An Open Letter to Jo-Jo at Capital One

JO-JO, hon, I'm sorry to break this to you, but people at your work (that being Capital One) don't like you. You know?

You may wonder, dear double-Jo, how I, a stranger from North Carolina, (when you clearly reside in the Midwestern part of the country) should come by this information. The answer is simple: Capital One has apparently, in some new-fangled, reality-TV inspired move gotten rid of 'on hold phone Muzak' in favor of just putting the customers on speakerphone so they can hear the private conversations of employees.

Either that or someone pushed the wrong button.

As another note to you, Jo squared, Capital One used to be friendly and helpful, and they would call me when they saw I'd been charged twice for the same thing. Now, it is apparently MY responsibility, AND I get chastised for not calling the merchant myself (good luck getting anyone at Paramount's Carowinds to care), and THEN they put you on speakerphone for five minutes and let you listen to some angsty teenaged Midwestern chick complain about Jo-Jo and apologize to another angsty teenaged Midwestern guy for ignoring him all day. ("It wasn't my fault, you know? I was in my meeting, then at break and I wasn't up here, you know? So, I wasn't, really, like ignoring you, okay? I just didn't see you, you know?")

I'm sorry to crush your world, Jo-Jo. But you've been warned...

Guess What I Just Did?

Ha! I finally took my emergency medicine test! And let me tell you this: I guarantee that there will be people in our class who cheat on this test. They give us two weeks to take it, on our own computers, anywhere in the hospital. Yeah, right, people won't cheat. Geez. I was tempted, and I haven't done that since second grade, when my friend Kelly had mis-spelled some words on her spelling test, and we were grading each other's and I fixed the mistakes for her so she could get 100% too. But then Kelly yelled at me for doing that (what a good seven year old, huh?!) and I have never been able to stomach the thought of cheating since.

I'm glad I'm done. It wasn't like I spent the whole week studying for the freaking thing. I just crammed for an hour before I took it.

Why am I making such a big deal out of this test? Let me tell you: this was the last - the LAST - test I have to take for school. Ever. Ever ever ever. ED is the only rotation of fourth year that comes with a test, and now I'm done with it! Granted, I do still have the boards to take, but that is for my career, not just some arbitrary little test to try to stratify us into 'good' and 'better' categories.

I don't think I've ever used as many italics in one post as I have today. Hmm.

Call last night went just dandy. I stuck around on the floor, did a couple of slightly doctor-ish things. ("Yes, go ahead and hold that Vanc until the blood is in," "He had a bowel movement? Great!") Then things got really quiet, and I went upstairs, watched John Stewart and went to sleep. I didn't sleep well, but I got a full seven hours in the bed... And then I got to be post-call and start the already long weekend early! Really makes me wish I was doing something more exciting than laundry.

Well, at least I don't have a test hanging over my head any more!!

Call On Me

Tonight is my first night on call as an "Acting Intern" That's AI for short. It is supposed to be a fourth year rotation where you act as an intern. Minus the ability to dictate, give orders or have any say in patient care. So, what it really boils down to is that I'm like a third year, but I don't have to go to lectures. And I'm not on the bottom of the totem pole for pimping - the third year has to field the questions before they get thrown to me.

Actually, it isn't quite as bad as I make it out. Everything in peds is micro-managed from the top down (as well as sideways - nurses are ever vigilant for mistakes... as are pharmacists and unit secretaries). I am given a little more freedom and responsibility as an AI. Not a lot, but some.

I am currently doing my AI in Pediatric Hematology/Oncology. We've got twelve patients in right now - some for routine chemo, some with more complicated problems. I am the only one from my team on call tonight. There are two general peds residents on, and it is generally their duty to cover the hem/onc patients overnight (unless a hem/onc AI is on). Here's my dilemma, though: If there is a problem with one of the patients, I want the nurses to call me! I'm the acting INTERN after all, I should be the first to be called. Problem is, when I went out and said "Hi, I'm Brenna, the AI on tonight, here is my pager number in case you have any problems" they all stared blankly at me and continued reading their magazines or gossiping. So I don't think they're going to call me... Which is in some ways good because I can't do anything anyway.

It could be a long night.

Cardiac Risk Factors

::Warning! Warning!!:: HIPPA Violation coming! Beware!

So, not being a very patient patient, I went ahead and looked up the results of my lipid profile. We're technically not supposed to. Which makes no sense, in my opinion. They ARE my results, after all. Why should I have to call someone to tell me what I can just find myself. I don't want to waste my cell phone minutes, after all.

I'm sure you are all dying to know what they are, right? Well, I know at least you are, Mom. Here you go:

CHOLESTEROL (LL) 174 (normal: 0-200)
TRIGLYCERIDE (LL) 109 (normal: 0-140)
HDL-CHOLESTEROL 56 (normal: 30-90)
LDL-CHOLESTEROL 96 (normal: 0-130)
CHOL/HDL 3.1 L (normal: 3.4-5.0)
VLDL-CALCULATE 22 (normal: 5-40)

Here's the problem, though... I am not quite certain what they mean. If I saw these numbers in a patient that I was seeing, I'd be like - "Hey! That's great!" But we don't tend to see lipid profiles in 26 year olds terribly often. Is 174 too high for me? Hmm. Oh, well. It looks good now, and that's all I care about! If I get it checked every year or so, I'll know, right? Of course, that would require going to the doc every year...

Man, is That One Ugly Head

Somehow, I thought that with age, with education and with patience, I would come to a point in my life where I would procrastinate less. Uh-uh. Ain't happenin'.

I am all done with my Emergency Medicine rotation (and all the people go: yay!) except for the test, which I can take any time between a few days ago and a week from now. In an ideal world, I'd take it today, and be done with it, right?

Unfortunately, I woke up this morning, and there was Mr. Procrastination, rearing his u-g-l-y head again (he ain't got no alibi!). See, I haven't really studied as much as I'd like. And I kind of have a headache. And I'm dizzy. And I have to meet with my fellow yearbook managers today (oh - by the way, I'm co-managing the yearbook for next year). And... I just got Empire of the Sun from Netflix, and Christian Bale is so cute, even as a little boychild, AND I had to watch The OC, which I recorded last night, and I've decided that it is time to read the Harry Potter series again in preparation for July 16th, and I'm almost done with a blanket I've been crocheting, I just need to figure out the border and... I just don't wanna take it.

So... hopefully I'll get my butt in gear by Sunday. I don't want to start my next rotation with this looming over me. Honestly, I don't know why I would even bother studying much more. I'm not an honors student (as I've proven time and time again), and the margin for 'pass' is pretty big. I don't think a few more hours is going to do me much good. Hmm. Maybe I will take it today...

Heal Thyself

As a medical student, I would be hard pressed to call myself a 'normal' twentysomething sort of person. These so-called 'normal' people in their twenties, as far as I can tell, are in the midst of trying to figure everything out. I can hold myself as an expert here since I have spent two whole years out of school... (that's self-directed sarcasm, for those of you who have a hard time with subtext) I think those of us in medical school are forced to deal with the whole free-floating anxiety, God-what-am-I-supposed-to-do-with-my-life-I-feel-like-I'm-play-acting-and-I-forgot-my-lines situations (see Dave Eggers, Chuck Palahniuk, Garden State to name a few) either a)early or b)late (leading to divorce, substance abuse, etc. in our middle ages) There ain't no way we're going to get very far if we admit, "Well, I'm not really sure what I want to do, but I always thought that being a doctor would be pretty cool. So I thought I'd give it a shot." To have the ability to tell other people what is wrong with them, and how you are going to help them, takes a lot of assuredness - both at work and in your mind.

Not sure how I got off on that tangent. The point of the matter is, that there IS one way in which I'm like a typical twentysomething: I avoid going to the doctor like the plague. Ironic, no?

I went today, though. And I'm very proud of myself! I'm not even sick! I just went for a check-up. I want to know what my cholesterol is... I'll keep everyone posted, as I'm sure you're just dying to know.

I must say - even though I'm fairly familiar with the whole doctor's office situation now, I was nervous! It makes me feel more empathy towards the people coming in that have NO clue what to expect. For me, going through my history was just like presenting any other patient, albeit a little more personal.

Tonight is my last shift in the ED. Yee-haw! First, I have to finish putting together a presentation on Ludwig's Angina. Factoid: "Angina" comes from the Greek "anchone" which means "strangulation." Nothing to do with chest pain.

Aitch

Today was "Sim Lab" day for the students rotation in Emergency Medicine (i.e. Me) How the emergency room functioned without fourth year med students, I don't know (that is sarcasm, by the way)

I was quite tired most of the day (I blame it on the latest book I've been obsessed with which kept me up until 2am last night). In the middle of our review on causes of PEA - that's pulseless electrical activity, not small green beans - I became inexplicably concerned with how one would spell the letter "H." I know, I know. It makes no sense. WHY do I care how you spell "H?" I don't know.

Now, to something much more exciting: I have only one shift left in the ED. ONE. So very excited. AND, it is in the Peds ED, which means I don't have to talk to any more drug seekers... ever, really. Unless I come across some very precocious children in the future. Or evil parents. Grrr...

The other night in the Peds ED, which was, incidentally the unofficial "Hurt Your Brother and Send Him to the Emergency Room" night, I felt more competent than I have in a long time. This kid came in with a knee laceration (inflicted while his brother dragged him around on a blanket). The attending told me to go ahead and stitch it up. And I did. Alone. NO supervision. And I was good! I didn't fumble around or drop anything. I just... did it. Granted, it was a knee lac, not like a chest tube or anything, but still... It is always good to know that you can talk a young kid through something like that and not freak out the mother by looking like a total clown.

Mmm. I'm hungry. With a capital Aitch.

This picture is the best answer I can give when someone asks the question "How did you end up all the way in NC from Oregon?" I should carry it around with me to point out the injustice of it all. This is actually a schematic of residencies, not med schools. It is also a scary blow to a girl (namely me) who desperately wants to 'Go West, Young Man'  

Some Stories, Not My Own

Grandma Trauma on Graduation Day
This morning, I picked up a "Nose Lac" patient (lac = chance to suture). It was an older woman, and I expected a nursing home patients, of which we see quite a few. Generally the demented/unstable on their feet/not agile with a cane patients that we patch up and send on their merry little way (have I mentioned that I want to be crazy when I'm old?).

Anyway (obviously I don't have what it takes to be a true reporter - get the story all within the first five sentences? Yeah, right), this older lady was very spry - seemed much, much younger than I expected. She'd been at church, had tripped and face-planted a brick column. I was about halfway through my work-up when she asked me if I knew one of the fourth year students. Turns out, she was (is, actually) his grandmother. And today was graduation day! She was in town specifically to see her little baby become a doctor (they're doctors now! SCARY) I promised her we'd get her through as quickly as possible.

Being at the biggest hospital in the area, we get a lot of patients. We also get relatives of attendings as patients - especially kids. They get the royal treatment, usually. They basically just walk right into a room - no waiting - and get everything done very quickly and nicely. It makes sense - they're attendings. They've put in a lot of hard work, and are generally well respected (or feared). I've also seen residents and nurses (especially nurses) get golden glove care. I didn't really know what to expect for relatives of med students... Turns out, they're just as special! Or, at least they are on graduation day. The ENT doc actually came right in when we called him. (Usually it takes...hours)

The point of that whole rambling was that I was happy to see that we med students get some benefit of our time in the trenches. Or, at least our grandmothers do.

Psych Patient Takes Pills, Calls Student
This morning, when I first got to work, I heard a psych resident telling an attending about a suicide attempt patient she had just talked to.

Psych Resident: She kept saying that [name] didn't care because he wasn't here.

This perked up my ears, because we have a [name] in our class, and it isn't the most common of [name]s.

Psych Resident: She said that [name] worked here, but the only one I know of was a medical student that rotated through psych.

Brenna (to herself): Hmmm. Maybe it IS [name]. Fantastic! Mystery time.

[Name]'s good friend was on the day shift with me today, so I told him about it, and he called [name] to find out. (Okay, so it wasn't a hard mystery to solve... I never claimed to be Encyclopedia Brown. Or Harriet the Spy. Or Nancy Drew....)

Apparently, [name] got a call at 3:30 in the morning:

Crazy Patient: [Name], it's me. I'm going to kill myself.

[Name]: {dumbfounded silence}

[Name] got their fiance to call the police, and in an hour long process, the police managed to track Crazy Patient down and brought them into the ED.

Good. God. Can you believe that? Right there is why you should not be nice to crazy people. Especially if you have a name tag on! Crazy Patient looked [name]'s name up in the phone book.

I was not nice to the crazy people. I scowled a lot and sometimes glared. I do not expect to be getting any middle of the night calls.

Student Gets Engaged, E-mails Friends
That's really all there is to that story, but I felt like I should have three stories. It is a nice, complete-feeling number, you know?

Five days left of my ED rotation. Thank goodness.

State of Mind

Saturday morning in the ED is slow. There are only 8 or so patients. I have nothing to say, but I had wanted to blog while in the ED. Just to say that I had. So here I go! Blog blog blog blog.

Ahhh... Satisfaction. (A state of mind, or a Justine Bateman movie?)

I'm going to go read the required article on Dog, Cat and Human bites. For some odd reason, it makes me think of Susan. Why, oh, why could that be?

To Forgive, Divine...

It appears that after all my venting about the ED over the weekend (to anyone and literally everyone who would listen), I don't hate it so bad! Maybe it was an abscess in my mind that I needed to drain... The attendings that are on for the night make a BIG difference. Big. Huge. (I have to go shopping...)

Tonight, in one shift, I tripled the number of rectal exams I've done, managed to not laugh hysterically when one of those patients started yelling "Mama! That lady had her hand in my BUTT!" (this was a full grown woman, not a child), saw the coolest dislocated ankle fracture EVER (the attending whipped out his camera for it) AND I got to do a central line!!!

It was like the heavens opened up and smiled down upon me. Perhaps my cosmic reward for crossing the rectal exam hurdle (it would appear I'm fixating on the rectal exam... Freud would have a field day)

Many a time have I watched a resident place a central line, after which they say some variation of "You should do the next one." Of course, I am never with the same resident twice, so all year, I just kept waiting and waiting. I know the landmarks. I know the technique. I know how to flush the ports, and that we need to get the fancy blue caps. And today I got to do it! So excited was I. AND I got the vein (an IJ) on my first stick. Like butter baby. Awe. Some.

Still not going to go into Emergency Medicine as a field, but at least I'm not getting hives before each shift any more...

You're Going to Feel a Little Pressure in Your Bottom

It's time for me to admit something. It is something that I've kept secret for... well, about a year now. I didn't tell because I was embarassed...ashamed...and secretly quite happy about it. Ready? Until about 2:00 this afternoon, I had never performed a rectal exam. I know, right? A medical student making it ALL the way through third year of medical school (read: The Year of the Scut without uttering the dreaded phrase "Relax, you're going to feel some pressure..." I even did Trauma! Every trauma patient gets a rectal, and all the surgery residents get to do their evil little laughs when they say "Student! Rectal!"

Anyway. I've done one now. That's a relief...

For those of you who have seen me in person in the last few weeks and know how much I despise the Emergency Room (this coming from a girl who has at least kind of liked everything up to this point), I must say: it is MUCH more exciting when there are at least two demented patients, each trying to out-scream the other. (Pt 1: Ahhhh! Pt 2: AHHHHhhh! Pt 1: Uhh-AHHHHHH!) Throw in a third who won't stay in her bed (Pt 3: Hell, hell, hell-hell), and Brenna may just change her tune.

Except that I got some man's nasty trauma blood on my white coat.

Hmm. At least it wasn't nasty fecal matter.

Keep on Swinging...

This week, I'm all about working the swing shift in the ED. That's 'evening' shift to those less into the vernacular. (Heh. Vernacular.)

Last night was my first shift over in the adult ED. I felt totally hopeless. And just when I was starting to feel less than a complete and total idiot (as I usually do during my first day anywhere), the surgeons descended en masse into the ED and started raising a ruckus. It was really quite awful. There were only a couple surgery residents down there (around 10 pm), but my goodness were they rude. Another reason not to go into surgery. A third year surgery resident actually chewed out the ED attending for letting a trauma come to this ED. Uh-uh. Residents don't DO that to attendings. That would be like me telling the resident what to do.

I had to talk to one of the other nasty residents about a burn that had come in. All I did was ask him to go see the patient (his own attending was the one that had okayed the patient's transfer to us) and he about went ballistic.

Ugh. Let's just say that I had a bad taste in my mouth when I left work last night. I'm hoping that tonight will be better...

I did get to help shove a scope up some guy's nose because he'd tried to use a garden hose as a siphon and ended up sucking something into his throat... Another chapter in "Things Not to Stick in Your Mouth."