn't this one be? So I took a guess and said, "well, let's see if the heartbeat is on the left." And sure enough, there was the cute little woosh-woosh I had heard so many times before. So I said, "I think the back is here on the left, and the butt is on the right." Then Dr. B came in and examined her. "So, you felt the back over here on the right, right?" "Uh," I stammered, "I kind of thought I did, but then I found the heart beart on the left..." So he took out the doppler and found the heart beat -- on the right! I tried to maintain my cool, but I was dumbfounded by what I had heard myself. "So what's that on the left, then?" He found what I had found, and told me simply, "Placenta." Unfortunately, the patient didn't hear him clearly, and you could tell SHE was freaking out, because we were all hearing heart beats in two different locations. "Do I have twins??" she asked nervously. We explained it to her, and I realized her anxiety over the potential for twins was more called for than my embarrassment at not being able to tell the difference between placenta and baby, but still, I was pretty embarrassed. And dumbfounded. To tell you the truth, I still couldn't hear the difference. Thank god no one's depending on me yet!
Overall, I kind of like OB/GYN. You get to see women at all stages of their lives, and you get to do a very wide range of things. Counseling on healthy behaviors, obstetrics, gynecological surgery, oncology, and tons of other things. The environment is pretty bad for malpractice insurance, but I haven't had the chance to ask Dr. B about that yet. I'm spending next Friday in the OR with him all day, so I'll get to see some cool stuff -- there's a C-section, ovarian tumor, and bladder surgery scheduled so far that I know of. So far, I haven't crossed OB/GYN off my list. However, there IS that stereotypical aspect of it -- women going into OB to get to play with babies. Not really realistic, I know, but I hate fulfilling stereotypes, so that might be reason enough to avoid it as a career, a la "Scrubs," Season 1, Episode 11:
"Elliot: Dr. Kelso, I need to present a patient: Nineteen-year-old complaining of abdominal pain. Turns out she's at least eight months pregnant. I'm just gonna let one of the Family Practice people handle it.
Dr. Kelso: Well, that sounds like a wonderful idea, Sweetheart, except I heard your smart-alec remark a second ago, so why don't you just keep your little pregnant girl? It'll be good practice for you, since you'll probably end up in a female specialty anyway.
Elliot: What do you mean by that? I'm Internal Medicine.
Dr. Kelso: Well, of course you are. But numbers don't lie, and most women end up in OB/GYN, Family Practice, or Pediatrics. It's like a riptide, Sweetheart, pulling and pulling, and you can swim against the current all you want, but when Mr. Stork comes a-calling, you're not going to be thinking, "I'm Internal Medicine." Nope. It's gonna be, "Oohhh, look at the baaaby!"
Elliot: Sir, I have to say, I'm offended!
Dr. Kelso: Oh no. Now I have to go buy flowers to make it right."
At least I have the kittens to assault with my baby voice for the time being, and in a few months I'll have a friend's baby to coo at; then I can hope for awful Peds and OB/GYN rotations third year. :)
---
In other news, we've gotten a couple pretty serious storms this week. Last Sunday, I missed Grey's Anatomy thanks to a tornado warning that had us holed up in the bathroom for 40 minutes. (I missed Grey's Anatomy because EVERY station was pre-empting for weather news.) Last night, we had another round of storms -- these actually did produce a tornado, in the southern part of the county. I'm not really sure how realistic it is that we would get hit with a tornado downtown -- we're in the middle of a lot of sort-of tall buildings, and don't tornadoes need wide, open spaces to develop? -- but we've prepared a tornado plan nonetheless. The disaster destination of choice is the hallway bathroom -- it's the only non-closet room that has no exterior walls. I've stashed some candles and matches in there, and I'm going to buy an extra flashlight to keep in there as well. Better safe than sorry! So far, I kind of like tornado coverage better than hurricane coverage: tornadoes come quickly and without warning, so the worst the media can do is cover it while it's hapenning. There's none of that dire, doomsday-approaching coverage for days beforehand, like there is with hurricanes. There's also not as much preparation needed: get into an interior room and stock some candles. No stocking up on canned food and bottled water or evacuating. If it hits, it hits, and then it's over. All the devastation, half the hassle!
The first thing that strikes me is the number of women around my age who have had multiple pregnancies. It IS southern Indiana, I know, but it's still ... weird. At 25, these women are on their second or third pregnancy and look like they're in their 30s. I wonder about their lives -- what is it like to be a stay-at-home mom married to a blue-collar husband? Did they want to get pregnant? And why did they choose a male gynecologist? (That part really gets me... I think I wouldn't mind seeing a male obstetrician, but I wouldn't want to see a male gynecologist... not that you can really separate the two, I know. Therefore, I always choose female physicians. But I know my mom likes male doctors. Is it a generational thing?)
The second thing that strikes me is that staring at female genitalia all day is a little bizarre. I've now seen more vaginal canals and cervixes (cervices?) than I thought possible -- and I've only been working with him for 6 hours over two days! Women look surprisingly similar -- the only differences come with having had children -- whether your cervix shows signs of childbirth, and how stretched out you look. I've also noticed that Dr. B. doesn't put KY jelly on the speculum before inserting it. From personal experience, I thought using KY was the norm, but I don't know if his not using it is due to age (he's in his 60s at least, so he trained a long time ago), gender (maybe it wouldn't occur to him that having a speculum inserted is uncomfortable?), or training (I've only ever seen nurse practitioners for my annual exams, because I like their caring attitude in this area; maybe physicians really don't get that empathetic training?). Nevertheless, it's the cause of a lot of grimaces, which I don't think he notices, but I certainly do!
Anyway, a couple funny stories. Last week, we saw a woman in her 50s being evaluated for urinary incontinence. We were performing a urodynamic flow study, which consists of four parts. First, you spray a stream of water at the urethra to see how much pressure it takes to breach the sphincter from the outside. Second, you insert a small catheter and see how much urine is left in the bladder when the patient thinks she's emptied it (she urinates before the test begins). Third, you slowly fill the bladder through the catheter and record the volumes at which the patient reports sensing there's "urine" (really saline) in the bladder; sensing that she's going to need to pee sometime soon but she can still hold it; and sensing that she has to pee so badly that she'll drop trou on the side of the road in front of the president and the pope to do so (that was Dr. B's actual analogy, which I thought was hilarious). Fourth, you drain most of the saline out and then have the patient cough hard, and you record the pressures produced by coughing and see if she loses any urine while doing so. This woman, when she coughed, did lose a little bit of urine from around the catheter, but Dr. B had her keep coughing harder and harder, to see what the pressures would max out at. On the final cough, the lady coughed so hard, a huge stream of water flew out threw the catheter all over Dr. B, who was still sitting in front of her. How disgusting! And embarrassing! I was mortified just watching it happen.
The other story isn't so much funny as it is an illustration of my poorly developed ear. Dr. B is awesome in that he lets me evaluate the pregnant women myself first before he goes in. These are the women who are having their monthly or weekly OB visits to make sure the baby is growing appropriately and things like that. So I go in first and listen to the fetal heart tones using a small ultrasound machine, then measure the uterine fundal height (to get the baby's crown-rump length). I'm pretty good at finding the fundus (the top of the uterus), although it's definitely easier on thinner, more pregnant women than on heavier or less pregnant women. So this one lady asked me if I knew which way the baby was lying inside her. Every other pregnant woman I had examined so far, the baby was lying with its back (and therefore heart) on the left and butt up on the right (head at the bottom). On this lady, it didn't really feel that way, but she wasn't THAT pregnant, so it was hard for me to be sure. Plus, I don't really know anything about obstetrics -- if the 20 other babies had been lying that way, why wouldn't this one be? So I took a guess and said, "well, let's see if the heartbeat is on the left." And sure enough, there was the cute little woosh-woosh I had heard so many times before. So I said, "I think the back is here on the left, and the butt is on the right." Then Dr. B came in and examined her. "So, you felt the back over here on the right, right?" "Uh," I stammered, "I kind of thought I did, but then I found the heart beart on the left..." So he took out the doppler and found the heart beat -- on the right! I tried to maintain my cool, but I was dumbfounded by what I had heard myself. "So what's that on the left, then?" He found what I had found, and told me simply, "Placenta." Unfortunately, the patient didn't hear him clearly, and you could tell SHE was freaking out, because we were all hearing heart beats in two different locations. "Do I have twins??" she asked nervously. We explained it to her, and I realized her anxiety over the potential for twins was more called for than my embarrassment at not being able to tell the difference between placenta and baby, but still, I was pretty embarrassed. And dumbfounded. To tell you the truth, I still couldn't hear the difference. Thank god no one's depending on me yet!
Overall, I kind of like OB/GYN. You get to see women at all stages of their lives, and you get to do a very wide range of things. Counseling on healthy behaviors, obstetrics, gynecological surgery, oncology, and tons of other things. The environment is pretty bad for malpractice insurance, but I haven't had the chance to ask Dr. B about that yet. I'm spending next Friday in the OR with him all day, so I'll get to see some cool stuff -- there's a C-section, ovarian tumor, and bladder surgery scheduled so far that I know of. So far, I haven't crossed OB/GYN off my list. However, there IS that stereotypical aspect of it -- women going into OB to get to play with babies. Not really realistic, I know, but I hate fulfilling stereotypes, so that might be reason enough to avoid it as a career, a la "Scrubs," Season 1, Episode 11:
"Elliot: Dr. Kelso, I need to present a patient: Nineteen-year-old complaining of abdominal pain. Turns out she's at least eight months pregnant. I'm just gonna let one of the Family Practice people handle it.
Dr. Kelso: Well, that sounds like a wonderful idea, Sweetheart, except I heard your smart-alec remark a second ago, so why don't you just keep your little pregnant girl? It'll be good practice for you, since you'll probably end up in a female specialty anyway.
Elliot: What do you mean by that? I'm Internal Medicine.
Dr. Kelso: Well, of course you are. But numbers don't lie, and most women end up in OB/GYN, Family Practice, or Pediatrics. It's like a riptide, Sweetheart, pulling and pulling, and you can swim against the current all you want, but when Mr. Stork comes a-calling, you're not going to be thinking, "I'm Internal Medicine." Nope. It's gonna be, "Oohhh, look at the baaaby!"
Elliot: Sir, I have to say, I'm offended!
Dr. Kelso: Oh no. Now I have to go buy flowers to make it right."
At least I have the kittens to assault with my baby voice for the time being, and in a few months I'll have a friend's baby to coo at; then I can hope for awful Peds and OB/GYN rotations third year. :)
---
In other news, we've gotten a couple pretty serious storms this week. Last Sunday, I missed Grey's Anatomy thanks to a tornado warning that had us holed up in the bathroom for 40 minutes. (I missed Grey's Anatomy because EVERY station was pre-empting for weather news.) Last night, we had another round of storms -- these actually did produce a tornado, in the southern part of the county. I'm not really sure how realistic it is that we would get hit with a tornado downtown -- we're in the middle of a lot of sort-of tall buildings, and don't tornadoes need wide, open spaces to develop? -- but we've prepared a tornado plan nonetheless. The disaster destination of choice is the hallway bathroom -- it's the only non-closet room that has no exterior walls. I've stashed some candles and matches in there, and I'm going to buy an extra flashlight to keep in there as well. Better safe than sorry! So far, I kind of like tornado coverage better than hurricane coverage: tornadoes come quickly and without warning, so the worst the media can do is cover it while it's hapenning. There's none of that dire, doomsday-approaching coverage for days beforehand, like there is with hurricanes. There's also not as much preparation needed: get into an interior room and stock some candles. No stocking up on canned food and bottled water or evacuating. If it hits, it hits, and then it's over. All the devastation, half the hassle!
Sunday, April 02, 2006
So *this* is what a weekend feels like!
Amazing what you miss out on by being a student. After finding out I passed my neuro final (yay!) and doing OK on my biochem and physiology tests (hey, there's still the next test to bring my grade up), we went to the Cadaver Ball. The theme this time was "Heroes and Villains," and I went as Supergirl in pastels instead of primary colors (complete with homemade pink boots!) and Eric went as Louis Lane, Daily Planet reporter. Haha.
Supergirl and mild-mannered reporter Louis Lane. I don't know what that ridiculous look on my face is.
The rest of the weekend was relaxing yet productive, a combination I rarely experience. Saturday morning I took the kitties to the vet (they have ear mites, round worms, and coccidia, an intestinal parasite) and came back with three different medicines we need to attempt to give them over the next week. My sense of grown-up-ness was reflected in the fact that when the receptionist at the vet asked me if I was going to enjoy the weather by working in the yard, I would have answered yes -- except we don't have a yard. I spent most of the day cleaning instead, which was extremely cathartic. Today we ran a few errands and went to Lynn's for dinner with some friends. Between sleeping late, not doing much today, and turning the clocks ahead, it definitely does not seem like it should already be almost 9:30. I'm going to try (for the 4th or 5th time this school year) to turn over a new leaf and be wide awake and attentive during all of my lectures for the next four weeks and study an appropriate amount each night. This time, it WILL happen -- I promise! Accomplishment #1 to achieve that goal would be to go to sleep at a decent hour, so after Grey's Anatomy, it's lights out!
In other news, my cell phone died inexplicably Friday. I didn't get it wet (this time!) or drop it, or anything like that. Luckily, I guess because it's obviously the phone's fault and not mine and because I got it less than a year ago, the Verizon guy said they could send me a replacement -- for free! It should come on Tuesday or Wednesday, and the only downside is, I don't have anyone's phone numbers anymore (they won't be able to get them off of the old phone). So, if you're reading this, please leave me your phone number if you ever expect to hear from me again!
And before I go, here is the requisite kitty picture:
Yin and Yang kittens.
And, in breaking news, Maryland beat UNC, 81-70, in the women's Final Four! Go Terps! Here's hoping for a Maryland-Duke championship game!
Supergirl and mild-mannered reporter Louis Lane. I don't know what that ridiculous look on my face is.The rest of the weekend was relaxing yet productive, a combination I rarely experience. Saturday morning I took the kitties to the vet (they have ear mites, round worms, and coccidia, an intestinal parasite) and came back with three different medicines we need to attempt to give them over the next week. My sense of grown-up-ness was reflected in the fact that when the receptionist at the vet asked me if I was going to enjoy the weather by working in the yard, I would have answered yes -- except we don't have a yard. I spent most of the day cleaning instead, which was extremely cathartic. Today we ran a few errands and went to Lynn's for dinner with some friends. Between sleeping late, not doing much today, and turning the clocks ahead, it definitely does not seem like it should already be almost 9:30. I'm going to try (for the 4th or 5th time this school year) to turn over a new leaf and be wide awake and attentive during all of my lectures for the next four weeks and study an appropriate amount each night. This time, it WILL happen -- I promise! Accomplishment #1 to achieve that goal would be to go to sleep at a decent hour, so after Grey's Anatomy, it's lights out!
In other news, my cell phone died inexplicably Friday. I didn't get it wet (this time!) or drop it, or anything like that. Luckily, I guess because it's obviously the phone's fault and not mine and because I got it less than a year ago, the Verizon guy said they could send me a replacement -- for free! It should come on Tuesday or Wednesday, and the only downside is, I don't have anyone's phone numbers anymore (they won't be able to get them off of the old phone). So, if you're reading this, please leave me your phone number if you ever expect to hear from me again!
And before I go, here is the requisite kitty picture:
Yin and Yang kittens.And, in breaking news, Maryland beat UNC, 81-70, in the women's Final Four! Go Terps! Here's hoping for a Maryland-Duke championship game!
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