Aug 31, 2005

Ripple Effect

Even though I'm physically closer to Katrina's destruction than many I know, I did not expect the ramifications to affect me more than paying a bit more for my gas.

Then I logged on to ERAS (which, by the way, I can submit tomorrow. TOMORROW.):

MYERAS ALERT:
Due to the damage from hurricane Katrina ERAS emphasizes the importance of contacting programs prior to applying to confirm they are accepting applications.


I don't think that will really apply to 'my' programs, but it is still shocking!

PLUS, there is the rumor going around that airlines are going to cancel flights that aren't booked due to fears of jet fuel shortages. And I'm flying to NY this weekend! Never fear, if the flight is cancelled, Susan and I will be hot-footing it there in SUV style, despite the $4.00/gallon gas.

And, despite what it sounds like with what I have written, my thoughts and prayers are with the people of the Gulf Coast. I only wish I was an actual MD so I could go help. No one wants a medical student in a tragedy. We'd just gum things up.

Aug 30, 2005

Bada Bing

By this point we all know how I feel about adult patients in general and the ICU in particular. (In brief: it is like having my soul sucked out through my toes) I had an experience yesterday that defies all words. I haven't even been able to file it under 'why adult medicine is interesting' or 'why adult medicine sucks.'

I was hanging in the ICU like normal yesterday afternoon working on ERAS application stuff (which we can submit on THURSDAY). Something aggravated me greatly (a whole 'nother story), so I decided to take a brief walk around the hospital. I left right as they were rolling a post-op patient up from the PACU (not pacu). I was gone for about twenty minutes, and when I came back in, I saw that everyone was clustered around the new patient's bed, which was relatively normal. Then I realized that there were TOO many people clustered there. And that some of the people were donning sterile gowns. And that one person was CRACKING HER CHEST. That's when I realized that something unusual was going on.

Turns out the patient's heart had stopped beating, and chest compressions weren't working, and she conveniently had a nice un-healed incision through her sternum, and bada-bing, bada-boom. Open heart surgery in the ICU.

The rest of the afternoon progressed in a similar fashion. Things just went crazy. I was actually happy to have stuff to do, even if a lot of it was just fetching and holding. (get me the chart! I need a suture removal kit!) I did get to do some procedure-ish stuff yesterday as well. I changed two lines over wire - which involves sticking a wire into a central line that is already inserted, pulling out the old line, sticking in a new one and stitching it down. I don't get to do the actual stick, which is generally the hardest part, but it is still a good chance to do something.

And during the open heart surgery, I got to squeeze in fluids. Which sounds like what it is. I squeezed a little plastic tube to make fluids go in faster.

In the end, it didn't matter. When you reach a point where you need your chest opened emergently, your chances of survival are minimal. We didn't beat the odds on this one.

I remember the first time a patient of mine died. I was horrified. I didn't write it down here, but I remember feeling that the world should stop to acknowledge the passing of a soul from this world. Even at that time, I knew that I'd have to accept death as a part of medical practice. I didn't realize that it would happen so quickly. Bada bing, bada boom: I'm 'professional.' I watched this person die yesterday, and what I'm left with is the coolness of seeing it all, and doing procedures, rather than the grief of losing a person.

I guess it is what we need to do to keep functioning on some level. I have yet to lose a pediatric patient, however. Somehow I feel that that will be different.

Aug 27, 2005

Good Advice

(From those who know better than me)

I was told tonight that one (especially if one is female) shouldn't wear anything to a residency interview that a man who is not gay would remember.

Makes sense, no?

Aug 26, 2005

Fellow

My fellow in the ICU hums all the time. Hmm-hmmm-hmmm. No tune, just humming. And he reads out loud. And he sits perched over the computer screen like a big scary bird about to snap up a worm.

It drives me BONKERS!

Now it is time to round. Again.

Aug 25, 2005

Dancing Through Life

My goal for today is to spend as little time as possible in the ICU. So far, outside of rounds, I have spent 35 minutes there. Including rounds, it has been four hours and 35 minutes. Did I mention that I hate rounding?

In that 35 minutes, I waltzed in, told the resident and attending that my patient's urine showed "Too Numerous to Count" bacteria and that is phosphorus was improving (it was 0.2 this morning - yes that is point two). Then I waltzed on out. 'Twas fantastic.

I really, really, really want to take a nap.

Aug 24, 2005

Vermin

Before I moved to North Carolina, I had this vague idea of there being cockroaches running rampant. I have lived in my apartment since I moved here, and in my three plus years there, I've only seen about two or three cockroaches. They seem to crawl out of whereever they live to die on my bathroom floor.

So, the other day, when I heard some rustling sounds coming from my bathroom, I assumed that maybe I'd have to battle an actual live roach. I avoided the bathroom for a while, but finally I had to go. That's when I saw The Evidence. The Evidence that I was sharing my apartment with something with teeth. Little teeth that nibble on things. Although, the fact that the little nibbly teeth had chosen to eat some Caress soap makes me think that at least the creature is hygiene-conscious.

Even after The Evidence, I decided to pretend to myself that it was an isolated, one-time incident, and the creature would get over its taste for soap and move next door.

But yesterday, when I was pulling out my garbage can to dispose of my coffee grounds, there It was. My brain couldn't at first process the large fuzzy gray thing perched on the edge of my trash can. I thought 'I don't remember throwing away any yarn.' Then, it moved. And I screamed.

If you'd asked me before yesterday what I would do if I saw a rat in my apartment, I don't think I'd have said that I would scream.

But I did.

Like a little girl.

A quick call to my apartment manager (landlord, I guess is the right term) and the exterminators played a little visit. Now I have this little black box under my sink. I don't know what it is supposed to do. I just don't want to see the rat again.

Oh, yeah. And when I got up this morning, there was a cockroach laying upside down on my bathroom floor. It was still alive, so I covered it with an upside down cup.

But I didn't scream.

Aug 22, 2005

Never Ending Story

A few months back, I declared the saga of the (MM)PWHM to be at an end. Once third year ended, I really thought it was so. It was quite thrilling to be free from the drama that surrounded all of that nastiness.

Shortly after the end of third year, however, I got a note in my box from one of the (MM)PWHM. And, oh how angry I got. How dare he disrupt my new-found peace and calm, thought I. I stewed in my own anger and resentment for a few days, and wrote a very mature (if I do say so myself) response. Basically, I said, it was bad and hard and I got over it and moved on.

Then... I felt some satisfaction, but also some... disappointment I guess is the right word. That was when it really felt over to me. I'd closed the door on what had once been a very good friendship.

Well, it turns out that someone's foot was in that door. Over the last few weeks, I've found myself in the company of the letter-writing (MM)PWHM. And what was most unusual was not only the fact that I didn't get nauseated or break out into hives in his presence, but also that it almost felt normal. But there was still that underlying thread of tension. See, I still thought that he hated me, or at least had at some point thought terrible things of me.

So, times passes on, and people gain courage and resolve, and suddenly I found myself in the park yesterday afternoon, having a real conversation with (MM)PWHM. And, it turns out he doesn't actually hate me. At all. Never did. He's a (MM)PWDAHM - that's (Mysteriously Missing) Person Who Doesn't Actually Hate Me.

And what does that all mean? I guess we're going to try to be friends. It just baffles me, really, as had this whole process. I am consciously entering into this. Both my eyes are open, and my feet are firmly planted on solid ground. I fear that I will end up back in the same place I was before, but I have faith that I know myself better now. So, even though it may not be the best decision, I am letting my heart beat out my reason on this one.

I just hope that I don't come to regret it.

(I don't think I will...)

Aug 19, 2005

Oompa-Loompacide

The saying "kids are not just little adults" is one maxim that we hear repeated a lot in the hospital. After a few months of pediatric medicine, I find myself needing to re-learn the opposite: Adults are not just big kids.

One thing that is relatively uniqe to adult medicine is the phenomenon of making fun of the patient. Well... maybe "making fun of" isn't the correct term. But with adults that have tons of comorbid conditions - the heart patients with COPD and liver disease, for instance - there is the underlying knowledge that they contributed to their own condition. And so many adults are non-compliant with their therapies that it is not uncommon to have a relative level of cynicism when treating them.

Which leads to comments like the one made by an intern to another this morning: "Something fishy's going on. Her glucose is still 400-something and she's on enough insulin to kill an Oompa Loompa."

Love it.

Aug 17, 2005

Day By Day

I was thinking about what I'd write in my blog all day today, and now that I'm sitting here, I just don't care! Not about you. I love all of you, my semi-anonymous blog-reading crowd.

No, I just am not terribly enthused about the ICU. It doesn't lend itself to epic odes. Neither does it lead to ranting tirades. So instead of either, let me just tell you what I did today. If you really care. Actually, your time would be much better spent handing out stuffed animals to orphans wandering the streets. Or eating zucchini or cultivating a resistance to Iocane powder.

Brenna's Wednesday
5:15-ish - Get up.
6:00-6:45 - Rounds with the CT surgery team (during which I function as a third year since those punks are on vacation)
6:45-7:45 - Anesthesia Grand Rounds (Perioperative Management of Cardiac blah-de-blah)
8:00-9:00 - CT Surgery Conference (Boring boring boring)*
9:00-11:00 - Rounds with the ICU team and Pharmacist
11:00-12:00 - Anesthesia lecture (Asthma)
12:00-1:00 - Lunch
1:00-4:00 - Excrutiating Boredom
4:00-4:40 - Rounds with CT Surgery fellow and ICU team


Ugh. We don't always have quite so many lectures, but we do Round like it is going out of style. Oh, and did I mention that we have four patients. Four. We spent TWO hours rounding on FOUR patients. I totally forgot that adult rounds get like this. But I am learning, so that is good. So they say...

*Somewhat related mini-rant: The CTS conference was about some sort of new-fangled radiology techniques. Fancy X-rays. Such a sweat stain. There was one guy - a salesman I'm sure - had this terribly annoying booming voice. And he kept saying "facile." Repeatedly. But he used it in this bizarre manner that I don't think was correct. Actually, I'm fairly certain it wasn't correct. Example: "I will sit down with you and make you facile with the buttonology." Buttonology. Facile. I was so annoyed my brain exploded.

Aug 15, 2005

Paint by Numbers: A Life

I finally got my board scores today (yay!) and while I'm not displeased with the results, I am struck anew how much importance people place on all these 'numbers' in our lives: IQ, salary, weight, GPA, test scores, class rank, etc. As if they define us. And yet, we all hide them, as if people will judge us. "NO! I can't tell you what I got - it will make me stupid or possibly arrogant!" Well, as we all know (or at least strongly suspect) I am both stupid(ish) and arrogant. So why not bare all. An existential streaking, if you will.

Here, then, is my life, in numbers:

SAT Verbal - 770
SAT Math - 740
HS GPA - 3.98
MCAT Biological Sciences - 9
MCAT Verbal - 11
MCAT Physical Sciences - 11
MCAT writing - can't remember...
College GPA - 3.85
USMLE Step 1 - 215
Med School Class Rank (years 1-2) - 46 of 104
USMLE Step 2 205
Med School Class Rank (year 3) - 71 of 98
Salary - yeah, right
Weight - yeah, right (okay, so one number still makes me cringe)

There you go. Feel like you know my any better? Didn't think so.

Some numbers that really matter:
2 - number of sisters I have
2 - number of parents I have
Innumerate - number of friends I have
2 - number of working eyes I have (or four depending on your maturity level)
About 30 - number of times I laughed today
Infinite - my possibilities (gag me! how cheesy!)

Now I'm off to get my 5-6 hours of sleep!

Aug 14, 2005

Personal Manifesto

For all y'all that have been clamoring for it (okay, so it was just my mom...), here is the famous "Personal Statement" that the residency programs will be receiving from yours truly.


In my dream life, I am a world renowned actress, have several best-selling novels under my belt, and spend my free time doing good deeds. I can also sing like an angel and am as graceful as a swan. In reality, I can’t act, haven’t the wherewithal to complete a novel, and sing more like an android than an angel. Plus, I am a bit of a klutz.

I realized early in life that I may not progress terribly far with a singing and acting career, so I focused on “doing good deeds.” By the age of twelve, I knew I’d be a pediatrician. Why? Because, as the regular neighborhood babysitter/game inventor, I knew that I liked kids, and I knew that doctors did good things. It sounded logical to my concrete brain.

Fast forward a few years to college where I joined the masses of pre-med students, striving to make myself a good applicant. The only problem was that my motivation had not changed since I was a junior high student: I liked kids and I wanted to do good. I had developed abstract thinking skills since I was twelve, but the reasoning behind my ultimate goal was still very concrete.

And then medical school started.

And it was everything I expected it to be, and nothing at all like I expected it to be. Everything was new – the people, the language, even the smells were completely foreign. It was all overwhelming at first, but I slowly began to see that saying “I want to go into medicine” was just as vague as saying “I want to do good.” This realization forced me to finally apply abstract reasoning to my decisions.

It was during third year that I was really able to put my motivation into actual words, and at the same time moved beyond liking pediatrics just because I like kids. While I enjoyed learning about diseases and treatments on a pathophysiologic basis, I found that I was even more drawn to the patients’ histories, trying to identify ways in which we could have prevented the disease in the first place. I found myself getting frustrated when I met patients suffering from avoidable illnesses.

Pediatrics to me, has come to mean more than simply diagnosing and treating sick children. It requires caring for entire families, and teaching them how to raise healthy children. I think anticipatory guidance is just as important, if not more so, than choosing the correct antibiotic to treat a sinus infection. It is the ultimate form of preventative medicine. While I do want to learn how to more accurately diagnose and treat children, I also plan on getting a Masters in Public Health at some point to better equip myself in promoting children’s health and welfare. I look forward to being a strong advocate for my patients.

My personality is ideally suited for both pediatrics and preventative medicine. In my third year rotations, I excelled in the categories involving rapport with others - patients and peers. I listen well, and am generally able to get my own message across without being condescending or mean. Working with children and families requires patience, creativity and a good sense of humor, attributes which I believe I can use to my benefit.

I can think of nothing more fulfilling than to spend my life helping and teaching children. They are full of surprises and joy and promise. How could any day be boring when there is a four year old in it? Is there anything more challenging than trying to get a fourteen year old girl to open up? Unless perhaps it is trying to look in the ears of an uncooperative eighteen month old?

I am no longer the concrete-thinking child who wants to be a pediatrician simply to “do good.” I have learned and grown a lot both in life and in medical school, but in the end what it boils down to is this: I like kids and I want to do good.

The twelve year old inside me is very happy.

Aug 12, 2005

100% of Me Wants to Go Home

According to the NBME site, my boards scores were mailed on Wednesday, which means that I expected to receive them today. No such luck! Susan got hers (whines Brenna), but my mailbox contained merely a survey from the NBME asking questions about the testing experience.

Sigh.

I get my scores sent to me at school, which means that I won't get them before Monday now. Today is my last day of Peds Neuro and Monday I start in the Cardiothoracic Surgery ICU on Monday. Interestingly, I got my Step 1 scores while I was in the CCU (coronary care unit) which is somewhat similar to the CTS ICU. I like the synchronicity of that.

I also like the word 'synchronicity.' Come on - say it with me: synch-ron-i-city. Now, was that not the most satisfying thing that has come out of your mouth today? The most satisfying thing that has gone in to my mouth today was a bowl of peanut butter cup ice cream. Mmm. That was good.

There is still a slight chance that when I leave clinic this afternoon my scores will have arrived. In fact, 57.8% of me is hoping that they still will. But the remaining 42.8% just wants to enjoy the weekend without the burden of knowing.

99% of me wants more ice cream...

Aug 10, 2005

Oh, Y!

Anyone who has been around me for a good length of time knows that I love the YMCA. It is like an oasis away from regular life where people go and get all sweaty and look nasty and no one can think bad of them because they're working out. Fantastic.

Another reason that I particularly love my particular Y is that there is a full work-out area in the women's locker room. Which means that, if I'm feeling particulary icky or girlish, I can get my sweat on away from prying male eyes. And there's a sauna and a hot tub and a swimming pool! Okay, the swimming pool isn't in the locker room, but you can get to it from there.

One thing I always did in the women's area was running on the treadmill. It is mostly because I turn a very distinctive shade of fuchsia. Plus I'm not the most graceful runner (I've been known to throw my CD player flying many a time). But one day a few weeks ago, I ended up on a treadmill next to a girl who inspired me to move to the treadmill in the upstairs, co-ed area.

I first came across this girl in the weight room. She spent half an hour - HALF an HOUR on a machine I was waiting for. It struck me at the time that she looked like a girl I'd gone to elementary school with. Except an evil version. Evil Elementary School Girl. She seems to live at the Y, too. I see her there a lot - always scowling.

So, back to the treadmill incident. I was innocently running my merry little way on the treadmill when EESG came up and started zipping away next to me. After a while, I noticed that she kept looking over at me. I generally tend to look around me as I run, too, so I thought nothing of it at first. But she KEPT doing it. Then I started to get angry. How dare the little punk judge me? At least I was trying! So what if I wasn't good. But, I finally realized she wasn't looking at me. She was looking at her ass in the mirror (yes I just used the word ass - it just seemed appropriate here). Stupid EESG was so fascinated with her own ass that she had to stare at it the whole time she was running. Who was she trying to impress? The 50 year old woman on the other treadmill?

Anyway. That annoyed me so greatly, that I graduated to the Big Girl treadmills. Which is nice, because it is a lot less hot and humid working out in an area where there is no sauna!

Aug 9, 2005

Survival of the Fittest?

I know I've blogged about PMS in the past, but... when you find a good topic, stick to it...

There are many lists of PMS symptoms out there, but none of them mention things like: back pimples. Or paranoia (that's Susan's) or over-analyzing everything (that's mine). I knew I was PMS-y today, when I had cake batter for dinner. Yes, cake batter. Pink cake batter to be specific. (and it was good. E. coli be darned!)

That's all beside the point, though. The point being that I have a theory as to why females that live/work in close proximity tend to cycle together. This phenomenon is known in research circles as 'menstrual synchrony' (look at me pretending to be involved in 'research circles!' haha!) There are some theories that it was an evolutionary development to prevent packs of wild animals from detecting bleeding females all the time so they'd only have to be prepared for attack, oh say 20-24 days a month. (huh?!? Caveman: "Uh-oh, women bleed, get sharp stick! Ugg!")

I have a new theory - also involving evolution. It is this: females living/working in close proximity need to be PMSing at the same time. That way we can all retreat to our paranoid/over-analyzing/teary corners, poke at our back pimples and eat cake batter at the same time. If we weren't PMSing at the same time, one PMSer could easily take out a few chipper girls in one bad day.

I think my theory is sound. Perhaps I will write it up for publication?

"My Daughter-In-Law Has it Worse Than You"

There is a woman working in the pediatrics neurology clinic who is... less than fully socially adept, I'll say. You know the type - if you make eye contact with them, they'll launch into their whole, long, drawn-out, tragic history (Granted, this particular woman really did experience a tragedy) while you sit there squirming, thinking 'Wait? Am I supposed to know you?' and 'How do I gracefully exit the room without looking like a jerk.'

After several such situations with this woman, it appears that we're on friendly terms now. She has now progressed to accidentally insulting me! Yesterday, I had the beginning of a conversation I have, oh, probably once or twice a month:

Other person (usually older woman): Is your hair naturally curly? (alternately: Is that your real hair?)
Me [humbly brushing hair out of face, and scowling on the inside]: Yes.


This is usually followed by a comment along the lines of: it's beautiful / you're very lucky / do you know how much people pay to get hair like that / etc. To which I generally reply: thanks / I know / Haha! All while thinking - jeez people, it's only hair!

Yesterday, however, as I was preparing to pretend to not be annoyed, I was surprised to hear Neuro Lady say: "My daughter-in-law has it even worse than you!"

Even worse than me?! I didn't have a response to that. Which was, as it turned out, okay, as Neuro Lady launched into several ways I could attpempt to straighten my hair. I just smiled and nodded...

No one has ever made me appreciate my curly hair as much as she did!

Sorry, Lindsay

I used to make fun of Lindsay for saying that mint made her sneeze. But then I realized that it makes me sneeze, too.

I still think she's weird for saying white chocolate give her hiccups, though.

Aug 4, 2005

Class Rank

One unfortunate aspect of medical school is the fact that we have to be graded. Along with the grading, goes the ranking. Class ranking. It is a hateful way to determine who is the best, and who is the... not so best.

At the end of first and second years of school, I was ranked at 46 (I think? 40-something anyway) of 104. I was totally okay with that. Not thrilled - we all want to be number one, right? - but not at all bothered.

Today, we just got our ranks for third year. I did okay during third year. I passed everything. No honors, no low passes. I did almost always get honors in the sub-categories "Health Care team rapport," "Patient rapport/Professionalism," and "Motivation/Attitude toward learning." (See - I'm nice and I'm interested. Not always the brightest bulb in the package, but at least people like having me around.) I don't know what I was expecting my new rank to be, but I find myself a tad disappointed. My rank is now 71 of 98. Again - not horrible (not in the bottom quartile anyway...barely) - but this time, I am... not happy.

Though, I did just go back and look and saw that this was JUST my third year rank, so hopefully the 46 of 104 will bring me back up a little bit in the ranks. Not that residency programs see that, though. They'll see the 71.

In the end, though, I am more proud of the things that I do excel in. I'd rather have my patients like me than have the correct answer 100% of the time. I am less likely to get sued that way for one; plus it will just be a better experience overall. And as far as residencies go - I just have to get my foot in the door and get an interview. Once I get that far, I should be fine.

On a separate, scary note - I will apparently be getting my Step 2 scores any day now. Keep your fingers crossed for me!

Aug 3, 2005

Money Money Money

One thing that apparently goes along with any final year at a private school is the official Asking for Money. It really does get a tad annoying, when I just received my latest loan installment. Yes, I will be close to 200,000 dollars in debt by the time I graduate. That is a lot of money. I can't even comprehend how much money that is. And now they're asking me to donate some to the school? What money is this that I'm supposed to be donating, may I ask?

I do actually make piddly donations (we're talking five bucks) to my undergrad. The only reason I do it is so that they can say a certain percentage of my class gives back to the school - it makes the school look better on those ranking lists when alumni give back. I had even been planning on giving a paltry amount to my med school this year, too - again, just to add to the percentage.

But today, I got a letter from them asking for money - and my NAME WAS SPELLED WRONG.

Sorry guys. No money from "Breanna."

Aug 2, 2005

The Worst Secret

Every day at 4:30, the peds neuro on-call pager is handed off to the night team. So any page that comes after 3:30 or so is a HUGE hassle. Which was why the page last Friday at 4:00 pm made us all roll our eyes and groan loudly. Very loudly. Like person-passing-by-in-the-hall-does-a-double-take loudly.

That particular page was about a young baby who had just been brought in with non-accidental head trauma and seizures. For those of you not in the know, 'non-accidental' is a legalistic euphemism for 'child abuse.' Babies don't really do all that much. They eat, they sleep, and they cry. Unfortunately, that crying can lead to frustration and anger, and a phenomenon known as Shaken Baby Syndrome. This particular child has it about as bad as it gets. This is a person that has no chance at all of being normal - that is if they even survive.

I've seen several cases of shaken babies, along with other forms of child abuse during my few months on peds rotations. The thing that is striking me about this case is that they still don't know who did it. In my (albeit limited) experience, they've known, or at least had a really good idea, who the culprit was. No one is breaking down in this case though. We suspect it was one of the parents. But we don't know which one. And, as awful as I feel for the baby, I can't help hurting for the parent that is hiding such a dark and painful secret inside.


How to make a Brenna
Ingredients:

5 parts success

3 parts brilliance

3 parts empathy
Method:
Add to a cocktail shaker and mix vigorously. Add emotion to taste! Do not overindulge!


Username:


Personality cocktail
From Go-Quiz.com