It’s the end of medicine!

[This post goes out to Grace, who I probably scared when I simply messaged her, "NO MORE MEDICINE, WOOHOO!" on gchat, and then disappeared. I later got a message from her that said, "WAIT, are you quitting med school?!" No, I am not. I think this story illustrates a growing difference in our vocabularies. Med school is tearing me apart from real life and real English!]

This past weekend was the end of my Internal Medicine rotation, which was my first rotation in 3rd year. If you’re thinking, “Wow, I didn’t realize she was on the same rotation since July; that seems really long,” you’d be right. It’s friggin’ long. Internal Medicine is a 10-week rotation in 3rd year, and it’s the longest rotation we do as students (3rd or 4th year). In fact, it used to be a 12-week rotation (meaning three whole months, ack), but this year, the school shortened the rotation to 10 weeks, because students in the past had asked to have extra time to explore other specialties as 3rd year students. Our choices were really wide-ranging and exciting, but instead of seeing something that I probably wouldn’t end up choosing as a career (ie, radiation oncology or dermatology or preventive medicine (I didn’t even know what this was when we were ranking our choices, but NOW I find out it would have meant working with the New York Department of Health on outbreak investigations(!) and Adolescent STD Education, maaaaan that would have been SO COOL dang it)), I decided to really take a look at a field I have been interested in since 1st year: I’m doing my elective in radiology! It’s funny because I came into med school thinking I could do anything except radiology because I didn’t think I would be able to stand sitting in a dark room all day. Imagine my surprise during 1st year when I realized I really liked looking at films, and was clearly a visual learner. Radiology keeps jumping in and out of my Short List of Possible Specialties (it has always lived on the Medium List), so much that I’ve now nicknamed it “The Siren Song of Radiology,” because while the specialty appeals to me so much, but the competitiveness of the field and the very real possibility of having to move to some really faraway place (such as a Dakota!) for residency makes it seem like a pipe dream. Anyway, we will see how the next 2 weeks go. One point for radiology: I don’t have to start until 9 AM every day! That seems luxuriously late, after 10 weeks of getting to the hospital before 7 AM.

In any case, when I say that I’m done with medicine, I don’t mean that I’m dropping out of medical school. Within the medical field, the word “medicine” has a very different meaning. To the New Me, “medicine” and “medical” mean having to do with Internal Medicine, internists, and basically anything that doesn’t have a procedure involved with it. Think pills, not scalpels.

Though I’m finished with the rotation, I have so many stories that I have been meaning to write about. (To blog about? That phrase just seems so wrong for me to be saying about myself. Would that make me a… blogger? Uh, I just threw up in my mouth a little at the idea.) I’m thinking that I’ll take advantage of these next 2 weeks of easy-peasy 9-to-5 working to catch up on storytelling. Here’s a good one to end with for today: at the end of each rotation, we have to fill out evaluations. One of the questions asked how many hours we worked per week, not counting the hours we stayed VOLUNTARILY (the word was in all caps). This was problematic because we are often told that we can leave, but it’s not like I’m going to take off at 2 PM simply because my interns don’t know what to do with me. Similarly, I have been on call and told that I could leave if I wanted to, even though technically we are supposed to stay for the duration of call. It’s a sticky situation because I don’t want to appear as though I don’t care, but I am sure that if I played it right, I could have been out of the hospital by 4 PM most weekdays (which is the absolute minimum we are expected to stay, as dictated by the school, not by our residents or interns). Does that mean that any time I’ve spent after 4 PM is considered “voluntary”? Of course not. But it wasn’t all against my will, either. I ended up splitting the difference and estimating that I spent 10 hours a day on non-call days plus 14 hours a day on call days, plus 6 hours on Saturdays, which came out to a rough estimate of 65 hours a week. 65. That is bananas, you guys. I will now proceed to scoff at anybody who complains about a 40-hour workweek (including the Old Me from 2004-2006).

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.

Poorly read

Full disclosure: I wrote parts of this in an email back in April, but it’s too good to pass up telling everybody about it.

I was reading a “scribe,” which is a transcript of each lecture given. This student-run service is pretty common at most medical schools. People transcribe the lectures, and some people edit those transcripts before they are released to the class at large. Transcribers are paid $50, and editors $10, per lecture.

This ridiculous transcriber is poorly read or stupid or both or… I don’t even know. I’ve already rolled my eyes and corrected a few of the errors. The edited version isn’t out yet, but I started reading it anyway, because I was like, “How bad could it be?” The answer: So bad.

A sample of medical student understanding of not-science (emphasis mine):

Is anybody interested in the history of breast feeding? I can go through it very fast. Actually, in history there really is no mention of it, because it was considered normal, the only people- I mean, Hypocrites, Soranth, Galen they all mentioned it, just to maintain pregnancies.

Listen, I can forgive “Soranth” instead of Soranus because I had to Google that with the ridiculously hard-to-construct search query of “history of breast feeding,” which gave me the answer in the first link in the search results, but hey, Soranus is not somebody I’d heard of, and I consider myself pretty well-read with a good general knowledge of history.

But “Hypocrites” instead of Hippocrates?!?! You take HIS OATH when you become a physician, they talk about him all the time, it’s WRITTEN on a big INSCRIPTION over the DOORWAY when we walk into school EVERY MORNING. And yet. “Hypocrites”!

It makes me want to cry.

We love acronyms

I was doing test questions on the renal system (kidneys and bladder), and came across this gem in the answer explanation:

“Straining on urination in the elderly male patient suggests bladder outflow obstruction (BOO). The most common cause of BOO is benign prostatic hyperplasia (BPH)…”

For some reason, this made me laugh and laugh. The most common cause of Boo!, like someone jumping out and scaring you. Or, boo as in “my boo,” like your beloved. Either way, hilarious.

(I have to get my kicks from someplace. If it means laughing at theoretical elderly men with enlarged prostates, then SO BE IT.)