Engaged! Ack!

It's been less than two weeks, and already I see why wedding planning is so insane. It's great when you're just the planner and not the bride. It's really, really, really bad when you're the planner, the bride, and the medical student on surgery. Here's my to-do list:

1. Pick a location. For both the ceremony and the reception. The first part is contingent on a decision the groom has to make, and the second part is contingent on available dates and prices.

2. Pick a date. We're thinking May 2009. Derby is May 2, I graduate May 9, and that leaves the weekend of the 16th or the 23rd (Memorial Day). I hope the 23rd works out.

3. The dress. Again, price is probably the biggest factor here. But didn't you know I have a love of bargain hunting? And haven't you heard of the Filene's Bridal Gown Event (aka "The Running of the Brides")? And what's that? You see that the next such event is in my past homebase of Mercer County, NJ? On Friday, October 19, when I will conveniently already be home for my fall break? All I need is a couple people as crazy as I am to help me navigate the madness. (In all likelihood, I won't be attending. But they haven't announced the dates for the 2008 events yet...)

4. Everything else. Which normally doesn't get worried about for quite a few months, but which I would love to start worrying about now, except I have no time to worry about anything. So there it goes, back to the back burner. The only problem is, I have to think about SOMETHING when I DOhave a minute to think about the wedding, so I tend to focus on tiny details, since it's too out of my hands to think about the big stuff (#1-3 above). So now I ponder DIY centerpieces (potted herbs? self-arranged flowers in charming containers?), decorations (plain or flowered pew bows?), and themes (a monogram? a whimsical design or motif? which of the million shades of purple or pink would work best, and with what complementary color?).

The bargain hunter and DIY-er in me has been waiting for this moment for 26 years. I can already anticipate needing to buy a new pair of floral shears, plenty more ribbon, and frequenting that paper store I saw in Clarksville a couple months ago. Not to mention the wonders of the Internet for ordering bulk everything -- flowers, paper and cardstock, ribbons, and knick knacks galore. I'm definitely going to need to find someone who can get me a copy of Photoshop and the use of a nice printer. If only my 8-year-old printer would give out, I could justify buying a nice, new one. But alas, that thing still works beautifully, if not quite high-quality enough to print, say, invitations or even envelopes.

But my No. 1 complaint right now is that I bought 3 wedding magazines, acquired a wedding planning book, and discovered this great website, and can't read any of it. Because don't you agree that reading this:

is so much more interesting than reading this:


?????
Yeah, I thought not.

More OB Addendum

Forgot about this...

Times I encountered heavy police presence while going to work:
-My very first day, when I walked to the hospital at 4:45 am (already nervous about that), and was stopped by 3 different police officers who sent me on various detours. It turns out there had been a bomb threat at nearby Norton's Hospital, and they were trying to keep me away from that building.
-My second-to-last week, when about 50 police cars were stationed in a two-block radius around the hospital, and I saw one police officer holding a large and very scary-looking rifle. After I got inside, the hospital went on lockdown because there were two men with AK-47s reported as being either inside the hospital or in the vicinity. Always reassuring. At least I was on the labor/delivery/nursery floor, which is always on lockdown anyway. They eventually caught the guys.

More OB

This is a new iteration of a post I began to write Friday night on my last overnight shift, while NO babies were being born (I think I've mentioned a few times how dead my night shifts were, but it was actually pretty ridiculous how slow it was).

My Ob/Gyn rotation is over -- the clinical aspect of it, anyway. We have lectures and study time this week, and an exam on Friday, but I'm not going to be seeing any more vaginas for a while.

Notable body fluids I came in contact with over the last 7 weeks (skip down to the next section if you are easily disturbed):
-The mucous from the inside of an ovarian tumor
-Urine. It would be nice to be able to pee prior to giving birth, so that when the doctor pushes down on your abdomen to help deliver the placenta, pee doesn't shoot out everywhere. But not everyone gets what they want in this world.
-Blood, most notably from vaginas. Vaginal deliveries are necessarily bloody, and that's easy enough to deal with. The most shocking thing that occurred, however, was when a woman had a placental abruption practically all over my feet. I have never seen so much bright red blood appear out of nowhere before. Needless to say, that became an emergency C-section, and we got the baby out just in time, with a 1-minute Apgar of only 1 (the 5-minute Apgar was 5 and the 10-minute one was 8, so the baby's doing well).
-Amniotic fluid, both the clear and meconium-filled kind. And I didn't just come into contact with it so much as had it burst all over and at me on multiple occasions. When a woman is laboring and you are preparing to deliver her baby but her membranes haven't broken, be sure you're wearing full waterproof protective gear before standing anywhere near her spread-open legs. And if you don't have your gown and gloves on all the way but a baby is sliding out, go ahead and catch with your ungloved hand still inside the sleeve of the gown (the wristband of which is the only non-waterproof part of the whole getup) and think about the 98.6-degree amniotic fluid soaking your arm. At least it's sterile, right? And finally, if you are ever acting as second assist in a C-section, you'd better be damn sure to wear a face mask that includes an eye shield, because when the surgeon cuts through those membranes with that scalpel, a steady stream of fluid is going to be shooting right at your face. Quick reflexes come in handy!
-Vaginal discharge during my first pelvic exam. And not just any vaginal discharge. The most disgusting, watery, pooled-at-the-back-of-the-vagina-and-dripped-out-the-end-of-the-
speculum-while-I-was-taking-the-Pap-sample-and-fell-on-the-floor kind of discharge. I don't even know what that liquid was, but I'm pretty sure it had something to do with the fact that she had a BMI well over 35 and her thighs didn't normally ever separate to let the stuff out. Are you disgusted? I was, too. My resident even offered me the chance to back out of it before I did it (just based on the patient's general body habitus she could tell it was going to be a bad pelvic exam), but congratulated me once I was done.
-Stool. Not coming from any laboring women's rectums (which I have seen before, just not in these past two weeks), but from many a colostomy bag on the oncology floor. Disgusting. At least I never did actually have to touch it, not even the bags, but looking at it was definitely enough.
-Fat. Fat patients are not fun to do surgery on, especially when your role in the surgery is to retract the fat. But hey, what else are third-year med students really good for?

Notable craziness I encountered:
-I saw at least three of my clinic patients on the labor floor, which was really cool. They were so excited to see a familiar face and didn't even care that I wasn't a doctor (see previously recounted story here). I almost got to deliver one of them (stupid shift change) and showed another the first glimpse of her baby on ultrasound (there had never been so many screams of joy coming from a room!).

-Had a patient abrupt all over my feet (in case you didn't read the story above), which was beyond crazy. She came in at 35 weeks with no prenatal care (bad), complaining of lower abdominal pain. Her fetal heart tones (FHT) were in the 140s (good), and then we took the monitor off to get an ultrasound. We saw a couple clots in the placenta on the ultrasound, but everything else looked normal and the intern told her she suspected round ligament pain and was just going to recheck the FHT and send her home. But the FHTs were in the 100s (very low for a baby, and not good), and we were sure we were picking up the mother's pulse instead, despite moving the monitor all over to try to pick up the baby. All of a sudden, the patient moaned something about something not feeling right, and we all looked at her pelvis and saw at least a pint of blood splashed all over the gurney, the floor, and very close to my shoes. Yikes! She started crying, the nurses started running around, I started having a silent heart attack, and the intern kept calm and got things going (at least, she looked like she was calm; she told me later she was having the same heart attack I was). So back for an emergency C-section we went, and although the baby came out just in time (Apgars of 1 at 1-minute and 5 at 5-minutes; not so great), everything turned out OK. And I got to staple her incision shut, yay!

-I clipped one side of a woman's tubes. It was pretty cool that I got to do that, but it is now time once again for my standard plea for anyone I know to never go to a teaching hospital unless you have a strange, rare disease or are in imminent danger of dying. Because really, do you want ME doing half of your tubal ligation? And sewing your skin shut? Even if I did a pretty good job of it, by all accounts? I didn't think so. I still have occasional palpitations that I didn't put the two clips close enough together, or that I didn't clip one of them all the way. At least it's not MY name on the operative report, so she can't sue me when she gets pregnant again (which I sincerely, honestly, 100% hope she does not!).

-I delivered four placentas in all, but no babies. I had no expectation of catching the first baby, it being the first one, but the second one tricked me by slipping out before we were gowned up, thereby causing the chief to admonish me to finish gowning while the intern exposed herself to the full onslaught of unprotected blood and amniotic fluid. I guess the department carries insurance for harming residents, but not med students. Oh well, I did sort of help catch that baby with my ungloved hand (see above). Yay, placenta delivery. The third baby popped out with just the nurses in the room, but the chief popped his head in, looked at me and said, "Why don't you deliver the placenta?" Yay, gowning up for a placenta. The fourth woman delivered at home with EMS on the scene (you shouldn't come to the hospital too early, all you "I'm having contractions every 10 minutes, help!" patients, but you can't wait too long, either!), but they were nice enough to bring her in to have us deliver the placenta. That night, the labor deck was so dead that I jumped at the chance to deliver the placenta, and got my wish. I had no help whatsoever and next to no supervision. As I massaged her fundus and tugged gently on the cord dangling between her legs, I was overwhelmed for a minute with pride that they trusted me enough to do the job by myself. Then I realized that this was one of the most menial jobs there was that actually still involved touching another human being, and there was pretty much nothing I could do to screw it up, and since the baby had already been born, none of the residents even cared to poke their heads in. It's nice to have your place in the order of things reaffirmed every once in a while, you know.

-And lest you think my life as a third-year medical student is a complete waste, I did manage to teach some of my patients a few things. Like on Saturday, my last morning, when I rounded on K.T., an 18-year-old who had had an emergency C-section three nights previously at 28-and-5-weeks' gestation for breech presentation, active labor, and an incompetent cervix (when they pulled the baby out, they flopped it on her pelvis while they dealt with the cord, and I got to suction its nose and mouth. Yay.). A day earlier, she had spiked a mild temperature so we checked a urine sample, which showed she was dehydrated and had either a UTI or skin contamination. We talked about a bunch of stuff, then I turned the conversation to the urine:
Me: So, we checked your urine and it shows that you're dehydrated and maybe have a UTI. You should probably stop drinking so much Sprite and try drinking some water instead.
K.T.: OK, I'll try. You know, there was blood in my pee.
Me: Yeah, I saw that. Did you clean yourself really well before you peed in the cup?
K.T.: Yeah. There was also tissue in the blood.
Me, thinking: It's normal for post-partum women to pass bloody tissue from their vagina (aka lochia). This sounds like a non-clean-catch urine specimen.
Me: Are you sure the blood came from your pee, or did it come from your vagina?
K.T.: It came from my pe -- wait, what do you mean?
Me: Did the blood come out in your pee or did it come from your vagina?
K.T.: What do you mean? There's two different places?
Me: Um... Yeah, you have TWO holes down there...
K.T.'s sister: You know, one's where the pee comes out and the other is where the blood comes out!
K.T.: Looks confused
Me: Here, let me draw you a picture...
... See, this is where the pee comes out (pointing to blue arrow), and this is where blood and babies come out and penises go in (pointing to green arrow).
K.T.: WHAT?!!? I have two holes down there?
K.T.'s sister, cackling uncontrollably: You don't know your own cootch! You don't know your own cootch!

There you have it, folks. I complained that medical professionals didn't do enough patient education, so I get to educate. Some people operate, some people save lives, and others do 4th-grade sex ed at 5 am on a Saturday to teenagers who have been pregnant three times and still don't know where pee comes from.

~~~~~~~~~~~~~~~~~~~~
Despite all the dire warnings that I was bound to hate my first rotation, I actually pretty much liked it all around, crappy hours and all. Ob/Gyn is definitely on my short list of career possibilities, so we'll see what the rest of the year does to change my mind.

And now, back to our regularly scheduled program

Never fear, an account of Saturday night's events will be posted soon, once the appropriate documentation has been gathered. In the meantime, back to medical school...

Here are some things I've been reading that you should read, too.

With a heart back from the brink, Southern Indiana man faces recovery and a new lifestyle
Eric's heart surgery story. Damn, he's a good writer

The Score
I read this article at the beginning of my Ob/Gyn rotation and found it really interesting. The other night, at the end of my rotation, I read it again, from a new perspective after seven weeks of actually doing this stuff. More detailed than the average article published for the lay audience, but it is the New Yorker. I hadn't heard of Dr. Gawande before, not being a regular New Yorker reader, but two of my friends say he is the best, so I might have to find some more of his stuff.

Ah Yes, Medical School
This blog by a just-graduated medical student had apparently gained some notoriety by the time he graduated in May. I was passed the link by a really awesome attending who thought I would enjoy it, but in typical doctor CYA mentality, warned me that it contained curse words. I hate that CYA mentality. Some of the guy's entries are graphic, a lot contain curse words, but it's also pretty damn funny. I started at the beginning and read through halfway into his third year the other night at 2 am while NO babies were being born, and here are the best of the entries I saw (he doesn't provide individual entry links, but you can search within his blog for them):
-Hypertalkers, Sept. 13, 2003 -- Apparently my med school class isn't the only one with this problem
-The Interview Day, Nov. 3, 2003 -- Good advice for all interviewing pre-meds
-If Darwin Only Knew, Dec. 3, 2003 -- An expansion on the Hypertalkers issue
-Holy Fucking Shit, Feb. 3, 2004 -- Obey the disclaimer at the top of the post and don't read if you can't handle very graphic medical stories. It's kind of weird to think about all the stuff I and every other doctor-in-training has gone through that most of the public just absolutely would not want to know about
-It Could Have Been Worse. I Think, Sept. 23, 2004 -- This made me glad we exclusively use standardized patients for our physical exam skills
-Taking A Trip Down Hershey Drive, Oct. 14, 2004 -- I'll tell you right now, this is about rectal exams
-The FIHTTTU Status Exam, Feb. 27, 2005 -- Thank goodness Step 1 is behind me, but in case you didn't get a sense of how crazy I was in May, this will give you another glimpse of it.
-Faking It, April 16 2005 -- For the first two years, I, too, faked physical exams. I aced my OSCE by simply going through the correct motions of physical exam techniques. I have never, ever seen a retina, but I know how to use the ophthalmoscope to make it look like I can! Well guess what, now I can't fake it anymore. Dammit.
-Tales From The... Ah Fuck It, May 20, 2005 -- Another glimpse into Step 1 studying. Wow, I cannot believe that just three months ago, that is what my life was like. With some minor edits, of course
-Tales From The Crypt VI: Yes, This Actually Happened, June 24, 2005 -- This story is 100% hilarious, and has nothing to do with medicine
-Oh, The Places You'll go, June 27, 2005 -- A description of this kid's lecture hall, complete with diagram, is amazingly similar to our own lecture hall and its inhabitants. Our Question Girl was instead named the Grand Inquisitor, but sat in almost the exact same spot!
-Glory, August 8, 2005 -- You think 3rd-year medical students are important? Think again.
-A Special Guide to Laryngoscopy, August 17, 2005 -- Hilarious, but sexual in nature, so don't read if you don't like the humor of the average 24-year-old male.
-NSWTHAIGTDWML-O-Meter, Sept. 2005 -- A great story of why he can't be an anesthesiologist, with the same magazine-reading observation Eric had.
-Eagle Eyes, August 27, 2005 -- Yeah, third year med students are pretty stupid, me included.

We interrupt our regularly scheduled programming...

...of whining about work to bring you this special announcement:

I have at least two blog entries in the works, one of which was written the other night at 2 am while NO babies were being born, but all that has been put on hold for the moment so I can inform you that:

Eric and I are engaged!

If you're planning to become engaged anytime in the future, I have some words of advice for how to celebrate. Please eat a full dinner prior to opening any bottles of wine or champagne, and limit your champagne consumption to 1 bottle split between the two of you, not two bottles, while you call all your family and friends. When you later meet up with friends to celebrate, remember that you are already quite beyond your limit and drink your three cocktails slowly. Better yet, don't have three cocktails. Although, if you're still going to, I must recommend the Capri Martini at Proof on Main as a must-try. I only recommend this so that you don't spend your first full day as a bride-to-be with a hangover the size of Washington (state, not city).

Whatever, who am I kidding? It was still totally worth it :)

The better question is how I am going to study for my Ob/Gyn shelf exam this week. Talk about major study distractions!

Nights off

I finished my day shifts Saturday, so Saturday evening we went out to dinner and saw Bourne Ultimatum. It was really, really, really good. Definitely better than the second one, possibly better than the first. Go see it.

I started night shifts on Sunday night, so I slept until noon on Sunday, then took a nap around 4 to prepare for an all-nighter beginning at 5 pm. It was really slow on the labor deck that night (no babies) so I ended up taking another nap on a row of chairs from 4 - 4:30 am (sounds like my last weekend at the airport). By the time I got home at 8 am Monday morning, I was ready to crash, and I slept soundly until 3:30 pm. That would have been almost perfect, except last night was my night off (we each get one off during the week of nights), so I didn't know what to do with myself once I woke up. I ate "breakfast" around 5, grabbed dinner with a friend around 9:30, and went out to a bar to meet new first year med students around 10:30. Two hours and two Cape Cods later, I was tired. Not a good sign when in theory I should have tried to stay up as late as possible. Nevertheless, I fell asleep at 1:30 last night (Tuesday morning) and woke up at 9:30 this morning. Which means I woke up at a normal time and am wide awake, but need to stay up all night again tonight, which means I'm screwed.

So now I need to lull myself back to sleep -- not just a nap, but sleep -- for the next 3 hours. I'm hoping a hot shower, glass of warm milk, and eye mask will do the trick.

At least I only have to do a week of nights. The time will soon come when I'll be on a month -- or two! -- of all nights. That just seems miserable. Really, why did I sign up for this again?

*********************************
It's really hot here. Right now it's 97 degrees out, with the heat index making it feel like 106. Thursday is supposed to be our high for the week, with actual temps of 103 and no predicted heat index at the moment. Of course, my car A/C is broken, which made driving to work last week miserable (even though it's less than a 5-minute drive). Now it's in the shop, so I have to walk to work tonight, which is not going to be fun. Apparently only Atlanta is feeling higher temps than Louisville right now.