How do you say ‘parenteral nutrition’ in Chinese?

One of the patients on my team (and by that, I mean that she is not my patient, but I do see her regularly on rounds) is a woman who is Cantonese- and Mandarin-speaking. For the big, long, important conversations with the patient and her family, the team uses a trained translator. But for the day-to-day, “how are you feeling?”/”do you need pain medication?”-type questions, I get pulled into the room quite often. I have to tell you, there is nothing that makes me feel more useful than getting paged by my attending physician (the boss of all of us) so that I can translate between her and the patient.

Sometimes, though, this comes back to bite me in the ass. Yesterday, I got called into this same patient’s room to discuss the feeding tubes she was getting. As of now, she is getting total parenteral nutrition, meaning that a mix of calories and vitamins are being put directly into her veins. If you think of food as traveling from mouth –> stomach –> intestines –> bloodstream (via absorption), then you can see how bypassing everything can sometimes cause problems, and not be the best solution, though it’s easiest to start an IV line. On the other hand, placing a direct tube into the stomach or intestines requires a slightly larger procedure, including anesthesia, even though it more closely mimics actual eating because the feeds are more food-like and less chemical parts-like. And even though this patient had already had a very long conversation with the translator the previous day about the need to switch to a stomach tube, she wanted to re-hear the reasoning. And I have to tell you, it amazed me that I remembered the words for “intestine” and “blood vessels,” though I was totally stumped on how to say “feeds” and “feeding tube.” I settled on the Chinese equivalents of “food-like liquids” and “tube in stomach for food-like liquids.” Someone asked me to translate “eating by mouth isn’t possible because she can’t protect her airway and might aspirate the food into her lungs,” which completely tapped me out as far as my vocabulary goes. I ended up saying something long the lines of, “using the mouth to eat isn’t possible because you can’t protect your air tube, and might cough and choke on the food after swallowing.” That’s close enough, right? I mean, I doubt all native English-speaking patients understand “aspirate” when we say it. This is what I tell myself, anyway.

Interestingly, the nurses on the floor (who are English-speaking only) were worried that she had a flat affect and might be getting depressed or feeling hopeless because she wasn’t talking to anybody. But this idea seemed ridiculous to my attending physician and anybody else on the team who has seen her talking to her family or to the one Chinese-speaking physical therapist who walks her around daily or to me. With people with whom she can converse in Chinese, she is super chatty and animated. It’s good to remember that a shared language (even through my crappy vocabulary and her weakened voice) can be simple but make the biggest difference in a day.

Naively, I told my mother this, and she is now ridiculously pleased with herself for having insisted I speak in Chinese with her and for having forced me to go to Chinese school for 10 years. Like she needed more ways to know she’d raised me well. I’m sure she’s told anybody who will listen. She will dine on this for years decades.

Can’t buy my love (maybe)

Earlier this week, I had a very nice patient who had a case of community-acquired pneumonia. His case was pretty simple, and he had no significant ongoing medical conditions. He spoke pretty good English, but as it wasn’t his first language, there were some instances of language problems. For instance, the first day, I asked about his bowel movements (please note: this blog will probably talk about bowel movements regularly (haha, “regular” talk of bowel movements — see what I did there?). I’d guess that on an average day, I spend about an hour’s worth of time talking about, asking about, or hearing about poop). When I asked if he was having any diarrhea, he said no. Later that afternoon, he told an attending physician that he’d had three episodes of “like water” bowel movements. So, instead of asking about “diarrhea,” I ended up having to ask exactly WHAT each bowel movement looked like, since “diarrhea” was not good enough. The day he finally started having formed bowel movements (which is what we call normal poop), he spent a good two minutes talking about how it was “soft” and “not as hard as normal” but how it wasn’t “like water” or “coming out fast” anymore. I’m SORRY, I know this is gross, but you all ASKED how med school was going, remember!

Anyway, he was ready to leave after almost a week, and in the meantime, I’d gotten to know him and his wife pretty well. His wife’s understanding and use of English was much more limited than his, so there was a lot of pantomiming and waiting for her to get the English word from her husband or from a dictionary. In any case, she’d asked a few times if there was anything I needed, and I had gotten the impression that she wanted to give me a gift to express her thanks. And what we’ve learned over the year(s) is that we first try to say no to a gift and tell the patient (or patient’s family) that we treat all of our patients the same no matter what (which is true, except maybe I might smile for real for patients who actually like me, and don’t yell at me). Then if the patient still insists on giving a gift, we can accept if the gift is within the patient’s capabilities — nothing outlandish or that cost them too much. So, on the last day of my patient’s hospitalization, his wife brought me a gift! My first gift from a patient while in medical school! (To be honest, though, this one will have to take a backseat to the first gift I ever, ever got from any kind of “my” patient, which happened when I was still working in clinical research, and one of my patients gave me a very sweet gift when I told her I wouldn’t be around anymore because I’d gotten into med school and was moving away. Anyway, that is an aside that deserves a longer post at another time.)

What was the loot? Well, the wife is an artist, so she made/bought (I’m not sure) a small origami folding that looked like a kimono, which was mounted on a backboard and ready to hang. It’s about 4″x6″, maybe? And, there was a small drawstring bag that had been dyed with a design of a fish on the outside. It was all very cute! Somewhere along in our conversation, it sounded like she was also a writer and wanted to write about me, or something. She ended up giving me her business card, and she wanted me to stop by her studio office (I swear!) to discuss something I couldn’t decipher, but I’m not going to do that. As much as I liked her, it was her husband who was my patient, and I’m pretty sure socializing with patients once they are out of the hospital violates some code from some policy. And anyway, I’d feel a bit creepy doing it, even if it meant my praise-mongering self would get written about. Hey, maybe she blogs! Maybe she is writing about me RIGHT NOW in her non-English blog! That would be awesome.

A new vocabulary

The first full week of my internal medicine rotation is over, and I feel like I’ve lived four lifetimes in the interim. At my hospital, everybody is divided into teams consisting of 1 attending physician (someone who has finished residency and is no longer in training), 1 senior resident (someone who is in the latter years of residency in internal medicine), 2-3 interns (someone who is in the 1st year of residency), 1 fourth-year medical student (commonly referred to as the “sub-intern” because he is doing a sub-internship rotation), and 2 third-year medical students. So, in total, the team can have between 7-8 people. With your team, you “round” on patients, presenting them to the attending physician in a surprisingly regimented manner, and giving your assessment of the patient’s problem(s) and possible solution(s).

A typical day for me last week looked like this:
6:30 AM – arrive at the hospital, check in on my patients to see how they’re doing.
7:00 AM – morning sign-in, where we get updates from the overnight team (aka, night float).
7:30 AM – if there are new patients from overnight (usually from the ER), we get info on them from the senior resident, and go get a patient history and physical exam.
8:15 AMish – meet with the senior resident to go over what we got on history and physical exam. This is key because the senior resident will figure out what we’ve missed and give us time to fill in the blanks before the attending physician shows up.
9:00 AM – finish up seeing old patients and learning about new patients.
10 AM – meet with the attending physician and the rest of the team for actual rounds.
12 noon – conference with other med students (we are excused from anything the team might be doing, to attend noon conference).
1 PM – squeeze in a lunch
1:30 PM – do all the things that the senior resident and attending physician said you needed to do, check up on blood labs, run around trying to get appropriate signatures, hope my patients don’t crash or do something crazy (like throw up or fall down or pass out on the bathroom floor, all things that happened last week).
4 PM, in theory – sign out patients to the on-call team, and leave the hospital. I have been leaving around 5 or 6 PM, though.

Oh, and guess what? Internal medicine has work 6 days a week! They tried to make it better by having Saturdays run from 7 AM to 12 noon, in theory, but as you can probably tell from the above schedule, most of the work happens from 7 AM to 12 noon, anyway. Fabulous.

Each team is on call every 4 days. Call consists of staying late from 5 PM to at least 7 PM (but usually 8 or 9 PM), until the night float team comes to the hospital. My first weekend on this rotation, we had call on Thursday night, which meant that we didn’t have call Friday, Saturday, or Sunday. This was referred to as a golden weekend. Between working nearly a full day on Saturday and cleaning/cooking/laundering like a madwoman on Sunday (my only day off), it did not feel quite so golden.

I’m sure I’ll have really great stories to report soon, but as for now, I have to get to bed because I have to be up by 5:45 (!!!) in order to get to the hospital by 6:30. A patient asked me the other day, “Do you live here?” and I kind of cried a little to myself because, well, at that point, I was seeing him before he ate breakfast and after he ate dinner. Sigh.

Rookie mistake!

Today was my very first day as a third-year medical student. My very first rotation is a 3-month rotation in internal medicine. Today was interesting. We didn’t start until 10 AM, though for the rest of the rotation, I expect to be at the hospital well before 7 AM from Monday to Friday, and by 8 AM on Saturdays. Yes, there is a half-day of work (at least) on Saturdays. It’s still better than studying for the Boards, don’t get me wrong.

Anyway, today was the first day, and I got lost in the hospital only twice. Great success! In addition, I went to take the blood pressure of a patient, and needed to get a reading with the patient lying down and with him sitting upright. When I asked him to sit up, he said he was a little dizzy, and asked if he could have extra time sitting up. I said sure, put down my pen and paper, and exited the room to give him a few minutes. When I came back, the patient had vomited all over my pen, paper, and his bedside table. Oh, man. There is only one thing I fear, going into third year, and that is vomit. I’d said as much during our orientation week, and it’s as though the universe was saying, “GET OVER IT” in as obvious a way as possible, on the very first day.

Lesson learned: never ever put things down and walk away from them, if you want them back. Also, apparently, some patients will say they feel dizzy when they in fact feel nauseated. Potato, potahto.

Grace and Claire will be happy to know that I wore my new beige cotton blouse from BCBG that they peer pressured me into buying when we went outlet shopping and I said I needed new work clothes. The shirt did not get vomited upon. Success!