Helped deliver a baby today (and by helped, I mean stood there while the intern caught the baby, then drew venous cord blood), which was the first delivery since we started L&D. She delivered in triage, no less, which is always more exciting than someone who's been laboring away in a delivery room. Two of my clinic patients came into triage today as well, and they recognized me and seemed grateful to be seeing a familiar face, which felt good. One of them even called me her doctor, even after I reminded her that I was just a med student. "You're STILL my doctor!" she exclaimed. Who says you don't get continuity of care at University Hospital?! Unfortunately, one of them was discharged (actually a very good thing) and the other didn't progress past 5 cm over 5 hours, so I didn't get to see her deliver and she was probably going to end up with a C-section this evening. I'll see her in the morning, though.
I seem to be dealing with the 5a-5p schedule a little better than I did on GynOnc, but that might be because I don't have to spend five hours standing in surgery. I like running around doing things much better. But don't get me wrong; getting up at 4 am is still horrible.
Goal for tomorrow: Deliver the placenta myself. Even better, beat the intern to the delivery and catch the actual baby.
*************************
I had a great visit with my friend Karen and her new baby this weekend. I had a horrible time getting to and from Massachusetts, though. My flight out of Louisville to BWI was delayed three and a half hours, and I ended up missing all the possible connections to Providence, so I spent the night at BWI. I could have gone to a friend's place in Baltimore, but she sounded so tired, and by the time I would have gotten to her apartment, I would have had to leave in five hours to get back to the airport to catch my 7 am flight on Saturday, so the airport was just easier. Luckily, BWI doesn't have armrests between its seats, so I was able to stretch out. Picture me lying on a row of chairs with my cell phone plugged into the wall and resting under my travel pillow, with my hand under the pillow and on top of the phone, curled up in the fetal position under a thin airplane blanket with my wallet between my thighs. It's a sad, sad picture. On top of it all, by the time I got to BWI all the food establishments were closed and I hadn't eaten any dinner, just two packets of peanuts and a 100-calorie snack pack of Oreos. I found a Starbucks that hadn't pulled its gate all the way down yet and begged the guy behind the counter to sell me something, anything. After initially refusing, he took pity on me and told me to put a turkey sandwich in my purse and deny I ever spoke to him. I definitely felt like a homeless person Friday night. My flights home were also delayed, but without as much drama. The culprit? BWI air traffic control. They screwed up Southwest flights around the country this weekend, and I bet it was nothing more than a single air traffic controller who called out sick or something ridiculous like that.
Tuesday, July 31, 2007
Wednesday, July 25, 2007
Health-related articles
Dark Ages' view of ailments was pretty bright
I'm kind of fascinated with the Middle Ages. I don't know much about it, but I really like art from that time period, with the people all having those same, weird flat faces (it's funny to think about the fact that up until a certain time, we didn't know how to draw perspective). Anyway, this article talks about how communities in those days dealt with illness and ill people.
Doctor cleared in Katrina hospital deaths
Most people I've talked to think this was a bogus case brought about to try to shift focus from the government's lack of action during Katrina. They arrested the doctor as she was leaving work, with tons of cameras there, so they could get her in her white coat, instead of at her home. I'm glad she was cleared.
Rabid kitten causes concern in 4 states
This is just amusing. Although rabies isn't a funny matter, people.
Cuba-trained US doctors graduate
I know about the Caribbean medical schools, but I've never heard of this Cuban program. Michael Moore should have tried to interview these guys while he was down there.
HIV medics released to Bulgaria
Stories like this one, and the Katrina doctor one, sometimes make me worry about the state of the world. There's obviously a risk in providing health care to people who don't understand it, which is disturbing. Also disturbing is the fact that although I heard this story on NPR throughout the day yesterday, from every possible angle (the news story itself, the implications of the EU-brokered deal in the business world, the possibility of Libya gaining a larger presence in the international market, etc), I couldn't find the story in any of the main sections of CNN.com. Is Beyonce falling down the stairs really more important?
Not health, but still relevant:
Five killed as Alaska sightseeing plane crashes
Ack! That's the cruise we were on! And the same ship! Luckily, we're too poor to have taken any plane rides. Still, that's really, really horrible.
I'm kind of fascinated with the Middle Ages. I don't know much about it, but I really like art from that time period, with the people all having those same, weird flat faces (it's funny to think about the fact that up until a certain time, we didn't know how to draw perspective). Anyway, this article talks about how communities in those days dealt with illness and ill people.
Doctor cleared in Katrina hospital deaths
Most people I've talked to think this was a bogus case brought about to try to shift focus from the government's lack of action during Katrina. They arrested the doctor as she was leaving work, with tons of cameras there, so they could get her in her white coat, instead of at her home. I'm glad she was cleared.
Rabid kitten causes concern in 4 states
This is just amusing. Although rabies isn't a funny matter, people.
Cuba-trained US doctors graduate
I know about the Caribbean medical schools, but I've never heard of this Cuban program. Michael Moore should have tried to interview these guys while he was down there.
HIV medics released to Bulgaria
Stories like this one, and the Katrina doctor one, sometimes make me worry about the state of the world. There's obviously a risk in providing health care to people who don't understand it, which is disturbing. Also disturbing is the fact that although I heard this story on NPR throughout the day yesterday, from every possible angle (the news story itself, the implications of the EU-brokered deal in the business world, the possibility of Libya gaining a larger presence in the international market, etc), I couldn't find the story in any of the main sections of CNN.com. Is Beyonce falling down the stairs really more important?
Not health, but still relevant:
Five killed as Alaska sightseeing plane crashes
Ack! That's the cruise we were on! And the same ship! Luckily, we're too poor to have taken any plane rides. Still, that's really, really horrible.
Tuesday, July 24, 2007
I loved Harry Potter. The saddest part of it was once I had finished it Sunday morning, and Eric was reading it, and I didn't have any more Harry Potter to read myself. Harry Potter withdrawal isn't any fun.
And neither is nasal spray withdrawal. Luckily, I think I realized just in time that I had been using that stuff too long, so hopefully I didn't sustain any long-lasting damage. Although this cold is STILL HERE.
I saw my first two deliveries last night (well, the first two of this year; I saw two during first year also). They were pretty cool. The first one was pushing under a failed epidural, and it can't be any fun to have to go natural when you weren't planning to -- especially not for the stitches afterward. The second one wasn't pushing at all, which made the baby's heart rate drop between contractions, so that was a tense delivery. There are likely many reasons she wasn't pushing, but I don't really think the epidural was one of them. I think the thing I was most struck with was how floppily a baby gets held once it's delivered. You spend the next six months worrying about head support, but in those first 30 seconds, it's just a vice grip around the neck and nothing else. Of course, it being private practice, I didn't get to do anything, but NEXT Monday will be here soon enough.
And while I'm on the subject of private practice, I just have to gripe about my doctor for a minute.
-She smokes. In her office with the door shut. She turns on a little desk air purifier and sucks them down like they're her last breath. Which, ironically, they are. She apologizes for exposing me to it, which I appreciate, but it's still disgusting.
-She's really, really smart and loves to educate her patients, but she takes forever to do it, which makes her run chronically behind schedule. In the first two hours yesterday, we saw 5 patients, when probably more like 10 had been scheduled. We saw the 2:45 appointment at 4:45. Why her patients put up with it, I don't know. But they really, really, really love her.
-She loves to talk about herself, which if I remember correctly, you aren't really supposed to do. But she illustrates every story and answer to a question with what happened to HER when she was pregnant, or how old SHE was at menarche, or what SHE'S doing for perimenopausal symptoms. I don't know if it's the fact that she does it at all or the fact that I've now heard it all multiple times a day for over a week that is driving me crazy.
-She's from Western KY, so she has an accent -- no big deal, everyone around here does. But she has some country turn of phrases that drive me crazy as well. Like, "Fair to middlin'" in response to "How are you?". She also says "mute point" and talks about putting her "John Henry" on documents. Seriously, she graduated magna cum laude from medical school but has been saying "John Henry" instead of "John Hancock" for almost 50 years!
There, I feel better now that I've gotten it out. Overall, I can't complain. She's a great teacher, even if I don't get to do much (but really, if I were going to my Ob/Gyn who I'd been seeing for 15 years, I wouldn't want a med student doing an internal exam on me, either). I am now very good at measuring fundal heights, though, which is trickier than it seems. She's also very frank and talks about the problems of the business of medicine, and of Ob/Gyn in particular, very willingly, which I find very interesting. But that's a discussion for another day.
Oh, and the best part about private practice? Office hours, 10-5. With a 7:30 am surgery thrown in a couple times a week, and some evening deliveries a couple times a week as well, but over all, it is not bad. For me, at least; she still rounds at the hospital every morning and takes overnight Ob call, but I don't have to do any of that, because as she says, my time will come soon enough.
And neither is nasal spray withdrawal. Luckily, I think I realized just in time that I had been using that stuff too long, so hopefully I didn't sustain any long-lasting damage. Although this cold is STILL HERE.
I saw my first two deliveries last night (well, the first two of this year; I saw two during first year also). They were pretty cool. The first one was pushing under a failed epidural, and it can't be any fun to have to go natural when you weren't planning to -- especially not for the stitches afterward. The second one wasn't pushing at all, which made the baby's heart rate drop between contractions, so that was a tense delivery. There are likely many reasons she wasn't pushing, but I don't really think the epidural was one of them. I think the thing I was most struck with was how floppily a baby gets held once it's delivered. You spend the next six months worrying about head support, but in those first 30 seconds, it's just a vice grip around the neck and nothing else. Of course, it being private practice, I didn't get to do anything, but NEXT Monday will be here soon enough.
And while I'm on the subject of private practice, I just have to gripe about my doctor for a minute.
-She smokes. In her office with the door shut. She turns on a little desk air purifier and sucks them down like they're her last breath. Which, ironically, they are. She apologizes for exposing me to it, which I appreciate, but it's still disgusting.
-She's really, really smart and loves to educate her patients, but she takes forever to do it, which makes her run chronically behind schedule. In the first two hours yesterday, we saw 5 patients, when probably more like 10 had been scheduled. We saw the 2:45 appointment at 4:45. Why her patients put up with it, I don't know. But they really, really, really love her.
-She loves to talk about herself, which if I remember correctly, you aren't really supposed to do. But she illustrates every story and answer to a question with what happened to HER when she was pregnant, or how old SHE was at menarche, or what SHE'S doing for perimenopausal symptoms. I don't know if it's the fact that she does it at all or the fact that I've now heard it all multiple times a day for over a week that is driving me crazy.
-She's from Western KY, so she has an accent -- no big deal, everyone around here does. But she has some country turn of phrases that drive me crazy as well. Like, "Fair to middlin'" in response to "How are you?". She also says "mute point" and talks about putting her "John Henry" on documents. Seriously, she graduated magna cum laude from medical school but has been saying "John Henry" instead of "John Hancock" for almost 50 years!
There, I feel better now that I've gotten it out. Overall, I can't complain. She's a great teacher, even if I don't get to do much (but really, if I were going to my Ob/Gyn who I'd been seeing for 15 years, I wouldn't want a med student doing an internal exam on me, either). I am now very good at measuring fundal heights, though, which is trickier than it seems. She's also very frank and talks about the problems of the business of medicine, and of Ob/Gyn in particular, very willingly, which I find very interesting. But that's a discussion for another day.
Oh, and the best part about private practice? Office hours, 10-5. With a 7:30 am surgery thrown in a couple times a week, and some evening deliveries a couple times a week as well, but over all, it is not bad. For me, at least; she still rounds at the hospital every morning and takes overnight Ob call, but I don't have to do any of that, because as she says, my time will come soon enough.
Wednesday, July 18, 2007
Sick and nervous: addendum
Didn't have to go to work until 11:30, was done at 1:45 (and I won't tell you how many cases we got through in that time; needless to say, they're quick procedures). It was about how I thought it would be, and not nearly as bad as my weird dreams last night had me worried about. Next week I'm going to see more of patients' total experience, including the counseling they get.
Got my scores this morning at 10:30. First I got the mass email that said that people who failed had already been notified and that scores were available for everyone else. I passed! It took a few minutes to get the actual score back, but at least I passed! That is a HUGE relief. I'm going to be a doctor!* Now I get to figure out what kind.
Yay!
Oh yeah, and my cold meds are working beautifully, so I just have a hoarse voice and a little bit of a couch, but otherwise feel just fine.
*What's funny is that I've had that thought multiple times over the last few years. When I got my MCAT score back in 2004 (OK, I didn't actually think I was going to be a doctor at that point!); when I got my acceptance to UofL in 2005; and then again when I passed first year. Step 1 was just another obstacle in my path to ACTUALLY becoming a doctor, and there are still several more in the way.
Got my scores this morning at 10:30. First I got the mass email that said that people who failed had already been notified and that scores were available for everyone else. I passed! It took a few minutes to get the actual score back, but at least I passed! That is a HUGE relief. I'm going to be a doctor!* Now I get to figure out what kind.
Yay!
Oh yeah, and my cold meds are working beautifully, so I just have a hoarse voice and a little bit of a couch, but otherwise feel just fine.
*What's funny is that I've had that thought multiple times over the last few years. When I got my MCAT score back in 2004 (OK, I didn't actually think I was going to be a doctor at that point!); when I got my acceptance to UofL in 2005; and then again when I passed first year. Step 1 was just another obstacle in my path to ACTUALLY becoming a doctor, and there are still several more in the way.
Sick and nervous
The cold I caught last week on Onc (I don't think I mentioned it before because it wasn't that bad) is BAD. Every 12 hours I have to take 1 gram of Tylenol, 400 mg ibuprofen, 1 Mucinex, 4 tsp guaifenisen syrup and 2 sprays of a nasal decongestant. On top of that I take 2 sprays of Nasonex, just in case my allergies are making any of this worse, but this is beyond allergies. I might add loratadine to the allergy arsenal and pseudephedrine to the cold arsenal. Oh yeah, and I'm sucking down cough drops and mint tea like.... candy and water. And rubbing Tiger Balm under my nose. My voice is hoarse when it's even present, and I have coughing fits on a regular basis.
Did I mention I still have to go to work?
Bah.
I thought I was going to have today off because my private practice doctor doesn't work Wednesdays. But last night when I got home I had an email saying my elective Ab observations had been set up, starting with today. So last night, like any good medical student, I read up on the procedure, in preparation for being pimped. But none of my books really talk about it, surprise surprise.
So last night, I had the craziest dreams involving shadowy bomb-filled clinics, crazy instruments, ME being pregnant and delivering at University Hospital in front of all my classmates, being late for work today, AND failing boards.
Because did I mention we find out our board scores today? I was looking forward to being able to obsessively sit at the computer checking my email every 30 seconds until I got my scores, but now I'm going to be in surgery. Boo.
Argh. I AM feeling nervous about today. To get into the fenced-in clinic parking lot, they said I should type out "HELP" on the gate code box. That's reassuring. Across the street from the clinic, which is a nondescript medical office, is another clinic, the kind that advertises loudly that it offers pregnancy testing, termination counseling, and ultrasounds, which makes it the kind that doesn't perform terminations, but that offers ultrasounds to convince women not to get them. I've been told that protesters are not uncommon in front of the clinic I'm going to. They said I should just wear regular clothes, because I'm going to be changing into scrubs in the office. But I don't know that walking into a clinic of that type with my white coat on is the smartest idea anyway.
I've never been the slightest bit apprehensive about anything medical related -- blood, guts, gore, smells, and sounds don't bother me (OK, sounds probably bother me the most of anything. Like the sound of someone retching makes me want to retch. But seeing vomit doesn't faze me.). But THIS has my stomach all tied in knots. I guess it's because it's so not ordinary, even in the medical world. Everyone at school has been very professional and supportive of me choosing to do this extra bit of work for the rotation. And I'm sure it's going to be a good experience. But did it HAVE to be today? Isn't being sick and worried about board scores enough for one day?
In case you're wondering, Student Affairs is going to email everyone who failed at some point today. Then they're going to send a mass email to the whole class (ie, everyone who passed) giving the instructions for score retrieval. Apparently two years ago, they PAGED the people who failed. Imagine the horror -- your pager going off for everyone to hear! And of course, some people paged each other at the set time as a joke, which didn't help matters any. So now they use email. But at least with the pager you'd get the page no matter where you were!
So, wish me luck. Observing surgery all day is never an easy task, and when you're sick and worried and observing what I'm observing I'm sure it's no easier.
Did I mention I still have to go to work?
Bah.
I thought I was going to have today off because my private practice doctor doesn't work Wednesdays. But last night when I got home I had an email saying my elective Ab observations had been set up, starting with today. So last night, like any good medical student, I read up on the procedure, in preparation for being pimped. But none of my books really talk about it, surprise surprise.
So last night, I had the craziest dreams involving shadowy bomb-filled clinics, crazy instruments, ME being pregnant and delivering at University Hospital in front of all my classmates, being late for work today, AND failing boards.
Because did I mention we find out our board scores today? I was looking forward to being able to obsessively sit at the computer checking my email every 30 seconds until I got my scores, but now I'm going to be in surgery. Boo.
Argh. I AM feeling nervous about today. To get into the fenced-in clinic parking lot, they said I should type out "HELP" on the gate code box. That's reassuring. Across the street from the clinic, which is a nondescript medical office, is another clinic, the kind that advertises loudly that it offers pregnancy testing, termination counseling, and ultrasounds, which makes it the kind that doesn't perform terminations, but that offers ultrasounds to convince women not to get them. I've been told that protesters are not uncommon in front of the clinic I'm going to. They said I should just wear regular clothes, because I'm going to be changing into scrubs in the office. But I don't know that walking into a clinic of that type with my white coat on is the smartest idea anyway.
I've never been the slightest bit apprehensive about anything medical related -- blood, guts, gore, smells, and sounds don't bother me (OK, sounds probably bother me the most of anything. Like the sound of someone retching makes me want to retch. But seeing vomit doesn't faze me.). But THIS has my stomach all tied in knots. I guess it's because it's so not ordinary, even in the medical world. Everyone at school has been very professional and supportive of me choosing to do this extra bit of work for the rotation. And I'm sure it's going to be a good experience. But did it HAVE to be today? Isn't being sick and worried about board scores enough for one day?
In case you're wondering, Student Affairs is going to email everyone who failed at some point today. Then they're going to send a mass email to the whole class (ie, everyone who passed) giving the instructions for score retrieval. Apparently two years ago, they PAGED the people who failed. Imagine the horror -- your pager going off for everyone to hear! And of course, some people paged each other at the set time as a joke, which didn't help matters any. So now they use email. But at least with the pager you'd get the page no matter where you were!
So, wish me luck. Observing surgery all day is never an easy task, and when you're sick and worried and observing what I'm observing I'm sure it's no easier.
Sunday, July 15, 2007
Harry Potter
The movie was OK, not great. It was too rushed; it was a movie full of "telling, not showing" (thank you, Mrs. Thompson; that did sink in in freshman English), which is stupid, since the point of a movie is to show. The 3-D at the end was kind of cool, but definitely not integral or necessary, and the glasses gave me a headache. The movie was only 2 hours and 15 minutes long; an extra 15 or 20 minutes would have helped a whole lot and wouldn't have made the movie unbearably long.
*Spoiler alert. Don't read below if you don't want to know what happens.*
-They should have visited Mr. Weasley in St. Mungos for three reasons: 1) To visit him. Duh. Instead he gets attacked, and the next minute, he's home for Christmas. 2) To see Neville visiting his parents, Frank and Alice Longbottom to learn that Bellatrix Lestrange had Cruciatus-ed them into insanity (especially since they foreshadowed it in movie/book #4). Instead, Neville TELLS Harry about what happened to his parents, which is not what Neville would do at all. 3) To introduce a new, fun, magical place to the viewer. We haven't seen St. Mungo's before, and it's supposed to be pretty cool. Wow us with another aspect of the wizarding world when you have the chance!
-Yes, most people who are seeing the movie have read the book, but that's a bad assumption to make. Now you have dialogue such as, "For a moment when I was looking at Dumbledore, I wanted to..." You wanted to WHAT, Harry? Attack him because you were still feeling like the snake? We the viewer only know that because we read the book; I don't think a naive movie-goer would have gotten that message.
-Everything involving the Order was hurried. They could have taken two seconds to ensure that the viewer understood that Snape DID understand Harry's cryptic message and alerted the Order, but again, they're hoping that people who read the book know it and those who didn't don't notice it. In the beginning, they don't explain in any way that Harry is upset that he hasn't heard any news from Ron and Hermione; instead, when he arrives at headquarters, he SAYS that he's pissed that he hadn't gotten any letters. I'm supposed to believe that? You have a whole summer of frustration pent up? I didn't see any evidence of it before now.
-I would have liked a little more Little Whinging (they pronounced it and now I know that it's "win-jing" not "wing-ing") action. They should have had the part where Aunt Petunia receives her howler ("Remember my last, Petunia"). Not just because I'm being an annoying "they left out all the details from the book" kind of viewer, but because it ends up tying into continuity bits later on. Again, the movie was very rushed in the beginning, through the dementor attack, the Order arriving, and the hearing. I got the sense that the director for some reason had this urgent need to get us to Hogwarts, because a Harry Potter movie doesn't really start until you get to Hogwarts. Which isn't true.
-Big plot hole: They left out the scene where Ron, Hermione, Ginny, and Neville are introduced to the thestrals, which if you remember, can only be seen by Harry and Luna. Instead, they show all six kids flying to London, with no sense of the fear and nervousness the other four must be feeling about flying on something they can't see.
-No quidditch. Boo. They left it out completely.
-In every other movie, you get a sense that Hogwarts is awe-inspiring and amazing. I don't know if it was the camera work or the music, but I definitely did not get that in this movie. It was just blah Hogwarts, our boring school.
-They could have expanded on the Hogsmeade trip a little. You know, show all the kids lining up to go to Hogsmeade, the general excitement of a Hogsmeade day. Instead, they just walk into the pub like it's totally normal for people to leave the school grounds.
-I'm OK with the fact that they implicated Cho as the snitch about the D.A., but only because they exonerated her by saying it was due to veritaserum.
So, in conclusion, blah. I'm not excited about the fact that this director is doing the next movie, too. I've never LOVED the movies compared to the books, but I always thought they were good, you know? This one really just wasn't that great. Or maybe it was my wine-with-dinner and 3-D glasses headache that made me grouchy? I'll give it another chance in a few months after it comes out on DVD. Until then, I just have to let the excitement mount for the book! We pre-ordered a copy from Borders; whether we'll be attending the midnight release party remains to be seen.
*Spoiler alert. Don't read below if you don't want to know what happens.*
-They should have visited Mr. Weasley in St. Mungos for three reasons: 1) To visit him. Duh. Instead he gets attacked, and the next minute, he's home for Christmas. 2) To see Neville visiting his parents, Frank and Alice Longbottom to learn that Bellatrix Lestrange had Cruciatus-ed them into insanity (especially since they foreshadowed it in movie/book #4). Instead, Neville TELLS Harry about what happened to his parents, which is not what Neville would do at all. 3) To introduce a new, fun, magical place to the viewer. We haven't seen St. Mungo's before, and it's supposed to be pretty cool. Wow us with another aspect of the wizarding world when you have the chance!
-Yes, most people who are seeing the movie have read the book, but that's a bad assumption to make. Now you have dialogue such as, "For a moment when I was looking at Dumbledore, I wanted to..." You wanted to WHAT, Harry? Attack him because you were still feeling like the snake? We the viewer only know that because we read the book; I don't think a naive movie-goer would have gotten that message.
-Everything involving the Order was hurried. They could have taken two seconds to ensure that the viewer understood that Snape DID understand Harry's cryptic message and alerted the Order, but again, they're hoping that people who read the book know it and those who didn't don't notice it. In the beginning, they don't explain in any way that Harry is upset that he hasn't heard any news from Ron and Hermione; instead, when he arrives at headquarters, he SAYS that he's pissed that he hadn't gotten any letters. I'm supposed to believe that? You have a whole summer of frustration pent up? I didn't see any evidence of it before now.
-I would have liked a little more Little Whinging (they pronounced it and now I know that it's "win-jing" not "wing-ing") action. They should have had the part where Aunt Petunia receives her howler ("Remember my last, Petunia"). Not just because I'm being an annoying "they left out all the details from the book" kind of viewer, but because it ends up tying into continuity bits later on. Again, the movie was very rushed in the beginning, through the dementor attack, the Order arriving, and the hearing. I got the sense that the director for some reason had this urgent need to get us to Hogwarts, because a Harry Potter movie doesn't really start until you get to Hogwarts. Which isn't true.
-Big plot hole: They left out the scene where Ron, Hermione, Ginny, and Neville are introduced to the thestrals, which if you remember, can only be seen by Harry and Luna. Instead, they show all six kids flying to London, with no sense of the fear and nervousness the other four must be feeling about flying on something they can't see.
-No quidditch. Boo. They left it out completely.
-In every other movie, you get a sense that Hogwarts is awe-inspiring and amazing. I don't know if it was the camera work or the music, but I definitely did not get that in this movie. It was just blah Hogwarts, our boring school.
-They could have expanded on the Hogsmeade trip a little. You know, show all the kids lining up to go to Hogsmeade, the general excitement of a Hogsmeade day. Instead, they just walk into the pub like it's totally normal for people to leave the school grounds.
-I'm OK with the fact that they implicated Cho as the snitch about the D.A., but only because they exonerated her by saying it was due to veritaserum.
So, in conclusion, blah. I'm not excited about the fact that this director is doing the next movie, too. I've never LOVED the movies compared to the books, but I always thought they were good, you know? This one really just wasn't that great. Or maybe it was my wine-with-dinner and 3-D glasses headache that made me grouchy? I'll give it another chance in a few months after it comes out on DVD. Until then, I just have to let the excitement mount for the book! We pre-ordered a copy from Borders; whether we'll be attending the midnight release party remains to be seen.
Saturday, July 14, 2007
Sad oncology patients
1. Ms. X, a 40-something-year-old with a history of cervical cancer, now in complete remission. However, she had to have a complete pelvic exenteration, which would leave anyone's quality of life in a slump, and she kind of just never really recovered from a psychosocial standpoint, so she keeps coming into the hospital for pain and depression and other issues that aren't really related to her primary cancer anymore. I have to say, she's pretty pathetic looking: long, greasy hair, nasty hospital gown, colostomy bags and ureteral stents that she doesn't take great care of. Not helping matters any is her husband, who looks about 20 years younger than her (because he's healthy, showers, and gets haircuts, not because it's a May-December relationship), and who checks her into the hospital every couple of weeks when he gets tired of taking care of her and wants to have some time alone. Not appropriate. If he were any meaner, he would have already divorced her, but she depends on him for health insurance and his conscience is keeping him with her for now. He has already planned her funeral and has invited the office chemo nurses to it. Did I mention she doesn't have cancer anymore? He's asked about what happens if she stops eating and refuses her TPN, even though she has expressed no desire to stop eating or stop her TPN, and yesterday he asked for a hospice consult. The woman isn't dying, she's depressed. But that (or her husband) is going to kill her anyway.
2. Ms. Y, a 50-something-year-old with a history of cervical cancer who came in late last week for uncontrollable nausea and vomiting. She hadn't eaten anything in two or three days, had dropped from 85 pounds to 75, and refused to eat in the hospital, complaining of continuous nausea despite anti-emetics and pain meds. She refused to entertain the thought of a temporary feeding tube down her mouth, and refused TPN as well. She was really sad and pathetic looking, remaining curled up in bed, looking determined to will herself to die. After a couple of days of this and numerous conversations about why she needed to start eating, we gave her Marinol, and within 24 hours, she was a new woman. The last time I saw her, she was sitting up in bed, drinking a soda and Boost and eating a humongous chef's salad, asking to be discharged. Who knew the munchies could be so effective?
3. Ms. Z, whose cancer history and admitting diagnosis I never really understood, because the students were asked not to see her and she was only in the hospital for about 24 hours. I believe her cancer had recurred despite numerous cycles of chemo and she was probably admitted for nausea and vomiting or something like that. The attending ended up having the end-of-life conversation with her, and they all decided she would go to hospice. (Hospice, in case you don't know, is for people who have an estimated six months or fewer to live, and they receive palliative care only, either at home or at a long-term care facility.) It was fairly straight-forward; she was OK with the decision to enter hospice and I think, based on her records, pretty happy to be done with trying to fight an incurable cancer. The saddest part was that while we were sitting in rounds that afternoon, her nurse poked her head in to say that she had eaten a whole cheeseburger (an accomplishment). "Yay!" said the physician, "She can have all the cheeseburgers and ice cream she wants!" It struck me that she was now allowed to eat anything she wanted, because she was just waiting to die, and that was very, very sad. Even out-of-control diabetics are allowed to eat Twinkies once they enter hospice, because it becomes a "big picture" situation.
So my two weeks with GynOnc are over, and I got 12 full hours of sleep last night to celebrate. It was really interesting, pretty fun, educational, and of course exhausting. As luck would have it, my last day was the worst, a full 16 hours long. My take-home impression is that in-patient oncology isn't actually all that sad and depressing, because the patients are acutely ill and you're focused on the short-term treatments, not long-term discussions of life and death and their chronic conditions. I didn't get to see any of the oncology patients in the office, where more of the somber conversations would take place. Plus, not all the patients are as sick or complicated as the three above; plenty of them have minor disease, are healthy other than having cancer, take good care of themselves, or have really positive attitudes. Even if I did go into Ob/Gyn, I don't think I would do GynOnc, but nothing has been ruled out completely yet, which means I still have about seven months to figure out what I want to be when I grow up. Monday I start two weeks of following a private practice physician; she'll either let me do nothing at all and I'll just be shadowing, or else she'll let me do a lot and I'll be helping with surgeries and deliveries. I hope it's the latter!
2. Ms. Y, a 50-something-year-old with a history of cervical cancer who came in late last week for uncontrollable nausea and vomiting. She hadn't eaten anything in two or three days, had dropped from 85 pounds to 75, and refused to eat in the hospital, complaining of continuous nausea despite anti-emetics and pain meds. She refused to entertain the thought of a temporary feeding tube down her mouth, and refused TPN as well. She was really sad and pathetic looking, remaining curled up in bed, looking determined to will herself to die. After a couple of days of this and numerous conversations about why she needed to start eating, we gave her Marinol, and within 24 hours, she was a new woman. The last time I saw her, she was sitting up in bed, drinking a soda and Boost and eating a humongous chef's salad, asking to be discharged. Who knew the munchies could be so effective?
3. Ms. Z, whose cancer history and admitting diagnosis I never really understood, because the students were asked not to see her and she was only in the hospital for about 24 hours. I believe her cancer had recurred despite numerous cycles of chemo and she was probably admitted for nausea and vomiting or something like that. The attending ended up having the end-of-life conversation with her, and they all decided she would go to hospice. (Hospice, in case you don't know, is for people who have an estimated six months or fewer to live, and they receive palliative care only, either at home or at a long-term care facility.) It was fairly straight-forward; she was OK with the decision to enter hospice and I think, based on her records, pretty happy to be done with trying to fight an incurable cancer. The saddest part was that while we were sitting in rounds that afternoon, her nurse poked her head in to say that she had eaten a whole cheeseburger (an accomplishment). "Yay!" said the physician, "She can have all the cheeseburgers and ice cream she wants!" It struck me that she was now allowed to eat anything she wanted, because she was just waiting to die, and that was very, very sad. Even out-of-control diabetics are allowed to eat Twinkies once they enter hospice, because it becomes a "big picture" situation.
So my two weeks with GynOnc are over, and I got 12 full hours of sleep last night to celebrate. It was really interesting, pretty fun, educational, and of course exhausting. As luck would have it, my last day was the worst, a full 16 hours long. My take-home impression is that in-patient oncology isn't actually all that sad and depressing, because the patients are acutely ill and you're focused on the short-term treatments, not long-term discussions of life and death and their chronic conditions. I didn't get to see any of the oncology patients in the office, where more of the somber conversations would take place. Plus, not all the patients are as sick or complicated as the three above; plenty of them have minor disease, are healthy other than having cancer, take good care of themselves, or have really positive attitudes. Even if I did go into Ob/Gyn, I don't think I would do GynOnc, but nothing has been ruled out completely yet, which means I still have about seven months to figure out what I want to be when I grow up. Monday I start two weeks of following a private practice physician; she'll either let me do nothing at all and I'll just be shadowing, or else she'll let me do a lot and I'll be helping with surgeries and deliveries. I hope it's the latter!
Wednesday, July 11, 2007
Spent $300 in no time flat
Danskos are my new favorite thing in the world. When you're getting in your 10,000 steps per day (I used a pedometer the last two days to check), plus standing in surgery for five hours, your feet hurt. But not in Danskos! They were $115 and worth every penny. I still have yet to try Crocs, but I'll stick with these for now... at least until my student loan refund clears.
When I'm forced to spend money on stupid things like ugly comfortable work shoes and books (another $80 today) and have no free time whatsoever, I tend to spend my precious free time doing errands interspersed with shopping. And I tend to buy a lot of clothes, I've realized. I plow through clearance racks at Old Navy, Banana Republic, Ann Taylor, and J Crew like a pro, seeing if things meet my mental requirements, and throwing things on in the dressing room. My purchases tend to be impulse buys, but I justify them because I am very busy and very poor and only buy things if they're the right price (and I am a BARGAIN shopper!). So this weekend I got (among other things) this dress:
It's way too dressy for work, and I don't really have anywhere else to wear it (maybe a wedding or two in September if I can get off from surgery?), but it was only $40, so how could I pass it up? Makes sense to me, anyway. I had to go to a different Ann Taylor today to try it on in a different size, and this shopping center had a J Crew, so of course I popped in just for a look, and ended up buying a pair of shorts on clearance for $9.99 plus an additional 25% off.
Do I need shorts? No. Do I ever have any occasion to wear shorts? Not really. But $7.49 for a pair of J Crew shorts? Can't pass that up!
And now you know my illness. I have a closet full of great-deal clothes that I could wear if I had the life I like to pretend I had (some sort of office job wear you get to wear cute-but-professional suits, go on yachting outings on the weekends, eat fancy dinners at night, have romantic rendez-vous on the beach, and never, ever, ever sweat), but hardly ever wear because I don't have that life and even when I do need to wear clothes for those kinds of activities, I wear other things instead.
And speaking of clothes, I'm lucky in that I get to wear scrubs on this particular rotation, which makes waking up at 3:45 slightly more bearable. The bad thing, though, is the hospital NEVER has any small scrubs, and doesn't appear to want to order more (but they carry plenty of L, XL, and XXL!), but I finally found some smalls the other day and stole a pair in addition to the pair I changed into. Now usually when you wear hospital scrubs, you can just bring them back to the locker room and throw them in the hamper and the hospital will wash them (in reality, you're not supposed to leave the hospital with them, but everyone does). But if I ever want to have small scrubs again, I can't let these two pairs leave my possession, so I still have to do my own scrubs laundry at home. Boo.
*******************
We operated on a woman yesterday with a BMI of 53. She was 5'2" and 290 pounds. Not only did that mean me getting to retract her pannus (representative images here), but it also meant that none of the surgical equipment was big enough to do her surgery; the attending and resident were trying to do a hysterectomy essentially blind, reaching their arms in and feeling for what they hoped were the right structures, then tying and cutting. Her uterus came back positive for cancer, which meant we should have taken out lymph nodes for staging, but after moving aside all her fat and bowels and more fat, we couldn't tell what was fat and what was nodes, so she's going to get radiation instead. Being morbidly obese is a serious issue for a variety of reasons, the one I learned yesterday being that you get suboptimal medical care out of necessity -- if it's not physically possible to do your surgery correctly, it won't get done.
*******************
In a magical stars-aligning-perfectly occurrence today, I was let free at 11 am. 11 am! What's crazy is that was still a 6-hour workday; I still cannot get over my alarm going off at 3:45 am. So now I have all afternoon and evening to study, run the dishwasher, do laundry, and clean the apartment. Except what I'm actually going to do is nap, and if napping at 4 pm turns into sleeping through the night, all the better.
When I'm forced to spend money on stupid things like ugly comfortable work shoes and books (another $80 today) and have no free time whatsoever, I tend to spend my precious free time doing errands interspersed with shopping. And I tend to buy a lot of clothes, I've realized. I plow through clearance racks at Old Navy, Banana Republic, Ann Taylor, and J Crew like a pro, seeing if things meet my mental requirements, and throwing things on in the dressing room. My purchases tend to be impulse buys, but I justify them because I am very busy and very poor and only buy things if they're the right price (and I am a BARGAIN shopper!). So this weekend I got (among other things) this dress:
It's way too dressy for work, and I don't really have anywhere else to wear it (maybe a wedding or two in September if I can get off from surgery?), but it was only $40, so how could I pass it up? Makes sense to me, anyway. I had to go to a different Ann Taylor today to try it on in a different size, and this shopping center had a J Crew, so of course I popped in just for a look, and ended up buying a pair of shorts on clearance for $9.99 plus an additional 25% off.Do I need shorts? No. Do I ever have any occasion to wear shorts? Not really. But $7.49 for a pair of J Crew shorts? Can't pass that up!And now you know my illness. I have a closet full of great-deal clothes that I could wear if I had the life I like to pretend I had (some sort of office job wear you get to wear cute-but-professional suits, go on yachting outings on the weekends, eat fancy dinners at night, have romantic rendez-vous on the beach, and never, ever, ever sweat), but hardly ever wear because I don't have that life and even when I do need to wear clothes for those kinds of activities, I wear other things instead.
And speaking of clothes, I'm lucky in that I get to wear scrubs on this particular rotation, which makes waking up at 3:45 slightly more bearable. The bad thing, though, is the hospital NEVER has any small scrubs, and doesn't appear to want to order more (but they carry plenty of L, XL, and XXL!), but I finally found some smalls the other day and stole a pair in addition to the pair I changed into. Now usually when you wear hospital scrubs, you can just bring them back to the locker room and throw them in the hamper and the hospital will wash them (in reality, you're not supposed to leave the hospital with them, but everyone does). But if I ever want to have small scrubs again, I can't let these two pairs leave my possession, so I still have to do my own scrubs laundry at home. Boo.
*******************
We operated on a woman yesterday with a BMI of 53. She was 5'2" and 290 pounds. Not only did that mean me getting to retract her pannus (representative images here), but it also meant that none of the surgical equipment was big enough to do her surgery; the attending and resident were trying to do a hysterectomy essentially blind, reaching their arms in and feeling for what they hoped were the right structures, then tying and cutting. Her uterus came back positive for cancer, which meant we should have taken out lymph nodes for staging, but after moving aside all her fat and bowels and more fat, we couldn't tell what was fat and what was nodes, so she's going to get radiation instead. Being morbidly obese is a serious issue for a variety of reasons, the one I learned yesterday being that you get suboptimal medical care out of necessity -- if it's not physically possible to do your surgery correctly, it won't get done.
*******************
In a magical stars-aligning-perfectly occurrence today, I was let free at 11 am. 11 am! What's crazy is that was still a 6-hour workday; I still cannot get over my alarm going off at 3:45 am. So now I have all afternoon and evening to study, run the dishwasher, do laundry, and clean the apartment. Except what I'm actually going to do is nap, and if napping at 4 pm turns into sleeping through the night, all the better.
Sunday, July 08, 2007
GynOnc Week 1 Update
Friday ended up being a 16-hour day, since the surgery that was supposed to start at 10:30 am didn't start until 4:30 pm, and lasted three and a half hours. It was pretty cool, though, since they took a 10-pound tumor out of a woman's pelvis that ended up being papillary serous adenocarcinoma of the left ovary. I scrubbed out to follow the tumor to pathology, which was pretty interesting, but then I couldn't scrub back in and just stood behind all the surgeons unable to see anything for two hours. Not cool.
Saturday I *only* had to be there by 7 am, and I *only* had to stay 6 hours. Yay!
Back again tomorrow at 5... My goal for this week is to actually study outside of being at the hospital, and, more importantly, to figure out how to behave like a normal human being when I'm
at home so Eric doesn't think I'm a zombie.
Saturday I *only* had to be there by 7 am, and I *only* had to stay 6 hours. Yay!
Back again tomorrow at 5... My goal for this week is to actually study outside of being at the hospital, and, more importantly, to figure out how to behave like a normal human being when I'm
at home so Eric doesn't think I'm a zombie.
Friday, July 06, 2007
GynOnc
Monday: 6 am - 3 pm. Saw a TLH/BSO. Took a fall-asleep-instantaneously nap for two hours, went to CarlyRae's for dinner to try it out, picked up Eric from the airport, went back to sleep.
Tuesday: 5 am - 1 pm. Went to the Zappo's outlet in Shepherdsville, didn't find any good shoes, then took a fall-asleep-instantaneously nap for two hours.
Wednesday: Off for the 4th. Slept, showered, made potato salad and ate buffalo wings.
Thursday: 5 am - 6 pm. Scrubbed on a mini lap / LSO for a 12 cm benign ovarian cyst. Went to clinic for 3 million hours and saw a bunch of initial OB visits, annual pelvic exams, and some crazy, crazy women. Discovered that saying, "I'm sorry I can't do anything to help you, I'm just a medical student" can be useful in certain situations. Picked up a burrito from Qdoba, fell asleep halfway through Good Eats at 7:15 pm and essentially slept straight through the night, waking up just once to move from the couch to the bed.
Today: 4:30 am - ? Got sent away at 10:30 to "read for two hours, then eat lunch, then come back" and interpreted "read" to mean "go home, eat a nice breakfast, and take a nap." Scrubbing on an exploratory lap for a 25 cm abdominal mass of uncertain etiology this afternoon. We're splitting the weekend up so I only need to go in tomorrow and I get Sunday off. And there aren't any surgical cases tomorrow, so I just need to stay until we're done rounding. Yay!
I am alive and barely functioning. I have no range of emotions, just a deadpan let-me-get-through-this state. This morning, one of my teammates ran into another third-year student on surgery and asked how it was going. She told us that he said he usually had to get there "early, by 5 am" and the three of us all commented, "That's not so bad. Definitely doable." WTF? When did I go through this complete personality change that lets me say 5 am is a reasonable time to have to be somewhere? Not cool.
Tuesday: 5 am - 1 pm. Went to the Zappo's outlet in Shepherdsville, didn't find any good shoes, then took a fall-asleep-instantaneously nap for two hours.
Wednesday: Off for the 4th. Slept, showered, made potato salad and ate buffalo wings.
Thursday: 5 am - 6 pm. Scrubbed on a mini lap / LSO for a 12 cm benign ovarian cyst. Went to clinic for 3 million hours and saw a bunch of initial OB visits, annual pelvic exams, and some crazy, crazy women. Discovered that saying, "I'm sorry I can't do anything to help you, I'm just a medical student" can be useful in certain situations. Picked up a burrito from Qdoba, fell asleep halfway through Good Eats at 7:15 pm and essentially slept straight through the night, waking up just once to move from the couch to the bed.
Today: 4:30 am - ? Got sent away at 10:30 to "read for two hours, then eat lunch, then come back" and interpreted "read" to mean "go home, eat a nice breakfast, and take a nap." Scrubbing on an exploratory lap for a 25 cm abdominal mass of uncertain etiology this afternoon. We're splitting the weekend up so I only need to go in tomorrow and I get Sunday off. And there aren't any surgical cases tomorrow, so I just need to stay until we're done rounding. Yay!
I am alive and barely functioning. I have no range of emotions, just a deadpan let-me-get-through-this state. This morning, one of my teammates ran into another third-year student on surgery and asked how it was going. She told us that he said he usually had to get there "early, by 5 am" and the three of us all commented, "That's not so bad. Definitely doable." WTF? When did I go through this complete personality change that lets me say 5 am is a reasonable time to have to be somewhere? Not cool.
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