My hypochrondriasis is incredibly prescient

Hey, remember when I told everybody that an insulinoma would explain my Insta-Bitch? Well, all that self-awareness made me actually pay attention to insulinoma as a disease, even though it is very rare. It paid off, though, because it was the answer on my exam last week! The question was a case presentation of a woman brought in by her friend, because the woman had been eating tons and gaining weight suddenly, acting generally irritated and anxious, and had a headache lasting weeks. I was reading it and not understanding what the question was trying to hint at, and thought, “Huh, that sounds like me when I’m hungry…. OH HEYYYY, insulinoma is an answer choice!” Very exciting. Good job, unfounded paranoia!

For the record, though, I did not see an insulinoma while on my Internal Medicine rotation. So really, the exam was not representative of my actual Internal Medicine rotation at a certain Manhattan hospital. Had the test been truly representative, the patient in the question would have been a 50-something-year-old male, probably homeless, with hypertension or high cholesterol or poorly-controlled diabetes (or all three), current or former smoker/drinker, coming in for shortness of breath or chest pain after drinking all weekend/doing cocaine/losing his medications (all things that happened). It’s like a really tedious and frustrating game of Mad Libs.

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.