VA Wards

I'm at the VA Hospital for my first month of medicine. It's not bad overall, but the VA system itself is pretty funny if you stop to think about it. Most of our vets are old -- my youngest patient so far is 50 years old, and our oldest is 84 or 85. And of course, most are men. The entire hospital is on a computer system -- all notes and orders are done online, which is very innovative from a systems point of view, very helpful from an access-to-old-records point of view, but still has some downsides, like tending to promote care coordinated from the team's computer room, rather than forcing interactions between nurses and physicians, or even better, physicians and patients. I've been back at the hospital for less than a week; here are the highlights so far:

• Ms. G., an 84-year-old woman who served at Normandy. Isn't that cool and crazy at the same time? She was a psych nurse at University Hospital before WWII, then was a pscyh nurse at Normandy during the invasion. Female vet patients, at least at our VA hospital, are few and far between. She has a lot of very cool stories to tell.
• Mr. C., a 70-something-year-old man we sent home today. This morning on rounds, our attending asked how his wife was doing. "Oh, she's doing pretty good," Mr. C. replied. "I talked to her on the phone yesterday. She's at home. That's why I want to get home so badly." We nodded in sympathy. "When you've been married to the same woman for 53 years, it's hard to spend even a few days away from her." Everyone together now: awwwwww.
• I did something very doctory but not fun: I helped pronounce a dead guy. When we were on call Friday night, my intern got a page that a hospice patient had died and needed to be pronounced. Like a good student, I tagged along. We met the nurse, who told us it had happened very peacefully, no big deal (the patient had an extensive head/neck cancer). I was very nervous as we approached the room -- it's the first time I've been around a dead person since pathology last year. But the patient did look very peaceful, in his pajamas, just lying there. The intern took out his stethoscope, and I realized I hadn't brought mine along. I kind of wanted to ask to borrow his, but thought it would sound stupid -- it's OK to ask to borrow someone's stethoscope if you have a legitimate teaching case (cool murmur, etc), but to hear... nothing? It didn't seem right. So I put on some gloves and checked for pulses instead. It was definitely weird to be checking for an absence of a pulse, rather than for the quality of a present pulse or even for the presence of a pulse at all. In a cool-in-a-medical-TV-show kind of way, I was asked to state the time of death, which was sort of creepy, too. Oh yeah, it was also his birthday, which was kind of weird/spooky. I guess the best teaching aspect of that patient was that I listened to the intern call the patient's family to break the news. "Breaking bad news" is an exercise we had to do last year with standardized patients, but I think I told someone they had a non-fatal illness, not that their father had died. Yeeks, in a couple years it'll be me doing that...

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In other news, Eric is getting his stuff packed up, and we're slowly getting things figured out for his move back east (have I mentioned that he got a new job back in NJ? I can't remember and don't feel like looking back to check). We reserved a moving truck last night, he's been on the phone with prospective roommates/landlords near Atlantic City, and this evening we're showing his car to a prospective buyer (we have a new car lined up in Pennsylvania already, so there was no sense in driving Vito (his car; mine is Tammy) back east just to sell it.

I just need to run to the liquor store to pick up some more boxes, and consolidate some of the office stuff into the bedroom so I can try to find a roommate as well. We might leave the extra bedroom empty until July at the latest, when the new first-year med students would be looking for a place. Me covering all the rent by myself for the next six months and then getting a roommate is still cheaper than me getting a smaller apartment and paying all the rent myself for the next 16 months -- that was a cool algebra equation we figured out.

On the one hand, being apart for the next 16 months is going to suck, but on the other hand, I can already tell it's going to go very quickly. I'm supposed to be figuring out my fourth year schedule very soon, and the wedding planning has entered legitimate planning/timeline mode, so time is probably going to pass a lot faster than we think! It's a weird feeling to be stressing out about what rotation I'll be doing in March 2009 and what our wedding invitations are going to look like when at the same time I have no idea what I'm going to eat for dinner tonight.