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."

Faster, FASTER!!!

Today was DAY ONE of Fourth year. Can you feel the excitement in the air? Can you taste it? (forgive the mixed metaphors) It tastes like... chocolate. With cinnamon. And peanut butter... Mmm...doesn't a chocolate-peanut butter and cinnamon sandwich sound good?

My First Rotation as a Fourth Year is Emergency Medicine. I chose to do this rotation first because 1)It is the only rotation that has a test at the end, thus making it more appealing to get it out of the way early and 2)It is a rotation that you only do during fourth year, thus ensuring that I actually feel like a fourth year (instead of a confused third year, which is essentially what I really am)

Part of the ED rotation is the EMS Ride Along. Which I did today!! When I got there, I tried to remember what I'd heard other people in our class say about the EMS-RA day. Then I remembered: No one else from my class has done it!!! I was first! I got quite a thrill when I realized that. I am used to being last (or second-to-last) at everything, since most things are arranged alphabetically. But now, I have knowledge that NO ONE else in my class does. (Except for the former EMTs and people who have done ride-alongs before...but they don't count)

Here's how the day went:

1:00: Brenna arrives at the County EMS. Parks in one spot, gets out of car. Stands and looks at big scary garage, filled with ambulances (ambulanci?). Gets back in car, and follows signs to "EMS Administration Offices" Gets directed (through an indoor stairwell) down to the same scary garage area. Signs liability type waiver.

1:05-1:45: Brenna sits in Lounge, watching some violent movie (which she later - aka right now - finds out to be The 51st State) in which a large number of words were bleeped out.

1:45-3:00: Brenna jumps up and follows the team from Unit 29 when they get called to the aid of a woman with Chest Pain. I must admit, up to this point, I was pretty bored, and sleepy, and trying to figure out when I could gracefully make my escape. Then, we got in the ambulance, and they turned on the lights and sirens and we were OFF! We got to go so fast! It was the coolest thing EVER. Zipping past all these cars, blatantly running red lights. It was supremely cool. The getting the patient part and going to the hospital was also okay, but not as cool as the SPEED.

I stuck around for two and a half more calls (one was to a traffic accident, where they didn't end up needing any assistance - everyone was okay). At one point, we were going 85 miles an hour on Peter's Creek - a road where the speed limit is 45. SO COOL.

I actually would have stayed longer, except 1)I was starving, 2)I wanted to work out this evening, and 3)We were told to leave before dark - "There are bad parts of Winston-Salem, and I don't want you guys going there" said the attending, and I must heed those words of warning - I did see the kinds of trauma that would come in at night... like the man who'd been stabbed 20 times by 'some guy' that just broke into his house. (Turned out 'some guy' happened to be the other boyfriend of the stabbed man's girlfriend...)

Tomorrow is a random, big test day, so no Emergency stuff. Bummer... I want more fast rides!

Done!!!

It's over! Third year is over. I could cry. I probably will.

I did just totally fail the radiology test - you'd think that would be impossible with questions whose options include a. hot, b. noisy, c. dark, and so on. But that's what you get for not studying at all. But oh well! I don't care! Because third year is finito.

Now begins the year that I have been told, by many people, on many occasions will be 'the best year of my life.' I'll try not to prove them wrong. (Although, I must say I'm planning on my best years being when I'm in my 60s-80s)

Congrats to my fellow finishers. We did what felt impossible. How cool are we???

Before They Were Stars

If you don't watch American Idol, I say 'Good on ya!' I, however, do. And I'm going to talk about it now, so deal.

There is much debate about one rocker-turned-non-rocker contestant. That would, of course be Constantine. (He of the over-done eyeliner last night) There are those that maintain that Constantine can't hold a tune, and manages to float through each week based solely on his ability to bat his eyes and grin evilly. Granted, the eye batting evil grin is quite enjoyable, but to these people, I have this to say: LISTEN to him. He is not bad. In fact, he is quite good.

Good enough to study at Boston Conservatory (granted, I don't know the reputation that this particular conservatory has, but I can tell you - they wouldn't accept me!). AND good enough to star as Roger in a touring production of Rent. (For those of you not as obsessively familiar with Rent as I am: Roger is a lead. Lots and lots of singing) And he was good as Roger. How do I know, you innocently ask? Because I SAW him!!! Yes, indeed. Rent toured here back in fall of 2003, and of course I went, and I just found out that Constantine was Roger.

Granted, Constantine will not win. He is a musical actor/singer, not a rock star. But, hey, it is cool to watch him knowing that I've been within throwing distance of him at least. As long as I was throwing a paper airplane or something else with good loft and flight distance. Maybe a Frisbee...

D-Day, Six Years Later

Flash back to April 17, 1999... I was 21, a junior at college busy with res life staff, class, friends and, on that particular day, taking the MCAT. The MCAT. The test that was going to determine my future. You cannot get into medical school without going thru the MCAT hurdle. The hardest test I had ever taken up to that point, it was really what felt like my first step towards my chosen career. That must be why this date has lived on in my head as An Important Day (whereas I totally forgot the anniversary of Step One of the Boards...) Back on that sunny Saturday, I had no idea where I'd be sitting in six years.

Back to April 17, 2005, an older and somewhat wiser me is preparing to start her Last Week of Third Year. I feel like I've been catapulted through time. I remember the MCAT day so clearly that I cannot fathom the thought that I'm so far beyond it. I remember exactly what I had for breakfast and lunch that day. Last Week of Third Year. That means that in little over 12 months, I will finally be reaching the culmination of the journey that I started six years ago. Of course, that will only mark the beginning of a much longer trip. (Don't you hate it when people use words like 'journey?')

If I took the MCAT today, I would fail miserably...!

Like a Babe in Arms

I am in the middle of my second to last week of third year. This is absolutely monumental.

I'm in anesthesia this week - it is just a brief, one week rotation. And it is supremely cool! There are all these gadgets and levers and knobs. And the residents are fantastic. A complete change from the OB residents (but they would even be cool without the comparison to OB). I worked with one first year resident who grew up in the Midwest (like me), then moved to the Northwest (like me), went back to the Midwest for med school (kind of like me - I went back for college) and then came here (like me!) And, she is blonde, like me. It was like meeting another version of myself!

So, in the Future of Brenna, Anesthesiology is officially added to my top three career choices (not just because of the residents - it is just dang cool stuff). My top three, again, in case you haven't been paying attention: Pediatrics, Neurology, Anesthesiology.

Pediatrics, Neurology and Anesthesiology are about as different from one another as you can get. Why am I drawn to all three of them? My theory: if you take the first letter of each specialty (P, N, A) and rearrange them, you can spell both "PAN" and "NAP" bringing to mind images of spending all day eating and sleeping - quite possibly the perfect life. (And a life that we all lived until we were about 9-12 months old... ahh, the good old days...)

It is presumably possible to combine all three - to be a pediatric neuroanesthetist. But that abbreviation would be "PNA" which, for you non-med speaking people out there, is the abbreviation for "pneumonia" - most definitely not a perfect life. Besides, I don't think the demand for pediatric neuroanesthetists is very large.

Fortunately, anesthesia is freaking hard to get into nowadays (No call and no clinic - can anyone say 'lifestyle?') Fourteenpeople from the class above us are going into anesthesia. That's over a sixth of the class! But that class is populated with impersonable gunners, the type of person currently flooding the anesthesia market. I am not a gunner, and have valued sanity and quality of life, and as a result, do not have the numbers one needs to become an anesthesiologist.

That's okay, because I hadn't really changed my mind from peds anyway!

Blackened Toenail

I almost painted my toenails last weekend. I think I tweezed my eyebrows instead, or watched a movie. Or something like that... The point is, had I painted my toenails, and assuming that I had not hated the result and promptly removed said polish, I would have missed seeing my left pinky toenail turn black. No, I don't have some sort of strange occlusive vascular disease. I'm just a klutz, and the battle of Brenna vs. Wal-Mart shopping cart didn't go my way.

Remember being a kid, and wanting to push the shopping cart, so that you could give it a good shove and then stand on the bottom shelf part, turning grocery shopping into an X-treme sport? Okay, I admit that I do that now, probably more often than I did as a child - there is no mom to say "Brenna!" in her exasperated voice (I heard that a lot when I was younger...still do, actually...) to prevent me from Xtreme shopping. (That wasn't what I did today, by the way - I was just a klutz.)

My bike offered me a little more freedon, because Mom didn't tend to be there when I was zipping around the neighborhood on my hot pink Schwinn.

I am house-sitting this week, which means that I'm in a real live neighborhood, with real live families and kids. With real live bikes. I saw several kids out zinnping around on their bikes today, and I really wanted to join them. Seriously, is there anything like being a kid on a bike? Such freedom and joy. Hills are never as exciting as they are when you are going down as fast as you can on your bike with your hands in the air. Or standing on the girly-bar of the frame. Or with your feet on the handlebars. Yes, of course, I did all of these things at one point or another. And, miracle of miracles, I never hurt myself. (Incidentally, the only time I did hurt myself on my bike was on level ground, with hands on handles and feet on pedals. I ran into a parked van...)

Unlike the Xtreme grocery shopping, though, these are things that I have not done for years! These are actually things that I think I'd be too scared to do now. With or without the exasperated mother.

I hate to feel that I'm growing up - I pride myself even, on certain aspects of my immaturity. Apparently, I've gotten old enough to learn fear, though. Or perhaps just a healthy respect for life-threatening activities.

The Laboring Parturient

Hee-hee. I think that is my favorite phrase/term in all of OB/Gyn. "The Laboring Parturient." It sounds like a book. Or a really bad band. (Like a band in which I'd be the lead singer/clarinet player) It means, in real-person talk (aka anyone other than the OB anesthesiologist who used the phrase repeatedly): a lady in labor.

But guess what? I never have to deal with any more laboring paturients! Or Papanicolaou smears. Or having to say 'pap smear' in Espanol. (BTW, it is 'papanicolau' in Spanish - they just don't shorten it). Or (wonder of wonders) OB/Gyn residents!!!

Okay, in reality, I will have to deal with all of these in the future. Especially as a budding pediatrician. And, you know, as a woman.

But I do breathe a large sigh of relief, even as I frantically cram for the OB Shelf test - a 100 question national exam designed to make us cower and whimper as we acknowledge our severe lack of ability to learn everything... well, anything, really. Let's just say that my brain has not been soaking up OB/Gyn knowledge terribly well. I can write a mean SOAP note, though:

S: Pt s c/o; no HA/RUQ pain/visual change; +FM, -LOF/VB
O: AF VSS, Exam: RRR, lungs CTAB, FF/NT, +BS, 2+ DTR B; FHT: 130-140, Toco: q2-3", SVE: 5/60/+1
A/P: 19 yo G2P1 at 41 c PreE on PPit for IOL, doing well, c/w expectant mgmt and Mg for sz px

Haha! It is like another language. Definitely not one of the Romance languages, though.

T minus two hours and fifteen minutes to test time. More cramming!

Doomed

The White Cloud Strikes Again. Today is my last day on call and we, with two patients on service, are at the busiest we've been all day. Do you know how slowly time passes with very little to do? The answer is very slow. Very, very slow.

And another, larger, problem with this white cloud junk is the lack of opportunity to actually do anything. My vaginal delivery tally is up to four. My standing around, just being in the way during a vaginal delivery tally is up to three. I did get to help a little during one. A little.

And that's it. One of our two patients just delivered, the other won't go for a while. And I'm done with OB call forever in three hours. All I wanted to do was deliver one baby!

BUT.

I am DONE with OB call FOREVER in three hours. You're not going to hear me complain.

Code Blue in the Vatican

One benefit of being up all night is being on top of the big news stories that happen while everyone else is sleeping. I've been checking up on the pope all night. And he is not doing well.

He has a tracheotomy from a few weeks ago, a feeding tube put in his nose a few days ago, and now they are saying he suffered "cardiocirculatory collapse." I'm honestly not sure what is meant by that phrase. To me, it means that his heart may have stopped and that they possibly had to give him drugs - or electric shocks even - to start it again. Not quite the same as a heart attack - that is when blood flow to the muscle of your heart gets blocked somehow, causing the muscle to malfunction. With something called a 'collapse,' I picture more of a situation where the heart just stops beating. His body is old and weak, and he has been putting up a fight for a long time.

What happens when people get old and frail and their bodies get tired of fighting? If left to their natural resources, most people would stop eating. It is a natural part of aging - just another way of your body slowing down. I of course don't have proof, but I think of it as a slow systems shut-down of sorts. Start giving your body less and less fuel, and eventually it just kind of drifts to a halt.

The pope, however, is a firm believer, as he wrote in 2004, that "The administration of water and food, even when provided by artificial means, always represents a natural way of preserving life ... not a medical procedure." And, since life should be preserved at all costs, it follows that all of those people who stop eating should get feeding tubes to prolong their lives.

I just don't think I agree with that. If that were true, we'd be force-feeding a lot more elderly people who don't necessarily want it. There are a lot of sons and daughters out there that want to keep their parents around for as long as possible for fear of losing that parent. There are also sons and daughters out there that want to keep their parents alive through the holidays, summer, vacation, whatever, until it gets to be a more convenient time for them to die.

There is a time when I think it is okay to let a person go. Not necessarily euthanasia (I am still undecided about that). Just a nice, peaceful, natural death. The way God intended. Slow systems shutdown.

Of course the question that comes then, is where to draw the line. But I don't have to answer that! Besides, it is 3:45 in the morning and I've been up for way too long to think about things like that.

As a last plug, I do encourage everyone out there, regardless of age, to have some sort of end of life plan and make sure that people know about it. (And I need to follow my own advice). The Pope is 84. Terri Schiavo was in her 20s when her tragic accident occurred. There is no way to know...

Yodelling Banshees from Neptune

I have absolutely nothing to say. There are some days where a lot of interesting stuff happens, and I spend the entire day composing blog entries in my head (most of which never actually make it out of said head). But today has been... ordinary? Boring? Eh. Maybe I'm just not picking up on the interesting things.

I did get to actually help with a vaginal birth this morning. That was pretty cool. Here is my issue with OB, though: delivering babies is pretty freaking cool, but after the baby is out, I want to stay with the baby. At that point, I don't care about the mother any more. I'm all like 'Hello! There's a baby in the room!' and am completely distracted. I much prefer the baby to the mother. Partly, because all that's left for the mother after the baby is out is delivering the placenta (disgusting) and achieving hemostasis (stopping bleeding = boring)

Did you know that yodelling can be spelled with one L or two? You learn something new every day...

Also somewhat interesting is the fellow/attending whose name is Nina, but is spelled Ngina. I am going to add a silent G to my name. I'll be Brengna.

The doctor's parking lot at this hospital (private hospital) is littered with Audis, BMWs and Mercedes. With the occasional Honda.

That's about it for now.

I Refuse!

Today is my penultimate day of call for my third year of med school (my penultimate year...)!

I'm trying to ignore the fact that for the last two hours, I've alternately been breaking out in a cold sweat and having chills. I refuse to be sick. I prefer to think it is a combination of lack of sleep, and a change from night to day shift. Night shift bumps the temp up to about 90, and day shift keeps it at around 50. I don't understand it. Night shift also sits around and talks the ENTIRE time.

Anyway, wish me luck on call. Hateful thing.

Drumroll....

Today was my last day EVER at the DHP. What, pray tell, is the DHP? I'm glad you asked. Unless you didn't, in which case, I'm a tad bit peeved with you.

The DHP is the "Downtown Health Plaza" which is the place where you go to see a doctor if you don't have any insurance. It is really a great service to the community, and is heavily used - as a place to receive medical care and as a place to force medical students to learn/practice Spanish. Lots and lots of Spanish. Once or twice, I started speaking Spanish (I use the term 'speaking' loosely here) to people with last names like 'Smith.' AKA Non-Spanish speakers.

We get the lovely experiece of going to the resident's clinics at DHP during Peds and OB/Gyn rotations. During Peds, I relied heavily upon the translators, but during OB I branched out more on my own. Dolor? Donde? OK, escuchar a la corazon de bebe ahora. (No clue if that is even close to right)

There are several translators there for people like me. Most of them are great. But then there is Miss Grumpy Pants. I have no clue what her real name is. She is a surly one, though. I was sorely tempted to grab her arm, maybe shake it a little and exclaim (because I do a lot of exclaiming in my mind) "If you hate the job so, why are you here?" Needless to say, no exclamations were made.

But, today was the last time I had to see Miss Grumpy Pants. Ever!

I'm stuffed up and my head hurts. I think Grumpy Pants cursed me.

Happy Easter!

As 40% of my grade in the OB rotation is based on the test that I take in... 12 days, I really would be doing myself a favor by studying. Apparently, I don't like myself all that much this weekend, though! I DO have the Discovery Channel on right now, though, and they are showing Babies: Special Delivery, whcih is chronicling several complicated pregnancies. So that is kind of like studying. Of course, with statements like "She's also been given penicillin, because she tested positive for Group Beta strep" however, are probably doing me more harm than good. It is Group B strep. The "B" stands for... well, "B."

Another great educational comment: "But in the high risk unit, nothing is ever routine!"

I think I may find more helpful (and relevant!) information here.

I hope everyone is sitting at home nursing a stomach ache after stuffing their faces with pounds of chocolate bunnies!

Mmmm....

I have fallen in love with a new book. It sustained me through call last night, and through a (cavity free!) dentist visit today. It may be pure fluff, with little actual nutritional value, but Candyfreak by Steve Almond (real name!) is fantastic. So says I.

I was reading it last night while sitting on the refrigerator in the dog house (don't ask). I had a really, really hard time not bursting out laughing at several parts.

It is a book (and we all know I love books) about candy (and we all know I love candy). Book! Candy! CANDY!! Pure bliss.

And interesting and funny, too!

It's Not Late, No - It's Early!

Another Night, Another Dream

(Apparently today is "Use a song Lyric as a Title Day")

I'm on call. Again. Not for the last time. But this time, instead of being on call with my happy, fun, goofy friend that makes time pass quickly, I'm on call with... (dum de dum dum) a (MM)PWHM...

Which brings me to something that has been on my mind for, oh, three or so days. Because, as I am acutely aware, it has been officially over a year since I was dumped by my friends. I cannot believe that I survived. Scratch that. I can believe I survived, I just can't believe that I did as well as I did.

:::Pause for a moment to send my sincerest thank yous to everyone who helped me remember that I am a nice person and that some people do manage to keep liking me. I don't say it enough, but I love you all. :::

I have not decided whether it was a good or a horrible thing to have been in the same rotation group as these people. In some ways it has been among the hardest challenges of my life - to have to see these people who quite literally crused me on a daily basis. In other ways, I think it was good for me to have them around. It let me keep everything in perspective. Had I been able to isolate myself from them, I think they would have built up into this gigantic force in my head. A force that I could see haunting me for a lot longer than a year. In real life, they are now nothing more than a couple of people I'd rather not be around. Hey! Look at that. I just decided (amazing what things come out of your brain at 1 am sitting in a tiny little closet waiting for babies to be born): it was a good thing. Hard, but good.

And really, that's where it ends. They deserve no more of my life now, than just some acquaintances. I will remember the fun times we had, because they were dang fun. But, that's it. I am officially retiring the (MM)PWHM.

How Can You Mend a Broken Heart

We have a patient on the high risk OB service right now that is just breaking my heart. But in reality, it is her heart that is broken.

She is a young Hispanic woman, and this is her first pregnancy. She went to the doctor for a check-up - the first one during the pregnancy (possibly the first doctor visit in a long, long time - at least, I hope so). The doctors noticed a murmur. A bad murmer. A cardiac echo showed that she has a hole in her heart (an atrial septal defect for those in the know). This is something that has almost certainly been there since she was born. Something - perhaps the pregnancy, perhaps time - has caused the blood flow to back up into her lungs, causing pulmonary hypertension (aka Eisenmenger's syndrome). Severe pulmonary hypertension. Plus a bit of severe pulmonic stenosis and severe mitral regurgitation on top of that. In real person terms: she is about one sneeze away from going into total heart failure. And she is pregnant.

Doing a little research online shows me that the official recommendation for women with Eisenmengers is sterilization. AKA no babies. None. Ever. Why? Because the mortality - that means death - rate is up to 50%. Half of these women who get pregnant will die, either before, during or after they give birth.

This young woman had no clue.

And she still didn't as of a few hours ago when I saw her. Because she speaks Spanish, and you need a REALLY good translator to go in to tell someone that we need to deliver her baby at just over 6 months gestation otherwise she may die. She may die anyway.

No one knows what to do with her. We'll probably have to transfer her to another university hospital. One that can do heart transplants, so that she can get added to the list.

It just breaks my heart.

I Wasn't Online Yesterday

Happy (day after your actual) Birthday Maripat!!!

Woop-woop! Bring down the hiz-ouse!